Sunday, March 19th


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The morning and welcome to another edition of living better in San Diego. Public service presentation of the and a count San Diego radio stations and Gary Lee. There's a new medical facility in San Diego that focuses on the treatment of prostate cancer. The prostate center of San Diego provides world leading and internationally recognized treatment for all grades and stages of prostate cancer. They're utilizing any breakthrough prostate cancer treatment and therapy. Joining us this morning is board certified radiologist. Doctor Ross Schwartz for. Welcome doctor Schwartz berg thank you now you are AM a board certified radiologists but more specifically your board certified. Neuro radiologist what's that. That's correct yes Obama radiologists that I did a couple years of us have specially trained a fellowship. And neural radiology which is. Look at the brain spine the back cut the nerves that's been a real justice OK and and a little bit more about your background. And well off a growth in Tucson Arizona I went out underground at UC Arizona. Common medical degree uterus of Arizona coach afternoon. Com then I. I out decided to go into radiology united didn't mind radiology training at Stanford university. And that's why did my residency and life fellowship. And I've been here in San Diego since 1997. And private practice you're doing reality. How can now leave the prostate center San Diego this is a new facility. And you are one of the doctors at the facility its crown how about a little background info on on the center. So the center are really is an outgrowth of mine a I'm keen interest in prostate. Cancer prostate imaging specifically prostate MRI. As I became kind of on enthralled with that and really work to create a great imaging program. Through various contacts. I developed a relationship with doctor Michael spelling. Who is eight in dimensional radiologists and then scientists. Going guy. Who's an often bucked Germany and he happens indeed really the world's experts in. And folk elation. For minimally invasive treatment of prostate cancer using this technology that we call not on life. In and after many discussions and trips back and forth that Germany. We decided that we'd like to bring that technology. That treatment news San Diego and that's what Tom the Genesis of the prostate sinners here San Diego in helens in an open. You really it's probably been. Three months that we. Opened it up for patients to inquire in and we've been speaking impatience. But that period time so it's a real brand new media for a us and where you're located. So we do our treatment treatments will be done in look in the UTC area at locally up. Outpatient surgeries that are hand down we see patients and in you TC and an office there. We do our imaging and it's also in the DC area. Now before we start talking about the center itself prostate center San Diego and this new treatment let let's talk a little bit about prostate cancer itself. First of all what is the prostate. But not getting too graphic. So so it's it's say its area as a small org and it's it's reproductive organ that. Males have minutes it's not located him in a period in between the new Iraq government and the blotter. And it happens to be on condition of copper miners reproductive type a function it tends to cause problems where if I'm growing too large in Olbermann getting enlarged and that's what we called DPH are benign prosthetic hyper plays job. It tends to get inflamed. Lord uses across the Titus. And it also tends. Fairly high eight incidents to develop cancer. So. It can be I can cause some issues in our particular interest of course is seen if we can help men with diagnosing cancer. With imaging and then offering treatment option now live the prostate and enlarged prostate in older man Wright like over fifty. Yes yes or essentially that process of over growth that prosecutors essentially. Happens as as as a man ages doesn't interest and it doesn't happen all in all men. Maybe 20% of men actually prostate doesn't doesn't increase the size shrinks but in the vast majority of men. 67% of men was they aged generally gets larger and prostate cancer the same thing with with more prevalent in an older man yeah absolutely in fact and so. Prevalent in older men. Come and listen we know from autopsy studies in other studies done. That you could almost say they're good nine year old man of the 9% chance of harboring. Microscopic Foci of prostate cancer doesn't mean that it's ever become. Problem for a camera but he will die with prostate cancer if you are looking for and and how is. Now prostate cancer diagnosed. So going back a little bit to frame the perspective of going back thirty years. Knowing what I was diagnosed was by physical exam the rectal exam and and if the doc could feel something very hard or very bulky bomb they need proceeded taking a tissue sample. The only other way presented back then as if the cancer gone so large head reserves causing problems with your nation in Norway with them. Other functions or even worse and spread outside the grand into the bones was causing pain. But but in the early ninety's in protein was discovered early that then it was adapted and started to be used for screen that's what we've. We call PSA. Prostate specific antigen today. It's a small protein that's that's produced by the prostate it's produced by all cells in the prostate not just cancer cells. But nowadays. For the last thirty years or so if a man is deemed to have an elevated PSA. I'm not as the first. Belt it is wrong that something might be going on and needs to be addressed and and mention beginning PSA I get one every single year. It is that. Average yet you know it's it's interesting there is it is that's a very it's actually you could make an argument. That question you just asked is the most controversial issue in men's health in other words. The utilization and PSA. Very controversial night in 2012. The united. You know states preventive task force service which is national body of scientists. Made a recommendation against routine screening of prostate cancer and they said really because of the issues with that test that you should explain the patient the the potential. Problems by our screening with PSA asymptomatic men I'm not here suggesting we shouldn't screen with PSA. I'm just pointing out that it's it's it's got some issues because it's a test that is false positive. A very high percentage of time. So. For certain men that are at increased risk for prostate cancer. Absolutely should be screaming PSA and specifically that would mean men who have a family history. Prostate cancer is probably one of the most in charitable evolve the major cancers of your father. Or brother has prostate cancer particularly if they had a young age and unfortunately succumbed to it. You are at a much higher risk of developing the cancer yourself than the next guy in that case in that setting that you absolutely should be screened. The other major group that is a very high risk are. Men and African. Dissent black men in this country of Afghanistan war of Caribbean descent. Have a much higher incidence of prostate cancer and not only that they tend to get. The disease younger and get the more aggressive type of cancer. So African American men. Probably should be starting a screen earlier some people say 45. On and even theirs slightly more complexity to that issue because of the where they can't just in the current black men and and the fact that they don't always pan out as much PSA. Then the type of cancer they get in and dead again and PS AM outside the normal range in an enlarged prostate doesn't necessarily mean. If you have prostate cancer. Right so the term we use medicines positive predictive value or which is low or the false positive rate is high mean. If a guy is deemed to have an abnormal PSA list elevated 78 out of ten times that's not related to a significant cancer in the common. That's common now culprits are will be called BP H the enlarged prostate and I'm puts out a lot of PSA. And then that the inflammation. Which can occur not just from infection. Concur from all sorts of things including. Parent you'll trauma or. Riding a bike so Lance Armstrong says it's not about the bike you remember that book sometimes elevated PSA it is about the bike if you're on the bike a lot. The point being. That. Just because that PSAs team elevated and but he needs to you know slowdown in and look at more than one value. You know put it in context. And one of the key things is the size of the land so. We called PSA density so it's dividing their peers they taken PSA value and dividing it by the volume of the prostate. Some men have a prostate that's the size of a walnut and some guys have a profit that's. Posted a small watermelon. And you can imagine that the PSA level those two guys might be quite different. Yes and I think is manifest now than in talking about now I'd I believe there was one time that I did have an elevated. PSA and my doctor just had me come back. Another month or so later it is I think I had a cold or something and that it is totally different that's that's a perfect example of really important point that. One data point a 11. Level at one moment it is not enough to. Initiate any kind of worry your treatment it's just a data point that should be followed and in most commonly like in your case. He checked with he'll be checked in and come back well things are okay after all. Right and we are talking about about this a little before we went on went on the air there's more than one type. Of prostate cancer right. Well yeah also that. Prostate cancer like many cancers the more we understand about the biology and molecular genetics of cancer there's complexity of federally. Fairly deep. But economy at a basic level prostate cancer you can divided into two main. Areas one is the low risk. Cancers would occur with which a curb where a commonly and it's covered quite commonly. Com. And vs the high grade aggressive. Cancers which are much less common but yet obviously. I'm import importance that it discovered before a day. Sprouts are the gland and caused problems but. On one of the issues we have with a diagnostic pop pathway currently. Is that it's hard to distinguish. Those two only based on. The standard pathway which is the PSA test and then me. What we call them random systematic. A blind biopsy which is what's usually done so little salute the low grade. That's nothing to be. That concerned with yeah so and that's where I think many guys and in including on your last podcast I think in November with the coalition. Prostate cancer Chrysler group right they discussed this a term called active surveillance so financed. Diagnosed with prostate cancer but it's deemed to be. This low risk of some even use the term clinically insignificant. Type and that's based on. Com the PSA level and the grade the the way the way it looks and the microscope and that's. Common Gleason grating that the pathologist. From the use for it. On if you are far in this category of low grade low volume. Cancer. Many many studies have shown that those men. Can go without treatment. As long as they're monitored to make sure nothing changes. Postman can go without treatment and live with. The cancer but never had any problems from that they won't die of cancer they'll dive with the diagnosis. In the key thing with that is what we discovered the medical community. Is that. Those men you don't want to submit them to treatment but they don't need because most of the treatments. How the potential for causing side effects. So. Make that distinction. A distinction between the low grade low risk clinic in significant. Prostate cancer vs the high grade aggressive is critically important. And it would be helpful to make as early as possible and in the diagnostic path and are there any symptoms anything that that anybody can can look forward with this cancer. Our answer is essentially no. The one thing that. It's still important it is is if a man has that elevated PSA is the physical exams physically the digital rectal exam because they're urologists are experts say. Knowing what they normal or in on diseases that are. Non cancerous clan feels like vs something that's worrisome. That's an easy task to do is not pleasant necessarily but it certainly it it's an essential part of the exam. Other than that. And those two things the PSA and the exam. If a patient presenting with symptoms. Related to a cancer of the prostate. That's pretty much means things are not too bad situation ready that is. Diseases spread outside of land and involving bones or it's caused a problem. With the surrounding structures. Not. And and and if I'm not mistaken to prostate cancer about survival rate one of the best of all cancers yeah absolutely no that's been active active part in this point about this high instance. And I detection of the low grade cancer so. And I think the statistics that are often on about is that one in seven or 17% roughly of men. We'll get a diagnosis of prostate cancer a lifetime yet about 3%. Would die and so you writes it's a common disease. Yet thank goodness the the mortality. Is is low. Now the the prostate center San Diego from one and Stan the first of its kind in the region and one of the first in the US to offer this new treatment. Tell stuff ST treatment. She loves it's called it's called non a knife in it and it's. The technical medical term is your reversible he left troop operation that took me quite a lot of things I think that fumble in order to. I'm so when nominates easier to say. It is say treatment that's a minimally invasive. Treatment focal therapy. And what it does is it can remove the cancer. Without removing the glance it's a non surgical procedure. It's performed went. Electrodes on needles which replaced with imaging guidance into the tumor. And the use electrical pulses. To. Remove the tumor killed me the tumor. And the main advantage of some non thermal energy. Which means it's not heat source or called source. And it preserves the surrounding structures. So if you know exactly where your electrodes are. You know exactly where to be what we copy of violations zone is. So be it it's a quite exciting. Technology. And we're excited we think that certain and it would be a reasonable option some then don't wanna have surgery bit there. Not candidates for surgery they don't like the idea of surgery. They don't want to have radiation so this is another option for them to explore. The flip side of that is in the beginning. These local therapies were thought to be. Best reserved for men with the lower greater in Armenia grade cancers but what doctor stowing expert. Rolled experts. Whose partner with us here and senior ago was discovered is that. Fiery your non on life is extraordinarily powerful and treating men who have failed treatment nor have recurrent disease after surgery or radiation. For those men there's traditionally been no good. Non medicine and therapy. And he's got a tremendous experience with treating men that otherwise would have no option. So it's equate. Quite exciting. Time finesse and is this only four specifically for prostate cancer no actually it's being used firm. The university is using it here in town for paying Chris it's been used backed initial. Experiences with liver and pancreas again when you how they eighteen minutes in very difficult area. Surrounding blood vessels and all sorts of vital organs. Com this lodge you have to treat the tumor while staring those surrounding structures. It's been less well adopted. Most commonly used for prostate it is being used for prostate and in various senators one is more memorial Sloan Kettering in New York City. Pat cancer centers using the non owner for prostate. You still based on a number of cases there's a few other places but it's still very early com. In this country although and other countries. London. You mr. Collins London's been doing it for a number of years and has great experience and and results and and doctor styling and often bock. Has been the most experienced world so pretty good success rate so far without him successfully is is is equal to. The way I guess that would flip that back the only way to know. The best way to measure of success is the rate of recurrence and their standard. Methods to do that so when you subject doctor spellings experience to be standing massive determine recurrence is red recurrence is. Since they're identical with the other major therapies specifically surgery. And then and other bandages not only is it the recurrence rate of success between the cancer of the same. This technology. Allows you to go back in treaty again should the cancer car. Whereas on if you do a radiation too impatient. And the cancer occurs. It's a very difficult situation surgeries really barely done in those settings because that's radiation. Really star stuff surrounding tissue makes it that section in the surgical procedure extraordinarily difficult and and you know quite problematic. Whereas with the non knife should the cancer recurrent and it does and about 10% of the time. You're able to go back and if you have an identifiable identifiable recurrence you can and re redo the dominant without without me. Extra that affects us and some decent benefits benefits to well I think I think tremendous benefits because we really haven't talked about. A couple key things we should which is. Precision imaging needed to find the cancer. And the reasons why some existing therapies. Or the traditional existing therapies for prostate cancer. Kind of are less than optimal. So. Traditionally. The main treatment has been what's called radical prost who texted me. You know and that that that's the medical term radical surgery were in the entire gland is removed. You can argue that that's and neurologists have long believed that the most definitive way to. He'll with the cancers through the whole organ yet if you use breast cancer as an analogy. Many many many many years ago for breast cancer you had to do a radical mastectomy take the entire organ. However that is those days are long gone women are now most often. The tumor has identified and that treatment is directed towards the tumor preserving the rest of lands of all Hamlet is called lumpectomy the monthly taken out and and in their that they need other treatment and get it but the preserve. The rest of the uninvolved Glantz. Well that's traditionally not the way it's been done with prostate so traditional treatment as did take out. The whole gland now. He and a surgical techniques that vastly improved and post op recovery is vastly improved compared to what was it still a major surgery. It's still got a fairly significant. I'm risk profile meaning side effects relates to the urinary stream and potency and there are various different. You know literature in numbers quoted but but it's not trivial. I'm whereas. We're just say let's if we have to Delhi to see the tumor. And we can and target that tumor with imaging guidance and just remove the tumor. While preserving the rest gland. On the sudden all of those that potential bad side effects are far by the wayside. And you have a subject subjected them into the surgery so this is a per cutaneous mean through the skin. Meals are inserted through his skin and we observe the patient for 2.3 dollars and and they they go now. Come and and side effects with this new treatment. So maybe be on the ancient thing it's fast and is there's no pain with the procedures the paint Maine then he's not have any pain from the procedure. Any time you're working in this area are the need to re from which is that you did trains from the Blatter on. That has a tendency to get inflamed irritated some men will mean we'll keep a Foley catheter which rose Catherine the blotter. Make sure that they're able to evacuate urine for about one to two weeks after procedure. On system and we'll have issues with blood clotting. But that those of those are transient. Temporary. Side effects. The gum this prominent side effect profile. With continent's problems currently Kearin extraordinarily low. Almost zero. And the potency issues Iraq cal function. A very about 10% or so much much lower then. Other treatments the other treatment yes. Lot of positives to this new treatment in a lot of positive for sure. How we are almost out of time I wanted to mention too that prostate center of San Diego. Utilizes. 88 business model that she did she call concierge care. Can you explain what that is. I would say it simply you know I can be really dedicated physician and great radiologist. On and do the best job ever but if my my colleague at the front desk is having a bad day. And short of the patient doesn't look them in the I that's an I've experienced that myself and I got a doctor our concept is that. We're gonna make we're not looking guy and treat you with dignity of the entire process than. I'm you can call it common shares are just color the way it's supposed to be. So rookie of facilitate bad days from the first time we talk to the patient enough phones throughout the whole procedure to follow up. On and that's what me mean who wouldn't talk to patients come when no time we don't know answer their questions. And and basically. Be partners with them and trying to help them out through the whole process a process and I think you're right you know that that first impression when you walk into an office. Sticks with you I can I could have my own personal absolutely. I do I hope we would have understood to talk about the key part of the imaging for assure us that. Appreciate that so with traditionally. As we talk code and then we'll have a PSA drug habits of abnormal. He will gonna be directed to urologist who will do a biopsy. And misses than usual because every other solid organ in the body we look before we Pau so. I'm what's happened the last number of years. Is we've developed her many many million people have developed. The ability to use our advanced imaging specifically MRI. Of the prostate we called multi Parametric MRI to. Detect and localized cancer. In the gland on and that for many many years has been recognized and prostate cancer care is the fact that we could not see. The cancer in the gland one we can't. On and to do a prize to memorize the right way you can tell a guy was an elevated PSA cheek and a lot. Turns out he's got a big prostate VP eight we don't have cancer. And you can avoid bots. Which is a very big deal. All are you can sum it looks like gets inflammation but there's nothing that looks like a significant cancer the flip side that is. We're able to maybe look at an African American male who doesn't have an extremely high PSA. But he still at high risk and we can find cancer and answer portion of win. Which is not necessarily by teachers and traditional mechanism. We can target we conceded tumor re suspicions region many can use that image to target the biopsy. The really key foundation and doing targeted therapy. Is doing outstanding imaging to see. The cancer. In the gland and that was essentially how I got interest in the in this whole process because I became ranged in that part of it. And a and again it's changed so much over the years it yet on how it's done. It is now it's silly it really hasn't certain parts of this country it's it's standard of care essentially before a man has a intervention. Five seeds are going to four treatments to look at it with. High quality MR multi Parametric MRI. It's not that way. In all parts of the country now we're still trying to get the word out that. You know just like you mentioned for your own self the beach shack the PSA before you move on we would suggest that. Before you can abide C strongly consider if available. High quality and ride this look before you. Before you start machine. Vibes. What's the what's the website for the he had prostate center of San Diego. So it's prostate center. ST dot com prostate center SD dot com all right doctor Schwartz -- Vietnam Saturday I learned a lot but I really did and I appreciate. We all appreciate all the work that you do and at the prostate senators and Gerri thanks so much for having me I really appreciate it. That concludes another addition of living veteran San Diego the opinions expressed on living veteran San Diego do not necessarily reflect the opinions and views of the staff management. Of the an account San Diego radio stations episodes of living veteran San Diego are available on the station's website. John next week when my guess will be permission federal credit union talking about their contributions to education and local nonprofit organizations until that. I'm Gary Lee have a great week.