Aaron Tharp 0:00
The information provided in this episode is provided for informational purposes only, and is not intended to replace professional medical advice. If you have questions regarding your health, please contact your medical provider.

All right. Welcome back, everyone. We are pleased to be joined again today by Dr. Lapke. How are you today, bud?

Dr. Steven Lapke 0:22
I’m good. Thanks for having me back.

Aaron Tharp 0:24
Yeah, you bet. And Josh too, it’s good to this feels normal. Like we got kind of back to the crew again. So

today’s topic is going to be around prostate cancer. So with September coming up, this is a good opportunity for us to, you know, talk a little bit more about the awareness abroad of prostate cancer, some prevalence, some leading causes, and some early detection. But as with the last episode that we did with Dr. Perlman the idea here is to just to provide resources, do our part, raise awareness, and, you know, make the convert, normalize the conversation. So,

you know, this is probably one of the most common leading causes of cancer, as I understand it.

Dr. Steven Lapke 1:14
Correct. in the US, approximately, one in eight men will develop prostate cancer.

Worldwide, it is the second most common cancer and has the fifth most common cause of death in regards to cancer worldwide. But in the US, again, it’s the second most common cancer, but the second leading cause of death with with cancers.

Aaron Tharp 1:43
Yeah, behind lung cancer, I believe.

Dr. Steven Lapke 1:45
Yeah.

Aaron Tharp 1:47
And we were talking a little bit off cam about, you know, sort of maybe the reasons why that may be why America really struggles or why it’s more,

more prominent, or why there’s a higher risk here. And we were sort of associating that with a diet a little bit.

Dr. Steven Lapke 2:04
Yeah, I mean, you know, I think, again, we see a lot of morbidity, mortality with a lot of disease processes in our country. And I, I do think a lot of it does lead back to our American diet and, and sedentary lifestyle. I mean,

you know, one of the things to reduce your risk for prostate cancer, one of the top two things are exercise and diet, and, and normalizing your weight, or, you know, avoiding obesity.

So, you know, that definitely points to that. I mean, there’s some other factors, certainly, certain

races, you know, at higher risk,

much higher in the black population, significantly lower risk in the Asian population.

So, you know, you’re seeing some of that, but there’s also they’re finding more and more a big genetic component to prostate cancer. Sure, like, significant. And they’ve found a number of genetic mutations, that if you have them, you’re definitely an increased risk.

Josh Simms 3:20
I think it’s, it’s the BRCA genes.

Dr. Steven Lapke 3:22
Yeah, that’s correct.

Josh Simms 3:23
Which is, which is very, very prevalent with women, breast cancer and ovarian cancer. So there, so if there’s a family history of any of that, like women are screened at young ages, and that’s where you kind of saw a few years ago, those

was kind of the elective master bilateral mastectomies, and

given the ovaries removed, and their breasts removed, just prevention of like, Mom had it, grandma had a great grandma had it, you’re probably gonna get it too. So these women who had kids and they were all done having kids they were just getting they would just get their breasts removed and just to reduce the risk.

Not that easy with the prostate though, unfortunately, no,.

Aaron Tharp 3:59
Yeah. So for the for the people that that don’t know what that is, what its function is, let’s do a little bit of education because we got to we got to make sure that people are aware and what so location and function I think is maybe we’re where we should start. Yeah.

Dr. Steven Lapke 4:15
Um, so the prostate gland sits immediately beneath the bladder.

And the urethra, which is the tube that drains the bladder, runs right through the prostate gland.

And

it’s only about the size of a walnut. So it’s a it’s a pretty small gland.

The main function of it is it secretes fluid that helps nourish sperm and and helps carry sperm. There’s also two glands on the side of it called seminal vesicles. And they also add to the fluid in the ejaculate.

So that is the the function of the prostate gland. Unfortunately, as all of us men get older, well the prostate gland gets bigger.

And what that causes is or can cause is urinary difficulties, some called urinary retention, because the fact that the urethra goes right through the middle of it, if you think about it, that gland gets bigger, what’s it going to do, it’s eventually going to squeeze down the diameter of that urethra, and make it more difficult to urinate. And, you know, my years in the ER, I can’t tell you how it’s so common, almost every shift, you’ll get an older gentleman who comes in, and they can’t urinate at all. And it’s like, that thing has finally gotten so big. Yeah, it’s just totally obstructed the urinary flow.

So, enlargement with ages is extremely common, unfortunately, with age or risk for prostate cancer continues.

Josh Simms 6:06
Yeah because number one risk factors age, that would be 65 or older is most common. Yeah. So that’s, that’s what they consider to be the number one like, studied risk factor that we can actually say like, your age puts you at a higher risk for prostate cancer than anything else that we know of right now.

Aaron Tharp 6:22
Yeah. So yeah, I saw on average is about age 66.

Josh Simms 6:27
Yeah. And we’ll talk about why that’s kind of important later for treatment options. So

Dr. Steven Lapke 6:32
Right. I mean, it’s always been known as a cancer of the elderly.

Josh Simms 6:38
Yep.

Dr. Steven Lapke 6:38
Right. I mean, you know, especially when we’re back in school, and, and it’s like, you know, it’s just, it’s common in the elderly. And usually, you’ll die of something else before you’ll die of prostate cancer. Well, that’s not necessarily the case anymore. Like I said, the most recent statistic I read was 60% of the cases are diagnosed in men over 65. Well, that leaves 40%. And I have known more and more guys in their 50s getting diagnosed with it.

Josh Simms 6:57
Because it can be a slow growing, very slow growing disease.

Dr. Steven Lapke 7:15
Some are some can be high grade, and, and more aggressive. But generally, it’s slower growing, but not without problems.

Josh Simms 7:24
And that’s, and that’s why it’s a complicated disease, because it can be there. And it can just be smoldering and smoldering and smoldering. And you know, one of the diagnostic tools we use is a PSA, which is the more we kind of use them, the more we know, it’s maybe not the best test.

Dr. Steven Lapke 7:39
Yeah.

Josh Simms 7:40
When we do medical tests, as far as lab work, or if you’re using strep or whatever, refers them as being specific or sensitive, right. incidence and the sensitivity of a test. If it’s positive, that means that there’s a high likelihood that there’s something there. Right? And if it’s specific, then that means that if it’s if that test is negative, there’s a there’s a 99.8% chance that that test is truly negative. Right? So it’s a it’s an I mean, it’s a poorly sensitive test. But I and it’s always been kind of referred to as a really good specific test. But I don’t think that’s necessarily the case, right? I mean, you told me the story of your dog or your friend that had just a little bump, and it was still normal, found out he had disease. So it’s not a reliable test. It’s an easy one. But that doesn’t mean it’s reliable. And so therefore, it’s, it’s, it can be hard to diagnose, especially early, because we don’t want to do unnecessary biopsies and other tests if we don’t if we don’t have to.

Dr. Steven Lapke 8:35
Yeah.

Josh Simms 8:36
So it gets complicated.

Dr. Steven Lapke 8:37
Josh and I have talked about this just in regard to patient care. And at Limitless Male, you know, we do a monthly lab panel and one of those lab panels consist of PSA. And the reason we do it, you know, it used to be thought of or,

you know, does testosterone therapy, cause prostate cancer? Well, there’s been multiple studies and they have shown no, it does not cause prostate cancer. But if you have prostate cancer, testosterone can certainly help potentially aid the growth of that cancer. So at Limitless, you know, we take that very seriously. And so in our monthly lab draws we we monitor PSA levels. Well, normal range is anything under 4.0. So generally like 1, or you can even you can have a level of point 6.

So, you know, a lot of people would think, Well, you know, as long as I’m under four, I don’t have prostate cancer, you know, it’s normal. No, not the case. So you could be following a guy for quite a while and yeah, let’s say his levels have always been 0.6

Well, all of a sudden he bumps up to like, say 1.5. So you’d be like, what’s the problem? You know, he’s still way under 4.

But no, that is a telltale sign of there something going on with that prostate, because the number you not only look for is it less than 4, but you look for doubling of the number. So if it’s doubled, two things could be going on. They could have prostatitis, which is an infection in the prostate gland, which is pretty common prevalent thing.

Or it could be an early indicator of prostate cancer. So that’s where Josh was talking where it gets a little sticky. It’s like, Oh, you know, what do we do with these guys? You know, they’re below four. But now they’ve bumped up a couple times, where do we go from there, you know, without delving into, okay, now, we got to do a bunch of tests, and we got to get biopsies right away, which aren’t without risk, and they’re uncomfortable, etc. So that is the tough thing about PSAs.

Aaron Tharp 11:02
Are you looking for consistency in those numbers more? I mean, if a reading is going to be up once, every three or four months, it’s like, it may be normal.

Dr. Steven Lapke 11:13
Exactly. I mean, like, again, we were talking, you know, you see at one month, I mean, you hope to God, that someone’s not just gonna jump on that and say, Oh, we got to get biopsies and stuff. Yeah, she looked for consistency. And if there’s a steady rise, or you know, you more than double and you hold there for a while, let’s say a few months or more, then you start like, well, maybe we need to look into this a little a little deeper. In the past, there hasn’t always been great options. But now, you know, with research, there’s a lot better options for helping to sort things out. One thing I was reading, I don’t know if you’ve ran across this, Josh, but that’s a test that Cleveland Clinic came up with and it’s called the 4k scoring. And what they did, they followed 20,000 men in Europe in the US for 10 years. And they followed for total biomarkers. So like PSA level, it’s the full name for just prostate specific antigen, and it’s an antigen that gets released by the prostate gland. And it’s measurable in the blood. Well, they followed for other biomarkers in the blood, and they look look at them, and then they came up with an algorithm calculation based on age, other risk factors, etc. And this test is much better than just a straightforward PSA. And it really helps to delineate your high grade cancer from your low grade helps delineate cancer from prostatitis. And by following this algorithm, they have reduced needless biopsies by 50%, which is very huge, huge.

Josh Simms 13:13
The risk of getting accepted sepsis from bad biopsies really business there is I mean, it’s

Aaron Tharp 13:21
So again, for those who are not medically inclined with what sepsis is, I’ve heard it and it doesn’t sound fun.

Josh Simms 13:24
So widespread, like it’s a widespread immune response to infection. Yeah, it’s a it’s nasty, it’s no good. You don’t want I mean, it’s, uh, it triggers, it triggers a lot of people to work really hard antibiotics and I mean, it can make it kills people, frequently.

Aaron Tharp 13:32
Yeah.

Josh Simms 13:39
It is. Not to be to not Yeah, so. And the interesting thing about the PSA test is you got to look at certain like certain patients that I that I work with, they’re say it’s October, January, October, November, January, their PSAs fine, their PSAs fine, April rolls around that PSA goes up. And I’m like, what’s going on man? Like, what do you do? Like, oh, you know, nothing. You know, like, what, what do you do for like, what’s fun? Do you ride a bike? Or your truck driver? Like, oh, yeah, I ride my bike. Well, bike seat is like when you sit down and rides perfectly on that prostate and you’re putting pressure on it. And you’ll see that prostate go up. And then once it gets cold again, it’ll it’ll trend back down. So it’s another thing we got it, we have to consider all those things and be careful. So we’re not doing unnecessary tests on on patients, just because he’s riding a bike.

He’s trying to do the right thing for himself. And we’re sticking needles in him and taking biopsies. And I think the other hard part about diagnosing prostate cancer is a lot of the symptoms are, are similar to just normal benign prostatic hypertrophy, which means just benign, non-cancerous growth of the prostate. It happens as we age, but it’s the same very, very similar symptoms and we don’t have great, we don’t really have any good imaging for prostate cancer, right? breast cancer, generally they can they can feel lumps and bumps and then you do mammography. And there’s really good imaging that you can do. It’s just in such a such a spot that it’s really hard for us to get good imaging to see tumor. It just makes it very challenging. And that’s, it’s kind of why we brought this up and want to talk about it and being proactive and screenings, and so on and so forth.

Aaron Tharp 15:28
So some of the some of the symptoms because you mentioned that before, it would be what weak or interrupted, urine.

Dr. Steven Lapke 15:38
Weak stream.

Aaron Tharp 15:39
More often. The frequencies, obviously, any pain or discomfort. Starting stopping?

Josh Simms 15:48
Yep. Yeah, the classic one is a guy goes to the bathroom, zips up and goes to wash his hands and can’t get back into the business pants or not, you know, because it’s like, wait, I was empty. The bladder was not empty.

Aaron Tharp 15:59
Yeah. Well, I suppose he doesn’t have any control. I mean, if Well, anyway, you know,

Josh Simms 16:05
I mean, you’re 100%, right? Because that’s guys just they don’t, that’s not normal. Right? What the hell’s going on? Why am I pissing my pants again. And that’s not normal. Right? That’s, you know, we that’s something that’s like, if you haven’t gone to the doctor, maybe it’s probably time just to go at least get a blood test. And I mean, the other fun part is the digital rectal exam, which, again, that’s a hard one, because it’s dependent upon the operator, because if you don’t have a lot of experience doing that exam,

Dr. Steven Lapke 16:34
Well, studies have shown it’s, it’s, again, not a reliable test or physical exam for finding prostate cancer. I mean, we were all taught to do it in medical school, and, you know, do it religiously, and but studies have shown it’s really not that effective.

Aaron Tharp 16:55
And so when you’re looking at so let’s say they take a biopsy, right? Or your PSA tests were alarming, and so that you moved to a biopsy IV, that would be the next

Dr. Steven Lapke 17:07
Sell so the imaging that’s most use is ultrasound.

And they’ll use because of the placement of the prostate, you know, it sits right,

you know, next to the rectal area. So they’ll use like, a rectal probe with the ultrasound and, and, you know, that’s where they found that they can probably get the best imaging. To be honest, I don’t know where they’re at with MRI. I haven’t heard or seen a lot of it. I knew Josh.

Josh Simms 17:40
I haven’t no. And that’s it’s I mean, I think as ultrasound has gotten so much better, specifically over the last, probably 10 to 15 years, because it’s so widely used. Like it’s cheap, it’s easy, especially like in the ICU is in the ER, replaced a lot of different things with such a good imaging modality. That’s probably I mean, those things. Look, I mean, you look at it, an ultrasound from 15 years ago, God, but now it’s like, 4k compared to just like tech mobile.

It’s true, man. I mean, yeah, you can see fine detail on those things. And that’s, and that’s good, right? We need we need that technology. So we can I mean, it’s no different than a transvaginal ultrasound, right. I mean, I don’t want an ultrasound

Aaron Tharp 18:25
Anybody listening is gonna really appreciate that you pulled in tech mobile.

Josh Simms 18:29
Yeah. Well, depends on the generation. That went to the heart of it. That was a very good analogy.

It’s technical to the Madden 22.

Dr. Steven Lapke 18:38
Yes. So, you know, generally they’ll proceed with an ultrasound and you know, it, they’ll good physical exam and comprehensive lab screen and then decide, you know, if they’ll do a biopsy or not, and the biopsies are ultrasound guided, but like Josh said, the risk, you know, high risk of infection rate with it, not only sepsis, but an infection in the prostate, prostatetitis, which those are really hard to get cleared up. I mean, there’s, you know, it’s not uncommon, you have to treat a man for a month with antibiotics to get it cleared up.

Josh Simms 19:17
And the hard part about the biopsy to the anatomy of the prostate is such as that there’s lobes, right? So it’s not just a one shot. I got it, I got the whole prostate. You could do a prostate biopsy, and if you don’t get the right spot, you could miss the tumor. I mean, they’re really I mean, these doctors they’re, they’re, they’re amazing at it, there’s no, sometimes they’ll do multiple biopsies, which I think that’s kind of the moving towards the standard of care, because otherwise it’s too easy to mess that’s not worth missing. You’d rather poke somebody three times and do one and be like, Oh, no, you’re fine. And the next thing and the guy has metastatic prostate cancer, it’s a bad book.

Aaron Tharp 19:50
So so they and in that event, so they, you know, you look at the cells and you have abnormalities in the cells and because they’re, they’re growing really fast, or they’re dying, too slow as I understand it.

Dr. Steven Lapke 20:07
So, I mean, obviously we talked about testosterone is the hormone that stimulates prostate gland and, and so if you have prostate cancer it can stimulate that growth. And you know, and when cells start dividing at a rapid rate, that’s what most malignancies are.

That rapid growth, more rapid than what takes place in that normal gland or organ or whatever else.

So

that almost all prostate cancers, they’ll they’ll find two different, what we call grades of cancer going on. And out of that two different grades,

they score them. And so the kind of the most common use scoring system for prostate cancer is called the Gleason score, okay.

So and they do it based on the two different cell types, they find. Your highest score is a score of 10. That’s you don’t want to have a score of ten.

Aaron Tharp 21:17
So it’s like golf, it’s like a golf score.

Dr. Steven Lapke 21:19
Now, that doesn’t mean that your prostate cancer has gone beyond the prostate, that is strictly defining the malignancy within the prostate gland. But, of course, the higher score, the higher your risk is that it spread outside the organ. Got it. The prostate gland is encapsulated, it’s got a capsule around it. But the risk is if it gets outside that capsule and gets into lymph nodes and other tissues like the seminal vesicles of bladder, the most common place in metastasizes is to bone.

Aaron Tharp 22:00
Wow.

Josh Simms 22:00
Yeah, so cancer is really interesting, and the organs that we that you get cancer in, you can kind of trace where it’s gonna go. And we do that through just the, the blood vessels that come in and come out of it. So bone is common, because there’s, I mean, blood bone is blood everywhere, right?

But then the next comment would be liver, lung. And the reason why that is, is the veins that drain the prostate flow right up into the major vein that comes back to the heart, which goes through the liver, and that goes to the heart and into the lungs. So you’re kind of right along the waystation of its while prostate cancer itself really isn’t dangerous, right? Once it gets outside the prostate, it’s going to three bad spots, bone, liver and lung, which are you get those that’s a

that’s not a good prognosis at that point. So that’s why that’s why prostate cancer and themselves, like we said is not super dangerous, but it’s where it goes is what is what kills people. And again, we it’s so hard to diagnose and sort you know, you have it, it could be too late by the time you find out. Because sometimes it’s like, oh, you know, I have shortness of breath, or hemoptysis, which means you’re coughing up blood, and then you go and you get a tumor, your lung, but they find the origin was actually in your prostate. And that’s when it’s, that’s when it’s very, very serious.

Aaron Tharp 23:17
So, and with with that analysis there, there’s a there’s a grade, right, and then there is like a stage, as I understand and maybe this is common with with cancers, and I’m, I’m well trying to play that the dumb guy in the room who has questions.

Josh Simms 23:37
You’re dead on, correct, right? Because not all cancer cells are are made equally, right? Yeah. Like, there’s like, if you were to grade like skin cancer, like a basal cell carcinomas. That’s, we don’t worry about that. You just clip it off and move on. Now, melanoma, that’s the cancer that kills you, right? It’s a higher grade more aggressive cancer, right? And the way that cancer is staged is kind of funny, because people think, oh, stage four cancer, like you’re dead, which is not necessarily the case, right? Stage four cancer, if you have metastasis to anywhere in the body, you’re automatically at stage four. So like, if you have prostate cancer, and it’s in the bone next to it, stage four cancer, or if it’s in the lymph nodes next to stage four cancer automatically, it does doesn’t mean it’s widespread, your whole body’s covered in cancer, you’re gonna die. That’s not the case.

But the grading in correct me if I’m wrong, is just the aggressiveness of the cancer.

Dr. Steven Lapke 24:28
Exactly.

Josh Simms 24:28
The staging is how far it’s progressed within your body. Does that make sense?

Aaron Tharp 24:34
Yeah, there was no there’s good those two pieces, because guys are I mean, if if in the unfortunate event that anybody listening has to go in and talk about that there’s verbiage being discussed with you and your urologist or whoever else that you’re working with. Those would come up. Oh, absolutely. Yeah, no. Yeah.

Dr. Steven Lapke 24:52
And Josh is absolutely right. I mean, like he said, the grading is the cell type which the majority of prostate cancers are called an adenocarcinoma, which is not going to mean anything to our people listening if they’re not in medicine, but that’s just what the cell type is. But then the staging is, you know, Where has it gone? And there’s multiple things they look at to stage different malignancies correctly.

But that’s, that’s how it’s done.

Josh Simms 25:27
Yep. And the interesting part about what you said earlier about the cell type is, while it is kind of a runaway train, that’s what cancerous cells are. You have these prostate cancer cells that have mutated into a different type of cell that just replicate, replicate, replicate, replicate. But when you said they’re dying slowly, cancer cells don’t die. They live forever. So they are at the end of our DNA, we have something called a telomere. It’s like a little band that that kind of degrades over time. I think we talkedabout it.

Aaron Tharp 25:53
Yeah, we we talked about it in the fatherlessness episode.

Josh Simms 25:55
Yeah, so just our telomeres as we age are cells that degrades. And eventually, once all tumors, we die of old age, right? Cancer cells, a telomere does not degrade. And so like I told you the heat, the heat loss cells that we use in my biology class was from a lady with cervical cancer from like,

the 50s, or 60s or something like that. So that’s the other dangerous part about and that’s whether that’s why cancer is so hard to fight is because the cells are constantly dividing a way, way more rapid rate than what our bodies used to. And they’re hard to kill. So, yeah, that’s the tough part about it. That’s why again, all cancers are serious. But prostate cancer, the prevalency, and it’s, you know, 50% of the entire world is at risk for it just by being a male and aging. This is why we’re talking about it.

Aaron Tharp 26:42
So I think the next conceivable place to go is like early detection and being proactive in this whole thing, so early diagnosis, because I think you’ve obviously, like with most things, if you can get in front of it, you can prevent it. And certainly you can prevent the spread of it. So how is it detected and talk us through like early diagnosis and detection?

Dr. Steven Lapke 27:06
Um, you know, one thing I, before we really get into that, I want to take a step back and, and talk about risk first. So because I feel if the guys can understand their risk, and the significance of it, then they’re more likely to come in and be tested be screened, get that done.

As we talked about before, your risk factors are obesity.

They generally say you know, a body mass index greater than 30. And that’s a calculation that, that we look at

a diet high in fat, low in fiber.

If he had a lot of processed food, processed carbohydrates definitely increases your risk. sedentary lifestyle. Smoking definitely increases your risk.

Alcohol can increase in excess can increase your risk for all malignancies.

Josh Simms 28:04
Thanks, Doc. Put a damper on the whole thing.

Aaron Tharp 28:08
Our next episode will be the whiskey episode. I’m right in there with you.

Josh Simms 28:11
How hypocritical can we be? Let’s find out how far we can swing the pendulum from the other direction.

Aaron Tharp 28:15
Yeah.

Dr. Steven Lapke 28:17
Age and then family history. And

so like, in my case, my grandfather, my dad, and two of his brothers have all had prostate cancer. So I’ve always said it’s not a matter of if I’ll get it, it’s a matter of when. So guys have to know and be aware, you know, if they have a family history of it, then they really need to be on it and be taking the screening process seriously.

Josh Simms 28:45
Just swing by the office anytime, doc, I’ll take care. I’ll do low salt that day.

Aaron Tharp 28:51
Bring your own vasoline. It’s BYOV.

Josh Simms 28:56
Yeah, yeah, we don’t have any of those little jelly packets we had when we were students who rip them open and just put them all over your fingers

Dr. Steven Lapke 29:01
I know what’s up with that?

Josh Simms 29:02
Maybe we should get some. I don’t want it dry docking.

Aaron Tharp 29:14
So and obviously it’s it’s something that if we’re in front of we can we can be it can be cured. But I feel like a lot of the things that are the preventative measures on most of all of our episodes are pretty fundamentally the same.

Dr. Steven Lapke 29:28
Yeah, it all goes back to the same.

Aaron Tharp 29:29
It’s like dude just get off your ass, you got to move you got to eat better. There’s just no other way around. You can’t buy it at Walgreens. It’s not going to be done for you. Yeah, it’s like you have to do it. You have to do it.

Dr. Steven Lapke 29:40
It’s a lifestyle choice.

Aaron Tharp 29:41
Yeah, absolutely.

Dr. Steven Lapke 29:43
Yeah. So and then as we talked about, it’s it’s getting that PSA level it’s, it’s understanding what it means. You know, having some

provider that’s really on it and watching you know, no was it you know?

What is it this year, but what was it the last three years, and you know, really going to that length to compare and see how things are changing, monitoring for other symptoms.

Josh Simms 30:10
That’s why I like that we do our monthly blood draws. While we don’t we don’t diagnose or treat prostate cancer, we can provide a wealth of data to urologists and oncologists to say, ‘Hey, this is Joe’s labs, his PSA since he started seeing me 18 months ago, I have 18 PSA draws, you can watch the trend. That really helps.’ Because the trend is more important than an isolated number. Yeah, like I said, like you get on a bike and you ride a bike, your PSA goes up, you know, that? Who knows? Was that because the guy was on the bike? Or is it because he has BPH? Or is it because he has prostate like, but and again, the trend doesn’t tell that story, but it allows us to see what’s been going on in this guy’s life and how the numbers have have adjusted and while it’s not necessarily practical on the primary care sense, but it allows us to do that at Limitless Male, it’s, it’s, it’s a super helpful tool for patients and for us too.

Dr. Steven Lapke 31:05
You know, as Josh was saying earlier, I mean, you know, the PSA is not a perfect test.

But,

you know, back in 2011, the you, US Preventive Service Task Force came out and recommended against screening.

I don’t know if you were practicing back then Josh. I’m just showing my age.

Josh Simms 31:29
When was that 2011? No, that was my second year of undergrad. So yeah, I was a late student, though. So I would have been if I was a good kid.

Dr. Steven Lapke 31:41
Well, what we saw by that is

delayed diagnosis. And then all of a sudden, years later, we’re diagnosing men with advanced prostate cancer.

So while it’s not a perfect test, it’s definitely one that needs to be done.

Aaron Tharp 32:00
So let’s address the guy that does not come into Limitless Male each month.

That is aging. And is not likely having this conversation with his his primary care would men be wise to as they age work with urologist directly? Or is it not until there’s a problem?

Dr. Steven Lapke 32:23
You know, I think it can be done through a good primary care provider, or urologist. I mean, you know, certainly as we age, we’re at risk for other issues coming up, which then would require a urology referral.

And, you know, further workups, but,

like, just like, Limitless, obviously, we’re not urologists, but we screen for it very thoroughly. And, you know, that’s where it starts. It doesn’t have to be done by a urologist. There’s not enough urologists out there to be screening every man, you know, 50 and above, and I’m sure they don’t want to be doing that. Yeah, I mean, they’re their training is as surgeons, and,

you know, and so, you know, they’ll gladly take the referrals, as they’re appropriate, but they don’t there’s not enough of them to be doing all the screening. Yeah, that makes sense.

Aaron Tharp 33:30
Okay, so we’ve gone into, you know, some of the testing and the early diagnosis.

What else is what else is there to know, some risk factors, some prevention?

Dr. Steven Lapke 33:43
Well, I guess one thing we haven’t talked about is when do I start screening? What?

Aaron Tharp 33:48
Yeah, yeah.

Dr. Steven Lapke 33:49
Um, yeah, I pulled information from three different sites, the US Preventive Services Task Force, which they make recommendations on all kinds of different screening, you know, health issues, nationally, the American neurological Association and the American Cancer Society. So the task force, they recommend screening starting at age 55 to 69. They don’t recommend screening after 70. And the reason for that is because generally prostate cancer is a very slow growing smoldering type malignancy. And course they take into consideration life expectancy. And so after that age, you’re a lot higher risk for dying of many more other things than prostate cancer. Right?

Josh Simms 34:46
So why put yourself through it which is very humane, right? Yeah, let’s not I don’t want to gloss that over people doing like won’t care. No, it’s because like, at that point, we should all be worried about the quality of our life.

Dr. Steven Lapke 34:59
Absolutely.

Josh Simms 35:00
And I mean, seventy years is not a long time. But yeah, it’s a good haul it is right. And it’s not not worth living the last year suffering from chemo and suffering from prostate surgery, it’s or even urinary incontinence that’s in all the havoc the prostate removed.

Dr. Steven Lapke 35:17
Now the American neurological Association,

they recommend 55 to 70. But if you have

a family history, like a first degree relative who’s had prostate cancer, or your African American, they recommend starting the screen at age 40.

Josh Simms 35:38
So that’d be like 45 for me since I’m half black? I’m trying to figure this.

Aaron Tharp 35:47
What’s in your drink today?

Josh Simms 35:49
I’m not trying to make a joke but

Dr. Steven Lapke 35:54
I’m going to look into that for you Josh. And they do recommend screening men after age 70, who are in good health? You know, and that’s the problem. I mean, we’re seeing more and more men, or women and men live a very advanced age. I mean, 70 year olds who were highly productive.

Josh Simms 36:23
Yep.

Dr. Steven Lapke 36:23
And then great health. So you know, I mean, while these recommendations are great, and you and I were talking about it before the show, it still comes down to everybody has the right to be informed, and to make their own decisions, along with their physician, what’s best for them? I mean, it’s easy to have recommendations, but they can’t be 100%, right? Because every case is different. So just something to think about American Cancer Society, they recommend starting at age 50. But age 40, if you have a family history.

Josh Simms 37:05
And so when we say screening, are we talking about PSA, PSA plus DRE, which is the digital rectal exam?

Dr. Steven Lapke 37:14
They were kind of plus/minus on the digital rectal exam, but this was strictly for getting PSA. So, really, I’ve always gone by age 50. But if you have a family history, or African American started age 40. I think just to make it easy. That’s kind of a pretty safe rule to go by.

Josh Simms 37:41
Yeah, yeah. I mean, again, early detection is key in every type of cancer, right? It’s not just prostate cancer. That’s why there’s recommended screenings for women with breast cancer and mammographies and all those types of things. And it’s, it’s because we know that early you find cancer, your chances of survival go up exponentially, exponentially.

And that’s why colon cancer screening is like, just get the camera stuck up your butt, because if you got something and it’s early, you’re probably gonna live through it. Colon cancer is not a great way to have to die. No.

Because there is no cancer death. That is a good that’s a nice easy death. It is a horrible way to die. It’s hard on your family. It’s hard on your friends. It’s hard on you.

Dr. Steven Lapke 38:22
Financially.

Josh Simms 38:23
Yeah, it’s and it’s because it’s such a long drawn out disease, depending on you know, what it is and when is diagnosed, but early detection is is key. Absolutely the number one thing that helps people survive cancer.

Dr. Steven Lapke 38:35
Well there’s a few, 90% of the cancers are diagnosed, and men have no symptoms. So if you’re waiting on symptoms,

Aaron Tharp 38:48
or waiting until you’re 55.

Dr. Steven Lapke 38:50
Or if you’re waiting on symptoms for any cancer to get screened for. Once you have symptoms, it’s not good. Not good at all.

Aaron Tharp 38:59
It’s like the dentist. I mean, those are very different size apples. What’s right let me

Josh Simms 39:04
Yeah but but the comparison, I want to hear what you’re saying.

Aaron Tharp 39:07
when you’re sitting in the dentist’s chair, you got pain, you should have been there when there was no pain.

Dr. Steven Lapke 39:12
A long time ago.

Josh Simms 39:13
Did you get yourself, did you get your your teeth cleaned twice year becasuse they do x rays every time.

Yeah, exactly.

Aaron Tharp 39:23
Okay. Yeah. Cuz I mean, what was it somewhere like, I think the PSA test or something like that was found at least 80% have some sort of prevention or early detection. So yeah, I actually looked that up.

Josh Simms 39:35
So if, remember I talked about the sensitivity versus specificity sensitivity is a good diagnostic tool specificity is a good tool to rule it out. So this is up to date. This is kind of the resource that doctors, PA, nurse practitioners we use this frequently because it is literally updated. whenever anything comes out like the new data rolls out. It’s put on up to date.

So system

estimated that PSA cut off a 4.0 nanograms per milliliter has sensitivity of 21% poorly sensitive test, not a good diagnostic test, right?

But a specificity of 91% for detection. So that means it’s good at ruling it out for detection of a high grade cancer, though sensitivity was 51%. So that goes up a doubles. If you got high grade cancer and your PSA goes up. But the high grade is more rare than the than the little guy that had no carcinomas episode was common one.

The positive predictive value is 30%, which is not good. So that’s why it’s a good screening tool, but not a good diagnostic tool. Right. I guess we should make that clear. Yeah. It’s a screening. It’s not it’s not a diagnostic tool. Diagnosis is biopsy with with positive or cancer cells on that tissue sample.

Dr. Steven Lapke 40:51
I think in the next five to 10 years, you’re going to see more more tests that are have a lot higher sensitivity specificity. Yep. Just like the 4k scoring.

Josh Simms 41:01
So yeah, we’re cascade of Yes, that will that’ll help us trigger one to the next to the next.

Dr. Steven Lapke 41:05
So like right now, with the 4k test, of course, it’s not covered by insurance yet.

Costs $750.

Which I think is money well spent. But I get it a lot of people don’t have that kind of disposable money.

Josh Simms 41:24
But a billion dollar insurance company does. Absolutely for some check out our last episode, when we’re all together, medical.

Aaron Tharp 41:33
And I think by and large, what we’re seeing too, is that these are earlier and earlier ages than we had predicted when we said that SOS drone, we said that for a number of different cases that it’s it seems like there’s a there’s a real big opportunity to fill and serve this at a younger age, in terms of prevention, and absolutely. research and data.

early onset.

Dr. Steven Lapke 41:56
You know, as far as prevention, I mean, obviously, we already talked about diet, exercise, smoking,

excessive alcohol intake. I know a lot of people ask, well, are there any supplements I can take?

Unfortunately, nothing great at this point. They did a lot of studies at one point they thought Oh, vitamin E, is is going to be it and then they actually found an increased incidence of heart high grade cancers with with vitamin D supplement. Selenium has always been the supplement that’s touted. I mean, you’ll find it in every multivitamin, etc. But studies really have not bore that out to be significant at preventing prostate cancer.

Josh Simms 42:44
Yeah, you’ll hear Dr. Lapke, I always talk about studies and studies and studies, right, we are trained in evidence based medicine, because that is what I believe is the best way to prove or disprove something, right. And the good thing about it is, is if you do you know, evidence based medicine, in five years, it might not be the same, but that means that we’re doing a good job. That’s the scientific method, you test and retest and you try to disprove and that way we can be, we can do better we can we can take care of patients better. So people are probably like, well, blah, blah, blah, study showed this and blah, blah, blah, but we actually find like, pretty well,

reputable journals and try to read through these things and make sure they’re because you can find a study that can prove anything, right? You know, this is these are from Reddit. Yeah, no.

Actual, but like we could publish a study on. Yeah, whatever we wanted to write doesn’t mean that it’s actually true. We could we could put all this statistics in there that we want. But a lot of these are peer reviews, where there’s other researchers and doctors reading over the data and saying, like, Hey, this is not correct, you did this incorrectly, you need to repower your study this way, so on and so forth. So that’s why we kind of talk in that lingo, it’s important for people to understand that the evidence or evidence is always good, right? Yeah. And the COVID evidence that we always hear actual studies on what studies were, yeah, who did the study, right? This is Joe in his basement with his brother and wearing their tinfoil hat. So that’s not what we’re here for. Like, right we’re trying to actually give you guys real medicine, real evidence to show that things are.

Dr. Steven Lapke 44:09
well, that’s why Josh like referencing up to date. I mean, that is probably the most widely used source for medical information most up to date studies. It’s, it’s why it’s widely accepted by by you know, all providers, etc. So you know, if you’re, if you’re quoting, information from a site like that, it is very accurate for the for the time like I said, it could change in six months, but that science.

Josh Simms 44:40
Yeah. And people don’t like to hear that, by the way, but I know that’s just the way it is.

Dr. Steven Lapke 44:45
Yeah.

Fortunately, it’s it’s good that things change because then we learn and we wouldn’t be where we’re at.

Josh Simms 44:51
We’d still think that asbestos great, right? Oh stuff great. You got everything nice and warm and cold. Why are you Why are you coughing up blood?

Dr. Steven Lapke 44:58
We’d still be practicing bloodletting with leeches. Yeah. But they’re still gonna do that a little bit, don’t they? What about the maggots on the necrotic wounds? They still do that. Oh, yeah. wounds. Yeah. necrotic wounds, they’ll put maggots on there.

Aaron Tharp 45:12
Yeah, well, we would see cigarette commercials. Yeah, still. Yeah, it wasn’t that long ago. No.

They were on when I was a kid. Joe cool. And that was not that long ago. Oh, man. Yeah, lung cancer.

He did. What about Joe? While we’re, I always thought it was really funny. And I have to inject this when we’re talking about camel cigarettes. I always thought it was really funny that like when you smoked more, because you know, you could turn in your miles your Salem miles, your Marlboro miles, that if you you know, you turned in more that they would give you a mountain bike?

Josh Simms 45:46
Oh, yeah.

Aaron Tharp 45:47
Or a canoe? All the things that you would absolutely never do after smoking that.

Josh Simms 45:54
Yeah, cuz your lungs are like a wet blanket.

Can’t absorb any oxygen whatsoever.

Aaron Tharp 46:02
Very good. So what else should we cover? What else is important? relevant? This is?

Dr. Steven Lapke 46:08
Yeah, just just a couple things real quick. I know is

provided providers again, without, you know, healthy diet, healthy diet. Well, and we’ve set it here. What does that mean?

I feel the best, the best diet to follow for all health right now is the Mediterranean diet. Google it. Mediterranean diet. I think if anybody would follow that for any prevention. You couldn’t go wrong. Josh, I don’t know if we’re screaming at you right.

Aaron Tharp 46:39
Now, that’s a political stance.

Josh Simms 46:40
It is. Yeah. Yeah. No, I mean, it’s true, right? It’s it’s high protein, moderate to low carbohydrates, high fiber, healthy fats. I mean, that’s

Dr. Steven Lapke 46:48
fruits, vegetables.

That’s the one diet they’ve been able to show that actually does make people healthier through evidence based medicine. So amazing. Yeah.

Aaron Tharp 46:57
So nobody’s gonna do it for you. There’s no quick fix, again, Walgreens, CVS doesn’t have you can order on prime Amazon, they don’t have it, you have to get off your tush and do it and do it.

Josh Simms 47:07
And I think one of the things we do need to really emphasize and highlight is that, because it’s a common question that I get in the clinic, as well, was this if I do testosterone replacement therapy, am I going to get prostate cancer? It’s just not true. There’s nothing because we couldn’t do it. Right. Right. Like why would the FDA allow people to take testosterone? If there was a if there’s proved proved that it causes cancer? Yeah. And it wouldn’t, just cause like it was causation? Yes. Yeah. Like there was a correlation. You take testosterone, you got like, a 7% chance to get prostate. I mean, it’s almost laughable, right? When you can just really kind of just go past the first layer of the onion. And like,

it’s just us. I don’t know what else to say. Yeah. It’s just it’s, it’s that’s, you know, again, that’s what Dr. Lapke. And I do. So that’s important to us. Because we want also want, you know, hopefully, a lot of our patients listen to us, we want them to feel comfortable and know that they’re safe taking it and that we’re we’re monitoring them, right. And if they do get prostate cancer, it’s not because of the testosterone either because their age, family history or lifestyle. But we if we have been actively screening that every single month, and we will send them to the places that they need to go. Once we did absolute minor sniff there’s anything that’s concerned. So just want to throw that out there.

Aaron Tharp 47:49
It’s part of the folklore that surrounds this kind of stuff.

Dr. Steven Lapke 48:20
No, absolutely.

Aaron Tharp 48:21
All the all the misinformation, all the stuff that’s driven to drive fear, and away and away from the truth and evidence based.

We’re the the best approach, but well, I think that we’ve done our part here. And again, the idea was to just make to normalize the conversation, provide resources, make this okay? And to speak to the guys out there who may be having some issues and maybe are getting a gut feeling they should go get something checked out. So thanks for your time again, and you’re welcome. I always we always have a ball when you’re on and Josh, it’s it’s good to have you back too. It’s good to be back. Thanks for joining in fellas and we’ll catch you on the next one. Cheers.

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