Logo

    #39 - Ted Schaeffer, M.D., Ph.D.: How to catch, treat, and survive prostate cancer

    enFebruary 04, 2019
    What led Ted Schafer to pursue a PhD at NIH?
    How did Ted's curiosity influence his career choices?
    What advancements allow Klinefelter syndrome patients to have children?
    Who was Hugh Hampton Young and his contributions?
    Why is informed decision-making emphasized in contraception?

    Podcast Summary

    • Embracing New Opportunities: The Path to Personal and Professional GrowthBy exploring diverse fields and seizing open doors, individuals can discover unexpected passions and opportunities that ultimately lead to personal and professional growth.

      Exploring opportunities and pursuing your interests can lead to unexpected and fulfilling paths in life. Ted Schafer's decision to do a PhD at the NIH, even though he wasn't on the traditional MD PhD path, shows the importance of seizing open doors and taking chances. Throughout his academic journey, Ted's curiosity and love for understanding how things work fueled his passion for biology and medicine. His interest in discovery and innovation led him to consider becoming an anthropologist at one point. Ultimately, his willingness to explore diverse fields and follow his instincts led him to where he is today. This story reminds us that taking calculated risks and embracing new opportunities can lead to personal and professional growth.

    • The Importance of Networking and Mentoring in Achieving SuccessSurrounding ourselves with intelligent and motivated individuals, seeking guidance from experienced mentors, and embracing continuous learning are crucial factors in achieving success in our chosen field.

      The path to success often involves networking and seeking advice from those with more experience. Ted Schaeffer found himself in the lab of a Nobel Laureate through a friend's recommendation and by shopping around for a motivated and talented mentor. Despite not initially knowing what he wanted to pursue, he recognized the importance of surrounding himself with intelligent individuals. This highlights the value of connecting with people who can guide and inspire us in our chosen field. Additionally, the story emphasizes the significance of continuous learning and growth. By immersing himself in the company of brilliant scientists, Ted was able to expand his knowledge and contribute to groundbreaking research.

    • Embracing Challenges: A Path to ExpertiseBy exploring weaknesses, scientists gain a deeper understanding, develop critical thinking, and achieve recognition, emphasizing the importance of stepping outside comfort zones for growth and success.

      Many great scientists purposely choose to explore their weaknesses in order to become well-rounded experts in their fields. This is demonstrated by both Ted Schaeffer and Steve Rosenberg, who pursued research in areas outside of their initial interests or expertise. By doing so, they were able to gain a deeper understanding of complex concepts and develop critical thinking skills. Additionally, their willingness to take risks and advocate for themselves led to unique opportunities and recognition within the scientific community. This highlights the importance of embracing challenges and stepping outside of one's comfort zone in order to grow and excel in their chosen field.

    • The Evolution of Genetics and Immunology: Uncovering the Complexities Within the Human BodyAdvances in science have revealed that diseases and conditions are not solely caused by single gene mutations, but rather a combination of genetic and environmental factors, emphasizing the importance of understanding the complexities of the human body.

      The field of genetics and immunology has evolved significantly over time. Previously, scientists focused on single gene mutations to understand diseases and conditions. However, as we now know, the human body is a complex organism with thousands of genes that interact in various ways. This understanding has led to the realization that many diseases and conditions are not simply caused by a single gene mutation, but rather a combination of genetic and environmental factors. Additionally, the concept of fine-tuning and modulating signals within cells has emerged, allowing for a deeper understanding of how cells communicate and function. Overall, this conversation highlights the importance of advancements in science and technology that have allowed researchers to explore and uncover new complexities within the human body.

    • Precision Oncology and Targeted Treatments: Focusing on Alterations and Mutations in Cancer CellsPrecision oncology focuses on targeting specific alterations and mutations in cancer cells, with tyrosine kinases being attractive targets for drug therapies. Multi-targeting approaches and motivation are critical for success in scientific research.

      When it comes to precision oncology and finding targeted treatments for cancer, focusing on specific alterations and mutations within the cell is crucial. Tyrosine kinases, which are temporary modifications within proteins, have become attractive targets for drugs in cancer biology. These drugs can specifically target altered fused genes caused by mutations within a cancer. While there may be resistance and recurrence in some cases, multi-targeting approaches, similar to how HIV management works, can lead to more durable effects. The conversation also highlights the importance of mentorship, brainpower, and motivation in the success of PhD students in research labs. Motivation and drive play a critical role in achieving success in scientific research.

    • Finding passion and applying it to your work for successPassion and drive are crucial for success. Finding your passion and applying it to your work can lead to significant impact and success in your chosen field.

      Having passion and drive are important factors in finding success in your chosen field. Ted Schaeffer discusses how he believes that some individuals may not have found their passion yet, which is why they may not be successful in their current endeavors. He also emphasizes the importance of being able to translate scientific research to have a significant impact on the human condition. Additionally, Ted highlights the value of gaining clinical experience before pursuing a PhD, as it allows for a deeper understanding and appreciation of the nuances of human diseases. Overall, it is clear that finding what you are passionate about and being able to apply that passion to your work can greatly contribute to your success in your career.

    • The Influence of Personal Experiences and Mentorship on Career ChoicesPersonal experiences, such as family history, and mentorship play a significant role in shaping one's career trajectory and aspirations.

      Personal experiences and connections can significantly influence one's career choices and aspirations. Ted Schaeffer's journey towards becoming a prostate cancer biologist and surgeon was deeply rooted in his family's history with the disease. The memory of his grandfather's battle with prostate cancer and his own curiosity about his father's cause of death shaped his career path. Additionally, the mentorship and support he received from the chair of the urology department at Johns Hopkins, who was a prominent figure in the field, played a crucial role in his decision to attend the institution. This story emphasizes the importance of personal experiences, mentorship, and motivation in shaping one's professional trajectory.

    • The Importance of Pursuing Excellence at HopkinsPursuing excellence at Hopkins creates an environment filled with exceptional individuals dedicated to their fields, leading to important discoveries and high impact in their respective areas of work.

      Pursuing excellence is a key factor in success. Both Ted Schaeffer and Peter Attia discuss their experiences at Hopkins and highlight the importance of the institution's pursuit of excellence. From faculty members to everyday employees, everyone at Hopkins had a passion for excellence. This pursuit of excellence created an environment filled with exceptional individuals who were dedicated to their fields. While there may have been sacrifices, such as moving to Baltimore, the opportunity to train at a top institution that prioritizes excellence is invaluable. They also acknowledge the impact of mentors like Pat Walsh, who fundamentally changed the course of one operation and influenced their respective fields. This conversation emphasizes the significance of working on important problems and making a high impact in order to make important discoveries.

    • Challenges in Prostate Cancer Surgery: Blood Loss and ComplicationsProstate cancer surgery in the early seventies was risky due to blood loss and complications, emphasizing the importance of advancements in surgical techniques for safer and more effective procedures.

      Prostate cancer surgery in the early seventies was a potentially life-threatening operation due to extreme blood loss and other complications. The anatomy of the pelvis, with its large number and variable distribution of veins, made it challenging to control bleeding during surgery. Unlike arteries, veins have thinner walls and are prone to tearing, making them harder to repair. Additionally, the depth and exposure of the prostate in the pelvis made it difficult to perform a successful surgery. While a perineal approach offered less bleeding risk, it was not an effective cancer operation. This highlights the need for advancements in surgical techniques to address both the safety and effectiveness of prostate cancer surgery.

    • The Origins of Urology and the Legacy of Surgeons at HopkinsThe conversation highlights the vital role played by Hugh Hampton Young in establishing the specialty of urology and emphasizes the importance of recognizing and honoring medical pioneers.

      The field of urology and other medical specialties emerged from the pioneering work of Halsted and his trainees at Hopkins. Hugh Hampton Young, a trainee of Halsted, was the first urologist at Hopkins and was assigned to establish a program for urologic problems. Despite initial reluctance, Young played a vital role in creating the specialty of urology. The conversation also highlights the rich history of surgical innovations and the lineage of surgeons at Hopkins. Sunday school sessions, led by renowned surgeons, provided an opportunity for learning and practicing clinical skills. These sessions fostered a deep appreciation for the history of surgery and allowed residents to present and discuss various topics. The conversation emphasizes the importance of recognizing and honoring the contributions of pioneers in medicine.

    • Reflections on Medical Training and Internship ExperiencesMedical professionals endure rigorous training, making difficult decisions and performing intricate procedures. Despite the challenges, they value the opportunities and camaraderie created during their internships.

      Medical training and internship experiences can be filled with both challenging and rewarding moments. The speakers reminisce about their surgical internship days and the camaraderie they shared with their colleagues. They recount their experiences, such as performing liver operations and learning how to insert nasogastric tubes, which were integral parts of their training. They also discuss the complications associated with prostatectomy, highlighting how it impacts a man's continence and erectile function. Through their stories, it becomes evident that medical professionals undergo rigorous training, facing difficult decisions and procedures. However, despite the challenges, they express a sense of fulfillment and gratitude for the opportunities and memories they created during their internship years.

    • Enhancing Surgical Outcomes through Innovation and PrecisionAdvances in surgical techniques and technology, such as recording and studying procedures, have led to improved patient outcomes and preservation of important functions, like sexual potency.

      Advancements in surgical techniques and technology have significantly improved outcomes for patients. By using innovative approaches like recording and studying surgical procedures, doctors can gain a deeper understanding of anatomy and identify ways to preserve important functions, such as sexual potency. Surgeons like Pat showcased the importance of being able to actually see what you're doing during surgery, as it allows for better control and precision. This paradigm shift in surgical practice has led to more successful operations with fewer instances of bad surgery. Although regaining sexual function after a prostatectomy is not guaranteed, the preservation of nerves during the procedure has greatly increased the chances of recovery compared to the past.

    • Nerve regeneration and function recovery: complexities and potentialsAchieving full recovery may not always be possible, but advancements in surgery techniques can greatly improve outcomes, especially for younger patients and considering tumor location.

      Nerve regeneration and function recovery are complex processes. While nerves that are myelinated can regenerate and regain function through microvascular nerve grafts, non myelinated nerves may not have the same regenerative capabilities. The discussion also highlights that urinary incontinence and erectile dysfunction are common side effects of prostate cancer surgery, even with successful operations. It is important to manage expectations and understand that achieving 100% recovery of function is not always possible. However, advancements in surgical techniques can greatly improve outcomes, with a majority of patients experiencing minimal urinary leakage and a high chance of sexual function recovery, particularly for younger patients. Age and the location of the tumor also play significant roles in the potential outcomes of surgery.

    • Understanding the Role of PSA in Prostate Cancer ScreeningPSA levels in the blood can indicate the presence of prostate cancer, but factors like prostate size and age can influence the results.

      PSA (prostate specific antigen) is a protein produced by the prostate that plays a role in liquefying semen. It is used as a tool to screen for prostate cancer by checking its values in the blood. PSA levels are higher in individuals with larger prostates, as the bigger the prostate, the more leaky it becomes and the more PSA can enter the bloodstream. Age also plays a role, as older individuals may have higher PSA levels compared to younger ones with the same prostate size. It is important to note that certain factors, such as recent rectal exams, can artificially raise PSA levels. Understanding the significance of PSA can help in the diagnosis and management of prostate cancer.

    • Factors influencing PSA levels and their implications for prostate health.PSA levels can be affected by factors such as infection and cancer, and higher levels are generally associated with a greater likelihood of detecting prostate cancer. The percentage of free PSA can provide further information about the probability of cancer.

      PSA (prostate-specific antigen) levels can be influenced by factors other than age and prostate size, such as infection and cancer. Infections in the prostate cause the entire gland to become leaky, leading to a significant increase in PSA levels. On the other hand, prostate cancer can result in a blockage in the sewer system analogy, causing more backflow into the bloodstream and elevating the PSA number. While there is no PSA number that guarantees the absence of cancer, higher PSA levels are generally associated with a greater likelihood of detecting prostate cancer. Additionally, the percentage of free PSA can provide further information about the probability of cancer, with lower percentages indicating a higher likelihood and higher percentages suggesting a lower chance. These considerations should be taken into account when interpreting PSA test results and determining the need for further evaluation, taking into consideration the individual's age and prostate health.

    • Advancements in Prostate Cancer DiagnosisThe 4k score and PHI tests accurately differentiate between cancerous and benign cells, helping identify patients who need further investigation or treatment and streamlining the prostate cancer screening process.

      The 4k score and the prostate health index (PHI) test are significant advancements in diagnosing prostate cancer. These tests leverage the fact that cancerous cells produce prostate-specific proteins differently than benign cells. By measuring specific proteins in the blood, the 4k score and PHI test can accurately differentiate between cancerous and benign cells, providing a percentile chance of high-grade and aggressive prostate cancer. These tests have been developed by experts in the field and have proven to be reliable indicators of cancer risk. Incorporating these tests into medical practice can help identify patients who require further investigation or treatment, while also providing reassurance for those with low scores. This advancement is particularly beneficial for prostate cancer screening, as it streamlines the process and improves accuracy.

    • Advancements in Prostate Cancer Testing and Improved Patient Outcomes Using the 4K Score.The 4K score in prostate cancer testing has improved patient outcomes by accurately assessing the probability of metastasis, leading to reduced cases of metastatic prostate cancer and effective treatment and cure methods.

      Advancements in prostate cancer testing, specifically the 4K score, have provided a more accurate way to assess the probability of developing metastatic prostate cancer. By using a continuous variable and a binary cutoff of 7.5%, doctors can determine the likelihood of a patient's survival over the next 20 years. This has significantly improved outcomes for prostate cancer patients, reducing the number of cases presenting with metastasis from 40% in 1990 to 4% in 2000. Despite skepticism suggesting it may be due to lead time bias, the screening and early detection methods have proven effective in treating and curing patients. This development mirrors similar controversies surrounding mammography for breast cancer detection.

    • Impact of Mammography and PSA Screening on Breast and Prostate Cancer DetectionPSA screening has reduced incidence of metastatic prostate cancer, but over-treatment can occur. Molecular biology research and accurate, less invasive diagnostic techniques are needed for improved prostate screening.

      The implementation of mammography and PSA screening has had different impacts on detecting metastatic breast cancer and prostate cancer. While mammography has not shown a significant change in the incidence of metastatic breast cancer, the implementation of PSA screening has led to a substantial drop in the incidence of metastatic prostate cancer. However, it is important to note that not all prostate cancers are lethal, and over-treatment can occur when using biomarkers like PSA to detect all prostate cancers. The focus now is on identifying the molecular biology of lethal prostate cancer to improve screening methods. Additionally, concerns about unnecessary biopsies in prostate screening highlight the need for more accurate and less invasive diagnostic techniques.

    • The Importance of Patient Advocacy in Prostate Cancer ScreeningsPatients should take an active role in their health, ensuring access to physicians who are knowledgeable and willing to discuss the benefits and risks of prostate cancer screenings.

      The shift in recommendations regarding prostate cancer screenings has led to a rise in the incidence of more advanced and lethal forms of the disease. While some guidelines now emphasize shared decision making between patients and doctors, there is concern that not all patients have access to physicians who have the time or knowledge to educate them properly. This can result in patients missing out on potentially life-saving screenings due to doctors considering it a controversial topic or not keeping up with the latest guidelines. It is crucial for patients to advocate for their own health and seek out physicians who are willing to engage in thorough discussions about the benefits and risks of prostate cancer screenings.

    • Regular prostate screening and rectal exams are important for early detection. Patients should discuss the risks with their healthcare provider to make informed decisions about their healthcare.Regular prostate screening and discussing potential risks with a healthcare provider can help patients make informed decisions about their healthcare.

      Regular prostate screening, including a rectal exam, is important for early detection of potential issues. While guidelines on rectal exams may vary, many experienced internists still include it as part of the physical exam. By performing these exams frequently, healthcare practitioners can gain a better understanding of what is normal and what may indicate a problem. Prostate biopsies, although relatively safe, can have some complications such as bleeding and infection. It is crucial for patients to discuss these risks with their healthcare provider and inquire about their personal experience and expertise. Understanding both average complication rates and individual risks can help patients make informed decisions about their healthcare.

    • Reliable Indicators and Effective Screening Tools for Prostate CancerThe 4k and PHI tests have shown promising results in diverse populations, including African Americans, making them valuable tools for detecting prostate cancer. A multi-parametric prostate MRI with DWI is recommended for further diagnostic imaging.

      The 4k and PHI tests are reliable indicators of prostate cancer, regardless of racial background. Both tests have been studied and developed using primarily Caucasian patients, but have shown promising results in diverse populations as well. In particular, the 4k test has been validated on a cohort that included 50% African American patients and performed equally well or better. This is significant because diseases like nonalcoholic fatty liver disease and diabetes can differ substantially across racial groups, making it challenging to develop universal screening tools. However, the 4k and PHI tests appear to be effective in detecting prostate cancer in various populations, making them valuable tools for clinicians. Additionally, when considering further diagnostic imaging, a multi-parametric prostate MRI with a focus on diffusion-weighted imaging (DWI) is recommended, as it provides crucial information and can be done without contrast in some cases.

    • Utilizing MRI for Prostate Cancer ScreeningMRI can provide valuable information for accurate diagnoses and treatment decisions, increasing detection of high-grade cancer while reducing over-detection of low-grade cancer. Finding a doctor open to advanced imaging techniques is important.

      Utilizing MRI for prostate cancer screening can provide valuable information that may lead to more accurate diagnoses and treatment decisions. While insurance coverage may be a concern, studies have shown that MRI can help increase the detection of high-grade cancer while reducing the over-detection of low-grade cancer. It is important to find a doctor who is open to utilizing these advanced imaging techniques and is willing to recommend biopsies if abnormalities are found. Additionally, the use of PSA density, along with MRI results, can further stratify patients and help determine if a biopsy is necessary. By implementing these screening methods, unnecessary biopsies can be reduced while maintaining the detection of higher grade disease.

    • The Personal and Fulfilling World of UrologyUrology offers the chance to make a meaningful impact on patients' lives while enjoying personal connections and fun interactions.

      Urology is a field that requires a sense of humor and provides grateful patients. The discussion highlights how urologists deal with sensitive, personal, and sometimes funny topics, making it essential to have a lighthearted approach. The patients in urology are described as wonderful people who are incredibly grateful for the care they receive. Choosing a medical specialty should involve considering the type of patients one wants to interact with, and urology offers the opportunity to make a meaningful impact on patients' lives. Additionally, urologists have the advantage of owning the diagnosis, performing interventions, and providing longitudinal care, fostering strong relationships with patients. The personal connections and fun interactions make urology an enjoyable and fulfilling profession.

    • The Power of Building Relationships and ConnectionsNetworking and leveraging relationships can lead to unique opportunities and collaborations, expanding horizons and creating new possibilities for personal and professional growth.

      Building relationships and connections can open the door to unique opportunities and experiences. In the story, Ted Schaeffer's introduction to Ben Stiller came through his relationship with an internist, Bernie Krueger. This connection eventually led to Ted and Ben going on a show together. Similarly, Peter Attia's introduction to Bernie was facilitated by Ted, which resulted in a fruitful relationship and professional collaboration. These examples highlight the importance of networking and leveraging relationships to expand one's horizons and create new possibilities. By engaging with others and showing genuine interest in their work and experiences, we can not only learn and grow but also open doors to unforeseen opportunities for ourselves and others.

    • Age and experience are not the only indicators of ability and competence.Success is determined by determination, dedication, and a continuous drive to improve, regardless of one's age or years of experience.

      Age and experience should not be the sole factors in determining one's abilities and competence. Ted Schaeffer, a relatively junior surgeon at the time, performed successful surgery on Ben Stiller, disregarding the difference in experience between himself and his mentors. He believed in pushing himself to be the best surgeon he could be, regardless of how long others had been practicing. This mindset allowed him to excel and gain recognition in his field. It serves as a reminder that determination, dedication, and a willingness to continuously improve are essential qualities for success, regardless of one's age or years of experience.

    • Simplifying Prostate Cancer Assessment and CommunicationProstate cancer assessment now utilizes the gray group system, simplifying information for patients and doctors. Unnecessary tests should be avoided, and active surveillance is recommended for low-grade cancer.

      There has been a shift in how prostate cancer is assessed and communicated. Previously, the Gleeson score was used to determine the aggressiveness of the cancer, ranging from 1 to 10. However, experts realized the need for a clearer way to convey this information to patients and doctors. Thus, the concept of the gray group was introduced, which categorizes cancers into five bins of aggressiveness. This new system allows for easier understanding of the severity of the cancer and its potential clinical outcomes. In terms of testing, it is emphasized that unnecessary tests should not be ordered unless they will alter the management of the patient. Active surveillance is generally recommended for patients with low-grade prostate cancer to monitor any changes in aggressiveness.

    • The Importance of Continuous Learning in MedicineStaying updated with new research and advancements in medicine is crucial for making informed decisions and providing the best patient care. Collaborating with other healthcare professionals is also significant in delivering quality treatment options.

      Continuous learning and staying up-to-date with new research and studies is crucial in the field of medicine, especially in the nuanced aspects of patient care. Peter Attia and Ted Schaeffer emphasize the importance of adapting to new knowledge and advancements in order to make the best decisions for patients. They discuss the use of genomic tests, PSA density, and MRI results to determine the aggressiveness of tumors and guide treatment options. They also emphasize the significance of interdisciplinary collaboration and the exchange of information among healthcare professionals. While surgical skills and technical knowledge are essential, the ability to make informed judgments based on the latest research is what truly sets apart a capable physician.

    • Balancing the Effects of 5 Alpha Reductase Inhibitors on DHT LevelsReducing DHT levels using 5 alpha reductase inhibitors can have positive outcomes in managing prostate volume and hair loss. However, caution is needed to assess the potential risks, such as increased aggressiveness of prostate cancer. Molecular tests play a crucial role in accurately evaluating cancer aggressiveness.

      Reducing DHT levels in the body through 5 alpha reductase inhibitors can have both positive and negative effects. These inhibitors are commonly used to reduce prostate volume size, treat benign prostatic hypertrophy, and minimize hair loss. However, studies have shown that suppressed DHT levels may lead to more aggressive forms of prostate cancer. It is still unclear whether this is due to the medication inducing high-grade cancer or selecting for it in a low DHT environment. Research has also revealed that the most aggressive tumors have the lowest androgen output, contradicting the assumption that high androgen signaling is always indicative of aggressive cancer. This emphasizes the importance of molecular tests to accurately assess the aggressiveness of prostate cancer.

    • Aggressiveness of prostate cancer and the role of androgen output.Low androgen output tumors in prostate cancer are highly aggressive and do not respond well to androgen deprivation treatment, leading to the development of a genomic-based commercial product. Testosterone replacement therapy does not increase the risk of prostate cancer.

      Low androgen output tumors are the most aggressive tumors in prostate cancer. While high androgen output tumors are also aggressive, they respond well to androgen deprivation treatment. On the other hand, low androgen output tumors are not dependent on this form of treatment for growth. This finding has led to the development of a commercial product that uses genomic data to determine the aggressiveness of prostate cancer. Additionally, the conversation highlights that physiologic testosterone replacement therapy does not seem to increase the risk of prostate cancer. The role of estradiol in prostate cancer is still unclear, but it is understood that testosterone decline over time is not solely responsible for benign neurologic conditions.

    • Hormone levels, mitochondrial function, and prostate cancer risk.Understanding the relationship between hormone levels, mitochondrial function, and prostate cancer can provide insights for prevention and treatment strategies.

      There may be a connection between hormone levels, mitochondrial function, and the development of prostate cancer. As testosterone values decline and estrogen levels increase, the risk of prostate cancer may be higher. However, it is important to consider the lag time between hormone fluctuations and cancer development, as mutations to DNA may occur decades before diagnosis. The metabolism within the prostate, including the activity of mitochondria, may also play a role in cancer growth. The influence of oxygen levels, pH differences, and alternate growth pathways in different regions of the prostate are areas of interest for further research. Understanding these connections can potentially lead to new strategies for prevention and treatment of prostate cancer.

    • Advancements in Prostate Cancer Research: The Role of Predictive BiomarkersIdentifying predictive biomarkers, such as BRCA1, BRCA2, and ATM gene mutations, in prostate cancer can aid in early detection and determining targeted therapy options for patients.

      The field of prostate cancer research is advancing, particularly in the area of predictive biomarkers. Early detection of lethal cancers is crucial, but researchers are now focusing on moving beyond prognostic biomarkers to identify predictive biomarkers. These biomarkers can be found in the DNA of tumors or patients, such as BRCA1, BRCA2, and ATM gene mutations. It was previously believed that these mutations only mattered in breast cancer, but recent studies have shown their significance in prostate cancer as well. Mutations in DNA repair pathways, including BRCA1, BRCA2, and RAD51, are found in a significant percentage of men with metastatic castrate-resistant prostate cancer. Understanding these biomarkers can help identify individuals who would benefit from targeted therapies, such as PARP inhibition.

    • Revolutionizing Cancer Treatment with Genomic Analysis and BiomarkersGenomic analysis and biomarkers have transformed cancer treatment, allowing for personalized therapies and improved prognoses. These advancements also emphasize the significance of accurate diagnosis and treatment.

      Advances in genomic analysis and biomarkers have revolutionized the field of cancer treatment. The ability to examine the alterations in the genome of cancer cells and determine their sensitivity to immunotherapy is a game changer. Moreover, screening for somatic DNA in tumor cells and germline DNA in individuals can now be used to detect various types of cancer. These biomarkers not only provide prognostic information but also predict the response to different drugs. Clinical trials have been conducted with biomarker-based tests to assess their predictive ability. On a lighter note, the conversation also highlights the importance of proper diagnosis and treatment, as showcased through a personal story about a prostate inflammation that was successfully resolved through a prostatic massage.

    • Understanding Inflammation in the Prostate and its Treatment OptionsInflammation in the prostate can occur without an infection. The exact cause is unknown, but symptoms can be managed through various treatments, including injections and robotic prostatectomy.

      Inflammation in the prostate can occur without an infection. Itis, which means inflammation, does not always imply infection. This condition, known as non-bacterial prostatitis, can cause acute symptoms and discomfort. The exact cause of this inflammation is still unknown, and treatment focuses on managing symptoms and preventing recurrence. Constipation and other factors can contribute to the development of chronic pelvic pain, a field that is still evolving in terms of understanding and treatment. Injections of Botox into the bladder have shown promise in alleviating interstitial cystitis in women, but it is not commonly used for this condition. In cases of recurrent bacterial infections in the prostate, direct injections of antibiotics can be administered, with ultrasound guidance making the procedure relatively straightforward. Overall, the use of robotic prostatectomy is becoming increasingly prevalent and is favored over open surgery.

    • Robotic surgeries revolutionize medical procedures, offering precise movements, improved optics, and enhanced detail, benefiting both patients and surgeons.The use of robots in surgeries has greatly improved precision and clarity, revolutionizing the field and benefiting both patients and surgeons.

      Advancements in technology, such as robotic surgeries, have significantly improved medical procedures like prostate removal. The use of robots allows for more precise and controlled movements, making the surgeries more effective and efficient. Surgeons who have experience with both traditional open surgeries and robotic surgeries often prefer the latter due to its exceptional precision and enhanced optics. The magnification and clarity provided by the robotic systems provide a level of detail that was not possible with traditional methods. It is evident that the use of robots in surgeries has revolutionized the field and greatly benefited both patients and surgeons.

    • The effectiveness of vasectomy and advancements in reproductive technologyInformed choices and responsible decision-making are important when considering contraception and personal preferences, such as luxury watches.

      Undergoing a vasectomy can be a highly effective form of contraception. It has a success rate of over 90% when performed by a skilled urologist. Additionally, advancements in reproductive technology have made it possible for individuals with conditions such as Klinefelter syndrome to have children through procedures like microdissection sperm retrieval. However, it is important to note that using protection in addition to contraception is recommended, especially when dating around. The conversation also touches on the topic of luxury watches, where the preference for an elegant dress watch with a GMT feature is discussed. Overall, the key takeaway emphasizes the importance of informed choices and responsible decision-making in matters of contraception and personal preferences.

    • Finding the Right Car: Balancing Performance and PracticalityWhen choosing a car, it's crucial to find a balance between performance and practicality to ensure everyday drivability and personal satisfaction.

      Practicality and everyday drivability are important factors to consider when choosing a car. While high-performance vehicles like Ferraris and McLarens may be impressive and exciting, they may not be suitable for daily use due to their limited functionality and potential self-consciousness that comes with driving them. Both Ted and Peter express a preference for cars like the Porsche 911 Turbo, which are well-engineered, drivable, and offer a balance between performance and practicality. They also mention the importance of emotional connection and personal preferences when it comes to car choices. Ultimately, finding a car that suits one's needs and preferences, both in terms of performance and practicality, is key.

    • Performance capabilities vary based on car purposeConsider specific use cases and preferences when evaluating car performance

      There is a distinction between track cars and street cars that people should understand. While hypercars like the Ferrari La Ferrari, Porsche 918, and McLaren P1 may be impressive on the track, it doesn't necessarily mean they are the fastest in every aspect. In fact, the 911 Turbo S was found to be faster than the 918 at the ring. This goes to show that there are different performance capabilities depending on the purpose of the car. Additionally, it's important to note that there are affordable track cars that can outperform expensive hypercars. This conversation emphasizes the need to consider specific use cases and individual preferences when evaluating car performance.

    Recent Episodes from The Peter Attia Drive

    #316 - AMA #63: A guide for hair loss: causes, treatments, transplants, and sex-specific considerations

    #316 - AMA #63: A guide for hair loss: causes, treatments, transplants, and sex-specific considerations

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    In this “Ask Me Anything” (AMA) episode, Peter dives deep into the topic of hair loss, exploring its relationship with aging and its impact on quality of life. The conversation focuses on androgenic alopecia, the most common form of hair loss in both men and women, and covers the differences in patterns and causes between the sexes. Peter delves into the right timing for treatment, breaking down various options such as minoxidil and finasteride, low-level laser therapy, platelet-rich plasma injections, and more. Additionally, Peter outlines the pros and cons of the two primary hair transplantation methods and concludes with practical advice on selecting the right specialist or treatment team for those facing hair loss.

    If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #63 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

    We discuss:

    • The impact of hair loss on emotional health [2:15];
    • The prevalence, patterns, and causes of hair loss in men and women [5:15];
    • The genetic and hormonal causes of hair loss, and the role of dihydrotestosterone (DHT) in androgenic alopecia [8:45];
    • The visual differences in hair loss patterns between men and women, and the importance of consulting a specialist to rule out non-genetic causes of hair loss [13:30];
    • How genetic predisposition influences the risk of androgenic alopecia, and how early detection through diagnostic tools and blood tests can help manage risk more effectively [16:45];
    • Ideal timing for starting treatment: why early treatment is crucial for effectively managing hair loss [19:30];
    • The various FDA-approved treatments for androgenic alopecia, their mechanisms, and additional off-label treatments commonly used to manage hair loss [24:30];
    • Topical minoxidil—the most commonly recommended starting treatment for hair loss [30:15];
    • Oral vs. topical minoxidil: efficacy, ease of use, and potential side effects that must be considered [33:45];
    • Finasteride for treating hair loss: efficacy, potential side effects on libido, and the need for careful PSA monitoring in men to avoid missing early signs of prostate cancer [37:15];
    • Other effective hair loss treatments for women: boosting hair density with spironolactone gel and ketoconazole shampoo as part of a comprehensive strategy [41:30];
    • Low-level laser therapy: effectiveness, costs, practicality, and a comparison of in-office treatments with at-home devices [49:00];
    • Platelet-rich plasma (PRP) as a treatment for hair loss: potential effectiveness, varying protocols, and significant costs [53:45];
    • Hair transplant for advanced hair loss: criteria and considerations [58:00];
    • Types of hair transplants: follicular unit transplantation (FUT) vs. follicular unit extraction (FUE) [1:02:00];
    • The financial cost of hair transplant surgery, and what to consider when seeking affordable options [1:06:15];
    • The potential risks and downsides of the various hair transplant procedures [1:09:30];
    • Post-procedure care for hair transplants and whether the procedure must be repeated periodically [1:16:30];
    • Combining different hair loss treatments: benefits, risks, and considerations [1:18:30];
    • Emerging hair loss treatments with limited data [1:21:00];
    • Key considerations for selecting the right treatment plan for hair loss [1:22:00];
    • A summary of the different considerations for men and women facing hair loss [1:24:30];
    • Practical advice on selecting the right specialist or treatment team [1:26:15]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enSeptember 09, 2024

    Improve your decision-making, frameworks for learning, backcasting, and more | Annie Duke (#60 rebroadcast)

    Improve your decision-making, frameworks for learning, backcasting, and more | Annie Duke (#60 rebroadcast)

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    In this episode, former World Series of Poker champion and author Annie Duke explains how poker is a pertinent model system for decision-making in the real world, a system which blends imperfect information with some unknown percentage of both luck and skill. Annie breaks down the decision-making matrix, revealing how we often focus too narrowly on just one of the four quadrants, missing out on valuable learning opportunities in the remaining 75% of situations. She delves into how our tendency to evaluate only negative outcomes leads to a culture of risk aversion. This mindset, she argues, stifles the kind of bold decision-making necessary for progress and innovation across various fields, from poker and sports to business and medicine. Annie also introduces a robust framework for learning and the levels of thought required to excel in any domain. Finally, she discusses a strategy called “backcasting”, a concept that resonated deeply with Peter in terms of how he thinks about extending healthspan.

    We discuss:

    • Annie’s background, favorite sports teams, and Peter’s affinity for Bill Belichick [1:30];
    • Chess vs. poker: Which is a better metaphor for decision-making in life (and medicine)? [6:45];
    • Thinking probabilistically: Why we aren’t wired that way, and how you can improve it for better decision-making [12:30];
    • Variable reinforcement: The psychological draw of poker that keeps people playing [19:15];
    • The role of luck and skill in poker (and other sports), and the difference between looking at the short run vs. long run [32:15];
    • A brief explanation of Texas hold ‘em [41:00];
    • The added complexity of reading the behavior of others players in poker [47:30];
    • Why Annie likes to “quit fast,” and why poker is still popular despite the power of loss aversion [52:45];
    • Limit vs. no-limit poker, and how the game has changed with growing popularity [55:15];
    • The advent of analytics to poker, and why Annie would get crushed against today’s professionals [1:04:45];
    • The decision matrix, and the “resulting” heuristic: The simplifier we use to judge the quality of decisions —The Pete Carroll Superbowl play call example [1:10:30];
    • The personal and societal consequences of avoiding bad outcomes [1:21:45];
    • Poker as a model system for life [1:31:30];
    • How many leaders are making (and encouraging) status-quo decisions, and how Bill Belichick’s decision-making changed after winning two Super Bowls [1:35:15];
    • What did we learn about decision-making from the Y2K nothingburger? And how about the D-Day invasion? [1:39:30];
    • The first step to becoming a good decision maker [1:43:00];
    • The difference between elite poker players and the ones who make much slower progress [1:49:45];
    • Framework for learning a skill, the four levels of thought, and why we hate digging into our victories to see what happened [1:52:15];
    • The capacity for self-deception, and when it is MOST important to apply four-level thinking [2:00:30];
    • Soft landings: The challenge of high-level thinking where there is subtle feedback and wider skill gaps [2:11:00];
    • The benefits of “backcasting” (and doing pre-mortems) [2:13:30];
    • Parting advice from Annie for those feeling overwhelmed (and two book recommendations) [2:21:30]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enSeptember 02, 2024

    #315 ‒ Life after near-death: a new perspective on living, dying, and the afterlife | Sebastian Junger

    #315 ‒ Life after near-death: a new perspective on living, dying, and the afterlife | Sebastian Junger

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    Sebastian Junger is an award-winning journalist, bestselling author, and previous guest on The Drive. In this episode, Sebastian returns to discuss his latest book, In My Time of Dying: How I Came Face to Face with the Idea of an Afterlife. This episode delves into Sebastian's profound near-death experience and how it became the catalyst for his exploration of mortality, the afterlife, and the mysteries of the universe. They discuss the secular meaning of what it means to be sacred, the intersection of physics and philosophy, and how our beliefs shape our approach to life and death. He also shares how this experience has profoundly changed him, giving him a renewed perspective on life—one filled with awe, gratitude, deeper emotional awareness, and a more engaged approach to living.

    We discuss:

    • How Sebastian’s near-death experience shaped his thinking about mortality and gave him a reverence for life [3:00];
    • The aneurysm that led to Sebastian’s near-death experience [6:30];
    • Emergency room response, his subsequent reflections on the event, and the critical decisions made by the medical team [16:30];
    • Sebastian’s reaction to first learning he nearly died, and the extraordinary skill of the medical team that save his life [26:00];
    • Sebastian’s near-death experience [37:00];
    • The psychological impact of surviving against overwhelming odds [48:00];
    • Ignored warning signs: abdominal pain and a foreshadowing dream before the aneurysm rupture [54:30];
    • Sebastian's recovery, his exploration of near-death experiences, and the psychological turmoil he faced as he questioned the reality of his survival [58:15];
    • A transformative encounter with a nurse who encouraged Sebastian to view his near-death experience as sacred [1:03:30];
    • How Sebastian has changed: a journey toward emotional awareness and fully engaging with life [1:08:45];
    • The possibility of an afterlife, and how quantum mechanics challenges our understanding of existence [1:15:15];
    • Quantum paradoxes leading to philosophical questions about the nature of reality, existence after death, and whether complete knowledge could be destructive [1:26:00];
    • The sweet spot of uncertainty: exploring belief in God, post-death existence, and meaning in life [1:37:00];
    • The transformative power of experiencing life with awe and gratitude [1:53:00]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enAugust 26, 2024

    #314 ‒ Rethinking nutrition science: the evolving landscape of obesity treatment, GLP-1 agonists, protein, and the need for higher research standards | David Allison, Ph.D.

    #314 ‒ Rethinking nutrition science: the evolving landscape of obesity treatment, GLP-1 agonists, protein, and the need for higher research standards | David Allison, Ph.D.

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    David Allison, a leading expert in obesity and nutrition, quantitative genetics, clinical trials, and research methodology, returns to The Drive to explore the evolving landscape of nutrition science and obesity treatment. In this episode, David begins by discussing the intricate relationship between nutrition, obesity, and body composition, emphasizing the multifaceted impacts of food beyond mere calorie intake. David provides a critical analysis of the complexities in nutrition research and their practical implications for tackling obesity. He critiques historical public health policies, addresses the trust issues plaguing nutrition science, and underscores the need for a paradigm shift to more effectively combat obesity. The conversation also delves into the rise of GLP-1 receptor agonists like Ozempic and Mounjaro, exploring their ethical and practical considerations in obesity treatment. The episode concludes with an in-depth look at protein intake recommendations and highlights the significant research gaps that remain in the field.

    We discuss:

    • The complex relationship between nutrition, body weight, and body composition [2:30];
    • The slow progress in addressing obesity and public health despite substantial effort and investment [7:30];
    • The very limited success of public health initiatives in curbing obesity [17:15];
    • The evolving landscape of obesity research: public health initiatives and the impact of pharmacological success [26:30];
    • Rethinking obesity solutions: the need for a paradigm shift [32:45];
    • Understanding environmental triggers and embracing a balanced approach to addressing obesity that includes both pharmacological treatments and realistic lifestyle changes [41:45];
    • The need for higher standards in obesity research [51:45];
    • The rapid success of GLP-1 receptor agonists for weight loss: a discussion on the societal impact and controversy of their growing usage [1:02:15];
    • The ethical and practical considerations of obesity drugs: risks, benefits, and motivations for usage [1:11:30];
    • The use of GLP-1 agonists by athletes as performance enhancers [1:23:45];
    • Unanswered questions about protein intake and health [1:30:45];
    • Future research needed to understand basic questions around protein intake [1:45:00];
    • David’s weekly newsletter: “Obesity and Energetics Offerings” [1:50:45]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enAugust 19, 2024

    #313 - AMA #62: Protein’s impact on appetite and weight management, and uric acid's link to disease and how to manage levels

    #313 - AMA #62: Protein’s impact on appetite and weight management, and uric acid's link to disease and how to manage levels

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    In this “Ask Me Anything” (AMA) episode, Peter dives into two important health topics: uric acid and protein, examining them from unique perspectives. For uric acid, he explores its metabolic role and connection to various diseases, focusing on the potential causal link with cardiovascular disease. He also discusses factors influencing uric acid levels, such as diet, genetics, and lifestyle, providing practical tips for effective management. Shifting to protein, Peter delves into its role in appetite and weight management, the consequences of insufficient protein, and the “protein leverage hypothesis” linking protein deficiency to obesity. He covers optimal protein intake and its impact on energy expenditure, and he compares the satiety effects of solid versus liquid protein. Finally, Peter shares his strategy for incorporating protein into a comprehensive weight management plan.

    If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #62 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

    We discuss:

    • Overview of episode topics (and an important discussion on fanny packs) [2:00];
    • Understanding uric acid: its role in metabolic processes, its association with gout and kidney stones, its impact on blood pressure, and more [6:00];
    • Non-modifiable factors that influence uric acid levels [11:00];
    • Modifiable factors that influence uric acid levels [14:15];
    • Association between high uric acid levels and cardiovascular disease [20:00];
    • Evidence suggesting a causal link between high uric acid levels and cardiovascular disease [24:00];
    • Inconclusive evidence about the cardiovascular benefits of lowering uric acid pharmacologically [28:15];
    • Exploring the potential risks of low uric acid levels in neurodegenerative diseases [37:00];
    • Managing uric acid levels: dietary interventions and pharmacological approaches [42:00];
    • The impact of protein on appetite and weight management [44:00];
    • The consequences of insufficient protein on eating behaviors and satiety [52:15];
    • The relationship between protein deficiency and obesity: exploring the “protein leverage hypothesis” [57:15];
    • The impact of protein intake on energy expenditure [1:02:15];
    • Determining optimal protein intake to avoid deficiency and support health [1:05:45];
    • The role of different amino acids and protein sources in promoting satiety [1:08:15];
    • Comparing the satiety effects of solid vs. liquid protein sources [1:10:30];
    • Peter’s framework for incorporating protein intake into a strategy for controlling body weight [1:12:00]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enAugust 12, 2024

    #312 - A masterclass in lactate: Its critical role as metabolic fuel, implications for diseases, and therapeutic potential from cancer to brain health and beyond | George A. Brooks, Ph.D.

    #312 - A masterclass in lactate: Its critical role as metabolic fuel, implications for diseases, and therapeutic potential from cancer to brain health and beyond | George A. Brooks, Ph.D.

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    George A. Brooks is a renowned professor of integrative biology at UC Berkeley. Known for his groundbreaking "lactate shuttle" theory proposed in the 1980s, George revolutionized our understanding of lactate as a crucial fuel source rather than just a byproduct of exercise. In this episode, George clarifies common misconceptions between lactate and lactic acid, delves into historical perspectives, and explains how lactate serves as a fuel for the brain and muscles. He explores the metabolic differences in exceptional athletes and how training impacts lactate flux and utilization. Furthermore, George reveals the significance of lactate in type 2 diabetes, cancer, and brain injuries, highlighting its therapeutic potential. This in-depth conversation discusses everything from the fundamentals of metabolism to the latest research on lactate's role in gene expression and therapeutic applications.

    We discuss:

    • Our historical understanding of lactate and muscle metabolism: early misconceptions and key discoveries [3:30];
    • Fundamentals of metabolism: how glucose is metabolized to produce ATP and fuel our bodies [16:15];
    • The critical role of lactate in energy production within muscles [24:00];
    • Lactate as a preferred fuel during high-energy demands: impact on fat oxidation, implications for type 2 diabetes, and more [30:45];
    • How the infusion of lactate could aid recovery from traumatic brain injuries (TBI) [43:00];
    • The effects of exercise-induced lactate [49:30];
    • Metabolic differences between highly-trained athletes and insulin-resistant individuals [52:00];
    • How training enhances lactate utilization and facilitates lactate shuttling between fast-twitch and slow-twitch muscle fibers [58:45];
    • The growing recognition of lactate and monocarboxylate transporters (MCT) [1:06:00];
    • The intricate pathways of lactate metabolism: isotope tracer studies, how exceptional athletes are able to utilize more lactate, and more [1:09:00];
    • The role of lactate in cancer [1:23:15];
    • The role of lactate in the pathophysiology of various diseases, and how exercise could mitigate lactate's carcinogenic effects and support brain health [1:29:45];
    • George’s current research interests involving lactate [1:37:00];
    • Questions that remain about lactate: role in gene expression, therapeutic potential, difference between endogenous and exogenous lactate, and more [1:50:45]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enAugust 05, 2024

    #311 ‒ Longevity 101: a foundational guide to Peter's frameworks for longevity, and understanding CVD, cancer, neurodegenerative disease, nutrition, exercise, sleep, and more

    #311 ‒ Longevity 101: a foundational guide to Peter's frameworks for longevity, and understanding CVD, cancer, neurodegenerative disease, nutrition, exercise, sleep, and more

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    In this special episode, Peter provides a comprehensive introduction to longevity, perfect for newcomers or those looking to refresh their knowledge. He lays out the foundational concepts of lifespan, healthspan, and the marginal decade. Additionally, Peter discusses the four main causes of death and their prevention, as well as detailing the five key strategies in his longevity toolkit to improve lifespan and healthspan. Detailed show notes provide links for deeper exploration of these topics, making it an ideal starting point for anyone interested in understanding and improving their longevity.

    We discuss:

    • Key points about starting exercise as an older adult [2:45];
    • Overview of episode topics and structure [1:45];
    • How Peter defines longevity [3:45];
    • Why healthspan is a crucial component of longevity [11:15];
    • The evolution of medicine from medicine 1.0 to 2.0, and the emergence of medicine 3.0 [15:30];
    • Overview of atherosclerotic diseases: the 3 pathways of ASCVD, preventative measures, and the impact of metabolic health [26:00];
    • Cancer: genetic and environmental factors, treatment options, and the importance of early and aggressive screening [33:15];
    • Neurodegenerative diseases: causes, prevention, and the role of genetics and metabolic health [39:30];
    • The spectrum of metabolic diseases [43:15];
    • Why it’s never too late to start thinking about longevity [44:15];
    • The 5 components of the longevity toolkit [46:30];
    • Peter’s framework for exercise—The Centenarian Decathlon [47:45];
    • Peter’s nutritional framework: energy balance, protein intake, and more [58:45];
    • Sleep: the vital role of sleep in longevity, and how to improve sleep habits [1:08:30];
    • Drugs and supplements: Peter’s framework for thinking about drugs and supplements as tools for enhancing longevity [1:13:30];
    • Why emotional health is a key component of longevity [1:17:00];
    • Advice for newcomers on where to start on their longevity journey [1:19:30]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enJuly 29, 2024

    #310 - The relationship between testosterone and prostate cancer, testosterone replacement therapy, and tools for predicting cancer aggressiveness and guiding therapy | Ted Schaeffer, M.D., Ph.D.

    #310 - The relationship between testosterone and prostate cancer, testosterone replacement therapy, and tools for predicting cancer aggressiveness and guiding therapy | Ted Schaeffer, M.D., Ph.D.

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    Ted Schaeffer is an internationally recognized urologist specializing in prostate cancer and a returning guest on The Drive. In this episode, Ted provides insights into the role testosterone plays, or doesn't play, in the initiation and progression of prostate cancer. He unpacks the findings and limitations of the recent TRAVERSE trial, exploring the complex relationship between testosterone and prostate cancer. Ted delves into the molecular nature of prostate cancer, explaining the androgen receptor saturation theory and the potential impact of testosterone on cancer growth. He also discusses the use of the Decipher test to predict cancer aggressiveness and guide targeted treatment. Furthermore, Ted shares how he counsels patients regarding testosterone replacement therapy (TRT), including its safe administration in patients with low-grade prostate cancer. Additionally, he highlights advancements in prostate cancer therapies and biomarkers that help develop precise treatment strategies while minimizing the need for broad androgen deprivation therapy.

    We discuss:

    • Background on the TRAVERSE trial: insights into exogenous testosterone and prostate cancer risk [3:00];
    • The androgen receptor saturation theory: how different organs respond to varying levels of testosterone [10:30];
    • The relationship between testosterone levels and prostate cancer aggressiveness: how aggressive prostate tumors have lower androgen receptor activity and rely on different growth mechanisms [16:15];
    • Using the Decipher score to assess prostate cancer aggressiveness and guide personalized treatment strategies [23:45];
    • Considerations for testosterone replacement therapy: how Ted counsels patients, how TRT can be safely administered in patients with low-grade prostate cancer, and more [31:15];
    • Advancements in prostate cancer therapies and PSA as a biomarker for precise treatment decisions, minimizing the need for broad androgen deprivation therapy [38:30]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enJuly 22, 2024

    #309 ‒ AI in medicine: its potential to revolutionize disease prediction, diagnosis, and outcomes, causes for concern in medicine and beyond, and more | Isaac Kohane, M.D., Ph.D.

    #309 ‒ AI in medicine: its potential to revolutionize disease prediction, diagnosis, and outcomes, causes for concern in medicine and beyond, and more | Isaac Kohane, M.D., Ph.D.

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    Isaac "Zak" Kohane, a pioneering physician-scientist and chair of the Department of Biomedical Informatics at Harvard Medical School, has authored numerous papers and influential books on artificial intelligence (AI), including The AI Revolution in Medicine: GPT-4 and Beyond. In this episode, Zak explores the evolution of AI, from its early iterations to the current third generation, illuminating how it is transforming medicine today and unlocking astonishing possibilities for the future. He shares insights from his unconventional journey and early interactions with GPT-4, highlighting significant AI advancements in image-based medical specialties, early disease diagnosis, and the potential for autonomous robotic surgery. He also delves into the ethical concerns and regulatory challenges of AI, its potential to augment clinicians, and the broader implications of AI achieving human-like creativity and expertise.

    We discuss:

    • Zak’s unconventional journey to becoming a pioneering physician-scientist, and his early interactions with GPT-4 [2:15];
    • The evolution of AI from the earliest versions to today’s neural networks, and the shifting definitions of intelligence over time [8:00];
    • How vast data sets, advanced neural networks, and powerful GPU technology have driven AI from its early limitations to achieving remarkable successes in medicine and other fields [19:00];
    • An AI breakthrough in medicine: the ability to accurately recognize retinopathy [29:00];
    • Third generation AI: how improvements in natural language processing significantly advanced AI capabilities [32:00];
    • AI concerns and regulation: misuse by individuals, military applications, displacement of jobs, and potential existential concerns [37:30];
    • How AI is enhancing image-based medical specialties like radiology [49:15];
    • The use of AI by patients and doctors [55:45];
    • The potential for AI to augment clinicians and address physician shortages [1:02:45];
    • The potential for AI to revolutionize early diagnosis and prediction of diseases: Alzheimer’s disease, CVD, autism, and more [1:08:00];
    • The future of AI in healthcare: integration of patient data, improved diagnostics, and the challenges of data accessibility and regulatory compliance [1:17:00];
    • The future of autonomous robotic surgery [1:25:00];
    • AI and the future of mental health care [1:31:30];
    • How AI may transform and disrupt the medical industry: new business models and potential resistance from established medical institutions [1:34:45];
    • Potential positive and negative impacts of AI outside of medicine over the next decade [1:38:30];
    • The implications of AI achieving a level of creativity and expertise comparable to exceptional human talents [1:42:00];
    • Digital immortality and legacy: the potential to emulate an individual's personality and responses and the ethical questions surrounding it [1:45:45];
    • Parting thoughts [1:50:15]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enJuly 15, 2024

    Zone 2 training: impact on longevity and mitochondrial function, how to dose frequency and duration, and more | Iñigo San-Millán, Ph.D. (#201 rebroadcast)

    Zone 2 training: impact on longevity and mitochondrial function, how to dose frequency and duration, and more | Iñigo San-Millán, Ph.D. (#201 rebroadcast)

    View the Show Notes Page for This Episode

    Become a Member to Receive Exclusive Content

    Sign Up to Receive Peter’s Weekly Newsletter

    Iñigo San-Millán is an internationally renowned applied physiologist and a previous guest on The Drive. His research and clinical work focuses on exercise-related metabolism, metabolic health, diabetes, cancer metabolism, nutrition, sports performance, and critical care. In this episode, Iñigo describes how his work with Tour de France winner Tadej Pogačar has provided insights into the amazing potential of elite athletes from a performance and metabolic perspective. He speaks specifically about lactate levels, fat oxidation, how carbohydrates in food can affect our lactate and how equal lactate outputs between an athlete and a metabolically unhealthy individual can mean different things. Next, he discusses how Zone 2 training boosts mitochondrial function and impacts longevity. He explains the different metrics for assessing one’s Zone 2 threshold and describes the optimal dose, frequency, duration, and type of exercise for Zone 2. Additionally, he offers his thoughts on how to incorporate high intensity training (Zone 5) to optimize health, as well as the potential of metformin and NAD to boost mitochondrial health. Finally, he discusses insights he’s gathered from studying the mitochondria of long COVID patients in the ICU.

    We discuss:

    • The amazing potential of cyclist Tadej Pogačar [2:00];
    • Metrics for assessing athletic performance in cyclists and how that impacts race strategy [7:30];
    • The impact of performance-enhancing drugs and the potential for transparency into athletes’ data during competition [16:15];
    • Tadej Pogačar’s race strategy and mindset at the Tour de France [23:15];
    • Defining Zone 2, fat oxidation, and how they are measured [26:00];
    • Using fat and carbohydrate utilization to calculate the mitochondrial function and metabolic flexibility [35:00];
    • Lactate levels and fat oxidation as it relates to Zone 2 exercise [39:15];
    • How moderately active individuals should train to improve metabolic function and maximize mitochondrial performance [51:00];
    • Bioenergetics of the cell and what is different in elite athletes [56:30];
    • How the level of carbohydrate in the diet and ketogenic diets affects fuel utilization and power output during exercise [1:07:45];
    • Glutamine as a source for making glycogen—insights from studying the altered metabolism of ICU patients [1:14:15];
    • How exercise mobilizes glucose transporters—an important factor in diabetic patients [1:20:15];
    • Metrics for finding Zone 2 threshold—lactate, heart rate, and more [1:24:00];
    • Optimal Zone 2 training: dose, frequency, duration, and type of exercise [1:40:30];
    • How to incorporate high intensity training (Zone 5) to increase VO2 max and optimize fitness [1:50:30];
    • Compounding benefits of Zone 2 exercise and how we can improve metabolic health into old age [2:01:00];
    • The effects of metformin, NAD, and supplements on mitochondrial function [2:04:30];
    • The role of lactate and exercise in cancer [2:12:45];
    • How assessing metabolic parameters in long COVID patients provides insights into this disease [2:18:30];
    • The advantages of using cellular surrogates of metabolism instead of VO2 max for prescribing exercise [2:25:00];
    • Metabolomics reveals how cellular metabolism is altered in sedentary individuals [2:33:00];
    • Cellular changes in the metabolism of people with diabetes and metabolic syndrome [2:38:30]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enJuly 08, 2024

    Related Episodes

    What If Money Were No Object?

    What If Money Were No Object?

    If money didn't exist, what would you spend your time doing? What are your truest passions in this life? In this episode, we're going to dive into this topic to see what adjustments you need to make to create a life you love!


    Want to master your mindset? Every Monday I send out an email with mindset tips for the week, click here to receive that email: http://mondayemail.com/

    Follow me on IG for more inspiration here: https://www.instagram.com/robdialjr/

    Tony Hawk: The Man With The $1.4 Billion Name! Burnout, Obsession & Regrets

    Tony Hawk: The Man With The $1.4 Billion Name! Burnout, Obsession & Regrets
    If you think about skateboarding, there is one name that will pop up in your mind: Tony Hawk. It’s the same name that fronts a billion dollar video game franchise. He has been called the Michael Jordan of skateboarding, and at the height of his career he was so dominant in competition that the real fight was for second place. But before skateboarding became the Olympic sport it is today and Tony the living legend that he is, he was an outsider in a sport for outsiders. Driven by his love of skateboarding and to prove his haters wrong, he created an entirely new path for the sport and brought it into the public light and popularity it has today. In this conversation Tony discusses his life’s dedication to skateboarding, the highs and lows that this commitment brings and how the sport has given back to him by teaching him lessons that he has used in both life and business. Tony Hawk: Instagram: http://bit.ly/3TRcn1V Website: http://bit.ly/3TQQYWM Follow me: https://beacons.ai/diaryofaceo Learn more about your ad choices. Visit podcastchoices.com/adchoices

    Ice Cube: Working with Dr. Dre, The TRUTH About Hollywood, & Inspiring Generations

    Ice Cube: Working with Dr. Dre, The TRUTH About Hollywood, & Inspiring Generations

    More than just a cultural icon, Ice Cube is a man of many layers - a music legend, a film star, and a sports enthusiast. He warmly opens up about his transition from the streets to the stage with Dr. Dre, and how he's evolved into a dynamic force across various industries. Ice Cube takes us back to his roots, sharing the tunes that sparked his musical flame and the pride he feels in his diverse achievements, including his leap from hip-hop into the world of acting with roles like 'Boyz n The Hood'. It's a heart-to-heart as he candidly talks about the thrills and challenges of wearing many hats in the entertainment world and staying influential in a constantly changing landscape.

    Ice Cube, a legendary figure in the world of music and entertainment, has proven time and time again that his talents and passions extend far beyond the realm of music and movies. While he initially gained fame as a member of the groundbreaking rap group N.W.A.,Ice Cube has since carved out a multifaceted career that spans acting, directing, producing, and even sports ownership.

    Following N.W.A., Ice Cube pursued a successful solo music career and later established himself as a prominent figure in the entertainment industry through his acting roles and contributions to filmmaking, starring in numerous films such as "Boyz n the Hood," "Friday," and "Barbershop." In 2017, he co-founded the BIG3, which aimed to bring an exciting 3-on-3 basketball league to fans, featuring former NBA stars and other professional players. Among Ice Cube’s many awards and honors, he was inducted into the Rock and Roll Hall of Fame as a member of N.W.A. in 2016 and received a star on the Hollywood Walk of Fame in 2017.

    In this episode you will learn

    • The significance of maintaining peace and positivity in personal and professional life.
    • Strategies for successfully transitioning between different career paths.
    • The importance of creative independence in the entertainment industry.
    • Insights into building and maintaining collaborative relationships in personal and professional life
    • The art of balancing fame, success, and family in a high-stress career.

    For more information go to www.lewishowes.com/1562

    For more Greatness text PODCAST to +1 (614) 350-3960

    More SOG episodes we think you’ll love:

    Jeezy – https://link.chtbl.com/1480-pod

    Rhonda Byrne – https://link.chtbl.com/1525-pod

    John Maxwell – https://link.chtbl.com/1501-pod

    Finding The Ultimate Level Of Success

    Finding The Ultimate Level Of Success

    Wylie McGraw joins us this week as we discuss how to achieve your ultimate level of success while not compromising your relationships, health and personal peace. Wylie talks about his past as a star pitcher, 3-tour army combat veteran and a competitive bull rider – what a resume! He now works as a “Performance Accelerator” and shares his expertise with us. He and Dave talk about success, sacrifices and finding balance through it all.