In this episode, Dr. Rena Malik, MD, is joined by urologist Dr. Stacy Loeb to tackle the topic of prostate cancer misinformation and ...

prostate-cancer-expert-explains-how-to-prevent-recurrence-amp-boost-erections-after-prostate-treatment

Prostate Cancer Expert Explains How to Prevent Recurrence &amp; Boost Erections After Prostate Treatment

I've seen some really scary stuff on social media you know even videos for injecting herbs into the prostate or things like that that are just like not even evidence-based they're not in the guidelines but yet you know these have a lot of views so I mean if something is being told to you that this is you know effective treatment with no side effects that is I'm sorry there is no treatment that has zero risk of side effects even the lesson based treatments still have a risk of side effects so I think number one if you're being told that this treatment has no risk of side effects that that is just not realistic unfortunately in 2024 for prostate cancer uh maybe one day we'll get there uh but we are not there yet um and you know I think some of the best ways to sort through this stuff is first of all to figure out who is the source of the information and not to just get your information from One Source you know cross referencing different you know uh trusted sources of information and also I think just seeing different types of doctors is really important for something like prostate cancer and most cases are not an emergency you do not have to get treated in the next week or two weeks even so you know there is time to take your time talk to different doctors get different opinions uh and it's so important you know for example you could see a urologist and a radiation oncologist and even a medical oncologist and just hear what everybody has to say about your case uh so there's no rush into this I think actually it's well worth taking the extra time to make sure that the treatment that you're going to get is the best one for you because we see a lot of treatment regret that is like people who uh think back like ooh if I knew what this could have been like I never would have done this and and that's really sad you know to have that situation and so making sure that you are as well informed as possible before you do anything is really key yes that is really good advice and I think taking your time for something like prostate cancer and this is not true for every Cancer but for prostate cancer taking your time and getting the advice of multiple disciplines and different types of doctors is going to be really beneficial um overall and just making sure that you cross reference like you said like there's um very good resources like the CDC and the Mayo Clinic has good content and um now on YouTube they have health verified sources so just sort of looking for sources that are trustworthy and reliable and and sort of not um falling into the Trap of looking for something that's like sounds amazing like no side effects 100% effective is is really important yeah and you know so in addition to some of those for prostate you know there's the Prostate Cancer Foundation has you know great educational content in fact they have a patient guide um that you can get through their website as well as stuff on YouTube and other social platforms um zero prostate cancer is another great organization uh they have a lot of content as well as support groups that can be very helpful and you know support is something that is really important uh going through this prostate cancer journey and they have all kinds of support groups for different types of people as well as partners of patients because this this condition can have a lot of impact for the partner as well and so it's nice that those kinds of resources exist um the Urology Care Foundation and is another group um who has a lot of good content that's trustworthy about prostate cancer so there are a lot of good things that are out there so that's not to say you know everything the internet is bad I think the internet is actually really wonderful for a lot of things about prostate cancer but you do have to be careful in terms of people who are newly diagnosed with prostate cancer are there certain lifestyle modifications that you recommend well really the same things in terms of preventing cancer you know so um eating more plant-based is very important for people who are diagnosed with prostate cancer we have a new paper coming out showing that the more plant-based you eat after you're uh treated for prostate cancer the less uh the better scores you had for erections urinary control and bowel function and so really important still these dietary factors so you want to you know avoid the meat and dairy and have as much as possible of plant-based food physical activity also really important uh so you know diet the uh physical activity guidelines for Americans are that people should be getting at least 150 minutes per week of moderate intensity physical activity so that's like you know let's say 30 minutes a day 5 days a week comes out to 150 minutes a week moderate intensity is where you can talk but you can't really sing so that's just sort of like a gauge of what the intensity should be like now if you do like more vigorous activity then you only need 75 minutes a week so if it's vigorous this means you can't really easily have a conversation or sing while you're doing this kind of activity so that would also be uh you know a great option and then in addition to the aerobic physical activity or the cardio you also want to be doing resistance training at least twice a week and so this is uh really what all Americans should be doing but very very important in cancer um because there's a lot of very wellestablished benefits from the physical activity in prostate cancer where it's been shown to increase people's energy and better quality of life uh during their prostate cancer Journey um another thing to consider is good sleep uh you know unfortunately sleep takes a big hit um after a prostate cancer diagnosis uh we did a big survey about a year ago of patients with prostate cancer and more than half had poor quality sleep and actually about more than two uh three quarters of their Partners have poor quality sleep and I think there's a lot going on here you know um prostate cancer treatments could affect you know sort of urinary patterns some patients with prostate cancer take drugs that cause hot flashes but then you know just other things like the um anxiety of having a Cancer and things like that so a lot of things can affect sleep but healthy sleep is also very important for you know good quality of life and so uh just something not to forget about sleep in there are there things things that potentially reduce the risk of biochemical recurrence or prostate cancer coming back after you've been treated are there things lifestyle-wise that can support that yeah so uh we have a new paper coming out also uh with uh the plant-based diet and showing that consuming more plant-based food reduces the risk of progression of prostate cancer and this is after people are diagnosed so it's never too late to improve the diet um there's also been study from this same um study population showing that brisk walking uh May reduce the risk of uh progression of prostate cancer or high-intensity interval training so you know physical activity very important so all these same things have you know are potentially beneficial in terms of reducing the uh risk of progression of the cancer that's really great that's really encouraging and you know guys if if uh if being plant-based means you have better erections after prostate cancer I mean I think that's a pretty good endorsement of of dietary change yeah well it's also associated with better erections in people who don't have prostate cancer so that was actually the impetus for the study because we published that about two years ago that people who ate more plant-based were less likely to get erectile problems you know to begin with uh however the prostate cancer population is a bit challenging because you know people have surgery or radiation for prostate cancer have some added challenges in terms of erection since those treatments may affect the nerves that are controlling the erection so above and beyond sort of the problems that contribute to erection issues in the general population things like you know obesity diabetes smoking uh prostate cancer treatment kind of gives this extra insult so it's nice to see that even in this population where there's some really additional barriers to good erections still the dietary pattern was significantly associated with better scores for erections so I think it's nice you know patients ask me all the time is there anything I can do and there is something that you can do and so I like this because I think it's nice to actually have a positive message because you know you don't want to feel hopeless uh we should have we have a lot of hope there is a lot that you can do to reduce the risk of progression and to have a better quality of life and so we should do it yeah yeah know and it you make a good point so you know typically you would think that a plant-based diet would only affect the blood flow aspects of erections and prostate cancer treatments often affect the nerves to erections but that is great because a lot of things that we do for people who have blood flow issues don't always work for men who have prostate cancer in terms of treatment so um that is really uh interesting and and great information yeah thank you yeah no I think you know I think if this stuff is all tied together right you know I mean the penis these blood vessels are very small you know the blood vessels in the penis are a smaller diameter than the blood vessels in you know the heart or that go to your brain and stuff like that so that it is a very early indicator you know if there's not enough blood flow it can be the indicator that the you know that there's something wrong in terms of the blood flow in the body and you know there's been um randomized trials for example Dean ornish has published randomized Trials of a vegan diet and physical activity to actually you know reverse coronary plaque in people with coronary heart disease um you know and so and that was in you know jamama one of the leading medical journals many years ago so if it's possible to actually reduce you know the plaque in coronary vessels you know and also even to uh you know um to cause remission of diabetes these kinds of factors are very important and the penis with these very small blood vess Vel in terms of trying to make sure that you can get as much blood in there as possible yeah absolutely um this is a big question I think a lot of people have so if they've gone through prostate cancer treatment and now their PSA is undetectable or at the lowest point is going to be for example after radiation what about starting testosterone replacement therapy from a cancer standpoint what are your thoughts yeah so great question so this is a huge issue of controversy over the years because um actually even the Nobel Prize many years ago was awarded for this discovery that if you basically uh you know uh do either surgical or chemical castration and reduce somebody's sex hormones to a castrate level that that is a way to treat Advanced prostate cancer so the thought was if the treatment for advanced prostate cancer is to achieve castrate levels of sex hormones then is the opposite a problem so if somebody actually takes testosterone could they be you know increasing their risk of prostate cancer or could it cause the progression of prostate cancer and so that's been a real uh big controversy now the current data thankfully suggests that people who have low testosterone that taking testosterone therapy does not increase the risk of prostate cancer so we public a big study on this out of Sweden we looked at the entire country of Sweden at everyone who used testosterone prescriptions there and we linked it with the cancer registry to see who got prostate cancer and actually the long-term users of testosterone actually at a lower risk of high-grade prostate cancer in the long term and so we did not find anything that was concerning there and then even more recently there was just this big randomized trial of testosterone therapy versus placebo and again they did not find um an increased risk of prostate cancer with testosterone therapy so I think we could say it's been put to rest that testosterone therapy in people who need it because they have low testosterone that's symptomatic doesn't cause prostate cancer now for somebody who's already has prostate cancer there isn't as much data on what to do because what happens if you have prostate cancer but you do have low testosterone and you're symptomatic you know maybe you have low energy low libido erection problems you know whatever it may be and can it ever be safe to take testosterone in these people um and you know there's different guidelines on this some of the guidelines say basically like you know there isn't a a lot of long-term data on this so we don't really know the balance of benefits and harms and talk to your doctor there are other guidelines that suggest that if the cancer has been treated did and there's been an interval of time where there's no evidence that the cancer is recurring you know that it is something that can be considered but it requires you know a thorough discussion of the risks and benefits with the doctor you know because we just truly don't have the long-term data and careful monitoring so I guess that was a very long answer to say that yes testosterone therapy can be considered and people who have been treated for prostate cancer and have gone a period of time where they have no evidence of disease but just like anybody else testosterone therapy should only be used in people who actually have a documented low testosterone who are symptomatic and so there is some inappropriate use of testosterone in this country and so it should not be used in people who haven't had their testosterone level checked and so that's one thing and especially if they have a history of prostate cancer because we need to be really sure that that person really needs this uh if we were to even consider this given the fact that there are potential risks and benefits here

Dr.

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