Prostate Cancer Doesn’t Fight Fair and Neither Should You!
According to the NIH National Cancer Institute, an estimated 14% of all new cases of cancer in 2022 were prostate cancer. Additional research published in JAMA Network shows that African American men are twice as likely to get prostate cancer compared to white men, and to die from it. Why and how can we turn the tables for all men to prevent prostate cancer? In this podcast, learn from Dr. David Levy, urologist at UM Charles Regional Medical Group – Urology, what prostate cancer is, how it is treated and what we can do to level the playing field.
Featured Speaker:
Dr. Levy graduated from Washington University in St. Louis in 1985. He received his Doctor of Medicine degree from Chicago Medical School and completed his General Surgery Internship and Urology Residency at University Hospitals of Cleveland, Case Western Reserve University. Following his residency, Dr. Levy completed a fellowship in Urologic Oncology at the MD Anderson Cancer Center in Houston, Texas. He was Clinical Associate Professor of Surgery/Urology at the Cleveland Clinic where he worked for 12 years prior to joining Chesapeake Urology and UM Charles Regional Medical Group – Urology.
Learn more about David Levy, MD
David Levy, MD
David Levy, MD is a urologist at UM Charles Regional Medical Group – Urology. He is an experienced physician who is the author of 30 scientific manuscripts and 16 book chapters, the founding editor of a board-reviewed book on urology, has been listed as a Top Doctor numerous times and is an accomplished speaker. Dr. Levy is a recognized expert in prostate cryosurgery, an outpatient curative prostate cancer procedure. He has been sought out as a referral source for minimally invasive prostate cancer therapy as well as radiation failure prostate cancer therapy. Additionally, he is a cancer nutrition specialist and believes nutrition is a key component to cancer care.Dr. Levy graduated from Washington University in St. Louis in 1985. He received his Doctor of Medicine degree from Chicago Medical School and completed his General Surgery Internship and Urology Residency at University Hospitals of Cleveland, Case Western Reserve University. Following his residency, Dr. Levy completed a fellowship in Urologic Oncology at the MD Anderson Cancer Center in Houston, Texas. He was Clinical Associate Professor of Surgery/Urology at the Cleveland Clinic where he worked for 12 years prior to joining Chesapeake Urology and UM Charles Regional Medical Group – Urology.
Learn more about David Levy, MD
Transcription:
Prostate Cancer Doesn’t Fight Fair and Neither Should You!
Joey Wahler (Host): It's a very common form of cancer. So we're discussing how prostate cancer doesn't fight fair, and neither should you. Our guest, Dr. David Levy, a Urologist at UM Charles Regional Medical Group. Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. Thanks for listening. I'm Joey Wahler. Hi, Dr. Levy, thanks for joining us.
David Levy, MD: Good afternoon. Thanks for having me.
Host: Great to have you. So first, what do we mean by prostate cancer doesn't fight fair and neither should you?
David Levy, MD: Well, prostate cancer is the most commonly diagnosed cancer in American men. In 2023, the American Cancer Society expectations are about 288,000 men in the United States are going to be diagnosed with prostate cancer and about 34,000 are going to die from the disease. That's twice as common as the next most common cancer in American men, which is lung cancer. And it's a pretty distant second. They're only about 117,000 lung cancers expected. And prostate cancer is more than three times as common as colon cancer with about 81,000 cases expected in the US. Now with lung cancer and colon cancer, oftentimes people are going to have symptoms. They're going to have coughing or coughing up blood or shortness of breath with lung cancers and with colon cancer, as many people are aware, you can have blood with bowel movements. Prostate cancer is silent. There are really no symptoms, and the overwhelming majority of the time, it's picked up off of a blood test that's done at your regular doctor's office, and if you don't have the blood test, it's very, very common that this cancer's going to grow silently and it's going to be near impossible to detect until it's very, very advanced.
Host: Well, obviously those numbers are quite whopping, to say the least. So let me pick up on what you just mentioned there at the end, the PSA test, which is what I believe you're referring to. At what age should men start having that done typically, and how often should it be done? Because really that's the key to early detection, right?
David Levy, MD: So PSA blood testing's been around since the very, very late 1980s, very early 1990s. And it's met with a fair bit of controversy over the decades because it isn't by any means, a perfect blood test, far from it for prostate cancer detection or suspicion to go ahead and assess the patients. So it's been the subject of thousands and thousands of research papers and the US Task Force on Preventative Medicine, in 2008, published a pretty well publicized study where they gave PSA testing a, a value of a D in terms of utilization and benefit to patients.
PSA blood test from the American Urologic Association has been relegated to men between ages of 55 and 69 in terms of having a discussion with their doctor about having the blood test done. So the reason it's been so controversial is yes, it dramatically aids in our decision making for going ahead and recommending a prostate biopsy be done for patients, but a lot of times the PSA testing is misleading. In other words, it can be elevated out of normal range based on a person's age, for a variety of reasons, and for that, that exact result, it needs to be interpreted very carefully because one of the major problems with PSA over the decades has been an excessive use of biopsies.
Even though the risk of having a biopsy done in the office is very low. The risk of getting any kind of infection is hovering around 2% of men because they get significant antibiotics at the time of the biopsy. The risk of bleeding, because we're putting a needle through the wall of the rectum into the prostate, and we use novocaine anesthesia in the office, so it really is not uncomfortable for the man to have this done in the office. They drive themselves to the office and they drive themself back to work or home or to the grocery, whatever. So we use novacaine. So there's really no significant pain. Bleeding from the biopsies is very, very rare. So side effects from the biopsy are few and far between.
PSAs resulted in a substantial number of increased biopsies being done across the country, and then what that's resulted in is a significant increase in men being treated for prostate cancer. And one of the big issues is, do all these men need to be treated because there can be side effects from treatment, and the answer is no.
All the men diagnosed with prostate cancer do not necessarily need to be treated. So what's happened happened over 30 years since PSA's been ushered into our armamentarium, genetic testing? So over the last so many numbers of years, roughly 10 years or so, genetic testing on the biopsy cores has been developed, which has been exceptionally helpful in terms of looking at the tissue from the diagnosis, even though it may say cancer, the genetic analysis may say, this person doesn't need to get treated because this cancer's really not going to be any more dangerous than having gray hair. So the docs who do the biopsies have to be very careful when using the PSA, deciding on going ahead and moving forward with a biopsy and then deciding yes or no does the person need to be treated? So there are the caveats of PSA utilization. It's still probably the best test that's out there, although there are newer ones. There are some urine based tests and there are some other blood tests aside from PSA that may work a little bit better. But the approach to the people has to be done very carefully.
Host: Gotcha. Great explanation on that. So that being said, any tips for people to try and cut down the risk of getting prostate cancer on their own?
David Levy, MD: Right, we know that there are definitely populations of Americans who are at higher risk. The African American population is about two to four times more likely to die from this disease compared to any other racial group in the US and that's a substantial increased risk.
Host: And why is that?
David Levy, MD: Well, it's pretty hard to nail that down. I would say there's not a conclusive answer to why.
Host: Okay.
David Levy, MD: But we know from statistics in terms of death rates, diagnostic rates, that, that statistic holds true pretty solidly, but the exact reason, I can't give you. I, I don't really think it's been delineated. But we know the African American populations have higher risk significantly. We also know that people who have a first degree relative, a father who had the disease, or a brother who had the disease, or a, a first uncle on the father's side, those people increased risk for being diagnosed with prostate cancer at times is 30% higher than the population otherwise, with no family history of the disease.
I became very heavily involved in dietary factors impacting prostate cancer about 10 years ago. And the reason behind that is because if you look at world population statistics, India, China and Japan have the lowest rates of prostate cancer of any developed nation. US, England, France, Germany, Norway, Sweden, Finland, Austria, take all of them. India, China, and Japan have rates of prostate cancer diagnosis that are at times 25 times lower than the US. So when you go in and look at the demographic data of what's going on in these countries compared to all the other nations that I named, dietary factors are a significant consistent trend in that dietary fat from animal-based protein, meat and dairy is significantly lower in India and China and Japan. So when we look at omega-3, omega-6 fatty acid ratios in the blood, the American based population, that ratio is about one to 15 or one to 20, omega-3 to omega-6. Omega-6 is the fatty acids that you get in your diet from meat and dairy based products. When you look at those ratios in India and China and Japan, the blood ratio is about one to four, one to five. And what we know about prostate cancer is that when the fatty acid ratios are lower, the metabolic rates of the cells are reduced by as much as 30%. So when we look at factors in America, that could be significant in terms of the rates of prostate cancer, and even in different segments of the American population; fried fatty foods, higher meat intake, lower fruit, lower vegetable intake can be significantly associated with higher rates of diagnosing prostate cancer. So when you ask, is there something identifiable that maybe we can do, the answer is yes, very likely.
And that simplest answer is get rid of meat and dairy in the diet and get rid of added sugar in the diet. What sugar does in the diet, from our fruit drinks, our sodas, our candy bars, cookies, anything like that, that has added sugar is it stimulates something called insulin like growth factor, and that stimulates something else called vascular endothelial growth factor. And it's putting like putting lighter fluid on the coals for these cancer cells. It stimulates their growth.
So by taking meat and dairy out of the diet and taking added sugar out of the diet, you can actually suppress the biology of these cells.
Host: Well, some good news there. How about simply put, nowadays, what are the best treatment options if you do have prostate cancer?
David Levy, MD: If someone has a biopsy and it shows cancer, in my practice, the first thing we do is genetic testing. What we want to identify is, is this a cancer that's going to significantly impact on this gentleman's future health? And if the genetic testing comes back and says, nope, this is not going to be a dangerous cancer, we can keep an eye on it. Then my next step is, okay, we change the diet. And we change diet based on what I was just alluding to in my former comments, my earlier comments. We get rid of meat and dairy, we get rid of added sugar, and we add several supplements that I've published research on in some of the international journals. We change the diet, that changes the immune system, that changes the biology of the signaling that goes to the cells.
If they are individuals that warrant treatment because of the genetic testing, then we start talking about possibly surgical removal, possible radiation, and I do a lot of cryosurgery where I go into the prostate with the person asleep and I actually freeze the cancer areas into a block of ice and then thaw it. The person's awakened from anesthesia and they go home, and that is the treatment.
Cryosurgery freezes, kills it, it's dead. They go home and they're monitored after that. So those are really the three cornerstones of treatment. And more recently, something called high intensity focused ultrasound has come on FDA approved in the US. It's been used in Europe for 20 years, and that's using an ultrasound probe in the rectum with the patient asleep and it actually heats the prostate cancer to about 40 degrees Celsius, which is pretty warm, and by heating, it destroys the cells. And then the person goes home after the heating process is done in the operating room, which takes about 45 minutes to an hour. There's also now pretty good investigations going on for using MRI to guide laser fibers into the prostate and use the laser energy to destroy the cells in the prostate.
And what we're getting to in terms of treating prostate cancer, is trying to avoid side effects from the treatment because that's a really big deal. Sometimes when we treat with surgical removal, it can result in loss of control of the urine afterwards, where they're leaking urine. So every surgeon tries their best to avoid that at all costs. We also get into side effects of impacting on erectile function, the ability that performs sexually. So strong efforts are made to not damage the nerves. The radiation, the cryosurgery, the freezing, the high intensity focused ultrasound, the heating of the tissue, and these laser applications in MRI, are all efforts to be minimally invasive and avoid some of those other complications that have been fraught with, with surgical removal.
There are a number of surgeons across the country that have excellent outcomes in terms of control of urine afterwards and erections, but you typically don't get those kinds of side effects from radiation or the freezing or the HIFU. And now the laser application that's really being studied and utilized in specific centers across the country.
Host: Well, I'm glad you covered all the side effects and what can be done to try to battle that. Because obviously, as you pointed out, doctor, that's a huge concern when someone is going through any of the procedures you mentioned. Folks we trust you are now more familiar with how prostate cancer doesn't fight fair, and neither should you. Dr. David Levy, very informative. Thanks so much again.
David Levy, MD: Thanks for having me.
Host: And you can find more shows just like this one at umms.org/podcast, as well as on YouTube. If you found this podcast helpful, please share it on your social media, and thanks for listening to Live Greater, a health and wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again. Hoping your health is good health. I'm Joey Wahler.
Prostate Cancer Doesn’t Fight Fair and Neither Should You!
Joey Wahler (Host): It's a very common form of cancer. So we're discussing how prostate cancer doesn't fight fair, and neither should you. Our guest, Dr. David Levy, a Urologist at UM Charles Regional Medical Group. Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. Thanks for listening. I'm Joey Wahler. Hi, Dr. Levy, thanks for joining us.
David Levy, MD: Good afternoon. Thanks for having me.
Host: Great to have you. So first, what do we mean by prostate cancer doesn't fight fair and neither should you?
David Levy, MD: Well, prostate cancer is the most commonly diagnosed cancer in American men. In 2023, the American Cancer Society expectations are about 288,000 men in the United States are going to be diagnosed with prostate cancer and about 34,000 are going to die from the disease. That's twice as common as the next most common cancer in American men, which is lung cancer. And it's a pretty distant second. They're only about 117,000 lung cancers expected. And prostate cancer is more than three times as common as colon cancer with about 81,000 cases expected in the US. Now with lung cancer and colon cancer, oftentimes people are going to have symptoms. They're going to have coughing or coughing up blood or shortness of breath with lung cancers and with colon cancer, as many people are aware, you can have blood with bowel movements. Prostate cancer is silent. There are really no symptoms, and the overwhelming majority of the time, it's picked up off of a blood test that's done at your regular doctor's office, and if you don't have the blood test, it's very, very common that this cancer's going to grow silently and it's going to be near impossible to detect until it's very, very advanced.
Host: Well, obviously those numbers are quite whopping, to say the least. So let me pick up on what you just mentioned there at the end, the PSA test, which is what I believe you're referring to. At what age should men start having that done typically, and how often should it be done? Because really that's the key to early detection, right?
David Levy, MD: So PSA blood testing's been around since the very, very late 1980s, very early 1990s. And it's met with a fair bit of controversy over the decades because it isn't by any means, a perfect blood test, far from it for prostate cancer detection or suspicion to go ahead and assess the patients. So it's been the subject of thousands and thousands of research papers and the US Task Force on Preventative Medicine, in 2008, published a pretty well publicized study where they gave PSA testing a, a value of a D in terms of utilization and benefit to patients.
PSA blood test from the American Urologic Association has been relegated to men between ages of 55 and 69 in terms of having a discussion with their doctor about having the blood test done. So the reason it's been so controversial is yes, it dramatically aids in our decision making for going ahead and recommending a prostate biopsy be done for patients, but a lot of times the PSA testing is misleading. In other words, it can be elevated out of normal range based on a person's age, for a variety of reasons, and for that, that exact result, it needs to be interpreted very carefully because one of the major problems with PSA over the decades has been an excessive use of biopsies.
Even though the risk of having a biopsy done in the office is very low. The risk of getting any kind of infection is hovering around 2% of men because they get significant antibiotics at the time of the biopsy. The risk of bleeding, because we're putting a needle through the wall of the rectum into the prostate, and we use novocaine anesthesia in the office, so it really is not uncomfortable for the man to have this done in the office. They drive themselves to the office and they drive themself back to work or home or to the grocery, whatever. So we use novacaine. So there's really no significant pain. Bleeding from the biopsies is very, very rare. So side effects from the biopsy are few and far between.
PSAs resulted in a substantial number of increased biopsies being done across the country, and then what that's resulted in is a significant increase in men being treated for prostate cancer. And one of the big issues is, do all these men need to be treated because there can be side effects from treatment, and the answer is no.
All the men diagnosed with prostate cancer do not necessarily need to be treated. So what's happened happened over 30 years since PSA's been ushered into our armamentarium, genetic testing? So over the last so many numbers of years, roughly 10 years or so, genetic testing on the biopsy cores has been developed, which has been exceptionally helpful in terms of looking at the tissue from the diagnosis, even though it may say cancer, the genetic analysis may say, this person doesn't need to get treated because this cancer's really not going to be any more dangerous than having gray hair. So the docs who do the biopsies have to be very careful when using the PSA, deciding on going ahead and moving forward with a biopsy and then deciding yes or no does the person need to be treated? So there are the caveats of PSA utilization. It's still probably the best test that's out there, although there are newer ones. There are some urine based tests and there are some other blood tests aside from PSA that may work a little bit better. But the approach to the people has to be done very carefully.
Host: Gotcha. Great explanation on that. So that being said, any tips for people to try and cut down the risk of getting prostate cancer on their own?
David Levy, MD: Right, we know that there are definitely populations of Americans who are at higher risk. The African American population is about two to four times more likely to die from this disease compared to any other racial group in the US and that's a substantial increased risk.
Host: And why is that?
David Levy, MD: Well, it's pretty hard to nail that down. I would say there's not a conclusive answer to why.
Host: Okay.
David Levy, MD: But we know from statistics in terms of death rates, diagnostic rates, that, that statistic holds true pretty solidly, but the exact reason, I can't give you. I, I don't really think it's been delineated. But we know the African American populations have higher risk significantly. We also know that people who have a first degree relative, a father who had the disease, or a brother who had the disease, or a, a first uncle on the father's side, those people increased risk for being diagnosed with prostate cancer at times is 30% higher than the population otherwise, with no family history of the disease.
I became very heavily involved in dietary factors impacting prostate cancer about 10 years ago. And the reason behind that is because if you look at world population statistics, India, China and Japan have the lowest rates of prostate cancer of any developed nation. US, England, France, Germany, Norway, Sweden, Finland, Austria, take all of them. India, China, and Japan have rates of prostate cancer diagnosis that are at times 25 times lower than the US. So when you go in and look at the demographic data of what's going on in these countries compared to all the other nations that I named, dietary factors are a significant consistent trend in that dietary fat from animal-based protein, meat and dairy is significantly lower in India and China and Japan. So when we look at omega-3, omega-6 fatty acid ratios in the blood, the American based population, that ratio is about one to 15 or one to 20, omega-3 to omega-6. Omega-6 is the fatty acids that you get in your diet from meat and dairy based products. When you look at those ratios in India and China and Japan, the blood ratio is about one to four, one to five. And what we know about prostate cancer is that when the fatty acid ratios are lower, the metabolic rates of the cells are reduced by as much as 30%. So when we look at factors in America, that could be significant in terms of the rates of prostate cancer, and even in different segments of the American population; fried fatty foods, higher meat intake, lower fruit, lower vegetable intake can be significantly associated with higher rates of diagnosing prostate cancer. So when you ask, is there something identifiable that maybe we can do, the answer is yes, very likely.
And that simplest answer is get rid of meat and dairy in the diet and get rid of added sugar in the diet. What sugar does in the diet, from our fruit drinks, our sodas, our candy bars, cookies, anything like that, that has added sugar is it stimulates something called insulin like growth factor, and that stimulates something else called vascular endothelial growth factor. And it's putting like putting lighter fluid on the coals for these cancer cells. It stimulates their growth.
So by taking meat and dairy out of the diet and taking added sugar out of the diet, you can actually suppress the biology of these cells.
Host: Well, some good news there. How about simply put, nowadays, what are the best treatment options if you do have prostate cancer?
David Levy, MD: If someone has a biopsy and it shows cancer, in my practice, the first thing we do is genetic testing. What we want to identify is, is this a cancer that's going to significantly impact on this gentleman's future health? And if the genetic testing comes back and says, nope, this is not going to be a dangerous cancer, we can keep an eye on it. Then my next step is, okay, we change the diet. And we change diet based on what I was just alluding to in my former comments, my earlier comments. We get rid of meat and dairy, we get rid of added sugar, and we add several supplements that I've published research on in some of the international journals. We change the diet, that changes the immune system, that changes the biology of the signaling that goes to the cells.
If they are individuals that warrant treatment because of the genetic testing, then we start talking about possibly surgical removal, possible radiation, and I do a lot of cryosurgery where I go into the prostate with the person asleep and I actually freeze the cancer areas into a block of ice and then thaw it. The person's awakened from anesthesia and they go home, and that is the treatment.
Cryosurgery freezes, kills it, it's dead. They go home and they're monitored after that. So those are really the three cornerstones of treatment. And more recently, something called high intensity focused ultrasound has come on FDA approved in the US. It's been used in Europe for 20 years, and that's using an ultrasound probe in the rectum with the patient asleep and it actually heats the prostate cancer to about 40 degrees Celsius, which is pretty warm, and by heating, it destroys the cells. And then the person goes home after the heating process is done in the operating room, which takes about 45 minutes to an hour. There's also now pretty good investigations going on for using MRI to guide laser fibers into the prostate and use the laser energy to destroy the cells in the prostate.
And what we're getting to in terms of treating prostate cancer, is trying to avoid side effects from the treatment because that's a really big deal. Sometimes when we treat with surgical removal, it can result in loss of control of the urine afterwards, where they're leaking urine. So every surgeon tries their best to avoid that at all costs. We also get into side effects of impacting on erectile function, the ability that performs sexually. So strong efforts are made to not damage the nerves. The radiation, the cryosurgery, the freezing, the high intensity focused ultrasound, the heating of the tissue, and these laser applications in MRI, are all efforts to be minimally invasive and avoid some of those other complications that have been fraught with, with surgical removal.
There are a number of surgeons across the country that have excellent outcomes in terms of control of urine afterwards and erections, but you typically don't get those kinds of side effects from radiation or the freezing or the HIFU. And now the laser application that's really being studied and utilized in specific centers across the country.
Host: Well, I'm glad you covered all the side effects and what can be done to try to battle that. Because obviously, as you pointed out, doctor, that's a huge concern when someone is going through any of the procedures you mentioned. Folks we trust you are now more familiar with how prostate cancer doesn't fight fair, and neither should you. Dr. David Levy, very informative. Thanks so much again.
David Levy, MD: Thanks for having me.
Host: And you can find more shows just like this one at umms.org/podcast, as well as on YouTube. If you found this podcast helpful, please share it on your social media, and thanks for listening to Live Greater, a health and wellness podcast, brought to you by the University of Maryland Medical System. We look forward to you joining us again. Hoping your health is good health. I'm Joey Wahler.