November 21, 2025 • 51 mins
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Are you over 40 and trying to stay muscular, lean, and strong, but PSA tests and prostate fears leave you confused? Worried that one elevated PSA could derail your strength training with an unnecessary biopsy?
In this conversation with men’s health expert Dr. Stephen Petteruti, we break down the truth about PSA testing, hormone health, and what most fitness podcasts get wrong about men’s health and longevity. We talk about why body recomp and lifting weights matter even more as you age, how certain treatments impact testosterone and weight loss, and what proactive steps keep you training hard for decades.
I share how evidence-based fitness shapes my own approach, and Steve gives a grounded perspective on protecting your hormones without sacrificing your physique.
Today, you’ll learn all about:
0:00 – PSA tests and misunderstood prostate risks
4:15 – Why biopsy thresholds are flawed
9:42 – How lifestyle shapes cancer and longevity
14:55 – Understanding atypical dormant cells
18:40 – Repurposed drugs and monitoring protocol
24:10 – Testosterone, muscle, and men’s health
31:42 – High-to-low dosing theory explained
41:20 – Philosophy of vitality over fear
48:05 – Strength training and premeditated nutrition
50:37 – Where to find Dr. Petteruti’s work
Episode resources:
- Intellectual Medicine Podcast. Start with this episode – Think Twice Before Getting a Biopsy
- Website: drstephenpetteruti.com
- Waitlist for his book “Fighting Cancer Like a Man”
- Instagram: @dr.stephenpetteruti
- YouTube: @intellectualmedicine
📱 Get Fitness Lab - Philip’s science-based AI app for fat loss, muscle building, and strength training for people over 40. It adapts to your nutrition, recovery, and training to improve body composition without guesswork.
🎓 Try Physique University - Evidence-based nutrition coaching and strength training to help you lose fat, build muscle, and master your metabolism with support and accountability (free custom nutrition plan with code FREEPLAN).
👥 Join our Facebook community - Free fat loss, muscle building, and body recomposition strategies for adults over 40 who want practical, science-backed fitness guidance.
👋 Ask a question or find Philip Pape on Instagram
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Philip Pape (00:01):
If you're a man over 40 who lifts weights and
wants to stay strong fordecades, your prostate health
might be the most misunderstoodrisk to your training and
hormones.
One elevated PSA reading.
That's all it takes for mostdoctors to push you toward a
biopsy.
And once you're on thatconveyor belt, the next step is
often treatment that potentiallytanks your testosterone and
(00:23):
muscle mass.
So the question we're answeringtoday is: how do you know when
prostate issues require abiopsy?
And is there a less intrusivediagnostic path that protects
both your prostate and yourphysique?
Today's guest who specializesin men's health and hormones,
and he will explain why thestandard approach to prostate
screening is broken and what youcan do about it for your
(00:45):
health.
You'll discover when elevatedPSA actually matters, when
biopsies are unnecessary, howcommon treatments affect muscle
and strength, and a proactiveprotocol to keep you training
hard well into your 70s andbeyond.
Welcome to Wit and Weight, theshow that helps you build a
(01:07):
strong, healthy physique usingevidence, engineering, and
efficiency.
I'm your host, certifiednutrition coach Philip Pape, and
today we're discussing prostatehealth and PSA testing.
If you're a man over 40, youmay have had a PSA test or been
told you should get one.
Maybe you've been told yournumber's high and you need a
biopsy right now.
But what if that's not thecase?
What if there's a better, lessdisruptive diagnostic approach?
(01:29):
My guest today is Dr.
Steven Petteruti, a boardcertified family physician and
host of the IntellectualMedicine podcast.
He has dedicated his practiceto men's health, hormone
optimization, and smarterapproaches to prostate care.
He's going to teach you whatthe PSA numbers really mean, the
choice between imaging andbiopsy, the effects of various
(01:51):
therapies on hormones andmuscle, and some steps you can
take right now to keep yourprostate healthy without
sacrificing your health orperformance.
To be clear, this is notmedical advice, but it is
information every man listeningneeds to understand.
Dr.
Petaruti, Steve, welcome toWits and Waits.
Great, Philip.
Thank you for having me.
So let's talk about this topic.
(02:12):
Um PSA or prostate health andthe blood markers that go along
with this are confusing.
And there's a lot of, I'll saythere's misinformation and
there's probably a lot ofentrenched uh information and
advice from generations ofhealthcare.
And I know we need to stay withthe times and understand uh for
men concerned about cancer,let's say, what is the
(02:34):
correlation?
What does the science say whenit comes to things we're
measuring, like PSA results andcancer?
Let's start there and then wecan go deeper.
Dr. Stephen Petteruti (02:43):
It's important to recognize PSA is
not a test for cancer.
It was never meant to be that.
It is a marker that you canfollow and its trajectory, its
direction can be helpful.
But there is no cutoff.
All the cutoffs that you readabout or that are published are
arbitrary and are just kind ofthrowing a dart at the board.
(03:05):
So when they tell men, hey,your PSA is above four and you
need a biopsy, that's made upscience.
There are men with PSAs of 30are totally fine.
So the thing I want youraudience to hear loud and clear,
you never need a biopsy.
I advocate they should never bedone.
And I'll expand upon that asthe conversation unfolds.
(03:29):
There's a reason why the PSA isentrenched, and there's a
reason why biopsies arerecommended.
It has more to do, Philip, withhistorical inertia than keeping
up with current technology.
If I can give you a quicksweep, maybe that'll illuminate
a bit, right?
So in the 1980s, there was noPSA, there was no MRI, there was
(03:50):
strictly the digital rectalexam where the doc would say,
well, it feels a littleabnormal.
I think you need a biopsy.
So now we've established thebiopsy as a standard.
The biopsy leads to a diagnosisof prostate cancer in some
cases, and then they jump to aprostatectomy, removing the
gland.
I mean, it seems logical.
(04:12):
Intuitively, it makes sense.
Cancer is in the gland, youtake the gland out, I no longer
have cancer.
Would that it were that simple.
Now we know there are severalstudies that have shown us that
taking out the gland doesn'tprotect you from cancer.
I know that sounds weird, butthat's what the data shows.
So you can get the glandremoved, men, you suffer all
(04:33):
that adverse consequence, andthen here comes the cancer
again.
What's going on?
Why?
And this is philosophy thatdrives it.
It's a lot having to do withwhat you've dedicated your own
profession to, right?
Live life robustly, guys.
Live vitally.
Don't do things that suck theenergy out of you unless there's
(04:54):
a compelling benefit.
So 1980s biopsies.
Then in the 1990s, a PSA comeson the scene.
And really nobody knew whatcould quite what to do with it.
You know, does this predictcancer?
Does it correlate?
For a while, it was not evenadvised to be done.
So the United StatesPreventative Task Force at one
point said, hey, don't botherdoing it.
(05:16):
Then they came about.
The urology community, and I ama family physician, so my
perspective comes from theoutside looking in.
And the urological communitysaid, Hey, you can't do that.
Men need this PSA test.
So it went back in the hopper.
Well, if there's a test,there's got to be a threshold,
and the threshold wasarbitrarily created.
(05:37):
Thus, we have a PSA threshold.
Now we have biopsies that arestill there.
Instead, we've got an MRI.
You have an elevated uh PSA.
You're nervous about it.
An MRI can be performed, looksat the anatomy.
It's kind of like a mammogramfor a man's prostate.
It gauges risk.
Nice study, not carved instone.
(05:58):
It is uncommon to have acompletely normal MRI past the
age of 50.
True.
Usually a nodule, there's gonnabe something in there, guys.
Here's another thing that'llhelp frame the conversation.
If you arbitrarily biopsied 100men off the street over the age
of 50, just biopsied everybody.
Half of them would haveprostate cancer cells.
(06:20):
Here's another variable thatyou need to reflect upon, guys.
In men over 90, they didcadaveric studies looking at
people who died of other causes.
The majority of them hadprostate cancer cells buried in
the gland.
Now that tells us, Philip, thatat some point, if we live long
enough, we may, we probably willdevelop cancer cells within the
(06:44):
gland.
It doesn't mean you need to godigging them out.
When you stick a needle intocancer, you disrupt it.
There's a capsule around theprostate.
It's like the rind on anorange.
And it contains the tissue.
It also contains cancer withinthe capsule.
If it stays in the capsule,it'll never hurt you.
(07:06):
So I have a philosophy of, youknow, think twice.
If a urologist tells you youneed a biopsy, take a deep
breath, get another opinion.
The problem, of course, Philip,is they're all reading off the
same sheet of music.
Philip Pape (07:21):
Yeah.
Dr. Stephen Petteruti (07:22):
So for men with an elevated PSA, it's a
it's a horrible dilemma.
They're told that this could becancer, the biopsy is needed to
make the diagnosis.
Both of those are not fullytrue statements.
You can look at thingssequentially.
So the best use of a PSA,whenever you get it, that's your
base number.
So if you had a PSA tomorrow,Philip, and it came in at six,
(07:46):
the doctors are going to havekittens.
You take a deep breath, say,okay, let's check it again in
three months.
Now the PSA will vary.
If you went on a long bikeride, if you had sex, if you did
a heavy workout, it's going tobump up.
Philip Pape (08:00):
Because it's a protein, right?
It's the antigen we're we'remeasuring from the gland.
Correct.
Like we didn't even define whatit was exactly, but just that's
why it could vary.
Yeah, okay.
Dr. Stephen Petteruti (08:08):
That's correct.
The prostate-specific antigenis found almost exclusively in
the prostate gland.
And when you squeeze it, youooze out more of it.
So monitoring it over time canbe valuable and helpful and can
give men an opportunity to avoidunnecessary interventions.
Philip Pape (08:28):
Yeah.
So okay, I'm glad youestablished all that.
That's why I wanted to have youon here because a common theme
with a lot of areas of ourhealth and women's health too,
because I we have a lot of womenin our audience, we talk
hormones as well, is that somestudy or intervention or
individual in the healthcareindustry, like you said, in the
80s, did something and uh made alogical conclusion that there
(08:51):
was fallacies in that chain oflogic, even though it looks like
it's causal.
And then it led to, you know,going into uh texts, medical
texts and going into studies.
And we've had studies that havecompletely changed health
outcomes for the negative as aresult.
Like the women's healthinitiative we talk about has
made all women afraid of hormonetherapy when they shouldn't be,
(09:11):
right?
So with men, I'm we're I'm kindof hearing a similar theme.
And then when you go to thedoctor, you're trusting this
man, this person, man or womanto be the expert, right?
And of course, many of them actlike they know it too, uh, but
that's a separate issue inhealthcare.
Um, the idea that you couldactually be causing harm with a
biopsy is probably a surprise tomany because when you said you
(09:35):
may not, you actually don't needa biopsy ever, like that's a
very definitive statement versuslet's say in women's health
where you're like, well, youshouldn't, you don't necessarily
need a mammogram or necessarilyneed this or that because it
leads to more anxiety and issuesfor people that are low risk.
You're saying definitively,maybe we should never have a
biopsy because of that harm ofthe intervention past the sheath
(09:58):
that then disturbs the cancercells.
Is that the idea here?
Dr. Stephen Petteruti (10:02):
That is my that is my approach.
But look, put in the context,Philip, of philosophy.
Every man has to decide theircomfort level.
You know, my philosophy,Philip, is we fight cancer like
a man.
We do not sacrifice ourmasculine vitality out of some
false pursuit of comfort andlongevity.
(10:24):
Those two are a false choice.
So when a man sees theurologist, it can be compelling.
When they look him in the eyeand say, you could have cancer,
you need a biopsy.
Totally disagree with the withthe emphasis here, right?
It's an option.
It's not wrong to get one.
You have to go into it withyour eyes wide open.
The biopsy, you should men, youshould always reflect upon the
(10:48):
consequence of any test beforeit's done.
If the biopsy is done and if itshows cancer, what are you
going to do next?
You're going to let them takeout your prostate gland?
Again, that's not a wrongdecision.
It's one I would never do, andI don't recommend.
Why?
Because the studies havevalidated there are two studies
in the literature, one calledthe Protect T, the other one
(11:09):
called the Pivot Trial.
And they looked at men withprostate cancer.
And one group they had thegland removed, the other group
did nothing.
One study had a third groupthat had radiation.
Followed them out for 20 years.
And at the end of 20 years,they found that there was no
difference in the death ratebetween the groups.
And there was no difference inthe death rate from prostate
(11:32):
cancer.
That's very sobering.
Yeah.
40% of the men who get theirprostate gland removed end up
with a relapse.
Now, this is where it startsthe dominoes, the downward
spiral.
Man gets his prostate out.
This is a common scenario.
I felt great.
I went in for my exam, my PSAwas elevated, they did a biopsy,
it showed cancer.
(11:53):
I felt great.
It took out my gland.
Now I'm wearing pads every day.
My erection's never been thesame.
I don't feel right.
They robbed a vital part of me.
Then the PSA starts to rise.
And this is something I fullydisagree with.
They call it a biochemicalrecurrence.
You feel great, you have noevidence of metastatic disease,
(12:17):
but the PSA number is creepingup.
What do they do next?
They castrate you, they cut offyour testosterone.
Oh my goodness, what a horriblething to do.
Take away your life energy, thebrain gets weak, depression
happens, you developgynecomastia, man boobs, your
muscles wither.
(12:37):
It's a horrible thing to do toa human being.
And then the prostate cancer,when you go on testosterone
blocking therapy because of arising PSA, it's not curative.
The cancer, 100% of the time,is going to progress.
So you put all these factstogether, Philip, and you're
starting to wonder what are wedoing?
(12:58):
Yeah.
You have to start with how youwant to live, men.
What's your philosophy?
Because at some point we'regoing to die.
And when we die, if it's aprostate cancer, a heart attack,
or something else, I advocatefor what I call a horizontal
lifestyle, right?
You do things to maintainvitality.
Yes, you lift weights orstrength train.
(13:19):
Gotta do it.
You should never wither.
There's nothing biologicallyabout us that requires us to
wither before we die.
So I want you, me, and all yourlisteners to die in great
health after a short illness ata very advanced age.
It's like, hey, where's Dr.
(13:40):
Petrudy?
No, you didn't hear, man, hedied last night.
Oh, crap.
Just saw him yesterday.
He just croaked.
Philip Pape (13:45):
Yeah, I always joke, I want to croak doing a
deadlift when I'm, you know, 95or whatever.
Uh, I I literally just recordedan episode called something
like, you know, why now is theperfect time to start building
muscle.
It targeted more at thenarrative that you're too old,
you know, too old to start.
But I totally agree.
And our listeners would agreewith that.
And I want to get to thelifestyle piece, which again
will be not really a debate onthis show at all.
(14:07):
We're all going to agree withthat piece of it.
What I'm trying to understandhere, though, is this chain of
events, because I'm learning aton already.
The idea that taking out thegland doesn't remove the cancer
right there sets, you know, putsa massive roadblock in the
logic of, okay, then you've gotthe PSA results, which have to
be based on your personalbaseline.
(14:28):
If, let's say, your PSA goeshigh versus your baseline and
there are cancer cells, then wehave to think, okay, well, you
said every man gets cancer cellsanyway over time.
I mean, DNA mutates and getsdamaged, and everything we do
and consume and are exposed toover our lifetime probably
causes lots of cancer cellsacross our body in all areas.
So you're gonna get thatanyway.
(14:49):
So then when does it matter?
When do the PSA results matter?
And then when does the factthat you have cancer in your
prostate matter?
And then what do you do aboutit, if anything?
That's I think the nextquestion.
Dr. Stephen Petteruti (15:00):
Yeah, it's a it's an important
question, Philip.
And I like to designate thesecells as atypical dormant cells.
Philip Pape (15:05):
Okay.
Dr. Stephen Petteruti (15:06):
They're kind of sleeping in the
prostate, you let them be.
And there are things that canbe done.
This is a chronic lifestylemanagement.
And we talked before about isit okay to get a biopsy?
Is it okay to remove the gland?
Although I would never do it,and I don't advocate my patients
to do it.
It is okay if you're the typeof person who can't live with
(15:29):
the notion that these cells arein your body.
And some men are like that, youknow, they'll just drive nuts.
The uncertainty factor is thereno matter what path is is
pursued.
So the things that keep them,our job, like why do we not all
have cancer?
Our immune system, it's killingcancer cells every day.
So if those cells are withinthat capsule, the job is to keep
(15:52):
them there.
Cancer is like an opportunisticdisease, it's there lurking.
It's kind of like shingles.
That's a good analogy.
When we were kids, we hadchicken pox and then it went
away.
It's asleep.
Why does it come out later?
It never actually went away.
We never actually killed allthe virus, it's just kept in
(16:13):
check by the immune system untilthe immune system weakens to
the point where it becomesmanifest.
Same with cancer cells.
If you've ever had cancer, youare never cancer free, you're
tumor-free, the cells arelurking.
I don't want to creep peopleout, but we all have them.
So that's why you live everyday in a balanced, healthy
(16:36):
manner, maintaining immunefunction.
What ruins the immune system?
You don't sleep right.
That's one.
You're on certain drugs thatcan weaken it, steroids, for
instance.
Now, um, disease-modifyingdrugs are quite popular.
The biologic agents forpsoriatic arthritis and other
conditions, they can belife-enhancing, but immune
(16:57):
immunologically weakening.
A bad diet, stress, these areall variables.
Uh, an acute phase of yourlife, a spouse dies, you go
through bankruptcy.
These are opportunistic momentswhere you need to amp up your
own vitality pathway.
Exercise is really helpful, butyou have to be tempered.
(17:19):
I like your philosophy, Philip,of being, hey, you can achieve
all you need to achieve withoutgoing crazy and spending three
hours in the gym.
There's a tipping point wheretoo much, too intense, can
weaken the immune system.
So you have these cancer cellsthat are isolated within the
gland.
You don't need to biopsy them.
You do your PSA levelperiodically.
(17:39):
And my I've developed aprotocol to help men avoid the
biopsy and take another path.
And in my protocol, we do a PSAevery three months monitoring
levels.
We do an MRI typically once ayear to look at the anatomy.
We use repurposed drugs, andthese are prescription agents
(18:00):
that have been shown to haveanti-cancer power and
attributes, even though they'reFD approved for other reasons.
Many of your listeners may befamiliar with ivermectin, uh,
fenbendazole, mobendazole.
They have merit, guys, but becareful.
The online pathways areharmful.
(18:20):
These drugs are not meant fordaily consumption.
So in my protocol, we use themsporadically to emphasize
safety.
You don't cure prostate cancerby dying of liver failure,
right?
That's not a good outcome.
So the repurposed drugs are putin there.
How about lifestyle?
Most important variableregarding nutrition, percent
(18:42):
body fat.
Excess adiposity correlateswith increased risk of cancer
and cancer relapse.
That is settled science,unequivocal.
How you get there, whetheryou're a vegetarian, a
carnivore, uh organic eater ornot, how you get there is less
important than that you getthere.
(19:03):
Now, there are clearly foodsbetter than others.
And when I say food, Philip, Imean food, not junk disguised as
food, right?
So thoughtful diet, stressreduction.
If you're inclined, repurposedrugs guided by a physician, you
don't want to fly on the on theinternet.
This needs to be monitored.
Certain supplements can havemerit.
(19:25):
I like alpha lopoic acid.
I like zinc, about 30milligrams a day.
It concentrates in the prostategland more uh zinc per gram of
tissue than any other organ.
It also supports immunefunction.
Philip Pape (19:37):
Is that zinc with copper or just zinc?
Dr. Stephen Petteruti (19:40):
No, I don't like copper.
Okay.
All right, all right.
Because you mentioned it.
Copper is an essential ummineral, it's an essential
metal.
But there are two kinds ofcopper.
There's cupric and cuprus.
Cupras is what we find in food.
That's great for you.
Cashews, almonds, darkchocolate, etamame, you can find
(20:02):
it in your food.
The problem with supplements,Philip, is they often use cupric
or C2, which is a neurotoxin.
In fact, in Japan, they don'tallow you to have copper pipes
in your house because of therisk to the brain.
So I see this frequently.
I don't like any supplementwith copper in it.
I keep cashews.
It's not good to know everyday, just because the copper is
(20:25):
so good for well, immune andskin and all that other cool
stuff.
But um, yeah, zinc I like,alpha poric acid, and then N
acetylcysteine or NAC, which isa precursor to glutathione.
As we age, you know, we makefewer uh antioxidants, free
radicals tend to become moredominant, and that inflammatory
(20:46):
tilt can increase risk uh, youknow, kind of across the board.
So if you're a man listening tothis and you've had a biopsy,
don't panic.
You can't undo the past.
However, going forward,contemplate an alternative.
There's something out therecalled active surveillance, it's
a term that is used when theyfeel your type of cancer is
(21:10):
early and therefore they don'twant to subject you to the
trauma of prostatectomy.
And what they'll offer issequential biopsies staggered,
right?
This is patently illogical, inmy view.
You know you have cancer, andnow you're gonna stick, not and
it's not just a little needle,it's a trocar, and it's multiple
(21:32):
jabs.
It hurts.
I've listened to men who havehad complications from the
biopsy, hospitalizations due tosepsis, or loss of erectile
function or compromise thereofcan occur.
You stick in these bigtrochars.
But most importantly, it's afalse notion to think that you
can take a snapshot of theprostate in one moment in time
(21:54):
and predict the future.
And I've heard that saidthey'll tell they'll tell you,
well, we need to do a biopsy sowe can tell how aggressive your
cancer is, or how aggressive itmay be.
That's not true.
You tell aggression by a pointof change.
Your PSA was six, and now it's25.
That's a manifestation ofaggression.
(22:15):
What should you do then?
Right?
I just told you, don't take thegland out.
Worse than that is irradiatingthe pelvis.
That's a terrible thing to dothat causes immediate adverse
effect and delayed consequence.
Five years later, you ever geta sunburn, you feel rotten,
right?
It hurts.
And then 10 years later, youhave basal cell cancer from that
(22:36):
sunburn.
Radiation has a delayednegative consequence that ends
up with radiation proctitis.
You can't control your stool.
I've seen men 10 years laterliterally leaking poop all day
long.
It's horrible.
For what?
You know, so this leaves a thisis it's a problem, it's an
unsolved problem.
(22:57):
My um departure fromconventional recommendations is
not that the pathway I've uhespoused is proven beneficial.
We are still actively studyingit.
It has evidence of benefit, itdoesn't have proof, but it has
proof of not harming people.
Conversely, conventionaltherapies, prostatectomy,
(23:20):
radiation, absolute 100%unequivocal harm.
Benefit?
So I've heard my patients willsay, Well, the urologist told me
that there's no proof thatsticking a trocar in my prostate
can spread cancer.
Technically, it's an accuratestatement.
However, they never looked.
There's never been a study tosee if that's the case.
(23:42):
But there are, because I didthis research recently, Philip,
over 95 articles in the medicalliterature looking at what's
called needle tract metastases.
This is a known risk that wehave to balance against the
potential benefit.
So it's a hard space to livein.
It's worthy of being slow.
(24:04):
It's never, almost never anemergency.
Prostate cancer, even if youhave it, guys, it's a
slow-moving train.
So you have time to reallythink through it.
And depending on your age anddepending on your global health,
it will help you direct youraction.
If you're 75 and you've hadthree heart attacks, you know,
(24:25):
prostate cancer is not going totake you out.
Ironically, getting aprostatectomy and having
aggressive treatment iscorrelated with increased risk
of heart disease, dementia, um,other side effects.
I do want to mention thetestosterone link too, Phillips.
So let me know.
Philip Pape (24:43):
We'll get to it.
So I'm listening because I'mlearning so much here.
And the protocol you mentionedobviously doesn't sound uh super
unconventional when it comes togeneral advice for any
age-related disease or beinghealthy and living a long life.
In other words, lifestyle andstrength training and eating
(25:04):
well, supplementation.
Obviously, the repurposed drugsare kind of a unique thing that
we could get into.
But you mentioned just cancerin general.
I I percent body fat, Ibelieve, is linked to at least
13 cancers, something like that.
I forget the magic number,definitively through studies so
far.
And, you know, some peopledon't like to say that out loud
(25:26):
that you have this massivechoice in the matter through
your lifestyle to potentiallystave off cancer, but it's true,
right?
So the PSA and MRI, what I'mtrying to understand here is
where's the preventive piece ofthis?
And where's the, oh, now wethink there's some cancer that
could develop into somethingconcerning.
(25:47):
Is this something you startonce you get a diagnosis?
Or is this, I mean, lifestyleyou're going to do anyway, guys.
I mean, anybody listeningshould be doing those things.
But like the protocol youtalked about, when when does
that begin?
Dr. Stephen Petteruti (25:58):
That that's a great perspective,
Philip.
The protocol really starts withyou, with this, what you
advocate for people, right?
You live a low tox lifestyle.
You don't wait to get sick.
We're all aging.
My wife said to me once, hey,if if you knew you were dying,
would you regret anything?
And she mentioned it becauseI'm a I do a lot of advanced
(26:19):
anti-aging in my practice.
I'm on testosterone, I do somepeptides, I you know, I take
Cirrellimus, an anti-aging drug.
I thought I said, Yeah, no, no,I'm not going to be the guy
that clutches his chest, go intothe ground, says, Oh, I should
have walked and exercised, oryou know, the end comes.
What I want for everybodylistening is to have peace of
(26:42):
mind.
When you do all the thingsyou're talking about, Philip,
you control percent body fat, apowerful risk factor for cancer,
for heart disease, and guesswhat, gang?
Dementia.
You know, yeah.
I want all the things that areit correlates it.
There was a study showing theaccelerated brain atrophy in the
context of excess adiposity.
(27:03):
So you start there and youstart with taking charge of your
nutritional health and reallygot to peel away from uh the
average American sort ofpattern.
If you're eating like everyother American, that's
problematic.
If you if other people look atyou and say, you're kind of, you
know, your nutrition is kind ofweird, you're probably closer
(27:25):
to a good place.
Philip Pape (27:26):
Yes, I like that perspective for sure.
If you're weird with mostthings in life, you're probably
doing the right thing.
Dr. Stephen Petteruti (27:31):
Probably in a good place.
You know, we call that eatingabnormal, yeah, but healthy.
So yeah, percent body fat'scritical.
Now, if you're in that positionwhere you've got that high PSA,
you have the MRI.
Now, the MRI is gauged onsomething called a pyrad scale,
one to five.
And it's a subjective look atthe anatomy, and the radiologist
(27:51):
will say, Yeah, this one lookslike cancer, this one might be
cancer.
It goes one to five.
Five means, yeah, you probablygot cancer.
You got a PSA of let's say it's12.
You get an MRI.
It's a pyridge of five, butit's confined to the capsule.
No evidence of disease outsideof the capsule, the lymph nodes,
(28:12):
seminal vesicle.
You feel good.
That is not a panic moment,folks.
It's an opportune moment.
The idea behind the repurposeddrugs and the amplified
lifestyle.
Now, this grabs people'sattention, Philip.
You know, now they're reallymotivated.
They're going to lose weight,they're going to start eating
differently.
They're really researchingthis.
(28:34):
One of the problems that menand women run into, and you
probably noticed this yourself,Philip.
You go to the internet, it's ablizzard of information.
And then they go to theirdoctor and ask the doctor, what
supplements it look, I'm a boardcertified family doctor, as you
mentioned.
I was trained uh osteopathicmedical school.
I was in the army, did myresidency, and I've been in
(28:56):
practice for 30 years.
20 years ago, if somebody askedme about supplements, my eyes
would have glazed over.
Like, what?
I know nothing.
And doctors usually are limitedin their knowledge in the
space.
So that leaves you knowpatients kind of on their own in
many cases.
But there is a growing cohortof physicians, of advisors that
(29:18):
can help guide, not somethingthey want to do on their own,
right?
So the repurposed drugs in myprotocol, I really like this
approach.
It's proactive, it has evidenceof potential benefit, and it
has this safety feature of notcausing harm.
So we're applying about sixdifferent pharmacologic agents
(29:40):
in modest dosing.
Technical term for this iscalled hormetic, which means
drugs have different effects atdifferent doses.
So that which may seem kind ofweird to apply can actually be
helpful.
We're trying to create anenvironment in the body that is
inhospitable toward cancercells.
You got that pyrides of.
Five.
(30:00):
It's isolated to the capsule.
Now we're going to watch thatPSA.
It is go 12, 13, 14, 13 again.
That's a plateau you can livewith.
If it goes 12, 45, that grabsour attention.
Now we maybe look at that MRIagain and maybe modify the
(30:21):
treatment, but you never jumpthe gun.
There's no need to put needlesin.
I tell a man that has thatscenario I just described to
you, Philip, I'll say, look, yougot prostate cancer.
The lining up of the PSA in theMRI, in your age, and in some
cases your symptoms, are socompelling that even if you had
a biopsy and it came backnegative, nobody would believe
(30:43):
it.
Philip Pape (30:44):
There's no point, is what you're saying, yeah, to
the biopsy.
Dr. Stephen Petteruti (30:46):
Yep.
So don't subject yourself to astudy that is academic,
historical, and petrified in thestandard of care.
Look, docs are good people, butthey're human beings.
What do I mean?
They're worried aboutliability, they have time
pressure.
You see a urologist, I've heardthis often, you know, go see a
(31:09):
urologist, my PSA is elevated.
It says, okay, when do you wantto do your biopsy?
Surgeons, folks, they get paidto do things.
They don't get paid to talk.
And if you want to sit and chatabout your PSA with your
urologist for 30 minutes, it'sunlikely to happen.
So you really owe it toyourself to step away, get out
of the uh sort of the vortex ofintensity, give yourself time to
(31:31):
decompress and think a littlebit.
There are exciting new thingshappening in the field of
intervening for prostate cancer,one of which is actually giving
men with prostate cancertestosterone.
Philip Pape (31:46):
Okay.
Yeah.
I I want to talk about thatnext.
One quick thing is alcohol.
I just want to touch on alcoholreal quick.
Um, because there was this, youknow, the alcohol um cancer
study that was supposed to comeout, came out in 2022.
The Surgeon General wantedlabels on alcohol.
And then I believe uh thedietary guidelines were going to
be updated to suggest one drinka day instead of two drinks a
(32:08):
day can start to cause issues.
And I know certain cancers likecolorectal and breast cancer
have a link to very lowconsumption of alcohol.
Where does prostate cancer fitin on that spectrum?
Dr. Stephen Petteruti (32:22):
I laugh because it reminds me of Frank
Sinatra's famous quote.
He said, you know, those of uswho drink feel bad for those of
you who don't, because when youwake up in the morning, that's
as good as you're going to feelall day long.
But to answer your question,these are all um observational
studies.
The real answer is nobodyknows.
My dad was a physician.
He used to joke the definitionof too much alcohol is anybody
(32:45):
who drinks more than theirdoctor.
But in all seriousness, alcoholis a toxin.
Lots of things are toxins, butthey're pleasurable toxins.
We call that a hedonistic path.
We human beings, we do twothings without fail.
We avoid pain and we seekpleasure.
(33:06):
Avoid pain means don't die,seek pleasure means reproduce.
So modifying limiting alcoholis logical, it's good health,
it's good psychosocially.
You go beyond two drinks, badthings are gonna happen.
Not in the future, but thatnight and the next morning.
So that's self-evident.
(33:27):
But the idea that alcoholitself is a pure toxin to be
avoided at all cost is anexaggeration.
Some folks like to end theirday with a glass of wine.
There's no evidence ofcompelling harm.
If you're deprived, so wetalked a moment ago about
stress.
Stress can occur from adeprivation of pleasurable
(33:50):
endeavors.
And I've seen like I'll peopleask me about nutrition.
And sometimes when a man getsthis diagnosis, his wife or
partner becomes very engaged,says, You have to drink this
concoction.
And the guy's choking it down.
Oh, this is awful.
It's not good for you then.
It's a stress moment.
So where I come down on alcoholis um when you go above one
(34:14):
drink per day, you're entering agray zone.
When you go above two drinksper day, you are in a harm zone
fairly unequivoc inequivocally,unequivocally, without doubt.
Philip Pape (34:25):
Yeah.
Dr. Stephen Petteruti (34:26):
So that helps frame it out.
Um, but when my patients cometo me and say, should I go
alcohol free?
You can if you want, but youdon't have to.
You know, you have to livelife.
Philip Pape (34:38):
It's a matter of degrees, yes.
Yeah.
Okay.
Yeah, I just wanted to touch onthat.
All right, let's get intotestosterone.
So you said uh TRT could be agame changer here, could be the,
you know, one of the thingswe're not talking about, and
we're going to right now uh incontext of prostate health.
So lay it on us.
Dr. Stephen Petteruti (34:54):
Yeah.
Well, let's talk about thesettled science first, right?
Testosterone does not increaseyour prostate cancer risk.
That likely has been emphasizedin the past, and that is pretty
solid.
And testosterone is not gas onthe fire either.
So historically, we've beentaught, and this goes back to
Dr.
Huggins in the 1940s.
(35:15):
He won a Nobel Prize when hisexperiments correlated
testosterone deprivation withregression of prostate cancer.
Since the 1940s, that has beensort of the dogma.
You know, testosterone equalsprostate cancer.
It does not increase risk.
In fact, men with lowtestosterone levels have a
(35:37):
higher risk of developingprostate cancer than those with
higher.
That doesn't mean that going onreplacement therapy and
elevating your level will makeyou less likely to get it.
That's an unknown.
But it is pretty solid evidencethat it won't harm you.
So those of you that are ontestosterone, you ought not to
fear it with regard to yourprostate health.
(35:58):
And you ought not to fear itwith regard to prostatic
hypertrophy.
That also doesn't correlate.
It also does not correlate, andthis is pretty settled science,
Philip.
It does not increasecardiovascular risk.
So those studies were verycomforting to those of us who
have been on testosterone forabout 20 years, uh, those of us
that are using it to benefit, soyou can maintain that.
(36:18):
The research and the scienceabout testosterone in the face
of prostate cancer is rapidlyevolving.
And this idea that you cannever be on testosterone is
being challenged.
Dr.
Abraham Morgenthaler, in hisbook, Testosterone for Life, he
is uh a urologist, a real uhthought leader in this field.
(36:39):
And he has uh something calleda prostate saturation theory.
In essence, your prostate canonly hold so much testosterone,
and any extra testosterone willgive value to the organs, the
tissue, the brain, right?
We all know testosterone is aneurotransmitter, but it doesn't
(37:01):
adversely affect the gland,which is now sort of maxed out.
It's like a full cup of water,you keep pouring water in it,
you're not gonna get any more inthere.
There are studies that showthat when you go from a high
level of testosterone to a lowlevel, that it disrupts the DNA
of prostate cancer cells.
And that's called the bipolartheory of testosterone's effect
(37:24):
on prostate cancer.
Now, I want to be clear, thisis not standard of care, and
there are circumstances where itshould never be considered.
If you have prostate cancermetastatic to the bone, that has
to be controlled before anybodycontemplates this.
It is a consideration with eyeswide open when you make
(37:46):
judgments about philosophy,quality of life, and your
willingness to consider risk,simply put.
So I'll give you an examplefrom my practice.
Gentleman had prostate cancer,you know, before I met him.
He actually flew to Europe, hada high food procedure, high
intensity focal ultrasound.
Doesn't work.
I don't like it.
(38:06):
He came back and uh had still aprostate cancer.
At the time it was diagnosed,he was on testosterone and he
suspended its use.
And he felt awful.
His sex drive went away.
His brain wasn't working well.
He's an executive and he hadtrouble functioning in his job.
His PSA is 45.
He has prostate cancer.
(38:28):
And he said, Doc, you gotta putme back on testosterone.
This is no way for me to live.
So I said, Okay, you know, thisis science says that this is
not irrational.
The science says that this isreasonable to consider, but it
is also an unknown quantity.
It's possible that thetestosterone could accelerate
(38:51):
the cancer.
And it's likely at his stage,or the stage at which this
cancer is for many people, it'slikely the cancer will progress
regardless of what you do.
This comes to that, right?
The philosophy of regret.
My patient goes ontestosterone, he feels great,
but five years later the canceris metastatic to the bone.
That could happen.
He has to be comfortable withthat decision looking back,
(39:14):
knowing that he's he's at peacebecause he had this great window
of time with it.
On the other hand, he doesn'tdo testosterone, he continues to
feel lousy, and in five yearshe gets metastatic disease to
the bone.
He's saying, What did I just Icould have, I should have.
So the individual has toreflect upon it philosophically,
(39:35):
and then what I will do in somecases is a modified approach to
this.
You go three months high, andhere's the irony.
If I do this for men, you can'tdabble, you can't go low dose
testosterone, you have to gohigh dose because the delta, the
high to low shift is where wethink the benefit may be.
(39:57):
So you go a period with highdose, and then boom, you pull it
out.
High, low.
We're trying really to balancerisk and benefit.
You know, is this gonna harmyou to put you on testosterone?
We know the benefit is there,but what about the harm?
It's preliminary, and I'm stilltracking these cases, Philip,
but thus far I've got a clusterof men doing this type of an
(40:21):
approach.
And what I'm bearing witness tois stability.
I'm not seeing PSAs go throughthe roof.
I'm not seeing um, you know,the cancer go on haywire.
Um, there's an alpha patient,one of my pioneers, he had a PSA
of about 10.
He had a pyridge of four,meaning, hey, it's likely
(40:42):
cancer.
He was on testosterone.
He said, Look, I don't want abiopsy, but I do not want to
come off my testosterone.
I said, Okay, we're gonna dothis bipolar, we're gonna
monitor things closely.
2018, PSA of 10, pyrides offour.
2025, a PSA of 10, a pyrides offour while on testosterone.
(41:04):
Now, granted, it's a singularcase, but this is how new
evidence builds, and this is howwe acquire insight into other
ways we may be able to approachthis problem.
So out of the mainstream oftreatment is an option for some
men that are so inclined.
It really comes down to yourphilosophy.
(41:26):
And I want to emphasize, guys,it's not wrong to do the
conventional pathway.
The problem I have with theconventional pathway, Philip, is
the monopolistic sort ofone-note piano approach that I
see.
Philip Pape (41:39):
Like this is the only way.
Yeah.
Are there any controlled trialsdoing what you're talking
about, or or at least planningto observationally look at men
who've gone through this?
Dr. Stephen Petteruti (41:48):
Well, there are actually there are.
So they're not actually in thecohort that I'm discussing.
The bipolar uh research is umJohns Hopkins did this.
They uh applied this to men whohad prostate cancer, had the
gland removed, had the PSA godown, and then come back up
(42:08):
again, at which point they putthem on androgen deprivation
therapy, castration.
Philip Pape (42:14):
AD2, okay.
Dr. Stephen Petteruti (42:15):
When a man starts castration therapy,
androgen deprivation, 100% as Imentioned, it will advance.
When it advances, that's calledcastration resistant prostate
cancer.
Basically, that's the end ofthe road.
There's no treatment left thathas been shown to have merit.
So they took these men with atheory of bipolar testosterone
(42:37):
and they, hey, let's try this.
They put them on high dosetestosterone and they would go
high to low.
It was an interestingcombination of testosterone.
They'd go 400 milligraminjection at the beginning of
the month while they had them onandrogen deprivation, so that
they would go from this highlevel bang down low.
And a significant number ofthem responded favorably.
(42:58):
The PSAs went down.
In some cases, the sensitivitytoward androgen deprivation
treatment was renewed.
So it's compelling, someevidence of the theory playing
itself out, but there is nothingthat I'm aware of that's in the
pipeline that looks at men thatare not castration resistant,
(43:19):
which may be a better place toapply it earlier in the course.
So it's incumbent upon me anddoctors like me to counsel
patients honestly and to trackthe results.
And that's what we're doing atIntellectual Medicine.
It's an observational cohort.
And all the men that enroll inthis protocol, we track them and
(43:41):
we're looking at PSAs, we'relooking at the MRI, we're
looking at the metastatic rate.
It'll be some time yet, butwe'll have that data and
hopefully that'll be widelypublicized and give people an
opportunity to see does thishave uh value?
If the if the results lookgood, that type of result may
then instigate a study.
(44:01):
The type of study you'retalking about would take you
know tens of millions and needsome evidence to help launch it.
Philip Pape (44:09):
Well, I appreciate the nuance.
Seriously, I the languageyou're using today is is
something I very much appreciatewith caution on on drawing
conclusions, which is what weneed to do, right?
It's a about falsification ofwhat is claimed to be true, not
proving something necessarilybeyond a shadow of a doubt.
I do the androgen deprivationtherapy.
I'm not too um familiar withit.
(44:30):
I know it lowers, does it lowertestosterone specifically?
Yes.
And then you're saying, like,why would people be doing that
and then add in testosterone?
Help me understand this.
Dr. Stephen Petteruti (44:40):
It's it's a it's a cruel thing to do to
any man.
You know, this is just so umit's called in the conventional
medicine, they'll sometimesrefer to this as androgen
annihilation.
They will crush testosterone aslow as they can make it go with
multiple drugs.
So there are drugs that willprevent the body from making
(45:00):
testosterone.
There are drugs that will blockthe receptor sites of the
testosterone, and often willcombine these drugs to get a
more thorough crushing oftestosterone level.
The theory behind that is thatit will help men live longer.
That theory is not stronglyvalidated.
(45:21):
The research on this is veryhard to do.
There are some studies, andI've read most of them.
The conclusions are hardbecause the patients are so
different.
Do they have metastatic to thebone?
Is it isolated to the pelvis?
You know, what was theirtestosterone?
So the consensus is that, hey,if we do this, they might live
longer at the back end.
(45:42):
But would they want to?
Are they gonna, is that lifegonna be one worth living?
You know, it's an easy thing tomeasure.
So there are studies that canshow statistically significant
increased uh survival when someof these modalities are applied.
When I say statisticallysignificant, it doesn't
(46:04):
necessarily mean it's clinicallyrelevant to that person.
There's a study called the taxtrial.
They looked at chemotherapy.
The conclusion wasstatistically significant
extension of lifespan comparedto placebo.
This was back in 2003.
When you read the study, theactual extension of life was
(46:26):
measured in weeks.
It's not like you got anotherfive years.
So you got to go beyond theheadline, kind of like the
women's health initiative,right?
People read abstracts and thenthey just draw a conclusion in
some cases.
And then you have to go beyondeven the conclusion.
If you live another, I don'tknow, on average, if it's
another 12 months, but you'regonna feel like blah, is that
(46:50):
worth it to you?
Uh you're willing to kind ofmake that deal.
It's not wrong, but it'ssomething that is optional.
Studies that look at strictlylongevity, I think they missed
the point.
You know, Philip, we're talkingabout vitality, about living
great.
And um that's what I advocatefor all my patients.
(47:12):
I don't want to see my patientswither ever.
You know, this idea of likeshuffling around with a walker,
God bless those people for theirpluck and their their uh sort
of grit.
But I don't want to be one ofthem.
You start now like you are, youknow, exercise, nutrition.
At the right time in life, youadd hormones.
(47:35):
Everybody should have hormones.
The only question is at whatage is when, yeah.
And then you live boldly, andwhen the end comes, it comes.
I don't know.
Philip Pape (47:44):
Yeah.
No, I hear you.
I so I'm turning 45 in a coupledays.
And uh I didn't I didn't reallyget into this lifestyle until I
was up almost 40.
And I I joke, or maybe notjoke, I'm pretty serious about
it that every year older I wantto get a year younger.
So I told my girls I'm turning35 tomorrow, and by the time I'm
50, I'll be 30.
And then from that point, I'mlike, I don't know if I can get
to be a 20-year-old again, butat least I've set things back to
(48:07):
a better baseline.
But uh just to end on apositive note here, then when we
think of all the things peoplecan be doing and should be
doing, which they should beanyway, probably.
What's the biggest hitter here?
It is it lifting weights?
Is it, you know, the themaintaining healthy body weight?
Yeah.
I mean, just just to givepeople thought of prior
prioritization if they're notdoing that today.
Dr. Stephen Petteruti (48:28):
Totally.
So if you're into thelifestyle, Philip, that you and
I espouse, that's how we definehealth, then yeah, uh percent
body fat, right?
You want to eat premeditatednutrition.
You do not eat based on hunger,you eat when it's time to eat.
You're fueling the machine.
I don't like fasting for mypatients, you're gonna shrink
muscle.
So I eat every three hours,whether or not I feel hunger,
(48:51):
because that's what fuelsmuscle.
You know, I'm 66 now.
By the way, happy birthday.
That's it's secret.
Um, so you do that.
And if you only have 20 minutesto exercise, skip the treadmill
and lift weights.
That's my clinicalrecommendation.
The practical application ispeople ask me often, what
exercise should I do?
(49:12):
And the answer is do the thingthat you like.
If you hate lifting weights,you don't have to do it.
But if you're asking me whichone has more evidence of benefit
regarding vitality, longevity,bone density, brain health, it's
strength training.
Philip Pape (49:28):
Yep.
Yeah, no, that's great.
And it's funny because I I Ihear that all the time about I
don't like lifting weights.
My goal is always to getsomeone to which type of lifting
weights will you like?
That that's like my inevitableconclusion for them.
That's just me.
Yeah, but I like I like yourpremeditated nutrition concept
for sure, which is planning,being intentional.
You know, it's it's not a whimor hedonism.
(49:50):
It's like we have goals,people, and and it's you're
gonna feel great anyway, muchgreater for the rest of your
life than you will by satisfyingsome short-term pleasure.
So and that's what it is aboutyou know, being a man and uh
going out there and being thebest you can be.
You remember uh Jack Lelane?
Yeah, yeah.
Dr. Stephen Petteruti (50:06):
Yeah, he was once asked, you know, how do
you learn to love exercise?
And he said, I don't.
He said, I love the result.
And that's another way to lookat it.
Philip Pape (50:14):
Exactly.
Dr. Stephen Petteruti (50:15):
You lift weights so that you can lift
your grandkids up, you liftweights so you can carry the
groceries up the stairs.
You do not buy that ranch andget off of the stairs because
you're anticipating withering.
You boldly go after it.
Philip Pape (50:29):
Boldly go after it.
All right.
So, with that, Steve, um, wherecan folks find you?
Because I want to send themyour way.
Dr. Stephen Petteruti (50:36):
No, thank you.
It's the intellectual medicinepodcast to be a great place to
connect with me.
I keep updates on prostatehealth, the protocol.
And by probably next month, mybook, uh Fighting Cancer Like a
Man will be coming out.
It describes the research I'vedone, the history of prostate
(50:56):
cancer, why we're stuck where weare, and what my alternatives
look like so that people canhave this available to them.
That'll all be coming out verysoon.
Philip Pape (51:06):
Okay, might when when this episode comes out, it
might be out.
So we'll see.
We'll include the podcast,we'll include fighting cancer
like a man.
I love that title, and I'mgonna be checking that out
myself.
Uh, Dr.
Petteruti, thank you so muchfor taking the time and teaching
us a whole lot of veryimportant things about health,
prostate cancer, being a man,uh, lifting weights, all of it.
Thank you so much for coming onWits and Weights.
Dr. Stephen Petteruti (51:27):
Thanks, Philip.
I really enjoyed it.
If you're a man over 40 who lifts weights and
wants to stay strong fordecades, your prostate health
might be the most misunderstoodrisk to your training and
hormones.
One elevated PSA reading.
That's all it takes for mostdoctors to push you toward a
biopsy.
And once you're on thatconveyor belt, the next step is
often treatment that potentiallytanks your testosterone and
(00:23):
muscle mass.
So the question we're answeringtoday is: how do you know when
prostate issues require abiopsy?
And is there a less intrusivediagnostic path that protects
both your prostate and yourphysique?
Today's guest who specializesin men's health and hormones,
and he will explain why thestandard approach to prostate
screening is broken and what youcan do about it for your
(00:45):
health.
You'll discover when elevatedPSA actually matters, when
biopsies are unnecessary, howcommon treatments affect muscle
and strength, and a proactiveprotocol to keep you training
hard well into your 70s andbeyond.
Welcome to Wit and Weight, theshow that helps you build a
(01:07):
strong, healthy physique usingevidence, engineering, and
efficiency.
I'm your host, certifiednutrition coach Philip Pape, and
today we're discussing prostatehealth and PSA testing.
If you're a man over 40, youmay have had a PSA test or been
told you should get one.
Maybe you've been told yournumber's high and you need a
biopsy right now.
But what if that's not thecase?
What if there's a better, lessdisruptive diagnostic approach?
(01:29):
My guest today is Dr.
Steven Petteruti, a boardcertified family physician and
host of the IntellectualMedicine podcast.
He has dedicated his practiceto men's health, hormone
optimization, and smarterapproaches to prostate care.
He's going to teach you whatthe PSA numbers really mean, the
choice between imaging andbiopsy, the effects of various
(01:51):
therapies on hormones andmuscle, and some steps you can
take right now to keep yourprostate healthy without
sacrificing your health orperformance.
To be clear, this is notmedical advice, but it is
information every man listeningneeds to understand.
Dr.
Petaruti, Steve, welcome toWits and Waits.
Great, Philip.
Thank you for having me.
So let's talk about this topic.
(02:12):
Um PSA or prostate health andthe blood markers that go along
with this are confusing.
And there's a lot of, I'll saythere's misinformation and
there's probably a lot ofentrenched uh information and
advice from generations ofhealthcare.
And I know we need to stay withthe times and understand uh for
men concerned about cancer,let's say, what is the
(02:34):
correlation?
What does the science say whenit comes to things we're
measuring, like PSA results andcancer?
Let's start there and then wecan go deeper.
Dr. Stephen Petteruti (02:43):
It's important to recognize PSA is
not a test for cancer.
It was never meant to be that.
It is a marker that you canfollow and its trajectory, its
direction can be helpful.
But there is no cutoff.
All the cutoffs that you readabout or that are published are
arbitrary and are just kind ofthrowing a dart at the board.
(03:05):
So when they tell men, hey,your PSA is above four and you
need a biopsy, that's made upscience.
There are men with PSAs of 30are totally fine.
So the thing I want youraudience to hear loud and clear,
you never need a biopsy.
I advocate they should never bedone.
And I'll expand upon that asthe conversation unfolds.
(03:29):
There's a reason why the PSA isentrenched, and there's a
reason why biopsies arerecommended.
It has more to do, Philip, withhistorical inertia than keeping
up with current technology.
If I can give you a quicksweep, maybe that'll illuminate
a bit, right?
So in the 1980s, there was noPSA, there was no MRI, there was
(03:50):
strictly the digital rectalexam where the doc would say,
well, it feels a littleabnormal.
I think you need a biopsy.
So now we've established thebiopsy as a standard.
The biopsy leads to a diagnosisof prostate cancer in some
cases, and then they jump to aprostatectomy, removing the
gland.
I mean, it seems logical.
(04:12):
Intuitively, it makes sense.
Cancer is in the gland, youtake the gland out, I no longer
have cancer.
Would that it were that simple.
Now we know there are severalstudies that have shown us that
taking out the gland doesn'tprotect you from cancer.
I know that sounds weird, butthat's what the data shows.
So you can get the glandremoved, men, you suffer all
(04:33):
that adverse consequence, andthen here comes the cancer
again.
What's going on?
Why?
And this is philosophy thatdrives it.
It's a lot having to do withwhat you've dedicated your own
profession to, right?
Live life robustly, guys.
Live vitally.
Don't do things that suck theenergy out of you unless there's
(04:54):
a compelling benefit.
So 1980s biopsies.
Then in the 1990s, a PSA comeson the scene.
And really nobody knew whatcould quite what to do with it.
You know, does this predictcancer?
Does it correlate?
For a while, it was not evenadvised to be done.
So the United StatesPreventative Task Force at one
point said, hey, don't botherdoing it.
(05:16):
Then they came about.
The urology community, and I ama family physician, so my
perspective comes from theoutside looking in.
And the urological communitysaid, Hey, you can't do that.
Men need this PSA test.
So it went back in the hopper.
Well, if there's a test,there's got to be a threshold,
and the threshold wasarbitrarily created.
(05:37):
Thus, we have a PSA threshold.
Now we have biopsies that arestill there.
Instead, we've got an MRI.
You have an elevated uh PSA.
You're nervous about it.
An MRI can be performed, looksat the anatomy.
It's kind of like a mammogramfor a man's prostate.
It gauges risk.
Nice study, not carved instone.
(05:58):
It is uncommon to have acompletely normal MRI past the
age of 50.
True.
Usually a nodule, there's gonnabe something in there, guys.
Here's another thing that'llhelp frame the conversation.
If you arbitrarily biopsied 100men off the street over the age
of 50, just biopsied everybody.
Half of them would haveprostate cancer cells.
(06:20):
Here's another variable thatyou need to reflect upon, guys.
In men over 90, they didcadaveric studies looking at
people who died of other causes.
The majority of them hadprostate cancer cells buried in
the gland.
Now that tells us, Philip, thatat some point, if we live long
enough, we may, we probably willdevelop cancer cells within the
(06:44):
gland.
It doesn't mean you need to godigging them out.
When you stick a needle intocancer, you disrupt it.
There's a capsule around theprostate.
It's like the rind on anorange.
And it contains the tissue.
It also contains cancer withinthe capsule.
If it stays in the capsule,it'll never hurt you.
(07:06):
So I have a philosophy of, youknow, think twice.
If a urologist tells you youneed a biopsy, take a deep
breath, get another opinion.
The problem, of course, Philip,is they're all reading off the
same sheet of music.
Philip Pape (07:21):
Yeah.
Dr. Stephen Petteruti (07:22):
So for men with an elevated PSA, it's a
it's a horrible dilemma.
They're told that this could becancer, the biopsy is needed to
make the diagnosis.
Both of those are not fullytrue statements.
You can look at thingssequentially.
So the best use of a PSA,whenever you get it, that's your
base number.
So if you had a PSA tomorrow,Philip, and it came in at six,
(07:46):
the doctors are going to havekittens.
You take a deep breath, say,okay, let's check it again in
three months.
Now the PSA will vary.
If you went on a long bikeride, if you had sex, if you did
a heavy workout, it's going tobump up.
Philip Pape (08:00):
Because it's a protein, right?
It's the antigen we're we'remeasuring from the gland.
Correct.
Like we didn't even define whatit was exactly, but just that's
why it could vary.
Yeah, okay.
Dr. Stephen Petteruti (08:08):
That's correct.
The prostate-specific antigenis found almost exclusively in
the prostate gland.
And when you squeeze it, youooze out more of it.
So monitoring it over time canbe valuable and helpful and can
give men an opportunity to avoidunnecessary interventions.
Philip Pape (08:28):
Yeah.
So okay, I'm glad youestablished all that.
That's why I wanted to have youon here because a common theme
with a lot of areas of ourhealth and women's health too,
because I we have a lot of womenin our audience, we talk
hormones as well, is that somestudy or intervention or
individual in the healthcareindustry, like you said, in the
80s, did something and uh made alogical conclusion that there
(08:51):
was fallacies in that chain oflogic, even though it looks like
it's causal.
And then it led to, you know,going into uh texts, medical
texts and going into studies.
And we've had studies that havecompletely changed health
outcomes for the negative as aresult.
Like the women's healthinitiative we talk about has
made all women afraid of hormonetherapy when they shouldn't be,
(09:11):
right?
So with men, I'm we're I'm kindof hearing a similar theme.
And then when you go to thedoctor, you're trusting this
man, this person, man or womanto be the expert, right?
And of course, many of them actlike they know it too, uh, but
that's a separate issue inhealthcare.
Um, the idea that you couldactually be causing harm with a
biopsy is probably a surprise tomany because when you said you
(09:35):
may not, you actually don't needa biopsy ever, like that's a
very definitive statement versuslet's say in women's health
where you're like, well, youshouldn't, you don't necessarily
need a mammogram or necessarilyneed this or that because it
leads to more anxiety and issuesfor people that are low risk.
You're saying definitively,maybe we should never have a
biopsy because of that harm ofthe intervention past the sheath
(09:58):
that then disturbs the cancercells.
Is that the idea here?
Dr. Stephen Petteruti (10:02):
That is my that is my approach.
But look, put in the context,Philip, of philosophy.
Every man has to decide theircomfort level.
You know, my philosophy,Philip, is we fight cancer like
a man.
We do not sacrifice ourmasculine vitality out of some
false pursuit of comfort andlongevity.
(10:24):
Those two are a false choice.
So when a man sees theurologist, it can be compelling.
When they look him in the eyeand say, you could have cancer,
you need a biopsy.
Totally disagree with the withthe emphasis here, right?
It's an option.
It's not wrong to get one.
You have to go into it withyour eyes wide open.
The biopsy, you should men, youshould always reflect upon the
(10:48):
consequence of any test beforeit's done.
If the biopsy is done and if itshows cancer, what are you
going to do next?
You're going to let them takeout your prostate gland?
Again, that's not a wrongdecision.
It's one I would never do, andI don't recommend.
Why?
Because the studies havevalidated there are two studies
in the literature, one calledthe Protect T, the other one
(11:09):
called the Pivot Trial.
And they looked at men withprostate cancer.
And one group they had thegland removed, the other group
did nothing.
One study had a third groupthat had radiation.
Followed them out for 20 years.
And at the end of 20 years,they found that there was no
difference in the death ratebetween the groups.
And there was no difference inthe death rate from prostate
(11:32):
cancer.
That's very sobering.
Yeah.
40% of the men who get theirprostate gland removed end up
with a relapse.
Now, this is where it startsthe dominoes, the downward
spiral.
Man gets his prostate out.
This is a common scenario.
I felt great.
I went in for my exam, my PSAwas elevated, they did a biopsy,
it showed cancer.
(11:53):
I felt great.
It took out my gland.
Now I'm wearing pads every day.
My erection's never been thesame.
I don't feel right.
They robbed a vital part of me.
Then the PSA starts to rise.
And this is something I fullydisagree with.
They call it a biochemicalrecurrence.
You feel great, you have noevidence of metastatic disease,
(12:17):
but the PSA number is creepingup.
What do they do next?
They castrate you, they cut offyour testosterone.
Oh my goodness, what a horriblething to do.
Take away your life energy, thebrain gets weak, depression
happens, you developgynecomastia, man boobs, your
muscles wither.
(12:37):
It's a horrible thing to do toa human being.
And then the prostate cancer,when you go on testosterone
blocking therapy because of arising PSA, it's not curative.
The cancer, 100% of the time,is going to progress.
So you put all these factstogether, Philip, and you're
starting to wonder what are wedoing?
(12:58):
Yeah.
You have to start with how youwant to live, men.
What's your philosophy?
Because at some point we'regoing to die.
And when we die, if it's aprostate cancer, a heart attack,
or something else, I advocatefor what I call a horizontal
lifestyle, right?
You do things to maintainvitality.
Yes, you lift weights orstrength train.
(13:19):
Gotta do it.
You should never wither.
There's nothing biologicallyabout us that requires us to
wither before we die.
So I want you, me, and all yourlisteners to die in great
health after a short illness ata very advanced age.
It's like, hey, where's Dr.
(13:40):
Petrudy?
No, you didn't hear, man, hedied last night.
Oh, crap.
Just saw him yesterday.
He just croaked.
Philip Pape (13:45):
Yeah, I always joke, I want to croak doing a
deadlift when I'm, you know, 95or whatever.
Uh, I I literally just recordedan episode called something
like, you know, why now is theperfect time to start building
muscle.
It targeted more at thenarrative that you're too old,
you know, too old to start.
But I totally agree.
And our listeners would agreewith that.
And I want to get to thelifestyle piece, which again
will be not really a debate onthis show at all.
(14:07):
We're all going to agree withthat piece of it.
What I'm trying to understandhere, though, is this chain of
events, because I'm learning aton already.
The idea that taking out thegland doesn't remove the cancer
right there sets, you know, putsa massive roadblock in the
logic of, okay, then you've gotthe PSA results, which have to
be based on your personalbaseline.
(14:28):
If, let's say, your PSA goeshigh versus your baseline and
there are cancer cells, then wehave to think, okay, well, you
said every man gets cancer cellsanyway over time.
I mean, DNA mutates and getsdamaged, and everything we do
and consume and are exposed toover our lifetime probably
causes lots of cancer cellsacross our body in all areas.
So you're gonna get thatanyway.
(14:49):
So then when does it matter?
When do the PSA results matter?
And then when does the factthat you have cancer in your
prostate matter?
And then what do you do aboutit, if anything?
That's I think the nextquestion.
Dr. Stephen Petteruti (15:00):
Yeah, it's a it's an important
question, Philip.
And I like to designate thesecells as atypical dormant cells.
Philip Pape (15:05):
Okay.
Dr. Stephen Petteruti (15:06):
They're kind of sleeping in the
prostate, you let them be.
And there are things that canbe done.
This is a chronic lifestylemanagement.
And we talked before about isit okay to get a biopsy?
Is it okay to remove the gland?
Although I would never do it,and I don't advocate my patients
to do it.
It is okay if you're the typeof person who can't live with
(15:29):
the notion that these cells arein your body.
And some men are like that, youknow, they'll just drive nuts.
The uncertainty factor is thereno matter what path is is
pursued.
So the things that keep them,our job, like why do we not all
have cancer?
Our immune system, it's killingcancer cells every day.
So if those cells are withinthat capsule, the job is to keep
(15:52):
them there.
Cancer is like an opportunisticdisease, it's there lurking.
It's kind of like shingles.
That's a good analogy.
When we were kids, we hadchicken pox and then it went
away.
It's asleep.
Why does it come out later?
It never actually went away.
We never actually killed allthe virus, it's just kept in
(16:13):
check by the immune system untilthe immune system weakens to
the point where it becomesmanifest.
Same with cancer cells.
If you've ever had cancer, youare never cancer free, you're
tumor-free, the cells arelurking.
I don't want to creep peopleout, but we all have them.
So that's why you live everyday in a balanced, healthy
(16:36):
manner, maintaining immunefunction.
What ruins the immune system?
You don't sleep right.
That's one.
You're on certain drugs thatcan weaken it, steroids, for
instance.
Now, um, disease-modifyingdrugs are quite popular.
The biologic agents forpsoriatic arthritis and other
conditions, they can belife-enhancing, but immune
(16:57):
immunologically weakening.
A bad diet, stress, these areall variables.
Uh, an acute phase of yourlife, a spouse dies, you go
through bankruptcy.
These are opportunistic momentswhere you need to amp up your
own vitality pathway.
Exercise is really helpful, butyou have to be tempered.
(17:19):
I like your philosophy, Philip,of being, hey, you can achieve
all you need to achieve withoutgoing crazy and spending three
hours in the gym.
There's a tipping point wheretoo much, too intense, can
weaken the immune system.
So you have these cancer cellsthat are isolated within the
gland.
You don't need to biopsy them.
You do your PSA levelperiodically.
(17:39):
And my I've developed aprotocol to help men avoid the
biopsy and take another path.
And in my protocol, we do a PSAevery three months monitoring
levels.
We do an MRI typically once ayear to look at the anatomy.
We use repurposed drugs, andthese are prescription agents
(18:00):
that have been shown to haveanti-cancer power and
attributes, even though they'reFD approved for other reasons.
Many of your listeners may befamiliar with ivermectin, uh,
fenbendazole, mobendazole.
They have merit, guys, but becareful.
The online pathways areharmful.
(18:20):
These drugs are not meant fordaily consumption.
So in my protocol, we use themsporadically to emphasize
safety.
You don't cure prostate cancerby dying of liver failure,
right?
That's not a good outcome.
So the repurposed drugs are putin there.
How about lifestyle?
Most important variableregarding nutrition, percent
(18:42):
body fat.
Excess adiposity correlateswith increased risk of cancer
and cancer relapse.
That is settled science,unequivocal.
How you get there, whetheryou're a vegetarian, a
carnivore, uh organic eater ornot, how you get there is less
important than that you getthere.
(19:03):
Now, there are clearly foodsbetter than others.
And when I say food, Philip, Imean food, not junk disguised as
food, right?
So thoughtful diet, stressreduction.
If you're inclined, repurposedrugs guided by a physician, you
don't want to fly on the on theinternet.
This needs to be monitored.
Certain supplements can havemerit.
(19:25):
I like alpha lopoic acid.
I like zinc, about 30milligrams a day.
It concentrates in the prostategland more uh zinc per gram of
tissue than any other organ.
It also supports immunefunction.
Philip Pape (19:37):
Is that zinc with copper or just zinc?
Dr. Stephen Petteruti (19:40):
No, I don't like copper.
Okay.
All right, all right.
Because you mentioned it.
Copper is an essential ummineral, it's an essential
metal.
But there are two kinds ofcopper.
There's cupric and cuprus.
Cupras is what we find in food.
That's great for you.
Cashews, almonds, darkchocolate, etamame, you can find
(20:02):
it in your food.
The problem with supplements,Philip, is they often use cupric
or C2, which is a neurotoxin.
In fact, in Japan, they don'tallow you to have copper pipes
in your house because of therisk to the brain.
So I see this frequently.
I don't like any supplementwith copper in it.
I keep cashews.
It's not good to know everyday, just because the copper is
(20:25):
so good for well, immune andskin and all that other cool
stuff.
But um, yeah, zinc I like,alpha poric acid, and then N
acetylcysteine or NAC, which isa precursor to glutathione.
As we age, you know, we makefewer uh antioxidants, free
radicals tend to become moredominant, and that inflammatory
(20:46):
tilt can increase risk uh, youknow, kind of across the board.
So if you're a man listening tothis and you've had a biopsy,
don't panic.
You can't undo the past.
However, going forward,contemplate an alternative.
There's something out therecalled active surveillance, it's
a term that is used when theyfeel your type of cancer is
(21:10):
early and therefore they don'twant to subject you to the
trauma of prostatectomy.
And what they'll offer issequential biopsies staggered,
right?
This is patently illogical, inmy view.
You know you have cancer, andnow you're gonna stick, not and
it's not just a little needle,it's a trocar, and it's multiple
(21:32):
jabs.
It hurts.
I've listened to men who havehad complications from the
biopsy, hospitalizations due tosepsis, or loss of erectile
function or compromise thereofcan occur.
You stick in these bigtrochars.
But most importantly, it's afalse notion to think that you
can take a snapshot of theprostate in one moment in time
(21:54):
and predict the future.
And I've heard that saidthey'll tell they'll tell you,
well, we need to do a biopsy sowe can tell how aggressive your
cancer is, or how aggressive itmay be.
That's not true.
You tell aggression by a pointof change.
Your PSA was six, and now it's25.
That's a manifestation ofaggression.
(22:15):
What should you do then?
Right?
I just told you, don't take thegland out.
Worse than that is irradiatingthe pelvis.
That's a terrible thing to dothat causes immediate adverse
effect and delayed consequence.
Five years later, you ever geta sunburn, you feel rotten,
right?
It hurts.
And then 10 years later, youhave basal cell cancer from that
(22:36):
sunburn.
Radiation has a delayednegative consequence that ends
up with radiation proctitis.
You can't control your stool.
I've seen men 10 years laterliterally leaking poop all day
long.
It's horrible.
For what?
You know, so this leaves a thisis it's a problem, it's an
unsolved problem.
(22:57):
My um departure fromconventional recommendations is
not that the pathway I've uhespoused is proven beneficial.
We are still actively studyingit.
It has evidence of benefit, itdoesn't have proof, but it has
proof of not harming people.
Conversely, conventionaltherapies, prostatectomy,
(23:20):
radiation, absolute 100%unequivocal harm.
Benefit?
So I've heard my patients willsay, Well, the urologist told me
that there's no proof thatsticking a trocar in my prostate
can spread cancer.
Technically, it's an accuratestatement.
However, they never looked.
There's never been a study tosee if that's the case.
(23:42):
But there are, because I didthis research recently, Philip,
over 95 articles in the medicalliterature looking at what's
called needle tract metastases.
This is a known risk that wehave to balance against the
potential benefit.
So it's a hard space to livein.
It's worthy of being slow.
(24:04):
It's never, almost never anemergency.
Prostate cancer, even if youhave it, guys, it's a
slow-moving train.
So you have time to reallythink through it.
And depending on your age anddepending on your global health,
it will help you direct youraction.
If you're 75 and you've hadthree heart attacks, you know,
(24:25):
prostate cancer is not going totake you out.
Ironically, getting aprostatectomy and having
aggressive treatment iscorrelated with increased risk
of heart disease, dementia, um,other side effects.
I do want to mention thetestosterone link too, Phillips.
So let me know.
Philip Pape (24:43):
We'll get to it.
So I'm listening because I'mlearning so much here.
And the protocol you mentionedobviously doesn't sound uh super
unconventional when it comes togeneral advice for any
age-related disease or beinghealthy and living a long life.
In other words, lifestyle andstrength training and eating
(25:04):
well, supplementation.
Obviously, the repurposed drugsare kind of a unique thing that
we could get into.
But you mentioned just cancerin general.
I I percent body fat, Ibelieve, is linked to at least
13 cancers, something like that.
I forget the magic number,definitively through studies so
far.
And, you know, some peopledon't like to say that out loud
(25:26):
that you have this massivechoice in the matter through
your lifestyle to potentiallystave off cancer, but it's true,
right?
So the PSA and MRI, what I'mtrying to understand here is
where's the preventive piece ofthis?
And where's the, oh, now wethink there's some cancer that
could develop into somethingconcerning.
(25:47):
Is this something you startonce you get a diagnosis?
Or is this, I mean, lifestyleyou're going to do anyway, guys.
I mean, anybody listeningshould be doing those things.
But like the protocol youtalked about, when when does
that begin?
Dr. Stephen Petteruti (25:58):
That that's a great perspective,
Philip.
The protocol really starts withyou, with this, what you
advocate for people, right?
You live a low tox lifestyle.
You don't wait to get sick.
We're all aging.
My wife said to me once, hey,if if you knew you were dying,
would you regret anything?
And she mentioned it becauseI'm a I do a lot of advanced
(26:19):
anti-aging in my practice.
I'm on testosterone, I do somepeptides, I you know, I take
Cirrellimus, an anti-aging drug.
I thought I said, Yeah, no, no,I'm not going to be the guy
that clutches his chest, go intothe ground, says, Oh, I should
have walked and exercised, oryou know, the end comes.
What I want for everybodylistening is to have peace of
(26:42):
mind.
When you do all the thingsyou're talking about, Philip,
you control percent body fat, apowerful risk factor for cancer,
for heart disease, and guesswhat, gang?
Dementia.
You know, yeah.
I want all the things that areit correlates it.
There was a study showing theaccelerated brain atrophy in the
context of excess adiposity.
(27:03):
So you start there and youstart with taking charge of your
nutritional health and reallygot to peel away from uh the
average American sort ofpattern.
If you're eating like everyother American, that's
problematic.
If you if other people look atyou and say, you're kind of, you
know, your nutrition is kind ofweird, you're probably closer
(27:25):
to a good place.
Philip Pape (27:26):
Yes, I like that perspective for sure.
If you're weird with mostthings in life, you're probably
doing the right thing.
Dr. Stephen Petteruti (27:31):
Probably in a good place.
You know, we call that eatingabnormal, yeah, but healthy.
So yeah, percent body fat'scritical.
Now, if you're in that positionwhere you've got that high PSA,
you have the MRI.
Now, the MRI is gauged onsomething called a pyrad scale,
one to five.
And it's a subjective look atthe anatomy, and the radiologist
(27:51):
will say, Yeah, this one lookslike cancer, this one might be
cancer.
It goes one to five.
Five means, yeah, you probablygot cancer.
You got a PSA of let's say it's12.
You get an MRI.
It's a pyridge of five, butit's confined to the capsule.
No evidence of disease outsideof the capsule, the lymph nodes,
(28:12):
seminal vesicle.
You feel good.
That is not a panic moment,folks.
It's an opportune moment.
The idea behind the repurposeddrugs and the amplified
lifestyle.
Now, this grabs people'sattention, Philip.
You know, now they're reallymotivated.
They're going to lose weight,they're going to start eating
differently.
They're really researchingthis.
(28:34):
One of the problems that menand women run into, and you
probably noticed this yourself,Philip.
You go to the internet, it's ablizzard of information.
And then they go to theirdoctor and ask the doctor, what
supplements it look, I'm a boardcertified family doctor, as you
mentioned.
I was trained uh osteopathicmedical school.
I was in the army, did myresidency, and I've been in
(28:56):
practice for 30 years.
20 years ago, if somebody askedme about supplements, my eyes
would have glazed over.
Like, what?
I know nothing.
And doctors usually are limitedin their knowledge in the
space.
So that leaves you knowpatients kind of on their own in
many cases.
But there is a growing cohortof physicians, of advisors that
(29:18):
can help guide, not somethingthey want to do on their own,
right?
So the repurposed drugs in myprotocol, I really like this
approach.
It's proactive, it has evidenceof potential benefit, and it
has this safety feature of notcausing harm.
So we're applying about sixdifferent pharmacologic agents
(29:40):
in modest dosing.
Technical term for this iscalled hormetic, which means
drugs have different effects atdifferent doses.
So that which may seem kind ofweird to apply can actually be
helpful.
We're trying to create anenvironment in the body that is
inhospitable toward cancercells.
You got that pyrides of.
Five.
(30:00):
It's isolated to the capsule.
Now we're going to watch thatPSA.
It is go 12, 13, 14, 13 again.
That's a plateau you can livewith.
If it goes 12, 45, that grabsour attention.
Now we maybe look at that MRIagain and maybe modify the
(30:21):
treatment, but you never jumpthe gun.
There's no need to put needlesin.
I tell a man that has thatscenario I just described to
you, Philip, I'll say, look, yougot prostate cancer.
The lining up of the PSA in theMRI, in your age, and in some
cases your symptoms, are socompelling that even if you had
a biopsy and it came backnegative, nobody would believe
(30:43):
it.
Philip Pape (30:44):
There's no point, is what you're saying, yeah, to
the biopsy.
Dr. Stephen Petteruti (30:46):
Yep.
So don't subject yourself to astudy that is academic,
historical, and petrified in thestandard of care.
Look, docs are good people, butthey're human beings.
What do I mean?
They're worried aboutliability, they have time
pressure.
You see a urologist, I've heardthis often, you know, go see a
(31:09):
urologist, my PSA is elevated.
It says, okay, when do you wantto do your biopsy?
Surgeons, folks, they get paidto do things.
They don't get paid to talk.
And if you want to sit and chatabout your PSA with your
urologist for 30 minutes, it'sunlikely to happen.
So you really owe it toyourself to step away, get out
of the uh sort of the vortex ofintensity, give yourself time to
(31:31):
decompress and think a littlebit.
There are exciting new thingshappening in the field of
intervening for prostate cancer,one of which is actually giving
men with prostate cancertestosterone.
Philip Pape (31:46):
Okay.
Yeah.
I I want to talk about thatnext.
One quick thing is alcohol.
I just want to touch on alcoholreal quick.
Um, because there was this, youknow, the alcohol um cancer
study that was supposed to comeout, came out in 2022.
The Surgeon General wantedlabels on alcohol.
And then I believe uh thedietary guidelines were going to
be updated to suggest one drinka day instead of two drinks a
(32:08):
day can start to cause issues.
And I know certain cancers likecolorectal and breast cancer
have a link to very lowconsumption of alcohol.
Where does prostate cancer fitin on that spectrum?
Dr. Stephen Petteruti (32:22):
I laugh because it reminds me of Frank
Sinatra's famous quote.
He said, you know, those of uswho drink feel bad for those of
you who don't, because when youwake up in the morning, that's
as good as you're going to feelall day long.
But to answer your question,these are all um observational
studies.
The real answer is nobodyknows.
My dad was a physician.
He used to joke the definitionof too much alcohol is anybody
(32:45):
who drinks more than theirdoctor.
But in all seriousness, alcoholis a toxin.
Lots of things are toxins, butthey're pleasurable toxins.
We call that a hedonistic path.
We human beings, we do twothings without fail.
We avoid pain and we seekpleasure.
(33:06):
Avoid pain means don't die,seek pleasure means reproduce.
So modifying limiting alcoholis logical, it's good health,
it's good psychosocially.
You go beyond two drinks, badthings are gonna happen.
Not in the future, but thatnight and the next morning.
So that's self-evident.
(33:27):
But the idea that alcoholitself is a pure toxin to be
avoided at all cost is anexaggeration.
Some folks like to end theirday with a glass of wine.
There's no evidence ofcompelling harm.
If you're deprived, so wetalked a moment ago about
stress.
Stress can occur from adeprivation of pleasurable
(33:50):
endeavors.
And I've seen like I'll peopleask me about nutrition.
And sometimes when a man getsthis diagnosis, his wife or
partner becomes very engaged,says, You have to drink this
concoction.
And the guy's choking it down.
Oh, this is awful.
It's not good for you then.
It's a stress moment.
So where I come down on alcoholis um when you go above one
(34:14):
drink per day, you're entering agray zone.
When you go above two drinksper day, you are in a harm zone
fairly unequivoc inequivocally,unequivocally, without doubt.
Philip Pape (34:25):
Yeah.
Dr. Stephen Petteruti (34:26):
So that helps frame it out.
Um, but when my patients cometo me and say, should I go
alcohol free?
You can if you want, but youdon't have to.
You know, you have to livelife.
Philip Pape (34:38):
It's a matter of degrees, yes.
Yeah.
Okay.
Yeah, I just wanted to touch onthat.
All right, let's get intotestosterone.
So you said uh TRT could be agame changer here, could be the,
you know, one of the thingswe're not talking about, and
we're going to right now uh incontext of prostate health.
So lay it on us.
Dr. Stephen Petteruti (34:54):
Yeah.
Well, let's talk about thesettled science first, right?
Testosterone does not increaseyour prostate cancer risk.
That likely has been emphasizedin the past, and that is pretty
solid.
And testosterone is not gas onthe fire either.
So historically, we've beentaught, and this goes back to
Dr.
Huggins in the 1940s.
(35:15):
He won a Nobel Prize when hisexperiments correlated
testosterone deprivation withregression of prostate cancer.
Since the 1940s, that has beensort of the dogma.
You know, testosterone equalsprostate cancer.
It does not increase risk.
In fact, men with lowtestosterone levels have a
(35:37):
higher risk of developingprostate cancer than those with
higher.
That doesn't mean that going onreplacement therapy and
elevating your level will makeyou less likely to get it.
That's an unknown.
But it is pretty solid evidencethat it won't harm you.
So those of you that are ontestosterone, you ought not to
fear it with regard to yourprostate health.
(35:58):
And you ought not to fear itwith regard to prostatic
hypertrophy.
That also doesn't correlate.
It also does not correlate, andthis is pretty settled science,
Philip.
It does not increasecardiovascular risk.
So those studies were verycomforting to those of us who
have been on testosterone forabout 20 years, uh, those of us
that are using it to benefit, soyou can maintain that.
(36:18):
The research and the scienceabout testosterone in the face
of prostate cancer is rapidlyevolving.
And this idea that you cannever be on testosterone is
being challenged.
Dr.
Abraham Morgenthaler, in hisbook, Testosterone for Life, he
is uh a urologist, a real uhthought leader in this field.
(36:39):
And he has uh something calleda prostate saturation theory.
In essence, your prostate canonly hold so much testosterone,
and any extra testosterone willgive value to the organs, the
tissue, the brain, right?
We all know testosterone is aneurotransmitter, but it doesn't
(37:01):
adversely affect the gland,which is now sort of maxed out.
It's like a full cup of water,you keep pouring water in it,
you're not gonna get any more inthere.
There are studies that showthat when you go from a high
level of testosterone to a lowlevel, that it disrupts the DNA
of prostate cancer cells.
And that's called the bipolartheory of testosterone's effect
(37:24):
on prostate cancer.
Now, I want to be clear, thisis not standard of care, and
there are circumstances where itshould never be considered.
If you have prostate cancermetastatic to the bone, that has
to be controlled before anybodycontemplates this.
It is a consideration with eyeswide open when you make
(37:46):
judgments about philosophy,quality of life, and your
willingness to consider risk,simply put.
So I'll give you an examplefrom my practice.
Gentleman had prostate cancer,you know, before I met him.
He actually flew to Europe, hada high food procedure, high
intensity focal ultrasound.
Doesn't work.
I don't like it.
(38:06):
He came back and uh had still aprostate cancer.
At the time it was diagnosed,he was on testosterone and he
suspended its use.
And he felt awful.
His sex drive went away.
His brain wasn't working well.
He's an executive and he hadtrouble functioning in his job.
His PSA is 45.
He has prostate cancer.
(38:28):
And he said, Doc, you gotta putme back on testosterone.
This is no way for me to live.
So I said, Okay, you know, thisis science says that this is
not irrational.
The science says that this isreasonable to consider, but it
is also an unknown quantity.
It's possible that thetestosterone could accelerate
(38:51):
the cancer.
And it's likely at his stage,or the stage at which this
cancer is for many people, it'slikely the cancer will progress
regardless of what you do.
This comes to that, right?
The philosophy of regret.
My patient goes ontestosterone, he feels great,
but five years later the canceris metastatic to the bone.
That could happen.
He has to be comfortable withthat decision looking back,
(39:14):
knowing that he's he's at peacebecause he had this great window
of time with it.
On the other hand, he doesn'tdo testosterone, he continues to
feel lousy, and in five yearshe gets metastatic disease to
the bone.
He's saying, What did I just Icould have, I should have.
So the individual has toreflect upon it philosophically,
(39:35):
and then what I will do in somecases is a modified approach to
this.
You go three months high, andhere's the irony.
If I do this for men, you can'tdabble, you can't go low dose
testosterone, you have to gohigh dose because the delta, the
high to low shift is where wethink the benefit may be.
(39:57):
So you go a period with highdose, and then boom, you pull it
out.
High, low.
We're trying really to balancerisk and benefit.
You know, is this gonna harmyou to put you on testosterone?
We know the benefit is there,but what about the harm?
It's preliminary, and I'm stilltracking these cases, Philip,
but thus far I've got a clusterof men doing this type of an
(40:21):
approach.
And what I'm bearing witness tois stability.
I'm not seeing PSAs go throughthe roof.
I'm not seeing um, you know,the cancer go on haywire.
Um, there's an alpha patient,one of my pioneers, he had a PSA
of about 10.
He had a pyridge of four,meaning, hey, it's likely
(40:42):
cancer.
He was on testosterone.
He said, Look, I don't want abiopsy, but I do not want to
come off my testosterone.
I said, Okay, we're gonna dothis bipolar, we're gonna
monitor things closely.
2018, PSA of 10, pyrides offour.
2025, a PSA of 10, a pyrides offour while on testosterone.
(41:04):
Now, granted, it's a singularcase, but this is how new
evidence builds, and this is howwe acquire insight into other
ways we may be able to approachthis problem.
So out of the mainstream oftreatment is an option for some
men that are so inclined.
It really comes down to yourphilosophy.
(41:26):
And I want to emphasize, guys,it's not wrong to do the
conventional pathway.
The problem I have with theconventional pathway, Philip, is
the monopolistic sort ofone-note piano approach that I
see.
Philip Pape (41:39):
Like this is the only way.
Yeah.
Are there any controlled trialsdoing what you're talking
about, or or at least planningto observationally look at men
who've gone through this?
Dr. Stephen Petteruti (41:48):
Well, there are actually there are.
So they're not actually in thecohort that I'm discussing.
The bipolar uh research is umJohns Hopkins did this.
They uh applied this to men whohad prostate cancer, had the
gland removed, had the PSA godown, and then come back up
(42:08):
again, at which point they putthem on androgen deprivation
therapy, castration.
Philip Pape (42:14):
AD2, okay.
Dr. Stephen Petteruti (42:15):
When a man starts castration therapy,
androgen deprivation, 100% as Imentioned, it will advance.
When it advances, that's calledcastration resistant prostate
cancer.
Basically, that's the end ofthe road.
There's no treatment left thathas been shown to have merit.
So they took these men with atheory of bipolar testosterone
(42:37):
and they, hey, let's try this.
They put them on high dosetestosterone and they would go
high to low.
It was an interestingcombination of testosterone.
They'd go 400 milligraminjection at the beginning of
the month while they had them onandrogen deprivation, so that
they would go from this highlevel bang down low.
And a significant number ofthem responded favorably.
(42:58):
The PSAs went down.
In some cases, the sensitivitytoward androgen deprivation
treatment was renewed.
So it's compelling, someevidence of the theory playing
itself out, but there is nothingthat I'm aware of that's in the
pipeline that looks at men thatare not castration resistant,
(43:19):
which may be a better place toapply it earlier in the course.
So it's incumbent upon me anddoctors like me to counsel
patients honestly and to trackthe results.
And that's what we're doing atIntellectual Medicine.
It's an observational cohort.
And all the men that enroll inthis protocol, we track them and
(43:41):
we're looking at PSAs, we'relooking at the MRI, we're
looking at the metastatic rate.
It'll be some time yet, butwe'll have that data and
hopefully that'll be widelypublicized and give people an
opportunity to see does thishave uh value?
If the if the results lookgood, that type of result may
then instigate a study.
(44:01):
The type of study you'retalking about would take you
know tens of millions and needsome evidence to help launch it.
Philip Pape (44:09):
Well, I appreciate the nuance.
Seriously, I the languageyou're using today is is
something I very much appreciatewith caution on on drawing
conclusions, which is what weneed to do, right?
It's a about falsification ofwhat is claimed to be true, not
proving something necessarilybeyond a shadow of a doubt.
I do the androgen deprivationtherapy.
I'm not too um familiar withit.
(44:30):
I know it lowers, does it lowertestosterone specifically?
Yes.
And then you're saying, like,why would people be doing that
and then add in testosterone?
Help me understand this.
Dr. Stephen Petteruti (44:40):
It's it's a it's a cruel thing to do to
any man.
You know, this is just so umit's called in the conventional
medicine, they'll sometimesrefer to this as androgen
annihilation.
They will crush testosterone aslow as they can make it go with
multiple drugs.
So there are drugs that willprevent the body from making
(45:00):
testosterone.
There are drugs that will blockthe receptor sites of the
testosterone, and often willcombine these drugs to get a
more thorough crushing oftestosterone level.
The theory behind that is thatit will help men live longer.
That theory is not stronglyvalidated.
(45:21):
The research on this is veryhard to do.
There are some studies, andI've read most of them.
The conclusions are hardbecause the patients are so
different.
Do they have metastatic to thebone?
Is it isolated to the pelvis?
You know, what was theirtestosterone?
So the consensus is that, hey,if we do this, they might live
longer at the back end.
(45:42):
But would they want to?
Are they gonna, is that lifegonna be one worth living?
You know, it's an easy thing tomeasure.
So there are studies that canshow statistically significant
increased uh survival when someof these modalities are applied.
When I say statisticallysignificant, it doesn't
(46:04):
necessarily mean it's clinicallyrelevant to that person.
There's a study called the taxtrial.
They looked at chemotherapy.
The conclusion wasstatistically significant
extension of lifespan comparedto placebo.
This was back in 2003.
When you read the study, theactual extension of life was
(46:26):
measured in weeks.
It's not like you got anotherfive years.
So you got to go beyond theheadline, kind of like the
women's health initiative,right?
People read abstracts and thenthey just draw a conclusion in
some cases.
And then you have to go beyondeven the conclusion.
If you live another, I don'tknow, on average, if it's
another 12 months, but you'regonna feel like blah, is that
(46:50):
worth it to you?
Uh you're willing to kind ofmake that deal.
It's not wrong, but it'ssomething that is optional.
Studies that look at strictlylongevity, I think they missed
the point.
You know, Philip, we're talkingabout vitality, about living
great.
And um that's what I advocatefor all my patients.
(47:12):
I don't want to see my patientswither ever.
You know, this idea of likeshuffling around with a walker,
God bless those people for theirpluck and their their uh sort
of grit.
But I don't want to be one ofthem.
You start now like you are, youknow, exercise, nutrition.
At the right time in life, youadd hormones.
(47:35):
Everybody should have hormones.
The only question is at whatage is when, yeah.
And then you live boldly, andwhen the end comes, it comes.
I don't know.
Philip Pape (47:44):
Yeah.
No, I hear you.
I so I'm turning 45 in a coupledays.
And uh I didn't I didn't reallyget into this lifestyle until I
was up almost 40.
And I I joke, or maybe notjoke, I'm pretty serious about
it that every year older I wantto get a year younger.
So I told my girls I'm turning35 tomorrow, and by the time I'm
50, I'll be 30.
And then from that point, I'mlike, I don't know if I can get
to be a 20-year-old again, butat least I've set things back to
(48:07):
a better baseline.
But uh just to end on apositive note here, then when we
think of all the things peoplecan be doing and should be
doing, which they should beanyway, probably.
What's the biggest hitter here?
It is it lifting weights?
Is it, you know, the themaintaining healthy body weight?
Yeah.
I mean, just just to givepeople thought of prior
prioritization if they're notdoing that today.
Dr. Stephen Petteruti (48:28):
Totally.
So if you're into thelifestyle, Philip, that you and
I espouse, that's how we definehealth, then yeah, uh percent
body fat, right?
You want to eat premeditatednutrition.
You do not eat based on hunger,you eat when it's time to eat.
You're fueling the machine.
I don't like fasting for mypatients, you're gonna shrink
muscle.
So I eat every three hours,whether or not I feel hunger,
(48:51):
because that's what fuelsmuscle.
You know, I'm 66 now.
By the way, happy birthday.
That's it's secret.
Um, so you do that.
And if you only have 20 minutesto exercise, skip the treadmill
and lift weights.
That's my clinicalrecommendation.
The practical application ispeople ask me often, what
exercise should I do?
(49:12):
And the answer is do the thingthat you like.
If you hate lifting weights,you don't have to do it.
But if you're asking me whichone has more evidence of benefit
regarding vitality, longevity,bone density, brain health, it's
strength training.
Philip Pape (49:28):
Yep.
Yeah, no, that's great.
And it's funny because I I Ihear that all the time about I
don't like lifting weights.
My goal is always to getsomeone to which type of lifting
weights will you like?
That that's like my inevitableconclusion for them.
That's just me.
Yeah, but I like I like yourpremeditated nutrition concept
for sure, which is planning,being intentional.
You know, it's it's not a whimor hedonism.
(49:50):
It's like we have goals,people, and and it's you're
gonna feel great anyway, muchgreater for the rest of your
life than you will by satisfyingsome short-term pleasure.
So and that's what it is aboutyou know, being a man and uh
going out there and being thebest you can be.
You remember uh Jack Lelane?
Yeah, yeah.
Dr. Stephen Petteruti (50:06):
Yeah, he was once asked, you know, how do
you learn to love exercise?
And he said, I don't.
He said, I love the result.
And that's another way to lookat it.
Philip Pape (50:14):
Exactly.
Dr. Stephen Petteruti (50:15):
You lift weights so that you can lift
your grandkids up, you liftweights so you can carry the
groceries up the stairs.
You do not buy that ranch andget off of the stairs because
you're anticipating withering.
You boldly go after it.
Philip Pape (50:29):
Boldly go after it.
All right.
So, with that, Steve, um, wherecan folks find you?
Because I want to send themyour way.
Dr. Stephen Petteruti (50:36):
No, thank you.
It's the intellectual medicinepodcast to be a great place to
connect with me.
I keep updates on prostatehealth, the protocol.
And by probably next month, mybook, uh Fighting Cancer Like a
Man will be coming out.
It describes the research I'vedone, the history of prostate
(50:56):
cancer, why we're stuck where weare, and what my alternatives
look like so that people canhave this available to them.
That'll all be coming out verysoon.
Philip Pape (51:06):
Okay, might when when this episode comes out, it
might be out.
So we'll see.
We'll include the podcast,we'll include fighting cancer
like a man.
I love that title, and I'mgonna be checking that out
myself.
Uh, Dr.
Petteruti, thank you so muchfor taking the time and teaching
us a whole lot of veryimportant things about health,
prostate cancer, being a man,uh, lifting weights, all of it.
Thank you so much for coming onWits and Weights.
Dr. Stephen Petteruti (51:27):
Thanks, Philip.
I really enjoyed it.
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