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When Urologists Get It Wrong: What Every Man Should Know Before Saying Yes · Intellectual Medicine

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  Be cautious, I told you, going to the urologist carries with a
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  great risk. If the primary tool you have is
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  a hammer, every problem looks like a nail.
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  The urologist are quick to move to biopsy.
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  Why? Because it is their standard of
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  care. The question needs to be asked,
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  why are we biopsying in the 1st place?
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  Is the idea that we can somehow predict the future by the
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  present? That's nonsense.
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  The Gleason score is semi useless when it comes to making
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  decisions about how to manage your prostate, is unneeded,
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  misleading and often times wrong.
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  Is it dangerous to see a urologist for an elevated PSA?
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  Now think about that. It is in fact the routine of
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  medicine. You got a high PSA, Your family
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  doctors worried send you to the urologist.
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  It makes sense on the surface. A urologist is a specialist in
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  the anatomy of the urogenital tract from the bladder through
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  the prostate. It makes sense, but it doesn't
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  really add up when you look at how things flow.
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  There is a distinct risk of harm being done by just floating down
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  that path. I'm not knocking urologist or
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  urology. I was very grateful for the
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  Doctor Who took care of my kidney stone.
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  He was a urologist. That was a high use of his skill
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  set. Prostate cancer and in
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  particular PSA is an entirely different animal.
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  Then my concern about you going into that den is that you're
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  going to get sucked up on the conveyor belt.
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  That is the current standard of care for dealing with an
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  elevated PSA. So the risk is simply 1980s
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  medicine being imposed. In what year are we now 202526?
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  Look at the point being, we're still treating an elevated PSA
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  quite similar to the manner we did 50 years ago.
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  Back then, we had no PSA. Back then, we had no MRI.
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  Back then, we had no PET scanning.
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  Back then, we didn't know what we know now, but prostate biopsy
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  became entrenched as a standard of care.
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  Doctors built their practice around it.
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  Companies made little needles, not little needles, harpoons to
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  biopsy the prostate. The research delved into how can
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  we biopsy the prostate better? Can we target it more
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  accurately? Maybe we'll get an MRI for the
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  purpose of targeting the biopsy. Stop the madness already.
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  This is ridiculous on my opinion.
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  The question needs to be asked, why are we biopsying in the 1st
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  place? Is the idea that we can somehow
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  predict the future by the present?
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  That's nonsense. The Gleason score is semi
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  useless when it comes to making decisions about how to manage
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  your prostate. Is unneeded, misleading and
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  often times wrong. Look, a Gleason score is simply
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  a guy looking at a cell and trying to decide if a a
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  pathologist. Granted looking at cells and
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  trying to describe them. What do they look like?
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  You get 3 different pathologist, you get 3 different Gleason
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  scars. Not needed.
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  We now have the ability to look at the prostate gland.
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  I love getting an MRI. Now be cautious.
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  Be cautious. I told you going to the
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  urologist carries with a great risk, right?
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  Remember that old cliche? If the primary tool you have is
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  a hammer, every problem looks like a nail.
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  I've heard this over and over again from my patients when I
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  speak to them. The urologist are quick to move
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  to biopsy. Why?
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  Because it is their standard of care.
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  Because it's what they do. Because they actually believe in
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  it. And they believe in it in part
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  because of the repetitive nature of the feedback they get.
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  They haven't stopped. I mean, think about this, if new
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  information threatens your livelihood, how anxious are you
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  to incorporate that in your practice?
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  I'm a family doc, board certified osteopathic family
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  physician. I come at this with a strong
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  belief that the body is an incredible healing machine and
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  we've got to stop harming it in the spirit of trying to help it.
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  Look, if there's something out there that's going to do you
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  harm, but it has a wonderful success rate, I'm considerate.
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  Consider it. But APSA and prostate cancer,
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  none of the above. Think about that.
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  If the treatments that they had available for prostate cancer
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  were so good, why would they delay?
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  Why would they even consider this concept of watchful
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  waiting, doing nothing, waiting to see what happens?
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  Is a prostate going to go metastatic?
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  Well, we need a biopsy to You can't tell the future.
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  Stop already with this misleading impetus toward a
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  biopsy. We'll do a biopsy now.
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  Active surveillance will stick a needle in it.
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  Question comes up all the time. Will that cause metastatic
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  disease? Will it spread the cancer?
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  Sayeth the urologist. No, there's no proof of that
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  happening. Now, technically, that's a
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  correct answer. Why?
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  Because they never looked. Who would ever stop to look?
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  Nobody really knows, do they? You know, in medicine we have
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  research, like in sciences, research, and it's helpful, it's
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  important. But you can't research
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  everything and you can't rely upon it for every decision you
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  need to make. You need to use your
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  intelligence. You need to use your intuition.
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  You need to use your philosophy, the intelligence part.
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  You have a tumor. You have cancer in the prostate.
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  How do you know that? You've got elevated PSA, You're
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  a certain age, you're above 50, and the MRI of the prostate
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  looks like it's got nodules and tumors within it.
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  You add those pieces up, it's safe to say there's some
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  prostate cancer there. All right, what next?
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  You stick a needle in it? Make it a bloody mess.
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  Not a needle. Multiple sticks in order to do
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  what? Confirm what you already know.
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  I got news guys. If your PSA is elevated and your
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  MRI is abnormal, even if you had a normal negative prostate
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  biopsy, they really wouldn't believe it.
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  They'd want to do another one later.
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  They're going to keep boxing you until they find what they know
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  is there. Here's so many problems with
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  biopsy. Yes, it can spread cancer in my
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  opinion, and there's lots of research based evidence, case
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  studies, small cohorts. There is not a definitive study
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  on this topic and there never will be because the powers that
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  be would be threatened by an outcome that validates the risk
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  of metastatic process. Think about that.
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  The whole industry would collapse.
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  The whole biopsy industry would collapse.
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  The guy who makes the needle, the guy who does the procedure
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  and in sequence the whole harvesting the prostate gland
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  would likely collapse. So the urology halfway.
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  It's not wrong to do it, but it it's potentially dangerous to
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  you, you must go into that environment well armed with your
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  philosophy, with your information, with your personal
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  resolve. Big problem out there.
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  What do you do as an alternative?
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  I have to let my protocol to answer that question to fill
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  that void. The book, I promise you it's
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  coming soon. It's at the editors.
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  And every time I think about it and I talk to you guys and I
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  continue my research, I want to add a little more, add a little
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  more. They're starting to get mad at
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  me. I got to stop.
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  I got to stop. So if you have an appointment
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  next week with the urologist or look, the urologist are, they're
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  by and large they're good people.
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  They care about your health. They just don't have time to
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  talk to you, talks to them. If you're a surgeon, any kind,
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  you get paid to do stuff. You do not get paid to talk or
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  sit around and listen. This is an incredibly complex
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  and nuanced phenomenon in elevated PSA.
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  What to do? Should you just do nothing and
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  get sequential PSA's? Should you get a biopsy?
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  Should you do an MRI? OK, I'll square it up.
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  Elevated PSA is a justification for a non contrast biopsy.
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  Now why non contrast? The, I'm sorry, non contrast
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  MRI. Did I say biopsy?
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  Yikes. No, no biopsy MRI, non contrast.
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  Why non contrast? Because the contrast they use
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  for Mr. is is gadolinium. Now can that harm you?
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  Gadolinium is a heavy metal. We know for a fact it
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  accumulates in the body and in the brain.
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  I don't know about you. I'd rather not have gadolinium
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  in my brain. Doesn't belong there.
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  Now we get to the issue. Does it harm?
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  I sigh. Medicine is so self-serving at
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  times. They did a study to see if
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  gadolinium caused harm. The study lasted 3 years and
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  they did not notice any decline in cognitive function, no memory
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  loss. That they declared the
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  gadolinium to be safe for use, That it does not cause harm?
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  That is misleading and thoroughly inadequate.
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  Whenever the brain gets insulted, injured or damaged,
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  there's about a 20 year lag between the trauma and the
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  manifestation of its consequence.
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  Those football players, by the way, chronic encephalitis,
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  chronic traumatic encephalitis. I got a whole nother take on
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  that, but suffice it to say that any injury to the brain, alcohol
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  free, free radical overload, chronic trauma, any injury to
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  the brain, you got a 20 year lag before you actually start to
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  forget where you put your car keys, right?
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  So this three-year study is semi useless.
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  I don't want gadolinium in my brain.
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  I don't want it in your brain unless, unless it's the absolute
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  positively only way to go. Now the radiologist and your
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  urologist and your doctors will tell you the images are better
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  with contrast. They're correct.
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  It is better, but it's not clinically relevant in my
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  opinion. All the information we need to
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  get from that MRI can be gotten without contrast.
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  OK, so we're clear about that. No contrast.
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  You might have to fight for that, folks.
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  I've had to, I've had to advocate on the, on behalf of
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  some patients because the insurance company didn't want to
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  pay to take the contrast out because the standard of care was
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  with contrast. Yikes.
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  The standard of care should never bulldoze common sense
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  people, your common sense and you know, no biopsy, that is my
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  advocacy against it. You know what I'm like without
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  contrast. Now we've got information.
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  Now we've got objective evidence.
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  Now we can contemplate what to do next.
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  Now, if you have the type of urologist who guide you away
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  from biopsy, if you have the type of urologist who is
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  contemplative and knowledgeable about alternative approaches to
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  support your health, to do things to make your body
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  inhospitable toward the progression of cancer, that's
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  cool, but keep them around. If you have a urologist that you
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  like and you want to have a monitor her monitor you, that's
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  cool too. And if you have a urologist who
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  is open minded and endorses your philosophy, keep them on board.
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  But if you have a urologist who says, well, we have to do, if
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  you hear the word have to coming out of their mouth, that should
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  be a red flag. You don't have to do anything.
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  You can choose to do something with good information.
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  Your PSA is elevated. We have to do a biopsy.
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  You know you don't. In my opinion, the MRI, always,
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  always, probably the urologist ordering an MRI, is that they
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  just see that as a step toward the biopsy.
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  They don't see that as an end unto itself.
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  This idea of a targeted biopsy is utter nonsense.
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  The idea that you can look at an MRI and then stick the needle
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  where the cancer is defies what we know about how cancer
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  behaves. It disseminates.
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  It spreads on a cellular level like tentacles going out
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  throughout the prostate gland. So you're just as likely to get
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  misleading information as helpful information, and you're
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  just as likely to spread the cancer.
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  So back to the initial question then, who do you go to?
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  I mean, I feel bad from these for you, for me, for us.
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  Medicine has become so monopolistic, so dominant, that
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  quite frankly, when you have a high PSAA lot of docs, just like
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  a hot potato baby, they just want to turf that
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  responsibility. However, if you have a good
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  functionally based primary care doctor or nurse practitioner or
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  a very well educated naturopath can fill in this role as well.
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  That type of healthcare expert can help bring temperance,
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  balance and guidance to your journey.
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  I really like nurse practitioners in this world.
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  It's been my experience that there as a group tend to be a
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  little bit more open minded, maybe because they felt the
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  brunt of conventional medicine trying to dismiss their
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  credibility. Maybe that's part of it.
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  So beware of the dogma, beware of the machine.
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  Get off the treadmill, stop and think.
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  Step one, stop and think. You can go to the urologist.
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  In fact, not a bad did do it. In fact, I encourage it on many
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  levels. Why?
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  Because you need to hear the standard of care it it's
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  reasonable for you to hear what the conventional take is because
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  you may choose it. And that's not wrong.
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  It's not what I would advise. It's not what I would choose for
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  myself or my patients. I would never have any man have
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  his prostate gland removed. I would never have any man get
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  radiation. I would never have any man get
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  mercy, get horribly castrated. No, this idea of testosterone
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  annihilation to try to, it's just just awful.
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  Just awful. You will suffer at their hands
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  and for what gain? So just as an example, as an
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  example of how information gets twisted, I'll leave you with
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  this one, one study because I think it's emblematic of what
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  can happen and how information gets disseminated.
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  In 2004, a study was done called the Tax Trial TAX.
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  And the question at hand was, in a man with metastatic prostate
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  cancer, is chemotherapy better than a placebo?
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  Is it, is it helpful? The study concluded that men who
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  received chemotherapy had a statistically significant
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  extension of their lifespan. That trial then validated the
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  role of chemotherapy with all of its horrible side effects, from
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  nausea, vomiting, fatigue to weight loss to infections.
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  Right, Extended lifespan. Do you know how much it extended
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  it? And that study around two
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  months, two months. What are we doing?
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  Where's quality? What are we doing?
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  Where's balance? What are we doing?
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  Where's the time to reflect? Put your philosophy first.
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  Get good information. Prostate cancer is a unique
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  entity. An elevated PSA is not an
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  emergency and it's not a call to impulsive action.
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  So take a breath, Continue your study, continue your search.
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  Do not fall into the whole of purely Internet based medicine,
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  guys. It's out there.
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  I know it is. I know you can order it up.
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  Stuff can come from you, from who knows where, India, China.
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  Look, I'm I'm an internationalist.
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  I got nothing against my brothers throughout the world,
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  but I ain't taking stuff that comes in the mail from No Name
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  Pharmacy out of nowhere. They're good doctors can guide
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  you on this path. So beware of the urologist.
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  Beware of the misguided pathways on the Internet.
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  Know yourself, get the information, then take your
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  time. There are doctors out there that
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  think like I think there are doctors out there that have
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  time, will give you time if they have.
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  So how do you tell if a guy has like the prostate biopsy center
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  of Omaha under Shingle? Yikes.
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  Is a person to avoid in my opinion, right?
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  You want to go to somebody with time who's going to be balanced.
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  All right, The dangers of medicine.
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  It's a real thing. Got to protect yourself folks.
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  And you can. It's a beautiful era with
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  artificial intelligence. With the Internet, you can start
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  to ask pointy, good, sharp, intelligent questions and you
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  can apply your own thought process to the journey you want
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  to go down. Someday I'm going to die.
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  Seems likely. Although I'm an anti aging
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  specialist and I practice anti aging medicine, I don't practice
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  immortality medicine. But there's nothing about us
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  biologically that requires us to age and decay before we die.
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  Stay strong, be vital, fight cancer like a man, live like a
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  man. Do not let them take that from
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  you in the absence of compelling, overwhelming good
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  evidence of benefit. And it's just not there, right
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  gang? I'll talk to you all next time.
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  Thanks for tuning in and being part of this journey with me.