On our show this weekend we are joined by special guest Chef Robert Tulco in a discussion of prostate cancer. We discuss his personal experience as a patient of Dr. Kasraeian as well as treatment options, symptoms and warning signs (or lack thereof!), and explain what some of the numbers in your laboratory tests mean to you. We will discuss the history of the recommendations for cancer screenings as well as Dr. Kasraeian’s recommendations, and talk about many of the supplements and prescription options for prostate cancer and some of the results of studies on those drugs.
Be sure to share any of our shows with friends and family you think may find them interesting or helpful! You may read a complete transcript of the show below.
Anneliese Delgado: Welcome everyone! It is now 5:06 and it’s time to get some good tips on The Conversation on News Talk WOKV, where health and wellness are explained. I’m Anneliese Delgado and I’m joined by our weekend expert, Dr. Ali Kasraeian, and our guest chef Robert Tulco. Welcome everyone.
Dr. Ali Kasraeian: Welcome back to Jacksonville, Anneliese.
Anneliese Delgado: Thank you!
Robert Tulco: Your name again is?
Anneliese Delgado: Anneliese.
Robert Tulco: Anneliese, I like that, Anneliese.
Anneliese Delgado: Thank you, thank you. It’s nice to be back.
Dr. Ali Kasraeian: How were your travels abroad?
Anneliese Delgado: I was actually in DC, so not too abroad, but I had a good time there. I was interning for two different organizations and now I am back.
Dr. Ali Kasraeian: Welcome back. Welcome everyone and thank you for joining us on The Conversation today as we kick off the day before prostate cancer awareness month. I am fortunate and we are fortunate to have back in the studio chef Robert Tulco, a good friend and the guy who got all this stuff started with, way back a year and a half into it or something of that nature? Welcome, chef.
Robert Tulco: My friend, I miss being on air with you. I miss being around with you.
Dr. Ali Kasraeian: This damn work thing gets in the way.
Robert Tulco: It is one of those things. It is just nice to be with you. And if you don’t know, folks, just what happened, I was diagnosed with prostate cancer approximately four days from now – the 27th of August I think it was, four years ago.
Dr. Ali Kasraeian: I think it was August 24th if memory serves.
Robert Tulco: August 24th, there you go. I just went back and four years ago, and Dr. Ali took out parts of my body and I am still missing a few. I don’t know if they are all in there or not but I think they are still in there. But the most important thing is the man saved my life. He really did save my life. I had prostate cancer and I was cool, like rolling down the highway. If you remember I was on TV and things were great, I had no symptoms, none whatsoever. I went in for my annual physical and guys, you need to do that. I’m sure ladies too – my wife is a doctor and Dr. Angela Martin, an OB/GYN doctor. And she says everybody needs to go in and get a physical every once in a while. I went in and you diagnosed that I had a high Gleason score?
Dr. Ali Kasraeian: You had a high PSA. So when you went for your regular screenings they checked the PSA and a rectal exam like everyone does and they found that the PSA was elevated. So that is how we met. And so with that we did a prostate biopsy and found that you had prostate cancer.
Robert Tulco: And guys, if you are afraid of this rectal exam and this biopsy thing, it doesn’t hurt. It’s not offensive. It’s something you need to have done. And I had a high Gleason, is that what you are saying?
Dr. Ali Kasraeian: Yeah, you had a higher risk prostate cancer. So when we discussed the various different options you were amenable to all of them because based on our imaging studies and things like that everything seemed to be confined to the prostate pre-surgery. So we spoke about all the different options and you decided to go the surgical route.
Robert Tulco: And I upset you an awful lot, didn’t I, after surgery?
Dr. Ali Kasraeian: I will tell you, it is interesting. To tell this whole story, as a physician, it is always very challenging and it is a big honor and a challenge to take care of friends and family of people that you know and respect and especially other doctors that you work with. Whether they mean to or not, at least for me, the pressure I put on myself not only when I do operations – it is higher. But with you and I, the very short time that we met beforehand, we struck up a good relationship. We got close, close. We got close quickly. So that becomes a challenge whenever you are considering the very different options because I hold myself to pretty high expectations of what I hold to myself but now it is someone you care about and Dr. Martin sitting outside of the operating room is very challenging.
Robert Tulco: My wife.
Dr. Ali Kasraeian: So with this there are a couple of things to kind of talk about. One, for you just like most men, it is not that you went and actively asked your doctor to get screened for PSA. It was just a routine thing that your doctor did. What do you think about what is going on now with all the controversies of whether or not to screen for prostate cancer? And it is very controversial. We have done shows on this in terms of where we reviewed the new recommendations for PSA screening and rectal exam being included in the PSA screening, which I think is very important. What are your thoughts in terms of screening someone who wasn’t actively pursuing a prostate cancer screening? It was something that your doctor did and it became something you are very passionate about now because you went through it. What would have happened if your doctor didn’t just do that? And now the expectation has become to have these in-depth discussions between the doctor and the physician of whether or not to screen. How dangerous could that possibly be in the vein where primary care doctors have a gazillion patients and very limited amount of time? What are your thoughts on that?
Robert Tulco: I think probably the most important thing out of all of this is peace of mind, my friend. I mean, not knowing and thinking I might be ill, or something hurts, or if you have some sort of erectile dysfunction, or whatever – trouble urinating. I didn’t have any of that.
Dr. Ali Kasraeian: And most people don’t – 90% of prostate cancer is completely asymptomatic.
Robert Tulco: And so I walked away from that era in my life thinking I’m going to do this – and as you know my birthday was July 31st and my birthday, gentlemen out there, I am 67 years old – I just went through dentist, dermatologist, cardiovascular guy. Because you know what? I’ve got a beautiful wife and an excellent family and a great golf game. I mean, I want to be out there. I want to stay there. I want to stay healthy and I am getting older, but I am not that old. I am getting older. You need to have this kind of stuff done if you want to continue to live. You are invincible and you are not invincible. And thanks to people like you and my general practitioner, Dr. Day, I am alive four years later. Who knows where the cancer would be right now, my friend. Now I understand there are some studies going on that says there is a wait and watch kind of thing. And if your Gleason scores are not very high and you sit back – again, with prostate cancer, I am a novice here. I just remember some stuff I read that prostate cancer is not a very fast-growing kind of thing.
Dr. Ali Kasraeian: So if you look at prostate cancer – there are a couple of things that are important for men to know when you go to your doctor for your regular screenings. Kind of pay attention to what your PSA level is. And we have some patients that actually keep a little record for themselves of what their PSA is.
Robert Tulco: What is PSA anyway?
Dr. Ali Kasraeian: PSA is prostate-specific antigen. So it is a lab test that you do to check for prostate cancer. So when you get that lab test and you do a rectal exam, if either one of those are irregular or if the PSA has changed erratically by more than a factor of 0.75 per year then we talk about doing a prostate biopsy. So when you do a prostate biopsy, that is aimed at figuring out the size of your prostate and using it as a guide to biopsy the prostate. Most of us do between a 12 to 14 core biopsy if we do it in the office or if it is the first time for a biopsy being done. Pretty well tolerated – people notice blood in the urine or blood in the stool for about a week or so. You may also actually notice blood in the semen for about 4 to 6 weeks. The risk of infection is about 5% to 6% and most of us give antibiotics beforehand and for a period of time afterwards. And a lot of us double cover with two antibiotics to minimize that risk. And then from that you come up with the stage and grade of your cancer. If you have a nodule it is a T2 cancer. If you don’t have a nodule and the reason that we did the biopsy was an elevated PSA it is a T1C and then you come up with a Gleason score like you are talking about. A Gleason score is when your pathologist takes a look under the microscope at the cells and assigns a number from 1 to 5 to the most common area, adds it to the second most common area, and gives you a total score. And the most common things we see are threes and fours. And the most common thing we see in terms of a total Gleason score is 6 or 7. Seven serves as a fence that divides aggressive cancers from less aggressive cancers. So 8, 9, and 10 is more aggressive cancer than 6, 5, or 4 and within the 7 if the 4 number is first it is a slightly more aggressive cancer than if the 3 number is first. Kind of like if all of us sitting inside the studio are 8, 9, and 10, the side of the door facing us is a 4. Everyone outside would be a 6, 5, and 4, yet the other side of the door would be a 3.
Robert Tulco: But in my situation I had no symptoms whatsoever.
Dr. Ali Kasraeian: And 90% or better of prostate cancer is completely asymptomatic.
Robert Tulco: So even if you think you are urinating correctly or whatever, that doesn’t mean anything.
Dr. Ali Kasraeian: Most of that is because of a big prostate, an enlargement called BPH, or benign prostatic hyperplasia.
Robert Tulco: Is that the reason you did a rectal exam?
Dr. Ali Kasraeian: The reason you do the rectal exam is you can potentially feel a nodule or a bump on the prostate.
Robert Tulco: So what is this about being swollen –?
Dr. Ali Kasraeian: So an enlarged prostate is BPH. So BPH is benign prostatic hyperplasia. If you think of your prostate as kind of like an orange – you have the outside rind, like the fruit, and that’s where cancer tends to live, on the outside portions of the prostate. The fruit itself is a growth that is noncancerous usually and it causes an obstruction. That usually causes the symptoms that people take medications for and things of that nature. And so when we do a rectal exam we are kind of feeling the back side of the prostate as it is budding and pushing into the rectum. And if we feel a nodule or a firmness that is an automatic prompt to do a biopsy, regardless of what your PSA is.
Robert Tulco: So that should be part of your annual physical, the rectal examination?
Dr. Ali Kasraeian: I believe so. And again, we can talk a little bit about the new screening guidelines. But in terms of your question for active surveillance, the time where we can monitor prostate cancer – there are prostate cancers that are low-volume and low-risk. And most of the time we look at PSAs that are less than 10, a Gleason score that is 6 or less, no more than one maybe two cores out of the 12 to 14 biopsies we did, none more than 50%. And another thing we look at also is a thing called a PSA density. So it is your PSA divided by how big your prostate is. So the idea with that is let’s say you have a PSA of 5 and your prostate is 20 grams that is a lot more significant than if your PSA was 5 and you have a 150 gram prostate.
Robert Tulco: And now when you say active surveillance, you are going in every three months? Every month?
Dr. Ali Kasraeian: So every three months we get a PSA and every year we do a repeat biopsy.
Robert Tulco: Oh, you do a biopsy again. Which, by the way was painless. That was a no-brainer.
Dr. Ali Kasraeian: How was your biopsy experience?
Robert Tulco: I don’t remember, to tell you the truth. I just remember laying on the table and you were inserting something into my rectum.
Dr. Ali Kasraeian: That sounds much more suspicious.
Robert Tulco: Believe me, it’s not a big deal. First of all, you have to have a little bit of an uncomfortable feeling to feel healthy. And so I don’t mind that kind of uncomfortable feeling. It’s like I just went to my cardiologist and I had a nuclear stress test, which sounds really bizarre, but when I walked out of there I was like if they find something, I’m going to be okay.
Dr. Ali Kasraeian: So for you the peace of mind of knowing what is going on is a lot more important than the potential small nuisance of the discomfort of the procedure.
Robert Tulco: And a lot of guys don’t realize that your wife is worried too but she is afraid to tell you to go because she knows you’re going to say, “I’m not going, I don’t want to go.” And you are going to have this big argument over it. So she is concerned also. So when you come home – I said to my wife, “I had this nuclear stress test and it seems like everything is okay, but we will find out.” And the doc said, “If it’s not okay, we’re going to fix it.” Well, if he fixes it I am going to live another 4 or 5 years. That’s a long time. I will be in my 70s then and I will be playing golf. Hopefully I won’t shoot 70 but I will be out there on the golf course. And that’s what I want to do, I want to live the rest of my life.
Dr. Ali Kasraeian: So the idea behind this stuff is you are trying to maintain and catch things early enough so that if an intervention is required it is a lot less invasive with a higher risk of benefit than if you wait longer, where the options of things we can do are less. And the challenge with prostate cancer screening is to try to catch things early enough where you can have discussions of possible acts of surveillance and if you need to do an intervention that you catch things while they are confined to the prostate. The challenge for prostate cancer becomes when prostate cancer emerges and it is already out of the prostate because we don’t have too many things that are definitively curative if that’s what going on at diagnosis. And then secondarily we want to make sure we minimize the side effects associated with the procedure.
Robert Tulco: I think the argument is not whether you should get screened or not, it is what should be done after you get screened, my friend. Don’t you think so?
Dr. Ali Kasraeian: I think that is the thing that gets missed in the argument.
Robert Tulco: And maybe you shouldn’t have surgery. Maybe it should be a watch and wait situation.
Dr. Ali Kasraeian: Yeah, I agree with you 100%. I think the challenge here is – and I say this all the time. I think not getting screened is like putting your head in the sand. You are going to miss the storm like we are having right now by not coming in and it is going to be too late. So I think over diagnosis is not the problem, it potentially may be overtreatment of cancers that don’t necessarily need aggressive treatment.
Robert Tulco: The other thing is finding a guy like you to take care of me. That’s the other thing, my friend.
Dr. Ali Kasraeian: And with that you have to make sure you have a good relationship with your physician, so make sure that you guys are on the same page and that you guys understand the conversation and that you have it in a way that both of you are able to have a relationship that is conducive to good health. And then you can both kind of engage in doing the things that you need to do.
Robert Tulco: Trust your doctor, that’s important.
Anneliese Delgado: Well, it’s 5:20 today. We have our guest chef Robert Tulco on The Conversation with us. If you have a question for Dr. Kasraeian you can call us at 904-340-1045. And we still have plenty of time left so stick around on News Talk WOKV.
Anneliese Delgado: Welcome back, this is Anneliese Delgado. You’re listening to The Conversation on News Talk WOKV. Thanks for staying with us. If you have a question for Dr. Ali Kasraeian you can call 904-340-1045. Let’s continue our discussion about prostate cancer.
Dr. Ali Kasraeian: So Anneliese, you had a question in the break?
Anneliese Delgado: Yes I did. You guys are talking about how important it is to get screened and tested. How early should be men get tested for prostate cancer?
Dr. Ali Kasraeian: Good question, and this may roll over into the next segment, but I will give you the history of this. So probably about 4 to 5 years ago the recommendation was for an average gentleman –
Robert Tulco: Before that though, when I went to the doctor for my annual physical, did he do a PSA and he didn’t tell me about it? So when I was 25, 35, and 45, he did it anyway, right?
Dr. Ali Kasraeian: Yeah, it’s a lab test.
Robert Tulco: I doesn’t hurt, it’s part of the blood thing, isn’t it?
Dr. Ali Kasraeian: You probably, at your age, and when all this stuff came about – you probably started screening at 50. So probably they saw a change, and they did see a change from your 63 to 64. So historically recommendations were to start screening at 50 and if you had a family history of prostate cancer or if you were an African-American gentleman (who have higher incidence of cancer and more aggressive disease at diagnosis for reasons unknown) the recommendation starts at 45.
Robert Tulco: So smoking, drinking, food, too much fat, too much fried chicken, it really doesn’t make a difference?
Dr. Ali Kasraeian: There really has not been anything that has shown that anything that people do that really consistently shows it increases your risk for prostate cancer. So that and the US Preventative Services task force said not to screen for prostate cancer at all – no PSA, no rectal exam, because they didn’t see a benefit and the harms of screening outweighed the benefit. On the cusp of that, the American Urological Association made a recommendation to start screening for prostate cancer regardless of race and regardless of family history. So everyone started with a PSA at 40 and based on that they were kind of vague on how often you screen.
Robert Tulco: Are these guys all urologists?
Dr. Ali Kasraeian: From the American Urologic Association, absolutely. The US Preventative Services task force, no, there were actually no urologists on the board or panel and there were actually no oncologists on the panel either.
Robert Tulco: That’s strange. I’m not going to say anymore.
Dr. Ali Kasraeian: So there was a lot of controversy with that. So the plot thickens even more because this year in May at the American Urological Association national meeting in San Diego the recommendation changed even more. A panel of experts were given the very difficult task of having level one evidence, so mostly randomized controlled trials and really comparative good, high-level studies to see what they recommend. And their recommendations, which we covered in the show right after that with Matt Cooperberg from the UCSF, University of California San Francisco, who is a very avid researcher and an expert in the field of prostate cancer and especially with screening issues. He is a big proponent of active surveillance and the genetics for prostate cancer. There we spoke about the recommendations where the AUA now does not recommend screening below the age of 40. They have stated there was no evidence to support screening between the ages of 40 and 54. They recommended people between 55 and 69 have shared decision making discussions with their physician about the risks and benefits of screening. And if they saw it was worthwhile to begin screening for prostate cancer with a PSA test and a digital rectal exam between one every year or every other year – and they actually recommend that every other year may do a little more effective job at catching more aggressive cancers and not just catching low-volume, low-risk cancers.
Robert Tulco: Tell me this – if you are diagnosed with prostate cancer what are the odds that you are going to get cancer someplace else in your body?
Dr. Ali Kasraeian: It depends on the stage and grade of your cancer. So if you have a low-volume Gleason 6 cancer with a low PSA the likelihood of you actually dying from your prostate cancer is very low. So based on that they also recommend not screening anyone over 70, who has a life span of less than 10 or 15 years because catching a prostate cancer that requires treatment may not be –
Robert Tulco: I’m only going to live until I’m 75, is that what you’re telling me? I want to live until 80 at least.
Dr. Ali Kasraeian: And that’s what our goal is. Our goal is to get people to live longer and live healthy longer.
Anneliese Delgado: Eighty? Let’s say 100.
Robert Tulco: A hundred? No, I don’t want to be greedy. What about drugs. Are there drugs that I should have taken or could have taken?
Dr. Ali Kasraeian: That’s a great question – did you plan that segment? When we come back to the next segment, there is actually a study that just recently came out looking at that we can discuss. Nice job, Chef.
Robert Tulco: Well you know, I have been doing this for a while.
Anneliese Delgado: And if you do have any questions you can call 904-340-1045. We’re getting ready for the second half hour on The Conversation on News Talk WOKV. News and weather are next, stay with us.
Anneliese Delgado: You’re listening to the second half hour of The Conversation on News Talk WOKV where health and wellness are explained. I am Anneliese Delgado and I am here with our weekend expert, Dr. Ali Kasraeian, and our special guest chef Robert Tulco. Thanks for staying with us. Now, before we get back into our discussion we had a caller who just told us that Powers Avenue is really flooded in that area, so make sure you drive with caution. I also see that 95 Northbound between Emerson and University Boulevard, all northbound lanes are blocked. That information is coming from the Florida Highway Patrol so it is really rainy out there, be sure you are driving with caution.
Now, let’s get back to our discussion about prostate cancer.
Dr. Ali Kasraeian: Thank you everyone for joining us on The Conversation today. I am in the studio with my good friend chef Robert Tulco and we have been talking about prostate cancer and kind of going over his story. And wonderfully we have kind of touched base on a lot of important issues in the world of prostate cancer diagnosis and management as we are going through this stuff. And one question Anneliese brought up was when to start screening. And I tell you, after doing all the prelude to it in the last segment, here are my thoughts on when to start screening. I think 45 is a nice balanced time frame to start screening for prostate cancer, even in face of the new recommendations from the AUA, which really say to think about starting to screen from 55 to 69. And here is why – a very elegant study was done by the guys from Memorial Sloan Kettering and a guy named Andrew Vickers is a statistician on the case on this study and he is very, very elegant in the statistics that he does. And they found that 21,000 men who were followed for their lifetime and had blood draws done in their 40s and kept in a freezer somewhere and kept over time. They went back and looked at their PSA levels and they found that the men whose PSA was in the top 10% of all PSA, so this number happened to be 1.5, 1.6. If you first PSA in your 40s was above that they found that it accounted for approximately 50% of the people who passed away of prostate cancer by 75.
So they did further statistics on that and they found that if someone has a PSA, that first PSA in their early 40s – and they kind of came up with this 45 age as the recommendation to start – if that PSA was less than 1, your likelihood of getting a prostate cancer that would eventually kill you was really, really low. If your PSA was above 1 then your chances were a little bit statistically higher so they recommended more frequent screenings. So based on that you can really personalize and do a really elegant job of screening for prostate cancer effectively to try to get prostate cancers that are probably going to require some kind of attention – whether it is active surveillance, whether it is an active treatment – through your lifetime and that can be medically sound. We won’t lose all the advantages we have had with prostate cancer screening, which decreases the risk of prostate cancer mortality by up to 44% or more. It decreases the risk of having metastatic diseases diagnosed by up to 75% in some studies. So let’s say you have a PSA of less than 1 at 45, maybe then we screen at 50. Then we screen again at 55 and based on that we can decide how frequently to screen in the future. If you have a PSA above 1 or if you have a family history of prostate cancer or if you are African-American, then maybe we start screening at 45 and continue to screen every year or two to make sure we don’t miss anything. That way I think you can be intelligent and you can be smart and you can personalize your prostate cancer management and your prostate cancer screening to you – to the individual.
Robert Tulco: Let me ask you this question, Dr. Ali, because I am sure there are guys out there listening to this and they are saying, ‘Well, maybe I shouldn’t have it done.’ In your history of being a urologist, tell me, is there an average age that you have taken out someone’s prostate?
Dr. Ali Kasraeian: To be honest with you we operate on people and we treat with radiation and HIFU and all these various different treatments, cryotherapy, and all these different treatments that are available. We treat through the spectrum of age. The things that are more impressive to me, especially with the recommendations that come up, is the amount of people in their 40s that get significant prostate cancer and that require treatment and that we treat. And if we didn’t screen for prostate cancer we wouldn’t catch them and they could potentially, if we started screening at 55 for example, it would be too late for those gentleman. And fortunately it is not something that happens every day but over the past year I can describe a not-insignificant number of 40-year-olds who have had significant Gleason 7 or higher prostate cancer that have required treatment.
Robert Tulco: Now, you don’t have to have your prostate removed like I did. There is a lot of other stuff you can do.
Dr. Ali Kasraeian: So there is active surveillance, if it is appropriate. You can do a surgical option where you actually remove the prostate. It is a definitive treatment. And then secondarily you can do radiation therapy options which are also aimed at –
Robert Tulco: And there are implants?
Dr. Ali Kasraeian: Yeah, you can do seed implantation. It is called brachytherapy where you deliver radioactive seeds into the prostate and try to deliver a focus of radiation therapy. That can be done alone or in concert with external beam radiation therapy where you deliver radiation from the outside using the guidance of imaging like CT scans and MRI scans. Proton therapy is another one. Cyber-knife is another treatment option for prostate cancer that is kind of a focused radiotherapy, so it is kind of like radiosurgery. For that we don’t have too many long-term studies with large volumes of patients so the American Urologic Association still is not hanging their hat on that one. So those are the gamut of the radiation therapy. You can do HIFU, which is using high-intensity focused ultrasound to deliver an ultrasound energy to prostate cancer. They are small volume.
Robert Tulco: I have another question for you – diet and drugs. Okay, I’m a chef and my first thought when I was diagnosed with prostate cancer is I am going to change my diet, maybe there is something I can do for that. The other thing is drugs – maybe there are some drugs that I should take or after I am diagnosed with it I should be taking another thing.
Dr. Ali Kasraeian: Very good. We will touch on both of those. One, a couple of weeks ago we spoke about the association between omega-3 and fish oil with prostate cancer. A study came out that was actually the third study to show a relationship between omega-3s and the incidence of prostate cancer. The most recent study showed that people that take high volume or high intake of omega-3s, which are things in fish for example, or if they take supplements – either way of coming into the high-intake group – had up to a 43% increased risk of prostate cancer. And they broke it down further and found a 44% increased risk of low-risk prostate cancer but up to a 71% increase in high-risk prostate cancer. So that is pretty significant and that was the third study that showed that. So the next logical question is what do they consider high intake of omega-3s? Well they found that if you had more than three servings per week of omega-3s or fish oil. So let’s say one serving of salmon is like 1,000 mg – so if you had more than three, such as four servings per week, that shot you into the high risk category.
Robert Tulco: It’s like anything. If you have one glass of wine a week and then you have six glasses of wine at night there is a big difference for sure.
Dr. Ali Kasraeian: So the interesting thing was they also found if you supplement, even as infrequently as every other day or every third day, that puts you in high risk. So up to two supplements, like oral medication supplements per week, put you in that high risk. So the author has recommended that if you are going to get your fish oil and omega-3 intake, which has been shown to have benefits in terms of memory, decreased dementia, cardiovascular implications, and some medications that are fatty acid or fish oil based or omega-3 based that decrease your cholesterol level. If you want to take those try to find the supplementation that you get in your diet – so do not take medicinal supplements for fish oil and omega-3. And that is the recommendation that the author came away with for this study.
Robert Tulco: I have a question for you. I see all these advertisements for supplements – as a patient, should I go to my general doctor and ask? How do I determine I should be taking it? Do I just make that decision on my own because someone I read in the paper took it? If it’s on the internet it’s got to be true, right?
Dr. Ali Kasraeian: Absolutely, on the internet they are 100% accurate. So with this the thing you have to look at is that for most of us even if you are taking something as simple as a multivitamin we don’t know where we are starting at. So with omega-3s if you want to be really intelligent to see what your actual need for supplementation is there is a fish oil index or a fatty acid index that you can ask your primary care physician about. It looks at where you are starting at to see if you even truly need supplementation.
Robert Tulco: And I think that is probably the most important thing. I often think about it myself as I am getting older. I see all these joint things I should be taking for this and taking for that and I don’t want to have this and I don’t want to have that. So I guess again it is another test – even though they are expensive I’m sure.
Dr. Ali Kasraeian: So with those things I think, in my personal opinion, there are no studies that have really shown any kind of benefit to any kind of supplementation that has been durable through study after study without knowing what your levels are beforehand and without having a doctor on board to make sure that you are monitoring what the levels of the supplementation are.
Robert Tulco: What about drugs? I mean, I take a little 81 mg aspirin and I went to the cardiologist last week or two weeks ago and he said, ‘Don’t worry about it, keep taking it.’
Dr. Ali Kasraeian: Aspirin has been shown to be beneficial for multiple things. It has cardiovascular benefits and increasing overall mortality. With regards to prostate cancer specifically, actually, a study came out recently that found that aspirin can potentially decrease the risk of prostate cancer; however, other non-steroidal anti-inflammatory medicines like ibuprofen, Motrin, or things of that nature did not show a benefit. So the finding her was that there was a decreased risk of prostate cancer among people who use aspirin when they compared to people who did not take aspirin.
Robert Tulco: But don’t you think we need to tell people that you need to talk to your doctor before you start taking it, right? Before you do any of this stuff.
Dr. Ali Kasraeian: I tell you with aspirin there was a really interesting study. We kind of know that chronic inflammation can have an implication in terms of the etiology of prostate cancer or being involved in developing prostate cancer, but we are not quite sure why that is. One thing they found is an enzyme called COX-2, or cyclooxygenase-2, which is involved in our inflammatory responses. It has been associated with prostate cancer when it has been over-expressed in prostate cancer. And high expression has been associated with poor prognosis with people who are prostate cancer patients. And so in the study coming out of Finland that was actually published in the European Journal of Cancer they looked at this and they found that aspirin specifically was associated with a decreased risk for prostate cancer.
Robert Tulco: One of the other things is we are talking about prostate cancer now but when I was diagnosed with prostate cancer you made me go and get an MRI and a CT scan. When I got the MRI they diagnosed an aneurysm.
Dr. Ali Kasraeian: Yeah that’s right, on your CT scan you had an aneurysm.
Robert Tulco: Right in my lower abdomen or something like that. I would have never known that if I had never gotten prostate cancer. You understand how this all kind of goes through?
Dr. Ali Kasraeian: I will tell you as your friend and has your doctor I think you are globally a lot more healthy now than you were when we first met because you are paying attention to a lot more things.
Robert Tulco: And mentally I feel so much more at ease because as I get older I am starting to worry more and more. So knowing that I have these things and I can watch out for them and have people like you and my cardiologist they are going to watch it also so that if something does happen or need to be changed it will be changed, which is really cool.
Dr. Ali Kasraeian: So tell me your question with the medication. They found that omega-3 increased the risk, vitamin E increases the risk. There is no effect with regards to prostate cancer with regards to selenium, vitamin D, sunlight, multivitamins, or even lycopenes, which are in tomatoes and had been associated with a decreased risk so it could be helpful. But they didn’t really find any benefit for that. One other medication, and this is really interesting, is something just came out in the New England Journal of Medicine that is called the prostate cancer prevention trial. So with this there is a medication called finasteride or Proscar, which people take to shrink their prostate. Propecia – which is for the hair.
Robert Tulco: Yeah, I have seen that before.
Dr. Ali Kasraeian: So with this they found in a study published around 2003 that there was about a 25% decreased risk in the relative risk of prostate cancer with this medication; however, there was a slight increase risk of having a more aggressive prostate cancer in the arm of the study that took the medication compared to the people who didn’t take it.
Robert Tulco: You know, you are talking about aggressiveness. I remember after I had prostate cancer it put this little pellet in my stomach every six months.
Dr. Ali Kasraeian: Right. So for you, your cancer warranted getting hormone ablation, where you get a shot that brings on testosterone level to kind of decrease the risk of recurrences and things of that nature.
Robert Tulco: So if you have high levels of that is that another reason why?
Dr. Ali Kasraeian: No, but they found with testosterone – which is another controversial thing in terms of testosterone supplementation in the face of prostate cancer. Most people that are floating around with normal testosterone levels aren’t increasing their risk of prostate cancer; however, if people have either one of the first go-tos for prostate cancer of the lymph nodes or prostate cancer in other places or if they are high-risk disease with certain different treatments, yeah bringing the testosterone level down for a period of time confers into less risk of recurrences in the future.
Robert Tulco: And I remember the side effects of that, some kind of weird stuff.
Dr. Ali Kasraeian: Hot flashes.
Robert Tulco: Gray hair – I mean, really, my hair was very soft and wavy. I mean, there were some pluses. I didn’t have to shave so it was really great.
Dr. Ali Kasraeian: Well good, I’m glad we helped you. So in the study with Proscar they actually followed it and they recently published a follow-up on it, following these guys for 18 years. And they found that very interestingly there was a 30% decreased risk in prostate cancer with people that took finasteride or Proscar. It helped decrease the risk of prostate cancer. There was a 40% decreased risk of low-grade prostate cancer and the reason that it is not being used as a chemo prevention for prostate cancer is that they did find an increased risk in more aggressive, Gleason 8, 9, and 10 prostate cancer in the people who took the medication. In this one they followed these people for now 18 years of analysis and they found the difference was only 0.5%. So the people that took Proscar had a 3.5% increased risk of more aggressive disease compared to the placebo. The people who took the sugar pill had a 3% increase, so it was not statistically significant. And the interesting thing about it is the overall mortality and prostate cancer survival regardless of stage of cancer and grade of cancer was exactly the same between the two groups. And that may be something that is revisited as chemo prevention. Right now it is taken for an enlarged prostate to help with urination.
Robert Tulco: Sometimes when I watch TV and the ads say if you have prostate cancer you shouldn’t take this.
Dr. Ali Kasraeian: And that’s all the risks and benefits analysis. I mean you really need to watch what you’re taking. Talk to your doctor about this stuff before you start.
Anneliese Delgado: Guys, we do have to take another break. Before we go, though, I am looking at our traffic max right now – 95 northbound between Butler Boulevard and Emerson is very congested. I am seeing delays and usually it only takes about 8 minutes from Butler up to I-10 and it is now taking 47 minutes so you definitely should use Phillips highway as an alternate. I will call Florida highway patrol on our break and see what is going on. Stay with us on News Talk WOKV.
Anneliese Delgado: Welcome back to The Conversation on News Talk WOKV. Thanks for listening. We have our guest, Dr. Ali Kasraeian, on the show and also our guest chef Robert Tulco. Thanks for joining us today.
Dr. Ali Kasraeian: So thank you chef for coming on. Any parting words for everyone?
Robert Tulco: I missed it. I missed the audience. People stopped me on Mondays and Tuesdays and say, “I heard you on the show, Chef.” So I look forward to it. Please, invite me back. I would be glad to.
Dr. Ali Kasraeian: You’re welcome anytime.
Robert Tulco: We used to do this gig called age before beauty. Naturally, you know I’m beautiful and you’re the old one.
Dr. Ali Kasraeian: So one thing as we go into this – I beat you to the punch. Running versus cycling?
Robert Tulco: It’s very simple. First of all, if you’re a cycling person you have to have lots of money because you have to buy a bike and a helmet and shoes and gloves and clothes. Now, if you run, you put on a pair of old sneakers, a T-shirt that says ‘I love America’ and you run for a couple of hours.
Dr. Ali Kasraeian: The studies show this – actually either one that you do is better than doing nothing. Running burns more calories. Cycling is a little bit gentler on the body with less injuries and things like that.
Robert Tulco: Well, I prefer running basically myself because if you run – I run with my wife, and she has this little running outfit that she wears. And I let her get ahead of me and she maintains the pace and I just follow along.
Dr. Ali Kasraeian: I guess it just depends who you are running with and who is running and cycling.
Anneliese Delgado: Exactly. Well, thank you Dr. Kasraeian for another great show. And thank you Chef Tulco for joining us. Thank you everyone for listening, and please join us again next week on The Conversation on News Talk WOKV. I am Anneliese Delgado, we will see you next week![End of Audio 0:52:59.2]