00:00:00:01 - 00:00:17:14 Unknown Hi, welcome to you live well with UCI Health. I'm Ryan Manno from coast of 3.5 and I heart radio privilege to be sitting across today from Dr. David Lee, the director of the Comprehensive Prostate Cancer Program at UCI Health. Doctor, welcome. Yeah, thank you. Wonderful to be here. Let's talk about it, man. Let's talk about prostate. I'm right there. 00:00:17:14 - 00:00:37:14 Unknown I'm like on that. I haven't gotten my check. I'm 44. Okay. Gay. Am I in the window? You're getting to the window. Okay. And no, 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. 00:00:37:16 - 00:01:02:01 Unknown 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 it early 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 work that you normally get. 00:01:02:03 - 00:01:20:10 Unknown And much more commonly we recommend starting around age 50. Okay. So, yeah. All right. 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, I don't know, bury their head in the sand a little bit when it comes to things we don't want to know. 00:01:20:15 - 00:01:39:12 Unknown 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? Yeah. So most commonly diagnosed is prostate. But yeah, lung cancer is the most deadly cancers. So. So what would you just tell, you know, a man that doesn't really know much about this disease? 00:01:39:17 - 00:02:05:15 Unknown 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, because it spreads to the bones. 00:02:05:17 - 00:02:30:06 Unknown 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 recover from that because it used to be done through a big incision through the lower abdomen. 00:02:30:08 - 00:03:05:08 Unknown So then this created a lot of stories in the past of 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 radical prostatectomy. And so by offering this type of surgery, guys can have a lot better coverage and kind of all of the important ways getting back to all their normal activities, getting good urine control back really very quickly. 00:03:05:08 - 00:03:27:16 Unknown And in the longer term, getting good sexual function back. Yeah. So 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. 00:03:27:18 - 00:03:51:10 Unknown Once the guys start having symptoms from prostate cancer, often it's too late, it's 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 the take home message get screened. It's super important and it saves lives. 00:03:51:10 - 00:04:20:21 Unknown Yeah, that's good. That's great. Pardon my ignorance, but what does PSA stand for? Prostate screening? I'm guessing very close. Okay, so it's prostate specific antigen. Okay. So antigen just means protein. So it's a blood test that detects that protein in our blood and it can detect 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 prostate cancer. 00:04:20:23 - 00:04:52:08 Unknown However, you know, there has been some controversy about it because PSA SE can go up for several different reasons, including infection and sexual activity, can make it go up temporarily. And so, yeah, there are some people who have kind of recommended to not get PSA, but you say you should get them. Yeah, absolutely. Yeah. There there are really good longer term studies which show that the guys benefit and PSA screening saves lives. 00:04:52:08 - 00:05:09:03 Unknown 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 UCLA Health. What what services are we talking about? What do you guys offer? I think comprehensive is the key word. Yeah. We really offer the state of the art. 00:05:09:05 - 00:05:32:11 Unknown Everything. So important aspects are diagnosis rates. And so once somebody has an elevated PSA years ago, it just meant going straight to a prostate biopsy. Now we have a lot of other diagnostic tools which help us to weed out some of the guys who may not need a prostate biopsy, which, you know, that in and of itself can be a little bit scary. 00:05:32:17 - 00:06:00:13 Unknown And the 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 somebody has a diagnosis of prostate cancer, we offer all the different treatment options that are related to prostate cancer, including surgery, which we just touched on a little bit. 00:06:00:13 - 00:06:29:22 Unknown 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 a small amount of slow growing prostate cancer. We have all of the latest in the imaging tools such as smart PET scans, which really are much more sensitive than what we used to use in the form of cats, CAT scans and bone scans in order to detect spread. 00:06:30:00 - 00:06:50:01 Unknown And then we have a careful follow up and survivorship program for the guys to help them in their recovery of side effects after any of the different treatments and to monitor them very closely in relation to possible recurrence. Yeah, so you can brag on yourself a little bit here. All right. Well, you're a you're a world leader in a nerve sparing technique. 00:06:50:06 - 00:07:11:12 Unknown Yes. And in a lot of cases, this allows guys, men to have this procedure and go home someday. Yes. Talk to us about this. It's something which I it goes hand in hand with it not being as scary as what it used to be. Yeah, I like the sound of that. Yeah, exactly. So with the old open operation, guys would stay in the hospital 2 to 4 days. 00:07:11:14 - 00:07:38:08 Unknown Now we send guys home the same day with the robotic surgery. Guys usually can go back to playing golf or tennis, running, swimming. And three weeks after the robotic surgery that used to be three months for some of the guys, you know, after the open surgery. And so the recovery is much, much faster. But then the nerves bearing aspects that really helps the guys then to regain their urine control and their sexual function much more. 00:07:38:10 - 00:08:01:09 Unknown So with the help of the robotic technology. See, our vision is much better, our tools are much more maneuverable. And then, you know, working in the pelvis where the prostate sits all 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. 00:08:01:09 - 00:08:22:00 Unknown 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 as we're taking the prostate out. And then if we can do a really good nerve sparing and not traumatize the nerves and the guys do really well with the urine control and sexual function, that's awesome. 00:08:22:02 - 00:08:51:07 Unknown Who would you say would be the right type of candidate for that particular surgery? So nerve sparing. We offer to all the guys if the cancer allows us. 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 road map going into the surgery so that we know how much nerve sparing that we can do for each individual, the robotic technology. 00:08:51:07 - 00:09:14:23 Unknown I think that's the standard gold standard of how we take our 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 of cancer, then we actually offer surveillance. 00:09:14:23 - 00:09:31:11 Unknown 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 what long term prognosis for something like this? Yeah. So the long term prognosis of prostate cancer is excellent if we're able to catch the cancer early. Gosh. Yeah. 00:09:31:11 - 00:09:57:10 Unknown So one important piece of information that we get from the biopsy is that 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 prostate cancers, and especially with the high risk prostate cancers, if we can catch it early and it's confined to the prostate, then the guys will do really well. 00:09:57:16 - 00:10:36:04 Unknown 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 lot of the radiation as far as a potential back up 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 pieces across the country, then the hormonal therapy and chemotherapies are available to help those guys. 00:10:36:04 - 00:10:53:14 Unknown And we don't want it to get to that point ever. But we never wanted to get to that point. No, we don't. Why would you say and maybe this is more I don't know what you've just found in maybe the condition of stubborn men, but why are men that are diagnosed with prostate cancer seeming to take like a watchful waiting approach? 00:10:53:14 - 00:11:27:02 Unknown Yeah. So it's 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 is on the younger and healthier side and they're going to be around another 20 or 30 years, then being more aggressive and giving a better or giving them a better at cancer treatment outcome such as surgery, I think really serves them well. 00:11:27:04 - 00:11:51:20 Unknown But 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 a really appealing way to go. Let's let's walk through this in a real life approach. Let's say let's say a guy goes in and you do find elevated PSA. What is step one from there? 00:11:51:20 - 00:12:18:09 Unknown Great. So often we'll just recheck the PSA because PSA can fluctuate up and down just, you know, 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 and a couple of urine tests which are available, which can help sort out the picture. 00:12:18:11 - 00:12:49:20 Unknown But the key next step is to do an MRI of the prostate. MRI 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 MRI can be used as targeting then for our biopsy. Got it. Because sometimes they're not located in the standard area and if the prostate sometimes is really enlarged, then doing a standard biopsy where we're just randomly sampling may not reveal the cancer. 00:12:50:02 - 00:13:21:21 Unknown So then that MRI is really key for targeting and making sure that we're hitting the right areas. What causes prostate cancer. 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 prostate cancer. 00:13:21:23 - 00:13:47:11 Unknown Guys with a family history, they have a higher risk of developing prostate cancer. Okay. 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, all of these things play a really important role in helping us to live healthy lives, but also to reduce our cancer risk. 00:13:47:13 - 00:14:27:18 Unknown So to some degree, would you say that it's preventable? I do think that prostate cancer is preventable 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 some aspects of some other risk factors, that these are other things that other steps that you can take to help improve the chances. 00:14:27:20 - 00:15:01:10 Unknown 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, 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 resource that I send a lot of my patients to in order for them to get the latest on that kind of information. 00:15:01:10 - 00:15:26:06 Unknown Yeah, as a 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. Absolutely, Yeah. So I've done over 7200 robotic prostatectomy cases now. So yeah, but the benefit of that I think is that we carefully study the outcomes of these guys. 00:15:26:07 - 00:15:53:08 Unknown Okay, 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 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 or cancer margin outcomes. 00:15:53:10 - 00:16:41:03 Unknown And we have several studies ongoing are trying to refine our techniques to improve surgery. We have medical oncologist who are working on different types of protocols with the hormone therapies and chemotherapy use in order to sort of order these at the right times in somebodies course of prostate 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, 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 prostate cancer. 00:16:41:03 - 00:16:56:19 Unknown And so it's a really exciting time. And yeah, research and improving care at the bedside from what we do in a careful, thoughtful manner. 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. 00:16:56:19 - 00:17:23:22 Unknown And also, you know, my dad was a urologist. I didn't necessarily want to be or is going into medical school. But then as I looked around at all the different specialties and I always really enjoyed doing stuff with my hands. Yeah. And so and surgery is a really nice way to translate that because you can actually do things for patients which can help them live better lives. 00:17:24:00 - 00:17:45:23 Unknown And then the whole prostate cancer surgery arena, it's a very obsessive compulsive type. Yeah, yeah, yeah. 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. You're a better patient, and I bet your dad was pretty happy that you followed in his footsteps. Yeah, I think my dad was happy, but he actually always told me. 00:17:45:23 - 00:18:01:13 Unknown Just do whatever you want. But my mom is like, yeah, yeah. My son's a successful surgeon. That's awesome. I love it. I love it. Okay, Dr. Lee, listen, we're going to put a bow on this thing, but I want you to. To talk to men right now. You can stare into the camera. I want you to look into their eyes, like so far that you're looking into their prostate. 00:18:01:14 - 00:18:28:19 Unknown What is the final message? 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 is 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 prostate cancer deaths than mammography is for helping women with breast cancer. 00:18:28:19 - 00:18:33:15 Unknown So get your PSA boom. Dr. Lee, thank you so much. Okay. Thank you so much.