Preventing and Curing Prostate Cancer (and Avoiding Unnecessary Biopsies and Prostatectomies - An Interview with Mark Scholz, MD (Podcast, 30:10 min)
Kirk's video overview of his interview with Dr. Scholz (3:00 min)
Mark Scholz is a medical oncologist, and medical director of Prostate Oncology Specialists (ProstateOncology.com) who has focused for more than two decades on treating only prostate cancer with the least invasive medical therapies, and, an emphasis on preserving the male’s quality of life, anatomy, and practicing active surveillance or "Watchful Waiting" when appropriate.
"Prostate Cancer as A Chronic Disease"
Prostate cancer is being diagnosed earlier with smaller cancers that can be treated more easily or just "watched" with periodic testing such as PSA levels, digital rectal exams, prostate MRIs (multi-parametric T2) or skilled usage of color doppler ultrasound. Frequently treatment is not necessary for a prostate cancer just observation. Also, with increased life expectancy more people will be living with prostate cancer longer and at a greater age. At Prostate Oncology Specialists they have 45 prostate cancer patients over the age of 90!
"Survival Rates for Prostate Cancer"
According to the most recent data from the American Cancer Society (survival rates), when including all stages of prostate cancer:
The 5-year relative survival rate is almost 100%
The 10-year relative survival rate is 98%
The 15-year relative survival rate is 95%
"Prostatectomy a Thing (Procedure) of the Past"
Total prostatectomies (prostate removed by surgery) is something that very rarely, if ever, needs to be done. You should definitely consider a second opinion if prostate surgery is recommended. One of 200 people die from the surgery, not to mention the potential side effects which include a reduction in penis size, acrooked penis, ejaculating urination, incontinence and the need to continually wear diapers (I know a bit graphic but once the damage is done, it's done).
Radiation now is much more targeted and safer than in the past coming within millimeters of the target area which minimizes side effects.
"Avoiding Unnecessary Biopsies and Getting an Accurate One"
The PSA as a screening tool for prostate cancer is not the problem. It is important and valuable to get a PSA done at least annually. Getting an "unguided" 12 core ("12 stabs") biopsy because of a high PSA level is a BIG problem!...and is bad and archaic medicine!
There are more than 1 million biopsies done in the United States annually. Many are not needed and/or they are not performed in a "guided" fashion which causes more human sufferings (blind stabs at the prostate = unguided core samples), medical consequences and less accurate biopsiedspecimens.
"DON'T DO A BIOPSY IF IT IS NOT GUIDED ("Targeted") BY ONE OF THREE TECHNIQUES"
1) With skilled operators using color doppler ultrasound it is effective at getting a good tissue sample with minimal "stabs" at the prostate. (Color doppler should only used if the doctors are doing several color doppler ultrasounds per day like the physicians at Prostate Oncology Specialist.
2) An "in bore" biopsy using a Multi-Parametric Prostate MRI (doing the biopsy while getting the MRI).
3) A prostate MRI with fusion images with regular ultrasound. The prostate MRI images are "fused" into the ultrasound machine so a targeted biopsy can be done.
***These targeted biopsies not only should be more accurate in getting into the cancerous tissue, but there should be LESS OF THEM DONE, like 2 or 3 samples. Not 6 samples and definitely not 12 samples.
***BEFORE YOU HAVE A GUIDED BIOSPY MAKE SURE YOU ASK THE PHYSICIAN WHO IS DOING THE BIOSPY HOW MANY SAMPLES THEY ARE GOING TO TAKE AND MAKE THEM STICK TO IT. SOME FACILITIES OR PHYSICIANS UNNECESSARILY DO 12 SAMPLES OR MORE BECAUSE THEY ARE USED TO DOING THAT MANY, OR, FOR RESEARCH PURPOSES. ALSO PHYSICIANS CAN CHARGE FOR EACH BIOSPY. ONLY 2-4 SHOULD BE NEEDED FOR A TARGETED (GUIDED BIOSPY)!!! MAKE SURE YOU ASK THE PHYSICIAN DOING THE TARGETED BIOPSY HOW MANY "STABS" HE IS GOING TO TAKE AT YOUR PROSTATE!
"Screening for Prostate Cancer"
A PSA should be routinely (annually) done at any age, and if elevated it should be repeated, then if still elevated taking into consideration the precautions mentioned below ("Getting an Accurate PSA Level"), a prostate MRI or skilled color doppler ultrasound should be done first for clarification if there is a lesion...not a biopsy first just because of an elevated PSA.
"Getting an Accurate PSA Level"
One should refrain from having sex the day before getting a PSA and avoid long bicycle rides the day before, especially on a road bike which can push up into the prostate area. A digital rectal (DRE) exam should be done annually to feel for the size and irregularities of the prostate and it is probably better to draw the PSA BEFORE receiving a DRE, but at DRE is less likely to cause an artificial increase in the PSA. If one has a prostatitis that has been treated it would be a good idea to wait 1-2 months after the treatment to check the PSA. It is always smart to repeat an elevated PSA with the above precautions before taking action.
"Prostate Volume and Elevated PSA Levels"
An MRI or color doppler ulstrasound can measure the volume of the prostate. So if you have an elevated PSA (above 4), and you have no suspicious lesions on the prostate from an MRI or ultrasound, then because both prostate cancer tissue and normal prostate tissue can elevate PSA levels, the PSA should be higher than normal. For example a 100 cc volume (BIG!) prostate with no lesion(s) will have a "normal" PSA around 10, even though the normal upper limit for PSAs is 4. If there is no cancer you divide the prostate volume (100 cc) by 10 and that gives you an estimate 10, a "ballpark" of what the PSA should be. Again if there is no cancer found by MRI or color doppler ultrasound then divide the volume CC/10 = approximate PSA. Both color doppler ultrasound and the prostate MRI will provide the volume of the prostate.
"Prostate MRI - Revolutionizing Prostate Cancer Assessment"
The prostate MRI has been around for several years but is coming into its own and will become the standard for evaluating the prostate for prevention, diagnosis and treatment of prostate cancer. But the MRI still has to be done at a skilled MRI center. It is covered by traditional medical insurance most of the time, but if not its costs is $800-900 which many men are willing to pay to avoid a biopsy. It takes about 45-60 minutes and if someone is claustrophobic they can take a sedative. There are no rectal probes with the prostate MRI.
The correct terminology is - "3 Tesla (3T), Multi-parametric MRI of the prostate". The "multi-parametric" stands for: 1) Use of a contrast media (need IV) 2) Diffusion weight at imaging and 3) T-2. So if a doctor writes a prescription for this it is a "3T Multi-parametric MRI of the prostate".
A list of prostate MRI centers that have been used by Prostate Oncology Associates patients can be found at PCRI.org.
"Diet and Prostate Cancer"
Dr. Scholz speaks of past experiences where the macrobiotic diet or vegan diets reduced PSA levels and nodules in some of his prostate cancer patients. Dr. Scholz agrees with the studies by Dr. Dean Ornish showing PSA levels being lowered in prostate cancer patients with a vegetarian diet and encourages its use in prostate cancer patients if patients are willing. (Scroll down and click on prostate cancer for 4 studies on a vegetarian diet and prostate cancer).
"Immunotherapy is for Real!"
Dr.Scholz is excited about immune therapies for prostate cancer that are currently emerging. He believes they will revolutionize prostate cancer treatment and they are not just hype.
Past Interviews/Podcasts with Mark Scholz, MD
Prostate Cancer and the “Invasion of the Prostate Snatchers: No more unnecessary biopsies, radical treatment, or loss of sexual potency.” - An Interview with Mark Scholz MD (2010) (25:39 min)
Prostate Cancer Treated as A Chronic Disease – One Oncologist’s Approach - An Interview With Mark Scholz M.D.(2009) (34:47 min)
Prostate Oncology Specialists take self-referrals or you can be referred by your doctor. Go to ProstateOncology.com.
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Be and Stay Well,