Latest / Intellectual Medicine / Stop the Prostate Biopsy Frenzy: The Truth About MRI, PI-RADS, and PSA| Dr. Stephen Petteruti #prostatecancer

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Stop the Prostate Biopsy Frenzy: The Truth About MRI, PI-RADS, and PSA| Dr. Stephen Petteruti #prostatecancer · Intellectual Medicine

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  The purpose of an MRI in my world, in the Pedro de protocol
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  world, is not so you can get a better target for a biopsy.
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  It's so we can get a good baseline to compare over months
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  and over years. Gleason score passe unnecessary
• 0:16
  dangerous. Why?
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  Because the number scares men into doing things that harm
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  their health irreversibly in some cases.
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  Really want to trust that? I don't think so.
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  The trust comes from an experience and an observation
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  that requires time, which requires patience, which
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  requires temperance. The standard of care regarding
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  prostate cancer must change. What we're doing right now is
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  not good enough, and you're going to change it, and I'm
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  going to help you change it. Today we're going to focus on
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  imaging. How should you have your
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  prostate gland evaluated? What is the best use of an MRI?
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  How can you direct your physician to do it?
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  The way that makes the most sense?
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  Now, the reason they do it, the way they do it, we'll talk about
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  that is because that's how they do it.
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  They are in the rhythm, it is efficient.
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  They know what to do MRI with contrast, standard of care,
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  right? It's not the best care.
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  It's just what they're used to doing.
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  And the minute you step out of line, you're only the guy at the
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  convenience store who breaks out his wallet and pays in cash
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  instead of swiping the card. Everybody behind you in the line
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  gets annoyed. You're the guy that's saying,
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  listen, I want to buy parametric MRI without contrast and they
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  look at you like you have two heads saying, well, we've never
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  heard of that, or we don't do that, or that's not going to
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  tell us what we need. Nonsense.
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  It is the cutting edge. It is the best way to use the
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  MRI. So we're talk about other means
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  of looking at the anatomy. Why is that important?
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  Because that's one of the ways you get rid of the prostate
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  biopsy. Can we just stop poking trocars
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  into a prostate that's already a little bit angry?
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  It's probably already a little bit inflamed.
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  And if it has cancer in it, you're going to spread that
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  cancer. Very high risk, in my opinion.
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  Now they'll tell you there's no evidence showing that it spreads
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  cancer. They never looked.
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  They never did a study, Zippo, never in 50 years.
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  Why not? Well, the ethic of it is
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  challenging and there's no motivation.
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  Who wins if they do a study and it shows there's actual
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  increased risk of metastatic spread.
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  Now the studies are out there in regard to other biopsies, breast
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  tissue. There are even studies, case
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  studies and case reports showing spread.
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  So no biopsy. Instead, we do the MRI and we do
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  it not so we can figure out where to stick the needle.
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  That's another just illogical, biologically implausible
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  concept. The idea that you're going to do
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  an MRI, right, so you can identify where to stick the
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  needle, as if prostate cancer clusters into tiny little
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  packages just waiting to be biopsied.
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  That's dumb. It doesn't behave that way.
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  Imagine that you had an infestation of cockroaches and
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  you want to get rid of them. You leave two behind.
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  You haven't solved the problem, have you?
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  They're coming back. The same is true for prostate
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  cancer. You stick the needle in, you do
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  a local ablation. Maybe it reduces the volume of
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  the disease. That's not a bad thing, but it's
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  not going to cure anything, ever, because there are less
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  cells left behind. That's why we do what we do,
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  systemic therapy. The repurposed drugs have a
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  carpet bombing effect. They have an impact on the
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  entire body. One of the ways we follow that,
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  yes, we use the PSA, the prostate specific antigen.
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  It's a helpful test if properly interpreted.
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  You need to look at it at appropriate intervals.
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  You need to not overreact if it's too high or too low because
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  there are a lot of things that affect it.
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  There's something called intra testing variability.
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  If I took the same blood specimen and test it on the same
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  day with the same reagent, I can get a difference in PSA of up to
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  10, maybe 15%. Same blood sample, same test.
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  So if you see a change in your PSA from one test to the next,
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  the first thing to do is to take a deep breath and interpret it
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  over time. Where's the change going?
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  What's the trend? So intra test variability
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  applies to the MRI as well. An MRI is not concrete evidence
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  of anything. It's information that needs to
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  be interpreted. The MRI itself is subjective.
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  The radiologist looks at it, says I think that is a pyrid's
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  A4. The next one may look at it and
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  say I think it's a three. A third one may say I think it's
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  a 5 S the pyrid's number. It sounds concrete, but it's
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  subjective and the same image can be interpreted differently.
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  The point is not that the images are invalid, it's that they need
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  to be carefully understood. Your doctor, your nurse
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  practitioner, needs to have a fund of knowledge like mine so
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  you can interpret these things in the context of the disease
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  and the global health. So let's go to that MRI.
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  You ordered the MRI. They do it with a gadolinium
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  contrast. Absolutely, 100% unneeded and
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  harmful. Now people argue about whether
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  or not it's harmful. Gadolinium is a heavy metal
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  folks, does not belong in the human body.
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  It gets filtered through the kidney.
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  Now healthy kidneys can handle that, we think.
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  But how about if you're going to use it for monitoring?
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  Well, that means you're going to do this MRI more than once.
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  And every time you do it, a little more gadolinium
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  accumulates and it accumulates in the brain.
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  Now I can think of no value, no purpose, no health enhancing
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  attribute of dropping heavy metal in the brain, right?
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  So they have to prove to us that it's going to be good for you.
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  They can't. The best they could say is,
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  well, we don't think it's going to hurt you, but if you get a
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  little demented in 10 years, let us know.
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  Too late. So if it was critical, I would
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  say, you know, maybe we have to suffer the risk, but we don't
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  just because they're trying to jam it down your throat.
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  And I've ordered many Mr. is for prostate and frequently there's
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  push back. We can't do this.
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  It has to be with contrast nonsense.
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  The MRI, there's a bi parametric means of doing this study.
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  The traditional method is called multi parametric that requires
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  the dye so they can do some of their metrics that they like to
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  do. Picture looks better.
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  They can get some measurements that cannot otherwise be
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  obtained but are not important to us to discern what's
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  happening with regard to prostate nodules and the
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  potential of cancer being present.
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  The multi parametric with contrast is passe.
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  It doesn't know it yet but it's day has gone.
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  The biparametric is king of the hill, and this is cutting edge
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  research. The research backs up what I'm
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  saying. The biparimetric studies are
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  shorter in duration and take 15, maybe 20 minutes.
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  There's no contrast and you can gain the same quality imaging
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  that lets us determine the level of your prostate cancer and
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  perhaps most importantly, a basis of comparison.
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  Oh, by the way, it's less expensive.
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  So let's review by parametric. Remember that word?
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  That's what you're going to request.
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  By parametric. Less expensive, faster no die
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  when there's. Look, when years ago I was
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  moonlighting and I had a job and my job was to sit in the
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  radiology suite whenever they were doing intravenous die.
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  Why? Because bad things can happen.
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  And I was there to resuscitate, to treat in the event there was
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  an allergic reaction. Well, guess what?
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  If you don't put a dye in, you can't get an allergic reaction.
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  Nothing bad can happen by avoiding it.
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  You, my friends, you must be assertive.
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  Decline the the contrast. Tell them it'll cause harm.
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  I'm not doing it. Your doctor will back you up.
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  And if your doctor doesn't back you up, you may want to
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  reconsider that relationship. It's in your best interest to
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  not get dye. Now suppose you have a hip
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  implant and you can't do an MRI. Plane X-rays aren't worth doing.
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  CAT scans have too much risk for this purpose.
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  Radiation, right? They can do micro ultrasounds
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  and there are some urologists who have high skill with the
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  ultrasound and they can do a great analysis of the prostate
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  without the MRI. Now I don't recommend this if
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  you can otherwise get the MRI. I like an MRI better.
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  Part of the reason I like the MRI better is because you're not
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  going to have to listen to the urologist tell you how you need
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  a biopsy or else you're going to die.
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  Some of them are like that or that they'll do the ultrasound
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  if you would acquiesce to letting them do a targeted
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  biopsy. It sounds elegant, doesn't it?
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  A targeted biopsy? No, it's dumb.
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  It is illogical. You're imagining that you can
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  identify the cancer in a manner that makes a difference.
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  Ironically, by targeting it, by getting it more likely to the
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  most dense portion of the cancer, you could well be making
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  things that much worse. So the micro ultrasound is an
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  option to consider, absent the biopsy.
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  Now there are many urologists out there that are really
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  processing what they're doing, and they're starting to
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  reconsider the biopsy frenzy. They're not there yet.
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  It's going to be another 15 years.
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  I think you really need a whole generation of doctors.
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  I hate to say it this way, guys, but they got to get their ROI
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  before they can get out of the game, right?
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  Or turn on investment. If you're JoJo the doc and 30%
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  of your income is coming from biopsies, you don't want that to
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  go away too quickly. I was at a a urology conference
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  recently talking about updates and conventional treatment.
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  It's my responsibility to you that I stay up to date with
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  conventional therapy just in case there's something out there
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  therapeutically worthwhile. And you know what?
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  There are some things that are of interest to me as your leader
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  in functional, the petroty protocol.
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  There's some things of interest. We'll talk about them in podcast
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  to come. In fact, this MRI information
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  comes from that conference as well.
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  But in the back of the room, one of the gentlemen got up on the
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  microphone. Doctor, he was talking about
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  immunologic treatment someday, obliterating the need for cancer
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  surgery and getting rid of the need for radiation.
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  So they're looking at that research space.
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  Not there yet. In the back of the room, a
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  Doctor Who makes his living cutting out prostate says woof,
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  I hope we doesn't come to the market for another two or three
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  years. Had to hit his retirement
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  threshold. There's a human variable in all
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  endeavors in medicine. It's not wrong, it's not
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  unethical, It is just unavoidable.
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  And if you're aware of that human element of the
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  self-interest woven into it, that can color recommendations.
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  Another interesting study was looking at the recommendations
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  that come from different doctors and what patients chose to do.
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  It's not surprising that if the consultation occurred with a
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  surgeon, the majority of men had surgery.
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  If it came from a radiation oncologist, the majority of men
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  had radiation therapy. If it comes from me, from the
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  Pederuti protocol doctors and they're going to be more of us,
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  we're reproducing out there. If it comes from me, I like to
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  believe a majority of men are going to say no to both.
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  It's OK guys, if you had radiation, it's OK if you had
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  your prostate removed. We're here to support your
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  vitality, to give you choices and options.
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  And this MRI is a critical step in the process.
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  The purpose of an MRI in my world, in the in the Pedro de
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  protocol world is not so you can get a better target for a
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  biopsy. It's so we can get a good
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  baseline to compare over months and over years.
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  How do we know if you have an aggressive cancer?
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  We check it over time. Gleason score passe unnecessary,
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  dangerous. Why?
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  Because the number scares men into doing things that harm
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  their health irreversibly in some cases.
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  And oh, by the way, the Gleason score is another subjective.
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  I think it's an 8. I think it's a seven.
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  Really want to trust that. I don't think so.
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  The trust comes from an experience and an observation
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  that requires time, which requires patience, which
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  requires temperance so you don't get excited and nervous.
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  Oh my God, I have prostate cancer, I'm going to die, and
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  you have the cloud following you.
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  So remember, biparametric MRI, no CAT scans, micro ultrasound
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  is an option if you have a hip replacement or otherwise cannot
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  do an MRI. If you're a little
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  claustrophobic and you get anxious, that biparametric study
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  is much more brief and we have drugs for that.
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  An anxiolytic is totally legit to use before you go in that
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  machine. So imaging the prostate is
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  essential. Whether you're going to do
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  conventional treatment or you're going to do a Petri protocol,
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  the imaging is essential. Do not proceed based on APSA and
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  a digital rectal exam alone. You need to insist on the MRI if
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  they're not offering it, and it needs to be done with what's
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  called the biparametric protocol.
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  Same equipment, biparametric, and you want to look for a 3T.
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  That's T as in Tango MRI. They're the state-of-the-art.
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  They're the best, the best imager.
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  There's something called a 1.5 T that was an earlier generation
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  of MRI. They're still out there, and you
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  will not know which kind of equipment you're being subjected
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  to unless you ask. I want a 3T by parametric MRI.
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  Yikes. Now you sound like an educated
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  guy. All right, folks, I hope this
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  was helpful to you. Stay healthy, Don't let them
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  push you. Get your information and then
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  craft a path that you feel confident with.
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  Keep fighting cancer like a man. We're born to live.
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  We're not born to wither. All right, guys, talk to you
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  next time. Bye.