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Is Watchful Waiting The Right Thing To Do When You Have Prostate Cancer? · Intellectual Medicine

• 0:00
  Watchful waiting is sort of water torture.
• 0:02
  Drip drip. Everyday.
• 0:04
  God is it getting worse? Drip.
• 0:05
  We should not ever accept decay. We should not accept withering.
• 0:10
  We should not accept passive waiting.
• 0:12
  Our bodies are self healing machines.
• 0:15
  They're fighting that cancer. Stay strong, stay vital, fight
• 0:19
  cancer like a man. The era of the biopsy to
• 0:35
  evaluate the prostate gland is over.
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  Just nobody told the urologist yet.
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  I mean, they're still doing it. The prostate biopsy is the dodo
• 0:46
  bird of medical procedures. It needs to be extinct.
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  I explain this all in my book. If you haven't bought it, do so.
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  The reason it's extinct. The reason it should be extinct
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  is because it doesn't correlate with any benefit regarding
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  outcome. The information gathered does
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  not help distinguish how you should manage your gland.
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  It's traumatic, it's painful, spreads cancer, awful.
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  So why are we still doing it? Well, they're starting to
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  contemplate some change now. There's a thing called Watchful
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  weighted, or also known as actives for Balance.
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  It's a weird backdoor way for the conventional urological
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  community, and for that matter, oncologic community, to
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  acknowledge that what they've been selling us for the last 80
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  years, prostatectomy, radiation therapy, is a colossal
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  disappointment, dare I say, an abject failure.
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  It does not alter your risk of dying of prostate cancer.
• 2:00
  So, oh, what are we doing it for?
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  Well, it's what we do. The studies have not supported a
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  benefit regarding avoiding death from prostate cancer.
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  That's the name of the game, folks.
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  Anything else they try to peddle?
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  Alteration of PSA numbers, delay of progression.
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  Nice, but ultimately not what we want.
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  I don't want to die of prostate cancer, but I don't mind having
• 2:31
  prostate cancer. Wait, that's weird.
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  It's true, most men will develop prostate cancer cells within the
• 2:39
  gland if they live long enough. So congratulations on living
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  long enough to have this become a nuisance that needs to be
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  managed. But what about this watchful
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  waiting? We hear about the idea that you
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  have an indolent kind of prostate cancer.
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  The idea that the only way they can determine is with a biopsy.
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  That's just dumb. You don't determine how things
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  are going to change by jamming a trocar in the prostate 12 times,
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  creating a bloody mass. It's one spot on a curve to know
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  how things are going to change. You've got to be able to observe
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  it over time. If I said to you, oh, the stock
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  market is at 950, I don't know what that means.
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  I don't know of anything about the stock market, but spare with
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  me. If I said it's 950 and then ask
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  another question, is it going up or down?
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  I don't know. It's one spot on the curve.
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  We need multiple spots. Does that mean I got to get
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  multiple biopsies? Some would advocate for that.
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  That's something called active surveillance.
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  It sounds good. It's active.
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  It's surveillance. What a nice word.
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  What's not to like about active surveillance?
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  Everything. There's no treatment rendered.
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  There's trauma imposed. It's sequential biopsies on the
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  theory that they can tell what's happening at a cellular level by
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  these random pokes. Oh I know they say it's targeted
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  now that's BS Cancer doesn't reside in neat little packages.
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  The nodule on the MRI may or may not be cancer, but if it is
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  cancer, rest assured it's scattered throughout the gland.
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  That's why they do multiple biopsies.
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  Cancer doesn't behave in a way that our rational mind wishes it
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  would. That little lump, Can't you just
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  cut it out? You can't.
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  Cancer is cellular, so we do the act of surveillance.
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  We do watch watchful waiting, by the way.
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  There's a fancy way of saying do nothing.
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  There's something interesting about doctors and about the
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  encounter you have when you go in the office.
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  Every encounter must have a diagnosis labeled to it.
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  Otherwise we don't get paid. Well, most people don't.
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  I don't bother with insurance, so it's different, but I'm
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  talking about the mainstream of docs.
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  You must have a label. So when you go to see the
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  doctor, you're walking out with a diagnosis.
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  Like it or not, they'll come up with something.
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  Chronic pain, Let's call that fibromyalgia.
• 5:26
  I get headaches. Well, let's call that cephalgia.
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  And there's a numeric code that correlates into a financial
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  reimbursement. Now let's go back to your poor
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  urologist. Poor guys and gals.
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  They now are staring at a treatment that they have been
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  doing for decades. They learned how to do it in
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  their residency. They became really, really good
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  at doing biopsies. Good for them.
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  You know, Once Upon a time, somebody became really, really
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  good at doing frontal lobotomies.
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  Being good at something doesn't mean it's worth doing.
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  You can be really good at a totally useless procedure,
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  right? You catch my drift?
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  So they're really, they're good at it.
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  They take pride in it. They do it better than anybody
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  else. They do prostatectomies better
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  than anybody else. Has there ever been a surgeon
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  who said, well, I do prostatectomies, but I'm OK at
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  it? I'm kind of average.
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  No, when they look at these outcome, the studies, they stare
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  at that study. Now, you can't be a surgeon,
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  folks, without a strong ego. That's not a bad thing, but it
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  can be difficult when the ego gets in the way of data, fact
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  and changes. So they look at that study that
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  says no benefit of prostatectomy and they think, huh, yeah, but
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  not my prostatectomies. Mine are better than those.
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  That's wishful thinking. That's wishful thinking.
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  So watchful waiting becomes a way that they can that we
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  medical community at large can bill the insurance company for,
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  well, kind of doing nothing. We're going to check your PSA
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  just to make it look good and justify the encounter.
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  Make you feel like you got something out of this other than
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  interrupting your day and making you wait in that waiting room
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  for who knows how long. I'm going to stick my finger up
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  your butt because it seems useful.
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  I mean, after all, I can touch the prostate gland.
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  Can we just stop? This is another proven useless,
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  intrusive, uncomfortable imposition on patients just to
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  show them we're doing something. Yeah, we're we're we're
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  watchful. Waiting.
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  Waiting for what? That's psycho torture.
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  Imagine this. Imagine going in and they think,
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  well, we think you have prostate cancer.
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  Let's go step beyond that. They do a biopsy.
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  It comes back. It shows what they describe as a
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  likely Indolin kind of prostate cancer.
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  They really are concerned. They don't want to take out your
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  prostate gland because they know, they really know it
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  doesn't work. They know that they don't share
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  that with you. Listen, if a surgeon suggests
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  surgery or an oncologist suggests radiation, and they
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  don't go over the Protect T trial with you and they don't go
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  over the evidence supporting the fact that there's no decrease in
• 8:33
  your risk of dying, then I think that consultation is incomplete
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  and is omitting critical information because it's
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  uncomfortable for them to admit that.
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  So make sure, folks, you take your time.
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  You got time. If you don't know what the
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  Protect T trial is, you must know it before you can become an
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  educated patient to help direct your care 'cause you're in
• 9:00
  charge. Make no mistake about it, it's
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  your life or your decisions. How do you want to live?
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  You fight cancer like a man. You maintain vitality.
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  There's not much we can guarantee patients in any
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  endeavor. In medicine, guaranteed outcomes
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  don't occur. Talk about odds, risks,
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  benefits, the thing you want to hold onto.
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  However, throughout it all, your vitality, your energy, your
• 9:28
  strength, how you feel. If you feel great, you have good
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  energy, but your PSA is elevated and your MRI of the prostate is
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  abnormal. Oh, my goodness.
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  And then they do a biopsy and they say, you know, you have
• 9:44
  cancer. We say, but I, I, I feel great.
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  Yeah. But it, it's a kind of cancer
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  that we think is going to go slowly.
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  So these are true but still unsettling facts.
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  Most prostate cancer moves so slowly that you will die of
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  something else first. But not all end up with that
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  pattern. And it's there is no singular
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  test that can determine who's going to be in column A, the
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  indolent people and who's in column B.
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  Which is why I advocate sequential PSA over time
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  periodic Mris. Let's look at what's happening
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  in there. We don't have to guess.
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  We can look without biopsy. It's more than watchful waiting.
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  It's active intervention and there's a ton of things you can
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  do to support your health. The problem with we docs is we
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  don't know. Present company excluded.
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  Most docs, let me say that they really don't believe that your
• 10:42
  body has any healing potential. They don't believe that
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  supplements are worth a dime. Expensive urine, they'll blow it
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  off. They don't think lifestyle
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  modification is worth doing. I've heard my patients coming
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  back to me for various forms of cancer, the oncologist telling
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  them eat whatever you want, it doesn't matter.
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  IE the only thing that matters is our chemotherapy and our
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  radiation. You can go home and have all the
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  bagels you want. Ain't going to.
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  That's nonsense. Absolute ridiculousnessness.
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  It's bad. Our bodies are self healing
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  machines. They're fighting that cancer.
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  They're fighting that prostate cancer.
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  They're endeavoring to keep those atypical doorman cells in
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  the gland. You just need to know what you
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  can do to tilt the field to your advantage.
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  You don't want puffery and you don't want a bunch of marketing
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  schmutz clouding the water. The Internet is cut in both
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  ways. It's an open Vista of
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  challenging information. Shoot everything I say.
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  You can challenge it. You can look for it.
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  Do that. You're going to find it
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  validated. If you see something out there
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  that is promoting A singular pathway of treatment.
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  Nothing other than patient affirmations.
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  I took apricot seeds and look at me.
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  I don't have cancer, all right? Dead men don't post, and there's
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  a ton of folks that are being sucked up by marketing, and I
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  can't blame you guys 'cause you're you're kind of stuck.
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  I just told you conventional treatment is miserable, that it
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  doesn't work. OK, doc, then what should I do?
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  Right. You have different layers of
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  treatment you can consider. And by that I'm talking about
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  safe, validated potential benefit based upon research
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  studies. Are these proven to prevent
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  progression? They're not.
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  But man, you tell me I've got a disease, a condition, whether
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  it's prostate cancer, whether it's coronary artery disease,
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  and you tell me there's nothing I can do about it except for
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  take drugs. That is biologically
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  implausible. And it is a reflection of
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  limited knowledge on the part of the clinician.
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  Whether you have heart disease, early onset cognitive
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  impairment, whether you have sarcopenia, a nice word for
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  muscle atrophy. No matter what is happening in
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  your body, you can unlock its healing power.
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  Our bodies are meant to last. They regenerate.
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  We should not ever accept decay. We should not accept withering.
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  We should not accept passive waiting.
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  Well, you know, Doctor Pad Rudy, looks like you have prostate
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  cancer. All right, what should I do?
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  Well, we can take your gland out.
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  You might become infinite, probably lose sexual vitality,
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  might leak urine, and it's not going to make a difference
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  regarding survival from prostate cancer.
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  What else can I do? You do radiation.
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  No surgery. Still some risk of sexual
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  dysfunction. And that radiation, you know,
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  radiation is a carcinogen, so it can damage your rectum, your
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  bladder, increase lymphoma, leukemia, solid tumor cancers
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  appears to correlate potential damage to your heart.
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  And oh, by the way, it doesn't help you live longer.
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  It doesn't prevent you from dying of prostate cancer.
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  All right, So what else can you do?
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  That's about it. That's all we got for you.
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  The rest is watchful waiting. So go home, sit on your hands
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  and hope things don't get worse. When you get stressed enough,
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  call us up and you'll beg us to cut out your gland even though
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  the odds of it succeeding or small.
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  This is where they paint men. This is the box they put you in.
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  Watchful waiting is sort of water torture.
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  Drip drip everyday. God is it getting worse.
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  Drip drip. Oh my PSA went from 7 to 7.5.
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  Oh my God, I better get that gland out.
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  I understand why men, why your knees buckle?
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  It is really hard to walk this path with a shadow over your
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  head. You know, when's the other shoe
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  going to drop? Watch while waiting is
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  psychologically unkind and I think is not the path to walk.
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  Let's call it something different.
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  Let's call it functional active treatment, strengthening the
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  body, strengthening the immune system, fighting cancer at a
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  cellular level. Now we don't have to passively
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  sit back and wait, nor do we have to dive into conventional
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  treatments and suffer trauma. Life changing negative effect.
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  Every time I read about some new celebrity was chirping about how
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  I'm glad they caught it early. They cut it out.
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  I think, Oh my goodness, I have a lot of work to do.
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  We have a lot of work to do. So join the Prostate vitality,
• 16:14
  Dr. Petrie's prostate vitality community.
• 16:17
  You can Google it. It will pop up.
• 16:19
  That's where you can get ongoing information.
• 16:22
  You can get information from other men on the journey.
• 16:26
  Once a month I do a go to meeting question and answer.
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  A very enriched environment. And oh, by the way, you help me
• 16:33
  become part of the solution, getting the message out there to
• 16:37
  everybody in the world. The book just got published in
• 16:40
  Spanish. It's being translated into
• 16:43
  Germany. The audiobooks coming out soon.
• 16:47
  We're scratching the surface, folks.
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  I need your help. We need to disseminate this.
• 16:52
  I'm training other clinicians in my protocol.
• 16:55
  The book is here for universal consumption, so we can change
• 17:00
  this. We can't wait for them to do it.
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  The change is not coming from the top down on this one gang.
• 17:07
  It's coming from the side, from the outsiders like me, like you,
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  the people that are thinking rationally and applying
• 17:17
  knowledge. I love the fact that you all can
• 17:20
  AI stuff. It's a good starting point.
• 17:23
  Don't lean on it though. Don't lean on it.
• 17:26
  Use it to guide research and don't get stuck down a rabbit
• 17:31
  hole without guidance. You shouldn't have to walk this
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  alone. That's why I do my podcast.
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  That's why we have the community at large.
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  That's why we're training other clinicians.
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  So watchful. Waiting well, doing nothing is
• 17:45
  better than traumatizing you. But there is a trauma woven into
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  that. That is the trauma of passivity.
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  Imagine if you're a woman with a breast lump and they do a biopsy
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  and say, well, looks like cancer, but we don't think it's
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  going to go anywhere, so why don't we do nothing and have you
• 18:04
  come back in a few months and oh, goodness, Right.
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  All right. So keep thinking, keep
• 18:11
  challenging, keep living. Vitally, the knock on the door
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  comes. Someday we're going to go home.
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  Not without our vitality, not by withering first, not by having
• 18:27
  our fear and anxiety drive us into making bad decisions
• 18:32
  regarding our health. All right, so I have you today.
• 18:37
  Thanks for tuning in the podcast, gang.
• 18:39
  I'll see you down the road. Stay strong, stay vital.
• 18:43
  Fight cancel like a man.