September 23, 2025 • 17 mins
Dr. David Lee sits down with Ryan Manno to discuss the comprehensive prostate cancer program at UCI Health. In this episode, they discuss everything from discovery to treatment, and even onto recovery.
For more details on Live Well With UCI Health, visit ucihealth.org/podcast
For more details on Live Well With UCI Health, visit ucihealth.org/podcast
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Episode Transcript
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Speaker 1 (00:00):
Hi, welcome to Live Well with UCI Health. I'm Ryan
Manno from Coast one of three point five and iHeartRadio.
Privilege to be sitting across today from doctor David Lee,
the director of the Comprehensive Prostate Cancer Program at UCI Health.
Speaker 2 (00:11):
Doctor welcome, Yeah, thank you, wonderful to be here.
Speaker 1 (00:14):
Let's talk about it, man, let's talk about prostates. I'm
right there. I'm like on that. I haven't gotten my check.
I'm forty four.
Speaker 2 (00:20):
Okay, kay, am I in the window. You're getting to
the window, Okay.
Speaker 1 (00:25):
And no.
Speaker 2 (00:26):
It's a great point to start off with because prostate
cancer is the most commonly diagnosed cancer in men in
the United States, and it's still the number two cancer
killer of men in the United States. But if we
catch it early, it's highly treatable. We do a really
good job of curing the guys from their cancer, which
is great news. But the way that we can detect
(00:47):
it earli is to screen. Yeah, and the screening method
that we use is it's a simple blood test. It's
called a PSA and men should start at some point
getting it once a year and you can just throw
it in with the other lab where that you normally
get and much more commonly we recommend starting around age fifty.
Speaker 1 (01:06):
What do men need to know about this disease? Because, look,
I think, as a man, and you know you're a man,
I think there's a tendency for men to bury their
head in the sand a little bit when it comes
to things we don't want to know. So what is
it about prostate cancer that we do need to know? Obviously,
you mentioned it's the second largest cancer diagnosis, what behind
lung cancer?
Speaker 2 (01:24):
Yeah, so most commonly diagnosed is prostate but yeah, lung
cancer is the most cancer.
Speaker 1 (01:30):
So what would you just tell, you know, a man
that doesn't really know much about this disease.
Speaker 2 (01:35):
It's really important that men know that it's not nearly
as scary as what it used to be, because prostate cancer,
for a long time, I think, was something that crept
up on guys and we didn't catch it very early,
and then guys would then die of their prostate cancer,
and then it was kind of this slow, painful death unfortunately,
(01:58):
because it spreads to the bones, and if we were
able to catch it early enough, then surgery was often
the recommended treatment option, but many guys would experience a
lot of side effects. Related to that, like what like
urinary leakage, issues like difficulty with sexual function, and then
just the surgery itself. It took a long time to
(02:19):
recover from that because it used to be done through
a big incision through the lower abdomen. So then this
created a lot of stories in the past the men
who underwent surgery and had a really rough time. But
fortunately as time went on, we would do a better
and better job of doing the surgery. But now the
current state of the art surgery is a robotic assisted
(02:43):
radical prosetectomy, and so by offering this type of surgery,
guys can have a lot better recovery in kind of
all of the important ways getting back to all their
normal activities, getting good urine control back really very quickly,
and the longer term, getting good sexual function back. So
(03:03):
the treatment options aren't nearly as scary as what they
used to be, and we can talk about some of
the other ones here in a few minutes. But then
the other thing to know is what we talked about screening.
There are no other symptoms that happen early enough to
catch it at a curable stage. Once the guys start
having symptoms from prostate cancer, often it's too late, it's
(03:24):
already spread. And then so by doing the PSA and
doing that on a regular basis, then we can catch
it actually years before it would potentially spread in a
really high percentage of the guys. So, yeah, take home message,
get screened. It's super important and it saves lives.
Speaker 1 (03:43):
Yeah, that's good, that's great. Pardon my ignorance, but what
does PSA stand for? Prostate screening?
Speaker 2 (03:48):
Very close? Yeah, so it's prostate specific antigen. So antigen
just means protein. So it's a blood test that detects
that protein in our blood and it can de TechEd
it very you know, on a very low level in
the blood. But then as that goes up, it is
something that can be a sign of procesa cancer. However,
(04:10):
you know, there has been some controversy about it because
PSAs can go up for several different reasons, including infection.
Sexual activity can make it go up temporarily, and so
there are some people who have kind of recommended to
not get PSAs.
Speaker 1 (04:29):
But you say, you say, get them.
Speaker 2 (04:30):
Yeah, absolutely, Yeah, there there are really good longer term
studies which show that the guys benefit and PSA screening
saves lives.
Speaker 1 (04:40):
Yeah, you mentioned just you said, well, we'll touch on
this in a minute, and here we are, so so
talk to me about the comprehensive prostate cancer program, your
program here at USA Health. What services are we talking about.
What do you guys offer.
Speaker 2 (04:50):
I think comprehensive is the key word. Yeah, we really
offer the state of the art everything. Important aspects are
diagnosis and so once somebody has an elevated psa years
ago it just meant going straight to a proseate biopsy.
Now we have a lot of other diagnostic tools which
help us to weed out some of the guys who
(05:11):
may not need a prostate biopsy, which you know that
in and of itself can be a little bit scary
to get a prostate biopsy. The way that we perform
the biopsy now is actually much more accurate and much
lower risk. Because there was a risk of infection associated
with prostate biopsy, we really don't see that anymore, which
is which is great. Then we go on. Then if
(05:35):
somebody has a diagnosis of prosely cancer, we offer all
the different treatment options that are related to prosely cancer,
including surgery, which we just touched on a little bit,
radiation therapy, medication, therapy, focal therapies which treat just part
of the prostate, as well as active surveillance which is
a really good option for some men if they have
(05:56):
a small amount of slow growing procesealy cancer. We have
all of the latest in the imaging tools such as
psma pet scans which really are much more sensitive than
what we used to use in the form of cat
scans and bone skins in order to detect spread. And
then we have a careful follow up and survivorship program
for the guys to help them and their recovery of
(06:18):
side effects after any of the different treatments and to
monitor them very closely in relation to possible recurrence.
Speaker 1 (06:25):
Yeah. So you can brag on yourself a little bit here,
all right, Well, you're a world leader in a nerve
sparing technique. Yes, And in a lot of cases this
allows guys men to have this procedure and go home
the same day. Yes, talk to us about this.
Speaker 2 (06:39):
It's something which goes hand in hand with it not
being as scary as what it used to me. Yeah.
Speaker 1 (06:45):
I like the sound of that, Yeah exactly.
Speaker 2 (06:46):
So with the old open operation, guys would stay in
the hospital two to four days. Now we send guys
home the same day. With the robotic surgery, guys usually
can go back to playing golfer, tennis, running swimming in
three weeks after the robotic surgery. That used to be
three months for some of the gas after the open surgery,
(07:06):
and so the recovery is much much faster. But then
the nerve sparing aspect that really helps the guys then
to regain their urine control and their sexual function much
so with the help of the robotic technology, our vision
is much better, our tools are much more maneuverable. And
then working in the pelvis where the prostate sits all
(07:28):
the way at the bottom, it can be really difficult
to see even when you make a bigger incision. With
the robotic technology, we can drive our lens all the
way down to the prostate and then see around the corners.
And then we have really remarkable tools which can help
us to maneuver around all of the corners of the
prostate and help us to push away the nerves gently
(07:50):
as we're taking the prostrate out. And then if we
can do a really good nerve sparing and not traumatize
the nerves, then the guys do really well with the
urine control and sexual function.
Speaker 1 (07:58):
That's awesome. Who would you say would be the right
type of candidate for that particular surgery.
Speaker 2 (08:04):
So nerve sparing we offer to all the guys if
the cancer allows us. Okay, sometimes the cancer unfortunately is
too extensive and then we have to get a wider margin,
which then could involve some of the nerves. But again,
these imaging techniques such as MRI really give us a
good roadmap going into the surgery so that we know
how much nerve sparing that we can do for each individual.
(08:27):
The robotic technology, I think that's the standard gold standard
of how we take out prostates these days because of
the advantages of the quicker recovery. But then, you know,
surgery may not be for everybody. Depending on what an
individual's health status is like they may be better served
or radiation may be more appealing for some of the guys.
And then again, if the guys have a small amount
(08:49):
of cancer, then we actually offer surveillance.
Speaker 1 (08:51):
Yeah, now you mentioned you know that these guys are
out playing tennis and golf and doing backflips and cartwheels
and stuff like, you know, maybe three weeks, but what
about like long what long term diagnosis for something like this.
Speaker 2 (09:01):
Yeah, so the long term prognosis of prossly cancer is
excellent if we're able to catch the cancer early. Yes.
So one important piece of information that we get from
the biopsy is the Gleason score. So the Gleason score
is the reflection of how quickly the cancer is going
to grow, and so we can break it down into
lower risk or intermediate risk or high risk prossly cancers.
(09:24):
And especially with the high risk prossy cancers, if we
can catch it early and it's confined to the prostate,
then the guys will do really well. But unfortunately, the
higher the risk the cancer cells are, the more likely
that it is to spread. And then so we do
see that for the higher risk guys that they do
have higher chances for spread. And then that's where a
(09:46):
lot of the radiation as far as a potential backup
after surgery comes into play. And then for guys that
we do find it's spread already at the time of diagnosis,
which we do see unfortunately because guys don't standardly get
PSAs across the country, then the hormonal therapy and chemo
therapies are available to help those guys.
Speaker 1 (10:08):
And we don't want it to get to that point ever.
Speaker 2 (10:09):
But we never wanted to get to that point.
Speaker 1 (10:11):
No, we don't. Why are men that are diagnosed with
prostate cancer seeming to take like a watchful waiting approach.
Speaker 2 (10:18):
Yeah, so it's appropriate in certain guys if we find
a small amount of slow growing prostate cancer, but we
have to be really mindful of what their overall health
picture looks like as well as what the cancer looks like.
So if somebody's on the younger and healthier side and
they're going to be around another twenty or thirty years,
(10:40):
then being more aggressive and giving them a better cancer
treatment outcome such as surgery I think really serves them well. Again,
if some of the guys don't have that aggressive disease,
then keeping an eye on it and then only acting
on it if it changes, that can be really appealing
(11:00):
way to go.
Speaker 1 (11:01):
Let's walk through this in a real life approach. Let's
say a guy goes in and you do find elevated PSA.
What is step one from there?
Speaker 2 (11:10):
So often we'll just recheck the PSA because PSA can
fluctuate up and down just on a daily basis, and
so just double checking and making sure that there wasn't
a lab error. That's the first step. If the PSA
truly is elevated, then we'll do some of these other
diagnostic tests. There are other types of blood tests than
(11:30):
a coupled urine tests which are available which can help
sort out the picture. But the key next step is
to do an AMRI of the prostate. AMRII gives us
a really beautiful picture of the prostate, how big the
prostate is, as well as sometimes suspicious looking areas. If
we see a suspicious looking area, then the AMRI can
be used as targeting then for our biopsy. Got it
(11:53):
because sometimes they're not located in the standard area and
if the prostate sometimes is really enlarged, then and doing
a standard biopsy where we're just randomly sampling may not
reveal the cancer. So then that MRI is really key
for targeting and making sure that we're hitting the right areas.
Speaker 1 (12:11):
What causes prostate cancer.
Speaker 2 (12:13):
So there are genetic factors. So there are some guys
who have gene changes like the BRCA gene, which can
predispose women to breast cancer. It also predisposes men to
prostate cancer. African American men have a higher risk of
getting prostate cancer as well as more aggressive forms of
(12:34):
prostate cancer. Guys with the family history they have a
higher risk of developing prostate cancer. But then there are
definitely things that we do in our lifestyle which can
help make a big difference. And so having a healthy diet,
exercise program, stress reduction and all of these things play
a really important role in helping us to live healthy
(12:55):
lives but also to reduce our cancer risk.
Speaker 1 (12:58):
So to some degree, would you say that it's preventable.
Speaker 2 (13:02):
I do think that process cancer is preventable, Okay, if
guys take really good care of and thoughtful care of
what they do, from how they eat, from how they exercise.
The diets that have been shown to actually improve that
risk the most are plant based diets, and so I
think that's an important message that if you do have
(13:25):
some aspects of some other risk factors, that these are
other things that other steps that you can take to
help improve the chances. And so we think so much
about this at UCI that we have actually recruited an
integrative urologist named Gary Dang. He came from New York,
but he's one of the world's authorities in lifestyle changes, supplements,
(13:49):
other types of exercise programs which can impact several different
types of cancer risk as well as your overall health.
And so he's a great recent source that I send
a lot of my patients to in order for them
to get the latest on that kind of information.
Speaker 1 (14:05):
Yeah, as an academic medical program, let's look into the future.
What are you guys working on? You know, I assume
you are exploring things to continue pushing this forward.
Speaker 2 (14:15):
Absolutely. Yeah. So I've done over seventy two hundred robotic
prositect me cases now so yeah. But the benefit of that,
I think is that we carefully study the outcomes of
these guys. So we get validated quality of life questionnaires
for all of our guys after surgery. We keep in
a database all their cancer information, their PSA information, and
(14:39):
we record a lot of technical information of what we
do during the surgery in order to keep making improvements
on how we do the surgery. Yes, I think that
actually optimizes our nerve sparing outcomes, our cancer margin outcomes.
And we have several studies ongoing trying to refine our
techniques to improve surgery. We have medical oncologists who were
(15:01):
working on different types of protocols with the hormone therapies
and chemotherapies in order to vest order these at the
right times in somebody's course of prostly cancer if it
has spread. And then we have some wonderful PhDs in
the lab who are looking at different aspects of prostate
cancer from racial differences and even down to the molecular level,
(15:25):
looking at how cancer cells can sometimes escape the normal
control methods that the chemotherapies provide and then find ways
even around that to better control prostly cancer. And so
it's a really exciting time and research and improving care
at the bedside from what we do in a careful,
(15:46):
thoughtful manner.
Speaker 1 (15:46):
That's great, And I can tell you're passionate about it,
and you know, I mean how rewarding for you. You get
to do this and help men live a better life,
live a longer life. Yeah.
Speaker 2 (15:54):
So you know, my dad was a urologist. I didn't
necessarily want to be here, eis going in to medical school,
but then as I looked around at all the different specialties,
I always really enjoyed doing stuff with my hands, and
so surgery is a really nice way to translate thatcause
you can actually do things for patients which can help
(16:16):
them live better lives. And then the whole prostate cancer
surgery arena. It's a very obsessive, compulsive type of thing,
kind of takes up a lot of your attention. But yeah, no,
I think it's worthwhile because that investment in your time
really pays off. It's a better patient though.
Speaker 1 (16:34):
And I bet your dad was pretty happy that you
followed in his footstuff.
Speaker 2 (16:37):
Yeah. I think my dad was happy, but he actually
always told me just do whatever you want. But my
mom is like, oh yeah, my son's are really successful surgeon.
Speaker 1 (16:46):
That's awesome. I love it. I love it. Okay, doctor Lee, listen,
we're gonna put a bow on this thing. But I
want you to talk to men right now. What is
the final message.
Speaker 2 (16:53):
Yeah, the final message is prostate cancer is very curable
if we treat it early. But we have to catch
it early in order to treat it early. So get
your PSA's really important to screen. It's a simple blood test.
It saves lives. The data shows that it's more impactful
for men to prevent processly cancer this than mimography is
(17:16):
for helping women with breast cancer. So get your PSA.
Speaker 1 (17:20):
Doctor Lee, thank you so much.
Speaker 2 (17:21):
Okay, thank you so much.
Speaker 1 (17:23):
Ucihealth provides exceptional healthcare. Visit ucihealth dot org for more information.
Hi, welcome to Live Well with UCI Health. I'm Ryan
Manno from Coast one of three point five and iHeartRadio.
Privilege to be sitting across today from doctor David Lee,
the director of the Comprehensive Prostate Cancer Program at UCI Health.
Speaker 2 (00:11):
Doctor welcome, Yeah, thank you, wonderful to be here.
Speaker 1 (00:14):
Let's talk about it, man, let's talk about prostates. I'm
right there. I'm like on that. I haven't gotten my check.
I'm forty four.
Speaker 2 (00:20):
Okay, kay, am I in the window. You're getting to
the window, Okay.
Speaker 1 (00:25):
And no.
Speaker 2 (00:26):
It's a great point to start off with because prostate
cancer is the most commonly diagnosed cancer in men in
the United States, and it's still the number two cancer
killer of men in the United States. But if we
catch it early, it's highly treatable. We do a really
good job of curing the guys from their cancer, which
is great news. But the way that we can detect
(00:47):
it earli is to screen. Yeah, and the screening method
that we use is it's a simple blood test. It's
called a PSA and men should start at some point
getting it once a year and you can just throw
it in with the other lab where that you normally
get and much more commonly we recommend starting around age fifty.
Speaker 1 (01:06):
What do men need to know about this disease? Because, look,
I think, as a man, and you know you're a man,
I think there's a tendency for men to bury their
head in the sand a little bit when it comes
to things we don't want to know. So what is
it about prostate cancer that we do need to know? Obviously,
you mentioned it's the second largest cancer diagnosis, what behind
lung cancer?
Speaker 2 (01:24):
Yeah, so most commonly diagnosed is prostate but yeah, lung
cancer is the most cancer.
Speaker 1 (01:30):
So what would you just tell, you know, a man
that doesn't really know much about this disease.
Speaker 2 (01:35):
It's really important that men know that it's not nearly
as scary as what it used to be, because prostate cancer,
for a long time, I think, was something that crept
up on guys and we didn't catch it very early,
and then guys would then die of their prostate cancer,
and then it was kind of this slow, painful death unfortunately,
(01:58):
because it spreads to the bones, and if we were
able to catch it early enough, then surgery was often
the recommended treatment option, but many guys would experience a
lot of side effects. Related to that, like what like
urinary leakage, issues like difficulty with sexual function, and then
just the surgery itself. It took a long time to
(02:19):
recover from that because it used to be done through
a big incision through the lower abdomen. So then this
created a lot of stories in the past the men
who underwent surgery and had a really rough time. But
fortunately as time went on, we would do a better
and better job of doing the surgery. But now the
current state of the art surgery is a robotic assisted
(02:43):
radical prosetectomy, and so by offering this type of surgery,
guys can have a lot better recovery in kind of
all of the important ways getting back to all their
normal activities, getting good urine control back really very quickly,
and the longer term, getting good sexual function back. So
(03:03):
the treatment options aren't nearly as scary as what they
used to be, and we can talk about some of
the other ones here in a few minutes. But then
the other thing to know is what we talked about screening.
There are no other symptoms that happen early enough to
catch it at a curable stage. Once the guys start
having symptoms from prostate cancer, often it's too late, it's
(03:24):
already spread. And then so by doing the PSA and
doing that on a regular basis, then we can catch
it actually years before it would potentially spread in a
really high percentage of the guys. So, yeah, take home message,
get screened. It's super important and it saves lives.
Speaker 1 (03:43):
Yeah, that's good, that's great. Pardon my ignorance, but what
does PSA stand for? Prostate screening?
Speaker 2 (03:48):
Very close? Yeah, so it's prostate specific antigen. So antigen
just means protein. So it's a blood test that detects
that protein in our blood and it can de TechEd
it very you know, on a very low level in
the blood. But then as that goes up, it is
something that can be a sign of procesa cancer. However,
(04:10):
you know, there has been some controversy about it because
PSAs can go up for several different reasons, including infection.
Sexual activity can make it go up temporarily, and so
there are some people who have kind of recommended to
not get PSAs.
Speaker 1 (04:29):
But you say, you say, get them.
Speaker 2 (04:30):
Yeah, absolutely, Yeah, there there are really good longer term
studies which show that the guys benefit and PSA screening
saves lives.
Speaker 1 (04:40):
Yeah, you mentioned just you said, well, we'll touch on
this in a minute, and here we are, so so
talk to me about the comprehensive prostate cancer program, your
program here at USA Health. What services are we talking about.
What do you guys offer.
Speaker 2 (04:50):
I think comprehensive is the key word. Yeah, we really
offer the state of the art everything. Important aspects are
diagnosis and so once somebody has an elevated psa years
ago it just meant going straight to a proseate biopsy.
Now we have a lot of other diagnostic tools which
help us to weed out some of the guys who
(05:11):
may not need a prostate biopsy, which you know that
in and of itself can be a little bit scary
to get a prostate biopsy. The way that we perform
the biopsy now is actually much more accurate and much
lower risk. Because there was a risk of infection associated
with prostate biopsy, we really don't see that anymore, which
is which is great. Then we go on. Then if
(05:35):
somebody has a diagnosis of prosely cancer, we offer all
the different treatment options that are related to prosely cancer,
including surgery, which we just touched on a little bit,
radiation therapy, medication, therapy, focal therapies which treat just part
of the prostate, as well as active surveillance which is
a really good option for some men if they have
(05:56):
a small amount of slow growing procesealy cancer. We have
all of the latest in the imaging tools such as
psma pet scans which really are much more sensitive than
what we used to use in the form of cat
scans and bone skins in order to detect spread. And
then we have a careful follow up and survivorship program
for the guys to help them and their recovery of
(06:18):
side effects after any of the different treatments and to
monitor them very closely in relation to possible recurrence.
Speaker 1 (06:25):
Yeah. So you can brag on yourself a little bit here,
all right, Well, you're a world leader in a nerve
sparing technique. Yes, And in a lot of cases this
allows guys men to have this procedure and go home
the same day. Yes, talk to us about this.
Speaker 2 (06:39):
It's something which goes hand in hand with it not
being as scary as what it used to me. Yeah.
Speaker 1 (06:45):
I like the sound of that, Yeah exactly.
Speaker 2 (06:46):
So with the old open operation, guys would stay in
the hospital two to four days. Now we send guys
home the same day. With the robotic surgery, guys usually
can go back to playing golfer, tennis, running swimming in
three weeks after the robotic surgery. That used to be
three months for some of the gas after the open surgery,
(07:06):
and so the recovery is much much faster. But then
the nerve sparing aspect that really helps the guys then
to regain their urine control and their sexual function much
so with the help of the robotic technology, our vision
is much better, our tools are much more maneuverable. And
then working in the pelvis where the prostate sits all
(07:28):
the way at the bottom, it can be really difficult
to see even when you make a bigger incision. With
the robotic technology, we can drive our lens all the
way down to the prostate and then see around the corners.
And then we have really remarkable tools which can help
us to maneuver around all of the corners of the
prostate and help us to push away the nerves gently
(07:50):
as we're taking the prostrate out. And then if we
can do a really good nerve sparing and not traumatize
the nerves, then the guys do really well with the
urine control and sexual function.
Speaker 1 (07:58):
That's awesome. Who would you say would be the right
type of candidate for that particular surgery.
Speaker 2 (08:04):
So nerve sparing we offer to all the guys if
the cancer allows us. Okay, sometimes the cancer unfortunately is
too extensive and then we have to get a wider margin,
which then could involve some of the nerves. But again,
these imaging techniques such as MRI really give us a
good roadmap going into the surgery so that we know
how much nerve sparing that we can do for each individual.
(08:27):
The robotic technology, I think that's the standard gold standard
of how we take out prostates these days because of
the advantages of the quicker recovery. But then, you know,
surgery may not be for everybody. Depending on what an
individual's health status is like they may be better served
or radiation may be more appealing for some of the guys.
And then again, if the guys have a small amount
(08:49):
of cancer, then we actually offer surveillance.
Speaker 1 (08:51):
Yeah, now you mentioned you know that these guys are
out playing tennis and golf and doing backflips and cartwheels
and stuff like, you know, maybe three weeks, but what
about like long what long term diagnosis for something like this.
Speaker 2 (09:01):
Yeah, so the long term prognosis of prossly cancer is
excellent if we're able to catch the cancer early. Yes.
So one important piece of information that we get from
the biopsy is the Gleason score. So the Gleason score
is the reflection of how quickly the cancer is going
to grow, and so we can break it down into
lower risk or intermediate risk or high risk prossly cancers.
(09:24):
And especially with the high risk prossy cancers, if we
can catch it early and it's confined to the prostate,
then the guys will do really well. But unfortunately, the
higher the risk the cancer cells are, the more likely
that it is to spread. And then so we do
see that for the higher risk guys that they do
have higher chances for spread. And then that's where a
(09:46):
lot of the radiation as far as a potential backup
after surgery comes into play. And then for guys that
we do find it's spread already at the time of diagnosis,
which we do see unfortunately because guys don't standardly get
PSAs across the country, then the hormonal therapy and chemo
therapies are available to help those guys.
Speaker 1 (10:08):
And we don't want it to get to that point ever.
Speaker 2 (10:09):
But we never wanted to get to that point.
Speaker 1 (10:11):
No, we don't. Why are men that are diagnosed with
prostate cancer seeming to take like a watchful waiting approach.
Speaker 2 (10:18):
Yeah, so it's appropriate in certain guys if we find
a small amount of slow growing prostate cancer, but we
have to be really mindful of what their overall health
picture looks like as well as what the cancer looks like.
So if somebody's on the younger and healthier side and
they're going to be around another twenty or thirty years,
(10:40):
then being more aggressive and giving them a better cancer
treatment outcome such as surgery I think really serves them well. Again,
if some of the guys don't have that aggressive disease,
then keeping an eye on it and then only acting
on it if it changes, that can be really appealing
(11:00):
way to go.
Speaker 1 (11:01):
Let's walk through this in a real life approach. Let's
say a guy goes in and you do find elevated PSA.
What is step one from there?
Speaker 2 (11:10):
So often we'll just recheck the PSA because PSA can
fluctuate up and down just on a daily basis, and
so just double checking and making sure that there wasn't
a lab error. That's the first step. If the PSA
truly is elevated, then we'll do some of these other
diagnostic tests. There are other types of blood tests than
(11:30):
a coupled urine tests which are available which can help
sort out the picture. But the key next step is
to do an AMRI of the prostate. AMRII gives us
a really beautiful picture of the prostate, how big the
prostate is, as well as sometimes suspicious looking areas. If
we see a suspicious looking area, then the AMRI can
be used as targeting then for our biopsy. Got it
(11:53):
because sometimes they're not located in the standard area and
if the prostate sometimes is really enlarged, then and doing
a standard biopsy where we're just randomly sampling may not
reveal the cancer. So then that MRI is really key
for targeting and making sure that we're hitting the right areas.
Speaker 1 (12:11):
What causes prostate cancer.
Speaker 2 (12:13):
So there are genetic factors. So there are some guys
who have gene changes like the BRCA gene, which can
predispose women to breast cancer. It also predisposes men to
prostate cancer. African American men have a higher risk of
getting prostate cancer as well as more aggressive forms of
(12:34):
prostate cancer. Guys with the family history they have a
higher risk of developing prostate cancer. But then there are
definitely things that we do in our lifestyle which can
help make a big difference. And so having a healthy diet,
exercise program, stress reduction and all of these things play
a really important role in helping us to live healthy
(12:55):
lives but also to reduce our cancer risk.
Speaker 1 (12:58):
So to some degree, would you say that it's preventable.
Speaker 2 (13:02):
I do think that process cancer is preventable, Okay, if
guys take really good care of and thoughtful care of
what they do, from how they eat, from how they exercise.
The diets that have been shown to actually improve that
risk the most are plant based diets, and so I
think that's an important message that if you do have
(13:25):
some aspects of some other risk factors, that these are
other things that other steps that you can take to
help improve the chances. And so we think so much
about this at UCI that we have actually recruited an
integrative urologist named Gary Dang. He came from New York,
but he's one of the world's authorities in lifestyle changes, supplements,
(13:49):
other types of exercise programs which can impact several different
types of cancer risk as well as your overall health.
And so he's a great recent source that I send
a lot of my patients to in order for them
to get the latest on that kind of information.
Speaker 1 (14:05):
Yeah, as an academic medical program, let's look into the future.
What are you guys working on? You know, I assume
you are exploring things to continue pushing this forward.
Speaker 2 (14:15):
Absolutely. Yeah. So I've done over seventy two hundred robotic
prositect me cases now so yeah. But the benefit of that,
I think is that we carefully study the outcomes of
these guys. So we get validated quality of life questionnaires
for all of our guys after surgery. We keep in
a database all their cancer information, their PSA information, and
(14:39):
we record a lot of technical information of what we
do during the surgery in order to keep making improvements
on how we do the surgery. Yes, I think that
actually optimizes our nerve sparing outcomes, our cancer margin outcomes.
And we have several studies ongoing trying to refine our
techniques to improve surgery. We have medical oncologists who were
(15:01):
working on different types of protocols with the hormone therapies
and chemotherapies in order to vest order these at the
right times in somebody's course of prostly cancer if it
has spread. And then we have some wonderful PhDs in
the lab who are looking at different aspects of prostate
cancer from racial differences and even down to the molecular level,
(15:25):
looking at how cancer cells can sometimes escape the normal
control methods that the chemotherapies provide and then find ways
even around that to better control prostly cancer. And so
it's a really exciting time and research and improving care
at the bedside from what we do in a careful,
(15:46):
thoughtful manner.
Speaker 1 (15:46):
That's great, And I can tell you're passionate about it,
and you know, I mean how rewarding for you. You get
to do this and help men live a better life,
live a longer life. Yeah.
Speaker 2 (15:54):
So you know, my dad was a urologist. I didn't
necessarily want to be here, eis going in to medical school,
but then as I looked around at all the different specialties,
I always really enjoyed doing stuff with my hands, and
so surgery is a really nice way to translate thatcause
you can actually do things for patients which can help
(16:16):
them live better lives. And then the whole prostate cancer
surgery arena. It's a very obsessive, compulsive type of thing,
kind of takes up a lot of your attention. But yeah, no,
I think it's worthwhile because that investment in your time
really pays off. It's a better patient though.
Speaker 1 (16:34):
And I bet your dad was pretty happy that you
followed in his footstuff.
Speaker 2 (16:37):
Yeah. I think my dad was happy, but he actually
always told me just do whatever you want. But my
mom is like, oh yeah, my son's are really successful surgeon.
Speaker 1 (16:46):
That's awesome. I love it. I love it. Okay, doctor Lee, listen,
we're gonna put a bow on this thing. But I
want you to talk to men right now. What is
the final message.
Speaker 2 (16:53):
Yeah, the final message is prostate cancer is very curable
if we treat it early. But we have to catch
it early in order to treat it early. So get
your PSA's really important to screen. It's a simple blood test.
It saves lives. The data shows that it's more impactful
for men to prevent processly cancer this than mimography is
(17:16):
for helping women with breast cancer. So get your PSA.
Speaker 1 (17:20):
Doctor Lee, thank you so much.
Speaker 2 (17:21):
Okay, thank you so much.
Speaker 1 (17:23):
Ucihealth provides exceptional healthcare. Visit ucihealth dot org for more information.
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