So, the next thing I wanted to talk about was a couple of big myths in prostate cancer.
So, I know that one of them that we hear quite often is that there are symptoms for prostate
cancer and that is a huge topic for our audience. Can you let us know, are there really symptoms
and if not, what do we do?
Yeah, that's a good clickbait type topic because we all have aches and pains, especially when
you get into my age group. Something hurts. Is it cancer? What is it? Especially if someone's
had a previous diagnosis of prostate cancer. Maybe they had a biopsy or they had surgery
three or four years ago—[now] something's hurting. But the PSA sort of eliminates that
as a relevant question. If men have a low controlled PSA level, it's impossible to have
symptoms. That means that there's just too few cancer cells in the body to create symptoms.
You have to have a chunk of cancer pushing on something sensitive to create symptoms.
Chunks of cancer create lots of PSA and so it's just a clickbait concept. When men get
advanced prostate cancer and their PSAs are in the hundreds, certainly they can get symptoms
and that's a different management situation, but for men that are otherwise healthy, maybe
they've had previous treatment, if you have an ache or a pain somewhere, you have to look
for a reason besides prostate cancer to explain it.
Yeah, I've heard sometimes it's like loss of sleep or constant urination, which we know
can be due to a lot of other issues.
A lot of those ideas were developed before PSA, back in the 1960s, 1970s, and men could
show up cancer spread through the body because there wasn't a way to monitor PSA back then.
And prostate cancer deservedly (in that era) had a bad reputation just like lung cancers
and pancreas cancers. It's amazing how much PSA testing has changed the landscape.
Yeah, that's a good segue into our next question. One big myth that we're still conquering when
it comes to prostate cancer is that PSA is not necessary. That that blood test is not
necessary. So, can you give a little history as to why some doctors even think that and
what patients need to do to make sure that they get their PSA test?
Yeah, so PSA is utilized in different roles. It can be used for screening (to try and detect
prostate cancer in people that have no previous knowledge or haven't been diagnosed), it can
be used to monitor men that have already had treatment, it can be used to determine if
a treatment is effective. The PSA should generally decline if a treatment is effective. So, the
big controversy is about screening and the concern is that because there's so many low-risk
prostate cancers and because we have an industry that is so poised to do surgery (this is the
only cancer that is run by surgeons, urologists) the government back in 2012 said, "Gads! maybe we're
doing more harm than good by diagnosing all these tiny little harmless prostate cancers
and throwing them into the arms of surgeons who are doing operations, making men impotent
and incontinent." Truly a problem even to this day. But, if people are getting appropriate,
up to date, expert advice, PSA is a fabulous screening test. It's really impossible for
the cancer to show up having already metastasized if people do careful PSA screening. So it's
very logical to do PSA screening unless you're dealing with a very uneducated population
or if you're, you know, maybe in some small town in the midwest. There's one urologist
seeing 100,000 people and he spends 5 minutes with each patient and, you know, operate—it's
a snap decision. Maybe a PSA in that setting is a problem. So, it's just a matter of how
educated you are and how intelligently you use the PSA. It's not the test itself that's
a problem.
So, in regards to men who are not being offered a PSA test, would you just tell them to go
in to their doctor after a certain age and get your PSA checked and that's probably around
40 or 45, 50?
I think that's a reasonable rule of thumb. I mean, you have to tell people to educate
themselves. Like any powerful tool, if it's misused, it could lead to unnecessary treatment
or harm, but if people will read up and study and think about it and be informed they, in
my opinion, definitely should start getting PSA tested when they're in their 40s.
So, my next myth is, I hear this quite often, and I know it almost sounds like why would
someone think that, but unfortunately I think that due to all the marketing that's out there
when it comes to prostate cancer treatments, this happens quite often. A lot of people
think that you have to have surgery first before you can have all of the other treatments.
Instead of thinking of them as alternatives, they think of it as the backup plan. Why do
you think that is?
Probably because surgeons run the industry. Urology as a specialty has been around since
1902 and prior to, say, 2005, the radiation treatments were ugly and scary and bad, and
so surgery was kind of the only thing you could do. Also, back then we thought every
cancer was deadly. So people would be rushed into surgery and there's been a lot of momentum
now. Decades and decades of doing surgery first. The urologists do the biopsies, they're
the ones that the patients that are newly diagnosed are talking to. They're talking
to a surgeon and so it's not surprising that the surgeons would present surgery as the
best option. The problem is when you look at the data now in 2020, the radiation options
are more effective than surgery and less toxic than surgery. So, I really can't think of
a situation in 2020 where I would recommend surgery for prostate cancer.
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