Dr. Scholz, a common question that we get here is,
"Do the proteins in dairy stimulate prostate cancer growth?" I know that there has been some
studies showing that dairy is not really good for prostate cancer patients; what do you think?
The studies that indicate that milk can promote prostate cancer growth are pretty
convincing. There are other studies using PET scans showing that prostate cancer grows better
with animal protein—with animal fats, and milk has high concentrations of both. The relative
importance of these different components — Is it the fat that's more important or the protein?
Or are different types of prostate cancers more predisposed to feasting on one more than the
other? We don't — I don't know. There may be other experts who have done a deeper dive into this,
but the evidence that milk products and red meat can promote the onset of prostate cancer and — or
maybe not the onset — but the growth of prostate cancer, I think, is pretty well established.
So in previous videos, we've talked about Rezum for BPH, so large prostates,
and Rezum is a steam treatment to help open up the passageways of the urethra.
People are kind of wondering how would they find a good resume practitioner. I know that we've talked
about ratings and things like that; can you give people some tips on how to find a good doctor?
Certainly. You can go online and you can get referrals from your primary care physician
who may have referred other people and be be familiar with the doctors in your area,
but I would probably contact the company, the Rezum company itself,
they are certainly interested in getting the potential clients to doctors who are
good at it so that they can maintain the good reputation of their product, and oftentimes,
they'll launch these new products with certain individuals or certain physicians that get early
experience and then develop a large amount of experience doing this particular procedure,
and the company the manufacturer itself would probably be familiar with who those doctors are.
So, we have a patient who has a doctor who told him there's two types of prostate cancer:
there's a type of prostate cancer that kills you and a prostate cancer
that doesn't, and he wants to know your opinion on that statement?
Well, if you boil it down into the most simplistic terms. I'd probably create a third category — the
kind that kills you, the kind that's harmless, and then the kind that can make you miserable without
killing you.The kind that can make you miserable without killing you might make you miserable with
the type of treatments you have to undergo to stay alive—hormone treatments or surgery or
radiation—which can mess up your quality of life in a really big way. I like the idea of thinking
of that dichotomy of the type that can kill you and the type that doesn't. I think that is true,
and part of the art is being able to know which category a patient is in, and
and then defuse the fears in the people that have the type that doesn't kill you,
and then tell the people to act responsibly that have the type that can kill you, but
there is sort of an in between those two extremes and that in between space is also very important
because people are are going to have to — those individuals are going to have to take treatments
so that they don't die, and the treatments will work — they will keep them from dying,
but the treatments can incur all kinds of unpleasant side effects and managing that
situation, those potential side effects, is quite an art.
So, we have a patient who has a large prostate of about 100cc's. His PSA is 9.1,
and he's taken an Exome Dx test and it shows that there's a 25 risk of prostate cancer, and then he
also took a 4k test and it was 99 negative, I guess, for aggressive prostate cancer, but he's
concerned because of his PSA being as high as it is. He's wondering if he should get a biopsy. So,
would you say that imaging in this situation would be better? Should he get a biopsy or are
those assays correct and he doesn't need to worry about it and the PSA is from his prostate size?
Yeah, this is a great illustration of how a PSA of 9 can be normal for someone with 100cc
prostate. You divide the prostate volume 100 cc's by 10; you find the average PSA for those folks,
and it's going to come out around 9 or 10. So, the PSA shouldn't be pushing us towards specific
fears of prostate cancer, but we know even men with normal PSAs can have prostate cancer, and
it's not unreasonable to be thorough and they've pursued thoroughness by doing these tests—the
blood test, the OPCO 4k, and the urine test that you mentioned. The problem, of course,
in this patient's case is that the the two alternative tests don't match — one suggests
that there's almost no risk of clinically significant prostate cancer; the other
said 25 risk. The usual threshold for action with these tests is, you know, if it's above 10%
maybe you better look further. So, I think that there's enough ambiguity here and it's pretty
simple to go get an MRI of the prostate, which is a very accurate even more accurate than a
biopsy — non-invasive, usually covered by insurance, and so I would proceed and get
an MRI just to make sure that we're not missing something, even though, we're going into doing
the MRI with the thought that there's probably nothing there; it's probably just a big prostate.
How often are you seeing patients, when we tell them to go get an MRI, do you see that it's pretty
often that they'll go get a 3T MRI right off the bat or are we still seeing 1.5 MRIs done?
It's mostly 3Ts from what I'm seeing. I'm in southern California and I think the medical
marketplace is more sophisticated in southern California than most parts of the world,
so it's unusual for me to see patients who are getting prostate MRIs with 1.5 t at this point.
And going back to this particular case,
is it, I don't always see newly diagnosed patients getting a 4k test or getting an ExomeDx
test. Is this something that you would prescribe to many patients as they're getting diagnosed?
It could be useful. I have to warn patients that the test isn't going to usually
get them out of having to have an MRI. Occasionally it will.
If they'd stopped in the example that we presented earlier where the patient had
a only a two percent chance on an OPCO 4K of having clinically significant prostate cancer,
I wouldn't have gone on and done a urine test; I would have just accepted that at
face value and and said okay that's let's just check the PSA again in six months and keep an
eye on things. These tests which give you an answer in the form of a percentage don't really
help you if the percentage is ambiguous; if it's 25 or 40 or 60 percent it's like a coin flip,
so it hasn't gotten you any closer to an answer. If it comes back at 5% or 95%, then that gives
you real direction, but in my experience those extreme numbers only show up in about one out of
six or seven patients. So, you're doing a lot of these tests where it's not changing your behavior.
For an occasional time when it does, it's not hard to do a blood test, so I just, when I do
it in patients, I set low expectations, "So this test may help us it; it probably won't, but it's a
simple test, it's a blood test, let's go ahead and do it find out what it says." If it is extreme,
then it'll give you good and clear direction; if it's not, then it doesn't really change anything.
Hey everybody, it's me Alex and our mascot, here, Hunter. He's obviously licking my hands
because we have lots of treats for him today, but yeah, we just wanted to let you know to go ahead
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website pcri.org for more information about prostate cancer. We hope it helps.