Latest / Wits & Weights | Strength & Fat Loss Over 40 / Prostate PSA Results and Unnecessary Biopsies (Dr. Stephen Petteruti) | Ep 403

Transcript

Prostate PSA Results and Unnecessary Biopsies (Dr. Stephen Petteruti) | Ep 403 · Wits & Weights | Strength & Fat Loss Over 40

• 0:01
  Philip Pape: If you're a man over 40 who lifts weights and wants to stay strong for decades, your prostate health might be the most misunderstood risk to your training and hormones.
• 0:10
  Philip Pape: One elevated PSA reading.
• 0:13
  Philip Pape: That's all it takes for most doctors to push you toward a biopsy.
• 0:16
  Philip Pape: And once you're on that conveyor belt, the next step is often treatment that potentially tanks your testosterone and muscle mass.
• 0:24
  Philip Pape: So the question we're answering today is: how do you know when prostate issues require a biopsy?
• 0:29
  Philip Pape: And is there a less intrusive diagnostic path that protects both your prostate and your physique?
• 0:36
  Philip Pape: Today's guest who specializes in men's health and hormones, and he will explain why the standard approach to prostate screening is broken and what you can do about it for your health.
• 0:46
  Philip Pape: You'll discover when elevated PSA actually matters, when biopsies are unnecessary, how common treatments affect muscle and strength, and a proactive protocol to keep you training hard well into your 70s and beyond.
• 0:59
  Philip Pape: Welcome to Wit and Weight, the show that helps you build a strong, healthy physique using evidence, engineering, and efficiency.
• 1:10
  Philip Pape: I'm your host, certified nutrition coach Philip Pape, and today we're discussing prostate health and PSA testing.
• 1:16
  Philip Pape: If you're a man over 40, you may have had a PSA test or been told you should get one.
• 1:21
  Philip Pape: Maybe you've been told your number's high and you need a biopsy right now.
• 1:24
  Philip Pape: But what if that's not the case?
• 1:26
  Philip Pape: What if there's a better, less disruptive diagnostic approach?
• 1:29
  Philip Pape: My guest today is Dr.
• 1:31
  Philip Pape: Steven Petteruti, a board certified family physician and host of the Intellectual Medicine podcast.
• 1:36
  Philip Pape: He has dedicated his practice to men's health, hormone optimization, and smarter approaches to prostate care.
• 1:44
  Philip Pape: He's going to teach you what the PSA numbers really mean, the choice between imaging and biopsy, the effects of various therapies on hormones and muscle, and some steps you can take right now to keep your prostate healthy without sacrificing your health or performance.
• 1:58
  Philip Pape: To be clear, this is not medical advice, but it is information every man listening needs to understand.
• 2:04
  Philip Pape: Dr.
• 2:05
  Philip Pape: Petaruti, Steve, welcome to Wits and Waits.
• 2:07
  Philip Pape: Great, Philip.
• 2:08
  Philip Pape: Thank you for having me.
• 2:09
  Philip Pape: So let's talk about this topic.
• 2:12
  Philip Pape: Um PSA or prostate health and the blood markers that go along with this are confusing.
• 2:18
  Philip Pape: And there's a lot of, I'll say there's misinformation and there's probably a lot of entrenched uh information and advice from generations of healthcare.
• 2:28
  Philip Pape: And I know we need to stay with the times and understand uh for men concerned about cancer, let's say, what is the correlation?
• 2:35
  Philip Pape: What does the science say when it comes to things we're measuring, like PSA results and cancer?
• 2:41
  Philip Pape: Let's start there and then we can go deeper.
• 2:43
  Dr. Stephen Petteruti: It's important to recognize PSA is not a test for cancer.
• 2:47
  Dr. Stephen Petteruti: It was never meant to be that.
• 2:49
  Dr. Stephen Petteruti: It is a marker that you can follow and its trajectory, its direction can be helpful.
• 2:56
  Dr. Stephen Petteruti: But there is no cutoff.
• 2:58
  Dr. Stephen Petteruti: All the cutoffs that you read about or that are published are arbitrary and are just kind of throwing a dart at the board.
• 3:05
  Dr. Stephen Petteruti: So when they tell men, hey, your PSA is above four and you need a biopsy, that's made up science.
• 3:12
  Dr. Stephen Petteruti: There are men with PSAs of 30 are totally fine.
• 3:16
  Dr. Stephen Petteruti: So the thing I want your audience to hear loud and clear, you never need a biopsy.
• 3:23
  Dr. Stephen Petteruti: I advocate they should never be done.
• 3:25
  Dr. Stephen Petteruti: And I'll expand upon that as the conversation unfolds.
• 3:29
  Dr. Stephen Petteruti: There's a reason why the PSA is entrenched, and there's a reason why biopsies are recommended.
• 3:35
  Dr. Stephen Petteruti: It has more to do, Philip, with historical inertia than keeping up with current technology.
• 3:41
  Dr. Stephen Petteruti: If I can give you a quick sweep, maybe that'll illuminate a bit, right?
• 3:45
  Dr. Stephen Petteruti: So in the 1980s, there was no PSA, there was no MRI, there was strictly the digital rectal exam where the doc would say, well, it feels a little abnormal.
• 3:55
  Dr. Stephen Petteruti: I think you need a biopsy.
• 3:56
  Dr. Stephen Petteruti: So now we've established the biopsy as a standard.
• 4:00
  Dr. Stephen Petteruti: The biopsy leads to a diagnosis of prostate cancer in some cases, and then they jump to a prostatectomy, removing the gland.
• 4:10
  Dr. Stephen Petteruti: I mean, it seems logical.
• 4:12
  Dr. Stephen Petteruti: Intuitively, it makes sense.
• 4:13
  Dr. Stephen Petteruti: Cancer is in the gland, you take the gland out, I no longer have cancer.
• 4:18
  Dr. Stephen Petteruti: Would that it were that simple.
• 4:20
  Dr. Stephen Petteruti: Now we know there are several studies that have shown us that taking out the gland doesn't protect you from cancer.
• 4:27
  Dr. Stephen Petteruti: I know that sounds weird, but that's what the data shows.
• 4:31
  Dr. Stephen Petteruti: So you can get the gland removed, men, you suffer all that adverse consequence, and then here comes the cancer again.
• 4:37
  Dr. Stephen Petteruti: What's going on?
• 4:38
  Dr. Stephen Petteruti: Why?
• 4:39
  Dr. Stephen Petteruti: And this is philosophy that drives it.
• 4:41
  Dr. Stephen Petteruti: It's a lot having to do with what you've dedicated your own profession to, right?
• 4:46
  Dr. Stephen Petteruti: Live life robustly, guys.
• 4:49
  Dr. Stephen Petteruti: Live vitally.
• 4:50
  Dr. Stephen Petteruti: Don't do things that suck the energy out of you unless there's a compelling benefit.
• 4:55
  Dr. Stephen Petteruti: So 1980s biopsies.
• 4:57
  Dr. Stephen Petteruti: Then in the 1990s, a PSA comes on the scene.
• 5:00
  Dr. Stephen Petteruti: And really nobody knew what could quite what to do with it.
• 5:05
  Dr. Stephen Petteruti: You know, does this predict cancer?
• 5:06
  Dr. Stephen Petteruti: Does it correlate?
• 5:08
  Dr. Stephen Petteruti: For a while, it was not even advised to be done.
• 5:11
  Dr. Stephen Petteruti: So the United States Preventative Task Force at one point said, hey, don't bother doing it.
• 5:16
  Dr. Stephen Petteruti: Then they came about.
• 5:17
  Dr. Stephen Petteruti: The urology community, and I am a family physician, so my perspective comes from the outside looking in.
• 5:24
  Dr. Stephen Petteruti: And the urological community said, Hey, you can't do that.
• 5:27
  Dr. Stephen Petteruti: Men need this PSA test.
• 5:29
  Dr. Stephen Petteruti: So it went back in the hopper.
• 5:31
  Dr. Stephen Petteruti: Well, if there's a test, there's got to be a threshold, and the threshold was arbitrarily created.
• 5:37
  Dr. Stephen Petteruti: Thus, we have a PSA threshold.
• 5:39
  Dr. Stephen Petteruti: Now we have biopsies that are still there.
• 5:42
  Dr. Stephen Petteruti: Instead, we've got an MRI.
• 5:44
  Dr. Stephen Petteruti: You have an elevated uh PSA.
• 5:47
  Dr. Stephen Petteruti: You're nervous about it.
• 5:48
  Dr. Stephen Petteruti: An MRI can be performed, looks at the anatomy.
• 5:51
  Dr. Stephen Petteruti: It's kind of like a mammogram for a man's prostate.
• 5:54
  Dr. Stephen Petteruti: It gauges risk.
• 5:56
  Dr. Stephen Petteruti: Nice study, not carved in stone.
• 5:58
  Dr. Stephen Petteruti: It is uncommon to have a completely normal MRI past the age of 50.
• 6:04
  Dr. Stephen Petteruti: True.
• 6:05
  Dr. Stephen Petteruti: Usually a nodule, there's gonna be something in there, guys.
• 6:07
  Dr. Stephen Petteruti: Here's another thing that'll help frame the conversation.
• 6:11
  Dr. Stephen Petteruti: If you arbitrarily biopsied 100 men off the street over the age of 50, just biopsied everybody.
• 6:18
  Dr. Stephen Petteruti: Half of them would have prostate cancer cells.
• 6:20
  Dr. Stephen Petteruti: Here's another variable that you need to reflect upon, guys.
• 6:24
  Dr. Stephen Petteruti: In men over 90, they did cadaveric studies looking at people who died of other causes.
• 6:30
  Dr. Stephen Petteruti: The majority of them had prostate cancer cells buried in the gland.
• 6:35
  Dr. Stephen Petteruti: Now that tells us, Philip, that at some point, if we live long enough, we may, we probably will develop cancer cells within the gland.
• 6:45
  Dr. Stephen Petteruti: It doesn't mean you need to go digging them out.
• 6:47
  Dr. Stephen Petteruti: When you stick a needle into cancer, you disrupt it.
• 6:52
  Dr. Stephen Petteruti: There's a capsule around the prostate.
• 6:54
  Dr. Stephen Petteruti: It's like the rind on an orange.
• 6:56
  Dr. Stephen Petteruti: And it contains the tissue.
• 6:58
  Dr. Stephen Petteruti: It also contains cancer within the capsule.
• 7:02
  Dr. Stephen Petteruti: If it stays in the capsule, it'll never hurt you.
• 7:06
  Dr. Stephen Petteruti: So I have a philosophy of, you know, think twice.
• 7:10
  Dr. Stephen Petteruti: If a urologist tells you you need a biopsy, take a deep breath, get another opinion.
• 7:16
  Dr. Stephen Petteruti: The problem, of course, Philip, is they're all reading off the same sheet of music.
• 7:21
  Philip Pape: Yeah.
• 7:22
  Dr. Stephen Petteruti: So for men with an elevated PSA, it's a it's a horrible dilemma.
• 7:26
  Dr. Stephen Petteruti: They're told that this could be cancer, the biopsy is needed to make the diagnosis.
• 7:31
  Dr. Stephen Petteruti: Both of those are not fully true statements.
• 7:34
  Dr. Stephen Petteruti: You can look at things sequentially.
• 7:36
  Dr. Stephen Petteruti: So the best use of a PSA, whenever you get it, that's your base number.
• 7:41
  Dr. Stephen Petteruti: So if you had a PSA tomorrow, Philip, and it came in at six, the doctors are going to have kittens.
• 7:47
  Dr. Stephen Petteruti: You take a deep breath, say, okay, let's check it again in three months.
• 7:51
  Dr. Stephen Petteruti: Now the PSA will vary.
• 7:54
  Dr. Stephen Petteruti: If you went on a long bike ride, if you had sex, if you did a heavy workout, it's going to bump up.
• 8:00
  Philip Pape: Because it's a protein, right?
• 8:01
  Philip Pape: It's the antigen we're we're measuring from the gland.
• 8:03
  Philip Pape: Correct.
• 8:04
  Philip Pape: Like we didn't even define what it was exactly, but just that's why it could vary.
• 8:07
  Philip Pape: Yeah, okay.
• 8:08
  Dr. Stephen Petteruti: That's correct.
• 8:09
  Dr. Stephen Petteruti: The prostate-specific antigen is found almost exclusively in the prostate gland.
• 8:15
  Dr. Stephen Petteruti: And when you squeeze it, you ooze out more of it.
• 8:18
  Dr. Stephen Petteruti: So monitoring it over time can be valuable and helpful and can give men an opportunity to avoid unnecessary interventions.
• 8:28
  Philip Pape: Yeah.
• 8:28
  Philip Pape: So okay, I'm glad you established all that.
• 8:30
  Philip Pape: That's why I wanted to have you on here because a common theme with a lot of areas of our health and women's health too, because I we have a lot of women in our audience, we talk hormones as well, is that some study or intervention or individual in the healthcare industry, like you said, in the 80s, did something and uh made a logical conclusion that there was fallacies in that chain of logic, even though it looks like it's causal.
• 8:55
  Philip Pape: And then it led to, you know, going into uh texts, medical texts and going into studies.
• 9:01
  Philip Pape: And we've had studies that have completely changed health outcomes for the negative as a result.
• 9:06
  Philip Pape: Like the women's health initiative we talk about has made all women afraid of hormone therapy when they shouldn't be, right?
• 9:12
  Philip Pape: So with men, I'm we're I'm kind of hearing a similar theme.
• 9:15
  Philip Pape: And then when you go to the doctor, you're trusting this man, this person, man or woman to be the expert, right?
• 9:22
  Philip Pape: And of course, many of them act like they know it too, uh, but that's a separate issue in healthcare.
• 9:27
  Philip Pape: Um, the idea that you could actually be causing harm with a biopsy is probably a surprise to many because when you said you may not, you actually don't need a biopsy ever, like that's a very definitive statement versus let's say in women's health where you're like, well, you shouldn't, you don't necessarily need a mammogram or necessarily need this or that because it leads to more anxiety and issues for people that are low risk.
• 9:49
  Philip Pape: You're saying definitively, maybe we should never have a biopsy because of that harm of the intervention past the sheath that then disturbs the cancer cells.
• 10:00
  Philip Pape: Is that the idea here?
• 10:02
  Dr. Stephen Petteruti: That is my that is my approach.
• 10:03
  Dr. Stephen Petteruti: But look, put in the context, Philip, of philosophy.
• 10:07
  Dr. Stephen Petteruti: Every man has to decide their comfort level.
• 10:11
  Dr. Stephen Petteruti: You know, my philosophy, Philip, is we fight cancer like a man.
• 10:16
  Dr. Stephen Petteruti: We do not sacrifice our masculine vitality out of some false pursuit of comfort and longevity.
• 10:24
  Dr. Stephen Petteruti: Those two are a false choice.
• 10:27
  Dr. Stephen Petteruti: So when a man sees the urologist, it can be compelling.
• 10:30
  Dr. Stephen Petteruti: When they look him in the eye and say, you could have cancer, you need a biopsy.
• 10:34
  Dr. Stephen Petteruti: Totally disagree with the with the emphasis here, right?
• 10:38
  Dr. Stephen Petteruti: It's an option.
• 10:39
  Dr. Stephen Petteruti: It's not wrong to get one.
• 10:41
  Dr. Stephen Petteruti: You have to go into it with your eyes wide open.
• 10:44
  Dr. Stephen Petteruti: The biopsy, you should men, you should always reflect upon the consequence of any test before it's done.
• 10:50
  Dr. Stephen Petteruti: If the biopsy is done and if it shows cancer, what are you going to do next?
• 10:55
  Dr. Stephen Petteruti: You're going to let them take out your prostate gland?
• 10:58
  Dr. Stephen Petteruti: Again, that's not a wrong decision.
• 11:00
  Dr. Stephen Petteruti: It's one I would never do, and I don't recommend.
• 11:02
  Dr. Stephen Petteruti: Why?
• 11:03
  Dr. Stephen Petteruti: Because the studies have validated there are two studies in the literature, one called the Protect T, the other one called the Pivot Trial.
• 11:10
  Dr. Stephen Petteruti: And they looked at men with prostate cancer.
• 11:13
  Dr. Stephen Petteruti: And one group they had the gland removed, the other group did nothing.
• 11:16
  Dr. Stephen Petteruti: One study had a third group that had radiation.
• 11:19
  Dr. Stephen Petteruti: Followed them out for 20 years.
• 11:22
  Dr. Stephen Petteruti: And at the end of 20 years, they found that there was no difference in the death rate between the groups.
• 11:29
  Dr. Stephen Petteruti: And there was no difference in the death rate from prostate cancer.
• 11:33
  Dr. Stephen Petteruti: That's very sobering.
• 11:34
  Dr. Stephen Petteruti: Yeah.
• 11:35
  Dr. Stephen Petteruti: 40% of the men who get their prostate gland removed end up with a relapse.
• 11:40
  Dr. Stephen Petteruti: Now, this is where it starts the dominoes, the downward spiral.
• 11:44
  Dr. Stephen Petteruti: Man gets his prostate out.
• 11:46
  Dr. Stephen Petteruti: This is a common scenario.
• 11:47
  Dr. Stephen Petteruti: I felt great.
• 11:49
  Dr. Stephen Petteruti: I went in for my exam, my PSA was elevated, they did a biopsy, it showed cancer.
• 11:53
  Dr. Stephen Petteruti: I felt great.
• 11:55
  Dr. Stephen Petteruti: It took out my gland.
• 11:56
  Dr. Stephen Petteruti: Now I'm wearing pads every day.
• 11:58
  Dr. Stephen Petteruti: My erection's never been the same.
• 12:00
  Dr. Stephen Petteruti: I don't feel right.
• 12:02
  Dr. Stephen Petteruti: They robbed a vital part of me.
• 12:04
  Dr. Stephen Petteruti: Then the PSA starts to rise.
• 12:07
  Dr. Stephen Petteruti: And this is something I fully disagree with.
• 12:10
  Dr. Stephen Petteruti: They call it a biochemical recurrence.
• 12:12
  Dr. Stephen Petteruti: You feel great, you have no evidence of metastatic disease, but the PSA number is creeping up.
• 12:18
  Dr. Stephen Petteruti: What do they do next?
• 12:20
  Dr. Stephen Petteruti: They castrate you, they cut off your testosterone.
• 12:24
  Dr. Stephen Petteruti: Oh my goodness, what a horrible thing to do.
• 12:27
  Dr. Stephen Petteruti: Take away your life energy, the brain gets weak, depression happens, you develop gynecomastia, man boobs, your muscles wither.
• 12:37
  Dr. Stephen Petteruti: It's a horrible thing to do to a human being.
• 12:40
  Dr. Stephen Petteruti: And then the prostate cancer, when you go on testosterone blocking therapy because of a rising PSA, it's not curative.
• 12:49
  Dr. Stephen Petteruti: The cancer, 100% of the time, is going to progress.
• 12:53
  Dr. Stephen Petteruti: So you put all these facts together, Philip, and you're starting to wonder what are we doing?
• 12:58
  Dr. Stephen Petteruti: Yeah.
• 12:59
  Dr. Stephen Petteruti: You have to start with how you want to live, men.
• 13:02
  Dr. Stephen Petteruti: What's your philosophy?
• 13:03
  Dr. Stephen Petteruti: Because at some point we're going to die.
• 13:06
  Dr. Stephen Petteruti: And when we die, if it's a prostate cancer, a heart attack, or something else, I advocate for what I call a horizontal lifestyle, right?
• 13:14
  Dr. Stephen Petteruti: You do things to maintain vitality.
• 13:16
  Dr. Stephen Petteruti: Yes, you lift weights or strength train.
• 13:19
  Dr. Stephen Petteruti: Gotta do it.
• 13:20
  Dr. Stephen Petteruti: You should never wither.
• 13:22
  Dr. Stephen Petteruti: There's nothing biologically about us that requires us to wither before we die.
• 13:28
  Dr. Stephen Petteruti: So I want you, me, and all your listeners to die in great health after a short illness at a very advanced age.
• 13:38
  Dr. Stephen Petteruti: It's like, hey, where's Dr.
• 13:40
  Dr. Stephen Petteruti: Petrudy?
• 13:40
  Dr. Stephen Petteruti: No, you didn't hear, man, he died last night.
• 13:42
  Dr. Stephen Petteruti: Oh, crap.
• 13:43
  Dr. Stephen Petteruti: Just saw him yesterday.
• 13:44
  Dr. Stephen Petteruti: He just croaked.
• 13:45
  Philip Pape: Yeah, I always joke, I want to croak doing a deadlift when I'm, you know, 95 or whatever.
• 13:49
  Philip Pape: Uh, I I literally just recorded an episode called something like, you know, why now is the perfect time to start building muscle.
• 13:55
  Philip Pape: It targeted more at the narrative that you're too old, you know, too old to start.
• 13:59
  Philip Pape: But I totally agree.
• 14:00
  Philip Pape: And our listeners would agree with that.
• 14:02
  Philip Pape: And I want to get to the lifestyle piece, which again will be not really a debate on this show at all.
• 14:07
  Philip Pape: We're all going to agree with that piece of it.
• 14:08
  Philip Pape: What I'm trying to understand here, though, is this chain of events, because I'm learning a ton already.
• 14:14
  Philip Pape: The idea that taking out the gland doesn't remove the cancer right there sets, you know, puts a massive roadblock in the logic of, okay, then you've got the PSA results, which have to be based on your personal baseline.
• 14:28
  Philip Pape: If, let's say, your PSA goes high versus your baseline and there are cancer cells, then we have to think, okay, well, you said every man gets cancer cells anyway over time.
• 14:37
  Philip Pape: I mean, DNA mutates and gets damaged, and everything we do and consume and are exposed to over our lifetime probably causes lots of cancer cells across our body in all areas.
• 14:47
  Philip Pape: So you're gonna get that anyway.
• 14:49
  Philip Pape: So then when does it matter?
• 14:51
  Philip Pape: When do the PSA results matter?
• 14:53
  Philip Pape: And then when does the fact that you have cancer in your prostate matter?
• 14:55
  Philip Pape: And then what do you do about it, if anything?
• 14:57
  Philip Pape: That's I think the next question.
• 15:00
  Dr. Stephen Petteruti: Yeah, it's a it's an important question, Philip.
• 15:01
  Dr. Stephen Petteruti: And I like to designate these cells as atypical dormant cells.
• 15:05
  Philip Pape: Okay.
• 15:06
  Dr. Stephen Petteruti: They're kind of sleeping in the prostate, you let them be.
• 15:10
  Dr. Stephen Petteruti: And there are things that can be done.
• 15:12
  Dr. Stephen Petteruti: This is a chronic lifestyle management.
• 15:16
  Dr. Stephen Petteruti: And we talked before about is it okay to get a biopsy?
• 15:19
  Dr. Stephen Petteruti: Is it okay to remove the gland?
• 15:21
  Dr. Stephen Petteruti: Although I would never do it, and I don't advocate my patients to do it.
• 15:24
  Dr. Stephen Petteruti: It is okay if you're the type of person who can't live with the notion that these cells are in your body.
• 15:31
  Dr. Stephen Petteruti: And some men are like that, you know, they'll just drive nuts.
• 15:34
  Dr. Stephen Petteruti: The uncertainty factor is there no matter what path is is pursued.
• 15:38
  Dr. Stephen Petteruti: So the things that keep them, our job, like why do we not all have cancer?
• 15:43
  Dr. Stephen Petteruti: Our immune system, it's killing cancer cells every day.
• 15:48
  Dr. Stephen Petteruti: So if those cells are within that capsule, the job is to keep them there.
• 15:52
  Dr. Stephen Petteruti: Cancer is like an opportunistic disease, it's there lurking.
• 15:57
  Dr. Stephen Petteruti: It's kind of like shingles.
• 15:59
  Dr. Stephen Petteruti: That's a good analogy.
• 16:00
  Dr. Stephen Petteruti: When we were kids, we had chicken pox and then it went away.
• 16:03
  Dr. Stephen Petteruti: It's asleep.
• 16:04
  Dr. Stephen Petteruti: Why does it come out later?
• 16:06
  Dr. Stephen Petteruti: It never actually went away.
• 16:08
  Dr. Stephen Petteruti: We never actually killed all the virus, it's just kept in check by the immune system until the immune system weakens to the point where it becomes manifest.
• 16:20
  Dr. Stephen Petteruti: Same with cancer cells.
• 16:22
  Dr. Stephen Petteruti: If you've ever had cancer, you are never cancer free, you're tumor-free, the cells are lurking.
• 16:28
  Dr. Stephen Petteruti: I don't want to creep people out, but we all have them.
• 16:32
  Dr. Stephen Petteruti: So that's why you live every day in a balanced, healthy manner, maintaining immune function.
• 16:38
  Dr. Stephen Petteruti: What ruins the immune system?
• 16:40
  Dr. Stephen Petteruti: You don't sleep right.
• 16:41
  Dr. Stephen Petteruti: That's one.
• 16:42
  Dr. Stephen Petteruti: You're on certain drugs that can weaken it, steroids, for instance.
• 16:46
  Dr. Stephen Petteruti: Now, um, disease-modifying drugs are quite popular.
• 16:50
  Dr. Stephen Petteruti: The biologic agents for psoriatic arthritis and other conditions, they can be life-enhancing, but immune immunologically weakening.
• 16:58
  Dr. Stephen Petteruti: A bad diet, stress, these are all variables.
• 17:03
  Dr. Stephen Petteruti: Uh, an acute phase of your life, a spouse dies, you go through bankruptcy.
• 17:07
  Dr. Stephen Petteruti: These are opportunistic moments where you need to amp up your own vitality pathway.
• 17:13
  Dr. Stephen Petteruti: Exercise is really helpful, but you have to be tempered.
• 17:19
  Dr. Stephen Petteruti: I like your philosophy, Philip, of being, hey, you can achieve all you need to achieve without going crazy and spending three hours in the gym.
• 17:26
  Dr. Stephen Petteruti: There's a tipping point where too much, too intense, can weaken the immune system.
• 17:31
  Dr. Stephen Petteruti: So you have these cancer cells that are isolated within the gland.
• 17:35
  Dr. Stephen Petteruti: You don't need to biopsy them.
• 17:37
  Dr. Stephen Petteruti: You do your PSA level periodically.
• 17:39
  Dr. Stephen Petteruti: And my I've developed a protocol to help men avoid the biopsy and take another path.
• 17:47
  Dr. Stephen Petteruti: And in my protocol, we do a PSA every three months monitoring levels.
• 17:51
  Dr. Stephen Petteruti: We do an MRI typically once a year to look at the anatomy.
• 17:56
  Dr. Stephen Petteruti: We use repurposed drugs, and these are prescription agents that have been shown to have anti-cancer power and attributes, even though they're FD approved for other reasons.
• 18:07
  Dr. Stephen Petteruti: Many of your listeners may be familiar with ivermectin, uh, fenbendazole, mobendazole.
• 18:13
  Dr. Stephen Petteruti: They have merit, guys, but be careful.
• 18:16
  Dr. Stephen Petteruti: The online pathways are harmful.
• 18:20
  Dr. Stephen Petteruti: These drugs are not meant for daily consumption.
• 18:24
  Dr. Stephen Petteruti: So in my protocol, we use them sporadically to emphasize safety.
• 18:29
  Dr. Stephen Petteruti: You don't cure prostate cancer by dying of liver failure, right?
• 18:33
  Dr. Stephen Petteruti: That's not a good outcome.
• 18:34
  Dr. Stephen Petteruti: So the repurposed drugs are put in there.
• 18:36
  Dr. Stephen Petteruti: How about lifestyle?
• 18:38
  Dr. Stephen Petteruti: Most important variable regarding nutrition, percent body fat.
• 18:43
  Dr. Stephen Petteruti: Excess adiposity correlates with increased risk of cancer and cancer relapse.
• 18:48
  Dr. Stephen Petteruti: That is settled science, unequivocal.
• 18:52
  Dr. Stephen Petteruti: How you get there, whether you're a vegetarian, a carnivore, uh organic eater or not, how you get there is less important than that you get there.
• 19:03
  Dr. Stephen Petteruti: Now, there are clearly foods better than others.
• 19:05
  Dr. Stephen Petteruti: And when I say food, Philip, I mean food, not junk disguised as food, right?
• 19:10
  Dr. Stephen Petteruti: So thoughtful diet, stress reduction.
• 19:14
  Dr. Stephen Petteruti: If you're inclined, repurpose drugs guided by a physician, you don't want to fly on the on the internet.
• 19:21
  Dr. Stephen Petteruti: This needs to be monitored.
• 19:22
  Dr. Stephen Petteruti: Certain supplements can have merit.
• 19:25
  Dr. Stephen Petteruti: I like alpha lopoic acid.
• 19:27
  Dr. Stephen Petteruti: I like zinc, about 30 milligrams a day.
• 19:30
  Dr. Stephen Petteruti: It concentrates in the prostate gland more uh zinc per gram of tissue than any other organ.
• 19:36
  Dr. Stephen Petteruti: It also supports immune function.
• 19:37
  Philip Pape: Is that zinc with copper or just zinc?
• 19:40
  Dr. Stephen Petteruti: No, I don't like copper.
• 19:40
  Dr. Stephen Petteruti: Okay.
• 19:41
  Dr. Stephen Petteruti: All right, all right.
• 19:42
  Dr. Stephen Petteruti: Because you mentioned it.
• 19:45
  Dr. Stephen Petteruti: Copper is an essential um mineral, it's an essential metal.
• 19:49
  Dr. Stephen Petteruti: But there are two kinds of copper.
• 19:51
  Dr. Stephen Petteruti: There's cupric and cuprus.
• 19:53
  Dr. Stephen Petteruti: Cupras is what we find in food.
• 19:56
  Dr. Stephen Petteruti: That's great for you.
• 19:57
  Dr. Stephen Petteruti: Cashews, almonds, dark chocolate, etamame, you can find it in your food.
• 20:03
  Dr. Stephen Petteruti: The problem with supplements, Philip, is they often use cupric or C2, which is a neurotoxin.
• 20:09
  Dr. Stephen Petteruti: In fact, in Japan, they don't allow you to have copper pipes in your house because of the risk to the brain.
• 20:16
  Dr. Stephen Petteruti: So I see this frequently.
• 20:18
  Dr. Stephen Petteruti: I don't like any supplement with copper in it.
• 20:20
  Dr. Stephen Petteruti: I keep cashews.
• 20:21
  Dr. Stephen Petteruti: It's not good to know every day, just because the copper is so good for well, immune and skin and all that other cool stuff.
• 20:29
  Dr. Stephen Petteruti: But um, yeah, zinc I like, alpha poric acid, and then N acetylcysteine or NAC, which is a precursor to glutathione.
• 20:38
  Dr. Stephen Petteruti: As we age, you know, we make fewer uh antioxidants, free radicals tend to become more dominant, and that inflammatory tilt can increase risk uh, you know, kind of across the board.
• 20:50
  Dr. Stephen Petteruti: So if you're a man listening to this and you've had a biopsy, don't panic.
• 20:55
  Dr. Stephen Petteruti: You can't undo the past.
• 20:56
  Dr. Stephen Petteruti: However, going forward, contemplate an alternative.
• 21:00
  Dr. Stephen Petteruti: There's something out there called active surveillance, it's a term that is used when they feel your type of cancer is early and therefore they don't want to subject you to the trauma of prostatectomy.
• 21:15
  Dr. Stephen Petteruti: And what they'll offer is sequential biopsies staggered, right?
• 21:20
  Dr. Stephen Petteruti: This is patently illogical, in my view.
• 21:24
  Dr. Stephen Petteruti: You know you have cancer, and now you're gonna stick, not and it's not just a little needle, it's a trocar, and it's multiple jabs.
• 21:32
  Dr. Stephen Petteruti: It hurts.
• 21:33
  Dr. Stephen Petteruti: I've listened to men who have had complications from the biopsy, hospitalizations due to sepsis, or loss of erectile function or compromise thereof can occur.
• 21:43
  Dr. Stephen Petteruti: You stick in these big trochars.
• 21:45
  Dr. Stephen Petteruti: But most importantly, it's a false notion to think that you can take a snapshot of the prostate in one moment in time and predict the future.
• 21:56
  Dr. Stephen Petteruti: And I've heard that said they'll tell they'll tell you, well, we need to do a biopsy so we can tell how aggressive your cancer is, or how aggressive it may be.
• 22:05
  Dr. Stephen Petteruti: That's not true.
• 22:06
  Dr. Stephen Petteruti: You tell aggression by a point of change.
• 22:09
  Dr. Stephen Petteruti: Your PSA was six, and now it's 25.
• 22:13
  Dr. Stephen Petteruti: That's a manifestation of aggression.
• 22:15
  Dr. Stephen Petteruti: What should you do then?
• 22:16
  Dr. Stephen Petteruti: Right?
• 22:17
  Dr. Stephen Petteruti: I just told you, don't take the gland out.
• 22:20
  Dr. Stephen Petteruti: Worse than that is irradiating the pelvis.
• 22:23
  Dr. Stephen Petteruti: That's a terrible thing to do that causes immediate adverse effect and delayed consequence.
• 22:29
  Dr. Stephen Petteruti: Five years later, you ever get a sunburn, you feel rotten, right?
• 22:32
  Dr. Stephen Petteruti: It hurts.
• 22:32
  Dr. Stephen Petteruti: And then 10 years later, you have basal cell cancer from that sunburn.
• 22:37
  Dr. Stephen Petteruti: Radiation has a delayed negative consequence that ends up with radiation proctitis.
• 22:44
  Dr. Stephen Petteruti: You can't control your stool.
• 22:45
  Dr. Stephen Petteruti: I've seen men 10 years later literally leaking poop all day long.
• 22:49
  Dr. Stephen Petteruti: It's horrible.
• 22:50
  Dr. Stephen Petteruti: For what?
• 22:51
  Dr. Stephen Petteruti: You know, so this leaves a this is it's a problem, it's an unsolved problem.
• 22:57
  Dr. Stephen Petteruti: My um departure from conventional recommendations is not that the pathway I've uh espoused is proven beneficial.
• 23:07
  Dr. Stephen Petteruti: We are still actively studying it.
• 23:10
  Dr. Stephen Petteruti: It has evidence of benefit, it doesn't have proof, but it has proof of not harming people.
• 23:16
  Dr. Stephen Petteruti: Conversely, conventional therapies, prostatectomy, radiation, absolute 100% unequivocal harm.
• 23:23
  Dr. Stephen Petteruti: Benefit?
• 23:24
  Dr. Stephen Petteruti: So I've heard my patients will say, Well, the urologist told me that there's no proof that sticking a trocar in my prostate can spread cancer.
• 23:34
  Dr. Stephen Petteruti: Technically, it's an accurate statement.
• 23:37
  Dr. Stephen Petteruti: However, they never looked.
• 23:39
  Dr. Stephen Petteruti: There's never been a study to see if that's the case.
• 23:42
  Dr. Stephen Petteruti: But there are, because I did this research recently, Philip, over 95 articles in the medical literature looking at what's called needle tract metastases.
• 23:53
  Dr. Stephen Petteruti: This is a known risk that we have to balance against the potential benefit.
• 23:58
  Dr. Stephen Petteruti: So it's a hard space to live in.
• 24:01
  Dr. Stephen Petteruti: It's worthy of being slow.
• 24:04
  Dr. Stephen Petteruti: It's never, almost never an emergency.
• 24:07
  Dr. Stephen Petteruti: Prostate cancer, even if you have it, guys, it's a slow-moving train.
• 24:12
  Dr. Stephen Petteruti: So you have time to really think through it.
• 24:15
  Dr. Stephen Petteruti: And depending on your age and depending on your global health, it will help you direct your action.
• 24:21
  Dr. Stephen Petteruti: If you're 75 and you've had three heart attacks, you know, prostate cancer is not going to take you out.
• 24:28
  Dr. Stephen Petteruti: Ironically, getting a prostatectomy and having aggressive treatment is correlated with increased risk of heart disease, dementia, um, other side effects.
• 24:39
  Dr. Stephen Petteruti: I do want to mention the testosterone link too, Phillips.
• 24:42
  Dr. Stephen Petteruti: So let me know.
• 24:43
  Philip Pape: We'll get to it.
• 24:44
  Philip Pape: So I'm listening because I'm learning so much here.
• 24:46
  Philip Pape: And the protocol you mentioned obviously doesn't sound uh super unconventional when it comes to general advice for any age-related disease or being healthy and living a long life.
• 25:01
  Philip Pape: In other words, lifestyle and strength training and eating well, supplementation.
• 25:05
  Philip Pape: Obviously, the repurposed drugs are kind of a unique thing that we could get into.
• 25:10
  Philip Pape: But you mentioned just cancer in general.
• 25:13
  Philip Pape: I I percent body fat, I believe, is linked to at least 13 cancers, something like that.
• 25:17
  Philip Pape: I forget the magic number, definitively through studies so far.
• 25:22
  Philip Pape: And, you know, some people don't like to say that out loud that you have this massive choice in the matter through your lifestyle to potentially stave off cancer, but it's true, right?
• 25:34
  Philip Pape: So the PSA and MRI, what I'm trying to understand here is where's the preventive piece of this?
• 25:41
  Philip Pape: And where's the, oh, now we think there's some cancer that could develop into something concerning.
• 25:47
  Philip Pape: Is this something you start once you get a diagnosis?
• 25:50
  Philip Pape: Or is this, I mean, lifestyle you're going to do anyway, guys.
• 25:52
  Philip Pape: I mean, anybody listening should be doing those things.
• 25:54
  Philip Pape: But like the protocol you talked about, when when does that begin?
• 25:58
  Dr. Stephen Petteruti: That that's a great perspective, Philip.
• 26:00
  Dr. Stephen Petteruti: The protocol really starts with you, with this, what you advocate for people, right?
• 26:06
  Dr. Stephen Petteruti: You live a low tox lifestyle.
• 26:09
  Dr. Stephen Petteruti: You don't wait to get sick.
• 26:11
  Dr. Stephen Petteruti: We're all aging.
• 26:12
  Dr. Stephen Petteruti: My wife said to me once, hey, if if you knew you were dying, would you regret anything?
• 26:16
  Dr. Stephen Petteruti: And she mentioned it because I'm a I do a lot of advanced anti-aging in my practice.
• 26:21
  Dr. Stephen Petteruti: I'm on testosterone, I do some peptides, I you know, I take Cirrellimus, an anti-aging drug.
• 26:28
  Dr. Stephen Petteruti: I thought I said, Yeah, no, no, I'm not going to be the guy that clutches his chest, go into the ground, says, Oh, I should have walked and exercised, or you know, the end comes.
• 26:38
  Dr. Stephen Petteruti: What I want for everybody listening is to have peace of mind.
• 26:42
  Dr. Stephen Petteruti: When you do all the things you're talking about, Philip, you control percent body fat, a powerful risk factor for cancer, for heart disease, and guess what, gang?
• 26:52
  Dr. Stephen Petteruti: Dementia.
• 26:53
  Dr. Stephen Petteruti: You know, yeah.
• 26:54
  Dr. Stephen Petteruti: I want all the things that are it correlates it.
• 26:57
  Dr. Stephen Petteruti: There was a study showing the accelerated brain atrophy in the context of excess adiposity.
• 27:03
  Dr. Stephen Petteruti: So you start there and you start with taking charge of your nutritional health and really got to peel away from uh the average American sort of pattern.
• 27:15
  Dr. Stephen Petteruti: If you're eating like every other American, that's problematic.
• 27:18
  Dr. Stephen Petteruti: If you if other people look at you and say, you're kind of, you know, your nutrition is kind of weird, you're probably closer to a good place.
• 27:26
  Philip Pape: Yes, I like that perspective for sure.
• 27:28
  Philip Pape: If you're weird with most things in life, you're probably doing the right thing.
• 27:31
  Dr. Stephen Petteruti: Probably in a good place.
• 27:32
  Dr. Stephen Petteruti: You know, we call that eating abnormal, yeah, but healthy.
• 27:36
  Dr. Stephen Petteruti: So yeah, percent body fat's critical.
• 27:38
  Dr. Stephen Petteruti: Now, if you're in that position where you've got that high PSA, you have the MRI.
• 27:43
  Dr. Stephen Petteruti: Now, the MRI is gauged on something called a pyrad scale, one to five.
• 27:48
  Dr. Stephen Petteruti: And it's a subjective look at the anatomy, and the radiologist will say, Yeah, this one looks like cancer, this one might be cancer.
• 27:55
  Dr. Stephen Petteruti: It goes one to five.
• 27:56
  Dr. Stephen Petteruti: Five means, yeah, you probably got cancer.
• 27:59
  Dr. Stephen Petteruti: You got a PSA of let's say it's 12.
• 28:02
  Dr. Stephen Petteruti: You get an MRI.
• 28:03
  Dr. Stephen Petteruti: It's a pyridge of five, but it's confined to the capsule.
• 28:08
  Dr. Stephen Petteruti: No evidence of disease outside of the capsule, the lymph nodes, seminal vesicle.
• 28:14
  Dr. Stephen Petteruti: You feel good.
• 28:15
  Dr. Stephen Petteruti: That is not a panic moment, folks.
• 28:19
  Dr. Stephen Petteruti: It's an opportune moment.
• 28:21
  Dr. Stephen Petteruti: The idea behind the repurposed drugs and the amplified lifestyle.
• 28:25
  Dr. Stephen Petteruti: Now, this grabs people's attention, Philip.
• 28:28
  Dr. Stephen Petteruti: You know, now they're really motivated.
• 28:29
  Dr. Stephen Petteruti: They're going to lose weight, they're going to start eating differently.
• 28:32
  Dr. Stephen Petteruti: They're really researching this.
• 28:34
  Dr. Stephen Petteruti: One of the problems that men and women run into, and you probably noticed this yourself, Philip.
• 28:39
  Dr. Stephen Petteruti: You go to the internet, it's a blizzard of information.
• 28:43
  Dr. Stephen Petteruti: And then they go to their doctor and ask the doctor, what supplements it look, I'm a board certified family doctor, as you mentioned.
• 28:50
  Dr. Stephen Petteruti: I was trained uh osteopathic medical school.
• 28:53
  Dr. Stephen Petteruti: I was in the army, did my residency, and I've been in practice for 30 years.
• 28:57
  Dr. Stephen Petteruti: 20 years ago, if somebody asked me about supplements, my eyes would have glazed over.
• 29:02
  Dr. Stephen Petteruti: Like, what?
• 29:03
  Dr. Stephen Petteruti: I know nothing.
• 29:04
  Dr. Stephen Petteruti: And doctors usually are limited in their knowledge in the space.
• 29:10
  Dr. Stephen Petteruti: So that leaves you know patients kind of on their own in many cases.
• 29:14
  Dr. Stephen Petteruti: But there is a growing cohort of physicians, of advisors that can help guide, not something they want to do on their own, right?
• 29:22
  Dr. Stephen Petteruti: So the repurposed drugs in my protocol, I really like this approach.
• 29:26
  Dr. Stephen Petteruti: It's proactive, it has evidence of potential benefit, and it has this safety feature of not causing harm.
• 29:35
  Dr. Stephen Petteruti: So we're applying about six different pharmacologic agents in modest dosing.
• 29:42
  Dr. Stephen Petteruti: Technical term for this is called hormetic, which means drugs have different effects at different doses.
• 29:48
  Dr. Stephen Petteruti: So that which may seem kind of weird to apply can actually be helpful.
• 29:52
  Dr. Stephen Petteruti: We're trying to create an environment in the body that is inhospitable toward cancer cells.
• 29:58
  Dr. Stephen Petteruti: You got that pyrides of.
• 29:59
  Dr. Stephen Petteruti: Five.
• 30:00
  Dr. Stephen Petteruti: It's isolated to the capsule.
• 30:02
  Dr. Stephen Petteruti: Now we're going to watch that PSA.
• 30:04
  Dr. Stephen Petteruti: It is go 12, 13, 14, 13 again.
• 30:09
  Dr. Stephen Petteruti: That's a plateau you can live with.
• 30:11
  Dr. Stephen Petteruti: If it goes 12, 45, that grabs our attention.
• 30:15
  Dr. Stephen Petteruti: Now we maybe look at that MRI again and maybe modify the treatment, but you never jump the gun.
• 30:24
  Dr. Stephen Petteruti: There's no need to put needles in.
• 30:26
  Dr. Stephen Petteruti: I tell a man that has that scenario I just described to you, Philip, I'll say, look, you got prostate cancer.
• 30:31
  Dr. Stephen Petteruti: The lining up of the PSA in the MRI, in your age, and in some cases your symptoms, are so compelling that even if you had a biopsy and it came back negative, nobody would believe it.
• 30:44
  Philip Pape: There's no point, is what you're saying, yeah, to the biopsy.
• 30:46
  Dr. Stephen Petteruti: Yep.
• 30:47
  Dr. Stephen Petteruti: So don't subject yourself to a study that is academic, historical, and petrified in the standard of care.
• 30:57
  Dr. Stephen Petteruti: Look, docs are good people, but they're human beings.
• 31:00
  Dr. Stephen Petteruti: What do I mean?
• 31:01
  Dr. Stephen Petteruti: They're worried about liability, they have time pressure.
• 31:05
  Dr. Stephen Petteruti: You see a urologist, I've heard this often, you know, go see a urologist, my PSA is elevated.
• 31:10
  Dr. Stephen Petteruti: It says, okay, when do you want to do your biopsy?
• 31:12
  Dr. Stephen Petteruti: Surgeons, folks, they get paid to do things.
• 31:16
  Dr. Stephen Petteruti: They don't get paid to talk.
• 31:17
  Dr. Stephen Petteruti: And if you want to sit and chat about your PSA with your urologist for 30 minutes, it's unlikely to happen.
• 31:24
  Dr. Stephen Petteruti: So you really owe it to yourself to step away, get out of the uh sort of the vortex of intensity, give yourself time to decompress and think a little bit.
• 31:33
  Dr. Stephen Petteruti: There are exciting new things happening in the field of intervening for prostate cancer, one of which is actually giving men with prostate cancer testosterone.
• 31:46
  Philip Pape: Okay.
• 31:46
  Philip Pape: Yeah.
• 31:47
  Philip Pape: I I want to talk about that next.
• 31:48
  Philip Pape: One quick thing is alcohol.
• 31:50
  Philip Pape: I just want to touch on alcohol real quick.
• 31:52
  Philip Pape: Um, because there was this, you know, the alcohol um cancer study that was supposed to come out, came out in 2022.
• 32:00
  Philip Pape: The Surgeon General wanted labels on alcohol.
• 32:03
  Philip Pape: And then I believe uh the dietary guidelines were going to be updated to suggest one drink a day instead of two drinks a day can start to cause issues.
• 32:11
  Philip Pape: And I know certain cancers like colorectal and breast cancer have a link to very low consumption of alcohol.
• 32:18
  Philip Pape: Where does prostate cancer fit in on that spectrum?
• 32:22
  Dr. Stephen Petteruti: I laugh because it reminds me of Frank Sinatra's famous quote.
• 32:24
  Dr. Stephen Petteruti: He said, you know, those of us who drink feel bad for those of you who don't, because when you wake up in the morning, that's as good as you're going to feel all day long.
• 32:31
  Dr. Stephen Petteruti: But to answer your question, these are all um observational studies.
• 32:37
  Dr. Stephen Petteruti: The real answer is nobody knows.
• 32:40
  Dr. Stephen Petteruti: My dad was a physician.
• 32:41
  Dr. Stephen Petteruti: He used to joke the definition of too much alcohol is anybody who drinks more than their doctor.
• 32:46
  Dr. Stephen Petteruti: But in all seriousness, alcohol is a toxin.
• 32:51
  Dr. Stephen Petteruti: Lots of things are toxins, but they're pleasurable toxins.
• 32:56
  Dr. Stephen Petteruti: We call that a hedonistic path.
• 32:58
  Dr. Stephen Petteruti: We human beings, we do two things without fail.
• 33:03
  Dr. Stephen Petteruti: We avoid pain and we seek pleasure.
• 33:06
  Dr. Stephen Petteruti: Avoid pain means don't die, seek pleasure means reproduce.
• 33:10
  Dr. Stephen Petteruti: So modifying limiting alcohol is logical, it's good health, it's good psychosocially.
• 33:18
  Dr. Stephen Petteruti: You go beyond two drinks, bad things are gonna happen.
• 33:22
  Dr. Stephen Petteruti: Not in the future, but that night and the next morning.
• 33:25
  Dr. Stephen Petteruti: So that's self-evident.
• 33:27
  Dr. Stephen Petteruti: But the idea that alcohol itself is a pure toxin to be avoided at all cost is an exaggeration.
• 33:34
  Dr. Stephen Petteruti: Some folks like to end their day with a glass of wine.
• 33:39
  Dr. Stephen Petteruti: There's no evidence of compelling harm.
• 33:42
  Dr. Stephen Petteruti: If you're deprived, so we talked a moment ago about stress.
• 33:45
  Dr. Stephen Petteruti: Stress can occur from a deprivation of pleasurable endeavors.
• 33:51
  Dr. Stephen Petteruti: And I've seen like I'll people ask me about nutrition.
• 33:54
  Dr. Stephen Petteruti: And sometimes when a man gets this diagnosis, his wife or partner becomes very engaged, says, You have to drink this concoction.
• 34:03
  Dr. Stephen Petteruti: And the guy's choking it down.
• 34:04
  Dr. Stephen Petteruti: Oh, this is awful.
• 34:06
  Dr. Stephen Petteruti: It's not good for you then.
• 34:07
  Dr. Stephen Petteruti: It's a stress moment.
• 34:09
  Dr. Stephen Petteruti: So where I come down on alcohol is um when you go above one drink per day, you're entering a gray zone.
• 34:17
  Dr. Stephen Petteruti: When you go above two drinks per day, you are in a harm zone fairly unequivoc inequivocally, unequivocally, without doubt.
• 34:25
  Philip Pape: Yeah.
• 34:26
  Dr. Stephen Petteruti: So that helps frame it out.
• 34:29
  Dr. Stephen Petteruti: Um, but when my patients come to me and say, should I go alcohol free?
• 34:33
  Dr. Stephen Petteruti: You can if you want, but you don't have to.
• 34:36
  Dr. Stephen Petteruti: You know, you have to live life.
• 34:38
  Philip Pape: It's a matter of degrees, yes.
• 34:40
  Philip Pape: Yeah.
• 34:40
  Philip Pape: Okay.
• 34:41
  Philip Pape: Yeah, I just wanted to touch on that.
• 34:42
  Philip Pape: All right, let's get into testosterone.
• 34:43
  Philip Pape: So you said uh TRT could be a game changer here, could be the, you know, one of the things we're not talking about, and we're going to right now uh in context of prostate health.
• 34:52
  Philip Pape: So lay it on us.
• 34:54
  Dr. Stephen Petteruti: Yeah.
• 34:54
  Dr. Stephen Petteruti: Well, let's talk about the settled science first, right?
• 34:57
  Dr. Stephen Petteruti: Testosterone does not increase your prostate cancer risk.
• 35:01
  Dr. Stephen Petteruti: That likely has been emphasized in the past, and that is pretty solid.
• 35:05
  Dr. Stephen Petteruti: And testosterone is not gas on the fire either.
• 35:10
  Dr. Stephen Petteruti: So historically, we've been taught, and this goes back to Dr.
• 35:13
  Dr. Stephen Petteruti: Huggins in the 1940s.
• 35:15
  Dr. Stephen Petteruti: He won a Nobel Prize when his experiments correlated testosterone deprivation with regression of prostate cancer.
• 35:24
  Dr. Stephen Petteruti: Since the 1940s, that has been sort of the dogma.
• 35:29
  Dr. Stephen Petteruti: You know, testosterone equals prostate cancer.
• 35:32
  Dr. Stephen Petteruti: It does not increase risk.
• 35:34
  Dr. Stephen Petteruti: In fact, men with low testosterone levels have a higher risk of developing prostate cancer than those with higher.
• 35:40
  Dr. Stephen Petteruti: That doesn't mean that going on replacement therapy and elevating your level will make you less likely to get it.
• 35:47
  Dr. Stephen Petteruti: That's an unknown.
• 35:48
  Dr. Stephen Petteruti: But it is pretty solid evidence that it won't harm you.
• 35:51
  Dr. Stephen Petteruti: So those of you that are on testosterone, you ought not to fear it with regard to your prostate health.
• 35:58
  Dr. Stephen Petteruti: And you ought not to fear it with regard to prostatic hypertrophy.
• 36:01
  Dr. Stephen Petteruti: That also doesn't correlate.
• 36:03
  Dr. Stephen Petteruti: It also does not correlate, and this is pretty settled science, Philip.
• 36:06
  Dr. Stephen Petteruti: It does not increase cardiovascular risk.
• 36:09
  Dr. Stephen Petteruti: So those studies were very comforting to those of us who have been on testosterone for about 20 years, uh, those of us that are using it to benefit, so you can maintain that.
• 36:18
  Dr. Stephen Petteruti: The research and the science about testosterone in the face of prostate cancer is rapidly evolving.
• 36:26
  Dr. Stephen Petteruti: And this idea that you can never be on testosterone is being challenged.
• 36:31
  Dr. Stephen Petteruti: Dr.
• 36:32
  Dr. Stephen Petteruti: Abraham Morgenthaler, in his book, Testosterone for Life, he is uh a urologist, a real uh thought leader in this field.
• 36:39
  Dr. Stephen Petteruti: And he has uh something called a prostate saturation theory.
• 36:45
  Dr. Stephen Petteruti: In essence, your prostate can only hold so much testosterone, and any extra testosterone will give value to the organs, the tissue, the brain, right?
• 36:56
  Dr. Stephen Petteruti: We all know testosterone is a neurotransmitter, but it doesn't adversely affect the gland, which is now sort of maxed out.
• 37:04
  Dr. Stephen Petteruti: It's like a full cup of water, you keep pouring water in it, you're not gonna get any more in there.
• 37:08
  Dr. Stephen Petteruti: There are studies that show that when you go from a high level of testosterone to a low level, that it disrupts the DNA of prostate cancer cells.
• 37:19
  Dr. Stephen Petteruti: And that's called the bipolar theory of testosterone's effect on prostate cancer.
• 37:25
  Dr. Stephen Petteruti: Now, I want to be clear, this is not standard of care, and there are circumstances where it should never be considered.
• 37:32
  Dr. Stephen Petteruti: If you have prostate cancer metastatic to the bone, that has to be controlled before anybody contemplates this.
• 37:39
  Dr. Stephen Petteruti: It is a consideration with eyes wide open when you make judgments about philosophy, quality of life, and your willingness to consider risk, simply put.
• 37:52
  Dr. Stephen Petteruti: So I'll give you an example from my practice.
• 37:55
  Dr. Stephen Petteruti: Gentleman had prostate cancer, you know, before I met him.
• 37:59
  Dr. Stephen Petteruti: He actually flew to Europe, had a high food procedure, high intensity focal ultrasound.
• 38:04
  Dr. Stephen Petteruti: Doesn't work.
• 38:05
  Dr. Stephen Petteruti: I don't like it.
• 38:06
  Dr. Stephen Petteruti: He came back and uh had still a prostate cancer.
• 38:10
  Dr. Stephen Petteruti: At the time it was diagnosed, he was on testosterone and he suspended its use.
• 38:14
  Dr. Stephen Petteruti: And he felt awful.
• 38:17
  Dr. Stephen Petteruti: His sex drive went away.
• 38:19
  Dr. Stephen Petteruti: His brain wasn't working well.
• 38:20
  Dr. Stephen Petteruti: He's an executive and he had trouble functioning in his job.
• 38:24
  Dr. Stephen Petteruti: His PSA is 45.
• 38:26
  Dr. Stephen Petteruti: He has prostate cancer.
• 38:28
  Dr. Stephen Petteruti: And he said, Doc, you gotta put me back on testosterone.
• 38:32
  Dr. Stephen Petteruti: This is no way for me to live.
• 38:34
  Dr. Stephen Petteruti: So I said, Okay, you know, this is science says that this is not irrational.
• 38:41
  Dr. Stephen Petteruti: The science says that this is reasonable to consider, but it is also an unknown quantity.
• 38:47
  Dr. Stephen Petteruti: It's possible that the testosterone could accelerate the cancer.
• 38:51
  Dr. Stephen Petteruti: And it's likely at his stage, or the stage at which this cancer is for many people, it's likely the cancer will progress regardless of what you do.
• 39:00
  Dr. Stephen Petteruti: This comes to that, right?
• 39:02
  Dr. Stephen Petteruti: The philosophy of regret.
• 39:03
  Dr. Stephen Petteruti: My patient goes on testosterone, he feels great, but five years later the cancer is metastatic to the bone.
• 39:09
  Dr. Stephen Petteruti: That could happen.
• 39:10
  Dr. Stephen Petteruti: He has to be comfortable with that decision looking back, knowing that he's he's at peace because he had this great window of time with it.
• 39:18
  Dr. Stephen Petteruti: On the other hand, he doesn't do testosterone, he continues to feel lousy, and in five years he gets metastatic disease to the bone.
• 39:26
  Dr. Stephen Petteruti: He's saying, What did I just I could have, I should have.
• 39:30
  Dr. Stephen Petteruti: So the individual has to reflect upon it philosophically, and then what I will do in some cases is a modified approach to this.
• 39:41
  Dr. Stephen Petteruti: You go three months high, and here's the irony.
• 39:45
  Dr. Stephen Petteruti: If I do this for men, you can't dabble, you can't go low dose testosterone, you have to go high dose because the delta, the high to low shift is where we think the benefit may be.
• 39:57
  Dr. Stephen Petteruti: So you go a period with high dose, and then boom, you pull it out.
• 40:02
  Dr. Stephen Petteruti: High, low.
• 40:03
  Dr. Stephen Petteruti: We're trying really to balance risk and benefit.
• 40:07
  Dr. Stephen Petteruti: You know, is this gonna harm you to put you on testosterone?
• 40:10
  Dr. Stephen Petteruti: We know the benefit is there, but what about the harm?
• 40:13
  Dr. Stephen Petteruti: It's preliminary, and I'm still tracking these cases, Philip, but thus far I've got a cluster of men doing this type of an approach.
• 40:21
  Dr. Stephen Petteruti: And what I'm bearing witness to is stability.
• 40:24
  Dr. Stephen Petteruti: I'm not seeing PSAs go through the roof.
• 40:27
  Dr. Stephen Petteruti: I'm not seeing um, you know, the cancer go on haywire.
• 40:31
  Dr. Stephen Petteruti: Um, there's an alpha patient, one of my pioneers, he had a PSA of about 10.
• 40:39
  Dr. Stephen Petteruti: He had a pyridge of four, meaning, hey, it's likely cancer.
• 40:43
  Dr. Stephen Petteruti: He was on testosterone.
• 40:44
  Dr. Stephen Petteruti: He said, Look, I don't want a biopsy, but I do not want to come off my testosterone.
• 40:48
  Dr. Stephen Petteruti: I said, Okay, we're gonna do this bipolar, we're gonna monitor things closely.
• 40:52
  Dr. Stephen Petteruti: 2018, PSA of 10, pyrides of four.
• 40:57
  Dr. Stephen Petteruti: 2025, a PSA of 10, a pyrides of four while on testosterone.
• 41:04
  Dr. Stephen Petteruti: Now, granted, it's a singular case, but this is how new evidence builds, and this is how we acquire insight into other ways we may be able to approach this problem.
• 41:15
  Dr. Stephen Petteruti: So out of the mainstream of treatment is an option for some men that are so inclined.
• 41:22
  Dr. Stephen Petteruti: It really comes down to your philosophy.
• 41:26
  Dr. Stephen Petteruti: And I want to emphasize, guys, it's not wrong to do the conventional pathway.
• 41:31
  Dr. Stephen Petteruti: The problem I have with the conventional pathway, Philip, is the monopolistic sort of one-note piano approach that I see.
• 41:39
  Philip Pape: Like this is the only way.
• 41:40
  Philip Pape: Yeah.
• 41:40
  Philip Pape: Are there any controlled trials doing what you're talking about, or or at least planning to observationally look at men who've gone through this?
• 41:48
  Dr. Stephen Petteruti: Well, there are actually there are.
• 41:49
  Dr. Stephen Petteruti: So they're not actually in the cohort that I'm discussing.
• 41:53
  Dr. Stephen Petteruti: The bipolar uh research is um Johns Hopkins did this.
• 41:58
  Dr. Stephen Petteruti: They uh applied this to men who had prostate cancer, had the gland removed, had the PSA go down, and then come back up again, at which point they put them on androgen deprivation therapy, castration.
• 42:14
  Philip Pape: AD2, okay.
• 42:15
  Dr. Stephen Petteruti: When a man starts castration therapy, androgen deprivation, 100% as I mentioned, it will advance.
• 42:22
  Dr. Stephen Petteruti: When it advances, that's called castration resistant prostate cancer.
• 42:27
  Dr. Stephen Petteruti: Basically, that's the end of the road.
• 42:29
  Dr. Stephen Petteruti: There's no treatment left that has been shown to have merit.
• 42:33
  Dr. Stephen Petteruti: So they took these men with a theory of bipolar testosterone and they, hey, let's try this.
• 42:38
  Dr. Stephen Petteruti: They put them on high dose testosterone and they would go high to low.
• 42:41
  Dr. Stephen Petteruti: It was an interesting combination of testosterone.
• 42:45
  Dr. Stephen Petteruti: They'd go 400 milligram injection at the beginning of the month while they had them on androgen deprivation, so that they would go from this high level bang down low.
• 42:55
  Dr. Stephen Petteruti: And a significant number of them responded favorably.
• 42:58
  Dr. Stephen Petteruti: The PSAs went down.
• 43:00
  Dr. Stephen Petteruti: In some cases, the sensitivity toward androgen deprivation treatment was renewed.
• 43:06
  Dr. Stephen Petteruti: So it's compelling, some evidence of the theory playing itself out, but there is nothing that I'm aware of that's in the pipeline that looks at men that are not castration resistant, which may be a better place to apply it earlier in the course.
• 43:24
  Dr. Stephen Petteruti: So it's incumbent upon me and doctors like me to counsel patients honestly and to track the results.
• 43:32
  Dr. Stephen Petteruti: And that's what we're doing at Intellectual Medicine.
• 43:35
  Dr. Stephen Petteruti: It's an observational cohort.
• 43:37
  Dr. Stephen Petteruti: And all the men that enroll in this protocol, we track them and we're looking at PSAs, we're looking at the MRI, we're looking at the metastatic rate.
• 43:46
  Dr. Stephen Petteruti: It'll be some time yet, but we'll have that data and hopefully that'll be widely publicized and give people an opportunity to see does this have uh value?
• 43:56
  Dr. Stephen Petteruti: If the if the results look good, that type of result may then instigate a study.
• 44:01
  Dr. Stephen Petteruti: The type of study you're talking about would take you know tens of millions and need some evidence to help launch it.
• 44:09
  Philip Pape: Well, I appreciate the nuance.
• 44:10
  Philip Pape: Seriously, I the language you're using today is is something I very much appreciate with caution on on drawing conclusions, which is what we need to do, right?
• 44:19
  Philip Pape: It's a about falsification of what is claimed to be true, not proving something necessarily beyond a shadow of a doubt.
• 44:26
  Philip Pape: I do the androgen deprivation therapy.
• 44:28
  Philip Pape: I'm not too um familiar with it.
• 44:30
  Philip Pape: I know it lowers, does it lower testosterone specifically?
• 44:34
  Philip Pape: Yes.
• 44:34
  Philip Pape: And then you're saying, like, why would people be doing that and then add in testosterone?
• 44:38
  Philip Pape: Help me understand this.
• 44:40
  Dr. Stephen Petteruti: It's it's a it's a cruel thing to do to any man.
• 44:42
  Dr. Stephen Petteruti: You know, this is just so um it's called in the conventional medicine, they'll sometimes refer to this as androgen annihilation.
• 44:51
  Dr. Stephen Petteruti: They will crush testosterone as low as they can make it go with multiple drugs.
• 44:57
  Dr. Stephen Petteruti: So there are drugs that will prevent the body from making testosterone.
• 45:01
  Dr. Stephen Petteruti: There are drugs that will block the receptor sites of the testosterone, and often will combine these drugs to get a more thorough crushing of testosterone level.
• 45:12
  Dr. Stephen Petteruti: The theory behind that is that it will help men live longer.
• 45:16
  Dr. Stephen Petteruti: That theory is not strongly validated.
• 45:21
  Dr. Stephen Petteruti: The research on this is very hard to do.
• 45:24
  Dr. Stephen Petteruti: There are some studies, and I've read most of them.
• 45:27
  Dr. Stephen Petteruti: The conclusions are hard because the patients are so different.
• 45:31
  Dr. Stephen Petteruti: Do they have metastatic to the bone?
• 45:33
  Dr. Stephen Petteruti: Is it isolated to the pelvis?
• 45:35
  Dr. Stephen Petteruti: You know, what was their testosterone?
• 45:37
  Dr. Stephen Petteruti: So the consensus is that, hey, if we do this, they might live longer at the back end.
• 45:42
  Dr. Stephen Petteruti: But would they want to?
• 45:44
  Dr. Stephen Petteruti: Are they gonna, is that life gonna be one worth living?
• 45:49
  Dr. Stephen Petteruti: You know, it's an easy thing to measure.
• 45:51
  Dr. Stephen Petteruti: So there are studies that can show statistically significant increased uh survival when some of these modalities are applied.
• 46:01
  Dr. Stephen Petteruti: When I say statistically significant, it doesn't necessarily mean it's clinically relevant to that person.
• 46:08
  Dr. Stephen Petteruti: There's a study called the tax trial.
• 46:11
  Dr. Stephen Petteruti: They looked at chemotherapy.
• 46:13
  Dr. Stephen Petteruti: The conclusion was statistically significant extension of lifespan compared to placebo.
• 46:20
  Dr. Stephen Petteruti: This was back in 2003.
• 46:22
  Dr. Stephen Petteruti: When you read the study, the actual extension of life was measured in weeks.
• 46:27
  Dr. Stephen Petteruti: It's not like you got another five years.
• 46:30
  Dr. Stephen Petteruti: So you got to go beyond the headline, kind of like the women's health initiative, right?
• 46:34
  Dr. Stephen Petteruti: People read abstracts and then they just draw a conclusion in some cases.
• 46:38
  Dr. Stephen Petteruti: And then you have to go beyond even the conclusion.
• 46:42
  Dr. Stephen Petteruti: If you live another, I don't know, on average, if it's another 12 months, but you're gonna feel like blah, is that worth it to you?
• 46:51
  Dr. Stephen Petteruti: Uh you're willing to kind of make that deal.
• 46:55
  Dr. Stephen Petteruti: It's not wrong, but it's something that is optional.
• 46:58
  Dr. Stephen Petteruti: Studies that look at strictly longevity, I think they missed the point.
• 47:03
  Dr. Stephen Petteruti: You know, Philip, we're talking about vitality, about living great.
• 47:07
  Dr. Stephen Petteruti: And um that's what I advocate for all my patients.
• 47:12
  Dr. Stephen Petteruti: I don't want to see my patients wither ever.
• 47:15
  Dr. Stephen Petteruti: You know, this idea of like shuffling around with a walker, God bless those people for their pluck and their their uh sort of grit.
• 47:24
  Dr. Stephen Petteruti: But I don't want to be one of them.
• 47:27
  Dr. Stephen Petteruti: You start now like you are, you know, exercise, nutrition.
• 47:31
  Dr. Stephen Petteruti: At the right time in life, you add hormones.
• 47:35
  Dr. Stephen Petteruti: Everybody should have hormones.
• 47:36
  Dr. Stephen Petteruti: The only question is at what age is when, yeah.
• 47:38
  Dr. Stephen Petteruti: And then you live boldly, and when the end comes, it comes.
• 47:43
  Dr. Stephen Petteruti: I don't know.
• 47:44
  Philip Pape: Yeah.
• 47:44
  Philip Pape: No, I hear you.
• 47:45
  Philip Pape: I so I'm turning 45 in a couple days.
• 47:47
  Philip Pape: And uh I didn't I didn't really get into this lifestyle until I was up almost 40.
• 47:52
  Philip Pape: And I I joke, or maybe not joke, I'm pretty serious about it that every year older I want to get a year younger.
• 47:57
  Philip Pape: So I told my girls I'm turning 35 tomorrow, and by the time I'm 50, I'll be 30.
• 48:01
  Philip Pape: And then from that point, I'm like, I don't know if I can get to be a 20-year-old again, but at least I've set things back to a better baseline.
• 48:08
  Philip Pape: But uh just to end on a positive note here, then when we think of all the things people can be doing and should be doing, which they should be anyway, probably.
• 48:16
  Philip Pape: What's the biggest hitter here?
• 48:18
  Philip Pape: It is it lifting weights?
• 48:20
  Philip Pape: Is it, you know, the the maintaining healthy body weight?
• 48:23
  Philip Pape: Yeah.
• 48:23
  Philip Pape: I mean, just just to give people thought of prior prioritization if they're not doing that today.
• 48:28
  Dr. Stephen Petteruti: Totally.
• 48:28
  Dr. Stephen Petteruti: So if you're into the lifestyle, Philip, that you and I espouse, that's how we define health, then yeah, uh percent body fat, right?
• 48:36
  Dr. Stephen Petteruti: You want to eat premeditated nutrition.
• 48:39
  Dr. Stephen Petteruti: You do not eat based on hunger, you eat when it's time to eat.
• 48:42
  Dr. Stephen Petteruti: You're fueling the machine.
• 48:44
  Dr. Stephen Petteruti: I don't like fasting for my patients, you're gonna shrink muscle.
• 48:47
  Dr. Stephen Petteruti: So I eat every three hours, whether or not I feel hunger, because that's what fuels muscle.
• 48:53
  Dr. Stephen Petteruti: You know, I'm 66 now.
• 48:55
  Dr. Stephen Petteruti: By the way, happy birthday.
• 48:56
  Dr. Stephen Petteruti: That's it's secret.
• 48:58
  Dr. Stephen Petteruti: Um, so you do that.
• 49:00
  Dr. Stephen Petteruti: And if you only have 20 minutes to exercise, skip the treadmill and lift weights.
• 49:04
  Dr. Stephen Petteruti: That's my clinical recommendation.
• 49:07
  Dr. Stephen Petteruti: The practical application is people ask me often, what exercise should I do?
• 49:12
  Dr. Stephen Petteruti: And the answer is do the thing that you like.
• 49:14
  Dr. Stephen Petteruti: If you hate lifting weights, you don't have to do it.
• 49:17
  Dr. Stephen Petteruti: But if you're asking me which one has more evidence of benefit regarding vitality, longevity, bone density, brain health, it's strength training.
• 49:28
  Philip Pape: Yep.
• 49:29
  Philip Pape: Yeah, no, that's great.
• 49:30
  Philip Pape: And it's funny because I I I hear that all the time about I don't like lifting weights.
• 49:34
  Philip Pape: My goal is always to get someone to which type of lifting weights will you like?
• 49:38
  Philip Pape: That that's like my inevitable conclusion for them.
• 49:40
  Philip Pape: That's just me.
• 49:41
  Philip Pape: Yeah, but I like I like your premeditated nutrition concept for sure, which is planning, being intentional.
• 49:47
  Philip Pape: You know, it's it's not a whim or hedonism.
• 49:50
  Philip Pape: It's like we have goals, people, and and it's you're gonna feel great anyway, much greater for the rest of your life than you will by satisfying some short-term pleasure.
• 49:58
  Philip Pape: So and that's what it is about you know, being a man and uh going out there and being the best you can be.
• 50:03
  Philip Pape: You remember uh Jack Lelane?
• 50:05
  Philip Pape: Yeah, yeah.
• 50:06
  Dr. Stephen Petteruti: Yeah, he was once asked, you know, how do you learn to love exercise?
• 50:10
  Dr. Stephen Petteruti: And he said, I don't.
• 50:11
  Dr. Stephen Petteruti: He said, I love the result.
• 50:12
  Dr. Stephen Petteruti: And that's another way to look at it.
• 50:14
  Philip Pape: Exactly.
• 50:15
  Dr. Stephen Petteruti: You lift weights so that you can lift your grandkids up, you lift weights so you can carry the groceries up the stairs.
• 50:21
  Dr. Stephen Petteruti: You do not buy that ranch and get off of the stairs because you're anticipating withering.
• 50:27
  Dr. Stephen Petteruti: You boldly go after it.
• 50:29
  Philip Pape: Boldly go after it.
• 50:30
  Philip Pape: All right.
• 50:31
  Philip Pape: So, with that, Steve, um, where can folks find you?
• 50:34
  Philip Pape: Because I want to send them your way.
• 50:36
  Dr. Stephen Petteruti: No, thank you.
• 50:37
  Dr. Stephen Petteruti: It's the intellectual medicine podcast to be a great place to connect with me.
• 50:41
  Dr. Stephen Petteruti: I keep updates on prostate health, the protocol.
• 50:46
  Dr. Stephen Petteruti: And by probably next month, my book, uh Fighting Cancer Like a Man will be coming out.
• 50:53
  Dr. Stephen Petteruti: It describes the research I've done, the history of prostate cancer, why we're stuck where we are, and what my alternatives look like so that people can have this available to them.
• 51:04
  Dr. Stephen Petteruti: That'll all be coming out very soon.
• 51:06
  Philip Pape: Okay, might when when this episode comes out, it might be out.
• 51:09
  Philip Pape: So we'll see.
• 51:09
  Philip Pape: We'll include the podcast, we'll include fighting cancer like a man.
• 51:13
  Philip Pape: I love that title, and I'm gonna be checking that out myself.
• 51:15
  Philip Pape: Uh, Dr.
• 51:16
  Philip Pape: Petteruti, thank you so much for taking the time and teaching us a whole lot of very important things about health, prostate cancer, being a man, uh, lifting weights, all of it.
• 51:24
  Philip Pape: Thank you so much for coming on Wits and Weights.
• 51:27
  Dr. Stephen Petteruti: Thanks, Philip.
• 51:27
  Dr. Stephen Petteruti: I really enjoyed it.