Prostate health: common problems, cancer prevention, screening, treatment, and more | Ted Schaeffer, M.D., Ph.D.

**Peter Attia, MD** (0:11)
Hey everyone, welcome to the Drive Podcast. I'm your host, Peter Attia. This podcast, my website and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone.
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If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription. If you want to learn more about the benefits of our premium membership, head over to peterattiamd.com forward slash subscribe. My guest this week is Dr. Ted Schaeffer. Ted is an internationally recognized urologist and prostate cancer oncologist, author, and speaker. He is the chair of the Department of Urology at the Feinberg School of Medicine, the Urologist-in-Chief at Northwestern Memorial Hospital, and the program director of the GU Oncology Program at Northwestern as well. Ted has published more than 400 peer-reviewed publications emphasizing at-risk populations, diagnoses, treatment outcomes, and the molecular biology of lethal prostate cancer. He is also the co-author of a new book, Dr. Patrick Walsh's Guide to Surviving Prostate Cancer, which is available on October 3rd of this year.
In addition to his work at Northwestern University, Ted is also a consultant to a variety of individuals who are going through various aspects of prostate cancer and prostate care. And you can learn more about these services on his website, which we'll link to. Ted was a guest way back on episode 39 in February 2019, and a lot has changed since then, and I wanted to have him back on to pick that up. In this episode, we talk about all things related to the prostate. We discuss the problems that can arise with the prostate as you age, including urinary symptoms and an increase in frequency. Going to the bathroom at night, we talk about prostatitis, pelvic pain, and prostate inflammation. We talk about the very popular drug finasteride used both to shrink the prostate and prevent hair loss, and something called post-finasteride syndrome, along with concerns that people have around this controversial diagnosis. We then move on to talk about prostate cancer. We talk about how androgens work, how testosterone and DHT work, how they relate to prostate size, how genetics and non-genetic factors factor into prostate cancer and its pathogenesis. We discuss the blood-based screening tools that are at our disposal for prostate cancer, including PSA, free PSA, PSA density, PSA velocity. Then talk about how MRI works and how we use it to facilitate biopsies. And then, of course, what biopsies mean. How do we interpret a biopsy, and how does that tell us about which patients should and shouldn't undergo prostate removal? And lastly, we talk about prostate cancer treatments that involve not just surgical intervention, but also things such as androgen deprivation therapy.
Lastly, I just want to highlight that prostate cancer is the second leading cause of cancer death in men. And it's not only the second leading cause of cancer death, I believe it's also one that is highly preventable. And as such, I think it is very important for everyone to listen to this, because unfortunately, it's very unlikely that you'll go through your life not being touched by this or knowing someone who is. So without further delay, please enjoy my conversation with Dr. Ted Schaeffer.
Hey! Ted, awesome to be sitting down with you to talk about all things prostate related. It's been probably four years since we did this.

**Ted Schaeffer, MD, PhD** (3:54)
Yeah, thanks for having me.

**Peter Attia, MD** (3:56)
So I think probably it's worth assuming that there are a lot of people who didn't hear that first podcast and those that did probably don't remember much anyway. Also a lot has changed in four years. So I think never a bad idea to start from the beginning.
So let's start with talking about what the prostate gland is, what it does, before we get into any of the pathology associated with it.

**Ted Schaeffer, MD, PhD** (4:17)
Yeah, so the prostate is an extracranial gland, and it's part of the reproductive system. It sits just below the bladder in men. So it's a dimorphic organ. It does not exist in women.
It develops in utero or in response to fetal androgens. And so it produces basically most of the components, or about 50 to 60% of the components of semen. So it's used in reproduction in all mammals, and we're a mammal, so we use it too.