The following
program presents principles
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designed to promote good health
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and is not intended
to take the place of
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personalized professional care.
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The opinions and ideas expressed
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are those of the
speaker. Viewers are
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encouraged to draw
their own conclusions
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about the information presented.
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Welcome to Wonderfully Made.
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My name is Stoy
Proctor and today
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our topic is
problems with the prostate.
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I have as my guest
Dr. Allan Handysides
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who is a
specialist in many areas.
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He has got many degrees and I'm
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certainly happy to
have him with us today.
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Dr. Handysides I
would like to ask
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you a question.
Would you explain
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the Prostate and how prevalent
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is Prostate
cancer? Thank you Stoy
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that's a good
question and first of all
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the prostate is a
gland that sits beneath
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the bladder in the
male. It is very beautifully
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and
anatomically designed so that
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it wraps around the
little tube that drains
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the urine out of
the bladder and it has a
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special function, that
function is to add fluid
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to the rest of
the semen and protect
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and feed the sperm
that are in that fluid.
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Unfortunately as you have said
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nearly every male
will develop a problem
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with the prostate if
he lives long enough.
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So one of the
problems that some of our
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older viewers
maybe aware of is that
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as the prostate gets
older it gets bigger.
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It enlarges. The
medical term for this is
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Prostatic
Hypertrophy. Now the prostate
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has an outer edge
and an area that is where
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predominantly cancer occurs,
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but the
innermost portion is where
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this hypertrophy takes place
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and it starts off
as clusters of cells
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start to grow
and you begin to get
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increasing
numbers of these clusters
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and they coil as
to form a generally
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enlarge gland which
squeezes the little tube
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that comes out of the bladder.
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Consequently males begin to find
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when they pass
their urine that the flow
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starts to be a
little less powerful,
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a little slower
and that is often
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the first sign of
prostatic enlargement.
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How many people are affected
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every year by this condition?
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Well if we're talking about
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prostatic hypertrophy
I would think probably
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65 to 75% of males
will notice some changes
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in their urinary
flow. The others will
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probably have
changes, but don't notice them.
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It's probable that
if we live to the age of
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100 nearly 100% males
would be found to have
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at autopsy not in
their steady life.
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At autopsy found
to have cancer cells
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in their prostate.
Now this is a question
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probably people who
have a prostatic enlargement
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won't need to answer,
but we will need to know
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the answer too,
but how do you know
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whether you have got problem
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with the
prostate? You have mentioned
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the decreased flow
of urine, but any other
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symptoms that you might have?
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Sometimes people
can have no symptoms,
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no signs of a
problem and in that case
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they can live
their lives in blissful
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ignorance and
many, many people have
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and for many, many
years' people did not
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understand that
there were problems.
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But we do
recommend that there are
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certain groups
people, who should begin
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prostatic surveillance
maybe a little earlier.
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For instance, we
know that black people
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North America
blacks living here on the
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continent particularly because
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we're in the
Northern climate seem to have
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increasing risk
of prostate cancer
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the further North they go.
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So, Canadian black
men living in Canada
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has a greater risk
of prostatic cancer
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than those one
living in Florida.
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So we have an
environmental factor
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that maybe playing
a role. Genetic factor
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is probably two,
so we recommend that
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American blacks
should begin surveillance
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of their prostates
maybe around the age of 40.
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But now that's with blacks,
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but with every
man at sooner or later
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they probably
gonna have problems
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in this area right?
Yes, there is a little
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controversy and
little argument about just
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how avidly we should screen for
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prostate cancer. I
think that with the
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American black we
should screen early
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because they tend to
have a more aggressive
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prostate cancer than do whites.
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In white males, we
suggest that probably
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by the age of 50
they should also begin
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a program of surveillance.
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Now suppose I
have been diagnosed
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as having enlarged prostate.
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When does a
physician began treatment?
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How do I know
whether the treatment
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should start? Let's talk about
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prostatic
enlargement. First of all
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not everybody with
an enlarged prostate
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is going to require treatment.
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This is because
the symptoms maybe a
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slowness in urinary
flow, but that's not a
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life threatening
problem. Then we say
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well what kinds of treatment
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can be offered. As
some of the treatments
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that are offered
are medical treatments
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such as giving
medications that block
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the conversion of
Hydroxy Testosterone
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into the active
form. Now that enzyme
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blocking can reduce
the amount of testosterone
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and therefore
reduce the hypertrophy.
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Another approach is
to give a beta-stimulant
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which is a drug
that actually causes
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relaxation of the bladder flow
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and let's the
urine flow more easily.
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So many people who are having
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a little
slowness, little difficulty,
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maybe little
dribbling these are all symptoms
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of this problem.
They may go to the doctor
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and say can you
help me and he may give
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them a medication that relaxes
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the bladder flow.
You have, you have
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any names that
you could mention?
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Well I don't think
that it really, matters,
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goes with,
Clonidine is the name,
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but I don't think that matters.
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I would want people to
go to see their doctors.
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Sure. One of the
natural things that people
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can have, one of
the natural remedies
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that has actually
been shown with studies
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that are reputable
studies is the use of
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Saw Palmetto and
the use of Saw Palmetto
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is an herbal remedy
that in this situation is
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shown to improve
the flow and improve
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the situation
without having very
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many side effects. So, medically
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or herbally there are approaches
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that can be made,
but if we move from
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the medical we
then talking about
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surgical
approaches. And what about
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I've heard that
some people they go,
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the position goes and reams out?
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Well that's a surgical approach.
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That's a surgical. Oh, this is
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surgical approach. That's a
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surgical
approach. In other words,
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surgical approach
doesn't always have
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to just be removal
of the entire prostate.
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No, it doesn't have
to. That's one approach
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right? That is one
approach. Yeah okay.
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You see one would
prefer to have less
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and invasive
procedure as possible.
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So if for all intents
and purposes this is a
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Benign Prostatic Hypertrophy
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then you can go
and see your doctor
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and the physician
can do what's called
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transurethral
resection of the prostate.
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Basically they
take a very fine tube,
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insert it up
through the urethra,
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which is not a
very pleasant thought
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to many men, but
through that little tube
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they then have a little
loop that is electrified
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and by moving
the loop up and down
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they can shave off
slivers of prostate
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which are then
washed and irrigated out.
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Slivers of prostate
to widened the opening
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through the
prostate gland and that is a
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very successful
surgical approach.
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Is there any other approaches?
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Well yes there are
many, many innovative
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approaches. I mean
successful approaches.
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Successful they
have used microwaves
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that they will
put a probe up through
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the prostate and then
microwave the prostate.
00:08:13.52\00:08:16.02
Sometimes they can
put a cold probe up
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through there and
they can actually chill
00:08:18.31\00:08:21.16
or freeze sections of prostate
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and then that will
die and shrivel back
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and open the
pathway. Now sometimes people
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with Prostatic Hypertrophy
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have a blood test done called
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Prostatic Specific
Antigen and when they
00:08:34.57\00:08:37.55
get that blood
test done. And we know
00:08:37.58\00:08:38.66
that as PSA
right? PSA we can get
00:08:38.69\00:08:41.40
that test done.
It can be elevated in
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prostatic
hypertrophy, but that causes a
00:08:44.36\00:08:46.64
problem because
it's also elevated in
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prostatic
carcinoma. And then we start
00:08:49.99\00:08:53.42
to have a problem as to what's
00:08:53.45\00:08:54.64
going on in this situation.
00:08:54.67\00:08:55.99
Now you have
talked a lot about the
00:08:56.02\00:08:58.63
the enlargement, what
about prostate cancer.
00:08:58.66\00:09:01.02
How do I know
when if I have got an
00:09:01.05\00:09:03.51
enlarged
prostate when do I know,
00:09:03.54\00:09:05.03
when should I maybe
get some more tests gonna
00:09:05.06\00:09:08.16
find out if I got
cancer. I'm little;
00:09:08.19\00:09:10.43
you know, I could be a
little worried about it.
00:09:10.46\00:09:12.03
You see my index
finger I'm wagging this finger
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because all
doctors know that the
00:09:14.55\00:09:18.26
rectal examination
to feel the prostate
00:09:18.29\00:09:20.60
in the male is very important.
00:09:20.63\00:09:22.49
Because the outer wall
of the, outer surface of
00:09:22.52\00:09:26.28
the prostate is
where cancer usually begins
00:09:26.31\00:09:28.17
and so by feeling
across that posterior wall
00:09:28.20\00:09:31.86
of the prostate
it's possible sometimes
00:09:31.89\00:09:34.17
to detect a knobbly
feeling or a firmness
00:09:34.20\00:09:38.68
to the prostate
that is unnatural.
00:09:38.71\00:09:40.71
If you have an
elevated PSA and you also feel
00:09:40.74\00:09:44.92
that knobbliness,
the doctor is immediately
00:09:44.95\00:09:47.36
going to say I think
we should move to a more
00:09:47.39\00:09:49.97
definitive diagnostic
procedure in which case
00:09:50.00\00:09:52.77
he will use an ultrasound.
00:09:52.80\00:09:53.88
And then they will then put a
00:09:53.91\00:09:56.30
transrectal
ultrasound. The transrectal
00:09:56.33\00:09:59.16
ultrasound goes up
behind the prostate.
00:09:59.19\00:10:01.32
It emits these sound waves.
00:10:01.35\00:10:03.76
They are not electromagnetic
00:10:03.79\00:10:05.56
or they are just sound waves.
00:10:05.59\00:10:06.96
It emits the sound
waves. The sound waves
00:10:06.99\00:10:09.49
go through the
tissue. They meet against
00:10:09.52\00:10:11.97
resistance and
bounce back and the computer
00:10:12.00\00:10:13.95
image that is made
from all of this very
00:10:13.98\00:10:17.38
modern technology
will then show an outline
00:10:17.41\00:10:20.75
of the prostate
and they can then see
00:10:20.78\00:10:23.19
if there are indeed
nodules or areas in the
00:10:23.22\00:10:26.51
prostate that
have an altered texture
00:10:26.54\00:10:30.13
or an altered
density to these sound waves.
00:10:30.16\00:10:33.29
If they do find this
and if the PSA is elevated
00:10:34.35\00:10:37.70
then we are going to
go the definitive step.
00:10:37.73\00:10:41.07
All cancer needs to be
definitively diagnosed.
00:10:41.10\00:10:45.47
And how they do that?
And the definitive step
00:10:45.50\00:10:47.42
is a biopsy. So a
needle will be taken,
00:10:47.45\00:10:51.20
it can be done transperineal,
00:10:51.23\00:10:53.13
it can be done transrectally.
00:10:53.16\00:10:54.29
It doesn't matter
how long the needle is.
00:10:54.32\00:10:56.84
Painful. Now for
the audience explain
00:10:56.87\00:10:58.81
this trans, what
do you mean by trans.
00:10:58.84\00:11:01.52
It can be across. It's across.
00:11:01.55\00:11:02.93
It's across, so the
needle can be inserted
00:11:02.96\00:11:05.59
across through
the rectum into the
00:11:05.62\00:11:07.18
prostate gland,
through the rectum okay.
00:11:07.21\00:11:08.85
Or it maybe come
up, through the penis.
00:11:08.88\00:11:11.48
No not through
the penis, through the
00:11:11.51\00:11:13.30
perineum, the base
of the pelvis there,
00:11:13.33\00:11:15.58
through that into the prostate.
00:11:15.61\00:11:17.13
It's done under
an ultrasound so the
00:11:17.16\00:11:19.25
directions they know
they putting it exactly
00:11:19.28\00:11:21.42
where they want to
put it and then they will
00:11:21.45\00:11:23.91
aspirate cells from that area.
00:11:23.94\00:11:26.80
They may do 10,
16 samples to see
00:11:26.83\00:11:30.01
if there is any
prostate cancer cells there.
00:11:30.04\00:11:32.44
Now you have mentioned so far
00:11:33.47\00:11:34.88
first of all we
should go see our physician
00:11:34.91\00:11:37.26
if we think we have a problem
00:11:37.29\00:11:38.48
and if we are, for
black maybe over 40 or 45
00:11:38.51\00:11:41.21
if we are another
ethnic origins we should go
00:11:41.24\00:11:44.40
maybe when we are 50. Yes.
00:11:44.43\00:11:45.90
And may we should go every year.
00:11:45.93\00:11:47.09
At least, once a year probably.
00:11:47.12\00:11:48.90
I think it depends
on what's our age is
00:11:48.93\00:11:51.55
and what our risk
factors are. If we have
00:11:51.58\00:11:52.71
an enlargement maybe
going once every year,
00:11:52.74\00:11:54.45
right. Yes for
instance, my father died of
00:11:54.48\00:11:56.47
prostate cancer.
Okay. So I know I have a 15%
00:11:56.50\00:12:00.87
greater chance
than a man who father
00:12:00.90\00:12:04.72
did not died of prostate cancer.
00:12:04.75\00:12:06.56
So I take more care
of myself in this regard
00:12:06.59\00:12:09.42
so that I go
regularly for my screenings
00:12:09.45\00:12:11.37
and checks. Now okay
so we go see a physician,
00:12:11.40\00:12:14.62
it takes a PSA test blood test.
00:12:14.65\00:12:18.30
If he finds some
problem he might do an
00:12:18.33\00:12:21.13
ultrasound to see
what kind of image
00:12:21.16\00:12:23.77
we have on the prostate and then
00:12:23.80\00:12:27.24
he might do a
biopsy. Yes. Alright,
00:12:27.27\00:12:29.75
if he finds that
the biopsy is clear
00:12:29.78\00:12:32.97
there are no
cancer cells then what?
00:12:33.00\00:12:35.40
Then he will put
his back to routine
00:12:35.43\00:12:37.72
sequential follow
up because it's very
00:12:37.75\00:12:40.87
important and I
would like all that people
00:12:40.90\00:12:42.47
who are watching
this program to understand
00:12:42.50\00:12:44.07
that you can still
have prostate cancer
00:12:44.10\00:12:47.11
even with the
normal PSA which means
00:12:47.14\00:12:49.71
that it's not
the absolute level,
00:12:49.74\00:12:52.96
but it maybe
the trend of the PSA
00:12:52.99\00:12:55.67
which is so
important and so we would like
00:12:55.70\00:12:58.42
our listeners and
particularly viewers
00:12:58.45\00:13:00.46
if you are out
there listening to me
00:13:00.49\00:13:01.90
and you are
wondering about this.
00:13:01.93\00:13:03.45
Regularity in
plotting and checking
00:13:03.48\00:13:06.41
your PSA level may,
because if it goes long
00:13:06.44\00:13:10.46
flat, flat, flat and
then suddenly it starts
00:13:10.49\00:13:13.78
to go up that
indicates that something needs
00:13:13.81\00:13:16.67
to be done. Investigation needs
00:13:16.70\00:13:18.13
to be made. What's
the normal PSA level?
00:13:18.16\00:13:20.26
A normal PSA level
is between 1 and 4,
00:13:20.29\00:13:24.08
usually we like
it to be less than 1,
00:13:24.11\00:13:27.27
but between 1 and 4 it's normal.
00:13:27.30\00:13:29.13
Though studies
have been done that show
00:13:29.16\00:13:31.61
that even at a PSA
of 1 there maybe 6 or 7%
00:13:31.64\00:13:36.34
of the male
population in an older over
00:13:36.37\00:13:39.00
70 age group
that actually do have
00:13:39.03\00:13:42.23
cancer cells in their prostate.
00:13:42.26\00:13:43.87
Now let's take
another scenario let's suppose
00:13:43.90\00:13:46.34
someone has a reading of 8 or 10
00:13:46.37\00:13:48.80
and that stay steady for years.
00:13:48.83\00:13:50.85
There is no
biopsy, there is no biopsy,
00:13:50.88\00:13:54.46
no cancerous biopsy,
there is enlargement.
00:13:54.49\00:13:58.36
What kind of situation?
Well then in that case.
00:13:58.39\00:14:00.69
How would you diagnose there
00:14:00.72\00:14:01.69
and what would
your prognosis would be?
00:14:01.70\00:14:02.72
In that situation if
you have done biopsies,
00:14:02.75\00:14:04.26
you know that you
cannot show cancer.
00:14:04.29\00:14:06.24
He has an enlarged
prostate then you will
00:14:06.27\00:14:08.52
attribute those
elevated levels to the
00:14:08.55\00:14:11.56
prostatic hypertrophy itself.
00:14:11.59\00:14:13.81
So that the benign
enlargement is producing
00:14:13.84\00:14:16.31
more of this
antigen although it is not
00:14:16.34\00:14:18.74
malignant cells
that are producing,
00:14:18.77\00:14:19.97
but still you want
to watch that individual
00:14:20.00\00:14:22.50
very closely, on at
least a yearly basis,
00:14:22.53\00:14:24.75
at least
probably with levels like
00:14:24.78\00:14:26.43
that six monthly.
Okay let's suppose
00:14:26.46\00:14:28.69
now we the, by
the way what will our
00:14:28.72\00:14:32.63
family doctor be
able to care for all this
00:14:32.66\00:14:35.37
or should we go further.
You know, family doctors
00:14:35.40\00:14:38.84
are linchpin in
healthcare system,
00:14:38.87\00:14:41.71
especially if
there is a family doctor
00:14:41.74\00:14:43.57
you know well, you can talk to,
00:14:43.60\00:14:45.95
you can converse
with, you feel at ease with
00:14:45.98\00:14:48.92
that doctor is a
wonderful confident.
00:14:48.95\00:14:51.39
Now I'm little
confused about this linchpin,
00:14:51.42\00:14:53.64
what does that mean?
Because he is the key
00:14:53.67\00:14:57.30
in seeing that
you get very good.
00:14:57.33\00:15:01.55
He is a gatekeeper.
He is the gatekeeper.
00:15:01.58\00:15:02.78
He is the person
that is going to look out
00:15:02.81\00:15:05.04
for you. And so if he finds that
00:15:05.07\00:15:08.11
you have an elevated
PSA or he is suspicious
00:15:08.14\00:15:11.21
or he has ordered an ultrasound
00:15:11.24\00:15:13.31
and there is
something being found.
00:15:13.34\00:15:14.78
He is then going
to refer you to an
00:15:14.81\00:15:18.55
urologist in
your community, who is
00:15:18.58\00:15:20.86
well versed, well experienced
00:15:20.89\00:15:22.98
and able to take care of you.
00:15:23.01\00:15:24.84
And that's way you
trust your family doctor.
00:15:24.87\00:15:26.81
You don't know the
urologists in your area,
00:15:26.84\00:15:29.49
but the family
doctors get to know
00:15:29.52\00:15:31.60
which
practitioners give good service,
00:15:31.63\00:15:34.29
very
knowledgeable, very competent
00:15:34.32\00:15:36.41
and capable. So
your family doctor
00:15:36.44\00:15:38.04
is a wonderful
advisor, but not necessarily
00:15:38.07\00:15:40.75
the one, who is
going to give you the
00:15:40.78\00:15:42.27
advanced
treatment. Allan, suppose that
00:15:42.30\00:15:45.71
I have done my
biopsy and I go back
00:15:45.74\00:15:49.48
to the doctor for the
report and he tells me
00:15:49.51\00:15:52.19
you have got cancerous cells.
00:15:52.22\00:15:54.11
What's the next
step, I mean besides
00:15:55.79\00:15:58.98
my devastation
and having a friend
00:15:59.01\00:16:01.96
that's dying of
prostate cancer and others
00:16:01.99\00:16:03.94
that have
cancer. This is serious
00:16:03.97\00:16:05.76
and I'm devastated
I know as many people
00:16:05.79\00:16:09.09
are there they have cancer,
00:16:09.12\00:16:10.09
but what do a doctrine I do?
00:16:10.10\00:16:13.52
Well you know
I'm very pleased that
00:16:13.55\00:16:15.42
you have talked
about the devastation
00:16:15.45\00:16:17.32
of diagnosis,
because I don't think
00:16:17.35\00:16:20.25
that physicians,
no patients really
00:16:20.28\00:16:23.65
understand the
enormous weight that suddenly
00:16:23.68\00:16:28.74
falls in an
individual who has diagnosis
00:16:28.77\00:16:30.33
of cancer. The good
news about prostate cancer
00:16:30.36\00:16:33.63
is that it is
usually and I say usually
00:16:33.66\00:16:36.70
not going to be the
disease that kills you.
00:16:36.73\00:16:39.17
It's good news.
You are going to die
00:16:40.07\00:16:41.54
of other thing.
Secondly, this is where
00:16:41.57\00:16:44.42
when we began we
said this isn't a disease
00:16:44.45\00:16:46.25
that affects
just the individual.
00:16:46.28\00:16:48.22
The whole family is
going to be involved
00:16:48.25\00:16:50.59
in this and that's
where a good loving
00:16:50.62\00:16:53.51
supportive wife and
family can come around
00:16:53.54\00:16:56.54
and give hope. Hope
is such an important
00:16:56.57\00:16:59.97
ingredient when we
are talking about cancer.
00:17:00.00\00:17:02.94
Such an essential
ingredient and you know
00:17:02.97\00:17:06.57
that's where I'm a
Christian physician
00:17:06.60\00:17:08.56
and I'm
unabashedly pleased to say so,
00:17:08.59\00:17:12.45
that not only do
we have the support
00:17:12.48\00:17:14.40
of the family, but
we also have the support
00:17:14.43\00:17:17.33
and the feeling that our Lord
00:17:17.36\00:17:19.75
and Savior Jesus
Christ can support us
00:17:19.78\00:17:22.06
and help us go
through this very difficult,
00:17:22.09\00:17:24.44
difficult time. It's
like Psalm 23 says Yea,
00:17:24.47\00:17:28.45
thou I walk
through the valley of the
00:17:28.48\00:17:30.18
shadow of death,
I will fear no evil;
00:17:30.21\00:17:32.71
for thou art
with me, so it's nice
00:17:32.74\00:17:35.24
if you can have a
Christian physician.
00:17:35.27\00:17:36.24
I shall not fear
of prostate cancer.
00:17:36.25\00:17:38.17
I will not fear of
prostate cancer see,
00:17:38.20\00:17:40.43
now. And what do we do now?
00:17:40.46\00:17:43.27
We got to do something. Right.
00:17:43.30\00:17:44.73
The diagnosis
has been made under
00:17:44.76\00:17:46.82
the microscope.
Under that microscope,
00:17:46.85\00:17:49.06
they will also look
at the sort of cells
00:17:49.09\00:17:51.75
how they dividing,
how aggressive they appear
00:17:51.78\00:17:53.90
to be, is this a
cancer that is particularly
00:17:53.93\00:17:57.49
aggressive or it
is an indolent slow
00:17:57.52\00:18:00.30
looking cancer and
they will assign to it
00:18:00.33\00:18:02.38
a score called
the Gleason score.
00:18:02.41\00:18:05.00
A Gleason score will tell us
00:18:06.70\00:18:09.20
if it's very aggressive
or if it's very indolent
00:18:09.23\00:18:12.61
which maybe important
as to how we manage it.
00:18:12.64\00:18:15.25
For instance,
if I'm 90-years-old
00:18:15.28\00:18:17.62
and I have got a
very lazy indolent cancer.
00:18:17.65\00:18:21.78
I have also got
diabetes and I have had
00:18:21.81\00:18:24.94
three heart attacks,
my kidneys are failing,
00:18:24.97\00:18:27.71
I have got liver
troubles and so forth.
00:18:27.74\00:18:29.37
My prostate cancer is
the least of my worries.
00:18:29.40\00:18:32.22
Of your worries, yeah. Seems the
00:18:32.25\00:18:33.41
least one of I
have. If I'm a 45-year-old
00:18:33.44\00:18:35.88
and my prostate
cancer is a very aggressive
00:18:35.91\00:18:38.62
Gleason you know
advanced. I don't wanna
00:18:38.65\00:18:41.97
give the numbers
because we don't want to scare
00:18:42.00\00:18:43.72
people, but it's
advanced then not only
00:18:43.75\00:18:47.37
myself, but my
doctors are going to look
00:18:47.40\00:18:49.09
and say we need
to be more aggressive
00:18:49.12\00:18:50.96
in the
management of this cancer.
00:18:50.99\00:18:53.41
What's my options if I
be diagnosed? Well before
00:18:53.44\00:18:56.13
we do options we
have to stage it. Okay.
00:18:56.16\00:18:58.49
What's staging
then? Staging is different
00:18:58.52\00:19:02.24
from classifying.
Classifying tells us
00:19:02.27\00:19:04.61
how virulent, how aggressive,
00:19:04.64\00:19:06.95
how it's gonna
you know go after us,
00:19:06.98\00:19:09.95
but staging tells
us how far has it gone.
00:19:09.98\00:19:13.19
Okay, now if it's
confined to the prostate
00:19:13.22\00:19:16.98
stage one we are
very pleased because
00:19:17.01\00:19:19.38
we know that,
that has an excellent,
00:19:19.41\00:19:21.75
excellent
prognosis. If on the other hand
00:19:21.78\00:19:24.64
when we detect it and
find it we do an x-ray
00:19:24.67\00:19:27.06
and a bone survey
and a bone scan as people
00:19:27.09\00:19:29.49
will be asked to do
and we find it's already
00:19:29.52\00:19:32.15
in the pelvis, in
the femur and something
00:19:32.18\00:19:34.58
like that. We
know that this is now
00:19:34.61\00:19:35.94
stage four, this is
metastasized a long way.
00:19:35.97\00:19:39.03
We may find in
between stages it may just
00:19:39.06\00:19:41.79
metastasize
outside the prostate.
00:19:41.82\00:19:43.69
It may have got into the bladder
00:19:43.72\00:19:45.28
or to the
rectum. It may have gone
00:19:45.31\00:19:46.54
in the lymph nodes. You know,
00:19:46.57\00:19:47.82
there are degrees of spread,
00:19:47.85\00:19:49.29
so we will
stage it 1, 2, 3 or 4.
00:19:49.32\00:19:51.69
And the treatment options depend
00:19:51.72\00:19:53.99
on that stages.
Okay let's go through
00:19:54.02\00:19:55.48
those treatment
options. First of all stage one?
00:19:55.51\00:19:57.76
Well for stage one,
we have a potentially
00:19:57.79\00:20:00.71
curable situation, so how we are
00:20:00.74\00:20:03.55
gonna cure it. Well
you could go undergo
00:20:03.58\00:20:06.48
a prostatectomy, a
radical prostatectomy
00:20:06.51\00:20:09.78
in which the
prostate is taken away,
00:20:09.81\00:20:11.65
surgically,
surgically. You remove it,
00:20:11.68\00:20:14.49
you put it in the surgical pot,
00:20:14.52\00:20:15.97
the pathologists
looks under it and says
00:20:16.00\00:20:17.55
it looks like its all here,
00:20:17.58\00:20:18.79
all margins are clear of cancer.
00:20:18.82\00:20:20.44
We have got it all in the pot.
00:20:20.47\00:20:22.51
Some people would
like that. Would that be
00:20:22.54\00:20:23.62
enough? Well for some it may.
00:20:23.65\00:20:25.72
Some will have a
radical prostatectomy
00:20:25.75\00:20:28.44
where there
will be dissection of
00:20:28.55\00:20:30.04
lymph nodes,
periotics around the pelvis.
00:20:30.07\00:20:32.59
They will
dissect all those nodes,
00:20:32.62\00:20:33.83
gather all the
nodes in them, put those.
00:20:33.86\00:20:35.86
That would
probably a stage 2 or 3.
00:20:35.89\00:20:37.18
That will be a
stage, well not necessarily.
00:20:37.21\00:20:39.16
No, no because if
it's a stage 2 or 3
00:20:39.19\00:20:41.01
we are not gonna
be doing this surgery
00:20:41.04\00:20:42.41
because it's too
late, but we are gonna go to
00:20:42.44\00:20:45.13
something other,
but we are just ensuring
00:20:45.16\00:20:46.36
that we got it all.
The problems with surgery
00:20:46.39\00:20:50.65
are that it
sometimes difficult to do the
00:20:51.47\00:20:54.18
surgery without damaging nerves.
00:20:54.21\00:20:55.86
What kind of nerves?
Well, the pelvic nerves
00:20:55.89\00:20:59.50
that are important
for bladder control
00:20:59.53\00:21:02.39
and also sexual
function. So now we are
00:21:02.42\00:21:06.30
getting serious. That
is one of the problems.
00:21:06.33\00:21:08.33
Bladder. Bladder
control is a serious problem,
00:21:08.36\00:21:11.04
but so is
impotence to a young man
00:21:11.07\00:21:14.52
and a
40-year-old is a young man.
00:21:14.55\00:21:17.25
So they now have
newer surgeries. But a 60
00:21:17.28\00:21:19.92
or 70-year-old
doesn't worry about it right.
00:21:19.95\00:21:21.62
Well, I don't know about that,
00:21:21.65\00:21:22.88
are you speak for
yourself so. Okay.
00:21:22.91\00:21:25.08
I mean who knows.
I'm asking a question.
00:21:25.11\00:21:27.21
Yeah that's right and I'm saying
00:21:27.24\00:21:28.91
it's important.
Yes it's important.
00:21:28.94\00:21:30.86
So, in other
words, so it's important
00:21:30.89\00:21:32.36
for most all ages.
Yeah, all most men,
00:21:32.39\00:21:34.06
who are healthy. Yeah okay.
00:21:34.09\00:21:35.55
So in another words
we want a nerve-sparing
00:21:35.58\00:21:38.40
operation and
skillful urologists can do
00:21:38.43\00:21:40.91
a procedure
which spares the nerves
00:21:40.94\00:21:42.80
and yet removes the cancer.
00:21:42.83\00:21:44.59
But because of this
a lot of people look to
00:21:44.62\00:21:47.63
other methods for treating
00:21:47.66\00:21:49.35
prostate cancer. And they are?
00:21:49.38\00:21:50.93
Well you know when
it comes treating cancer
00:21:52.28\00:21:54.55
they usually fall
into several groups.
00:21:54.58\00:21:56.62
The one important
group is a kind of a
00:21:56.65\00:21:59.66
radiotherapy; a
radiation therapy.
00:21:59.69\00:22:02.54
But it's not all
radiation therapy is not
00:22:02.57\00:22:04.82
all the same because sometimes
00:22:04.85\00:22:06.66
you can put little
seeds of radioactive
00:22:06.69\00:22:09.24
substances insert
them into the prostate
00:22:09.27\00:22:12.24
and they have
this kind of hallow of
00:22:12.27\00:22:14.26
radioactivity which
kills of the prostate.
00:22:14.29\00:22:16.37
So that's one
method that maybe used.
00:22:16.40\00:22:18.65
The other is the external beam,
00:22:18.68\00:22:20.41
which maybe used
to actually irradiate
00:22:20.44\00:22:23.52
the prostate. And
if there is evidence
00:22:23.55\00:22:26.35
of spread the beam.
Is that same as protein,
00:22:26.38\00:22:28.15
proton. No. That's
different okay. This is
00:22:28.18\00:22:30.62
regular radiotherapy.
Okay. Proton therapy,
00:22:30.65\00:22:33.86
I'm so glad you have mentioned,
00:22:33.89\00:22:34.93
because proton
therapy is an advanced
00:22:34.96\00:22:37.84
that has been
brought to the world largely
00:22:37.87\00:22:40.56
by Loma Linda
University. Located in
00:22:40.59\00:22:44.02
Southern California.
Located in Loma Linda,
00:22:44.05\00:22:45.94
Southern
California and proton therapy
00:22:45.97\00:22:48.34
is a most
fantastic therapy because
00:22:48.37\00:22:51.73
the proton waves can
actually be contoured,
00:22:51.76\00:22:54.91
which you can't
do. Radiation goes
00:22:55.97\00:22:57.76
in a straight line.
The protons they can
00:22:57.79\00:22:59.92
actually
contour to a little bit,
00:22:59.95\00:23:01.57
so that they
can actually deliver
00:23:01.60\00:23:04.07
these protons
into a given shape.
00:23:04.10\00:23:07.64
Allan, I'm very
interested in this
00:23:08.60\00:23:10.20
proton therapy at
Loma Linda University.
00:23:10.23\00:23:12.26
You know people
today being in the area of
00:23:12.29\00:23:14.50
nutrition, people
are concerned about
00:23:14.53\00:23:16.59
microwave ovens.
Now how does this proton
00:23:16.62\00:23:19.62
affect the rest
of my body? Does it,
00:23:19.65\00:23:21.77
you know, if I
just it's designed
00:23:21.80\00:23:24.69
for the prostate, but what about
00:23:24.72\00:23:26.24
other parts of my
body, does it affect
00:23:26.27\00:23:28.40
that at all? Well a
proton is a sub-atomic
00:23:28.43\00:23:31.88
particle that is
put into this very, very
00:23:31.91\00:23:36.58
prescribed place and
it's not going to affect
00:23:36.61\00:23:41.16
the rest of your
body. It's only going
00:23:41.19\00:23:42.41
to affect that
particular portion
00:23:42.44\00:23:44.06
where it's focused
and then it's going to
00:23:44.09\00:23:45.53
defuse out and
disappear and dissipate.
00:23:45.56\00:23:48.17
Of course it's not
just prostate therapy;
00:23:48.20\00:23:50.94
this can be used
for many many different
00:23:50.97\00:23:53.28
applications, so it's
a wonderful, wonderful
00:23:53.31\00:23:55.58
advance. In fact,
MD Anderson is just
00:23:55.61\00:23:58.62
in the process of
getting one installed.
00:23:58.65\00:24:00.41
Where is that
located? That I don't know,
00:24:00.44\00:24:01.91
I can't give you the location.
00:24:01.94\00:24:03.46
It's in Texas I
think? It's in Texas I think
00:24:03.49\00:24:06.14
but I'm not sure
yet. And so is at Harvard
00:24:06.17\00:24:09.84
they have one in
Boston. They have one of those.
00:24:09.87\00:24:12.24
These things cost
millions of dollars.
00:24:12.27\00:24:13.96
The one at Loma
Linda happened to know
00:24:13.99\00:24:16.46
was developed there, Dr. Slater
00:24:16.49\00:24:19.67
was the doctor that
put that in his team,
00:24:19.70\00:24:22.18
put that together and
it costs many millions
00:24:22.21\00:24:24.47
of dollars to get into place,
00:24:24.50\00:24:26.73
but a very very effective and
00:24:26.76\00:24:28.87
proven therapy
for prostate cancer.
00:24:28.90\00:24:31.06
Now very
interesting you've first talked
00:24:31.09\00:24:33.08
about options that
a person might have,
00:24:33.11\00:24:35.07
that's been
diagnosed with prostate cancer.
00:24:35.10\00:24:36.81
First of all was
surgery, then it was
00:24:36.84\00:24:39.39
radiotherapy,
then it was the proton,
00:24:39.42\00:24:42.29
now is this the
order that usually
00:24:42.32\00:24:45.93
you are treated
in. Yes. Or a surgery
00:24:45.96\00:24:48.11
the first before
for the proton or.
00:24:48.14\00:24:51.26
This depends on the stage. Okay.
00:24:51.29\00:24:53.00
So when we get to
more advanced forms
00:24:53.03\00:24:55.54
then prostate
cancer is very often
00:24:55.57\00:24:58.03
dependent on testosterone male
00:24:58.06\00:25:00.09
hormone to fuel its
fire of cell division
00:25:00.12\00:25:03.54
and so forth. So by
blocking testosterone
00:25:03.57\00:25:06.31
production either with
the certain medications
00:25:06.34\00:25:08.79
that block it, so
there are testosterone
00:25:08.82\00:25:11.15
blockers. There is
also a substance called
00:25:11.18\00:25:14.38
a GnRH analog, which
is actually a pituitary
00:25:14.41\00:25:17.36
stimulator and it
can shut the pituitary
00:25:17.39\00:25:20.56
production of
luteinizing hormone
00:25:20.59\00:25:22.96
down, so that we
don't get the production
00:25:22.99\00:25:25.93
of testosterone. And that can be
00:25:25.96\00:25:28.02
used things like
Lupride and some of those
00:25:28.05\00:25:31.80
medications given by
injection or pallets.
00:25:31.83\00:25:35.04
And then of
course there is another
00:25:35.07\00:25:37.11
surgical
approach which is in a way
00:25:37.14\00:25:38.87
and indirectly a
kind of medical therapy
00:25:38.90\00:25:42.98
and that is castration
to remove the testicles,
00:25:43.01\00:25:46.02
so that they do not
produce a testosterone.
00:25:46.05\00:25:48.71
So, yes we have a
full range of treatments.
00:25:48.74\00:25:52.16
Now, there is one you
have mentioned though.
00:25:52.19\00:25:53.79
What about drug
therapy any, any promise there?
00:25:53.82\00:25:57.77
Yes drugs therapy chemotherapy,
00:25:57.80\00:25:59.88
where there are many
agents that will attack
00:25:59.91\00:26:02.12
rapidly dividing
cells. But in practice for
00:26:02.15\00:26:05.69
prostate cancer we
tend to find that the
00:26:05.72\00:26:08.13
therapies have been
more along the lines
00:26:08.16\00:26:09.82
of these hormonal manipulations.
00:26:09.85\00:26:12.45
Occasionally, a
person will get severe
00:26:12.48\00:26:14.84
bone pain and that
will respond often times
00:26:14.87\00:26:17.62
very well to non-steroidal
00:26:17.65\00:26:19.04
anti-inflammatories
and later on it maybe
00:26:19.07\00:26:21.68
more powerful
medications will be
00:26:21.71\00:26:23.48
required and on
occasion a shot of radiation
00:26:23.51\00:26:26.70
to a lesion in a bone
will relieve bone pain.
00:26:26.73\00:26:30.24
And so many many
therapies are team
00:26:30.27\00:26:33.36
approach to one's
care. And that's why
00:26:33.39\00:26:35.74
yes the second
opinion is very important.
00:26:35.77\00:26:37.99
I would like to leave
the last minute or two,
00:26:38.02\00:26:40.38
to prevention.
Now, there is lot where
00:26:40.41\00:26:43.52
you have mentioned I
think of Saw Palmetto,
00:26:43.55\00:26:45.99
but what about
prevention or yeah,
00:26:46.02\00:26:49.99
what about
prevention. Is there anyway
00:26:50.02\00:26:51.30
we can keep from going through,
00:26:51.33\00:26:53.73
getting this surgery
or this proton therapy
00:26:53.76\00:26:58.26
or radical
prostatectomy and so on.
00:26:58.29\00:27:01.56
The literature
has looked at that
00:27:01.59\00:27:03.19
and the Adventist
health study done out
00:27:03.22\00:27:04.54
of Loma Linda
University has looked at that
00:27:04.57\00:27:06.21
in great detail
and Baldwin presented
00:27:06.24\00:27:08.87
a paper that
suggested that the regular
00:27:08.90\00:27:11.43
consumption of
tomatoes provides sufficient
00:27:11.46\00:27:14.99
Lycopenes,
especially if they are cooked
00:27:15.02\00:27:17.17
tomatoes. Give
sufficient Lycopenes
00:27:17.20\00:27:20.19
to reduce the risk.
Okay what else quickly?
00:27:20.22\00:27:22.61
Well, I think that's
the main one soy products
00:27:22.64\00:27:25.53
are another. Soy milk,
a daily glass of soy milk
00:27:25.56\00:27:28.21
maybe very helpful.
I think the Loma Linda
00:27:28.24\00:27:30.50
study showed that
those who had two or three
00:27:30.53\00:27:33.14
glasses of soy milk had lot less
00:27:33.17\00:27:35.32
with prostate
cancer. Yes lot less.
00:27:35.35\00:27:36.66
That's a
possibility. But the study
00:27:36.69\00:27:38.53
was not
sufficiently abroad though
00:27:38.56\00:27:41.21
we can make a
definitive statement
00:27:41.24\00:27:42.42
that if you drink
soy milk you won't get
00:27:42.45\00:27:44.02
prostate. Remember
with all of these things
00:27:44.05\00:27:45.76
although lifestyle
can lower your risk.
00:27:45.79\00:27:48.96
It doesn't always prevent it.
00:27:48.99\00:27:51.99
Allan that's a very good point
00:27:52.02\00:27:53.72
and I would like to thank you
00:27:53.75\00:27:55.02
today for being
our guest. It's been a
00:27:55.05\00:27:57.04
pleasure of
discussing this topic with you.
00:27:57.07\00:27:59.01
Has been a pleasure for me too
00:27:59.04\00:28:00.64
and a privilege thank you.
00:28:00.67\00:28:02.05
And now with the
audience I would like
00:28:02.08\00:28:03.53
to leave one of
the points and that is
00:28:03.56\00:28:05.86
if you are diagnosed
with prostate cancer,
00:28:05.89\00:28:08.08
it's not your
fault and God can be
00:28:08.11\00:28:11.31
with us during
this time of need.
00:28:11.34\00:28:13.43