Joey Wahler (Host): They're the latest advancements in addressing a crucial medical issue for men, so we're discussing prostate health breakthroughs. Our guest, Dr. Salvador Peron. He's a urologist with Wood County Hospital. 

This is Health Matters: Insights from WCH medical experts. Thanks for joining us. I'm Joey Wahler. Hi there, Dr. Peron. Thanks for taking the time. We appreciate it.

Salvador Peron, MD: Thank you for having us.

Host: So first, how would you say things are trending right now in the U.S. regarding the number of incidence of prostate cancer?

Salvador Peron, MD: I think the incidence of prostate cancer recognition is changing simply because patients are more aware, family physicians are very able to educate their patients, and there's an increasing frequency of at least testing being done by family physicians and internal medicine doctors. And patients actually coming to urologists throughout the country, getting at least some initial testing to find out could they have a problem with their prostate or prostate disease.

Host: And so, speaking of greater awareness and increased testing, remind people please, Doc, what does PSA stand for and how often should most men have that test done?

Salvador Peron, MD: PSA stands for prostate-specific antigen. It is a chemical released by prostate technically since we're born. But beginning at age 29, technically the PSA test can increase simply because at 29 years of age, our prostate starts enlarging the normal enlargement, which is labeled benign prostatic hyperplasia or BPH technically called. And so, that can be a reason the PSA goes up. Now, the American Cancer Institute, American Board of Urology recommends that, whereas years ago, we would start telling men to get their PSAs checked beginning at age 50, that age has been lowered to 45. In an African-American gentleman and gentleman who have had a parent on the father's side of the family who's had prostate cancer, the age of starting the PSA test and possible examination has now gone down to 40 years of age as a standard of practice around the country.

Host: So, what advancements have been made in the diagnostic testing for prostate cancer? 

Salvador Peron, MD: Well,in the past, to give a little history, PSA was elevated, and usually that led to a biopsy, and the level of normalcy of PSA was different, because it used to be called between zero and four nanograms per deciliter was considered normal. Now, most urologists go by something called the PSA velocity or PSA density, that there was a change of an amount of 0.75 nanograms per deciliter per year that the blood test could raise and be considered normal. But if that rise is above 0.75 per year, it is considered abnormal, and most urologists, based on the patient's age and background, would then consider doing further evaluation and testing.

That testing can include, in fact, going right to a biopsy, which some urologists will do. It's not always necessary, but a digital rectal exam is always recommended. Now, a great tool that we have at our disposition is the use of MRI of the prostate, which is specific technology for a prostate itself. And our radiology colleagues can then actually classify the types of changes that are seen on the MRI by something called a BI-RADS scale. And depending on the level of BI-RADS that they describe can make a doctor suspicious for cancer being present based on the degree that they see changes in. We also have a urine test, and of which there are many now being developed, one that we specifically use called the ExoMed test. It actually looks for the DNA of prostate cancer cells in the urine. And depending on the number of those cells that we find, it then leads us to a higher chance of whether we do a biopsy or not, so a patient hopefully doesn't undergo testing unless it's absolutely necessary. That has really decreased the number of unnecessary biopsies being done.

Host: You led me beautifully into my next question, Doc, because I was going to ask when we talk about things like the use of MRI and ExoMed, how much more helpful has that been to you and yours in getting to the bottom of this quickly and more effectively?

Salvador Peron, MD: Well, especially since the ExoMed test has been released, which is now American Board of Urologists recommended as part of the standards and diagnoses, we have probably reduced our number of unnecessary biopsies by a third, at least. It's not a perfect test. But most of the time, it will lead us to a diagnosis of cancer, usually early. And again, nowadays, where as opposed to when I graduated medical school during prehistoric times, where 80% of men came to a urologist already with six months to a year to live, now the disease is very curable, especially in its early stages.

Host: And speaking of which, maybe just punctuate for us, Doc, if you would, how important that early detection and early prevention is, because it can really sometimes save lives, right?

Salvador Peron, MD: Absolutely. And I've been lucky enough to live through generations of the development of these diagnoses and treatments in that we now know, if a gentleman comes to see a urologist and his PSA is less than 10, research has now shown for 45 years that that cancer is contained to the prostate.. I always tell patients it has not reached the fence that surrounds our prostate anatomically, and we know that that patient, hopefully with his age, the type of cancer we find, will be a candidate for many of the different options of treatment, which are many successful treatments nowadays.

Host: And for those unfamiliar, just to backtrack quickly for a moment, we mentioned the PSA test. We should point out that's a simple blood test, right? And you mentioned digital exam, which is still sometimes done as well. And as unpleasant as that can be for both the patient, and I would imagine the physician as well, it's quick and it's painless, right? I mean, you guys can tell literally in, what, about three seconds with a digital exam, if you're feeling something that doesn't seem right, correct?

Salvador Peron, MD: Correct. And it goes back beyond before the years I was a urologist. It's the only way we would ever detect prostate cancer before all this testing was done is that experience, I like to say, a digital rectal exam where you feel a change in the anatomy from year to year, a hardness or firmness, which would definitely designate that there was cancer available 90% of the time, if not more.

That's very, very important and, as uncomfortable as it is, me included when I yearly get that exam, it still picks up 10% of men who would not be diagnosed with the PSA test. So, as much as we'd like to say, yeah, just get the blood test and you're fine. It's not always the perfect scenario and you might be that unlucky person. I will tell you, maybe every year, there's 10 patients that I will diagnose with a normal PSA, yet my examination is what finds a cancer or the assistance of a wonderful family physician who has found that change to their credit. 

Host: So if you really want it to be foolproof, you should double up and do both, right?

Salvador Peron, MD: Correct. 

Host: Okay. Moving up. When we talk about new treatment options available for prostate cancer, how about high-intensity focused ultrasound and radical prostatectomy. How do they compare to some of the more traditional methods that have been used over the years?

Salvador Peron, MD: In the overall scheme of all the options that we have available, robotic prostatectomy now, which is what most of the urologists do in training since probably the last 20 years, that we've been able to have training methods in robots in hospitals like ours, for example. Robotic surgery still remains one of the classic ways and highest success rate for treatment of prostate cancer with the potential of preserving the nerves of potency and also the nerves of continence. It'still an excellent form of therapy and, again, depending on the cancer and the patient's age and comorbidities, another excellent treatment. 

High frequency ultrasound therapy, which we've recently started doing in the last year at Wood County Hospital, involves using ultrasound technology in four dimensions, where we literally identify the sites where the cancer is. And this is primarily in patients with low-grade disease, are the only candidates for this. They literally go to the cancer sites using laser therapy, heating the cancer cells. And by heating the cancer cells, we destroy the cancer. It's a localized therapy, so people come in as an outpatient, eat the same day. And there is no incision, there is no cutting, there is no bleeding. The rate of continence is phenomenal. The rate of preserving the nerves of potency is tremendous. So, it's become very popular, but it's very important because it has been around for 30, 40 years. It's just that it was not accessible to patients because insurance companies were still treating it as an experimental therapy. It's no longer experimental. It's done throughout the country. And I hate saying that it's becoming a fad, because it shouldn't be a fad. It should be included as one of the therapies that is available. But it's for early disease, very localized disease, and frankly, in some patients, it's an alternative if they want to do something but can still be having a type of cancer that can be observed.

Host: Gotcha. So, a couple of other things, having said all of the above, when we talk about these different advancements in treatment options, including what you just discussed, HIFU, prostatectomy, et cetera, you mentioned incontinence there briefly. Give people an idea, please, Doctor, what are some of the things you and a patient need to mull over when deciding which of those options is best for them between attacking the issue, but also dealing with the possible after effects as well, which is a big consideration, right?

Salvador Peron, MD: First of all, the most important thing I think that can happen is a conversation between patient including having the patient express all their fears because with knowledge comes power and the more you empower a patient to understand how incontinence can occur and what procedures and what percentages can help a patient feel more comfortable as to the decision-making process.

I'm finding, thanks to, again, all the factors we talked about, early detection, the PSA, the biopsies, a lot of great family physicians that we have in our system and throughout the world, I'm sure, by finding it early, we, again, don't have to pigeonhole people that they have to have an operation. But continence, treatable now. When I first graduated, we only had one way of treating incontinence after you had a radical prostatectomy or radiation, which is doing an artificial valve. Nowadays, we have medicines we can inject into the valve to make it stronger so the patient is not as incontinent as before if they have damage by surgery or radiation.

There are medications for the bladder to sometimes help them recover the incontinence sooner as well as physical therapy. It is something that can be treated, should be treated, and most doctors in training now don't wait an entire year to start treating incontinence if that's a consequence of the disease treatment. So, it's just important to have the conversation and which way to treat it if it does happen to that person.

Host: And so in summary, you mentioned earlier as well, that it's just a natural part of life for men that the prostate is going to enlarge eventually over time, obviously at different rates for different people involving different factors, et cetera. But in a nutshell, to prevent prostate cancer or try to as best as possible on our own, any advice regarding lifestyle changes that can be helpful there?

Salvador Peron, MD: Well, as there are many diseases that have a cause and effect, prostate cancer, ironically enough, until recently hasn't had a cause and effect relationship with the exception of smoking now has become a factor in increasing the chance of getting prostate cancer. Obesity has been recognized as increasing the chances in a person who just doesn't genetically inherit the disease. So, we always caution patients to understand we inherit this from our dad's side of the family. So if there are uncles, dads, grandfathers, great grandfathers, down the line, we always can inherit the gene. So, we are the guys that should be getting checked at age 40. Beyond that, those smoking, obesity, those are things that are causative agents. 

Now, recently, the National Cancer Institute, for example, and I'm saying in the last 10 years, has literally found there are substances that can help mediate the importance of pumping up, so to speak, the anti-cancer natural products that we have in our body. These are things as simple as baby aspirin, selenium, which is in our tomatoes, for example. So, it is predicted by the National Cancer Institute if you have two slices of pizza, a cup of soup, certainly a tomato and a salad per week, you're boosting your selenium. Lycopenes are in broccoli. Vitamin E, 400 international units are another one of the powerful antioxidants and very important. The most powerful antioxidant comes in a bottle. It's shape of a woman called pomegranate juice. And it said that if you take a shot of pomegranate juice, it increases our antioxidants. Again, prostate cancer disease, whether you have cancer, it helps you in a sense to natural build up your immune system. If you don't have it, it's one of the few preventive things we can do to hopefully mitigate the disease.

Host: Hopefully indeed. And you mentioned several options there ranging from pomegranate juice to pizza. I'd opt for the latter, but that's just me.

Salvador Peron, MD: So would I.

Host: Absolutely, Doc. Well, folks, we trust you're now more familiar with prostate health breakthroughs. Dr. Salvador Peron, valuable information indeed. Keep up the great work and thanks so much again.

Salvador Peron, MD: Thank you for the opportunity to talk with you.

Host: Absolutely. And for more information, please visit woodcountyhospital.org or to make an appointment, please call 419-352-1404. Now, if you found this podcast helpful, please share it on your social media. I'm Joey Wahler. And thanks again for being part of Health Matters, Insights from WCH Medical Experts.