Latest / Intellectual Medicine / Peter Attia, MD is wrong about Prostate Cancer and PSA

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Peter Attia, MD is wrong about Prostate Cancer and PSA · Intellectual Medicine

• 0:00
  He quotes a study from 2010 that looked at men who had regular
• 0:04
  PSA screening versus those who did not and quotes the following
• 0:10
  stat that there was a reduction of 44% in prostate cancer death.
• 0:16
  Now that sounds very impressive. Men who get APSA test have a 44%
• 0:23
  reduction in death from prostate cancer.
• 0:25
  But oh, stop the presses. 44% of relative reduction is not the
• 0:32
  same thing as an actual reduction.
• 0:36
  The actual reduction was 0.34% reduction in death from prostate
• 0:42
  cancer and no differential in all 'cause mortality.
• 0:52
  In his recent podcast, Peter Atia gives advice about how to
• 0:58
  evaluate for prostate cancer using the PSA test.
• 1:03
  I'm going to share with you why that was pretty good advice
• 1:06
  maybe 20 years ago and what he gets wrong and why I disagree
• 1:12
  with most of what was said. We have to break this down.
• 1:16
  It's critical for the way you approach the prostate issue
• 1:21
  globally. There's a lot of misconception,
• 1:24
  there's a lot of misrepresentation of studies and
• 1:28
  a percentage of outcomes. We're going to talk about those.
• 1:31
  Let's look at the headline to that podcast, The Problem.
• 1:35
  And I don't mean to pick on Peter Attia.
• 1:38
  He may have some real positive attributes of clinical
• 1:41
  relevance, but prostate cancer advice is not one of them.
• 1:46
  I merely need to highlight this because the conventional big
• 1:51
  medicine profit machine relies upon the status quo.
• 1:58
  The advice coming out of this podcast could have come directly
• 2:02
  from big medicine. There's nothing novel.
• 2:05
  There's nothing incorporating advances in information.
• 2:09
  So let's start with the fundamental premise, and this is
• 2:12
  a quote from the top of the podcast.
• 2:15
  The timing of when you find the cancer is not a minor detail.
• 2:19
  It's arguably the determining factor in life and death.
• 2:24
  Emphasis my own. See, that's where it goes,
• 2:27
  folks. They make you feel like you're
• 2:30
  going to die. Your PSA is up.
• 2:34
  We must do a biopsy. How are we going to know if it's
• 2:37
  aggressive or not? We must.
• 2:40
  The biopsy leads to what? It leads to prostatectomies.
• 2:44
  It leads to radiation therapy, castration.
• 2:47
  Why are we actually preventing people from dying?
• 2:51
  Is this a good thing? We're not.
• 2:54
  The idea that this type of early diagnostic intervention is good
• 2:59
  for men is mistaken. Prostate cancer is different
• 3:04
  than any other malignancy. Those cancer cells sleep in the
• 3:08
  gland. They will not harm you unless
• 3:12
  they're rudely awakened and become metastatic.
• 3:16
  So where do these stats come from?
• 3:17
  Where does Peter Attia come off telling you how dangerous it is?
• 3:21
  And you got to get an early diagnosis?
• 3:23
  He quotes a study from 2010 that looked at men who had regular
• 3:28
  PSA screening versus those who did not and quotes the following
• 3:34
  stat that there was a reduction of 44% in prostate cancer death.
• 3:40
  Now that sounds very impressive. Men who get APSA test have a 44%
• 3:46
  reduction in death from prostate cancer.
• 3:48
  But oh, stop the presses. 44% of relative reduction is not the
• 3:56
  same thing as an actual reduction.
• 3:59
  The actual reduction was zero point.
• 4:03
  Let me get my number right. 0.34% reduction in death from
• 4:08
  prostate cancer and no differential in all 'cause
• 4:12
  mortality. Checking the PSA or not checking
• 4:17
  it had no impact on death. That's the headline you need to
• 4:22
  know Now. I'm not suggesting that you
• 4:25
  abandon evaluating the potential for prostate cancer to be
• 4:29
  present. However, the conventional
• 4:33
  pathway that that sucks you into must be avoided lest horrible
• 4:39
  things happen to you. A lot of countries have advised
• 4:42
  against doing the PSA test. The problem isn't prostate
• 4:47
  specific antigen testing, which by the way is.
• 4:50
  In fact, a simple blood test takes but a minute.
• 4:55
  It's inexpensive. If you have to pay out of
• 4:56
  pocket, you can expect maybe 10 bucks.
• 4:59
  If you're getting ripped off, maybe 50.
• 5:02
  The test is simple. The question is what to do with
• 5:04
  the result. So the conventional pathway, and
• 5:07
  the reason I so strongly disagree with the emphasis on
• 5:13
  this podcast is because it amplifies fear.
• 5:17
  It IT projects the notion that you must get an early diagnosis
• 5:22
  to survive. Not true in the PROTECT T trial.
• 5:27
  And in this trial, the PROTECT T trial was a study, a 15 year
• 5:33
  study, and it was really propelled by some forward
• 5:36
  thinking clinicians. Dr. Hamby was one of the lead
• 5:39
  authors and he was asked afterward, like what motivated
• 5:44
  you to do this study? He said, you know, we were
• 5:46
  thinking about the fact that we have all these treatments for
• 5:50
  prostate cancer, but we don't know if they work.
• 5:54
  Nobody ever looked think about that.
• 5:58
  The harm done to men, nobody ever looked Impotence, urinary
• 6:03
  leakage, infections, nobody ever looked to see if the treatments
• 6:07
  actually worked. Now it is correctly quoted in
• 6:11
  the podcast that the 15 year mortality from prostate cancer
• 6:16
  for men with the disease is low. That 97% of the men with
• 6:23
  prostate cancer are alive 15 years later.
• 6:27
  OK. Or didn't die from prostate
• 6:30
  cancer. OK, that's a good thing, right?
• 6:33
  What they failed to mention, however, is that there is no
• 6:36
  difference between men who did nothing and men who had
• 6:42
  conventional treatment. No difference regarding death
• 6:45
  from prostate cancer when you compare men who did literally
• 6:49
  nothing to men who had their prostate removed to men who had
• 6:53
  radiation therapy. It had no impact.
• 6:58
  So why are we still doing it? We have a treatment that causes
• 7:02
  harm and does not affect the desired outcome.
• 7:07
  Well, the reason that I continue to bring this up in my podcast
• 7:11
  is because few others will this study outcome was revolutionary
• 7:17
  is revolutionary. It should have rattled the
• 7:20
  foundation of conventional treatment.
• 7:23
  There should have been an immediate pause or at the very
• 7:28
  least an alteration and how things are framed.
• 7:31
  It's no longer your PS as elevated.
• 7:34
  We must biopsy. Stop.
• 7:37
  The biopsy causes harm. 5 to 7% infection rates, depending on
• 7:43
  whose study you're looking at. And don't get me going on the
• 7:48
  guy who thinks, oh, I do a biopsy better than anyone else.
• 7:52
  I do the the biopsy that doesn't get you infected.
• 7:57
  That's like saying you're the best guy doing frontal
• 7:59
  lobotomies. It's a passe procedure, in my
• 8:03
  opinion, that ought to be dispensed with.
• 8:06
  We shouldn't do this anymore. We shouldn't do it anymore
• 8:10
  because the results are not relevant to the survival rates.
• 8:16
  When it comes to the treatment decisions, the non biopsy
• 8:21
  approach to assessing the prostate is present.
• 8:25
  We can take advantage of this. We can analyze the change in PSA
• 8:29
  over time. We can look at the prostate with
• 8:32
  an MRI. That's pretty awesome.
• 8:34
  Nobody gets stabbed. No risk of disseminating
• 8:37
  prostate cancer cells. No risk of infection.
• 8:41
  What to do with the result? We know that taking the prostate
• 8:45
  out doesn't change the death rate.
• 8:48
  We know that irradiating it doesn't change the death rate.
• 8:52
  Castration awful. The non pharmacologic I should
• 8:57
  say. The repurposed drug approach
• 8:59
  that I outlined in my protocol is worthy of consideration.
• 9:04
  This is another pathway for men to consider.
• 9:07
  This needs to be disseminated because it doesn't harm people
• 9:13
  because it has potential benefits to their health on
• 9:17
  other levels. I mean, what do men with
• 9:19
  prostate cancer die from? Answers, You know, heart
• 9:21
  attacks. So we got to back up the camera,
• 9:24
  guys. You got to look at the big
• 9:26
  picture. Do not be driven by fear.
• 9:29
  Do not feel like you have to go down that conventional pathway.
• 9:34
  The disappointment I have with Doctor Peter Tia's podcast is
• 9:39
  the echoing of the conventional medicine talking points.
• 9:45
  PSA, biopsy, onward to conventional care.
• 9:49
  They're stuck in their paradigm where they're not looking beyond
• 9:54
  the walls of what they currently do.
• 9:57
  It's not financially or medically within their vision to
• 10:03
  consider it. The standard of care has been
• 10:06
  established. The fact that it doesn't work is
• 10:09
  an inconvenient footnote in the minds of those that are
• 10:11
  perpetuating it, and you'll see them dancing around the issue.
• 10:15
  They'll talk about why the protectee trial shouldn't alter
• 10:19
  their current practice. Nonsense.
• 10:23
  It should rattle it. They hope it'll fade away.
• 10:27
  They hope people will forget about it.
• 10:30
  A surgeon who does not bring this study to the attention of a
• 10:33
  would be patient contemplating prostate removal.
• 10:37
  A radiation therapist who does not discuss these outcomes with
• 10:41
  their patient, in my view, is below the ideal standard of
• 10:46
  ethical disclosure. That's how powerful the study
• 10:49
  is. Here's how the consultation
• 10:52
  should unfold. Mr. Smith, you have an early
• 10:55
  stage of prostate cancer. We can take your prostate gland
• 10:58
  out. However, it's not been shown to
• 11:01
  diminish the likelihood that you'll die from prostate cancer.
• 11:04
  It can cause infection. It can cause heart attack,
• 11:07
  death, it can cause impotence, It will do you, absolutely will
• 11:11
  do you harm, just a matter of to what degree, but it will not
• 11:15
  have any impact upon your risk of dying from prostate cancer.
• 11:19
  Now, when would you like to schedule that surgery?
• 11:21
  Right that informed consent doesn't happen.
• 11:25
  Same thing with radiation therapy.
• 11:28
  Is it reckless to get surgery? Is it reckless to get radiation
• 11:31
  therapy? It really is not.
• 11:35
  Every man has to make these decisions.
• 11:38
  My argument is that there is a dearth of honest information and
• 11:44
  there is an absolute negligence of alternative approaches that
• 11:48
  don't do harm and may in fact turn out to be superior in their
• 11:53
  outcomes. Now we have an ongoing clinical
• 11:56
  cohort. We're monitoring our patients.
• 11:59
  We now have disseminated the Pederuti protocol for prostate
• 12:02
  cancer to multiple states providers who become certified.
• 12:07
  So they're coming to a neighborhood near you.
• 12:10
  Do not go lonely down that path. You need to get outside of the
• 12:15
  oncological and neurological consultative feedback loop.
• 12:21
  Unfortunately, Peter Attia's public service announcement
• 12:26
  educating us about the PSA doesn't do anything to alter
• 12:30
  this fixed paradigm. That's what needs to happen.
• 12:34
  That's where we need to be outside of the boundaries of
• 12:38
  conventional medicine at this particular niche.
• 12:42
  Niche. Look, I am a therapeutic
• 12:46
  agnostic. I'm a board certified family
• 12:48
  physician. I've been studying prostate
• 12:50
  cancer for decades, and I've arrived at this place through my
• 12:55
  own study and experience with patients.
• 12:57
  And we've developed a treatment approach to give men an
• 13:01
  alternative. Fight cancer like a man, Don't
• 13:05
  let them whack you, diminish you, weaken you without your
• 13:11
  thoughtful input and consideration of alternatives.
• 13:15
  My fear factor is when somebody with a prominence like Doctor
• 13:20
  Peter Attiya starts talking like a conventional medicine
• 13:24
  informational distributor. It's disappointing.
• 13:28
  What we need is a fresh perspective.
• 13:31
  What we need is the protocol and things like this that have been
• 13:36
  developed. It's never going to be funded by
• 13:41
  conventional medicine. We will never see significant
• 13:46
  research dollars put into it. So we have to do it ourselves,
• 13:50
  and that's what we're doing every day.
• 13:53
  So be cautious about where the information comes from, folks.
• 13:56
  Be cautious about conflict of interest.
• 13:59
  You should know who's providing funds to the person or people or
• 14:04
  things disseminating your information.
• 14:07
  So in the spirit of that type of transparency, I'm going to tell
• 14:12
  you all of the funding sources we currently have.
• 14:16
  I've written them all down on this piece of paper.
• 14:19
  All right, there you go. Who funds us?
• 14:23
  Our patients do, by virtue of their commitment to their own
• 14:27
  fight, cancel like a man pathway.
• 14:30
  We're doing this together, grassroots.
• 14:33
  Well, that's what I got for the moment.
• 14:36
  You got to be wary. Even providers who appear to be
• 14:40
  cutting edge, even providers who appear to be novel in their
• 14:45
  thought pattern and their approach need to be looked at
• 14:48
  cautiously. Biopsies are not necessary in my
• 14:53
  view. They should not be done.
• 14:56
  They are antiquated procedures that do not help us guide men
• 15:02
  towards better lives. They do not help us guide men
• 15:05
  towards surviving that cancer. And they can lead to harm unto
• 15:09
  themselves. Now what I just said goes
• 15:12
  against the grain of every urologist lighting up biopsies
• 15:15
  tomorrow. That's OK.
• 15:18
  Not here to make everybody happy.
• 15:20
  Just the men who are enlightened enough to consider an
• 15:23
  alternative walk. Well, that's all I got for
• 15:27
  today, folks. Thanks for being part of the
• 15:29
  journey. Thanks for watching my podcast
• 15:32
  and disseminate the information. You know, we should challenge
• 15:36
  the conventional approach. We should invite men and women
• 15:41
  to study this alternative, become knowledgeable about it.
• 15:45
  Then you can make a decision that suits your philosophy, that
• 15:49
  suits your own interpretation of the data.
• 15:51
  And if that decision is a prostatectomy, radiation, or
• 15:54
  castration therapy, that's fine. As long as you have a choice to
• 15:59
  make and you're not forced down a pathway through false urgency,
• 16:04
  there's never a rush. All right, gang, until next
• 16:07
  time. Thanks for being part of the
• 16:08
  podcast. See you then.