Alternative Treatments for Prostate Cancer | The Stoler Report

Alternative Treatments for Prostate Cancer | The Stoler Report


♪ [THEME MUSIC] ♪>>PROSTATE CANCER, YOU HEAR ABOUT IT AND HEAR ABOUT DIFFERENT IDEAS AND APPROACHES. PEOPLE REALIZE THAT ONE OUT OF SIX MEN WILL HAVE PROSTATE CANCER, NOT EVERYONE WILL DIE FROM IT, AND THERE HAVE BEEN CHANGES IN TREATMENTS OF WHAT IS HAPPENING. TO DISCUSS THE TOPIC I BROUGHT THE LEADERS FROM THE NYU LANGONE HEALTH, HERBERT LEPOR, CHAIRMAN PROFESSOR AT THE NYU LANGONE, AND HIS NUMBER ONE DISCIPLE, JAMES WYSOCK WHO IS ASSOCIATE PROFESSOR, ALSO THE HEAD OF THE BELLEVUE SERVICES FOR THE NYU LANGONE. WHAT HAS HAPPENED IN THE TREATMENT OVER THE PAST 25 YEARS AND HOW IS IT BEING DONE TODAY?>>LET US GO BACK TO 25 YEARS AGO WHEN WE MET. I THINK YOU ARE ONE OF THE FIRST PEOPLE I MET HERE AT NYU LANGONE CENTER. PSA JUST CAME ABOUT IN THE 1980s, AND WHAT WE LEARNED WAS THAT THE HIGHER THE PSA, THE GREATER THE RISK OF PROSTATE CANCER. WE KNOW THAT PSA HAS A LOT OF LIMITATIONS. IT IS PROSTATE SPECIFIC, NOT PROSTATE CANCER SPECIFIC.>>HOW DID THE TEST, COME OUT?>>IT IS AN ENZYME THAT WAS DISCOVERED TO BE AN ENZYME THAT WAS ONLY IN PROSTATE TISSUE, FOR THE MOST PART. FOR MEN WITH PROSTATE CANCER, THEY HAD A TENDENCY TO HAVE A GREATER RISK OF HARBORING A PROSTATE CANCER.>>25 YEARS AGO, YOU WERE RECOMMENDING TO PEOPLE TO TAKE THE PSA TEST.>>THAT WAS PROBABLY MORE IN THE 1990s THAT SOME OF THE SEMINAL PAPERS SHOWED THAT WITH PSA, WE CAN INCREASE THE DETECTION OF EARLIER PROSTATE CANCER, WHICH WAS MUCH –>>EARLIER PROSTATE CANCER. WHAT HAPPENED A COUPLE OF YEARS AGO WITH THE BOARD SAYING THAT PSA TESTING WAS NOT IMPORTANT?>>YOU HAVE TO GO BACK TO THE CONTEXT OF WHAT THE DIAGNOSTIC PARADIGM WAS BEFORE PSA. YOU HAVE TO PRESENT WITH SOME FORM OF SYMPTOM, AND THE ONLY RELIABLE TEST WE HAD WAS A DIGITAL-RECTAL EXAM. YOU WOULD HAVE TO HAVE A CLINICALLY RECOGNIZABLE TUMOR FOR THE DOCTOR TO PICK UP ON PROSTATE CANCER. PSA TOOK US TO THE LEVEL WHERE WE COULD TAKE A BLOOD TEST. AND THEN, WE WOULD WORK UP FROM THERE. MANY STUDIES WERE PERFORMED AND THERE WERE TWO THAT WERE AIMED AT TRYING TO IDENTIFY AT USING THAT TEST TO DECREASE THE MORTALITY. THOSE RESULTS CAME OUT AROUND 2011. THEY ARE HIGHLY CONTROVERSIAL. THEY PROMPTED THE HEALTH PREVENTATIVE SERVICE TASK FORCE TO GIVE PSA A LOWER RATING WHICH PROMPTED PEOPLE TO QUESTION IF IT SHOULD BE USED AT ALL.>>WE HEAR ABOUT PROSTATE CANCER AND THE STATISTICS, ONLY 3% WILL DIE FROM PROSTATE CANCER. WHAT DO WE RECOMMEND FOR TESTING FOR PROSTATE CANCER?>>LET US PUT IT IN CONTEXT. THERE ARE TWO COMPETING SOUNDBITES. NUMBER ONE IS YOU DO NOT DIE FROM PROSTATE CANCER, YOU DIE WITH IT. IF WE DID AUTOPSIES, 70% OF MEN WILL HAVE SOME PROSTATE CANCER. 3% DIE OF PROSTATE CANCER, AND THAT IS SAYING YOU DO NOT DIE FROM IT, YOU DIE WITH IT. THE OTHER SOUNDBITE IS THAT IT IS THE SECOND MOST LETHAL CANCER FOR MEN. IF MEN DID NOT SMOKE, IT WOULD BE THE MOST LETHAL CANCER. ON ONE HAND YOU ARE HEARING YOU DO NOT DIE FROM IT, ON THE OTHER HAND WE ALL FEAR DYING OF CANCER, AND PROSTATE CANCER IS A BIG KILLER. WHAT WE WANT TO DO, AND JIM HAS BEEN ONE OF THE PIONEERS ALONG WITH OUR COLLEAGUES AT NYU, IS HOW DO WE IDENTIFY THOSE CANCERS THAT ARE LETHAL AND TREAT THOSE CANCERS, AND DO NOT EVEN DIE OF THOSE CANCERS.>>PEOPLE DO NOT REALIZE THAT YEARS AGO THE ONLY THING YOU DID WHICH WAS A STUDY WHERE YOU DID A BIOPSY. AS YOU SAID TO ME BEFORE, THAT WAS NOT ALWAYS THE KEY. THE KEY IS –>>I WILL TRY AND SET IT IN CONTEXT, AND I WILL TRY TO BE BRIEF. WHEN PSA CAME ABOUT, IT WOULD BE ELEVATED AND YOU HAD A HIGHER RISK. WE HAD NO IMAGING TOOLS OR BIOMARKERS THAT DIFFERENTIATED THE 30% THAT WOULD HAVE CANCER, AND THE 70% THAT WOULD NOT. WE RANDOMLY PUT NEEDLES INTO THE PROSTATE TO DETECT THE CANCER. SOMETIMES WE MISSED THE AGGRESSIVE CANCER, AND SOMETIMES WE HIT LOW RISK CANCERS AND THEY WERE OVER TREATED. HOPEFULLY, IF THERE WAS AN AGGRESSIVE CANCER, WE DIAGNOSED IT, AND WE SAVED LIVES. THAT PARADIGM ACTUALLY DECREASED MORTALITY BY 50%. JIM SAID, YOU JUST HEARD THAT THE U.S. PREVENTATIVE SERVICE TASK FORCE SAID THAT WE ARE GOING TO ADVISE AGAINST PSA SCREENING, BECAUSE THERE IS MORE HARM THAN BENEFITS. AND YOU SAY, WHAT ARE THEY THINKING? WE SHOW THAT WE DECREASED MORTALITY FROM THE SECOND MOST COMMON KILLER OF MEN, AND THAT WAS DRIVEN BY PSA. AND NOW THEY ARE SAYING DO NOT GET A PSA. I THINK THE PROBLEM WAS THAT, FROM THEIR POINT OF VIEW, THE RISK OF THOSE UNNECESSARY BIOPSIES, AND THE RISK OF ALL OF THOSE MEN WHO WERE BEING TREATED WITH CANCER THAT WAS NOT DESTINED TO BE A PROBLEM, THOSE HARMED THE OUTWEIGHED BENEFITS. JIM CAN GO OVER HOW WE ARE TAKING THAT PATIENT, BECAUSE PSA IS STILL THE FOUNDATION OF SCREENING THAT LED TO THE DECREASE IN MORTALITY BY 50%. WE HAVE BEEN DOING A LOT OF WORK OVER THE LAST DECADE TO FIGURE OUT HOW CAN WE BETTER DETERMINE AHEAD OF THE BIOPSY WHO IS AT HIGHER RISK, AND HOW CAN WE MORE PRECISELY FIND THAT LETHAL CANCER.>>BEFORE SURGERY, THERE IS THE MRI BEING DONE.>>EVEN BEFORE YOU GET A BIOPSY.>>THE DIAGNOSTIC PARADIGM DOES SHOW IMPROVED ABILITY TO DIAGNOSE A MAN WITH PROSTATE CANCER EARLY, THE PROBLEM WAS WE COULD NOT IDENTIFY WHERE THE TUMOR WAS. THAT IS WHERE MULTI-PARAMETRIC MRI CAME INTO PLAY. IT ALLOWED US TO SEE THE PROSTATE IN A BETTER WAY THAN THE ULTRASOUND THAT WAS GUIDING OUR BIOPSIES IN THE PAST. WE WERE ABLE TO DIRECT BIOPSIES TO AN AREA OF SUSPICION. THAT HAS SHOWN TO PROVIDE YOU WITH AN INCREASE IN THE DIAGNOSIS IN THE TYPE OF PROSTATE CANCER TO BE TREATED, AND DECREASE THE DETECTION OF INDOLENT PROSTATE CANCERS THAT MIGHT NOT BE A RISK TO THE HEALTH. WE HAVE THE ABILITY TO MAKE A BETTER BIOPSY, AND THAT COMES FROM HAVING AN MRI BEFORE THE BIOPSY.>>IF YOU COME TO NYU, AND WE WILL TAKE A HISTORY. IS THE PSA SLOWLY GOING UP? THAT SOUNDS LIKE CANCER. IF THE PSA IS UP AND DOWN, THAT IS PROBABLY INFLAMMATION. WE ASK ABOUT FAMILY HISTORY — AND ARE WE CONCERNED ABOUT THAT PSA? WE WILL EITHER DO BIO MARKERS, AND WITHOUT GOING INTO THE DETAILS OF THOSE BIOMARKERS, WHAT THEY DO IS THEY TELL US WHAT IS THE LIKELIHOOD IF YOU DID A BIOPSY THAT YOU WOULD FIND AN AGGRESSIVE CANCER. IN MANY CASES WE WILL DO AN MRI. IF IT IS NEGATIVE IT HAS A 90% NEGATIVE PREDICTIVE VALUE, WHICH MEANS YOU WILL NOT FIND AN AGGRESSIVE CANCER. IF YOU COME TO NYU, I BET 20 OR 30% OF MEN WILL NOT GET A BIOPSY, BECAUSE, BASED ON THEIR BIOMARKERS AND M.R.I., THEY ARE AT VERY LOW RISK OF HAVING A PROSTATE CANCER THAT IS AGGRESSIVE, SO WE WILL NOT BIOPSY.>>SAY, AFTER ALL OF THESE TESTINGS, YOU FIND OUT THAT THE PERSON HAS PROSTATE CANCER. IT COULD BE A SMALL TYPE, OR A LETHAL TYPE. WHAT ARE THE DIFFERENT TREATMENTS TODAY, AND WHAT ARE THE RECOMMENDATIONS FOR PEOPLE BASED ON AGE, AND TESTING, AND SO ON. WHAT ARE THE DIFFERENT APPROACHES?>>I CONSIDER PROSTATE CANCER HAS A TREMENDOUS SPECTRUM. I HAVE HAD 33 YEARS OF TREATING PROSTATE CANCER. THE YOUNGEST PATIENT WAS 37, THE OLDEST, 83. SOME MEN HAVE SUCH LOW RISK CANCER WE WONDER IF IT IS A THREAT. OTHERS THAT COME TO US, WE WONDER, IF WE CAN CURE THEM BECAUSE IT IS SO AGGRESSIVE. SOME COME IN AND SAY “JUST CURE MY CANCER, AND I KNOW THE ISSUES, BUT JUST CURE ME AND I WILL DEAL WITH IT.” OTHERS WILL SAY, QUALITY OF LIFE IS IMPORTANT. I KNOW THAT MANY MEN WITH PROSTATE CANCER DO NOT DIE OF IT OR ARE NOT HARMED, SO I MIGHT BE MORE INCLINED TO TAKE A LESS AGGRESSIVE APPROACH. HISTORICALLY, WE BASICALLY GET SURGERY AND RADIATION. THIS GOES BACK TO THE 1980s. WE REALIZED THAT THERE WERE A LOT OF LOW RISK CANCERS THAT DO NOT NEED TREATMENT. THAT IS CALLED ACTIVE SURVEILLANCE. RIGHT NOW, WE WILL DO A BIOPSY. WHAT JIM, AND I, AND OTHERS AT NYU HAVE PIONEERED, THE MRI WILL BE ABLE TO HELP US IDENTIFY WHERE THE CANCER IS. THE RANDOM BIOPSY DID NOT. IF WE SEE A CANCER THAT IS LOCALIZED TO ONE AREA, WHAT DID YOU DO IN BREAST CANCER? YOU TOOK THE WHOLE BREAST OUT. KIDNEY CANCER? WE TOOK OUT THE WHOLE KIDNEY. NOW WE DO A PARTIAL NEPHRECTOMY. WHEN WE DID NOT KNOW WHERE THE CANCER WAS, WE HAD TO TAKE OUT THE WHOLE PROSTATE. NOW THAT WE CAN IDENTIFY THE AREA –>>AM I HEARING THAT THERE IS LESS CHANCE FOR TAKING OUT THE ENTIRE PROSTATE, MORE FREEZING OR RADIATION?>>THE KEY POINT IS BEING ABLE TO LOCALIZE THE TUMOR WITHIN THE PROSTATE ITSELF OPENS THE DOOR TO EXPLORING AND TREATING IN DIFFERENT WAYS THAT WE DID NOT HAVE AVAILABLE WHEN WE DID NOT KNOW WHERE THE TUMOR WAS. THIS HAS OPEN AVENUES FOR DIFFERENT TYPES OF STRATEGIES. AS HE MENTIONED, THEY ARE ALSO EMPLOYED IN MANY OTHER PROCESSES. WE ARE JUST STARTING TO ADAPT THOSE TO THE PROSTATE, BECAUSE WE CAN TELL WHERE THE TUMOR IS. IT IS VERY EARLY IN OUR EXPERIENCE, THE IDEA IS TO DO A PARTIAL ABLATION, WHICH IS TO IDENTIFY WHERE THE TUMOR IS AND TREAT THAT AREA. IF YOU CAPTURE ALL OF THE CANCER CELLS, YOU DECREASE MORBIDITY. THIS IS DIFFERENT THAN THE WHOLE GLAND TREATMENT OPTIONS.>>AND THOSE WERE TAKING OUT THE WHOLE GLAND.>>OR IRRADIATING IT. YOU CAN HAVE FEWER SIDE EFFECTS, BUT YOU MAY RISK HAVING A TUMOR DEVELOPED IN A DIFFERENT PORTION OF THE GLAND LATER ON OR NOT ABLATING ALL OF THE TUMOR. YOU TRADE OFF THE SIDE EFFECTS WITH SOME RISK THAT WE NEED TO UNDERSTAND OVER TIME. THAT IS WHAT THE MRI HAS EMPOWERED US TO DO.>>LET US TAKE THE PATIENT WHO COMES IN. THIS WEEK, TWO OF US TOOK THREE PROSTATES. WE ARE DOING FIVE OF THESE FOCAL THERAPIES. WITH A REASONABLE CONFIDENCE WE HAVE IDENTIFIED WHERE THE AGGRESSIVE DISEASE IS. JUST THIS WEEK WE ELECTED TO DO THE CRYO USING FREEZING. WE HAVE HIGH INTENSITY FOCUS ULTRASOUND. IF THERE IS A TECHNOLOGY THAT IS IN DEVELOPMENT, IT’S PASSED THROUGH NYU. THE PATIENT COMES IN, WE DO GENERAL ANESTHESIA, AND IT TAKES AN HOUR AND A HALF. ABOUT AN HOUR OR TWO LATER, THEY’RE ON THEIR WAY HOME. THEY ARE BACK TO WORK IN THREE TO FOUR DAYS. WE HAVE NEVER HAD A PATIENT WITH ANY ELEMENT OF INCONTINENCE. IN SOME MEN THERE IS A TRANSIENT DECREASE IN ERECTION, BUT AS JIM INDICATED, THERE IS NO FREE LUNCH. IF YOU CAN BE TREATED FOR YOUR PROSTATE CANCER WITH FOCAL THERAPY, WE HAVE THE RADICAL PROSTATECTOMY.>>WHO IS BEING RECOMMENDED FOR THE RADICAL?>>HIGHER RISK DISEASE, MULTIFOCAL DISEASE, YOUNGER MEN WHO ARE BETTER SURGICAL CANDIDATES ARE STILL VERY GOOD CANDIDATES FOR THE RADICAL OPTION. THEY SHOULD BE OFFERED THAT. IT DOES OFFER GOOD IF NOT THE BEST CANCER CONTROL. IT DOES COME WITH A HIGHER SIDE EFFECT BURDEN THAN DOING A PARTIAL. THIS DISCUSSION IS COMPLEX AND IT RELIES ON A GOOD UNDERSTANDING OF WHAT THE OUTCOMES THE PATIENT EXPECTS, THE SIDE EFFECT PROFILE THEY ARE WILLING TO TOLERATE AND THE RISK LEVEL THEY ARE WILLING TO TOLERATE. THE MRI HELPS US AS A TOOL ON ALL OF THOSE FRONTS. IT MAKES THE DISCUSSION MUCH MORE THOROUGH AND UNDERSTANDING.>>WHEN YOU ARE DOING A BIOPSY, ARE YOU DOING SPECIFICALLY DIFFERENT LOCATIONS BASED ON THE MRI, OR ARE YOU STILL DOING SIX TESTS?>>IT IS COMPLICATED, BECAUSE WHAT WE DO, THE MONEY IS IN THE TARGET, AND WE HAVE DONE CO-REGISTRATION, WE TAKE MRI. LET’S ASSUME MY RING IS THE AREA OF CONCERN. WE HAVE MRI AND WE MAKE A 3D MODEL AND PUT THEM TOGETHER. THE COMPUTER TAKES THE TARGET AND TRANSFERS IT, AND THE NAVIGATION ARM WILL SPECIFICALLY TARGET THAT REGION. WE END UP STILL DOING THE RANDOM BIOPSIES TODAY, IT IS A BIT COMPLEX ONE, BECAUSE OUR CO-REGISTRATION MIGHT NOT BE PERFECT ON THE SITE OF THE LESION, AND WE WANT TO HAVE GREATER CONFIDENCE THAT THAT IS A GOOD CANDIDATE FOR FOCAL THERAPY BY HAVING A NEGATIVE MRI, AND A NEGATIVE RANDOM BIOPSY ON THE OPPOSITE SIDE THAT WILL BE THE UNTREATED SIDE IF THEY ELECT TO UNDERGO FOCAL THERAPY.>>HERE A BIG QUESTION. THE GOOD AND THE BAD ARE THE GOOD AND THE BAD, BECAUSE PEOPLE, WHEN THEY HAVE A CONDITION, THEY GOOGLE IT AND READ THE FIVE THOUSAND DIFFERENT OPINIONS AND DIFFERENT APPROACHES. THEY HEAR PSA, ABLATION, THIS AND THAT. HOW DOES SOMEONE MAKE A CONSCIOUS DECISION THAT THEY SHOULD TAKE THE PROSTATE OUT, THEY SHOULD HAVE RADIATION?>>YOU COME TO JIM AND I.>>I AGREE WITH THAT. I AM REALLY ASKING FOR THE SITUATION.>>IT IS VERY DIFFICULT. I THINK STACY IN OUR DEPARTMENT PUBLISHED AN ARTICLE ON THE FRONT PAGE OF “THE NEW YORK TIMES” WHICH WAS TAKING THE INTERNET AND LOOKING TO SEE WHICH WAS THE HIGHEST SEARCHABLE INFORMATION. THERE WAS ALMOST AN INVERSE RELATIONSHIP BETWEEN THE LEAST RELIABLE INFORMATION AS JUDGED BY A GROUP OF EXPERTS, AND THE NUMBER OF HITS THAT IT WAS GETTING. I GUESS THE ANSWER IS TO MAKE SURE THAT WHEN YOU GO TO A PROVIDER, THAT THEY ARE TRYING TO FIGURE OUT WHAT IS BEST FOR YOUR CANCER RATHER THAN FIGURE OUT HOW THEIR TREATMENT IS THE BEST FOR YOU.>>A PERSON WHO HAS AN ENLARGED PROSTATE, WHAT IS THE CHANCE OF THAT PERSON HAVING PROSTATE CANCER? OR WHAT DO YOU RECOMMEND FOR THEM?>>IT IS THE SAME APPROACH AS A MAN WHO DOES NOT HAVE BENIGN PROSTATE HYPERPLASIA. WE WOULD STILL APPLY PSA, OR USE BIOMARKERS OR AN MRI. MOST MEN WILL HAVE SOME COMPONENT AS THEY AGE, AND THAT JUST CLOUDS THE DIAGNOSTIC CAPABILITY.>>MANY PEOPLE WHO CALL ME, WHEN THEY HEAR THAT THEIR PSA IS THREE OR SIX, THEY GET OUT OF SHAPE AND THERE — THEIR MIND IS SAYING I HAVE PROSTATE CANCER. I SAY YOU NEED TO GO TO SEE SOMEONE WHO UNDERSTANDS DIFFERENT APPROACHES.>>EVERY MAN, WHETHER YOU COME IN WITH SYMPTOMS OR NOT WILL GET A PSA. THEY ARE NOT TOTALLY INDEPENDENT, BECAUSE IF YOU HAVE A VERY LARGE PROSTATE, THEN THAT LARGE PROSTATE WE WOULD EXPECT TO MAKE MORE PSA THAN A SMALL PROSTATE. WE CAN MAKE SOME ADJUSTMENTS. IF YOU COME IN, AND YOU ARE A 75-YEAR-OLD MAN, AND HAVE A GLAND THAT IS THREE TIMES THE SIZE AND YOUR PSA IS 4.5, WE ARE NOT THAT CONCERNED. WE MIGHT GET A BIOMARKER. IF YOU ARE 50 YEARS OLD AND YOU HAVE SYMPTOMS, BUT YOUR PSA IS FOUR AT AGE 50, AND YOU HAVE A FAMILY HISTORY, WE WILL BE MUCH MORE CONCERNED ABOUT PROSTATE CANCER. WE WILL PRETTY MUCH ASSESS THEIR SYMPTOMS INDEPENDENT OF THEIR PSA.>>WHAT DO YOU RECOMMEND FOR SCREENING? SOMEBODY IS 40 YEARS OF AGE, NO FAMILY HISTORY OF PROSTATE CANCER. DO YOU RECOMMEND THAT THEY GET A PSA TEST, A DIGITAL-RECTAL TEST? WHEN SHOULD SOMEBODY BE TESTED?>>I WILL TELL YOU THE GUIDELINES. BETWEEN THE AGES OF 50 TO 69, YOU SHOULD CONSIDER THE RISKS AND BENEFITS OF SCREENING AND HAVE A DISCUSSION WITH YOUR DOCTOR. LESS THAN 50, OUR AUA GUIDELINES DO NOT RECOMMEND SCREENING BECAUSE THEY DO NOT HAVE ENOUGH DATA. WHAT I WOULD SAY, BETWEEN 40 AND 50, THAT IS A GOOD TIME, NOT NECESSARILY TO GET AN ANNUAL SCREENING TEST, BUT A COUPLE OF TESTS ALONG THE WAY. FAMILY HISTORY, AFRICAN-AMERICAN, I RECOMMEND STARTING EARLY. THE OTHER CHALLENGE IS AT WHAT AGE DO YOU STOP GETTING A PSA. AS A GENERAL RULE, IF YOU HAVE A 10 YEAR LIFE EXPECTANCY OR GREATER, I BELIEVE THAT IS THE SWEET SPOT WHERE FINDING AN EARLY CANCER CAN MAKE A DIFFERENCE IN PREVENTING METASTASIS OR MORTALITY.>>YOU HAVE DONE OVER 25,000 OPERATIONS. WHAT ARE THE STATISTICS WE ARE TALKING ABOUT FOR SURVIVAL RATE?>>IT IS VERY REASSURING. WE ARE GETTING READY TO PUBLISH OUR DATA. WHAT WE DID JUST TO MAKE SURE, IT IS VERY HARD TO FOLLOW PATIENTS FOR 15 YEARS. WE WENT TO THE NATIONAL DEATH INDEX AND USE THE SOCIAL SECURITY NUMBERS AND WE COULD TELL WHO WAS ALIVE AND WHO WAS DECEASED. AT 15 YEARS, OVER 90% OF OUR PATIENTS AT 15 YEARS ARE ALIVE. SOME OF THEM MAY STILL HAVE THEIR DISEASE AND WE WERE NOT ABLE TO BE –>>THESE ARE OF THE 5000 PATIENTS THAT YOU DID RADICAL SURGERY ON.>>I REALIZE THAT IN THAT GROUP, THERE ARE SOME MEN THAT I DID SURGERY WHO, IF I DID NOT DO SURGERY, THEY WOULD STILL BE ALIVE, SO IT IS NOT AS THOUGH — I THINK TO HAVE PREVENTED 90%. I HAVE ALLOWED 90% OF THE PEOPLE TO LIVE UP TO 15 YEARS. MANY OF THOSE PROBABLY WOULD HAVE LIVED HAD I NOT TAKEN OUT THE PROSTATE, AND SO WHAT WE ARE NOW — THIS IS FROM THE 1990s TO THE 2000s, WHEN WE OPERATED ON LOW RISK. IF I OPERATED ON MEN WHO DID NOT NEED IT, I KNOW WHO WILL DIE OF IT. IF I OPERATED ON MEN WITH VERY ADVANCED DISEASE, AND FEW WILL BE ALIVE IN 15 YEARS. WHAT WE ARE TRYING TO DO IS IDENTIFY UPFRONT WHO IS THE PERSON WHO HAS DISEASE THAT I CAN CURE, BUT IF I DID NOT OFFER THEM A CURATIVE TREATMENT, THEY WOULD DEVELOP METASTASIS AND — THAT’S OUR CHALLENGE.>>THERE ARE MANY ALTERNATE TREATMENTS, AND PEOPLE NEED TO EVALUATE. IF IT NEEDS TO BE DONE, LET SURGERY BE DONE APPROPRIATELY. I AM HAPPY THAT THE CITY HAS TWO OF THE TOP NOTCH IN THE ENTIRE NYU UROLOGY GROUP WHICH IS HOW MANY DOCTORS?>>25. YOU KNEW IT WHEN IT WAS FOUR.>>I WOULD LIKE TO THANK YOU, AND I WILL SEE YOU NEXT WEEK. ♪ [THEME MUSIC] ♪

2 Replies to “Alternative Treatments for Prostate Cancer | The Stoler Report”

  1. Why was this 'alternative treatments'. Looks mainstream to me.
    You state the general perceptions of treatment as 'you'll die with it' and 'its the 2nd biggest killer in men', yet you don't state which one is correct.
    The PSA test is a bad test. It's basically a lottery system. The threshold is 4. This threshold is a made up number plucked out of thin air. Theres no science behind its selection. People with PSA below 4 can have cancer or not. People with PSA above cancer can have cancer or not. All it does is pass more people through the testing door since the way its designed it will randomly select a percentage of people taking the test for a biopsy.

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