#273 ‒ Prostate health: common problems, cancer prevention, screening, treatment, and more | Ted Schaeffer, M.D., Ph.D. | The Peter Attia Drive

Intro

In this episode of “The Peter Attia Drive,” Dr. Peter Attia interviews Dr. Ted Schaefer, an internationally recognized urologist and prostate cancer oncologist. They delve into various aspects of prostate health, including common problems, cancer prevention, screening, and treatment options. Dr. Schaefer shares his expertise and insights based on his extensive experience in the field.

Main Takeaways

Prostate Problems and Management

• Prostate problems can arise as you age, leading to urinary symptoms, prostateitis, pelvic pain, and inflammation.
• Behavioral modifications and diary tracking can help manage lower urinary symptoms.
• Alpha blockers and M3 agonists are medications that can improve urinary symptoms.
• Minimally invasive surgical techniques like Holup and TURP are effective for managing urinary symptoms.
• Prostatitis, a chronic pelvic pain syndrome, can have various causes and may require different treatments.

Prostate Cancer Screening and Treatment

• Blood-based screening tools like PSA, free PSA, PSA density, and PSA velocity aid in prostate cancer detection.
• MRI can facilitate biopsies and determine treatment options.
• Active monitoring and surveillance are options for low-risk prostate cancer.
• Advanced hormonal therapies and radiation techniques can improve outcomes for advanced prostate cancer.
• Surgical treatments like prostatectomy require skilled surgeons and consideration of functional outcomes.

Prostate Size, Hormones, and Genetics

• Prostate size relates to androgens, testosterone, and DHT, which also play a role in prostate cancer pathogenesis.
• Genetics and non-genetic factors contribute to prostate size and cancer risk.
• Finasteride and its potential side effects, including post-finasteride syndrome, are discussed.
• Testosterone and estrogen levels have a nuanced relationship with prostate cancer risk.
• Understanding the molecular underpinnings of tumors is crucial for precision medicine.

Summary

Prostate Problems and Management

As men age, prostate problems can arise, leading to urinary symptoms, prostateitis, pelvic pain, and inflammation. These issues can be managed through behavioral modifications, such as regulating fluid intake and avoiding diuretics. Keeping a diary of fluid intake and urination can help identify excessive fluid intake and unusual symptoms. Medications like alpha blockers and M3 agonists can help improve urinary symptoms. In more severe cases, minimally invasive surgical techniques like Holup and TURP can effectively manage urinary symptoms. Prostatitis, a chronic pelvic pain syndrome, may require different treatments depending on the underlying cause.

Prostate Cancer Screening and Treatment

Blood-based screening tools like PSA, free PSA, PSA density, and PSA velocity are available for prostate cancer detection. MRI can facilitate biopsies and help determine appropriate treatment options. For low-risk prostate cancer, active monitoring and surveillance are viable options. Advanced hormonal therapies and radiation techniques have shown promising results for advanced prostate cancer. Surgical treatments like prostatectomy require skilled surgeons and consideration of functional outcomes to ensure the best possible quality of life for patients.

Prostate Size, Hormones, and Genetics

The size of the prostate is influenced by androgens, testosterone, and DHT. These hormones also play a role in prostate cancer pathogenesis. Both genetics and non-genetic factors contribute to prostate size and cancer risk. The use of finasteride, a drug that can shrink the prostate and prevent hair loss, is discussed, along with concerns about potential side effects like post-finasteride syndrome. The relationship between testosterone and estrogen levels is more nuanced than previously thought, and understanding the molecular underpinnings of tumors is crucial for precision medicine.

Conclusion

Dr. Ted Schaefer’s expertise sheds light on various aspects of prostate health, including common problems, cancer prevention, screening, and treatment options. By understanding the complexities of prostate health, individuals can make informed decisions about their own well-being. Regular screenings, lifestyle modifications, and access to advanced treatment options can help improve outcomes for those affected by prostate conditions.