Everything You Need to Know about Prostate Cancer

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Hello and welcome to the Ask Dr. V Show, where you can be informed and empowered about health issues that are important to you and to your family. Now, you know, when you have this conversation, they want to get into it, and other folks are like, oh, do we have to talk about this? But this is a major killer of black men in our community. I'm going to go into exactly why our men are more likely to get prostate cancer and what can actually be done about it. But let's start from the very beginning. What is a prostate? Where is it? Why do men have a prostate? Let's kind of go over a little bit of that. So, first of all, a prostate is a small gland and it's part of a men's reproductive system. And basically, it produces fluid that transports sperm. So a poorly functioning prostate can lead to sort of weak sperm or sperm that don't swim as fast or sperm that die sooner before they meet and fertilize an egg. The prostate in general is roughly about the size of a walnut, and it's located below the bladder, but in front of the rectum. And so the urethra, which is a tube that allows urine to flow from the bladder to the outside when you urinate into a toilet, the urethra goes through the prostate gland, right, on its way out. So what happens is with aging, that prostate gland begins to enlarge. That enlargement usually starts around the age of 40 or so. And it can actually begin to block the outflow of the urine. And you can get symptoms like a weak urine stream, urine stream that starts or stops, or sometimes you get a completely blocked urine stream. And when you get a completely blocked urine stream, that's called urinary retention. The urine actually builds up in the bladder. It can be extremely uncomfortable, usually requires people to go to the emergency department. You know, I often tell people, you know, if it's Christmas day and I see men in the emergency department is for urinary retention. They need a folio catheter to release the retention, and actually the urine then goes into the folie bag, the tension is released, and then we send them to the urologist to go from there and actually get everything diagnosed. So the most common problem associated with the prostate is that it gets larger as men get older. So the enlargement of the prostate can be cancerous or it can be non-cancerous. So if the enlargement of the prostate is non-cancerous, it's called benign prostatic hyperplasia. And we call it in medicine BPH, B like in boy, P like in Paul, H like in Happy. If it's cancerous, then you actually have prostate cancer. So today we're discussing this health issue because this affects millions and millions and millions of men. So let's start first with BPH, the non-cancerous benign prostatic hyperplasia. Every year, three million American men get diagnosed with BPH. If you are a man and you live a long, healthy life, you will get this. So let me tell you how the numbers roll. Okay? So starting at the age of 40 is around the time that the prostate actually begins to enlarge. Sometimes around this time, there aren't really any symptoms. By the time a man turns 50, 50% of them have some signs of prostate enlargement. They may not have symptoms, but they do have signs if you did an ultrasound or an MRI or a CAT scan or you actually looked at their prostate. By the time a man turns 60 years old, 60% of them have some signs of enlargement of their prostate. And by the time a man turns 80 years old, 90% of men have some signs of prostate enlargement. So what does this actually really look like? When you do finally have some signs and symptoms related to prostate enlargement, whether or not it's cancerous or not cancerous, you're gonna get these types of symptoms, right? So you'll see symptoms like uh frequent urination, particularly at night. You'll have strong urges sometimes to urinate associated with sort of difficulty starting the urine stream, right? So you'll you'll see men, women, if you hear your men in the bathroom grunting, like, uh, uh, uh, to start and start their urine stream, this is he is having prostate problems, okay? I can tell you right now, he's having prostate problems. So now, the other thing you can get is weak urine stream or stream or a urine stream that sort of starts and stops. And also what you get is not completely emptying your bladder. So you have to urinate several times. You got to go back and back and back, and you think you're done, but you're not done, and then you're going back and back and back. So these are the symptoms that you get when the prostate enlarges, and again, it can be cancerous or it can be not cancerous. So let's talk first about benign prosthetic hyper hyperplasia, and then we'll start to talk about the cancerous form. So, with benign prosthetic hyperplasia, let's talk about what you can do about it. So, there are some lifestyle things, like one of the things that we tell people to do is don't drink any fluids, water, and stuff after four or five o'clock. Um, limit the amount of caffeine or things that kind of act as diuretics and make you actually uh urinate more. The other thing that we have is there's a whole technique called double voiding, which is basically you go to the you go and urinate, and then whether or not you feel like you have to urinate or not, you go again. You just push it out again and see if you can push out more. And that sort of helps people with sort of emptying out their bladder a little bit more. There are all sorts of medications that can shrink the prostate over time. There's also medications that relax the prostate and relax the bladder to really improve urine flow. So you want to talk to your physician about these types of medications that are usually in a pill format that you can take to sort of help with this. Then there's what we call minimally invasive procedures. And again, this is for benign prostatic hyperplasia. So for this, this is for enlargement of the prostate where there is no cancer. So in that situation, um their minimally invasive procedures are things like uh prosthetic artery embolization. It's very similar to uterine artery embolization that women get when they have fibroids. And basically, what this does is the embolization actually blocks the blood flow to the prostate and thereby causes the prostate to shrink. There's also a thing called urollift, which kind of lifts and holds the enlarged prostate tissue away from the urethra so that it can actually flow urine uh freely. Um, and then there's also a thing called resume, which is steam that's used to shrink an enlarged prostate. Now, when this benign non-cancerous prostate hyperplasia actually occurs, some people get it really severe and they actually do need surgery. So when you need surgery, some people actually get what's called a TERP, right? And it's T U R P. It stands for transurrethral resection of the prostate. And this is really the gold standard for actually removing all of the excess prostate tissue. Now, some people have actually referred to this procedure as the rotor rooter procedure. So you'll hear some doctors talk to their patients and say this is the rotor rooter procedure. And that's because basically they go up the urethra and it is a circulating rotor rooter-like device, and it literally pulls that tissue, pulls it, pulls that excess tissue out. There's also laser therapy, and then there's also open and robotic removal of the prostate completely, which is called a prostatectomy, right? And we'll go into some things about that. But let's move on now to what happens when the prostate is cancerous. So it's enlarged, it's not benign, and um, instead there are cancer cells there. So the the problem with prostate disease is that the benign form of the disease that is not cancerous and the cancerous form of the disease can really look very much alike. From the standpoint of actually looking at uh various symptoms, you can't really tell the difference as far as symptoms. In addition, there is a blood test, which is a PSA, and both can have an elevated PSA. So uh and the PSA test is specifically uh called prostate-specific antigen. How do we really tell whether or not someone has benign prostatic hyperplasia, the benign non-canterous form versus the cancerous form? So there's a couple of ways to sort of uh figure this out, and and one way is that um they look at how high is the PSA or how quickly is the PSA, the blood test, rising. So your doctor may ask you to come back and actually get a second blood test so you can actually see what is going on. Is it staying the same? Is it dramatically increasing? So, roughly about a quarter million people, a quarter million American men, 268,000 American men every year are diagnosed with prostate cancer. And it makes it the most common cancer among men after skin cancer. And so if you actually look, since you know, black men don't get skin cancer as often as white men, prostate cancer is probably the number one cancer for African American men. We actually get it. African American men actually get it earlier. It is often more aggressive and they are more likely to die from it. So, roughly about 34,000 men die of prostate cancer every year. Yes, and that's roughly about one out of every eight men in America will be diagnosed with prostate cancer during their lifetime. This is really important. While prostate cancer is rare in men under 40, it can occur in younger men depending upon certain things like smoking, uh, family history, things along that line. If you have a father or a brother or an uncle or a grandfather that had prostate cancer, it dramatically increases the likelihood that you have will have prostate cancer. And if you have a family member that has prostate cancer, and then in addition you smoke or have some other risk factors, then it makes it even more likely. Now, what is actually good about prostate cancer is that if it is caught early, prostate cancer has an excellent prognosis and it's one of the few cancers that can actually be completely cured. This is why I really wanted to talk about this show because this is one area where we can really do something about this. So if you have just a localized prostate cancer, the five-year survival is 100%. Even with cancers that have spread regionally, the five-year survival is at or near 100%. So it really, really uh is important to actually get regular screening, get early detection, and actually deal with this from the very beginning. The other thing about this is that prostate cancer compared to other cancers. So, like for instance, if I compare prostate cancer to lung cancer or stomach cancer or breast cancer, uh prostate cancer is relatively slow growing compared to other cancers. So, in addition to having a really good survival rate, is also very slow growing. So, this is something that we can really, really do something about. So, let's talk about the risk factors. So, as I said, you more likely to develop prostate cancer as you get older. Also, if you have a family history, uh, again, brothers, fathers, grandfathers. Also, African Americans have a higher rate of prostate cancer and also are more likely to develop the aggressive forms of the disease, and we're also more likely to die of prostate cancer. So I want to just kind of share how much more likely we are, because sometimes we say something is more likely, but I don't know, we don't really put some numbers to it. And so it is important that we support each other in our community and that we make sure to get early detection for prostate cancer. So let me show you kind of what the numbers, what the numbers look like. Um, African American men are 70% more likely to get prostate cancer than their white counterparts. 70%. That's a lot. They're 200 to 300% more likely to die from prostate cancer. So two to three times more likely to die from prostate cancer. So this is preventable. This is something that we can do something about. This is all about getting the screening and everything that we need to do. So today we'll be exploring the latest screening guidelines, treatment options, and what every man should know about protecting his health. So, you know, it we're gonna separate today fact from fiction. We're gonna also actually look at, you know, what are some of the things that hold people back from actually getting uh getting uh the screening and the things that they need. So, first of all, prostate cancer is staged in numbers one through four. And that is mainly telling you where is the tumor. So one is the tumor is very small, it's it's inside the prostate. Two is a little bit bigger, but still inside the prostate, three is locally invasive, and four is metastatic disease, which means it could be in your lungs, it could be in your bone marrow. Now, there is another scoring mechanism, which is the Gleason score. The Gleason score actually goes over how aggressive does the tumor look under a microscope. So more aggressive tumors look very erratic and don't quite look like a cell. Tumors that are not as aggressive look more like a cell. That scoring system is six to nine. So President Joe Biden has stage four tumor and a gliesen score of nine. So that means that the tumor is outside of his prostate, it is metastatic, it is in his bone marrow, and it is very aggressive because nine is is the only more aggressive tumor you can get is ten. So he has a gliesen score of nine. Again, this is not good, this is not a good diagnosis for him, but I have seen people live for years with this aggressive tumor and with it being metastatic because sometimes the tumors are gr grow very slowly. So I don't know how long he's had this diagnosis, I don't know how long he's been dealing with this, so I really can't speak to it specifically for President Biden. But I just wanted to go over the numbering system because there was a lot in the news about, you know, why is he saying he's a stage nine, there's no stage nine, he has a Gleason score of nine, and he has stage four cancer. All right, it's time for some QA. I've got I've got a couple of questions that I got by email related to this. Uh so Gloria from Maryland asked, at what age should African American men begin prostate screening? And how does this differ from the general recommendations? So, great question, um, uh Gloria. So, African American men with no family history and no other risk factors, like you don't smoke, should get a prostate check and a PSA level checked at 45. Um, if you have additional risk factors, either you have someone in your family who has prostate cancer or you are a smoker and you're African American, then the recommendation starts at 40 years old. Some people are actually being checked that have multiple risk factors even sooner than that. This does actually differ from the general recommendation in the in the white male population with no risk factors, asked to get their prostate checked at 50 years old. So that kind of gives you some idea. So 40 years old if you have, if you're African American and you have an additional risk factor, and 45 years old is the current recommendation if you're African American with no family history and no risk factors. So Mike wants to know why are African American men twice as likely to develop prostate cancer, and why are they more likely to die from prostate cancer? There's a lot of different reasons for this, and I'm gonna go over a couple of them. So, one of the main things is that there are some biomarkers and some genetic things that are associated with prostate cancer. Um, inherited genes actually do play some role, and African-American men are more likely to carry the gene variants, and specifically BROCA 1, BROCA 2, and HOXB13. Now, many women have heard of BRCA 1 and BROCA 2 associated with breast cancer. When these actually genes uh are passed on to men, they're associated with a very aggressive form of prostate cancer. So, one reason why African American men are more likely to actually get prostate cancer is because they're more likely to have the gene, right? And those genes are associated with a particularly aggressive uh type of cancer. The other reason suggests that higher testosterone levels can actually, and hormone differences can actually make a difference in um in how fast these tumors actually grow. And you know, when you talk about um when you talk about, you know, why we're less likely to get diagnosed and also why men are more uh African-American men are more likely to die from prostate cancer, it also has to do with their interfacing with the healthcare system. So a lot of times um African-American men are less likely to go get screening. The screening actually is really important to to get the actual diagnosis. If you don't get the screening, then you you don't get the diagnosis and then you don't get the treatment. You'll also find that you know you have to have insurance, right? So, you know, you to walk into your urologist office, get lab tests done. This is not free. It's really, really important that we um that we actually get these screening tests done. Sometimes if you don't have insurance, you can actually uh find a free clinic that will actually uh do some of this screening for you. It's really important, no matter how you get it, get the PSA checked uh and get uh get an exam. I have I have a question that came in. So I would like to know what is the difference between PSA test and the digital rectal exam and why do we have to get the digital rectal exam? I think it's really important. I don't want people to actually not get checked because they're trying to avoid the digital rectal exam. But let me tell you what the digital rectal exam does. The digital rectal exam tells us whether or not your prostate is smooth or whether or not it's bumpy. And if it's bumpy, that's more associated with cancer. If it's smooth, that's more associated with something that's benign. Also, the digital rectal exam will tell us if your prostate is enlarged at all. Now, here's what's really important. If you go to the urologist, if you are avoiding going to the urologist because you do not want to have the rectal exam done, just tell them you don't want to have the rectal exam done and get everything else done. If it's causing you that much angst, don't not go to the urologist at all. But obviously, if it's causing you that much discomfort or oh, worried about it or whatever, and just just still go to the urologist, but just don't get the rectang, just refuse the rectal exam. No one likes it. We don't like it. We have to get pelvic exams, we have to get breast exams. You know, I can't stand the mammograms. You know, they squeeze, they squeeze your tatas to smithereens. So, you know, I mean, there are these things that we have to get done that are uncomfortable, but if it causes you that much angst, just say no and do that as opposed to actually not get it, not get. The exam at all. What happens with prostate cancer and actually uh benign prostatic hyp hyperplasia is you that disease is going on before you get symptoms. Symptoms sometimes come very, very late in the disease. So you don't want to wait until you have symptoms. You want to get, if it's recommended for you to have the screening at a particular age, get the screening, right? Because that disease is brewing in your system. And again, the earlier you catch it, then you can have a 100% cure. And everybody wants a 100% cure, don't you?

Okay, that's why we're like we have a caller on line one.

Let's line one.

And you know, I'm gonna ask you a question, not as some kind of conspiracy theorist, um, but more along the lines of really what the disease does to folks. Um do you think Biden knew all all the time or for longer period than what they're saying?

Absolutely. Absolutely. So, so so I I you know, I'm trying to think. I I think I think President Biden is uh 78, 78 or so year years old, uh 78 to 80 years old. Um he's been, you know, president, vice president, and a senator. He's been in the federal government uh as a as a public servant for, you know, I don't know, 30, 40 years. Um they have very, very, very good insurance, right? So um he was uh he would have actually gotten his initial screening um at the age of 50. Now, what was interesting is um a couple of physicians went back to the, you know how the presidents released their medical reports when they're at um when they're president of the United States? You know how you know Trump released his and he said, you know, the most healthiest president in the world, right? But those reports get those reports get listed, uh uh released. One of the physicians went back over the report, and there was no PSA level that was listed. It would have been medical malpractice not to do a PSA level on uh President Biden uh anytime after 50 years old. So um I believe they knew. I believe they just kept that out of the report. Um I can't say I blame them. Um he has a right, he has a HIPAA right to his to his privacy as well, just like the rest of us do. And people are very prejudicial against people that they think have cancer. I mean, if you go and tell your job you have cancer, they may not promote you. You know, so you know I can't really say I blame them, but uh no, I th I think I think he knew. I I'm actually kind of surprised they were able to keep it a secret.

Doesn't the PSA testing like end at a certain age too? Like, is there like it sounds like I was just listening to the caller or to your your your colleague there who was like, I don't have any symptoms. I'm wondering if people just like, I don't want that test because I don't want to have to go through whatever is gonna it might find.

Yeah, so yeah, because so the PSA normally should be like less than four, right? So if it's over four, it it used to be that the only thing that we had was doing a biopsy, right? So that's an an invasive procedure, right? Now we have some other tests and some other things that can be done. But I think that, you know, it's it's to put your head in the sand. Now some people at 70 years old, if you've had a PSA that's been normal all the way up till 70 years old, and then people go, hey, you know what, if I catch cancer at 75 and it's a slow-growing cancer, maybe I don't want to know about it. But I think it's a totally different thing when you're talking about our black men who are dying of prostate cancer at 60 and they've had it at 45, they've had it at 50 years old. Right? So there are there are some people who decide for a lot of this cancer screening, even colonoscopies, they decide at a certain point in time, even looking for colon cancer. Well, when you know, at 80, you know, 75 or 80, we're just not going to look for these things anymore. So I understand people actually doing that. I I think the place for us to actually really make uh an improvement in the health of our community are those people that are have risk factors, don't realize they have risk factors, um, and need to get tested at 40, 45 years old. Now, has anybody in your family been impacted by prostate cancer?

No, but it seems like, you know, your your friends from college and things that are like men get to the age of in their 60s, and all of a sudden you hear about them, you know, like they're why somebody saying they're urinating more. Like all these things that are somehow related to at a certain age to the prostate. But again, I don't really understand all of that.

Yeah, so so you that that prostate starts to enlarge at 40. And uh, like I said, by the time you're 80 years old, 90% of men are gonna have problems urinating. Like that's just that is like that is like a part of male aging. It's just a matter of is it benign or is it cancerous? But um, yeah, that prostate starts to grow. And, you know, when you're talking about in between the your bladder and your rectum, there's just not a whole lot of space there, right? So growing, you know, small amounts of growing actually cause a pretty a pretty significant obstruction. And I I think that that is that is something that um, and that's how comes some men decide, well, I'm gonna just go ahead and get my prostate completely taken out. I've had family members do that. Um, and then that that ends a conversation about the prostate enlarging, and it also ends a conversation about cancer.

Oh, wow, I didn't know you could remove them. Thank you, Dr. Probably.

Yeah, yeah, it it comes with complications. I'm gonna talk about that because I got a question from somebody, and I'm gonna go to that question now. But thank you for your call. All right. So here is the question. So I had someone actually send in a question: what are the potential side effects of treatments as far as sexual function and urinary control? So this is really important, and this is how come this is important. So radical prostatectomy, which is the removal of the prostate completely, can be associated with about a 50% incidence of impotence. And this is how come a lot of times men are looking for different options. So one of the things that can be a different option is to actually get a radical prostatectomy with what we call nerve sparing. And basically, there's like a delicate bundle of nerves that are around the prostate, and this actually controls male erections. And so, with the nerve sparing techniques, what that does is that actually preserves that nerve bundle so that that way men do not experience a pro a uh impotence after uh radical prostatectomy. You can actually get nerve sparing unilaterally on one side or nerve sparing bilaterally on both sides. And what you will find is that dramatically decreases, that dramatically decreases the incidence of um of impotence by almost uh 50 to 70 percent. Um, so it's really, really very significant. The other thing that is really making a difference, and I know I've talked about technology and the impact of technology on our health, but there's robotics-assisted, laparoscopic prostatectomy. So let's let's break that down. So that is robotics assisted, that means the surgeon is assisted by a robot. They're gonna go in laparoscopically, so they go in through small holes. They're not, it's not an open prostatectomy, and they actually are removing the prostate and doing the prostatectomy. And so this can cause less trauma. There's more uh nerve preservation because what happens with the robotics and some of the technology is a robot is able to tell the difference between nerve tissue and non-nerve tissue better than a surgeon can. So that this is why this is really, really um dramatically uh making a difference. Um, the other thing that makes a difference in impotence is get a doctor that does a lot of prostatectomies. I cannot I had a family member uh that was going to um uh uh a surgeon who did like one a month. I was like, no, you do not get a prostatectomy done by somebody who does one a month. Okay. I wound up sending him to somebody who does 30 a month, okay? Alfonso, would you agree with that? Experience matters, right?

30 better than one, right? He just on standby. That's not gonna work.

That's not gonna work. Not when you're talking about this delicate area, okay? That's right. Experience matters, okay? So you need to ask your doctor, if you are looking at prostate problems, how many prostatectomies do you do a month or a week or a day? You need to ask that question. It is really, really important.

Now, use an intern help doctors, right?

So you will have, so yeah, so that's another thing you might want to ask. If you're going to a place where there is a um where it's an academic teaching center, okay. Like uh, you know, most of the hospitals in Washington, D.C. are teaching centers, right? So Howard University, GW, Georgetown, all of those are teaching. So there will usually be a resident in the case, correct?

Are they special residents?

They are usually urology residents. You can sometimes have a general surgery resident that is rotating through, um, but you will usually have a urology resident. Um, and um, you know, they're very, they're they're very careful nowadays with training, you know. So the other place that technology has really made a difference is we used to only be able to get practice on cadavers, right? But now with virtual reality, they're able to almost set up like a virtual living patient that we actually get to practice on before we actually practice on live patients. So um when you look at the field of medicine and how we're being trained now, we're being trained in a much safer environment. So by the time a resident actually begins to operate in the operating room, they've actually done it on a cadaver, then they've actually done it on a virtual patient. Like they're they've gone through several iterations of everything, right? Um but you can ask that question: will there be a resident? Will there be someone in training? And are you doing the surgery or are they doing the surgery? Now, I'm gonna tell you almost all the time the attending physician is the one who is responsible and should be doing the surgery. Sometimes what they'll do is they'll let the resident close or let the resident do some things. But if they're a senior resident, they could be doing the case.

They better have good grades in their class.

They better to all the kids out there listening. See, people want good doctors and they want good doctors that have been doing good and been in the books, right?

Keep it real.

Keep it real, keep it real. Now, what happens? Let me I'm gonna talk next, Alfonso, about what happens. I got a question from Torrance. And he says, a man's ability to perform is a big hit to his manhood. What tools do you recommend if he has some impotence problems, right? Like what to do, whether or not you have it and it's surgical related, or whether or not you have it and you just have impotence issues in general, right? So now I'm gonna tell you, Alfonso, I bet you did not know this. The most common thing that causes impotence is what? I'm gonna give you two guesses. Overflow. Overflow of what? Okay, second guess. That's horrible.

Uh-oh. I don't know. That's a good question.

Cigarettes. Really? Cigarettes. All right. So if you're smoking, anything. Hooking, hooking, hook, hookahs, hookahs, you know the hookahs. Yeah, the hookahs smoking, that is the big that is the number one cause of impotence. So I tell people, you know, you oftentimes they're concerned about other things causing it. It is puffing anything. So whether or not it's smoking cigarettes, smoking cigars, smoking black and mild, smoking marijuana, or hookahs. That is the most common cause of impotence. The second most common cause of impotence is high blood pressure. And this is the reason to actually take your high blood pressure medicine. Um, and if your high blood pressure medicine is causing you problems performing, you need to tell your doctor that you want another high blood pressure medicine. You can go to something else. So, again, you got to speak up and say what's going on. So, whether or not you have prostate cancer and you have surgery and you're impotent, or you're smoking and you have impotent, or you're hypertension and you have you're impotent because of that, I'm just gonna talk quickly. I could do a whole nother show on this particular issue. You know, you know, Alfonso, impotence is a whole show in and of itself, right? Right? That's a whole show. So, but I'm gonna just run through a couple of things. So, one is that um medications like Viagra and Cialis um really do make a difference. Um, they increase the blood flow uh to the penis area, and they really help with impotence. Um, some people actually like to use uh non-invasive uh uh tools. They have a uh vacuum erection devices, which are like the penis pumps, and that actually helps to draw blood into that area. Um you can also get injections. There are injections of medications uh that people uh that men use uh in that area. Um it requires uh a lot of training and and knowing how to do it, uh, but that also uh helps. Um there's also suppositories, um, and then some people actually go all the way and actually get a penile implant, right? Which is a surgical implant. So, but the main thing, the main thing if you have if you have any sort of um performance problems is don't assume that you know why. Please don't assume. Please don't be your own doctor. You'll kill yourself being your own doctor. Don't do that. So don't assume why you have it. Go see a urologist. Urologist is the type of doctor that men should see if they have problems with performance issues. If you're smoking, quit. If you have diabetes, get it under control. If you have high blood pressure, get it under control. And go to the urologist and actually get a workup and actually see what is actually making a difference and why are you having these performance issues? Alrighty. Next question. Dr. V, I feel like we need more research for people of color. Are there clinical trials specifically studying treatments for African American men with prostate cancer since they have such poor outcomes? Oh my gosh, this is the this is this is a hot topic. Now, you all know that our current president has been actually ending money for clinical trials. Okay? So again, this is why voting matters, right? Voting matters. Um many, many, many NIH trials, particularly trials that have to do with why we as African American people are more affected by certain diseases, the funding has been shut off. All right. So I just want people to remember this research is very, very important to be done and it requires funding, and it is funded in general by uh by the federal government. But if you actually want to know what clinical trials are out there, the NIH has a great website. It's called clinicaltrials.gov. That's clinicaltrials.gov. And it will tell you what all the clinical trials are for every disease you could imagine, nationwide and worldwide. So if you have any disease and you wonder, gosh, my doctor told me I have absolutely no options left, go to clinicaltrials.gov and you can actually uh look it up and they'll tell you whether or not the clinical trial is open. Uh they'll tell you whether or not the clinical trial is taking new patients or not. Um, they'll also tell you what are the criteria. So um it's really important with clinical trials that you actually know the criteria because it will sometimes we'll say you need to have had no treatment, or sometimes they'll say you need to have failed this treatment and this treatment. Um, you can always bring the clinical trial into your physician's office and show it to him or her, and they will tell you whether or not you qualify for it. What's really important is if the clinical trial is not at your doctor's hospital that they actually work at, they may not know about it and they may not refer you to it. If you qualify for a clinical trial, whether or not it's for prostate cancer, any other sort of cancer, or any other sort of disease, it is part of your patient bill of rights that your insurance company pays for it. I want to repeat that. If you qualify for a clinical trial and you've been you meet all the criteria to be a part of that clinical trial, and that clinical trial is open, your insurance company does not have the right to actually deny you uh payment uh for your medical treatment while you were in that clinical trial. All right, really, really important. All right, so another quick question here. Um I've got a question that says, you know, you talked about uh uh the prostate getting larger. Is that is is is the prostate getting large or prostate cancer the only diseases of the prostate? Um, it is not. So there are other diseases of the prostate. Um, and um they uh one of the main ones that is very common is prostatitis. And prostatitis is inflammation of the prostate. And um that usually occurs uh either as a result or in conjunction with a urinary tract infection. Um it can also occur as a result of a uh sexually transmitted disease like uh gonorrhea or chlamydia. Um men can get it at any age. Um and it is um and it is treated with um it is treated with a uh with the antibiotic. And usually with the antibiotic, the inflammation goes down, um, the urinary symptoms go away, um, and the pain and the discomfort uh go away. So um I uh kind of focused today on uh the enlargement of the prostate because it is so uh common, but there are other diseases of the prostate, and the most common one is prostatitis.

All right. Question How much does a diet play in it?

You know, you know, it's so it's always interesting for enlargement of the prostate. So um I I don't know what the uh relationship is with the enlargement of the prostate, because that seems to occur with age, but certainly uh prostate cancer, any sort of cancer, so I tell people all the time, cancer loves sugar. Okay. So cancer loves carbohydrate. So obesity is associated with cancer, prostate cancer. Um, any sort of uh high carbohydrate or ultra processed food diet is actually going to be associated with prostate cancer. So, and all sorts of cancers. So great, great, qu great question. But I will tell you this if you have a family history of it, you cannot healthy eat your way out of this, right? So if you have a Uh if you have a family history and you have one of those genes, and a lot of people don't know that they have those genes, um, healthy eating will not get you um will not get you out of this, unfortunately. All righty. So I got a question from Vana. She says, are there other uh new screening technologies that are available for uh prostate cancer? So uh great question. I love the technology questions because I'm always interested in what the what the new technologies are. So, yeah, so there's a couple of things out there. Um so there is um many times we've heard of people talking about uh uh PSAs. There's a percentage of free PSA, which is a ratio of free to total PSA. There's a 4K score, and there's also a prostate health index. So these are all um some new testings, and they're very and there's also uh MRI related uh biopsies that are not as invasive. All right, we've got James, we've got a caller on line on line one. James, you have a question?

Yeah, Dr. V, thanks for taking my call. Um I'm 81 years old, and um I have an enlarged prostate. Um I have um a kid my kidney doctor uh wants me to drink uh at least three to four bottles of water a day, and so like it keeps me up like uh going to the bathroom at night. Yeah. Is there anything that uh you can do? Uh once the prostrate is is enlarged, does it ever shrink? Is there anything that ever you can you know, is it ever shrink? Mine the last time they took it, uh the PSA score was night three point three.

Oh, that's good.

And my um my urologist said that I was asking him about uh if he was gonna do, you know, the you did do the physical exam animation.

Yes.

And he said that, oh, don't worry about it. Uh um you you'll be dead before the uh before it kills you.

Right.

So that's not telling me that much.

Right. Right. So he was saying he was saying that because so he was saying that because prostate cancer in general is so slow growing. So what you're so what you're dealing with is having to get up at night and urinate a lot.

Yes.

How many times are you getting up at night?

Um, it it could be four times.

Yeah, that's really disturbing your sleep.

Yes. Uh one thing I don't wet the bed, so that's good.

That's good. That's good. That's good. Well, so here's what here's what here's what I would do is one is I would actually switch over to alkaline water. So alkaline water actually is held in your body more than it's urinated out, right? So that's like the water that says high pH. Uh one brand is essential. They save it in, they sell it in a safe way. They sell it in all the grocery stores. And it'll say some of the stuff, some of them will say pH 9 or pH above nine. The other thing you want to do is you want to drink the water in the morning. So you want to drink as much of this water before four o'clock.

Okay.

Right? So that that way you're actually not getting up in the middle of the night. Because getting up in the middle of the night is also very dangerous. People get up in the middle of the night, and I can tell you from working in the emergency department, they stumble over stuff, it's dark, they fall, they break their hip. Now they got a whole nother problem, right?

Yeah.

Right? So, so you want to actually make sure that you drink all your water that you need to drink before four o'clock. And don't drink anything after four o'clock. And see if that actually makes a difference and change over to the alkaline water.

Okay, I'll try that.

Try that and see what happens, and then call back in and let me know what happens.

Okay, I will. Uh uh just one other question. Umce your uh PSA score gets up past four. Mm-hmm. Up to four, is that could that does that mean that you have prostate cancer?

No. So it doesn't, no. So that's the that's the difficult thing with um diagnosing prostate cancer, is you can have an elevated PSA with benign prostatic hypertrophy, and you can have an elevated PSA with prostate cancer. So what in your situation, he's probably saying if it gets above four, I'm not even gonna really check on anything because what happens is if you have cancer, usually it gets up very high or it goes up high quickly. And what he's saying is at 80, you know, people live people live 20 years with prostate cancer. So, you know, you know, you know, now now there's some people who are like, hey, you know what, I think I'm gonna make 100, so I really want to get it checked. I mean, you can, you know, you can you can find the urologist that will really check, but right now you're less than four. So I would just uh I would focus on getting those kidneys in shape with the alkaline water and um not drinking past four o'clock.

Okay, just what do one last question. Uh-huh. My primary care doctor, I had a primary care doctor told me that she had done a test on me, um, and that she said that I would never have prostate cancer. And is that true? They can do tests. What kind of tests could she have done?

I do not know what that is. Um, I'm gonna have to cut the conversation, but I I don't know what that is, and you should ask her what that is, get it, and call back and let me know, because I don't know. I don't know what that test is. I don't know of any test that you can do to guarantee that you're not gonna have prostate cancer. All right, guys, that's a wrap. I had so much fun talking to you today. Uh, remember the podcast has dropped, and it's called What the Health Is Happening. You can get it on almost any podcast platform. Make sure to email me or send me an audio message at info ataskdrv.us, info at asdrv.us. I'll be back next week right here to talk to you about your health.