273 ‒ Prostate health: common problems, cancer prevention, screening, treatment, and more

[@PeterAttiaMD]

In this episode, we discuss: 0:00:45-Changes to the prostate with age & problems that can develop 0:05:56-Behavioral modifications to help manage nocturnal urinary frequency & lower urinary tract symptoms 0:15:08-Pharmacologic tools for treating nocturnal urinary frequency & lower urinary tract symptoms 0:26:41-Surgical tools for treating symptoms of the lower urinary tract 0:33:24-HoLEP surgery for reducing prostate size 0:42:06-Prostate size: correlation with cancer & considerations for small prostates with persistent symptoms 0:49:09-Prostatitis due to infection 1:02:28-Prostatitis caused by factors besides infection 1:09:33-How to minimize risk of urosepsis in Alzheimer’s patients 1:15:00-Prostate cancer: 5-alpha reductase inhibitors & how androgens factor into pathogenesis 1:24:10-Post-finasteride syndrome 1:33:33-The relationship between testosterone & DHT & the development of prostate cancer over a man's lifetime 1:43:21-Genetic analysis of tumors can indicate the aggressiveness of cancer 1:46:10-Genetic risk factors of prostate cancer & the use of PSA to screen for cancer 1:54:53-Non-genetic risk factors for prostate cancer 2:07:16-PSA as a screening tool: what is PSA, definition of terms, & how to interpret results 2:25:59-MRI as a screening tool & the prostate biopsy options 2:37:24-Ted’s randomized trial comparing different methods of prostate biopsy 2:40:45-When a biopsy is necessary, interpreting results, explaining Gleason score, & more 3:03:01-Implications of a Gleason score of 7 or higher 3:10:30-Metastasis of prostate cancer to different body locations, treatment options, staging, & considerations for patients' quality of life & survival 3:28:51-How prostate cancer surgery has improved 3:42:03-Questions to ask your neurologist if you are considering prostatectomy for cancer

[@arallskiant9923]

Great interview very instructive but it seems his view on DHT and finasteride (and its impact on prostate cancer detection etc) seems a minority stance. Maybe one should actually shows first the more mainstream stance on the subject or actually state that his stance is not the main one and provide actual evidence etc. because this narrative of PFS actually feed this psychopathology. DHT is a paracrine hormons that have no real positive effect in adults (otherwise grow beard in teens) unlike testsosterone for instance and finasteride only act on one isoenzyme. The few people who get PFS will solve on its own after a bit of time (even ongoing finasteride usage) or can be treated by lowering the finasteride dose or simply stopping it. The nocebo or "delusional disorder" (see Trüeb 2019) not related with the drug has to be treated with a psy.

[@JadenGregg-su9no]

2 REPLIES

[@fatalradius]

Dr. Attia, I can't speak for everyone here but I take Finasteride and I'm fine, my friend who's on it is fine, and so do millions of men. Perhaps you should try bringing in a doctor that has another opinion on PFS so that people can see both sides instead of one. The topic of Endocrine vs Paracrine is not even present with these Finasteride talks, which is kind of perplexing to me since DHT works as a Paracrine hormone.

[@fatalradius]

@@arallskiant9923 I agree, I am a long time Finasteride user, so is my close friend, and we find it very odd that there wasn't even a mention of Endocrine vs Paracrine in this talk. I'm reading some of the comments and all I hear are horror stories that is hard to believe.

[@leonchou]

This was such an in depth look into issues with a prostate. Thank you both for sharing this information. One note, I think the last chapter title above might have a typo (neurologist?).

[@goyo2897]

Dr. Attia: "Why wouldn't we do PSA tests every year?" The answer is because the medical profession has been guilty of overtreating prostate problems and ruining the lives of men who were not in any real danger from the disease. That is a fact. That being said, I agree: Do the test every year starting at 45. If you have a high PSA, it is critical that you study, read, learn, and make good decisions that include not being rushed into treatment unless it is clearly warranted. I respect Dr. Attia greatly but he knows exactly why certain organizations recommend advisements and precautions before men test their PSA... This is, by far, the best presentation on prostate cancer I have ever seen!

[@jimpoole9800]

Perfectly stated. This does not get said enough.

[@michaelswonderfulworld]

In Australia, is common every year to do a PSA with a full range blood test.

[@tmvga]

I am a Primary Care Physician with a family history of Prostate Cancer. This discussion was outstanding! Thank you for this public service.

[@kbkesq]

Don’t just rely on big medicine. kzbin.info/www/bejne/rofWdZWLlruLiKssi=FQefc_Zyw_N5dTmB

[@guitarhillbilly1482]

I am a major supporter of Annual PSA testing. Increasing PSA [doubled in 12 months] is why my Urologist did more investigation with PELVIC MRI and Pelvic CT Scan . PSA Density is an important number to monitor. My prostate was producing a high amount of PSA for its physical size. This led to a Biopsy which revealed PC in 4 of the 12 samples. The Gleason Score was 8 in the Lab. PSA post treatment after 3 years has been 0.1 No matter which treatment you select when treating PC there are short term and long term side effects. Each individual must make the choice on the treatment path.

[@tonynes3577]

Very comprehensive discussion but was grim towards the end with cancer / surgical discussion. The old saying that "an old man may die with cancer in their body rather than from the cancer" There was no talk about that. No talk about metabolic intervention such as Long term Intermittent fasting for cancer prevention. No talk about immunotherapy or even something like Rapamyciin for reducing the immune response. But great talk! Next step for me is an MRI which Kaiser Medical Center did Not mention or recommend for my high but stable, over 10 PSA, for over a decade. But I did have a biopsy over 10 yrs ago which was miserable for me and not necessary. I'm 65 years old now. Will listen to your Rapamyciin video. Thank you!

[@peterlewellyn2389]

Dr. Attica, I was given a death sentence that never should have happened, I w as having trouble urinating, at 76 years old. The urologist sent the camera up my manhood and said you will probably need a procedure to open up your urinary track because your prostate is closing it off. At that time, I mentioned to him that shouldn’t I have a Psa test? He said your last test was 1.28 so no, at your age and with that result it is not necessary. About 18 months later, I went for a procedure. As part of his pre-op the. Doctor did a Psa. He called me a few days later and told me the result was 134. An mri indicated the cancer had spread outside the prostate. You were correct Doctor, a cheap test, when I asked for it could have saved my life. WTF were the medical decision makers thinking?

[@Ethan.Brown24]

I struggled with prostate issues for years, dealing with pain and having to go to the bathroom all the time. I tried many different treatments, but nothing helped. Then I found a simple solution that didn’t require anything complicated. It worked almost right away! The pain went away, I stopped waking up so much at night, and I finally felt better. I can’t post it here, but it’s on my channel.

[@charuckshy]

If you cannot post it here , no thank you.

[@mitchellclarke2569]

⅞ĺ. U​@@charuckshy

[@afkVahn]

Thanks DR Attia for speaking up about PFS. I have been chemically castrated for 4 years with (physically) numb shrivelled genitals. Cannot feel arousal anymore. It’s hell and not a day goes by I don’t think about suicide as a result. I’m an otherwise young healthy male. Life ruined and nobody believes it. Please help us raise more awareness.

[@vulcan2519]

Just by taking finasteride?

[@ftroop8462]

@@vulcan2519 PFS is a reaction to stopping finasteride, usually after side effects become unbearable. It can do permanent life-changing damage.

[@mohanish]

Have you tried porn arousal therapy (PAT)?

[@JadenGregg-su9no]

​@@ftroop84623 REPLIES

[@gutsssz]

PFS does not exist, it is biologically and physiologically impossible because after stopping the drug, the 5AR enzyme is no longer inhibited, meaning testosterone will continue to be converted to DHT. It is all in your head, seek psychiatric help, these past four years of you being "chemically castrated" is nothing more than some delusion or some other health disorder causing it.

[@stephenpisani1730]

Hi I'm 65yrs young and for the last 14 months my psa have been 12.4. My Urologist sent me for an MRI scan and the results came back showing inflammation and enlarged prostrate. My Urologist informed me that i have prostatitis. I asked for a biopsy and the Urologist was against the idea as their is no target for the biopsy needle. Im a touch nervous as both my Dad and Grandad both passed away with prostrate cancer. Im contemplating paying private to have my prostrate removed as its giving me much anxiety. I had a psa blood test yesterday 2 months after my last blood test. Results next week. Praying the psa levels have come down🤞🏿🙏

[@edinburgh1578]

I'm 67 and have had a PSA between 10 and 20 for 3 years now, same MRI results. A prostate Inflamation will send your PSA haywire. My first MRI came back with PIRADS 3, the second, just week ago, with PIRADS 2 . I think your Urologist made the right call. Stay calm and keep an eye on things. I know it sucks. Those afternoons waiting for my PSA results are nerve racking!

[@stephenpisani1730]

@@edinburgh1578 Thank you so much for the info. Must admit I'm feeling a touch better already. But yes definitely keep an eye on the situation. I'm due a blood test end February, got a gut feeling my psa will be 12+ but will take another MRI scan and check it all out. Good luck at your end🙏

[@Moral_Medicine]

Thank you so much for covering PFS, Dr. Attia. Our channel features patients that have absolutely had their lives destroyed by this horrendous disease. Unfortunately, PFS goes far beyond just sexual symptoms. We've featured people that are suffering with muscle wastage, joint issues, genital shrinkage, head pressure, severe cognitive impairment, insomnia, muscle twitching, stretchy skin, speech disturbances, body composition changes, and a myriad of other debilitating symptoms that have unfortunately resulted in career and relationships losses for many. This is an urgent issue that needs to be addressed.

[@welanduzfullo8496]

NOT A THING BRO

[@Mperry3579]

Thank you for this very interesting discussion. My husband's Dad and younger brother both had PC. My husband recently went through a biopsy after an elevated PSA of 4.5 and enlarged prostate . Biopsy was negative for cancer and they want to see him again in 6 months. We will definitely be asking about MRI in the future.

[@aim4723]

I have had PFS for 3 years. It ruined my life. The medical field is way behind on this issue, needs to be addressed urgently

[@augustnkk2788]

There is 0 proof PFS is a real condition. You might just be psychotic

[@TrustandDo]

You tried to heal the symptoms?

[@welanduzfullo8496]

no you dont

[@MUST-TRT]

This Doc Colleague/guest of yours is Magnificent! Thank you both for this amazing episode. 🙏 Worked with and have had various mentors in the health and medical field and this gentleman is probably the most meticulous, logical and articulate physician I've ever heard speak about their given scope of practice/expertise. Truly amazing! Will re-watch and share this with my dad who recently has finished his 8 week plan of proton therapy for prostate cancer. Looking good and God-willing it will be cleared fully at his checkup.

[@danschreck834]

This is the absolute best segment ever, thank you doctors.

[@pontussoderqvist3840]

Thank you Peter for asking all those questions many of us have and can afraid to ask. All respect and admiration to dr Schaefer for sharing his knowledge and honest opinions .

[@LowKey657]

tHESE DUDES ARE THEY PUBLISHED?

[@DavidDabbs-mz7ht]

He didn't mention that some countries no longer do biopsies thru the rectal but go in thru the base of the penal. He also dismissed any use of nutraceuticals as being effective. Lifestyle choice is a great factor in a healthy prostate I never hear these experts start with health and healing.

[@Lolipop59]

It wasn't time to mention everything about this huge topic. One cannot cover the entire topic in 3 hours .

[@andywilson5677]

Thanks for talking about PFS Dr Attia. I have something similar known as PSSD (Post-SSRI Sexual Dysfunction). It's not just sexual dysfunction, it also affects your emotions and personality. I feel like a shell of my former self. Some people go on to commit suicide after getting it because people don't believe them and they are living a nightmare every day. It might be epigenetic changes that cause it but we need more awareness and research to find out. People with these conditions just want to be believed and listened to with compassion. Unfortunately it is very often blamed on mental illness and those affected have no way to prove otherwise.

[@proddreamatnight]

As a 30 year old this topic is something that I never think about but I know I'm going to have to at some point. This is extremely valuable

[@nickstrapko7549]

Definataly when you get over 40 if not earlier start getting a psa blood test with a yearly physical .

[@jp7357]

If I was 30 agin, I’d invest in a battery of tests to establish a “healthy” baseline. Standard panels (CBC, CMP), complete lipid panel, glucose, insulin, PSA etc.

[@JohnCircens]

Thanks Peter for this discussion. My prostate was monitored for 3 years then it became aggressive. So, I had surgery to have it removed. Post surgery, my PSA jumped to 6 despite having a clean PSMA which baffled all of the doctors. Even thought my insurance denied it, I am having a third PET scan with a AXIUM to see if it can detect the C. As soon as we can see it, I’ll undergo radiation. Your video provided me with a good overview of the entire process. Thanks again.

[@AC-ns4gu]

Thank you so much for talking about PFS. This condition is destroying lives all over the world. I’ve been suffering for 4 years. This condition is ruthless. I pray we can get a cure or treatment one day. Life isn’t worth living with severe PFS.

[@billfisher8647]

Jesus will heal you

[@brianrichards7006]

Dr. Thomas Seyfried has had great success in treating all cancers as a metabolic disease. I personally would go to a clinic that followed his protocols, and undertake the therapy before considering a prostatectomy. I'd love for Dr. Attia to interview Dr. Seyfried.

[@jp7357]

I’m going to listen to this again. 66yo, just saw a urologist, my PSA is low (0.7), I got “the finger”, “you have a tiny prostate” nice to know, then I read that small prostate are more susceptible to aggressive cancer. WTF it seems you can’t win.

[@jimg7010]

It is very strange that these MD's don't discuss the "newer" focal therapies (HIFU, cryo, laser ablation). This is typical of our health care "system" and the doctors who buy into it. It is all about the money - use the expensive robots, use the expensive radiation technologies....use these techniques to generate revenue. this discussion is evidence that most urology practices are part of a broken system that includes the FDA (hasnt approved focal therapy so it doesnt get paid for by insurance or reimbursed by CMS....even tho in use in the EU for almost 20 yrs) This is just shocking. Duke, Mayo, Cleve Clinic are all now offering focal therapy for private pay. Peter, why would your expert guest not even mention this as it is giving alot of men hope that their lives wont be destroyed (incontinence, impotence, depression...from being maimed by surgery or radiation)? Terrible podcast Peter. Not up to your standard.

[@onomatoleahs1094]

Would like to see response from Podcaster to this question.

[@NA_Hemi]

I am going in for high PSA in a few weeks. If it is cancer I think the HIFU sounds really good.

[@33vi]

I would love to hear Peter discuss laser ablation or ultra sonic ablation therapy as well. My father was recently diagnosed & his urologist didn’t mention ablation when asked about any alternative treatment. She only mentioned radiation & prostatectomy. I found a medical group named sterling in Florida that does the ablation therapy but out of pocket you’re looking at roughly $30k. It makes sense that Medicare/FDA won’t approve so Insurance doesn’t have to pay. The men that had ablation procedures done at sterling have left stellar reviews & it appears to be a really great way to treat prostate cancer without being so invasive…especially if you have a soft 7 Gleason score. The system is broken to a certain extent!!

[@NA_Hemi]

@@33vi Are you kidding no Medicare or insurance will pay for it ??

[@markportu3634]

@33vi focal procedures are starting to be covered. Double check.

[@wilznimbwen2719]

Thank you so much doctors Ted and Peter for the interesting, powerful, knowledgeable and challenging discussion on the topic of prostate problems and so forth. My late dad has had this problem and had died 3 years ago, I wished we would have known experts like you before, so that we could have proper advice and better treatment. However, all the praise and glory to the one above for yous. You're a great and awesome blessing to everyone in this area of concern.👍👏👏💯🙏🙏❤️

[@stampwithct]

I'm so glad I found this video. My husband was diagnosed with prostate cancer today. Very informative. Thank you so much!

[@karenleh7795]

My husband was diagnosed (after bx) he is a Gleason 6 Urologist recommends prostatectomy. He's a healthy 71 yo. Wondering why not active surveillance or radiation tx?

[@ethanbaggoo1513]

Thanks for raising awareness about post finasteride syndrome

[@Yiahi65]

Post finasteride Syndrome is terrible man.. I do not wish that on my worst enemy

[@notdisclosed4597]

Super video, thanks Drs. Attia & Schaeffer. pca patient here early in second bcr. prostatectomy, salvage and hormone therapy, diagnosed : age 51, gleason 9, epe, positive margins etc...

[@JetPackFlame]

Current PFS research suggests epigenetic changes are the likely cause. The androgen receptor appears to be persistently over expressed in this condition. Symptoms go beyond those discussed here.

[@fcwins6400]

Are we optimistic this can be reversed?

[@Yiahi65]

@@fcwins6400been in the community awhile many ppl recover eventually some get pudendal nerve surgery others at lest improve and you have a subset of people that are at the point of no return. I think with future medicine it will be reversible for all.

[@ovidiuvelican6823]

Does not upregulated meaning increase in this case ? So my question why is bad to have more androgen receptors? I think the problem is down regulated, there was no need of that much androgen receptors because we cut DHT by using fin, and our body dow regulated the androgen receptors. Same case when someone start using exogenous testosterone, the body detect enough testosterone and stop producing naturally.

[@JetPackFlame]

@@ovidiuvelican6823That seems to be part of the problem. Upregulation may lead to a paradoxical reaction by which the body can’t detect androgen signals correctly. This is just what has been hypothesised thus far based on the findings, obviously more research is needed to get a full picture. Amplification of AR is attributed to some other diseases, including prostate cancer.

[@ovidiuvelican6823]

@@JetPackFlame For how long you deal with PFS ?

[@miaash3870]

Fresh garlic/DAILY All men ought to include it in their diet!

[@MC-oz5px]

Thank you Dr Attia for adressing Post finasteride syndrome. Countless lifes have been destroyed by finasteride, and still some refuse to accept the ovewhelming amount of evidence. On behalf of tens of thousand suffering people, thank you for speaking the truth in such an intelligent and professional way.

[@んムムÐタモモ]

This is Day 25 of my 1mg finasteride per day

[@seriousbees]

@@んムムÐタモモ If it works for you, keep taking it. I've been on it for 7 years, no symptoms beyond the first few weeks

[@augustnkk2788]

WHAT EVIDENCE?

[@EmreY25]

there is no scientific evidence.

[@kenadams5504]

@@EmreY25Plausable anecdotes from thousands of actual people doesn't strike you as relevant !?.

[@lgingermcdonaldfrederiksen7437]

EXCELLENT! Soo very glad that men are now able to maintain their quality of life and sexual health!!! As a gyn specializing in hormonal and sexual wellness....it is of utmost importance to uphold sexual intimacy in our aging, motivated and still very active couples!!! Thank you for this extensive detailed and data driven review....

[@TBarlan]

Thank you for once more acknowledging PFS Dr Attia. I have been dealing with life altering mental, physical and sexual symptoms for over two years now after only taking finasteride for a little over 3 weeks. My life is entirely unrecognisable to that which I was able to enjoy before taking the drug. One of the few things which is preventing me from committing suicide is the increased recognition which the disease is receiving. Of the medical professionals which I have seen, about half had heard of the condition. I hope that increased recognition will eventually in many years lead to a treatment, but also increased recognition may lead to fewer young men ending up with this rare but incredibly debilitating condition.

[@catfunt3404]

I heard trt regardless of age completely cures it and a doctor might be happy to put you on. Try more plates more dates “should you take?” finasteride for into its somewhere in there

[@walterski8377]

​@@catfunt3404what did you say here?!

[@garygermaine109]

Nice informative piece on the negative effects of Finasteride! It throws the chemical/hormonal system off balance and leaves a lot of young man and their families struggling to understand what is going on and puts the financial burden on them to pick up the pieces!

[@augustnkk2788]

It doesnt throw the endocrin system of balance, it simply reduces DHT and increases testosterone

[@radim279]

@@augustnkk2788Yes. And those are hormones. Part of the endocrine system. Being thrown out of balance. Hence the one in ten poor bastards who have persistent side effects.

[@raymondwade2433]

My PSA recently increased from 1.2 to 4.6; eager to listen to this discussion.

[@obsidian66]

Mine: 55 yrs old 2019 1.8 2021 2.35 2024. 5.15. (This week) But I had sex the day before and surfed 13 out of 16 days in fairly large surf so my body was really worn out . I read physical activity could cause the number to raise. Each surf session was 2-3 hrs and sometimes 4 hours. It was a good late fall. Lol

[@obsidian66]

I’m concerned to say the least

[@jirihutecka9020]

From my own research it looks like iodine deficiency is huge factor here.. Prostate cancer is driven by high estrogen and high estrogen depletes iodine because the body is using iodine to metabolize estradiol to less potent forms of estrogen that can be eliminated from the body.. Same goes for breast and ovarian cancers in females.. I am giving my mom just one drop of 2% lugol solution and her breasts are in perfect shape(her doctors says) + she is so much leaner even when she eats sweat a lot.. I give her other things like selenium, zinc, molybdenum, B1, K2 etc.. But I would say that the iodine is doing most of the job to prevent any issues related to estrogen inbalance. Estrogen drive cancers are very aggressive.. My grandfather had prostate cancer, my father as well.. They had no iodine in their diets.. Will see if I can change "my destiny" by taking some iodine..

[@orbifold4387]

Why weren't they using iodized salt?

[@jirihutecka9020]

@@orbifold4387 the amount of iodine in salt is good maybe to prevent goiter. Not prevent estrogen driven cancers.. You need to understand that iodine evaporates easily into the air. So by the time you consume that salt there can be hardly any.. For the benefits I am talking about you need dose in miligrams not micrograms.. You have to keep in mind that all human cells need iodine not just thyroid and also the more toxic you are with other halogens (fluorine, bromine, chlorine) the more iodine you need to detox them and also heavy metals deplete iodine so if you have amalgams for example the mercury from them deplete selenium and iodine from the body.. When I first started with iodine I felt crazy detox symptoms from iodine pushing out of the tissues all the antagonistic toxins. In my case mostly mercury from amalgams(which I no longer have fortunatelly) and my stupid high mercury fish consumption.. Now I don't even look on fish like tuna... Btw I am not saying that iodine is the only key factor for prostate cancer, but it can be major one.. But you don't hear about it from doctors etc.. Because it will not make them any money. I mean I buy bottle of lugol solution for 14 dollars and it lasts for years if I dose lets say 3mg a day... Which I do now because it looks like people from Japan have intake around 1-3mg from sea vegetables and fish and all that sea stuff. So to me it shows that around 3-4mg can be considered natural dose.. Some people take crazy doses like 50-100mg. But that can be dangerous and from my experience it is not a good idea to take any micronutrient in crazy high dose. It can throw the whole body off balance.. Hair tissue mineral analysis is great for finding out what is the status of elements in the body..

[@apothos666]

I'm cautious about taking iodine since I have Hashimoto's. I wonder if it can have any negative effects

[@rberka555]

Attia doesn't mention iodine once in a 4 hour video on the prostate gland. That's insane. He studied at Stanford Medicine and John Hopkins. It's scary this is how we're minting new doctors today - without a basic knowledge of nutrition.

[@jirihutecka9020]

@@rberka555 Yeah they are all about genes and nonsense, but they have no idea about basics like what is the role of each element in the body if it's deficiency of minerals or toxicity of them or toxicity of metals etc.. Modern medicine doesn't care about things like that AT ALL, because you can patent use of mineral/vitamin and because telling people take this or that mineral will make them ZERO money. I have bottle of lugols Iodine which is like 15 dollars and it will last me for years... Nobody is interesting in "products" like that hahahah... It is funny how Attia and other "longevity experts" think that they have the key for longevity etc.. but have no idea about element balancing. Which is the most basic factor to stay healthy. Elements are base for enzymes, hormones, detoxification etc..

[@rogerbritus9378]

What an impressive wealth and depth of knowledge made simple and understandable. Congratulations to you both.

[@thb6680]

Mother’s husband passed away 2 days ago of radiation induced bladder cancer. 20 years ago, he had prostate cancer radiation seeds. His doctor said 16-20 years after this treatment men are developing bladder cancer.

[@guitarhillbilly1482]

If a man is diagnosed with an Aggressive form of Prostate Cancer then Radiation is one of the options for treatment. Any honest Medical Professional will inform you that there is a possibility of developing a Secondary Cancer as a result of the Radiation Treatment. I was faced with this very decision and chose IMRT knowing this info before starting the treatment. Doing Nothing for me would have been fatal so I was willing to take the risk. Surgical removal was an option but I did not like the possibility of immediate long term side effects and sometimes after a prostatectomy it still has to be followed up with Radiation. 20 years is better than 18-36 months with an aggressive form of prostate cancer. Every man has to make their own decision when faced with this diagnosis. No matter whether surgery or Radiation is chosen serious TRAUMA is being inflicted to the pelvic area of a man's body.

[@insane_jarvis_9857]

2:42:45 I think Dr Schaeffer meant to say "a PSA density that is ABOVE that threshold" but he actually said BELOW. Can anyone clarify?

[@MSAli86]

Peels from citrus fruits like lemons, limes, grapefruit etc. help with urine frequency at night. Apparently it contains an aromatase inhibitor which helps slow down testosterone converting into oestrogen which helps prevent the prostate gland from swelling. Don't know if it actually is the case but it helps me after only 2/3 days of making a smoothie with a whole lemon in it.

[@blacktaxi2d]

This is interesting, never heard that. I personally have not very high E (measured by LCMS) but still wake up to pee a lot. 35 yo. I can’t see how this is it in my case

[@nichtsistkostenlos6565]

This is pretty counterintuitive because I know that foods that are high in acidity are actually bad for people with overactive bladder, it's not the same issue, but I don't know why it would have an opposite effect on people with say an enlarged prostate. Are there any studies on this? I can't find any.

[@ken4924]

​@@nichtsistkostenlos6565Actually, I think that lemons, while initially acidic are later converted into an alkaline state after digestion and have an alkalizing effect on the body.

[@MSAli86]

possibly prediabetes?@@blacktaxi2d

[@darcybrown7369]

WOW ! - exceptional discussion, so much information, all worth listening to for any men or people who care about the men in their life.

[@pinotwinelover]

That's the surgeon I visited with although I did not go with surgery. I went with focal treatment with a Glisan 3+4 but if you're looking for a highly qualified, amazing surgeon that's the guy.

[@Cathy-xi8cb]

Waking to pee 1x/week for any adult, with any condition, is normal. Consider addressing NOCTURIA by avoiding food and beverages that irritate the bladder lining. You guys don't need more urgency. These include spicy food, caffeine, alcohol, and citrus foods. Do NOT become dehydrated in your effort to lower urgency, because you are acidifying your urine; major bladder lining irritant. You will get up, but not pee very much. Then get frustrated and be unable to fall back asleep. That triggers urine production, because being alert stops ADH release....AGHHHHH! And of course guys w/BPH, you now are as vulnerable to a UTI as ladies. Big problem: the prostate acts as a sponge for bacteria, holding onto it after your 10 days of antibiotics. So if you are getting chronic UTIs, you may need 14 days or more to kill off the bacteria in that sponge.

[@markseelig4719]

Hello Everyone, This stellar podcast convinced me to book the HOLEP procedure with Dr. Krambeck at NMN Chicago. I got it done yesterday. She and her team are the absolute best one could wish for. This comment comes with much gratitude to the amazing doctores Peter Attia, Ted Schaeffer, and Amy Krambeck.

[@walterski8377]

Great info!! (Attia pls stop interrupting, let him finish his thought, you will have a chance to answer)

[@BenK64]

He's definitely a smart guy, but I too get so frustrated with his interruptions. It's the main reason I don't follow him that much any more. He should clam up and let his guests speak.

[@westfield90]

Thank you Peter for always asking the questions that everyone in the audience would be asking.

[@keithinwr]

PhD. Bruce Hollis has done a lot of research showing how high enough Vitamin D levels work great against Prostate Cancer. It takes a much higher level than most Dr's would consider having their patients attain.

[@ianmcdonald8888]

Thanks for doing such a brilliant and informative episode.

[@carendilauro3114]

I can not find the mentioned "prostate cancer risk table" in the notes. Can someone please post the link?

[@westfield90]

Honestly a lot has changed in the field of urology but not necessarily for the better. New meds haven’t been developed and still the field is depending on the alpha blockers and finesteride class which work average at best with many side effects. Then you have a whole variety of procedures like staples, water vapor, green light and embolization and yet none of them match the gold standard of Turp which still sounds scary to most men. Furthermore most of these new procedures may need repeating or don’t make too much of a difference especially with large prostate sizes. Furthermore each urologist has their own favorite because they were trained on it and not necessarily on its best efficacy. Finally we still rely on the PSA where each year a study is published contradicting the previous study in its usefulness. So the field seems lost. I wish a new gold standard procedure would be developed or new effective meds would be developed with perhaps less side effects.

[@ricknowak4582]

I am seventy years old and my p s a two months ago was ten. A month later it went up to twelve. Had a M r I. I have a medium size lesion on my prostate. He wants to do it biopsy. Which I don't like! Take twelve pieces out! I play tennis daily in excellent shape. Don't drink or smoke. But urinate at least seven times a night! But I always urinated at least three times. My whole life! Any suggestions would be very thankful! I'm doing research and all these therapies seem to be ...... a "REVENUE GENERATED BUISNESS (DISEASE)!!!! with a lucky " ROLL-OF-THE-DICE" chance .

[@westfield90]

@@ricknowak4582I think most of these therapies are aimed to help with BPH but not for possible cancer. I wish you luck. I feel this is in my future as my uncles had prostate cancer. But I’ve had a 14 core biopsy two years ago and they were negative but biopsies are not always conclusive since they may have just missed the spot where the cancer lies

[@evelynramos445]

Thank you Doctor, be your advocate! Careful

[@whosoever316]

Where is the link to the table (family history) mentioned at the very beginning of the video?

[@josephnessschmoe2864]

30:00 my brother did this, "doctor" did too much now leaks all the time I'm not understanding what's going on. He's having a rough time

[@Epictetus1980]

I’ve had PFS symptom for 5 months now with no signs of improvement. The condition is very real and debilitating. I’m so grateful that Dr Schaeffer is not dismissing the issue like so many of his colleagues. We’ll be seeing more cases in younger men as finasteride is marketed as a safe hairloss remedy. I should add I took the topical version from Hims.

[@JStiehl]

Dang I thought topical was safer.. how long did you take it?

[@Epictetus1980]

@@JStiehl I was on oral on and off for years. I had low libido and mild ED issues. I ignored it for awhile but then switched to topical when “KZbin research” showed it was safe and wouldn’t go systemic. I used topical for about three months when my dong went completely numb. My orgasms became painful. I immediately stopped and a few weeks later I “crashed” and everything went to hell. Several guys on the PFS support group got it from topical only. My personal belief is PFS is rare but if you get it you’re life as you know it is ruined. I’d rather be bald. I mean look at those two handsome bald devils up there! There are a lot of symptoms one of which is excess fat, muscle wastage and exercise intolerance so even if you’re ok with being bald and fit that becomes impossible.

[@BrianSladek]

Topical is just as bad if not worse, I took oral on and off from 24-28 with minor sides and then did topical at low dose. Sides just creep up gradually. I had a bunch of scary panic attacks with very high heart rate and was in the ER 3 times a couple months. That caused me to quit for good. I had some minor flare ups, but thankfully my body bounced back as it always did after quitting. I am just on minoxidil now. DHT is a very important hormone in many many things and it is not studied enough. Too much information online says it is bad. My testosterone increased 200 points from 540 to 740 2 months after quitting. I am 38 now and at least the experience has led me to exercise regularly and eat healthy always. My heart goes out to those who did not bounce back, but give the body time to adjust. Cutting out all added sugar, daily vitamin, fish oil, and walking or exercise everyday helped a lot

[@corinm6567]

A very important factor to note is that finasteride inhibits the 5 alpha reductase enzyme. This enzyme does more than just convert testosterone to DHT. Specifically, in the brain it is upstream to the production of allopregnenalone, converting progesterone into and intermediate neurosteriod which ends downstream in allopregnenalone. IV allopregnenalone is used to treat post partem depression in pregnant women whose progesterone levels crash after giving birth. This is most likely the culprit for the majority of PFS symptoms in my view. I pray this helps all who see.

[@joshnilson]

So you're saying you never took it orally?

[@Sold_a_dummy]

Jamaican here, I was told we tend to have a higher than usual occurrence of prostate cancer. Some think it is related to Ackee.

[@KINGGOD69]

I was told ackee was actually good for the prostate. I would say african/Caribbean people are more prone to prostate issues due to our diet. I lost my dad to prostate cancer. He was from Barbados we don’t eat ackee at all.

[@joetoocool]

I wish there had been a deeper discussion on non surgical procedures, such as HIFU - High Intensity Focused Ultrasound. Non invasive, no recovery.

[@Lolipop59]

For what condition is used that kind of intervention? Thank you.

[@robertciancio3239]

Great Podcast Peter. Probably the best on this subject in awhile. Throughout the podcast there was mention to add links to bottom for various items that were discussed. I dont see any links to any of Dr Ted Shaeffer items. Sometime "Show Notes" were mentioned. Thank you.

[@BobRiley]

Is there a better way to do a prostate biopsy than to the one with the needles through the rectum biopsy?

[@tango-bravo]

Thanks for talking about this

[@rickjust]

none of the slides and case studies are in the show links as you said.

[@sandromasucci3354]

Very informative. High level conversation on the topic.

[@blakemalin2597]

PFS is horrific. Needs to be looked at

[@jimo50]

The argument that yearly PSA testing after 40 can (and possibly even should) be avoided based on the likelihood of PCP’s not knowing what to do with the information is telling. Peter is correct, PSA trend is the most valuable part of the test. I’ve never heard a better example of why patients need to educate themselves. Men in particular, out of fear, generally don’t want to know any details about their health. Thus being entirely at the mercy of their doctor, which is insane.

[@user-eg1sw7kd6g]

Median Lobe HoLep: My only issue is a large median lobe which protrudes into the bladder and essentially blocks Flow. Is it recommended to do a full HoLep when the median lobe is the only issue? Information and discussion of ml-HoLep is not easy to find. Any references to ml-HoLep? Ultra Sound Prostate size 55 g.

[@tonytrimbolijr]

Thank you for covering PFS. It’s an unbelievably life-altering condition that doesn’t get recognised at all. Symptoms are many and much more broad than just libido issues; most MDs know nothing of it and the ones that do can’t help.

[@augustnkk2788]

It doesnt get recognised because there are 0 studies confirming its existence and most dermatologists dont believe its real.

[@NA_Hemi]

@@augustnkk2788 What is PFS, I don't recall hearing it on the podcast ?

[@augustnkk2788]

@@NA_Hemi It stands for post-finasteride syndrome. Its a syndrome some people believe exists, they say it has terrible, usually sexually, side effects for people who have taken 5-ar inhibitors. The problem is that the vast majority of researchers and dermatologists dont believe it is real and the side effect incidents, in quality studies with over 1000 people, are very low, around 0,5% after 5 years. And no one reports anything close to "PFS".

[@andywilson5677]

@@NA_Hemi Post-Finasteride Syndrome. It's long term damage that some people experience after taking finasteride. There are a few channels on youtube that have interviews with people who have it.

[@DCGreenZone]

Conclusion: This study confirmed that prostate cancer risk decreased with increasing duration of metformin administration. Metformin should be considered as a new strategy in the treatment and prevention of prostate cancer characterized by heterogeneity.

[@Rockster1989]

No mention of the Prostate Cancer Prevention Trial, in which 18,882 men were randomly assigned to receive finasteride or placebo for 7 years. The study’s primary end point - the prevalence of prostate cancer during the 7 years of the trial - was met: the relative risk of prostate cancer with finasteride was 24.8% lower than the risk with placebo ???

[@w00t3r]

What about prostate massage?

[@pinotwinelover]

I just went to Dr. Schaeffer for my prostate cancer very reasonable professional which I love both the research aspect of his work and his surgical work although I'm not sure with my Gleason 3+4 I want to do the surgery but if I did it would be with him

[@mikezieminski2355]

Excellent. But how come the digital probe was never mentioned?

[@MrKomadant]

My father have Prostate Cancer . I am 37 years old . When I should start with PSA checking??

[@rodneypeck197]

Yes get PSA test every year. I found My prostate cancer at 46 from a PSA test.

[@christophermoore1776]

Are there any herbs or foods that nourish and possibly shrink the prostate?

[@DesignCutters]

I'm curious about and considering having the PAE procedure done. Wondering if the x-rays during the entire procedure will have a negative effect. PAE is prostate artery embolisation for those that don't know.

[@StevenLewis-u1j]

About 2 hours 45 minutes Dr. Attia says the cutoff for prostate cancer concern is a PSA density "point 002." He should have said 0.2. Wish there was a discussion of benign prostate nodules and their treatment. Why no mention of Vitamin D and risk of prostate cancer in African Americans?

[@carlor.s.4742]

I had green light surgery for a 35 gram prostate. In this technique the tissue impinging on & around the urethra is vaporized by laser. This is supposed to be the gold standard, although never mentioned here. Apparently this technique was developed at McGill University in Montreal.

[@oliver.straka]

This is for bening prostatic hyperlasia..not curative for diagnosed prostate cancer. They are talkin about surgery for diagnosed prostate cancer - radical robotic prostatectomy.

[@carlor.s.4742]

@@oliver.straka They were talking about Turp & Holep(?)-- this is an alternative.

[@Lolipop59]

For what condition did you have green light surgery? Thank you

[@carlor.s.4742]

@@Lolipop59It was for an enlarged prostate that made urinating difficult.

[@guitarhillbilly1482]

In my area of the USA HoLEP is the Gold Standard for surgical intervention of BPH. If I ever need Intervention I would NEVER CHOOSE TURP.

[@edinburgh1578]

A wealth of information here! I can't thank you enough!

[@andrewnicholas3715]

Amazing Podcast and timely for my father and father in law. Would love an episode such as this on Chron's disease of which I suffer from.

[@OliverEmmero]

About prostate cancer surgery, don't you use irreversible electroporation (IRE) that involves the use a NanoKnife® device in the US? To my understanding It does not have the side effects mentioned here. It is a standard treatment at Heidelberg, Germany

[@schmingusss]

Can this Holep procedure be used to remove prostate cancer from the prostate as well? i.e. instead of a prostatectomy or radiation?

[@stacys447]

Would love to hear more about urology for women. It seems to be way less understood and parallels the hrt discussions around estrogen and hormone deficiency of menopause.

[@JoeBtfzplk]

Regarding the difference in cancer rates between blacks and whites, have there been any studies regarding Vitamin D levels? Has there been a study comparing African American men compared to South Asian which have similar melanin?

[@anonymuz7791]

Thank you doctor ! We pfs sufferers really appr it.

[@vleldaddio210]

My doctor sent me to Urologist who said i needed a biopsy I feel pressured my ins denied an MRI so he wants to do the needle through the rectum procedure but at 71 yrs I feel it is a risk especially infection so im not really too intused about it probably will not do it !

[@secretcinemalagos5662]

incredibly important info. thank you both

[@Savedbyhuskies]

Mangione is a hero. He has possibly sacrificed himself for his country’s future. I hope he walks and soon. Sometimes change only comes with a radicalization. He is shining a necessary light on a cancerous industry. Doctors should not have to answer to a dollar!

[@lancewillingham1479]

Fantastic presentation. You still need to define some terms and acronyms for those of us that are science/medicine savvy, but not medical practitioners. Would help bring us along a little better and improve our full understanding. Thanks.

[@fhowland]

FANTASTIC audio. (And a great interview). 👏

[@leclaireguy263]

thank you Doctors very much that was incredible and a lot to take in! luv yah xx

[@christishusbandakastan7618]

Very helpful discussion. Thank you for posting.

[@kenpe1455]

Thank for talking about post finasteride syndrome, it's a true silent epidemic going on right now especially with young men who are lured into taking these hairloss drugs by big companies.

[@BioRimedio]

Ciao è possibile intervenire su questa sintomatica anche attraverso prodotti biologici naturali specifici biorimedio😊

[@schnauzer777]

Excellent podcast -thank you

[@allanpatterson7653]

Is there any benefit for older males to have an Orchiotomy or a theraputic Castration. Would that lower Cancer risk? It looks like a simple procedure .

[@semacaa]

Do you think it matters how much coffee you drink, like 3 cups of coffee or one shoot of espresso , any difference? Like the amount of the caffeine matters?

[@ArthurMoore-ii8nn]

I've read that black coffee may have a protective effect due to the relatively high levels of antioxidants.

[@ngg9366]

Dear Dr. Attia: Every time, EVERY time you interrupt your guest, you stop him from saying something more interesting and probative than your own question, comment or remark.

[@jonkerbs3265]

I agree.

[@JohnnyB92]

That's the one thing that Joe rogan has honestly mastered. He has incredibly good listening skills

[@Jessica-kk1cz]

Completely agree. It seems Dr. Attia is competing with his guests, trying to seem smarter or in control of the conversation, instead of just listening and learning himself. Smart people are the ones who learn more than instruct.

[@Jessica-kk1cz]

@@JohnnyB92Agree. While I don’t agree with Joe Rogan on many things, he does indeed have very strong interviewing skills.

[@williamhenry3337]

Just watch cat videos.

[@bnjmn_smth]

Why not recommend annual PSMA PET scans?

[@mrwilliamson62]

61 yo male PSA 30. (Up from 27

[@schmingusss]

Some research into diet shows that psa doubling time can be dramatically reduced by switching to a plant based diet.

[@mrwilliamson62]

@@schmingusss I went keto and lost 78 lbs, no longer pre diabetic, My PSA dropped for the first time since 2016. Plants are sprayed with toxic chemicals, And have natural defense mechanisms as well so good luck and I hope you find what works for you.

[@jonsays3762]

That’s not a personal history of cancer. That’s immediate family members who have had cancer. Words mean things. Often, they are even important in communication.

[@roccocapobianco2167]

I would like to hear a bit about HIFU - High Intensity Focused Ultrasound as a way to eradicate prostate cancer.

[@TommyB-e8r]

Thank you for this information. But man I think I'm screwed and scared.The more I'm able to understand what you are saying about all this. I don't have insurance Medicaid or money. So... I know I have prostate problems. Im61 yrs old. What first procedure of analysis do I try to pursue and with which type of specialist?