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The PSA Test Myth: What Doctors Never Explain To Men | PSE | EPI | 4k Score · Intellectual Medicine

• 0:00
  Somewhere out there, poor Doctor Alvin is spinning in his grave.
• 0:05
  Hey, today we're going to be talking about the PSA test.
• 0:09
  This is the conversation starter for many doctors and urologists.
• 0:15
  But what is it? Why do we have PSA?
• 0:18
  What's normal and abnormal? And how about all these other
• 0:21
  tests that are coming down the Pike?
• 0:23
  Should you incorporate those into your strategy to see if
• 0:28
  you've got prostate cancer or if it's more aggressive?
• 0:34
  Somewhere out there, poor Doctor Albin is spinning in his grave.
• 0:39
  Hey, today we're going to be talking about the PSA test.
• 0:44
  This is the conversation starter for many doctors and urologists.
• 0:50
  But what is it? Why do we have PSA?
• 0:53
  What's normal and abnormal? And how about all these other
• 0:56
  tests that are coming down the Pike?
• 0:58
  Should you incorporate those into your strategy to see if
• 1:03
  you've got prostate cancer or if it's more aggressive?
• 1:07
  Let's start out with APSA. The prostate specific antigen is
• 1:11
  a naturally occurring protein. Our bodies make it actually
• 1:14
  enzyme and it helps to liquefy semen.
• 1:18
  So when a man ejaculates the PS as job is to take that big
• 1:24
  sticky glob and liquefy it so the little swimmers can get to
• 1:28
  their destination. Perfectly natural.
• 1:32
  Most of it stays right in the gland.
• 1:34
  It's secreted into the channels, into the lumen, but it doesn't
• 1:39
  get in the blood very much. As the prostate gets bigger, it
• 1:43
  makes more PSAA, little more can leak in cancer cells leak more.
• 1:48
  They break down the natural barriers.
• 1:51
  So the PSA can go up in the setting of cancer.
• 1:54
  So that's what PSA is. It has a purpose in our in our
• 1:58
  lives, our reproductive lives. But how about it as a screening
• 2:03
  test? This was Doctor Albin.
• 2:04
  Now he was the inventor of prostate specific antigen.
• 2:08
  He wrote the book The Great Prostate or the Great PSA Hoax.
• 2:13
  It's not really a hoax. We'll explain what went wrong.
• 2:16
  But his fear has become realized.
• 2:20
  His fear was that it would be used as a screening test was
• 2:24
  never its intent. It was intended to follow the
• 2:28
  cancer and determine how it's progressing.
• 2:32
  That's how we use it with my protocol the way it's intended.
• 2:36
  1986 it was FDA approved to follow cancer, not for a
• 2:42
  screening test. That came in 1994 as a screening
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  test and that ignited an industry that is perpetuated to
• 2:52
  this day, a multi billion dollar juggernaut.
• 2:58
  The PSA is not a hoax. The way it's used has pushed
• 3:03
  over diagnosis, over treatment, excessive procedures, all in the
• 3:08
  interest of what? Trying to help men not die from
• 3:11
  prostate cancer? It has been an abject
• 3:14
  disappointment in that regard. But PSA isn't worth getting.
• 3:19
  You know, many countries do not acknowledge or recognize it or
• 3:22
  recommend it as a screening test.
• 3:26
  All right, that's a little bit nihilistic.
• 3:28
  If you're not going to do APSA as a screening test.
• 3:30
  And if prostate cancer really doesn't have any symptoms, you
• 3:34
  know, wait around until your bones ache, jump right into an
• 3:37
  MRI. You can see where we men are at.
• 3:40
  The issue's not the test, guys. It's the interpretation and it's
• 3:45
  the reaction. I was at a urology conference.
• 3:48
  There was a charitable organization there that gave PSA
• 3:51
  test for free. Seems like a good thing it's
• 3:54
  free. You're helping people get the
• 3:56
  test right? Their cut off.
• 4:00
  Anybody who had APSA greater than 2.0 was giving an alarm
• 4:05
  message that you got to go get this checked.
• 4:08
  Oh my goodness, you have a 2.0, You do cartwheels, you're a
• 4:12
  happy guy. What about the cut off?
• 4:15
  It's currently 4.0. Let me grab a number out of thin
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  air and pretend it's meaningful because I got to have something
• 4:25
  to tell my patient. And after all that, 4.0 is a
• 4:28
  made-up cut off worthy of being nearly completely ignored.
• 4:36
  As you get older guys, the prostate gets a little bigger.
• 4:40
  The number naturally goes up If you ejaculate it within 48
• 4:45
  hours, the number is going to be higher.
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  If you went on a bike ride, it's going to be higher.
• 4:50
  If you're sick, it's going to be higher.
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  So let's stop scaring. Do not let them scare you with
• 4:56
  APSA, OK? You get one number.
• 4:58
  A lot of problems with that one number.
• 5:02
  There's something called biological or analytical
• 5:05
  variance. This refers to the machine
• 5:08
  itself that's used to do the testing is not perfect.
• 5:12
  If you've ever gotten on a scale, looked at your weight,
• 5:15
  gotten off, then gotten on again and seen a different number, you
• 5:19
  get a sense of what the biologic or the analytical variances.
• 5:23
  So the equipment can can vary. The individual can vary
• 5:28
  depending on what they had for breakfast, what supplement they
• 5:31
  took, or their inflammatory state.
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  You can take the same specimen from the same man on the same
• 5:39
  day and put it in the same equipment three times.
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  You get 3 different numbers. Now, it's not completely
• 5:46
  arbitrary, but we have to factor that in that biological
• 5:51
  analytical variance can be 20%. Now, if you didn't know that and
• 5:57
  you had APSA of 10 and you came back and it's an 11 and they
• 6:02
  said, Oh my goodness, it's going up, we need to do something.
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  Well, maybe it didn't go up at all.
• 6:08
  Remember, the PSA is for tracking purposes.
• 6:14
  It's not diagnostic. There's something even more
• 6:17
  dramatic that's in the background and that's called the
• 6:21
  intra assay variance from one piece of equipment to another.
• 6:25
  The difference can be 50%. Guys, that's huge and you don't
• 6:31
  know, is it a, is it a, a Beckman test?
• 6:34
  Is it an Abbott? There are five different
• 6:36
  companies, major companies that offer a test for PSA in your
• 6:43
  friendly neighborhood lab. You don't know what company
• 6:45
  they're using. It's a problem.
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  Sometimes they'll change companies maybe based on who's
• 6:51
  giving them the best price. It's all going on behind the
• 6:54
  curtain. So slow down.
• 6:57
  You have an elevated PSA. The number can vary.
• 7:00
  So what can help us? This is where there's been a
• 7:03
  surge of FDA cleared testing. Everybody wants the the the test
• 7:11
  in quotes, the one that'll tell them do I have cancer or not?
• 7:16
  Now, the doctor Petteruti RDT protocol, repurposed drug
• 7:23
  therapy protocol, does not rely on any test for screening.
• 7:30
  We use it to guide therapy. We use it to follow outcomes.
• 7:35
  But the decision is not whether or not to get a biopsy.
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  We've already decided we're not going to advise you to get one
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  ever. OK, but what about conventional
• 7:46
  medicine? They want this test to help
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  guide them toward a biopsy. Now, in most cases, the test
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  becomes another amplifying agent because none of the tests come
• 7:56
  back with a you don't have cancer, go home and have a nice
• 8:00
  day. They're all Shades of Grey.
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  There is one test that has the audacity to only have two
• 8:08
  results, high and low risk. I kind of like that.
• 8:11
  It forces them to make a call. The others are like, well, you
• 8:15
  know, it's medium. Well done.
• 8:17
  I don't know. We'll talk about those and I'll
• 8:19
  give you my thoughts on them as well.
• 8:22
  But here's a piece of information that you should push
• 8:24
  for. Nobody puts a needle in your
• 8:27
  biopsy, ever. But if you're inclined to
• 8:31
  consider it, you must get an MRI of your prostate first.
• 8:36
  Ideally A biparametric. That's another topic for another
• 8:40
  podcast, but you want the MRI. With an MRI you can calculate
• 8:45
  the PSA density, which is simply imagine how much PA is packed
• 8:52
  per gram of prostate. See prostate cancer is dense,
• 8:58
  normal prostate tissue is a little more loose.
• 9:01
  So the PSA density takes the PSA and divides it by the size of
• 9:07
  the prostate. PSA size of the prostate in
• 9:11
  milliliter. You get that from the MRI and it
• 9:15
  comes out with a density number. So a big prostate could have a
• 9:19
  high PSA, but a low density if it's below .15, that's generally
• 9:26
  considered a low risk environment.
• 9:29
  And my experience has been that even in a low risk environment,
• 9:33
  the urologist may say, well, we can't rule it out.
• 9:37
  We must get a biopsy. No 1000 times, no follow it.
• 9:42
  Men don't jump to the needle, don't jump to the biopsy.
• 9:45
  All right, let's talk about some of the other tests.
• 9:48
  I'm going to start out with the ones that I don't like.
• 9:52
  I don't like men having to have a finger put up their butt.
• 9:56
  It's not that I'm squeamish. I've done thousands of rectal
• 10:00
  exams back in the day when we thought we were helping men.
• 10:05
  Actually, a lot of this was before colonoscopies.
• 10:07
  And we said, hey, this is great. We'll check the prostate, get a
• 10:10
  specimen of stool, see if it has blood.
• 10:13
  You know, in 1990 that was worth doing.
• 10:16
  Not today. It's not only unpleasant for the
• 10:20
  man, but it's been shown not to really make any difference, or
• 10:25
  they try to pretend they know. It feels a little boggy.
• 10:30
  Translating that into clinically meaningful results.
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  That's a big leap. I don't recommend rectal exams.
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  I don't think they have any merit and I'm not alone.
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  So we're going to eliminate 2 tests, the PC, the PCA 3,
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  because it requires A rectal exam.
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  Oh, I'm sorry, that requires A rectal massage.
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  It's a urine test. I don't like it.
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  The other one, select MDX. That's another one requires A
• 10:58
  rectal exam as part of the test. Not cool.
• 11:03
  Now I was telling you about the high low test.
• 11:07
  That's the EPI switch PSE. EPI switch PSE, it's a blood
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  test, no rectal exam. It gives your doctor a result
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  that says either high risk or low risk.
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  If you're high risk, they're going to absolutely push you
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  toward a biopsy. I still don't want you to go
• 11:26
  that path. You need the MRI.
• 11:29
  You need a timeout. You really need to read my book,
• 11:34
  The Fighting Cancer Like a Man book.
• 11:37
  In fact, I have a copy over there.
• 11:39
  I should have had it with me, but I'll do it on my next
• 11:42
  podcast. It's available on Amazon.
• 11:44
  It's fighting Cancer like a man and it's fabulous.
• 11:50
  I wrote it. There's no ghost writer.
• 11:53
  I wrote every word. I like writing.
• 11:56
  I think ghost writing is cheating.
• 11:57
  Not only that, but I, I, it would be annoying for me to have
• 12:00
  to explain to a non doctor everything that I want in the
• 12:03
  book. Now Shannon helped me.
• 12:05
  She wrote some sections, There's information in the book about
• 12:08
  diet, there's recipes, there's shopping list.
• 12:12
  There's a whole section on how to lose weight, percent body fat
• 12:16
  that's important when treating prostate cancer.
• 12:19
  Do this first. Don't jump to the biopsy.
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  Get the book and implement your best effort.
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  All right, the EPI switch not bad, plus minus right high, low.
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  Kind of like that blood test. No rectal exam cost.
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  Sometimes get insurance to cover it but if not it can be over 100
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  / 900 dollars. Is it worth the price?
• 12:43
  Maybe, certainly depending on your circumstance.
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  Right? You don't want to go broke
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  chasing cancer, but with insurance coverage it makes it a
• 12:50
  little bit easier as a test in order to pause, think and get a
• 12:54
  little more data. Seems reasonable to me.
• 12:58
  There's another one, the EXO Exodex FB test EPI.
• 13:03
  This also is a blood test. It is scored zero to 100.
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  It incorporates APSA as one of its metrics.
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  Now these tests typically are going to take other biomarkers,
• 13:16
  exosomes, sometimes protein derivatives, other things that
• 13:21
  are manufactured by prostate cancer or or a large gland.
• 13:26
  Now this test is zero to 100. If it's below 15.6, it's
• 13:30
  considered low risk. That'll set you back 750.
• 13:34
  The ISO PSA test analyzes structural variance within the
• 13:39
  PSA. Another blood test runs around
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  $500. Which test is to the best?
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  All these tests have been shown to be more sensitive than APSA
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  in determining whether or not the cancer is at a Gleason level
• 13:57
  of seven or greater. In my protocol, the Gleason
• 14:00
  score is dismissed with because we don't need it.
• 14:05
  We're going to follow and determine the aggression of your
• 14:09
  cancer with sequential monitoring.
• 14:12
  Another test, the 4K score. This test uses a rectal exam
• 14:18
  optional, which you just declined, and it's scored in
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  percentages less than 7.5% is considerable risk.
• 14:25
  So how do I use these tests? Right now we're I'm studying
• 14:31
  them. I'm not sure how they might fit
• 14:33
  into my protocol, but they may help guide decisions about
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  intensity of repurposed drugs. I can guarantee you they're not
• 14:42
  going to compel any of my patients to be advised to get a
• 14:45
  biopsy because I don't think the biopsy has any value, can
• 14:49
  potentially spread cancer. And we don't need it to decide
• 14:52
  how to treat a man. And you know that because, well,
• 14:55
  you've been listening to me. So folks, when it comes to the
• 14:58
  ancillary test, the ones I don't like, I mentioned the others,
• 15:03
  I'm still studying the EPI Switch, PSE kind of cool because
• 15:08
  it's a high, low test. All the others with the shades
• 15:12
  of Gray, they leave your dock in a quandary.
• 15:16
  If I biopsy him, I'm medical legally covered, I get paid and
• 15:23
  the conversation's over. The PSA done sequentially
• 15:29
  requires tolerance from the doctor because now they're
• 15:33
  worried about a lawsuit for delayed diagnosis of prostate
• 15:36
  cancer. Doctors PSA was 7.4.
• 15:38
  How come you didn't biopsy him? Right?
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  You therefore need to know this so that you can be assertive.
• 15:46
  I understand the biopsy doctors your recommendation by him
• 15:48
  choosing to delay. Remember that biological
• 15:53
  analytical variants. Remember the inter assay
• 15:56
  variants. Get another PSA three months
• 15:59
  later. If you're nervous about it, get
• 16:02
  one of the other diagnostic tests.
• 16:04
  Your doctor may have a favorite. It's worth it if it'll help keep
• 16:09
  you from getting a biopsy and it'll give you Peace of Mind.
• 16:12
  MRI. Absolutely biparametric, no dye.
• 16:17
  All right, well, I hope this sheds a little light on the PSA.
• 16:19
  This comes up frequently. Here's one thing, guys, don't
• 16:23
  burn your money. Get in APSA every week.
• 16:26
  You know, I just started apricot seeds.
• 16:28
  I'm going to do APSA in two weeks and see if it goes down.
• 16:31
  Now, you know, the number can shift randomly and you know, it
• 16:34
  takes time. My advocacy, a minimum of a
• 16:39
  month only in the case where it's going up uncomfortably.
• 16:42
  Otherwise, three months if you're tracking PSA.
• 16:47
  All right, gang. Well, remember the book Fighting
• 16:49
  Cancer Like a Man? We need your help.
• 16:51
  We want to spread the word to men that they have options.
• 16:55
  The seminar happens here in Fort Lauderdale in April.
• 16:58
  We're going to be training other providers.
• 17:00
  How cool is that? We're not just promoting this
• 17:03
  for ourselves and for our patients.
• 17:05
  We're creating a new standard of care and we're going to get
• 17:09
  other providers, nurse practitioners and doctors to
• 17:12
  join us. Pretty soon we'll be available
• 17:14
  throughout the entire country. For now, you got to read the
• 17:18
  book standby podcast and come see me in Florida if you're if
• 17:23
  you're motivated. All right, team, till next time,
• 17:25
  thanks for watching.