Latest / Intellectual Medicine / Your Free Prostate Cancer Screening Is a Trap — Here Is the Truth

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Your Free Prostate Cancer Screening Is a Trap — Here Is the Truth · Intellectual Medicine

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  No hospital sat around thinking, well, what can we do that'll
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  prevent people from needing our services?
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  No, they're a corporate entity. Yeah, yeah, yeah.
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  They're not-for-profit. That's BSA, not-for-profit
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  entity making millions of dollars per year.
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  I'm sorry, I'm not buying that. Remember, you don't have health
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  insurance. You have sick insurance.
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  You need to put your focus on maintaining your health, and
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  that means avoiding medicine, minimizing the encounter of the
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  healthcare system, right? It's a sick intervention system,
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  and if you're not really sick, they want you to think you are
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  so that you will pay for their services.
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  Just because you can do something doesn't mean you
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  should. The fact that you're really good
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  at something that doesn't matter anymore doesn't make it worth
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  doing. There certainly are better ways
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  to go about business than imposing harmful procedures.
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  How can you tell? How do you know if those
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  symptoms you're experiencing are the early signs of prostate
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  cancer or the normal consequence of prostatic enlargement?
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  As men get older, our prostate gland will gradually increase in
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  size. That's normal.
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  What about the symptoms and how can we discern this?
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  It's very overlapping, so I'm going to help you out here.
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  First, you cannot afford the price of a free prostate cancer
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  screening test. Now, what do I mean?
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  That's a boondoggle. If you ever see a hospital or
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  urological Group, A charitable entity offering a free prostate
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  cancer screening, it is just to suck you into the system, to
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  make you do stuff you really don't need to generate profit,
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  period. No hospital sat around thinking,
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  well, what can we do that'll prevent people from needing our
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  services? No, they're a corporate entity.
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  Yeah, yeah, yeah. They're not-for-profit.
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  That's BS. You see the salary of these
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  hospital administrators, a not-for-profit entity making
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  millions of dollars per year. I'm sorry, I'm not buying that.
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  And I've been on the inside, folks.
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  I've seen the beast. They talk about the funnel.
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  We need to get lives, right? So I was at a urological
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  conference and there was a booth and they were promoting the
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  fantastic free service, getting PSA testing out there for
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  everybody. What's wrong with that?
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  Early diagnosis is good, right? Not so quick.
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  Not with the prostate. With the prostate and early
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  diagnosis as an invitation for a horror show.
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  But put that aside for a moment. The charitable booth is doing
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  free PSA testing. OK.
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  Yeah. Where's the money come from for
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  that? Oh, what a shock.
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  It's coming from pharmaceutical companies.
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  Yeah. They don't make any money unless
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  you're taking their drugs to treat prostate cancer.
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  And it's hard to make money just treating sick people.
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  This is the hidden dilemma. This is why these free testing
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  things are such a boondoggle. So their cut off, in addition to
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  being skeptical about their mission, the cut off, the PSA
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  level that they shared with individuals that was at risk was
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  2 APSA of 2. Are you out of your mind if you
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  have APSA of two? You do a cartwheel and you don't
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  think about it. Why do they have two as a panic
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  level or as a concern? Not panic or concerned level.
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  They want to generate recurring activity, capitalizing upon our
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  existential fear of death, of disease.
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  It's horrible. Remember, you don't have health
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  insurance, you have sick insurance.
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  You need to put your focus on maintaining your health, and
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  that means avoiding medicine as much as possible, minimizing the
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  encounter of the healthcare system, right?
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  It's a sick intervention system, and if you're not really sick,
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  they want you to think you are so that you will pay for their
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  services. Now let's get back to your
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  prostate. It's kind of normal.
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  As we age, the the bladder starts to lose some of its
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  elasticity, so you will feel more of an urgency.
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  The time from you feel the need to go to the bathroom until you
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  actually have to pee tends to shorten.
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  Now this can be trained men. You can use reflective
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  meditative activities, bladder training to extend the intervals
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  if you'd like, right Because the bladder you remember those of
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  you that played sports or you had a big test coming up, or how
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  about going out on a date or you got to call that girl and make a
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  date. The all of a sudden you feel
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  like you got to go to the bathroom, but you got to go.
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  You got to go pee. What's going on?
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  It's a sympathetic nervous system stimulating the bladder
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  to contract. All right, that can be
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  retrained. So it's normal to pee with a bit
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  more frequency. You know what else is normal?
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  Waking up in the middle of the night to go to the bathroom.
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  Majority of people over 50 start to have that experience.
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  Does not mean prostate cancers in the wings.
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  So how can you tell? Well, these are normal
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  phenomena. If the perceived event of that
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  is beyond the normal, you're getting up not once in the
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  middle of the night, but three or four times.
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  You're peeing not every few hours, but every 30 minutes.
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  And you're you, you're not able to control it.
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  That's not normal. Obviously, if you bleed, if you
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  pee blood, that's not normal. So there are some thresholds,
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  normal variants and then symptoms of concern.
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  Here's another thing that is absolutely irrelevant and you
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  should not allow anybody to do this to you.
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  Prostate rectal exam. Can we just stop already?
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  This is so 20 year old BS Look, I, I don't object to being
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  thorough. I think it's a good thing.
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  But really, this, this rectal exam, the studies have
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  invalidated that. Clearly.
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  I've done thousands of them. There's little to be gained
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  other than discomfort. So just decline there.
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  Could do a rectal exam, say. Well, doc, I'd prefer not.
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  Can we skip that part? They will likely acquiesce.
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  All right, so we don't do that. What do you do?
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  And what makes sense? Well, the PSA test, but not that
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  2 cut off. Remember, this goes up
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  naturally, men. It's going to go up every year
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  in all likelihood. The goal is not to have it
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  remain the same. That's not normal.
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  The goal is not to have it go down.
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  That's not normal either. You want to make sure that when
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  you get your PSA test performed, you're well hydrated, you're not
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  suffering any other illness, you're feeling good.
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  If you're inflamed for any reason, any reason, you can have
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  a chest cold, PSA is going to be elevated.
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  If you had a couple of shots of tequila last night, you went to
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  bed late, PSA is going to be elevated.
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  Bad news, right? So be well rested.
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  No ejaculation for two days before the test.
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  At least 1-2 can be hard, right? At least one day before the
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  test, no ejaculation. As much as possible, try to get
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  the test done at the same lab. That's nearly impossible.
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  Remember from one lab to the next the difference in PSA can
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  be as much as 50%. So don't panic if they find this
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  variability occur. So what does matter?
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  APSA above 4 is an absolute made-up number and arbitrary cut
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  off that really should be discarded.
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  You have to put it in the context.
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  What's your age? It's going to be higher as you
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  get older. And what's your baseline?
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  So when do I recommend that PSA should be done?
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  If there's a high risk profile, family history, you've got other
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  predisposing variables. If you're a diabetic, if you're
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  obese, maybe get it age 40. And then what?
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  How often That once a year is totally adequate.
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  You don't want to chase it too often.
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  Guys. What's normal?
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  From age 50 to age 70, your PSA is going to go up on average 0.3
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  nanogram per deciliter per year. So if you are 1.0 now, at age
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  50, at 51, you're going to be 1.3 on average.
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  Now bear in mind there's a lot of testing variability depending
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  on what kind of test is done. Well, that extrapolates into an
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  increase of 6 / 20 years. So from 50 to 70, let's say at
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  age 50 or 4.5 and age 70 you're 10.5.
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  That's kind of a normal trajectory, kind of normal
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  prostate cancer. When it is significant, when it
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  is high risk, when it is aggressive, you hear that term
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  used by urologist, PSA numbers jump, they don't creep, they
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  double. And when that happens, that's a
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  sign of potential issues, not an indication.
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  By the way, to get a biopsy. Please, if you haven't already,
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  get my book. Read my book.
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  Be prepared. This moment hits men like a pie
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  in the face. I'm walking along.
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  I feel fine. I go to the doctor.
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  My PSA is 12. The next thing I know, they're
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  shopping in the knives. They can redo that prostate
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  biopsy thing. All right, so pause.
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  What else can help? Well, we talked about the PSA,
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  the rate of increase. Although I'm not a huge advocate
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  of the new generation of prostate testing, all these
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  tests have the same limitation. They're simply there to give you
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  a direction toward a biopsy. I've already decided no biopsy,
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  so the test has less value if and they're all Shades of Grey
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  that is well could be might be odds are possibly percent
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  invariably the Ural says, well, let's let's just do the biopsy.
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  There is one test, however, that has the benefit of being a yes,
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  no, no number, no gradient. Now in in monitoring
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  circumstances, if you want to look at prostate cancer or it's
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  risk being monitored, you do need the number.
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  However, for those of you that are contemplating I'm having
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  these symptoms, how do I know if it's benign prostatic
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  hypertrophy or cancer? We talked about the rate of PSA
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  increase. We talked about the symptoms.
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  The EPI switch PSE test is a yes no test.
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  It is a blood test that will come back, either low risk,
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  don't worry about it, or high risk might be if it's low risk,
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  it doesn't guarantee that it's benign, but it certainly tilts
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  the field in your advantage. So if the rate of increase is
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  modest, your symptoms are expected.
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  That is, you know, occasional urgency, some nighttime
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  urination, the vigor of urinary stream will diminish.
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  You get past 60. Not too many of us are writing
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  our name in the snow anymore. Those days are gone.
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  I think every guy did that at some point, at least if you're
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  up in the North sense of power. I don't know.
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  Yeah, they're gone. That's not happening.
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  What did you all do in the South?
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  There was no snow to write your name in.
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  Anyhow, we digress. Where was I?
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  We're talking about the about the EPI switch test the PSC.
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  So if it's negative, if it's low risk, that's comforting.
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  PSA, slow trend, that's comforting.
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  Depending on your psychosocial comfort level, you can stop
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  right there. Do once a year PSA.
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  If you choose to proceed, a prostate MRI is a reasonable
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  consideration. Now you all know I like it
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  without contrast and if you get that prostate MRI performed, it
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  is normal for it to have nodules in it.
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  So when a report comes back and all the other things align
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  favorably for you and it says you know prostate gland has a
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  1.1cm nodule, 0.6 centimeter nodule.
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  Not a panic moment guys. The nodularity often can be
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  associated with benign prostatic hypertrophy.
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  What about that Pyrad score that we talked about?
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  There's a human element to interpreting the Pyrads.
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  I'm going to explain it to you. It's a subconscious dynamic that
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  I believe is at play. Picture the radiologist.
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  He's looking at the MRI. The Pyrads is his judgement
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  about how that picture looks? Yeah, he has criteria to help
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  guide him, but ultimately he has to put a stamp on it.
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  A Pyrid's three means, yes, probably not cancer A4 means
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  might be cancer. A5 means yeah, I think it's
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  cancer. A2.
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  Yeah. We don't think this is cancer at
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  all. In general, the subconscious
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  drift is to tilt it toward a higher risk category.
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  Why is that? Because no doctor, no
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  radiologist wants to miss something.
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  So if he's looking at it, could be a three, could be a four.
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  I'm going to call it a four because I don't want to under
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  diagnose an entity. If I call it a three and the
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  urologist perceives that as being a comfort level and later
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  on it turns out cancer happens in three or four years.
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  I don't want to get caught with my pants or on my ankles.
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  The guy that sort of dropped the ball, they perceive, right, this
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  is subconscious at play, but I believe it's a real thing.
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  Now go on to the urologist and he looks at a four and he
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  thinks, well, I've got a biopsy that so you can see how this
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  dynamic plays out. My advice is to be very slow in
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  reaction. An elevated PSA, an abnormal
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  prostate MRI is never a panic moment.
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  You have time and you can also monitor it over months, even
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  years. Is it benign?
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  Is it cancer? Can it change?
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  Can a benign prostate ultimately develop cancerous cells?
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  Yes, in fact, it's my personal goal to develop prostate cancer
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  cells within my gland someday. No, I'm not an idiot wishing
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  horrible things upon myself. But I know the majority of men,
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  if we live long enough, we're going to develop those cancer
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  cells inside the gland. Now think about that for a
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  moment. What makes prostate and prostate
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  cancer so utterly unique, so different from any other form of
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  cancer, is its inevitability. The majority of people will end
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  up with these. If you live past 90, which I
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  hope you do, you're going to get them inside the gland.
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  There's no other cancer that you can say that about.
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  Nobody would say, yeah, you know, if you live long enough,
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  everybody, nearly the majority of people that is, are going to
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  get, you know, cancer cells within the lung or the liver or
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  the colon or the breast, totally abnormal.
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  Not so for the prostate. So benign prostatic hypertrophy,
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  it happens. We'll talk about what you could
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  do. There are some things that have
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  value reducing the inflammatory response.
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  But today's focus is on discerning the symptom and
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  analyzing how to proceed. Don't get swept up in the
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  hysteria. And it is hysterical, the fear
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  factor, the profit gouging. That's a little bit harsh, maybe
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  not profit gouging. Let's just say the incentivizing
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  to do things. Given a choice between doing
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  nothing and doing something, most doctors try to do something
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  that's not always good. You're the one that needs to put
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  a brake on the system. You're the one that needs to
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  protect yourself from iatrogenic adverse consequence.
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  Simply put, being hurt, killed, or otherwise harmed by medical
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  intervention, it's a known thing.
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  Going to the doctor can be a dangerous experience.
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  Not knocking docs, I am 1 after all.
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  Yes, I've hurt my share of folks over the years, but we try to
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  minimize that, and the way we do that is by temporizing our zeal,
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  our impulse, our desire to do stuff because we can.
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  Once Upon a time, women would get Pap smears when they became
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  sexually active and we found abnormal cells on those Pap
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  smears. We would then cut out the
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  surface of the cervix to protect them from progression towards
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  cervical cancer. We thought we were doing a good
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  thing. Cut out the cervix.
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  Woman doesn't get cervical cancer.
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  We found out decades later that were harming young women that
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  those abnormal cells never grew up in a cancer.
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  They tended to go back to normal.
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  Decades of damaging women's cervix for no benefit till we
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  figured it out. This is not uncommon in medicine
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  because we can do something. We sometimes get swept up.
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  When I was a resident back in the Army, we used to work in the
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  intensive care unit. I felt really, really cool
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  because baby, I could swod a Swan Ganz catheter beautifully.
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  It was a catheter that would go into the artery, into the heart.
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  We can measure the output. We can measure the stroke.
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  It was fantastic numbers, and we would study those numbers.
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  We would adjust the drug therapy based on the Swan Ganz numbers.
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  Yeah, we found out decades later we were hurting people.
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  Putting those catheters in was damaging people.
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  Even though we like the numbers, this is not uncommon in the
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  realm of medicine. It tends to be we get enamored
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  of numbers in pursuit of things. So bring it back to the
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  prostate. Just because you could do
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  something doesn't mean you should.
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  If a urologist is pleased with their skill in doing a biopsy,
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  they're very happy about a procedure that should be done
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  away with. The fact that you're really good
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  at something that doesn't matter anymore doesn't make it worth
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  doing. All right, that's a bold
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  statement on my part, but I believe I'm right.
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  I believe the research supports my impressions, and there
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  certainly are better ways to go about business than imposing
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  harmful procedures. Well folks, here's wishing you.
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  Many long years and men. Yeah, let's plan on getting
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  prostate cancer in our Glen. Let's plan on living with it.
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  Let's plan on dying with it. Let's plan on living past 100.
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  All right, till next time, thanks for watching.
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  Keep up with the podcast and go get my book.
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  All right, bye now.