Who should get a prostate biopsy? | Peter Attia & Ted Schaeffer

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This clip is from The Drive, 274 - Performance-enhancing drugs and hormones-risks, rewards, & broader implications for the public
In this special episode of The Drive, Peter is joined by Derek, a fitness educator & the entrepreneur behind More Plates More Dates. He is also an expert in molecules commonly used & misused by bodybuilders & athletes.
In this clip, they discuss:
- Who needs a prostate biopsy
- What if an MRI shows a lesion?
- PSA density
- And more
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About:
The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 70 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more.
Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan.
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[@petegodfrey5735]

Im 74, & dealing with the PSA roller coaster. God has done more through prayer than these urologits...

[@hypolitej]

I’m 71 and in 2011 my psa was 4 but I did not get a biopsy. My psa rose to 7.1 two years later but I still did not get a biopsy. Three years later my psa was 21 but still no biopsy and three years later my psa was 28 and still no biopsy. Throughout this entire period I experienced no difficulty or discomfort passing urine or pain of any kind. My quality of life from my view was unaffected. My psa declined first the first time the following year to 26.7. I still have no symptoms that bother me or affects my daily routine. No pain or obstruction symptoms and still no difficulty passing urine. I will be 72 in June and at this point don’t think I will ever get a biopsy unless something drastically changes to affect my quality of life. I respect the decisions taken by others as they see fit but for me these are my decisions for which I’m prepared to take responsibility. I’m left to wonder had I gone in for a biopsy 14 years ago what would have been my situation right now health wise at age 71 with all the risks involved. I feel no different now than I did 14 years ago.

[@Troyboy2121]

As an African-American. do you feel that the rising PSA levels are a concern? It sounds like your PSA was at the limit of 4 at the age of 58 and increased steadily over the years. Did you get an MRI?

[@physicsprof.9639]

That's good but of course it's all about statistics. Some smokers live a long time without getting cancer, but that doesn't mean smoking isn't dangerous. I hope readers don't take your experience to mean they shouldn't follow up if they have similar tests. Statistics of one case mean almost nothing.

[@MM-sf3rl]

The MRI will give you factual information and direct your next action: to have or not have the biopsy. The biopsy should be your second choice.

[@michaell3711]

​@@physicsprof.9639,,, Sometimes it is great to AVOID Doctors invasion of your person. I have proven that they're keen on saying "You need treatments " ..... Blah, blah, blah..... Sorry,,, BE your Doctor FIRST!!!!!!

[@MM-sf3rl]

@@thailandbuddy4451 What was your PIRADS? PI-RADS 1 - Very low (clinically significant cancer is highly unlikely to be present) PI-RADS 2 - Low (clinically significant cancer is unlikely to be present) PI-RADS 3 - Intermediate (the presence of clinically significant cancer is equivocal) PI-RADS 4 - High (clinically significant cancer is likely to be present) PI-RADS 5 - Very high (clinically significant cancer is highly likely to be present)

[@denniswhite5215]

I have had 2 prostate biopsies with no lesions either time psa was 7.2 and 10. That was 14 years ago. I have not gone back .

[@bocapete88]

I don't see the risk calculator link mentioned at 3:57 mark??

[@timelston4260]

Dr. Attia, when you interrupt your guest with the next question, you and he may be effectively communicating with each other, because you understand where the sentence he is speaking is going. But interruptions do not allow the guest to finish his sentences for those of us who need the whole sentence to be completed to know what he was going to say. The interview has to be for your audience, not for you and him.

[@abrahamkalichman6845]

All I have to comment on is , the repore that you have with your guests are extremely informative for anyone who has had the slightest fear of this subject matter. I value all of your discussions!

[@buckeye200175]

My psa around 10-11 past five years two negative biopsy and then a negative MRI

[@supportpyango]

Same here my friend. PSA of 10-12, 2 negative biopsies and multiple MRI's

[@petegodfrey5735]

Thank you for explaining so clearly!!

[@christishusbandakastan7618]

Very good interview/discussion.

[@tobyhammett6807]

Thanks for having these conversations, much appreciated - oh and I did buy your book sir :)

[@hugs92104]

Where can the risk calculator be found? Thank you!

[@DeuceDeuceBravo]

Where are the reference materials mentioned in this video?

[@DS62581]

What about PSA levels and TSH hormone? Hyperthyreosis might be associated with higher PSA levels. What about ExoDx Prostate test vs Prostate biopsy?

[@waeldeirki2152]

please advise me where may I find all these figures and statistics mentioned in the interview....

[@JuanPerez-bn2jo]

Any issues with delaying prostate biopsy a couple of months? In my area, earliest appointment is about 2-3 months out.

[@DavidDabbs-mz7ht]

The percent free PSAi s the ratio of the amount of free PSA compared to the total PSA level. The percentage of free PSA is lower in men who have prostate cancer than in men who do not. So when my Urologist refuses to do this test and only does PSA total, how can I calculate the present free PSA myself or is it possible?

[@charlesgair8608]

AT 65 I Had A Prostate Cancer That Was Gleason 4+4 And I Refused To Take The ADT Shot And I Got 4 Weeks Of EBRT And Permanent BRACHY SEED IMPLANTS .10 Months Later My Oncologist Said My PSA Was 0.3 And My Cancer Is Undetectble.

[@thailandbuddy4451]

Are you on any therapy now, such as Lupton injections. Lupron may be a testosterone blocker also.

[@charlesgair8608]

@thailandbuddy4451 No. I Refused To Go On ADT Hormone Therapy. But They Did Try To Get Me To Get On FIRMAGON Injections .All Have Brutal Side Effects.So Far It Looks Like I Definitly Made The Right Choice.

[@charlesgair8608]

@@thailandbuddy4451 FIRMAGON Is The Testoterone Blocker That The V A Hospital Uses.

[@jimpoole9800]

Has anyone found the link for the risk calculator?

[@janetw9430]

PiRad score of 2-3 with a 9mm lesion shows mild hypointense and mild hyperintense. Psa density of 0.063. Of a 83 cc prostate?

[@MbongeniMtimkulu-te7hu]

I like to know whether the prosted gland can be removed or not?

[@PeteHob]

Is it difficult to find a medical staff that will give general anesthesia before biopsy or do you have to really “ shop around” to find one?

[@hencape]

I've had 3 negative biopsies and I was scheduled for another in October. My PSA has gone from 5 to 11.5. Will I need a biopsy immediately?

[@BMT-by5ve]

I think i missed the conversation. If i have PIRAD 4 with,0.004 cm and PSA density of 0.07, PSA 2.5 on Finasteride, will require biopsy?

[@MM-sf3rl]

PIRADS4 indicates that “clinically significant cancer is likely to be present”. However, the PIRADS could be downgraded or upgraded. You should have an institution that deals with PC read the MRI. I would believe that a prostate doctor would tell you to have the biopsy. Only in the pathology report do you get the most clear evidence of how “significant” the cancer is that is present.

[@bluesky2145]

Where's the risk calculator guys?

[@markfll]

My MRI showed several lesions, so I had the biopsies done. Six of them showed cancer. I have 2, 4+5s. 2, 3+5s. 1, 4+4. And one 3+4. On the Gleason scale. My doctor told me I need to take care of this as quickly as possible.

[@crpunks]

Take care how? Removal or chemo? Or both?

[@markfll]

@@crpunks I consulted with both, and in my situation, opted for surgery knowing there's still a chance of needing radiation therapy down the road.

[@crpunks]

@@markfll hope everything goes smoothly and turns out well!

[@markfll]

​@@crpunks Thank you.

[@hamsterdangler]

I am 74 and am concerned that with a PSA of 17.7 and a prostate 7 times original size, it was noticed in a prostate scan that I had a tumour in the left kidney, tumour removal scheduled for the end of July but the surgeons are not planning a biopsy of the prostate until after the kidney surgery. It seems a long time away.

[@Ralphdc19]

I attended a talk by Dr. Scott Eggener of University of Chicago!

[@tonyberry850]

I refusedca biopsy with a uroligist when i was only 62 nothing since either at now 85 is thjs luck?

[@vs-yy5cx]

I am surprised he did not mention localized treatment of the cancers that preserve the rest of the prostate.

[@Freedom24560]

Doesn't a Psma pet scan, combined with a 3T MP MRI give you most of the critical information you need to go forward, without punching numerous holes in someone's prostate? Gleason scores are great, but are they absolutely mandatory? In addition, the biopsy procedure itself seems rather random and unreliable....."hit and miss".

[@markscholz1219]

Wish that the urologists were as forward minded as Dr Schaefer implies. Sadly, lots of surgeons and radiation specialists still recommend treating Gleason 6

[@Jim-ok9zi]

I have a question. Is there any side effects from the Biopsy.

[@brucecampbell6133]

It would be helpful if you would let your guest answer the current question before interrupting with a different question.

[@Adamas11]

💯 What a douche!

[@susandeehutton]

Very helpful, thank you! Pardon if I missed it but what is PSA?

[@Scottlp2]

Blood test for prostate specific antigen.

[@karlpk3907]

Prostate Specific Antigen. The test for PSA is standard. www.cancer.gov/types/prostate/psa-fact-sheet

[@creez1]

I'm not a doctor but I had prostate cancer. Prostate-specific antigen, or PSA, is a protein produced by both normal and cancerous prostate cells. Its main role is to keeps semen in liquid form so that sperm can swim. A simple blood test can measure how much PSA is present in your bloodstream. In almost all cases of prostate cancer the PSA level increases. It should be less than 2.5 ng/ml. Mine was 4.7.

[@Maiden4eva1995]

@@creez1 What age were you? Mine at age 30 is 1.3

[@creez1]

@Maiden4eva1995 I was 58. My PSA was increasing year over year and I was finally referred to a Urologist. They say one in nine men get Prostate cancer. It is among the most treatable and curable and like most cancers the earlier it is treated the better.

[@scooter29]

I had a biopsy and got sepsis. I’ll pass. I do MRIs now

[@onlineaccount63]

I'll put my trust in the math and science.

[@td4004]

Two prostate biopsies for me. I would not do it again. First, biospies only gather samples from half the prostate. Second, painful and expensive. Third, while most doctors would disagree, psa is a better overall indicator of a problem. Fourth, I wil go on Tippens Protocol before chemo, radiation or surgery. Fifth, inflammmation is not your friend is you have cancer. A biopsy creates a lot of inflamation in the prostate.

[@Clay54883]

Can I ask how old you are please?

[@AllenTweed]

What about 3+4=7? Inquiring minds want to know!

[@user-vv9np5iq7n]

Those 3 + 4 = 7 are a part of the biopsy pathology report and are for determining the Gleason score which is the aggressiveness of the tumor. The best is 3+3=6 because Gleason 6 never grows. Gleason 7 is by two ways: 3+4 and 4+3. 3+4 Gleason 7 means that the tumor is mostly Gleason 6 but has some aggressive Gleason 8. 4+3 means that it’s more of a aggressive Gleason 8 with a bit of Gleason 6. 4+3 types need surgery to treat their cancer.

[@threeftr3349]

@@user-vv9np5iq7n Your explanation is a generalization from person who does not specialize in cancer, your explanation "4+3 need surgery to treat cancer" is so absolutely incorrect.

[@threeftr3349]

Gleason Score 7 =3+4---Grade 2--Risk Group Intermediate (favorable) Gleason Score 7 =4+3----Grade 3--Risk Group--Intermediate (unfavorable) A Decipher Test-is a tissue-based genomic test that helps in treatment decision-making for localized prostate cancer. It uses the tissue samples from the biopsy. You can get a 2nd opinion of the pathology of the biopsy to check the accuracy of the Gleason Score Your oncology can order a 3TMRI of the prostate

[@threeftr3349]

When it comes to the possibility of cancer a doctor never says it will never grow Gleason score 6 is the lowest grade of prostate cancer. This rating means that the prostate cancer is considered to be low- or very low-risk disease, or group 1.1 Most of these tumors are found during routine prostate cancer screenings. Gleason 6 prostate tumors grow slowly and may never cause a problem-or even need treatment. Still, they should be monitored

[@normturcotte4206]

@@threeftr3349 YOU ARE CORRECT. The statement “4+3 need surgery to treat cancer.” Is TOTALLY FALSE.

[@Troyboy2121]

The makes no sense. If you have a high PSA and low Free PSA, but have a clean DRE, Pi-rad 1 or 2, and a low prostate density, you still need a biopsy. This process is starting to sound like witchcraft.

[@jaybrox1652]

The best solution of ANY kind of tumor in prostate if if it is 3+3 is to remove it immediately...the longer you wait the bigger and worse it becomes.Forget monitoring with treatments available today.I have plenty of experience with tumors talking for the sake of talking And gor sure I would NOT use this expert. Hahaha.