273 ‒ Prostate health: common problems, cancer prevention, screening, treatment, and more

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Ted Schaeffer is an internationally recognized urologist who specializes in prostate cancer. Ted delves deep into the realm of prostate health, starting with strategies for vigilance & effective management of the issues that can arise with aging, including urinary symptoms, prostatitis, pelvic pain, & prostate inflammation. Ted sheds light on the popular drug finasteride, renowned for its dual purpose in prostate shrinkage & hair loss prevention, as well as the contentious topic of post-finasteride syndrome. Ted then shifts to the topic of cancer, explaining how androgens, genetics, & non-genetic factors contribute to the pathogenesis of prostate cancer. He provides valuable insights into cancer screening, examining blood-based screening tools like PSA & the use of MRI in facilitating biopsies & their interpretation. Finally, he explores the various treatment options for prostate cancer, including surgical interventions, androgen deprivation therapy, & more.

We discuss:
0:00:00-Intro
0:00:45-Changes to the prostate with age & problems that can develop
0:05:56-Behavioral modifications to help manage nocturnal urinary frequency & lower urinary tract symptoms
0:15:08-Pharmacologic tools for treating nocturnal urinary frequency & lower urinary tract symptoms
0:26:41-Surgical tools for treating symptoms of the lower urinary tract
0:33:24-HoLEP surgery for reducing prostate size
0:42:06-Prostate size: correlation with cancer & considerations for small prostates with persistent symptoms
0:49:09-Prostatitis due to infection
1:02:28-Prostatitis caused by factors besides infection
1:09:33-How to minimize risk of urosepsis in Alzheimer’s patients
1:15:00-Prostate cancer: 5-alpha reductase inhibitors & how androgens factor into pathogenesis
1:24:10-Post-finasteride syndrome
1:33:33-The relationship between testosterone & DHT & the development of prostate cancer over a man’s lifetime
1:43:21-Genetic analysis of tumors can indicate the aggressiveness of cancer
1:46:10-Genetic risk factors of prostate cancer & the use of PSA to screen for cancer
1:54:53-Non-genetic risk factors for prostate cancer
2:07:16-PSA as a screening tool: what is PSA, definition of terms, & how to interpret results
2:25:59-MRI as a screening tool & the prostate biopsy options
2:37:24-Ted’s randomized trial comparing different methods of prostate biopsy
2:40:45-When a biopsy is necessary, interpreting results, explaining Gleason score, & more
3:03:01-Implications of a Gleason score of 7 or higher
3:10:30-Metastasis of prostate cancer to different body locations, treatment options, staging, & considerations for patients’ quality of life & survival
3:28:51-How prostate cancer surgery has improved
3:42:03-Questions to ask your neurologist if you are considering prostatectomy for cancer

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About:
The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, & all that goes into that from physical to cognitive to emotional health. With over 70 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, & much more.
Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan & simultaneously improving their healthspan.

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