August 26, 2024 • 52 mins
If you're a dude, you've probably heard those dreaded words, "bend over, it's time for your prostate exam" from your doc'. And if you're getting an annual physical, you've likely had your PSA tested, maybe even heard that your number was high.
What are you supposed to do? The National Cancer Institute recommends additional testing for a PSA above 4.0 in anyone over age 60, or above 2.5 in anyone younger than 60. But there's so much more to understanding your risk of Prostate Cancer, and how to treat it once you've been diagnosed.
In this episode we bust myths about prostate cancer's aggressiveness in black men, highlight the importance of early detection, and dig in to the emotional and mental aspects of dealing with the disease.
The conversation is enlightening, heartfelt, and empowering, ultimately encouraging men to prioritize their health.
I'm joined by an impressive lineup of guests:
Dr. Mack Roach III, a specialist in urologic tumors from UCSF, shares his extensive knowledge on the subject. Mark Harris, diagnosed in 2013, discusses his journey and efforts to support others. David Fields, diagnosed in 2020, provides a candid look at his experience and the choices he made for treatment.
The guys share their personal experiences with the disease, discuss the impact it's had on their lives and the challenges they've faced in navigating their treatment options.
Tune in to learn more about prostate, the importance of early detection and treatment, and the innovative approaches being used to combat this prevalent disease.
Remember, don't let pride stand in the way of prevention. Stay informed, get checked, and keep the conversation going.
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For more information on prostate cancer, visit:
- Prostate Cancer Foundation: www.pcf.org
- American Cancer Society: www.cancer.org
To learn more about Dr. Mack Roach III and the UCSF Helen Diller Family Comprehensive Cancer Center, visit: www.ucsfhealth.org/cancer
To learn more about the Health, Hope & Hip-Hop Foundation visit: www.healthhopehiphop.org.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Yes, yes, yes. Welcome back to Hip-Hop Parade, Black Men Talking Health.
I am your emcee for this evening. I am Oya Gilbert, and we got a really,
really dope program for you tonight.
Tonight, we're going to be discussing prostate cancer, and as you well know,
(00:20):
it affects African Americans on a higher level than our white counterparts.
And today in the building. I got some fly guests, and I mean that in the most wonderful way.
We got Mark Harris, and I got David Fields, and the infamous Mac Roach III.
(00:41):
I'll let them introduce themselves. We're going to start off with Mac.
And Mac, could you please tell the audience who you are?
Well, I'm a professor at the University of California, San Francisco in the
Departments of radiation oncology
and urology and my specialty involves urologic tumors which is about 95,
(01:02):
prostate cancer and i've been working in this field for more than 30 years oh
that's dope see that's what that's what we do we bring the experience in the
building and so we got mark harris and mark can you tell us who you are yeah
i'm uh again mark harris uh i'm uh i was diagnosed
with the prostate cancer in 2013 so um I've and since then I've been able to
(01:28):
you know help other other people so I'm a co-facilitator of a cancer support group I'm.
Music.
Especially the black and brown community, but everybody, everybody who's diagnosed
with prostate cancer, try to help them on with their journey.
(01:48):
And then try to help the researchers and try to help them as they find better,
treatments or improved treatments for prostate cancer.
Wow. Okay. That was a nice intro too. I got sure I'm going to have to let you
introduce me. I'm going to program. Come on.
The next is we got David. David, please introduce yourself, brother.
(02:11):
Yeah, I'm David Fields out of Wake Forest, North Carolina, 53 years old.
I was diagnosed with prostate cancer in November of 2020.
And pretty interesting story once we finally get into it. But that's about it.
But that's enough. You know what I mean? So, look, I want to go straight.
(02:36):
You know, I don't play no games, but I want to go straight to it,
dive right all into this. So, Mark, you know, tell us, you know,
your story and how you came to come to, you know, discovering it.
Well, first of all, your journey on finding out you have prostate cancer and
then where you are today.
Yeah, well, OK, well, I have to go. I said I was diagnosed in 2013,
(02:59):
but in 2011, my PSA was 5.3 or something like that. And at that time,
they wanted between zero and four.
But my physician said, well, if you had ridden a bike or had sex,
that could have spiked your PSA.
(03:20):
So come back in a week. Well, I forgot.
I forgot. So two years later, I had to get some medication.
And then he wouldn't OK it over the phone. So he had me come in.
And my wife was there, she was saying, Mark wasn't happy about it, and I was not.
Music.
(03:42):
Full physical so my psa was now 10.8 or
no no no sorry 13.8 or something like that
so um so now
i'm you know it's got my full attention so a friend of
mine dr delorestein brown she's uh she's a
uh primary care physician so i i know
she's like lentil soup so i took her out for it for lunch and we
(04:04):
talked a couple hours about my case and stuff you know she
said mark you got to get this to check that so i
you know got the uh biopsy and
then um so on october
3rd 2013 you know dr solomon calls at 8 23 p.m says uh your biopsy came back
(04:25):
positive for uh prostate cancer you know you have prostate cancer and he said
but i'll do everything i can to help you and because he said that I said, thank you. You know?
So he, um, and all during the rest of the conversation, I'm saying,
thank you. Thank you. Thank you to the point. I think Dr.
Solomon said, I'm telling this idiot, he has prostate cancer.
He's thanking me. So just to be clear, just to be, he didn't say it this way, but I'm my paraphrase.
(04:51):
Just to be clear, your box, he came back positive for prostate cancer.
And, uh, and, uh, and I'll do everything that I can help you.
I said, thank you. You know? So, um, So I hang up the phone and it's interesting
because I realize now, again, this is a decade later, that I took that news
and just put it in the back of my mind.
(05:11):
And so I thought for a second about not telling my wife, telling my ex-wife
and my daughter, because, you know, as I see my role as a man,
I'm supposed to be the rock, the foundation,
the stabilizer of things and not the reason there is angst and all this other stuff.
But, you know, I put that aside after about a minute, called out to my wife.
(05:35):
Hey, you know, we came back positive for prostate cancer.
My wife comes running out. She said, what are we going to do?
So I said, you know, this was a Thursday night. I said, you know, I don't know.
We're going to have a, he said, we're going to have a meeting on Monday and
we'll talk about, you know, our, you know, what we need to talk about as far
as getting a design on a treatment.
(05:57):
So my wife is, what are we going to do?
I said, I really don't know. I've never been here. I don't know.
I don't know what's going on. You know, we got to work it out together.
What are we going to do? And I said, I said, now you got to remember I was in the moment.
I said, can't you see I'm watching television? Oh, Lord.
(06:22):
Wow. Yeah, yeah. I mean, you know, because, again, I had never had this.
Well, there's nothing you can do about it at that point anyway,
so you're going to deal with it Monday, so deal with it Monday. Absolutely.
And the thing is, you find out at that moment.
That there's very few things in life that can change your
(06:44):
life so suddenly as your name or loved one name and cancer being in the same
sentence sure all the stuff you thought before that the second before you heard
that you had cancer all the stuff you thought was it was was a priority is now
not a priority and i've had people say well you know my children my grandchildren,
number one thing are you gonna be there to see them so it's all it's always
(07:08):
that's gonna affect everything in your life, you know, so, and then,
you know, so that evening, I go to bed,
and, because I watched the rest of the movie, and I realized the movie was just white noise,
so I go to bed now, you know, there's quiet, and, you know, tranquility,
and stuff, so I'm thinking, oh,
my human side said, I'm gonna die, I'm gonna die, but then my spiritual side
(07:31):
said, but how do I use this to help others, you know, that's what,
because God has always given me experiences that that I can help people that
I can walk in that I've walked in their shoes.
So I can help people from that, that, that point of view. Right.
So that's what I've been doing since then. And then go ahead.
Now I was just saying, so did you, when you decided to say, Hey,
(07:52):
I'm going to help people, had you had treatment or you still,
you still on the weekend talking about I'm going to wait till Monday.
Yeah. No, that was that, that was that night. That was that Thursday night.
I would help others, you know, and then I, again, Little did I know that helping
others would be my son six days later, because he was diagnosed with a different
cancer, adenocarcinoma of the parotid gland, and he died four months later.
(08:14):
Oh, wow. We were really blessed that I was, you know, I told my daughter,
you know, the Bible says a point of a man wants to die.
So that path, that date was already set.
But God had me, God blessed me that I was diagnosed first, because my 30-year-old
son would not have listened to me if I hadn't been 9-0 sturdy. He knows everything.
(08:38):
So we were blessed. We were blessed.
So, Matt, listening to Mark's story, is that something typical that you hear
as far as the people, you know, saying, hey, they don't really pay attention to it?
Yeah, it's very typical.
But also the first thing I'm thinking about is, well, what was the grade of
(09:00):
the tumor? We use a system called the Gleason,
There was a guy named Don Gleason who came up with this system.
And basically, you can have patients who have low-grade tumors,
intermediate-grade tumors, and high-grade tumors.
And if he told me that he had a low Gleason score, I could immediately tell
him your chances of dying of prostate cancer in the next 10 years is less than 1%.
(09:25):
But if it's intermediate risk, it's a little bit higher.
And if it's high risk, it's a bit higher. So really, the bottom line is until
you actually find out what the Gleason score is, I mean, that PSA is a little
bit of a problem, but the Gleason score is far more important.
That's how the cancer looks under the microscope.
(09:48):
That makes sense. Go ahead, Mark. Yeah, 100.
So I, 100%. So I, um, so actually my Gleason score was three plus four,
um, which is, which is, you know, which is a candidate for active surveillance,
what they call active surveillance.
This but but and this would i i try to tell a friend of mine he he's into this
(10:10):
liquid liquid biopsy and stuff but right now they can't tell but so then when
they take the biopsy they call those cores they took they usually for most people
they take 12 for me they took 13 cores.
11 out of the 13 were cancerous okay and of the 11 more than half of that core
(10:31):
was cancerous So even though it was three plus four,
in my mind, and the other thing is that the cancer was encapsulated.
That's the term they used. They thought the cancer was still inside the prostate.
Yeah. But Mark, let me pause you right there.
(10:52):
So when you said you were a candidate for active surveillance,
that's according to the doctors you were talking to.
I would never recommend active surveillance in a young, otherwise healthy African-American
man who's got Gleason 3 plus 4 and a lot of positive chorus.
That would be, no, you're not a candidate for active surveillance.
(11:12):
Now, what happens sometimes is doctors will tell you, well, you could do active surveillance.
And then some patients go, really, doc? Oh, yeah, you don't have to be treated.
Well, if that was them. Yeah. Yes.
Are their loved ones? They'd be telling them no, no, no, no, no.
(11:33):
So active surveillance is a great recommendation for a person with a Gleason score of 3 plus 3.
But once you get into 3 plus 4, the only patients who would be reasonable for active surveillance,
surveillance if you got some guy who's 85 years old
and he's got diabetes hypertension had a stroke blah
(11:53):
blah you got all kind of medical problems he can live a
long time but you got a man who's got a 20-year life expectancy yeah i mean
you know the thing is when you treat patients with intermediate risk disease
with radical prostatectomy you only cure about half of them that's with treatment
right so if you do active surveillance and your psa is already 10.
(12:18):
Next thing the patient is going to be a high risk patient
where the success rates even lower so although your doctor said you could be
a candidate for active surveillance not everybody and i would i would suggest
most experts would not tell a young african-american man with a gleason seven
that you should even think about active surveillance yeah yeah so that and that's That's correct.
(12:41):
So that's, that's how I made my, yeah, I made my decision based on that.
Um, again, because so much of it was, uh, was, was, was, uh,
and then that's another thing I did.
I went to five different positions in three different hospitals,
three, three, three different hospital or thing.
So, so to your point, Mac, I had, I got all these different,
(13:06):
uh, different, opinions.
And then I took, then I did, I had a prostatectomy.
Okay, gotcha. So that's a great point, Dr.
Roach. And I appreciate you, you know, chiming in because from doctors,
from specialists to specialists, people who have different,
(13:28):
different, I guess, treatments that they would prescribe based on what they
think or what their knowledge is.
And so So that's huge, you know, for the listeners to know, you know,
that kind of information so that it can help make them make a sound decision.
Because like I said, none of this is easy.
Well, there are also guidelines, right? So there is something called the NCCN,
(13:51):
National Comprehensive Cancer Network.
So it turns out that the National Cancer Institute, the largest cancer research
institution in the world, has these
things that they call, there's certain institutions that are members.
And it has to do with institutions that are deemed to be comprehensive cancer centers.
(14:13):
And we write guidelines. I'm on the committee that writes guidelines.
So every different cancer site has different committees. So I'm on the one for
treatment of prostate cancer. And so you can go on. It's in the public domain.
You can look up your cancer. So if you go to NCCN, the website,
and you look it up, they don't say active.
(14:34):
They don't recommend active surveillance for a young, healthy man with intermediate risk disease.
And how many cores did you have positive out of how many biopsies?
I had 11 out of 13. Right. So you actually, not only did you have intermediate
risk, but you had unfavorable intermediate risk.
(14:54):
And you had unfavorable intermediate risk for two reasons.
One, you can be intermediate risk if your PSA is between 10 and 20,
even if your Gleason score is low, like 3 plus 3.
Or you can be intermediate risk if your Gleason score is 7 by itself.
But once you have two factors, PSA between 10 and 20 and Gleason 7,
(15:18):
you become unfavorable intermediate risk.
Or if you have more than half of your biopsy core is positive,
you become unfavorable intermediate risk.
So you have unfavorable intermediate risk for two reasons, for three reasons,
actually. Your Gleason score is 7, more than 50% of your cores are positive, and you had a PSA over 10.
(15:43):
So suggesting that someone like you would be a candidate for active surveillance,
I would consider malpractice.
I'm not sure if anybody suggested that, but it seemed like that was on the table.
It seemed like it was on the table.
At that time, you know, stuff is, you know.
(16:04):
Yeah, no, I understand. Yeah, it makes perfect sense.
You know, I want to pivot a little bit and we're going to come back around to you, Mark.
I got my brother David here who definitely want him to chime in because his
story is just, you know, with all these stories, no matter what kind of cancer
you're dealing with, it's always a unique aspect to it.
(16:26):
And then there's also some overlap, some things that have some common commonalities
to it. But but David, if you could chime in and share, you know,
your journey, I would I would truly appreciate it. OK, well.
To be honest with you, I hadn't given a PSA test any thought until my father
(16:50):
suggested it to me. My father, he's a retired colonel.
So, you know, he's always at the VA getting checked up, getting treated,
doing what he does. So I was around 2018.
He said, so I need to go get your PSA checked.
Someone got it checked and it was like 7.5.
(17:11):
So I came home and I said, you know, I told him, I said, hey, dad, my PSA was like 7.5.
I said, how old were you then? I was 18.
I was 40. Well, between 47, 48.
So I asked him, I said, what is your PSA been?
He said, he said, son, he said, be honest with you. He said,
(17:32):
my PSA has been all over the place.
He said, it's been, he said, it's been as low as like, say, a one or two.
He says, it's even been as high as I think he told me, like a 25.
But my father now i think he's uh 83 he's never had prostatitis never had prostate
cancer none of that right so i didn't think anything so i didn't think anything
of it so i'm like all right well i guess it's just in the family just got a
(17:54):
high psa keep it pushing right.
So 20 2020 comes i
had a new doctor new a new urologist and he suggested i get my psa check because
he asked me if i'd ever had a check before so i think when he checked it it
was i think it's 7.8 he's like yeah you know we need to take a look at that
(18:14):
he said um he said what i'm gonna do first he said is um i can't remember if
he did the mri first i think he did the mri first,
set him up for mri um came back and said yeah you know we see a little spot
he said it was like about like the size of from what he could tell the size
of about a half a grain of rice and so what he told me and so then that's when
(18:35):
he wanted to do the biopsy we did the biopsy,
and I don't remember how many cores it was. I don't think it was a lot, but he said.
The Gleason score was like a four plus three, seven, right? But he said it was
like more on the aggressive side.
And four plus three would be more on the aggressive side than three plus four.
(18:59):
So I said, okay. And I said, so what's next? So he talked to me about the treatment options.
By this time, I pretty much had quit listening. And I'm like,
can't feel me cause prostate cancer, man. I'd rather have, I don't know.
Well, I guess in your mind, cause you know, as a man, you're thinking your prostate,
I'm like, I got a wife that's seven years younger than me. She's beautiful.
What do you mean? I got prostate cancer. There's no way. It's not happening.
(19:22):
And so I'm just kind of blanked out at that point in time. But then,
um, Riley said, said that he's
talking to me about, um, the different procedures. I think he said, uh.
He said chemo wasn't an option he said
it was either i think he said radiation or like the robotic uh
i forget the word prostatectomy prostatectomy
(19:43):
there you go and i said well what is that he said well yeah i'm gonna stick
like six arms in your abdomen and i'm gonna go in there and be cutting this
and cutting that i'm just like man there's no way there's no freaking way and
um so you know i asked him about the radiation and you know then he's talking
about mountain continents and all these other issues,
I'm like, there's got to be another option.
(20:05):
I said, I'm too young for this.
So I told him, I said, all right, well, give me some time to think about it,
see what I want to do. So I went home and started just doing some research.
And what I found out was, number one, his specialty was the robotics.
So he was kind of pushing me in that direction.
So when I got home, I started doing my own little research. That's when I found out about Haifu.
(20:29):
And for those that don't know that's um i think it's a high intensity um focal focus,
yeah right i was like okay so basically to go in with ultrasound and i guess
destroy the cells and you know see what happens so i started reading the stats on it and,
you know um all that kind of good stuff so i went back to see him and he's like
(20:54):
so you know what did we decide to do?
And I said, well, I said, I'm thinking about Haifu. He came in and just looked like.
Like, why do you know about Haifu? It kind of got that feel from him.
Like, how do you know about that? Because he didn't give it to me as an option.
And he's like, well, you know Haifu. Let me pause you right there.
Break it down for my peoples out there in layman terms. What's Haifu?
(21:19):
Basically, it's ultrasound. So basically, you go into a room,
they put you under, they do whatever they do with the ultrasound probe.
And I guess I think the term is ablation, I think is what it's called.
They go in there and destroy the cells with ultrasound that's my understanding of it,
and so then you know he started you know you know how people when they're trying
(21:42):
to handle you it's like you know well you know it's expensive you know I'm just
like okay well I got an insurance you know it's not a problem it's like yeah
well you know insurance doesn't normally cover it,
I'm like so what are we talking about and he told me straight up he said it's
$25,000 he had the number right there in his head it's $25,000 procedure I'm like okay well.
(22:08):
I'd rather do that than get cut on period that's not even an option I don't
care where the $25,000 is coming from you know what I'm saying it don't matter
to me I don't care if I gotta,
you know second mortgage on the house or whatever it doesn't matter to me yeah
pretty much but But that was my situation, and that's what we did,
(22:29):
and so far, that was 2021.
I think April, May 2021 is when we had the procedure. I've been back twice just
to do follow-ups, but every time you go back, they want to do the,
what do they call it? What now?
You were just talking about it, Mark, the biopsy.
(22:50):
I'm like, nah, I'm not cool with a biopsy because to me, I guess the way I think
about it, like sticking metal probes up in your prostate or whatever it is,
and that just to me doesn't sound like it's creating a problem more than it's helping.
Well, you know, David, I got bad news for you. The HIFU is not very effective.
It's not included in the NCCN guidelines.
(23:12):
I don't know what your Gleason score was, 4 plus 3, which means you're at higher
risk. Your PSA was 7, but you don't know how many cores there is.
So you're unfavorable intermediate risk as well, like Mark was.
But, you know, the problem is a layperson like yourself would not understand
(23:32):
what the implications of the data.
Actually, I have an extensive file on HIFU papers.
And my urologist here will do HIFU as focal therapy. So the ideal patient for
HIFU, there's a type of therapy category called focal therapy. Okay.
Which means that if you can image the prostate and you think that the cancer
(23:57):
is limited to one part of the prostate, you can freeze it with cryosurgery,
which is freeze to kill that part of the cancer.
Or you can do high-frequency focused ultrasound. sound.
And essentially that burns the cancer up in one location.
But you can destroy parts of the prostate several different ways.
(24:20):
The problem is the biology of prostate cancer.
So first of all, most people do not have prostate cancer. They have prostate cancers, plural.
Usually the disease is multifocal. It's in other places beyond one little place.
So even if the biopsy only shows it in one area, statistically,
(24:42):
they're likely to be other foci in other parts of the prostate.
So not that many people are good candidates for focal therapy unless they do
something called a saturation biopsy, where they take you to the operating room
and they create a grid and they
biopsy the bejeebers out of you, and they find out there's one little spot,
(25:05):
of a relatively low grade tumor, that's an ideal candidate for focal therapy.
But the reason that a patient with a Gleason score of four plus three is not
a great candidate for focal therapy is because if you remove the prostate.
Completely remove the prostate in a patient that has a Gleason score of four
(25:26):
plus three, at least half of the patients recur.
The cancer comes back, even though the prostate's been removed.
People, wait a minute, I've had patients come to me. I'm a radiation oncologist, right?
I've had people come to me and say, well, wait a minute, I don't know why my
doctor told me to come see you. He removed my prostate.
Well, a lot of those people recur right where the prostate they used to be because
(25:50):
they cut the prostate out and then they sew the bladder neck down to the external sphincter.
And so some people recur in that area and the other people tend to recur in the lymphatics.
So it turns out that cancer can spread to the lymph nodes.
And even though a CT scan doesn't show it and an MRI doesn't show it,
(26:10):
microscopic disease can be low the resolution.
And one of the problems with HIFU is like, well, what should your PSA be if
your prostate is still there and you have HIFU?
Now, when you take a patient who's had their prostate removed,
(26:30):
the PSA should be undetectable.
That means that the normal PSA, as Mark alluded to, is supposed to be up to four.
After the prostate's removed, what we look for is a value that has a less than
sign, less than 0.02, that's ideal, that's the kind of number you're looking for, undetectable.
(26:54):
When we do radiation on people with high doses of radiation.
Prostate is still there, so it can still make a little bit of PSA.
And our standard definition for a recurrence is if the PSA starts to rise,
and it rises by more than 2.0, okay?
(27:15):
But that's because the whole prostate's there.
But the criteria for what a PSA should be after HIFU has not been well worked out. Right.
So when you're followed, you know, you have a normal part of your prostate that
wasn't high food and part of your prostate that was high food.
(27:36):
It's hard to know where that PSA is coming from and it's hard to know how much
PSA you should be producing.
Okay. The good news is you can still have effective therapy if the high food doesn't work.
You can still have your prostate removed or you
can do radiation and generally uh radiation
(28:00):
is tolerated better than having
your prostate removed so if your cancer if your psa starts to go up and they
biopsy you and confirm that you still have cancer then uh more people would
recommend radiation than not in the treatment of that disease instead of actually
okay yeah well i I know last time they checked it,
(28:22):
I was at one on the PSA.
So like I said, I'm keeping an eye on it and.
I guess that's really all I got. Well, you know what's interesting about that
is my father was telling me, because he was friends with General Schwarzkopf.
I don't know if you remember him, the Operation Desert Storm.
And he died with prostate cancer. Well, a whole lot of people died with prostate
(28:47):
cancer. Yeah, and I remember him telling me that.
Tiger Woods' father died of prostate cancer.
Stokely Carmichael just died of prostate. I mean, I could go down the whole
list. Oh, yeah, I'd imagine.
But what was interesting. a lot of black men died of
prostate cancer and or had it and got cheated for
it dusty baker got cheated for it hallowed harry belafonte
got cheated for it uh sydney portier
(29:10):
got cheated for it i mean it's like real common so yeah you know what i was
gonna say though what was interesting about schwartzkopf was that his my dad
told me that like his psa was somewhere like around 1.7 something something
like that when he passed away i was but it's weird because my My father's is
like off the rails, but he has.
Well, but the PSA, the PSA by itself doesn't tell you anything.
(29:32):
If the what you don't know is what his testosterone was.
Right. So and also prostate cancer can de-differentiate.
Like normally when we talk about the Gleason score, we're looking at categories
like Gleason six or less, Gleason seven, Gleason eight to ten.
But some people have what we call anaplastic thyroid cancer.
(29:55):
So these are neuroendocrine thyroid, excuse me, neuroendocrine prostate cancer.
So these cancers can become very aggressive.
And when they do, they tend to make less PSA.
So PSA, 99% of the time, you can use it to monitor people.
But in small percentage of cases, people don't make much PSA.
(30:18):
So if they have a very high grade tumor they can
have a low PSA the other thing is that a PSA is
not accurate if you're necessarily if
your testosterone is not in place so if you take a man like if your father was
put on given medication to eliminate the male hormone testosterone even if the
(30:39):
cancer had spread the PSA could come down and be relatively low even if you
have widespread disease.
So it really, if you don't know whether a person has a prostate or not,
you don't know what that PSA will mean.
If you don't know what their testosterone is, you don't know what that,
(30:59):
and if you don't know which direction the PSA is going in.
If you have a PSA of 1.5 and your prostate's gone, but six months ago it was
undetectable, That's a bigger, that's a big difference than somebody whose PSA
is fairly stable at a low level.
So, Mac, so I'm just thinking, like, when you say this.
(31:24):
I'm going to try to make a comparison. So I have multiple myeloma.
And so there's things you can test in the urine and the blood.
And so I consider like the PSA like an indicator.
But then they do the bone marrow biopsy to be like to say officially this is what it is.
And that kind of sounds, is that a good comparison to make it in layman's terms?
(31:46):
Yeah, so the diagnosis, see, there's a syndrome called monoclonal gammopathy
of undetermined nature or something like that.
So if you see a person that has some of the markers of myeloma in their serum,
they're producing these proteins.
They may not have myeloma. You want to biopsy their marrow and look at it in
(32:10):
a microscope and say, yeah, this is multiple myeloma.
And then there's different types and there's different categories. So, yeah.
And it's actually and myeloma is more common in black men like prostate cancer. Exactly.
And that's that's you know, and that's the reason why, you know,
we had this program because we are trying to to make sure we shed light on.
(32:32):
One of the things that I say is first and foremost, as African-American men,
especially in that certain age bracket, you know, I would say in the 50s on
up. We've been having that taught that thing, you know, about, you know, pride.
And I always say, don't let pride stand in the way of prevention.
You know, we got that old kind of stinking thinking of, first of all,
(32:53):
we don't even go to the doctors, you know, and then to even try to go get tests.
So it's important to make sure we do go get our annuals and things of that nature.
Because if it sounds like, David, you use because of your father's situations,
that's what sent you to decide to go to the doctors. Am I right with that?
(33:13):
Well, yeah. Well, I was going to the doctor and, you know, and I was,
you know, they were doing like the prostate.
I had the digit exam done, you know what I'm saying? But it never really looked
into the PSA or anything like that.
It wasn't until, you know, my dad talked to me about it and I was just like,
yeah, let me go ahead and get checked.
You know, because I was already beyond 45 years old. So I'm like,
OK, I'm 48, 47. I think it's 47, 48.
(33:37):
I was like, OK, it's time to go get it checked, which I'm glad I did,
you know, because otherwise Otherwise, you know, I felt fine.
So I probably wouldn't even have looked into it, you know, because a lot of times we tend not to.
Address an issue until it starts hurting. Yeah, you can use that.
But most people that get prostate cancer have no symptoms.
And people that have urinary symptoms, it's usually not from cancer.
(34:00):
It's from what we call benign prostatic hypertrophy, just an enlarged prostate.
So you can have trouble getting empty in your bladder or getting up a lot at night.
So people with urinary symptoms frequently think, oh, man, maybe I got prostate cancer.
Most people with prostate cancer don't have any symptoms. And the other thing
is that, you know, we won't have enough time to talk about all the areas,
(34:27):
but there are a lot of myths about prostate cancer.
One is that prostate cancer is inherently more aggressive in black men.
OK, that's a total myth. The fact that prostate cancer is more common in black
men and it comes on at an earlier age. So black men tend to get prostate cancer
(34:47):
about five years earlier than white men. We don't know why.
It probably is multifactorial environment, diet.
It could be other things. But if you take a black man and a white man,
and they have the same PSA and the same Gleason score, and they get the same
treatment, the results will be the same.
(35:09):
So being black doesn't is not is not.
And I can tell you that there are like 30 years ago, there were all these papers
claiming that prostate cancer was inherently more aggressive than black men.
And I was one of the people saying, no, it's not. No, it's not. No, it's not.
And now they acknowledge that it's not. Oh, yeah. Well, it probably is not.
(35:33):
OK, I wrote it, just published a paper last year on health disparity and prostate
cancers, summarizing the reasons in the data.
And I have another paper which is under review looking at artificial intelligence.
Where we took pathology specimens for more than 5,000 patients,
of which 900 were African-American men.
(35:55):
And they were all treated on prospective studies where the quality of care was controlled for.
And actually, the African-American men did a little bit better than the white
men treated on those studies when you adjusted for those parameters.
So this notion that black men have inherently more aggressive prostate cancer is a total myth.
(36:17):
And one of the problems when you get a myth like that, so when I submitted this
paper, this more recent paper with artificial intelligence in this journal,
one of the reviewers was like, but how come you didn't do analysis by race?
And I'm like, you know, a separate type of statistical analysis. And my response is.
(36:37):
We've done that repeatedly. There have been at least 12 randomized trials,
and 11 of the 12 studies said African-American men did as well or better.
And only one of the studies suggested African-American men did worse.
So why do I have to go back and pretend like African-American men did worse
simply because you have been affected by the myth?
(37:00):
Right. Wasting resources that could be. Right. So we'll wait and see what their
response is to that. But the bottom line, that's a common myth,
that prostate cancer is inherently more aggressive in black men.
Yeah, so... Go ahead, Mark.
Well, I was just saying, there's a study that was done out of the VA that actually supports that.
(37:25):
You know, all the soldiers have the same access to care.
So it showed that everything was basically equal. Everything was equal.
They all received the same care.
They all had the same mortality rate. They all had the same treatment,
blah, blah, blah. So, yeah, that was...
(37:47):
Well, Mark, that's reassuring, but I can tell you that there are other studies,
not specifically in prostate cancer, but also in some prostate cancer studies.
If you look at, for example, there was a paper many years ago out of Kaiser,
and they looked at survival rates among black men in Kaiser and white men in
Kaiser, and they concluded that prostate cancer was inherently more aggressive
(38:10):
in black men. And the bottom line is this.
Even in healthcare systems where you get equal insurance, black men do not get equal care.
For example, there are studies showing, if you look at the risk,
the use of cardiac catheterization,
if you look at the use of bypass surgery, If you look at the use of kidney transplants,
(38:36):
there's all these people, they all have Medicare. They all had the same thing.
And they also did a study once where they went to the American medical studies. They went to a meeting.
And they created these videos where they had actors pretending like they had,
you know, heart problems or whatever.
And they presented these cases to the doctors. And they had black patients and
(38:58):
they had white patients with identical situations.
And the doctors managed them differently.
Wow. So the VA is not as bad as some places, but there are plenty other.
There's a plethora of data published showing that black people and white people
don't get the same treatment, even if they have the same insurance.
(39:20):
And there's also data to show that black patients get better care from black doctors.
Facts. That's why you say that, because I made it a point to seek out black doctors.
You know, and it's true. And it's a smart thing to go on.
But then when my insurance plan changed I had another brother
(39:41):
but he's I think he's from the Caribbean yeah starting
out with pediatric care well you did studies starting
out with little children working up black doctors do
vet this is part of the reason that when we talk about diversity
equity and inclusion we're not talking about
diversity equity and inclusion because we want more
(40:02):
jobs we're talking about because the care
that our people receive is different yeah it's
yeah we want better care right so we need to have
diversity equity inclusion because I can tell you 30 years ago when I was arguing
with all these crazy people about why I said prostate cancer is not inherently
more aggressive in black men they all disagreed with me but we need black people
(40:25):
to challenge dogma when the dogma is making us look bad so basically Basically,
what they were doing was giving us shit. Can't scoop.
You're right. You can censor that one out. Yeah. And then they were blaming us.
Right. Exactly. They were saying, it's your fault because we can't help you
got them funky jeans like that that make you die at a faster rate.
(40:47):
And in fact, it wasn't our jeans. It was...
Care quality of care and so forth that had nothing to do with any inherent genetic,
aggressive disease so you know there's statistics out there
that support everything you just said uh dr roach and
you know to your point uh it's important to to we have to infuse inside the
(41:10):
healthcare system more people that look like us and i'm not just talking about
from the doctors i'm talking about the whole spectrum of health care and then
one of the things and i want to to talk about quickly and I know we're running short.
One of the things I wanted to talk about is the mental side of it.
And I think, David, you kind of alluded to that.
You know, you know, I had a buddy of mine who was talking on another episode
(41:33):
about how he had to get his prostate checked and he really want to do it.
So he asked his black doctor, let me see your hands.
You know, he was like, so they went and got a different colleague.
It was a woman. and she had a look here, smaller, smaller hands.
But I guess my point is my uncle did have his prostate removed and everything.
(41:57):
He talked about the emotional aspect of it. And I just wanted to see if you
guys would touch on it and doctor, I would love for you to comment afterwards.
There's an emotional side to this. You know, we talk about our manhood and how
that, you know, you know, when that happens, things change as we well know.
And so, Mark, I wanted you to touch on it real quick.
(42:18):
And then, David, I want you to touch on that. What was the thought process when you think about that?
Well, you know, in my case, I tell my guys in the support group,
keep the main thing the main thing.
You know um is because
(42:39):
i know a lot of guys who didn't have didn't get
their prostate checked out because they they want this this ideal
sex life uh and then after a while i said hey if you did you're not gonna have
no sex trust me you're not gonna have any sex so it's all about being here and
i just i just i just kept that focus i just kept that focus you know i i guess
(43:02):
i'm not the the typical macho thing,
because I, you know, my, my thing is, you know,
it's all about, I want to be here for my family.
I want to be here. I just want to be here, period.
And I just, I just stayed on that one, that one track. That was my one lane.
I want to, I want to be here.
And I think it probably would also depend on your age and your situation.
(43:24):
I'm sure that's a huge factor in it. David, what's your thoughts on that?
Well, at first I was in like just disbelief, like, nah, you know,
and then it didn't then I got angry.
You know what I mean? Because it's like you want to understand,
like, this is like kind of like the whole why me scenario.
And then you start going through, OK, well, why did this happen?
(43:47):
And then I'm starting thinking about, you know, just my relationship with my
wife and, you know what I mean? and just being able to be functional,
just being functional as a man, because, you know, I've never dealt with prostate
cancer before, so you don't really know what to expect.
All you think of is worst case scenario.
You know, it's like it's like it's like being sentenced to death almost.
(44:08):
In my mind, it was at the time because I didn't know anything.
I'm like, it's over, you know, I was I was I was a pain in the behind for a
while around the house. You know what I mean? Just processing it and dealing with it.
But then once it all started to settle in, I was like, OK, we can we can deal with this.
You know, you know, the thing is, is that no matter what it is, it's OK, though.
(44:34):
You know what I mean? Because, you know, cancer, no matter what type of cancer
it is, it's a dark place when you talk about it.
And so, you know, there's different emotions that people have to go through.
And it's okay to be in it what i've
always said it's okay to go through emotions that the issue is
you can't stay there you can't stay there or you
can't fall in the rabbit hole and just you know and spiral down to a path of
(44:58):
just you know i hate to use it so simple but the woe is me thing because as
mark indicated you know there is still life and i and i get it you know our
sex you know we put so much,
we put a lot of value on having sex and I get it.
You know, but the point is, is like,
The thing is, if you're not here, when I talk about multiple myeloma or I have
(45:21):
a friend of mine who says he don't want to go to the doctors and I'd be like, why?
He's like, because I don't want to know. I'd be like, well, let me tell you something.
You're going to find out. You're going to find out.
You can find out now and have maybe a chance to do something.
But if you don't do nothing, regardless of whichever decision you make,
you are going to find out. And if you find out in the way of just waiting,
(45:46):
it could be fatal. And so, Dr.
Roach, I'm going to go ahead and let you chime in on maybe the mental side that
you might have experienced with the patient.
Yes. So the thing is, first of all, the point you brought about age is really
important because it turns out that by age 70,
50% of the men have erectile dysfunction anyway.
(46:11):
Right. Their things are starting to go down now.
You know, so and the other thing is that erectile dysfunction is treatable.
So it turns out I remember one time I saw a patient. He had had a radical prostatectomy
and he was looking depressed.
(46:31):
And his wife looked like Marilyn Monroe. I mean, literally sitting there and
and and I'm not really into Marilyn Monroe type.
And that's what she looked like and uh
that was a nice way of saying it i told him
a story about how when i was a resident at stanford
i had this patient that came in
(46:53):
and i asked him you know we were told always after he had
he had had his radiation some years before and i
asked him so how are you doing blah blah blah what about sexual function
he said well about five years after radiation
my sexual function went away
but then I got an implant and
he said before the implant my wife used
(47:15):
to have one orgasm now she has three oh
well okay that's good okay so then the next patient came in and he was looking
all depressed and I asked him I was like so hard things going fine and everything
And I said, what about sexual function? He was like, no.
(47:38):
I told him about the guy who had left. He said, can I talk to him?
I don't want to talk to him.
Music.
Looked like Marilyn Monroe who had had the surgery who came to
me I said I told him a story and so his wife had not said a word the whole time
she's sitting there I'm talking to him and I said yeah you know I had this guy
(48:01):
he's why he said my wife used to have one orgasm now she has three that man's
wife said he wants one of those.
My my resident who happened to be a woman turned red and blushed and everything you know,
(48:21):
yo that's he said he wants maryland maryland monroe said he wants one of those
right she wasn't playing yeah and then the other thing is that that was before we had viagra,
so now there's a lot of people i
could tell you all kinds of stories about viagra i i have
(48:43):
paid i just one pay i just my only story i'll tell about this
because this guy i thought he was married to
this lady because they used to come in together and then turns out they were
getting apart and everything but every time they would come in together i would
ask him you know did he need viagra and his partner would say no i don't want
him taking that you know blah blah blah, blah, blah, and then they would leave.
(49:07):
And then one time they left and then they were in the lobby.
And then he came back to my office. Hold on, let me ask Dr. Roach.
He came back to me, he says, it's working good, but I don't want her to know.
So can you hook me up with some more?
Yo, that's dope. Listen, I want to tell you guys, I appreciate you coming on.
(49:30):
That was a great way. That was a mic drop moment right there. But,
So listen, it's important that you go get your annuals. It's important to get checked.
Obviously, if you have somebody in the family that has any cancer,
it's typically something you might want to investigate as well.
But I close my show out, you know, I close my show out the same way.
(49:53):
And I know I got some older gentlemen on here.
I hope I don't lose my black card on this one.
So I close out my show the same way every time. Older gentlemen?
What do you mean by older gentlemen?
I'm O2. I'm going to, I know. Watch out now. Where you going with this, old and gentle?
Well, okay, so let me just go there. Let me just jump right into it then.
(50:14):
Let me just jump right into it. I'm going to say this.
If, when you want to get hyped up and you're trying to do your thing,
and I'm talking about your personal life, and you're going to get hyped up and
geeked out, I want you to give me a hip-hop song that you would like to play.
Like it could be old hip hop new hip hop whatever it
(50:35):
is and i'm gonna start with i'm gonna
start with you david because you look like you got something get hyped up i
would say x x gonna give it to him oh okay dmx i love it i love it x is coming
yep all right uh mark do you got something for me. You smiling. What you got?
(50:57):
I go to work.
Kumo D. Kumo D. I go to work.
That's a dope joint right there. I go to work. Kumo D.
He kept those Star Trek sunglasses on all the time. He did.
(51:19):
We're batting a thousand, Dr. Roach. Well, I'm the OG in the groove right now.
So listen, so I'm going back a bit further. I go dance with the music. Oh.
Sly and the Family Stone. I'm a runner. I'm a runner. So I go out and run my,
I run around Lake Misset and I have my music on.
I have dance to the music.
(51:42):
There you go. So listen, the dope thing is Sly and the Family Stone,
that particular song, Dance to the Music. I'm going to tell you a little nugget.
Is it was sampled by DJ Mark the 45 King, and it produced a song that Queen
Latifah spit her songs, and it was called Dance to the Music, and it was a dope track.
(52:03):
So that song and a lot of hip-hop, especially the earlier hip-hop,
comes from the music that you grew up on, brother.
So listen, I appreciate y'all joining the show.
This was a really dope episode. I hope my listeners learned a lot.
And as I always conclude, we great say peace out and keep 5-0 guessing.
(52:25):
Music.
Yes, yes, yes. Welcome back to Hip-Hop Parade, Black Men Talking Health.
I am your emcee for this evening. I am Oya Gilbert, and we got a really,
really dope program for you tonight.
Tonight, we're going to be discussing prostate cancer, and as you well know,
(00:20):
it affects African Americans on a higher level than our white counterparts.
And today in the building. I got some fly guests, and I mean that in the most wonderful way.
We got Mark Harris, and I got David Fields, and the infamous Mac Roach III.
(00:41):
I'll let them introduce themselves. We're going to start off with Mac.
And Mac, could you please tell the audience who you are?
Well, I'm a professor at the University of California, San Francisco in the
Departments of radiation oncology
and urology and my specialty involves urologic tumors which is about 95,
(01:02):
prostate cancer and i've been working in this field for more than 30 years oh
that's dope see that's what that's what we do we bring the experience in the
building and so we got mark harris and mark can you tell us who you are yeah
i'm uh again mark harris uh i'm uh i was diagnosed
with the prostate cancer in 2013 so um I've and since then I've been able to
(01:28):
you know help other other people so I'm a co-facilitator of a cancer support group I'm.
Music.
Especially the black and brown community, but everybody, everybody who's diagnosed
with prostate cancer, try to help them on with their journey.
(01:48):
And then try to help the researchers and try to help them as they find better,
treatments or improved treatments for prostate cancer.
Wow. Okay. That was a nice intro too. I got sure I'm going to have to let you
introduce me. I'm going to program. Come on.
The next is we got David. David, please introduce yourself, brother.
(02:11):
Yeah, I'm David Fields out of Wake Forest, North Carolina, 53 years old.
I was diagnosed with prostate cancer in November of 2020.
And pretty interesting story once we finally get into it. But that's about it.
But that's enough. You know what I mean? So, look, I want to go straight.
(02:36):
You know, I don't play no games, but I want to go straight to it,
dive right all into this. So, Mark, you know, tell us, you know,
your story and how you came to come to, you know, discovering it.
Well, first of all, your journey on finding out you have prostate cancer and
then where you are today.
Yeah, well, OK, well, I have to go. I said I was diagnosed in 2013,
(02:59):
but in 2011, my PSA was 5.3 or something like that. And at that time,
they wanted between zero and four.
But my physician said, well, if you had ridden a bike or had sex,
that could have spiked your PSA.
(03:20):
So come back in a week. Well, I forgot.
I forgot. So two years later, I had to get some medication.
And then he wouldn't OK it over the phone. So he had me come in.
And my wife was there, she was saying, Mark wasn't happy about it, and I was not.
Music.
(03:42):
Full physical so my psa was now 10.8 or
no no no sorry 13.8 or something like that
so um so now
i'm you know it's got my full attention so a friend of
mine dr delorestein brown she's uh she's a
uh primary care physician so i i know
she's like lentil soup so i took her out for it for lunch and we
(04:04):
talked a couple hours about my case and stuff you know she
said mark you got to get this to check that so i
you know got the uh biopsy and
then um so on october
3rd 2013 you know dr solomon calls at 8 23 p.m says uh your biopsy came back
(04:25):
positive for uh prostate cancer you know you have prostate cancer and he said
but i'll do everything i can to help you and because he said that I said, thank you. You know?
So he, um, and all during the rest of the conversation, I'm saying,
thank you. Thank you. Thank you to the point. I think Dr.
Solomon said, I'm telling this idiot, he has prostate cancer.
He's thanking me. So just to be clear, just to be, he didn't say it this way, but I'm my paraphrase.
(04:51):
Just to be clear, your box, he came back positive for prostate cancer.
And, uh, and, uh, and I'll do everything that I can help you.
I said, thank you. You know? So, um, So I hang up the phone and it's interesting
because I realize now, again, this is a decade later, that I took that news
and just put it in the back of my mind.
(05:11):
And so I thought for a second about not telling my wife, telling my ex-wife
and my daughter, because, you know, as I see my role as a man,
I'm supposed to be the rock, the foundation,
the stabilizer of things and not the reason there is angst and all this other stuff.
But, you know, I put that aside after about a minute, called out to my wife.
(05:35):
Hey, you know, we came back positive for prostate cancer.
My wife comes running out. She said, what are we going to do?
So I said, you know, this was a Thursday night. I said, you know, I don't know.
We're going to have a, he said, we're going to have a meeting on Monday and
we'll talk about, you know, our, you know, what we need to talk about as far
as getting a design on a treatment.
(05:57):
So my wife is, what are we going to do?
I said, I really don't know. I've never been here. I don't know.
I don't know what's going on. You know, we got to work it out together.
What are we going to do? And I said, I said, now you got to remember I was in the moment.
I said, can't you see I'm watching television? Oh, Lord.
(06:22):
Wow. Yeah, yeah. I mean, you know, because, again, I had never had this.
Well, there's nothing you can do about it at that point anyway,
so you're going to deal with it Monday, so deal with it Monday. Absolutely.
And the thing is, you find out at that moment.
That there's very few things in life that can change your
(06:44):
life so suddenly as your name or loved one name and cancer being in the same
sentence sure all the stuff you thought before that the second before you heard
that you had cancer all the stuff you thought was it was was a priority is now
not a priority and i've had people say well you know my children my grandchildren,
number one thing are you gonna be there to see them so it's all it's always
(07:08):
that's gonna affect everything in your life, you know, so, and then,
you know, so that evening, I go to bed,
and, because I watched the rest of the movie, and I realized the movie was just white noise,
so I go to bed now, you know, there's quiet, and, you know, tranquility,
and stuff, so I'm thinking, oh,
my human side said, I'm gonna die, I'm gonna die, but then my spiritual side
(07:31):
said, but how do I use this to help others, you know, that's what,
because God has always given me experiences that that I can help people that
I can walk in that I've walked in their shoes.
So I can help people from that, that, that point of view. Right.
So that's what I've been doing since then. And then go ahead.
Now I was just saying, so did you, when you decided to say, Hey,
(07:52):
I'm going to help people, had you had treatment or you still,
you still on the weekend talking about I'm going to wait till Monday.
Yeah. No, that was that, that was that night. That was that Thursday night.
I would help others, you know, and then I, again, Little did I know that helping
others would be my son six days later, because he was diagnosed with a different
cancer, adenocarcinoma of the parotid gland, and he died four months later.
(08:14):
Oh, wow. We were really blessed that I was, you know, I told my daughter,
you know, the Bible says a point of a man wants to die.
So that path, that date was already set.
But God had me, God blessed me that I was diagnosed first, because my 30-year-old
son would not have listened to me if I hadn't been 9-0 sturdy. He knows everything.
(08:38):
So we were blessed. We were blessed.
So, Matt, listening to Mark's story, is that something typical that you hear
as far as the people, you know, saying, hey, they don't really pay attention to it?
Yeah, it's very typical.
But also the first thing I'm thinking about is, well, what was the grade of
(09:00):
the tumor? We use a system called the Gleason,
There was a guy named Don Gleason who came up with this system.
And basically, you can have patients who have low-grade tumors,
intermediate-grade tumors, and high-grade tumors.
And if he told me that he had a low Gleason score, I could immediately tell
him your chances of dying of prostate cancer in the next 10 years is less than 1%.
(09:25):
But if it's intermediate risk, it's a little bit higher.
And if it's high risk, it's a bit higher. So really, the bottom line is until
you actually find out what the Gleason score is, I mean, that PSA is a little
bit of a problem, but the Gleason score is far more important.
That's how the cancer looks under the microscope.
(09:48):
That makes sense. Go ahead, Mark. Yeah, 100.
So I, 100%. So I, um, so actually my Gleason score was three plus four,
um, which is, which is, you know, which is a candidate for active surveillance,
what they call active surveillance.
This but but and this would i i try to tell a friend of mine he he's into this
(10:10):
liquid liquid biopsy and stuff but right now they can't tell but so then when
they take the biopsy they call those cores they took they usually for most people
they take 12 for me they took 13 cores.
11 out of the 13 were cancerous okay and of the 11 more than half of that core
(10:31):
was cancerous So even though it was three plus four,
in my mind, and the other thing is that the cancer was encapsulated.
That's the term they used. They thought the cancer was still inside the prostate.
Yeah. But Mark, let me pause you right there.
(10:52):
So when you said you were a candidate for active surveillance,
that's according to the doctors you were talking to.
I would never recommend active surveillance in a young, otherwise healthy African-American
man who's got Gleason 3 plus 4 and a lot of positive chorus.
That would be, no, you're not a candidate for active surveillance.
(11:12):
Now, what happens sometimes is doctors will tell you, well, you could do active surveillance.
And then some patients go, really, doc? Oh, yeah, you don't have to be treated.
Well, if that was them. Yeah. Yes.
Are their loved ones? They'd be telling them no, no, no, no, no.
(11:33):
So active surveillance is a great recommendation for a person with a Gleason score of 3 plus 3.
But once you get into 3 plus 4, the only patients who would be reasonable for active surveillance,
surveillance if you got some guy who's 85 years old
and he's got diabetes hypertension had a stroke blah
(11:53):
blah you got all kind of medical problems he can live a
long time but you got a man who's got a 20-year life expectancy yeah i mean
you know the thing is when you treat patients with intermediate risk disease
with radical prostatectomy you only cure about half of them that's with treatment
right so if you do active surveillance and your psa is already 10.
(12:18):
Next thing the patient is going to be a high risk patient
where the success rates even lower so although your doctor said you could be
a candidate for active surveillance not everybody and i would i would suggest
most experts would not tell a young african-american man with a gleason seven
that you should even think about active surveillance yeah yeah so that and that's That's correct.
(12:41):
So that's, that's how I made my, yeah, I made my decision based on that.
Um, again, because so much of it was, uh, was, was, was, uh,
and then that's another thing I did.
I went to five different positions in three different hospitals,
three, three, three different hospital or thing.
So, so to your point, Mac, I had, I got all these different,
(13:06):
uh, different, opinions.
And then I took, then I did, I had a prostatectomy.
Okay, gotcha. So that's a great point, Dr.
Roach. And I appreciate you, you know, chiming in because from doctors,
from specialists to specialists, people who have different,
(13:28):
different, I guess, treatments that they would prescribe based on what they
think or what their knowledge is.
And so So that's huge, you know, for the listeners to know, you know,
that kind of information so that it can help make them make a sound decision.
Because like I said, none of this is easy.
Well, there are also guidelines, right? So there is something called the NCCN,
(13:51):
National Comprehensive Cancer Network.
So it turns out that the National Cancer Institute, the largest cancer research
institution in the world, has these
things that they call, there's certain institutions that are members.
And it has to do with institutions that are deemed to be comprehensive cancer centers.
(14:13):
And we write guidelines. I'm on the committee that writes guidelines.
So every different cancer site has different committees. So I'm on the one for
treatment of prostate cancer. And so you can go on. It's in the public domain.
You can look up your cancer. So if you go to NCCN, the website,
and you look it up, they don't say active.
(14:34):
They don't recommend active surveillance for a young, healthy man with intermediate risk disease.
And how many cores did you have positive out of how many biopsies?
I had 11 out of 13. Right. So you actually, not only did you have intermediate
risk, but you had unfavorable intermediate risk.
(14:54):
And you had unfavorable intermediate risk for two reasons.
One, you can be intermediate risk if your PSA is between 10 and 20,
even if your Gleason score is low, like 3 plus 3.
Or you can be intermediate risk if your Gleason score is 7 by itself.
But once you have two factors, PSA between 10 and 20 and Gleason 7,
(15:18):
you become unfavorable intermediate risk.
Or if you have more than half of your biopsy core is positive,
you become unfavorable intermediate risk.
So you have unfavorable intermediate risk for two reasons, for three reasons,
actually. Your Gleason score is 7, more than 50% of your cores are positive, and you had a PSA over 10.
(15:43):
So suggesting that someone like you would be a candidate for active surveillance,
I would consider malpractice.
I'm not sure if anybody suggested that, but it seemed like that was on the table.
It seemed like it was on the table.
At that time, you know, stuff is, you know.
(16:04):
Yeah, no, I understand. Yeah, it makes perfect sense.
You know, I want to pivot a little bit and we're going to come back around to you, Mark.
I got my brother David here who definitely want him to chime in because his
story is just, you know, with all these stories, no matter what kind of cancer
you're dealing with, it's always a unique aspect to it.
(16:26):
And then there's also some overlap, some things that have some common commonalities
to it. But but David, if you could chime in and share, you know,
your journey, I would I would truly appreciate it. OK, well.
To be honest with you, I hadn't given a PSA test any thought until my father
(16:50):
suggested it to me. My father, he's a retired colonel.
So, you know, he's always at the VA getting checked up, getting treated,
doing what he does. So I was around 2018.
He said, so I need to go get your PSA checked.
Someone got it checked and it was like 7.5.
(17:11):
So I came home and I said, you know, I told him, I said, hey, dad, my PSA was like 7.5.
I said, how old were you then? I was 18.
I was 40. Well, between 47, 48.
So I asked him, I said, what is your PSA been?
He said, he said, son, he said, be honest with you. He said,
(17:32):
my PSA has been all over the place.
He said, it's been, he said, it's been as low as like, say, a one or two.
He says, it's even been as high as I think he told me, like a 25.
But my father now i think he's uh 83 he's never had prostatitis never had prostate
cancer none of that right so i didn't think anything so i didn't think anything
of it so i'm like all right well i guess it's just in the family just got a
(17:54):
high psa keep it pushing right.
So 20 2020 comes i
had a new doctor new a new urologist and he suggested i get my psa check because
he asked me if i'd ever had a check before so i think when he checked it it
was i think it's 7.8 he's like yeah you know we need to take a look at that
(18:14):
he said um he said what i'm gonna do first he said is um i can't remember if
he did the mri first i think he did the mri first,
set him up for mri um came back and said yeah you know we see a little spot
he said it was like about like the size of from what he could tell the size
of about a half a grain of rice and so what he told me and so then that's when
(18:35):
he wanted to do the biopsy we did the biopsy,
and I don't remember how many cores it was. I don't think it was a lot, but he said.
The Gleason score was like a four plus three, seven, right? But he said it was
like more on the aggressive side.
And four plus three would be more on the aggressive side than three plus four.
(18:59):
So I said, okay. And I said, so what's next? So he talked to me about the treatment options.
By this time, I pretty much had quit listening. And I'm like,
can't feel me cause prostate cancer, man. I'd rather have, I don't know.
Well, I guess in your mind, cause you know, as a man, you're thinking your prostate,
I'm like, I got a wife that's seven years younger than me. She's beautiful.
What do you mean? I got prostate cancer. There's no way. It's not happening.
(19:22):
And so I'm just kind of blanked out at that point in time. But then,
um, Riley said, said that he's
talking to me about, um, the different procedures. I think he said, uh.
He said chemo wasn't an option he said
it was either i think he said radiation or like the robotic uh
i forget the word prostatectomy prostatectomy
(19:43):
there you go and i said well what is that he said well yeah i'm gonna stick
like six arms in your abdomen and i'm gonna go in there and be cutting this
and cutting that i'm just like man there's no way there's no freaking way and
um so you know i asked him about the radiation and you know then he's talking
about mountain continents and all these other issues,
I'm like, there's got to be another option.
(20:05):
I said, I'm too young for this.
So I told him, I said, all right, well, give me some time to think about it,
see what I want to do. So I went home and started just doing some research.
And what I found out was, number one, his specialty was the robotics.
So he was kind of pushing me in that direction.
So when I got home, I started doing my own little research. That's when I found out about Haifu.
(20:29):
And for those that don't know that's um i think it's a high intensity um focal focus,
yeah right i was like okay so basically to go in with ultrasound and i guess
destroy the cells and you know see what happens so i started reading the stats on it and,
you know um all that kind of good stuff so i went back to see him and he's like
(20:54):
so you know what did we decide to do?
And I said, well, I said, I'm thinking about Haifu. He came in and just looked like.
Like, why do you know about Haifu? It kind of got that feel from him.
Like, how do you know about that? Because he didn't give it to me as an option.
And he's like, well, you know Haifu. Let me pause you right there.
Break it down for my peoples out there in layman terms. What's Haifu?
(21:19):
Basically, it's ultrasound. So basically, you go into a room,
they put you under, they do whatever they do with the ultrasound probe.
And I guess I think the term is ablation, I think is what it's called.
They go in there and destroy the cells with ultrasound that's my understanding of it,
and so then you know he started you know you know how people when they're trying
(21:42):
to handle you it's like you know well you know it's expensive you know I'm just
like okay well I got an insurance you know it's not a problem it's like yeah
well you know insurance doesn't normally cover it,
I'm like so what are we talking about and he told me straight up he said it's
$25,000 he had the number right there in his head it's $25,000 procedure I'm like okay well.
(22:08):
I'd rather do that than get cut on period that's not even an option I don't
care where the $25,000 is coming from you know what I'm saying it don't matter
to me I don't care if I gotta,
you know second mortgage on the house or whatever it doesn't matter to me yeah
pretty much but But that was my situation, and that's what we did,
(22:29):
and so far, that was 2021.
I think April, May 2021 is when we had the procedure. I've been back twice just
to do follow-ups, but every time you go back, they want to do the,
what do they call it? What now?
You were just talking about it, Mark, the biopsy.
(22:50):
I'm like, nah, I'm not cool with a biopsy because to me, I guess the way I think
about it, like sticking metal probes up in your prostate or whatever it is,
and that just to me doesn't sound like it's creating a problem more than it's helping.
Well, you know, David, I got bad news for you. The HIFU is not very effective.
It's not included in the NCCN guidelines.
(23:12):
I don't know what your Gleason score was, 4 plus 3, which means you're at higher
risk. Your PSA was 7, but you don't know how many cores there is.
So you're unfavorable intermediate risk as well, like Mark was.
But, you know, the problem is a layperson like yourself would not understand
(23:32):
what the implications of the data.
Actually, I have an extensive file on HIFU papers.
And my urologist here will do HIFU as focal therapy. So the ideal patient for
HIFU, there's a type of therapy category called focal therapy. Okay.
Which means that if you can image the prostate and you think that the cancer
(23:57):
is limited to one part of the prostate, you can freeze it with cryosurgery,
which is freeze to kill that part of the cancer.
Or you can do high-frequency focused ultrasound. sound.
And essentially that burns the cancer up in one location.
But you can destroy parts of the prostate several different ways.
(24:20):
The problem is the biology of prostate cancer.
So first of all, most people do not have prostate cancer. They have prostate cancers, plural.
Usually the disease is multifocal. It's in other places beyond one little place.
So even if the biopsy only shows it in one area, statistically,
(24:42):
they're likely to be other foci in other parts of the prostate.
So not that many people are good candidates for focal therapy unless they do
something called a saturation biopsy, where they take you to the operating room
and they create a grid and they
biopsy the bejeebers out of you, and they find out there's one little spot,
(25:05):
of a relatively low grade tumor, that's an ideal candidate for focal therapy.
But the reason that a patient with a Gleason score of four plus three is not
a great candidate for focal therapy is because if you remove the prostate.
Completely remove the prostate in a patient that has a Gleason score of four
(25:26):
plus three, at least half of the patients recur.
The cancer comes back, even though the prostate's been removed.
People, wait a minute, I've had patients come to me. I'm a radiation oncologist, right?
I've had people come to me and say, well, wait a minute, I don't know why my
doctor told me to come see you. He removed my prostate.
Well, a lot of those people recur right where the prostate they used to be because
(25:50):
they cut the prostate out and then they sew the bladder neck down to the external sphincter.
And so some people recur in that area and the other people tend to recur in the lymphatics.
So it turns out that cancer can spread to the lymph nodes.
And even though a CT scan doesn't show it and an MRI doesn't show it,
(26:10):
microscopic disease can be low the resolution.
And one of the problems with HIFU is like, well, what should your PSA be if
your prostate is still there and you have HIFU?
Now, when you take a patient who's had their prostate removed,
(26:30):
the PSA should be undetectable.
That means that the normal PSA, as Mark alluded to, is supposed to be up to four.
After the prostate's removed, what we look for is a value that has a less than
sign, less than 0.02, that's ideal, that's the kind of number you're looking for, undetectable.
(26:54):
When we do radiation on people with high doses of radiation.
Prostate is still there, so it can still make a little bit of PSA.
And our standard definition for a recurrence is if the PSA starts to rise,
and it rises by more than 2.0, okay?
(27:15):
But that's because the whole prostate's there.
But the criteria for what a PSA should be after HIFU has not been well worked out. Right.
So when you're followed, you know, you have a normal part of your prostate that
wasn't high food and part of your prostate that was high food.
(27:36):
It's hard to know where that PSA is coming from and it's hard to know how much
PSA you should be producing.
Okay. The good news is you can still have effective therapy if the high food doesn't work.
You can still have your prostate removed or you
can do radiation and generally uh radiation
(28:00):
is tolerated better than having
your prostate removed so if your cancer if your psa starts to go up and they
biopsy you and confirm that you still have cancer then uh more people would
recommend radiation than not in the treatment of that disease instead of actually
okay yeah well i I know last time they checked it,
(28:22):
I was at one on the PSA.
So like I said, I'm keeping an eye on it and.
I guess that's really all I got. Well, you know what's interesting about that
is my father was telling me, because he was friends with General Schwarzkopf.
I don't know if you remember him, the Operation Desert Storm.
And he died with prostate cancer. Well, a whole lot of people died with prostate
(28:47):
cancer. Yeah, and I remember him telling me that.
Tiger Woods' father died of prostate cancer.
Stokely Carmichael just died of prostate. I mean, I could go down the whole
list. Oh, yeah, I'd imagine.
But what was interesting. a lot of black men died of
prostate cancer and or had it and got cheated for
it dusty baker got cheated for it hallowed harry belafonte
got cheated for it uh sydney portier
(29:10):
got cheated for it i mean it's like real common so yeah you know what i was
gonna say though what was interesting about schwartzkopf was that his my dad
told me that like his psa was somewhere like around 1.7 something something
like that when he passed away i was but it's weird because my My father's is
like off the rails, but he has.
Well, but the PSA, the PSA by itself doesn't tell you anything.
(29:32):
If the what you don't know is what his testosterone was.
Right. So and also prostate cancer can de-differentiate.
Like normally when we talk about the Gleason score, we're looking at categories
like Gleason six or less, Gleason seven, Gleason eight to ten.
But some people have what we call anaplastic thyroid cancer.
(29:55):
So these are neuroendocrine thyroid, excuse me, neuroendocrine prostate cancer.
So these cancers can become very aggressive.
And when they do, they tend to make less PSA.
So PSA, 99% of the time, you can use it to monitor people.
But in small percentage of cases, people don't make much PSA.
(30:18):
So if they have a very high grade tumor they can
have a low PSA the other thing is that a PSA is
not accurate if you're necessarily if
your testosterone is not in place so if you take a man like if your father was
put on given medication to eliminate the male hormone testosterone even if the
(30:39):
cancer had spread the PSA could come down and be relatively low even if you
have widespread disease.
So it really, if you don't know whether a person has a prostate or not,
you don't know what that PSA will mean.
If you don't know what their testosterone is, you don't know what that,
(30:59):
and if you don't know which direction the PSA is going in.
If you have a PSA of 1.5 and your prostate's gone, but six months ago it was
undetectable, That's a bigger, that's a big difference than somebody whose PSA
is fairly stable at a low level.
So, Mac, so I'm just thinking, like, when you say this.
(31:24):
I'm going to try to make a comparison. So I have multiple myeloma.
And so there's things you can test in the urine and the blood.
And so I consider like the PSA like an indicator.
But then they do the bone marrow biopsy to be like to say officially this is what it is.
And that kind of sounds, is that a good comparison to make it in layman's terms?
(31:46):
Yeah, so the diagnosis, see, there's a syndrome called monoclonal gammopathy
of undetermined nature or something like that.
So if you see a person that has some of the markers of myeloma in their serum,
they're producing these proteins.
They may not have myeloma. You want to biopsy their marrow and look at it in
(32:10):
a microscope and say, yeah, this is multiple myeloma.
And then there's different types and there's different categories. So, yeah.
And it's actually and myeloma is more common in black men like prostate cancer. Exactly.
And that's that's you know, and that's the reason why, you know,
we had this program because we are trying to to make sure we shed light on.
(32:32):
One of the things that I say is first and foremost, as African-American men,
especially in that certain age bracket, you know, I would say in the 50s on
up. We've been having that taught that thing, you know, about, you know, pride.
And I always say, don't let pride stand in the way of prevention.
You know, we got that old kind of stinking thinking of, first of all,
(32:53):
we don't even go to the doctors, you know, and then to even try to go get tests.
So it's important to make sure we do go get our annuals and things of that nature.
Because if it sounds like, David, you use because of your father's situations,
that's what sent you to decide to go to the doctors. Am I right with that?
(33:13):
Well, yeah. Well, I was going to the doctor and, you know, and I was,
you know, they were doing like the prostate.
I had the digit exam done, you know what I'm saying? But it never really looked
into the PSA or anything like that.
It wasn't until, you know, my dad talked to me about it and I was just like,
yeah, let me go ahead and get checked.
You know, because I was already beyond 45 years old. So I'm like,
OK, I'm 48, 47. I think it's 47, 48.
(33:37):
I was like, OK, it's time to go get it checked, which I'm glad I did,
you know, because otherwise Otherwise, you know, I felt fine.
So I probably wouldn't even have looked into it, you know, because a lot of times we tend not to.
Address an issue until it starts hurting. Yeah, you can use that.
But most people that get prostate cancer have no symptoms.
And people that have urinary symptoms, it's usually not from cancer.
(34:00):
It's from what we call benign prostatic hypertrophy, just an enlarged prostate.
So you can have trouble getting empty in your bladder or getting up a lot at night.
So people with urinary symptoms frequently think, oh, man, maybe I got prostate cancer.
Most people with prostate cancer don't have any symptoms. And the other thing
is that, you know, we won't have enough time to talk about all the areas,
(34:27):
but there are a lot of myths about prostate cancer.
One is that prostate cancer is inherently more aggressive in black men.
OK, that's a total myth. The fact that prostate cancer is more common in black
men and it comes on at an earlier age. So black men tend to get prostate cancer
(34:47):
about five years earlier than white men. We don't know why.
It probably is multifactorial environment, diet.
It could be other things. But if you take a black man and a white man,
and they have the same PSA and the same Gleason score, and they get the same
treatment, the results will be the same.
(35:09):
So being black doesn't is not is not.
And I can tell you that there are like 30 years ago, there were all these papers
claiming that prostate cancer was inherently more aggressive than black men.
And I was one of the people saying, no, it's not. No, it's not. No, it's not.
And now they acknowledge that it's not. Oh, yeah. Well, it probably is not.
(35:33):
OK, I wrote it, just published a paper last year on health disparity and prostate
cancers, summarizing the reasons in the data.
And I have another paper which is under review looking at artificial intelligence.
Where we took pathology specimens for more than 5,000 patients,
of which 900 were African-American men.
(35:55):
And they were all treated on prospective studies where the quality of care was controlled for.
And actually, the African-American men did a little bit better than the white
men treated on those studies when you adjusted for those parameters.
So this notion that black men have inherently more aggressive prostate cancer is a total myth.
(36:17):
And one of the problems when you get a myth like that, so when I submitted this
paper, this more recent paper with artificial intelligence in this journal,
one of the reviewers was like, but how come you didn't do analysis by race?
And I'm like, you know, a separate type of statistical analysis. And my response is.
(36:37):
We've done that repeatedly. There have been at least 12 randomized trials,
and 11 of the 12 studies said African-American men did as well or better.
And only one of the studies suggested African-American men did worse.
So why do I have to go back and pretend like African-American men did worse
simply because you have been affected by the myth?
(37:00):
Right. Wasting resources that could be. Right. So we'll wait and see what their
response is to that. But the bottom line, that's a common myth,
that prostate cancer is inherently more aggressive in black men.
Yeah, so... Go ahead, Mark.
Well, I was just saying, there's a study that was done out of the VA that actually supports that.
(37:25):
You know, all the soldiers have the same access to care.
So it showed that everything was basically equal. Everything was equal.
They all received the same care.
They all had the same mortality rate. They all had the same treatment,
blah, blah, blah. So, yeah, that was...
(37:47):
Well, Mark, that's reassuring, but I can tell you that there are other studies,
not specifically in prostate cancer, but also in some prostate cancer studies.
If you look at, for example, there was a paper many years ago out of Kaiser,
and they looked at survival rates among black men in Kaiser and white men in
Kaiser, and they concluded that prostate cancer was inherently more aggressive
(38:10):
in black men. And the bottom line is this.
Even in healthcare systems where you get equal insurance, black men do not get equal care.
For example, there are studies showing, if you look at the risk,
the use of cardiac catheterization,
if you look at the use of bypass surgery, If you look at the use of kidney transplants,
(38:36):
there's all these people, they all have Medicare. They all had the same thing.
And they also did a study once where they went to the American medical studies. They went to a meeting.
And they created these videos where they had actors pretending like they had,
you know, heart problems or whatever.
And they presented these cases to the doctors. And they had black patients and
(38:58):
they had white patients with identical situations.
And the doctors managed them differently.
Wow. So the VA is not as bad as some places, but there are plenty other.
There's a plethora of data published showing that black people and white people
don't get the same treatment, even if they have the same insurance.
(39:20):
And there's also data to show that black patients get better care from black doctors.
Facts. That's why you say that, because I made it a point to seek out black doctors.
You know, and it's true. And it's a smart thing to go on.
But then when my insurance plan changed I had another brother
(39:41):
but he's I think he's from the Caribbean yeah starting
out with pediatric care well you did studies starting
out with little children working up black doctors do
vet this is part of the reason that when we talk about diversity
equity and inclusion we're not talking about
diversity equity and inclusion because we want more
(40:02):
jobs we're talking about because the care
that our people receive is different yeah it's
yeah we want better care right so we need to have
diversity equity inclusion because I can tell you 30 years ago when I was arguing
with all these crazy people about why I said prostate cancer is not inherently
more aggressive in black men they all disagreed with me but we need black people
(40:25):
to challenge dogma when the dogma is making us look bad so basically Basically,
what they were doing was giving us shit. Can't scoop.
You're right. You can censor that one out. Yeah. And then they were blaming us.
Right. Exactly. They were saying, it's your fault because we can't help you
got them funky jeans like that that make you die at a faster rate.
(40:47):
And in fact, it wasn't our jeans. It was...
Care quality of care and so forth that had nothing to do with any inherent genetic,
aggressive disease so you know there's statistics out there
that support everything you just said uh dr roach and
you know to your point uh it's important to to we have to infuse inside the
(41:10):
healthcare system more people that look like us and i'm not just talking about
from the doctors i'm talking about the whole spectrum of health care and then
one of the things and i want to to talk about quickly and I know we're running short.
One of the things I wanted to talk about is the mental side of it.
And I think, David, you kind of alluded to that.
You know, you know, I had a buddy of mine who was talking on another episode
(41:33):
about how he had to get his prostate checked and he really want to do it.
So he asked his black doctor, let me see your hands.
You know, he was like, so they went and got a different colleague.
It was a woman. and she had a look here, smaller, smaller hands.
But I guess my point is my uncle did have his prostate removed and everything.
(41:57):
He talked about the emotional aspect of it. And I just wanted to see if you
guys would touch on it and doctor, I would love for you to comment afterwards.
There's an emotional side to this. You know, we talk about our manhood and how
that, you know, you know, when that happens, things change as we well know.
And so, Mark, I wanted you to touch on it real quick.
(42:18):
And then, David, I want you to touch on that. What was the thought process when you think about that?
Well, you know, in my case, I tell my guys in the support group,
keep the main thing the main thing.
You know um is because
(42:39):
i know a lot of guys who didn't have didn't get
their prostate checked out because they they want this this ideal
sex life uh and then after a while i said hey if you did you're not gonna have
no sex trust me you're not gonna have any sex so it's all about being here and
i just i just i just kept that focus i just kept that focus you know i i guess
(43:02):
i'm not the the typical macho thing,
because I, you know, my, my thing is, you know,
it's all about, I want to be here for my family.
I want to be here. I just want to be here, period.
And I just, I just stayed on that one, that one track. That was my one lane.
I want to, I want to be here.
And I think it probably would also depend on your age and your situation.
(43:24):
I'm sure that's a huge factor in it. David, what's your thoughts on that?
Well, at first I was in like just disbelief, like, nah, you know,
and then it didn't then I got angry.
You know what I mean? Because it's like you want to understand,
like, this is like kind of like the whole why me scenario.
And then you start going through, OK, well, why did this happen?
(43:47):
And then I'm starting thinking about, you know, just my relationship with my
wife and, you know what I mean? and just being able to be functional,
just being functional as a man, because, you know, I've never dealt with prostate
cancer before, so you don't really know what to expect.
All you think of is worst case scenario.
You know, it's like it's like it's like being sentenced to death almost.
(44:08):
In my mind, it was at the time because I didn't know anything.
I'm like, it's over, you know, I was I was I was a pain in the behind for a
while around the house. You know what I mean? Just processing it and dealing with it.
But then once it all started to settle in, I was like, OK, we can we can deal with this.
You know, you know, the thing is, is that no matter what it is, it's OK, though.
(44:34):
You know what I mean? Because, you know, cancer, no matter what type of cancer
it is, it's a dark place when you talk about it.
And so, you know, there's different emotions that people have to go through.
And it's okay to be in it what i've
always said it's okay to go through emotions that the issue is
you can't stay there you can't stay there or you
can't fall in the rabbit hole and just you know and spiral down to a path of
(44:58):
just you know i hate to use it so simple but the woe is me thing because as
mark indicated you know there is still life and i and i get it you know our
sex you know we put so much,
we put a lot of value on having sex and I get it.
You know, but the point is, is like,
The thing is, if you're not here, when I talk about multiple myeloma or I have
(45:21):
a friend of mine who says he don't want to go to the doctors and I'd be like, why?
He's like, because I don't want to know. I'd be like, well, let me tell you something.
You're going to find out. You're going to find out.
You can find out now and have maybe a chance to do something.
But if you don't do nothing, regardless of whichever decision you make,
you are going to find out. And if you find out in the way of just waiting,
(45:46):
it could be fatal. And so, Dr.
Roach, I'm going to go ahead and let you chime in on maybe the mental side that
you might have experienced with the patient.
Yes. So the thing is, first of all, the point you brought about age is really
important because it turns out that by age 70,
50% of the men have erectile dysfunction anyway.
(46:11):
Right. Their things are starting to go down now.
You know, so and the other thing is that erectile dysfunction is treatable.
So it turns out I remember one time I saw a patient. He had had a radical prostatectomy
and he was looking depressed.
(46:31):
And his wife looked like Marilyn Monroe. I mean, literally sitting there and
and and I'm not really into Marilyn Monroe type.
And that's what she looked like and uh
that was a nice way of saying it i told him
a story about how when i was a resident at stanford
i had this patient that came in
(46:53):
and i asked him you know we were told always after he had
he had had his radiation some years before and i
asked him so how are you doing blah blah blah what about sexual function
he said well about five years after radiation
my sexual function went away
but then I got an implant and
he said before the implant my wife used
(47:15):
to have one orgasm now she has three oh
well okay that's good okay so then the next patient came in and he was looking
all depressed and I asked him I was like so hard things going fine and everything
And I said, what about sexual function? He was like, no.
(47:38):
I told him about the guy who had left. He said, can I talk to him?
I don't want to talk to him.
Music.
Looked like Marilyn Monroe who had had the surgery who came to
me I said I told him a story and so his wife had not said a word the whole time
she's sitting there I'm talking to him and I said yeah you know I had this guy
(48:01):
he's why he said my wife used to have one orgasm now she has three that man's
wife said he wants one of those.
My my resident who happened to be a woman turned red and blushed and everything you know,
(48:21):
yo that's he said he wants maryland maryland monroe said he wants one of those
right she wasn't playing yeah and then the other thing is that that was before we had viagra,
so now there's a lot of people i
could tell you all kinds of stories about viagra i i have
(48:43):
paid i just one pay i just my only story i'll tell about this
because this guy i thought he was married to
this lady because they used to come in together and then turns out they were
getting apart and everything but every time they would come in together i would
ask him you know did he need viagra and his partner would say no i don't want
him taking that you know blah blah blah, blah, blah, and then they would leave.
(49:07):
And then one time they left and then they were in the lobby.
And then he came back to my office. Hold on, let me ask Dr. Roach.
He came back to me, he says, it's working good, but I don't want her to know.
So can you hook me up with some more?
Yo, that's dope. Listen, I want to tell you guys, I appreciate you coming on.
(49:30):
That was a great way. That was a mic drop moment right there. But,
So listen, it's important that you go get your annuals. It's important to get checked.
Obviously, if you have somebody in the family that has any cancer,
it's typically something you might want to investigate as well.
But I close my show out, you know, I close my show out the same way.
(49:53):
And I know I got some older gentlemen on here.
I hope I don't lose my black card on this one.
So I close out my show the same way every time. Older gentlemen?
What do you mean by older gentlemen?
I'm O2. I'm going to, I know. Watch out now. Where you going with this, old and gentle?
Well, okay, so let me just go there. Let me just jump right into it then.
(50:14):
Let me just jump right into it. I'm going to say this.
If, when you want to get hyped up and you're trying to do your thing,
and I'm talking about your personal life, and you're going to get hyped up and
geeked out, I want you to give me a hip-hop song that you would like to play.
Like it could be old hip hop new hip hop whatever it
(50:35):
is and i'm gonna start with i'm gonna
start with you david because you look like you got something get hyped up i
would say x x gonna give it to him oh okay dmx i love it i love it x is coming
yep all right uh mark do you got something for me. You smiling. What you got?
(50:57):
I go to work.
Kumo D. Kumo D. I go to work.
That's a dope joint right there. I go to work. Kumo D.
He kept those Star Trek sunglasses on all the time. He did.
(51:19):
We're batting a thousand, Dr. Roach. Well, I'm the OG in the groove right now.
So listen, so I'm going back a bit further. I go dance with the music. Oh.
Sly and the Family Stone. I'm a runner. I'm a runner. So I go out and run my,
I run around Lake Misset and I have my music on.
I have dance to the music.
(51:42):
There you go. So listen, the dope thing is Sly and the Family Stone,
that particular song, Dance to the Music. I'm going to tell you a little nugget.
Is it was sampled by DJ Mark the 45 King, and it produced a song that Queen
Latifah spit her songs, and it was called Dance to the Music, and it was a dope track.
(52:03):
So that song and a lot of hip-hop, especially the earlier hip-hop,
comes from the music that you grew up on, brother.
So listen, I appreciate y'all joining the show.
This was a really dope episode. I hope my listeners learned a lot.
And as I always conclude, we great say peace out and keep 5-0 guessing.
(52:25):
Music.
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