Taking Control: Understanding and Combating Prostate Cancer with Dr. Richard Kennedy MD

Can you imagine taking control of your health and arming yourself against prostate cancer? That's what we promise you'll learn from this episode of Micro Musketeers Moment. Our co-host, Dr. Richard Kennedy MD, offers a wealth of knowledge from his 36 years of clinical experience in primary care, and he shares this with us in a captivating conversation that explores the world of prostate cancer — from understanding incidence rates and risk factors to discussing the PSA test and its pivotal role in detecting the disease.

Navigating the path of prevention strategies, we illuminate the importance of exercise, fitness, and recognizing your family history. We delve into the ongoing debate around regular screenings and their impact on decreasing death rates from prostate cancer. Dr. Kennedy candidly evaluates various treatment options for those diagnosed with prostate cancer, outlining their pros and cons. With personal anecdotes and insights, this episode is more than a data dump or medical jargon. It’s a call to action, a chance for you to seize control over your health. Listen in to learn about when and how often the PSA test should be done, and how you can protect yourself from prostate cancer. Don't let this opportunity pass you by.

Prostate Cancer Foundation - Resources:

https://www.pcf.org/patient-resources/
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Transcript

Speaker 1: 0:07

Welcome to Micro Musketeers Moment, a short podcast episode on health, wellness and other topics from Wellness Musketeers. I'm your host, aussie Mike James, a freelance writer and speaker with over 30 years of international experience managing leading corporate fitness centres in Australia and in Washington DC with the World Bank Group. Our special guest today is our co-host and fellow Musketeer, dr Richard Kennedy MD. Dr Kennedy is an internist who has over 36 years of clinical experience, including the World Bank clinical services and private practice. He is currently a primary care physician in Washington DC with MedStar. Today, dr Kennedy is going to discuss something that's very important Prostate cancer screening. Welcome, dr Kennedy.

Speaker 2: 1:02

Thank you, Mike. fellow Musketeer, Glad to talk about a very important topic.

Speaker 1: 1:07

And let's get right into it, richard, and I'll call you Richard or Dr Kennedy. We've known each other for such a long time.

Speaker 2: 1:14

Perfectly fine, Mike.

Speaker 1: 1:15

First question What is the incidence of prostate cancer in the US and the incidence of prostate cancer globally?

Speaker 2: 1:23

The incidence of prostate cancer in the United States the last readings were from 2020, was 111 cases per 100,000 population, And then, if you look at it in 2023, there is an expectation there'll be about 288,300 cases of prostate cancer in the United States And globally. Worldwide, there were 1,414,000 cases of prostate cancer throughout the globe. That's a high incidence.

Speaker 1: 2:07

Richard, what factors are associated with an increase in prostate cancer?

Speaker 2: 2:12

The most important risk factors are advancing, age, the black race and family history, and what we see is that, when they look across the globe, the cases of prostate cancer tend to be highest from 55 to 69. But of course, we see it in people much younger, and more so as we get older and older. Now, the belief is that if we live long enough as men in the world, one out of 10 men will have prostate cancer diagnosed in their lifetime.

Speaker 1: 2:57

I guess increasing ageing society, people living longer generally, is going to compound that factor.

Speaker 2: 3:04

Absolutely. And then the other similar risk factors that we've all talked about that are associated with other diseases like obesity, diabetes, level of fitness, dietary patterns meaning eating a diet higher in fat and red meat All of those things are thought to increase the chance that prostate cancer may visit men. Now, that being said, most men who be diagnosed with prostate cancer in their lifetime will not die of the prostate cancer, and that has a lot to do with the fact that in the 1990s they came up with the PSA test. It's called the prostate-specific antigen, or short for PSA, and that is a chemical that only is made in the prostate gland And it will elevate when certain things happen. So you can have it elevated with infection, you could have it being elevated as the prostate gland itself gets bigger, and it can be elevated with cancer.

Speaker 1: 4:26

What is the measure there? Is there a range that we should be looking at?

Speaker 2: 4:31

Yes, the normal range for prostate cancer, or rather I should say for the PSA test, is zero to four.

Speaker 1: 4:42

Anything under four is considered normal, so over four, and that goes up to adenthinitim, or does it have a ceiling?

Speaker 2: 4:52

Adenthinitim. The highest PSA test I've seen in practice has been 496. Oh wow.

Speaker 1: 5:04

So that's advanced. When should the PSI 20 much like done?

Speaker 2: 5:08

There's a global debate about whether dreaming for prostate cancer decreases the death rate from prostate cancer, and so what has happened is and we'll use the PSA test that started being used around the world in 1990.

Speaker 2: 5:33

At that time, what we did is once we started doing PSA screenings. We started doing the screenings at the age of 50, because that was when the incidence of the prostate cancer seemed to be increasing globally. But what they also found out is that when you found an elevated PSA so, for instance, you can have a person who has a PSA of 3.2, which again, technically would be normal. But if this individual had a PSA test done the year prior, or two, three years prior, and it was 1.1, then that was more than a 50% increase in the PSA. So there's a suggestion that there might be something going on. So you want to make sure that just because the test is normal doesn't necessarily mean you have to take in the factors family history, because those who have a family history of a father, a brother or son who had prostate cancer, there's a much greater risk that person will have prostate cancer going in their life. So which?

Speaker 1: 6:58

you're having the PSA done, say when you get to over 60,? how often should you have it done? Is it an annual type of thing?

Speaker 2: 7:06

I think it depends on you and your doctor, because there are pros and cons to doing tests. So, if you do the test and the test is elevated, it might suggest that you might have prostate cancer And, as I said earlier, the majority of men who get prostate cancer are not going to die from, they're going to die from other things. It is only the aggressive forms of prostate cancer that are more likely to be associated with that, and so, as an example, in the United States, this coming year 2023, the Leaf is going to be close to 34,700 men who will die from prostate cancer, whereas globally, that number will turn out to be about 375,000 who will die from prostate cancer Global. Should you get a positive test and it's been confirmed, what treatment options are available if you do get diagnosed with prostate cancer.

Speaker 1: 8:15

So they are more likely to be more likely to get prostate cancer.

Speaker 2: 8:21

So there are multiple treatment options. The first one, if it's a localized cancer, meaning the cancer is still within the prostate and the value is low, and there's a special test called the Gleason test which measures is a summation of the type of cancer cell and how much of the prostate is affected, will determine what the Gleason score is, and you'll have that discussion with the oncologist and or the Ural. But the one that has been recommended for a localized cancer, meaning that it is completely confined to the prostate, it has. A Gleason score meaning less than six is what we call watch for waiting or active. Now in Europe that is more of an accepted practice than it is here in the US, although it's gaining teeth in the US these days. These are all discussions you have with your doctor at the time of the diagnosis.

Speaker 2: 9:33

The second option for a treatment would be surgery. The intention of surgery would mean to remove the entire prostate, the blood supply that goes to the prostate, but sparing the nerve, and then again, for patients who have localized disease, it's not spread. Then there's radiation. There's external radiation and internal radiation. And then external radiation is basically you go to see a radiation oncologist and they radiate the area where your prostate would sit. The internal radiation is where they literally move thing in place indirectly to where the cancer cells are in the prostate and have it go, and so that's one.

Speaker 2: 10:34

Then there's radiophosphatecals, which is essentially radioisotopes, and this is for, specifically, castration resistant prostate. And then there's hormone therapy, chemotherapy and immunotherapy. All of these are different options And the more extensive the disease, the greater the chance that you can't do watchful waiting and you can't do surgery. Now, all of those things any surgery, any radiation, hormone therapy, chemotherapy they all have side effects And that is the reason why people are reluctant to always say everybody should get treated for prostate cancer, because the treatments are associated with side effects, the two most important ones being bladder contineness, or where you lose control of your bladder, and sexual dysfunction, loss of good erection.

Speaker 1: 11:45

And Dr K with this prostate cancer. let me just backtrack a little bit. You mentioned that you have to confer with your doctor and that's great. You have a good relationship with your doctor. But, as I'm sure more than most people, there's a thing called Google these days and people tend to look up Google and hear all manner of cures and so forth. Is there any site you would recommend for a more sober scientific analysis of the options with prostate cancer, whether it be the Mayo Clinic or whoever anything you could recommend?

Speaker 2: 12:22

Most of the places Mayo Clinic, nih, the CDC, the American Cancer Society, the Johns Hopkins, any of the major cancer sensors around they're all available, they all use the same data and pretty much across the globe, because everybody's comparing data and research and studies across the globe to get an idea of how best to look at this. And probably and you bring up a good point about this discussion with provider and patient is that this is a shared decision, but the final decision is always the patient And backtracking a little.

Speaker 1: 13:11

Maybe I should have asked this question at the start. And what actually does the prostate do? what is its function?

Speaker 2: 13:20

Good question.

Speaker 1: 13:21

A lot of people don't really know.

Speaker 2: 13:25

So the prostate its primary function is that it makes semen, and semen is part of the lubricant and nutrition for sperm cells as we relate it to impregnation and pregnancy. So its job is really to provide an environment that the sperm cells can survive in while they're trying to make their way up in through the vagina, into the cervix and into the womb to get pregnant. And so I would say the most important thing here is that the vaginal and the uterine environment is not conducive to sperm survival. In a way, that's why it takes one egg but a couple of million sperm to create a fetid.

Speaker 2: 14:30

So that seminal fluid is what helps those things to survive.

Speaker 1: 14:34

So why is the prostate very susceptible to cancer, Dr Co.

Speaker 2: 14:38

I wouldn't say it's very susceptible to cancer. I'd say every cell in our body is susceptible to cancer. So you could say that about the lung, you can say that about the breast, you can say that about the skin, you can say that about the kidneys, liver, etc. It's the second most common cancer in men. Number one happens to be skin cancer, and I'm a firm believer that all of us have cells that have the potential to become cancer And there are multiple factors that will dictate whether that comes true or not, because we also have immune cells who spend their time trying to keep those cells from turning into the bad cells.

Speaker 1: 15:25

Another factor we talked about and that's a particular interest to me, having managed fitness centers on my life, the importance of exercise and staying fit is a good deterrent, if that's the right word, for helping to prevent prostate cancer. Is there increasing research that's showing exercise and fitness is a big component?

Speaker 2: 15:47

Yes, is all of these things reflected. So, if you think about it, when we exercise and stay fit and by default, if you exercise regularly and stay fit, you have to eat well. You can't eat poorly and stay fit, and so what does that do? It means that your body makes use of all of the nutrients that come in so that you get everything that you need to sustain normal cellular function. What exercise does is it keeps us from being obese. Obesity has been tied to cancers of all kinds prostate as well And so what they see is that there are people who stay fit, are much less like. Now all of that goes out the window. If you're a, genetics play a role, meaning there's a family history. If you happen to be of African heritage, you're more likely for this to be an issue.

Speaker 2: 16:57

It doesn't mean it's going to happen And it's interesting. The US preventive task force back in 2012 recommended against prostate cancer screening because they didn't feel like doing. It decreased the mortality for the incidence of prostate cancer And, interestingly, the European Union did the same thing. And then one of the things from 2013 to 2017, what they found was that there was less PSA screening, and what happened is, during that time period, the incidence of more advanced or aggressive cancers of prostate started to increase. So now they back the bit, and now that's why the option is having this discussion with your provider to determine whether checking for prostate cancer is easy.

Speaker 1: 17:59

We're cutting a lot of areas there. Dr Kate, in closing, what's your key message regarding prostate cancer screening, or be your key message or key points, if you will.

Speaker 2: 18:10

I'd say one of the most important things is to get screened. Screening does save lives And the dilemma here is we don't know if one person getting screened is going to have an aggressive or far advanced cancer, meaning outside of prostate, or not. Probably get screened And this is one of the other important things about prostate cancer. For the most part, there aren't really any symptoms of prostate cancer until it's spread outside of the gland. A lot of men think gee, as I get older, gee, it takes longer for me to urinate, it takes longer for me to I get up in the middle of the night to pee a lot. And one of those things is that it's really important to be aware of that and to make sure that you at least get checked, because you can have an enlarged prostate and be giving you all of the symptoms and give you an elevated PSA and it not be prostate cancer. But it could be And, on a personal note, i'm one of those people.

Speaker 2: 19:32

My dad had prostate and my dad got diagnosed with prostate cancer when he was 70 and it was because he had symptoms. He stopped being able to pee. He ended up in the emergency room because his bladder and kidneys were still making urine and he couldn't get it out because the prostate had gotten so big it's used to tubing. So that then meant that me and my brothers were all at risk for getting prostate cancer, and so far two out of the three of us have had prostate cancer at much younger age. Mines was at 52, my brothers was at 97 and had no symptoms.

Speaker 1: 20:17

So you've got a personal knowledge of this from more than most people. That was a really educational session. Dr Kay, Thank you very much for being our guest today. And again, the key message is get screened. huh, Would you agree? Absolutely.

Speaker 2: 20:33

Terrific.

Speaker 1: 20:34

Thank you again, dr Kay, for joining us today for this wellness musketeers moment. Tune in for upcoming episodes to gain the tools to improve your health, work performance and live a more balanced quality of life. Please subscribe, give us a five star review, share this recording with everyone you know and you can make a contribution through a link provided in our program notes. To allow this podcast to grow, please let us know what you need to learn to help you live your best life. Send your best questions and ideas for future episodes to davidmless at gmailcom. Thank you again, dr Kennedy, and have a wonderful day.