Joey Wahler (Host): This is Health Matters: Insights from WCH Medical Experts. Thanks for joining us. I'm Joey Wahler. Our guest, Dr. Salvador Peron. He's a urologist with Wood County Hospital. Hi there, Doctor. Welcome.

Salvador Peron, MD: Hi, Joey. How are you today?

Host: I'm great yourself.

Salvador Peron, MD: Pretty great and good.

Host: All right. Well, we appreciate the time. And first, for those that don't know, what exactly does PSA stand for and what is a PSA test?

Salvador Peron, MD: PSA stands for prostate-specific antigen. It is a blood test that's now done, usually on a once-a-year basis, and it is a blood test that actually describes an antigen that's in our bloodstream, and helps us understand is there something awry within the prostate. The PSA itself can rise when the patient has benign prostatic hypertrophy, which is a normal run-of-the-mill enlargement of the prostate that we all men get beginning at age 30. It rises when a patient has had a prostate infection. It can rise actually very temporarily after intercourse or ejaculation. And the most important part is it can detect potentially a change in the cells that could be turning from benign to malignant. And that way, it gives a head start or a warning that something's wrong; and therefore, we evaluate the situation.

Host: And so, there's a wide range of things, as you just pointed out, that a change in PSA could indicate. Without testing, a high PSA level may or may not have noticeable symptoms, correct? Often, it does not.

Salvador Peron, MD: Correct. That is absolutely correct. So, a PSA can be elevated and a patient has zero symptoms to a patient having multiple symptoms from benign disease. And it can show still a concerning elevation.

Host: So, at what age these days should men begin having PSA screenings? And how often should they have it?

Salvador Peron, MD: This should be a yearly exam at least. And there's controversy whether a digital rectal exam is necessary at the same time. American Cancer Society suggests now the beginning age, it used to be 50 years of age like colonoscopy, it's come down to 45 years of age because the detection rates of cancer have so much increased. The cure levels of cancers have increased as a result of finding cancer early.

Now, there's a wide range. Also, it has been suggested Cancer Society, that if we're African American, Hispanic, Mediterranean, or very importantly, if there's a genetic predisposition in the family, in other words, someone on our dad's side of the family had prostate cancer, that age range that it should be started is now 40 and very soon, from what I'm understanding, and the research is showing that they may start suggesting that family members of a member of a family, a dad, a grandfather and uncle on the father's side of the family, just start at 38 to at least have the blood test and, hopefully, the digital rectal exam.

Host: And before we go any further and talk about the test in a little more detail, this is something, this area that's kind of a double-edged sword, right, when we talk about prostate cancer. Because on the one hand, it's very common among men and very likely that most men will get it if they live long enough, right? But on the other hand, if it's caught early enough, and that's why we're talking about screening, it can be nipped in the bud, yes?

Salvador Peron, MD: That is absolutely correct. So, I always share with my patients a story that the year I graduated in 1982 from medical school was the year that the American Cancer Society actually declared prostate cancer to be the leading cause of cancer death in the country. I'll never forget, our dean at the time gave at graduation the State of the Medicine Speech. And he said, "Well, I know 13 of you out there are going to become urologists. And the sad news is that approximately 80% of the men you'll see for the first time will have passed within three to six months after diagnosing them. And 20%, you might be able to help." By 1985 when PSA was discovered through 1995, those statistics reversed in that 80% of men came in time to hopefully be cured and diagnosed and cured early, and 20% did not, and still had the same terrible statistic. Today, it's almost 98%. If it's caught early enough, you have a great chance of being cured by one of many methods. And so, that's why even though we all don't disagree as urologists, it is not a screening tool. It's sure a test that is helping a lot of men save their lives in certain senses and certainly deter any chance that there will have a terrible disease that they will pass from in the future.

Host: Absolutely. So to back up for a moment, Doctor, how does someone obtain a PSA test in the first place?

Salvador Peron, MD: First of all, most of the time our family physicians, I give them credit and our Internal Medicine doctors for doing as part of their annual physical. If they see a urologist, a lot of urologists will do that as their routine yearly exam. And simply asking by a patient standpoint, asking the physician to get the test done. We've had situations-- in fact, I recently had a very sad story in which a patient whose father was my patient as well, was diagnosed early with cancer, had surgery and was cured. His son followed exactly my suggestion when he was in his 30s, turned 45; from 45 to 49, begged his family physician for a PSA. Finally, he threatened the family physician by saying, "I'm leaving, getting another doctor." Finally got a PSA and, unfortunately, we found his cancer to be metastatic at the time we diagnosed him after a biopsy. So, ironically enough, he's still going to have help and still have a higher chance of being cured than the next guy 20 years ago, or 15, 20 years ago. But he did the right things in asking for the test to be done even earlier just because he had the education to say, "Hey, I better get it done earlier, because my dad had cancer."

Host: Wow, that's certainly terrible to hear. And, well, I don't know obviously why that particular doctor didn't want to give him the test. We should point out that most general practitioners will willingly give it, right?

Salvador Peron, MD: Oh, absolutely. And we're very fortunate here at Wood County-- and again, kudos to our physicians here and across the world and across the country-- that we're educated enough, I think, in medical school that it is a simple blood test. It is not expensive and most insurances will cover given the right coding that we all have to do for everything we do nowadays. But it is something that can be as helpful as any other test that's a preventative test to see could there be something wrong and what can we do about it early.

Host: Sure. And it certainly seems like not just in Urology, but as you well know and just about all areas of medicine nowadays, preventative medicine and screening, there's more of a message of getting out the word about the importance of that than ever. So, what do urologists like yourself do once you have those screening results after the test?

Salvador Peron, MD: Well, once I see an elevation, first is education. Because most of us fear the minute you're told that elevation is eminent, that all of a sudden, "I'm going to die of cancer." Unfortunately, we have not educated the public enough, and we thank you for doing a podcast like this. Education is knowledge and power, right? So that the more power we have over a disease, the better we're going to be as a patient. So, just getting the knowledge out and then basically having the test done.

And then, hopefully, on the urologist part, our part is to teach and educate so that every time a PSA is elevated, it doesn't mean we have cancer, but there's a certain pathway that we can take from-- there are some urologists who go straight to a biopsy. I love the new innovations that have been created to prevent a biopsy if necessary, because now we can do a urine test, for example, called the ExoMed test that checks for the DNA of the genes associated with prostate cancer. And if the simple urine test in the cup is elevated, it gives me a higher reason to suggest a biopsy. And there's actually percentage just that I discussed with the patient that's depending on the results as to how high of a chance we'll find cancer because of that urine test. MRI has become an essential tool as well as our radiologists who have become extremely inquisitive and apt at doing MRIs. We are now able to pick out benign cells from cancerous cells. And for example, now, today at least we do this here at Wood County and throughout the city is what we call targeted fusion biopsies, where we either visibly have an MRI of the prostate, know the location to where the radiologist is saying the cancer is. And instead of maybe doing 12 or 24 standard biopsies, we might do four. We might do three, we might do less depending on the sites of the MRI sees. So, just those two advances had literally lessened the number of unnecessary biopsies have been done by literally a third, just in the last four to five years, have targeted and made it simpler. And then, when you get the diagnosis of cancer, the information that we receive from the locality and location of that cancer and what the cancer is, is then helping us-- like if you and I went into a restaurant-- have a menu of options of what we can do. I tell every patient, "Listen, cancer is not one-shoe-fits-all, and there are many options that we can have. They're all excellent, and the key is getting the right treatment for the right cancer."

Host: So, PSA testing, as we've covered, can save lives literally. Maybe talk a little bit more, Doc, about what a difference they can make in that area because it seems so often when someone has more of a dire prostate cancer diagnosis, it's because they weren't tested on a regular basis right?

Salvador Peron, MD: That is correct. And so, not only has it been helpful in finding the cancer. But even, for example, a person undergoes radiation or an operation of all the different types that we can do nowadays, our followup of the patient doesn't involve invasive testing. It involves the same test that got them to us in the first place, the diagnose their cancer. That PSA becomes the threshold of what we can-- I always, It's like the radar screen in the patient's body, that says, "My cancer is completely inactive. I'm in remission," or "I still have active cancer. And there's other things that the urologist has to do to help that patient," working along, for example, with our radiation oncologist or medical oncologist, to use other medicines to still help that patient survive.

And I think of something very important, it's not just the survival, it's the quality of life that the patient gets to enjoy. So, no one today-- I feel very strongly about this-- should suffer a cancer death of which prostate cancer is a very painful death. And with the numerous of new medicines that we have, the radiation therapies that, for example, we have here at Wood County, the adjuvant therapies, even when the cancer's been extended out of the prostate gland itself. Working as a team with the other doctors, we can do lots of wonderful things to give that person the quality of life they actually all deserve.

Host: Yeah, certainly. Great to hear. Just a couple of other things. First, you touched on this a bit earlier as well, but what are the treatment options after a positive PSA? Because we should again, emphasize, it could mean prostate cancer, but so often it doesn't. It could mean urinary problems or things that are certainly far less serious and far more easily treatable, right?

Salvador Peron, MD: Number one, I'll say offhand that we now know so much about cancer and the nature, and the pathology of cancer and pathologists and all the research that's gone on in the last 47 years since PSA was discovered that one of the treatments for cancer is sometimes no treatment. There are many cancers, and I have probably hundreds of patients in all the years I've been doing this that don't need any treatment. And their survival will be the same as a person who doesn't have cancer. They have to have that right cancer, and they have to have the right age.

You started talking a little bit about that at a certain age. There's a good percentage of us that will have cancer and does not need treatment. That sets up a lot of controversies as to when should PSA be stopped. I don't really feel it should be stopped. But that's a discussion that I have privately with every patient as soon as they turn 79 and above. And I let it be the patient's will as to whether they want to be tested or not in that point. But as far as options of treatment observation, there's hormonal therapy, which is when a patient's cancer has spread. We have a way of basically starving the cancer cell from growing as fast and sometimes going in the state of hibernation. There's radiation therapy, which is more and more precise these days. There's surgery, which we do robotically here at Wood County, to remove the prostate and reconnect the bladder to the valve, save the nerves of potency, and save the nerves of continence, which is the biggest controversy with surgery. We have cryosurgery, which is freezing the prostate, which has been around for 45, 50 years.

One of the newest methods, which we've fortunately had a podcast about this before, high-intensity focus ultrasound, where we use ultrasound technology to guide lasers right to the cancer to kill the cancer locally, no incision, outpatient, and we've had amazing and wonderful results for the right patient. HIFU is not for everybody, nor is radiation neurosurgery. There's cryosurgery nor there's observation. So, it's like getting back to my theory of one shoe doesn't fit all. There's a lot of discussion between patient, family physicians and us as to what the right things are for the patient. And I always tell people, "Take your time, make a decision." There's very rare a time that you have to make a decision a day you're at the doctor's office once you're diagnosed. You read, take the time, get a second opinion, there's nothing wrong with that, before you make your final decisions

Host: And so in summary here, Doctor, for men that think, "I feel fine. I don't need PSA testing," let's drive home the importance again. What's your message for them?

Salvador Peron, MD: Prostate cancer is silent. If PSA was never developed, we'd still be in the dark ages like we were in 1982. And 80% of men would still come to the doctor too late and pass three to six months a horrible death. It's made a difference. Quality of life, length of life, and that people should carry on to whenever God's supposed to take them from this earth, but not let cancer be the one that takes them from it.

Host: Very well said indeed. A great place to end, and certainly a great job by you getting that message across

Salvador Peron, MD: Thank you so much for the opportunity to talk to everybody.

Host: Please. It's our pleasure and it's something that really can't be out there as a reminder enough. Well, folks, we trust you are now more familiar with PSA testing. It can literally save lives as we've discussed. Dr. Peron, please keep up all your great work and thanks so much again.

Salvador Peron, MD: Thanks for the time.

Host: Same here. And to make an appointment with Dr. Peron, please call Wood County Urology at (419) 352-1404. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks so much again for being part of Health Matters: Insights from WCH Medical Experts.