So, everyone wants to try and squeeze PSA into something it isn't. It's a very non-specific
test and they've looked at rates of rise and all kinds of different algorithms which really
don't add much more than just knowing the number. We've learned that PSA is useful if
it's from 1 to 10, 10 to 20, or 20 and above. That's pretty crude. I mean, so these numbers
where it goes from 6 to 7 and 5 to 3, unfortunately, don't translate into useful information. The
only thing that has been shown useful is to compare it to the size of the prostate, called
the PSA density—that's what Mark's talking about. You can't compare it to the size of
the prostate if you don't know the size of the prostate. So, we see patients that—largest
prostate in my—the winner in my practice right now is 350cc. Alright, I've got about
five guys over 200cc and that's big because the average is 30cc-40cc, alright. So you're
looking at almost 10 times bigger than normal.
Yeah, because the average size is a walnut and that's a watermelon.
It's not really a watermelon. I just did that for drama, but it's huge.
No, it's only a grapefruit.
I know, but...
So, the point is these gentlemen, most of them have come to the office. They've been
biopsied like 5 to 10 to 15 times because everyone is so terrified that they have cancer.
Over and over and over the biopsies are clear, they just have a giant prostate because their
PSA is running 10 to 15 to 20 and they don't have cancer. Mark, so you say, they could
have been spared all those biopsies if someone had just measured the size of the gland and
put the PSA into context.
You're damn right. Because the number one reason a PSA goes up in America and around
the world today is because the prostate gets bigger, not because of cancer. So, you have
to differentiate what's going on, and by knowing the size, you can level the playing field.
The other way you level the playing field, and I know I sound like a broken record, year
after year, is that if you don't take care of yourself then they're gonna think that
the rising PSA must be due to cancer. I can't emphasize that enough. So when someone is
gaining weight and their blood sugar is going up, so is their blood pressure, all these
things are happening, it can actually make the prostate bigger. The prostate doesn't
like to be heart unhealthy. If you are heart unhealthy, the prostate responds in many men
by getting bigger. So, it's a cruel joke that God plays on men as you age. The only thing
that really gets bigger on your body are bellies and prostate. But you've got to go against
that, so what happens is, when you take care of yourself, it's the ultimate truth serum
as to what is really going on here. So what happens all the time, I see, because I'm subject
to this, but I wish this was standard, is a guy starts taking care of himself with a
rising PSA and they can't tell if it's BPH or not. And then the PSA starts to plummet
as he loses weight. So what was happening was his prostate was getting bigger and bigger
and then it either relaxed or started to shrink a little bit and they still can't find a tumor
and then the PSA stabilizes and he's okay. So I wonder about these guys who never get
the opportunity to make that lifestyle change. You know, we talk about prevention, but it's
so amazing. If I stood up to you and I said, "When diet and exercise doesn't work, there's
Lipitor!" You would go, "Oh yeah, I know that. That's true, there's Lipitor. That's a statin."
But let me tell you this. For the rest of your life, I want you to remember this: "When
diet and exercise doesn't work, there's Proscar. When diet and exercise doesn't work, there's
Viagra! When diet and exercise doesn't work, there's Vesicare!" It's true of everything!
"When diet and exercise doesn't work, there's Fosamax for your bones!" It's true for everything.
It's not just "when diet and exercise doesn't work we have a drug for you." So we have to
find out what diet and exercise is going to do. Whether it's for your hot flashes, whether
it's for your bone loss, whether it's for your rising PSA because your prostate is getting
too big. So this is a really critical point. I mean, how many guys do you know can tell
you the exact size of their prostate?
And, of course, I'm surrounded by a lot of savvy patients, but I'm going to guess less
than 10%