An Interview with Medical Oncologist Mark Scholz, MD from Prostate Oncology Specialist By Kirk Hamilton PA-C. (***KIRK'S NOTE: I have interviewed Dr. Mark Scholz, Medical Director of Prostate Oncology Specialists, since 2009 about his medical group's work in treating prostate cancer with the most up-to-date medical therapies with an emphasis on preserving quality of life and the patient's physical constitution. I refer all my prostate cancer patients to Prostate Oncology Specialists for treatment, or at least a second opinion. I have never had anyone come back and not thank me and say it wasn't worth it. Also, I have never had any patient have to get prostate cancer surgery. Between the most up-to-date medical therapies AND diet and lifestyle change the vast majority of prostate cancers are cured or treated as a chronic disease. Listen to this podcast (below) I recently did with Dr. Scholz on his new book "The Key to Prostate Cancer" where he has 30 experts contribute to this self-help guide for prostate cancer patients and their families.
Listen to Kirk's Podcast/Interview with Mark Scholz, MD (38:23 min) - What Are The Keys to Successful Prostate Cancer Detection, Prevention and Treatment?
The purpose of Dr. Scholz's second book was to help patients take the diagnostic information available to them through biopsies, scans and other testing and identify the stage of their cancers so the patient, in a more focused and simplified manner, could better decide on the appropriate therapies and risks for their particular type and stage of prostate cancer.
In most prostate cancers cases the patient can take up to several months, even 6-12 months to evaluate their current cancer situation before therapy should be initiated without any difference in outcome.
Instead of the traditional stages of prostate cancer being identified as Low, Medium or High Risk, or Relapsing or Metastatic Disease Dr. Scholz uses different shades of "Blue" for prostate cancer (in contrast to pink being for breast cancer). These five "Blue" stages are called Sky, Teal, Azure, Indigo and Royal. This system is labeled by the acronym STAIR.
The patient can read about their specific stage, or what "Shade of Blue" they fall into, reasonable therapies and tests for each stage ("shade"), and the expertise from 30 prostate cancer specialists who contribute to this book. Dr. Scholz makes clarifying commentaries on many of these chapters to simplify the essence for the reader to make it more user friendly and applicable. The end goal is helping the patient be more in control of their disease with informed and focused decision making.
Unlike other cancers, prostate cancer is generally a slow growing disease, and if treated early by either appropriate and specific treatment or "non-treatment" (active surveillance), should result in few men dying from prostate cancer. Men with prostate cancer as a whole are at a greater risk of dying from vascular diseases (heart attacks, stroke, hypertension, etc.), diabetes, Alzheimer's disease, other types of cancers (colon, lung, etc.) and other chronic diseases.
Prostate Cancer Incidence
It is difficult to determine if prostate cancer is really increasing since there is better detection techniques like color Doppler ultrasound and prostate MRI, and, the male population is growing older so more prostate cancers are being detected in this ever-growing group of adults. There was a slowing of the incidence of prostate cancer because of negative publicity of the PSA's value in diagnosing the disease, thus resulting in less routine screening for PSA levels several years ago. That said, the survival of prostate cancer patients is better and the therapies to treat prostate cancer are getting much better leading to longer survival, less side effects and better quality of life.
PSA (Prostate Specific Antigen) Levels
PSA levels are a valuable test and should start being assessed in high risk patients in their 40s and in the 50s for the average male. A high PSA level doesn't necessarily mean prostate cancer. A large prostate volume in a non-cancerous prostate will lead to a higher "normal" PSA level. For example and 80cc prostate volume should result in an approximate PSA of 8. That is normal for that person with that prostate volume and is non-cancerous even though the upper range of normal for PSA levels is 4. Prostate volume can be determined by a skillfully administered color Doppler ultrasound (which Prostate Oncology Specialists doctors are expert in) or prostate MRI. Therefore this person with a PSA level outside the high normal range of 4 has a normal, non-cancerous prostate. Prostate volume will go up with age as will the PSA level.
PSA levels that rise quickly (1-2 points) over 6 months to a year should be investigated by either of these techniques, or by a skilled and experienced prostate examiner doing a digital rectal exam (DRE).
PSA levels are extremely valuable in following cancer treatment because they are the only way to really know if the cancer is gone or coming back.
How Prostate Biopsies Should Be Done!
Dr. Scholz does not believe that prostate biopsies spread prostate cancer because millions of biopsies have been done and there does not appear to be a correlated increase in prostate cancer incidence. That said, PSA levels are relied on too much for diagnosis of prostate cancer, and with the advent of the prostate MRI, one should never have done a "non-guided" or "shot-gun" biospy of prostate. Biospies should always be "guided" either by a skilled physician using color Doppler ultrasound (like the physicians at Prostate Oncology Specialists) or with the prostate MRI. IN ADDITION, if your physician is using a prostate MRI to guide the biopsy you should ask the radiologist, or whoever is conducting the biopsy, how many samples they are going to take from the prostate. They should know from the MRI or color Doppler results where they are going to take the biopsy and there should only be 1 or 2 samples, maybe up to 4 samples, but never 12 samples as the standard has been in the past. If "they" say 12 samples are needed you should find another radiologist/physician to do the biopsy in a guided way with only 2-4 samples taken at most.
Unnecessary Prostate Cancer Surgery - Get A Second Opinion First!
In Dr. Scholz's view there is almost never a need to do a prostatectomy. Even though there are well marketed robotic surgery programs, this is a therapy whose time has passed, as well as all the side effects that have and can occur. I always plead with my patients, their friends and my friends, before you ever consider prostate cancer surgery go visit Prostate Oncology Specialists for a second opinion first and....FAST (prostateoncology.com)!
"Watchful Waiting" or "Active Surveillance"
Almost 50% of prostate cancer patients may receive "active surveillance". This is a well established medical treatment for prostate cancer. You would be "watched" by periodic, or at least yearly PSA levels, and probably some monitoring with either a prostate MRI and color Doppler ultrasound of the prostate.
Lifestyle, Hormones and Prostate Cancer Patients
Prostate cancer is a unique cancer that should be diagnosed and treated according to the stage you are in, but are something that most men will live out the rest of their lives with and die of other causes such as heart disease, stroke or other vascular disease, other cancers, Alzheimer's, diabetes or some other chronic diseases.
Eating to keep from being overweight and more whole food plant-based if you can do it (see Dean Ornish, MD, prostate cancer and diet studies) would reduce prostate cancer risk and is a treatment for low level prostate cancer. Dr. Scholz strongly feels exercise, especially weight or resistance training 3 x eek during cancer therapy, especially with androgen suppression therapy, is strongly recommended and highly beneficial and helps the individual maintain their muscle mass and helps improve their low energy.
After successful prostate cancer treatment testosterone replacement therapy can be recommended and is not contraindicated. It will not cause the prostate cancer to "regrow".
Finding a Physician to Treat Prostate Cancer
Ideally you would find a medical oncologist (cancer doctors) who specializes in prostate cancer treatment such as Prostate Oncology Specialists. Urologist are surgeons generally and still treat most prostate cancer. You want to find someone who is experienced in treating prostate cancer; who doesn't recommend "unguided biopsies" as a means of diagnosis; who does not recommend a surgical approach as their primary therapy (or at all); is open and supportive of active surveillance; who is open to hormone replacement therapy after treatment if indicated; and who talks about lifestyle (diet and exercise) and reducing the risk to chronic diseases such as heart disease, diabetes, obesity, bone loss, and other chronic conditions as a very important component of the total care of the prostate cancer patient.
Contact Prostate Oncology Specialists
You can go to ProstateOncology.com and self refer yourself. People come from all over the country to be treated by this group. Their office is 20-30 minutes of north of Los Angeles International Airport.
Past Interviews with Dr. Scholz on Prostate Cancer Prevention and Treatment
Prostate Oncology Specialists, 4676 Admiralty Way, Suite 101 Marina del Rey, CA 90292, (310) 827-7707, (310) 574-4002 (FAX) www.prostateoncology.com
You can order the book, "The Key to Prostate Cancer" from prostateoncology.com and soon it will be available on Amazon.
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