Beyond the Coat: Prostate Cancer Diagnosis and Treatment Innovations featuring Dr. Rajesh Shingal

LIAM MAYCLEM: Hello, friends, and welcome
to Beyond the Coat, What You Should
Know About Prostate Cancer Diagnosis and Treatment
Innovations.
I'm your host, Liam Mayclem.
I'm thrilled to have you all with us here today.
Wherever you're watching from, thank you and welcome.
And I'm delighted to introduce to you our very special guest--
just want to let you know, though, you
will have an opportunity to put some questions to our doctor
at the end of my Q&A with the doctor,
so fill in the little forms you have there
and send those questions in.
And I also have my Five Tasty Questions
for our doctor, the fun ones.
We'll do those at the very end of the segment--
so an opportunity to learn, an opportunity for discovery.
And let me tell you about our doctor.
Dr. Shinghal is the chair of urology at the Palo Alto
Medical Foundation.
Growing up in South Dakota, he matriculated to Stanford,
where he earned his bachelor's degree
and then went on to get his MD from Stanford Medical School.
After his residency at Stanford in 2002,
he served on the teaching faculty
at Stanford for 10 years.
He then joined Palo Alto Medical Foundation in 2013,
where he is now chair of the Urology Department.
He has the privilege of seeing patients
at the Fremont and Palo Alto clinic locations,
delivering cutting-edge, personalized care for men
and women with a variety of urological issues.
His focus includes kidney stones and prostate diseases.
Outside the Medical Center and his medical world,
he enjoys eating, cheering on all--
yes, all-- Bay Area sports teams, and spending time
with his wife, who's a dermatologist at PAMF, and also
his two teenage boys.
So friends, let's say hello and welcome to Chef Shing--
chef-- to Dr. Shinghal.
The food mention made me think of chefs.
Doctor, welcome.
Thank you so much.
Thanks for being with us today.
RAJESH SHINGHAL: Well, thank you so much for having me, Liam,
and thanks to the group at Palo Alto Medical Foundation
for organizing this event.
LIAM MAYCLEM: And friends, again,
stand by with your questions in about 15 minutes, 20 minutes,
or so.
But let's get straight to it-- straight
to the heart of our topic, if you will,
and just that first question.
Doctor, what exactly is the prostate gland?
RAJESH SHINGHAL: Great.
So the prostate gland is a walnut-shaped gland--
a walnut-sized gland that sits between the bladder
and the urethra.
It is only found in men.
Its purpose is to produce enzymes and fluids
that help nourish the sperm and make, in men, the ejaculate.
This allows the sperm to fertilize the egg
and allows us to have children.
Once you're done having children,
however, the prostate gland is a troublesome gland.
It can get larger and cause urinary problems.
It can get infections, and, of course, it can develop cancers.
And so after you're done having children,
the prostate can just be a troublesome little bugger.
LIAM MAYCLEM: Yeah, you said it.
And, you know, I hope--
I know this is of interest, of course, to the men watching--
men in my age bracket--
also, the women watching as well.
Let me ask you this follow-up question.
Prostate cancer, that's something that many men fear.
So is this the same thing as an enlarged prostate?
How can you differentiate the two,
and what do they have in common?
RAJESH SHINGHAL: A great question,
and, you know, it's interesting.
September happens to be Prostate Cancer Awareness Month,
so this is a very timely talk that you've organized.
Prostate cancer is an uncontrolled growth
of abnormal cells that originate from the prostate gland.
It is the most common non-skin cancer
in men in the United States and the second leading
cause of cancer death in men in the United States.
One in six men in the United States
will be diagnosed with prostate cancer.
One in 40 men or so will die of their disease,
or about 33,000 men a year.
So it's a very common disease, but it doesn't necessarily
lead to death from prostate cancer.
Nonetheless, it still can have significant implications
and can cause significant side effects for men.
Now, you asked an important thing there,
the differentiation between prostate cancer
and enlargement.
Enlargement of the prostate is a noncancerous process.
Enlargement of the prostate is very common.
About 70% of men over the age of 70
will have enlargement of the prostate.
However, that is not cancerous enlargement.
Enlargement of the prostate tends
to cause urinary symptoms, slow urine stream,
waking up at night to urinate, urgency to go to the bathroom,
or incomplete bladder emptying.
That's different than prostate cancer,
which can be quite silent and have no symptoms whatsoever.
LIAM MAYCLEM: Yeah, so Doctor, you know,
I hear talk of a PSA test.
Should I be getting a PSA test?
And then describe to our friends watching
what is a PSA test exactly.
RAJESH SHINGHAL: Great.
So the PSA test is something called the Prostate-specific
Antigen test.
Prostate-specific antigen is basically a molecule
only produced in the prostate.
Pretty remarkable, it's just specific to that gland,
and, in fact, Dr. Stamey, who was at Stanford back in 1987,
published the pivotal paper that showed that the PSA test is
correlated to prostate cancer.
Now, the PSA test is a blood test.
You simply go in and get a blood test done.
You don't have to be fasting for it.
It can be in morning or evening, doesn't really matter.
It's a screening test for prostate cancer.
That is, it's kind of our first pass through men to say,
do we have to worry about prostate cancer or not?
It's not a perfect test.
There are things that can cause the PSA to go up that don't
necessarily mean cancer.
However, the PSA test overall is a very effective test.
There was a large study that was done in Europe to kind of test
this hypothesis to see does PSA testing or screening
for prostate cancer actually make
a difference in men's lives.
This is very controversial because after the test was
introduced, virtually every man and his grandmother
were getting PSA tests--
grandfather, I should say.
You would go to an NFL game, and they'd
have a trailer out there, and they're like,
come in and get a PSA test.
And that's not how PSA testing should be done.
So we had a whole bunch of men who
were getting PSA tests that probably shouldn't
have been getting it done.
So this study was done in Europe,
where they took about 90,000 men,
and they gave them a PSA test and 90,000 men who
didn't get a PSA test, and they followed them along.
And at 10 and 15 years after the study,
they showed that if you tested and screened for prostate
cancer early enough, you would reduce the chances of death
from prostate cancer by about 20%.
It's a pretty big difference.
That's actually better than even mammograms
do in terms of screening for breast cancer for women.
Now there was a second study that was done,
and that was done in the United States.
And unfortunately, we Americans aren't
good at listening to instructions
like the Europeans are.
So this study took about 30,000 men
on each side, and unfortunately, in America,
the men who were not supposed to get the PSA test went ahead
and snuck out and got one anyways.
So it wasn't really a good study.
So there's a lot of controversy about that.
The bottom line is that the current recommendation
is talk to your doctor.
If you're over the age of 50 to about the age of 75 or so,
talk to your doctor about the value of the PSA--
this can be with your primary care doctor--
and see am I a good candidate for it,
and should I get a PSA test done?
LIAM MAYCLEM: Yeah, and Doctor, my doctor told me
my PSA test was abnormal.
So should I be concerned?
And what should I do next?
RAJESH SHINGHAL: Great question.
So the moment a man gets an abnormal test, of course,
it strikes fear in their heart.
And I want to reassure you that A, an abnormal PSA test
does not mean prostate cancer.
It's not like a pregnancy test, where yes, you're pregnant.
It's not like that at all.
It's just telling us that we need
to do some further evaluation.
So an abnormal PSA test can be abnormal in prostate cancer
cases.
But it also can be abnormal due to recent ejaculation,
enlargement of the prostate-- which is what I talked about
before-- that's not cancerous, infections of the prostate.
There's a lot of different causes.
So the first thing that you do is you go back to your doctor,
and they often are going to recommend another PSA test.
We're going to go ahead and repeat it and get another value
there to make sure that that is a consistent evaluation.
If the PSA test is abnormal, that's
often where a urologist comes into the picture,
and we're going to go ahead and see you in our office.
We'll examine you, including a prostate exam, which
isn't as bad as everyone thinks, and then we'll
talk about some different options.
One of the things that we have introduced recently
in the last five years is getting
something called an MRI.
An MRI is a noninvasive way to get
a three-dimensional, high-definition picture
of the prostate and look for abnormal spots in the prostate.
If the MRI is normal, in some cases,
we don't have to do something called a prostate biopsy.
In other cases, where the PSA is abnormal
and the MRI is abnormal, we potentially
will offer something called a prostate biopsy,
where we go ahead and take small samples of the prostate
to look for prostate cancer.
So that's a very brief summary of what
can be done with an abnormal PSA test,
but you definitely want to follow up
with that with your primary care doctor
and then potentially come see a urologist
for further evaluation.
LIAM MAYCLEM: Yeah, I'm curious to know,
are all prostate cancers the same, or are they different?
RAJESH SHINGHAL: Yeah, that's a very challenging question
to answer, but a great one.
So prostate cancer, as I mentioned, very common cancer--
notice what I talked about, one in six men
will get prostate cancer, yet only one in 35 to 40
will die of prostate cancer.
What this tells you is that while prostate cancer is very
common, it does not necessarily mean
that it's something that's going to take a man's life.
So there are a variety of different things
that we look at when we are diagnosing prostate cancer.
One of the most important factors we look at
is what's called the grade of the cancer.
There was a pathologist named Gleason
who, 40 years ago, looked under the microscope
and looked at prostate cancer cells.
And he said, ha, let's correlate how
it looks under the microscope with how men do.
And he came up with the grading system, called the Gleason
grading system.
And ultimately, what he found was
that cancers of a certain appearance
are very slow-growing and almost never spread,
and then there are other cancers that are less common that
are more likely to spread.
And he came up with this grading system.
So, for instance, if you are told
you have a Gleason 6 cancer, or a very low-grade cancer,
those cancers, in general, don't spread.
They don't grow.
They just kind of stay in the prostate,
and in fact, some people even say
we shouldn't even be using the word "cancer"
for that type of diagnosis.
We should just call it something else, a prostate proliferation,
but that hasn't taken on necessarily.
On the other hand, some of the more aggressive ones,
Gleason 9 and 10 cancers, are much more aggressive,
and therefore, we need to think about doing some type
of treatment for them.
LIAM MAYCLEM: Yeah, and a question
that just came in-- are there things that raise
the PSA outside of cancer?
RAJESH SHINGHAL: Right, so enlargement of the prostate
is probably the most common thing, what
we call BPH, or Benign Prostatic Hyperplasia,
or hypertrophy-- very common condition.
It's a confusing thing because men get enlargement
of the prostate after the age of 50,
and they also are more at risk for prostate cancer
after the age of 50.
So we have to help sort this out.
Ejaculation or bike riding--
now bike riding does not cause prostate cancer.
However, if you've recently ridden a long distance
on your bike, and you get a PSA, like,
the following day, sometimes that
can cause an artificial transient spike in the PSA.
Likewise, recent ejaculation-- if you
happened to ejaculate the night before,
that could cause the PSA to go up.
Again, ejaculation does not cause prostate cancer.
In fact, there was a study that came out
of Europe that showed men who ejaculate more than 21 times
a day--
sorry, 21 times a month--
a day would be another problem--
21 times a month in their 30s had a lower risk
of prostate cancer.
And we always giggle about this because those men likely
were just very relaxed and unemployed, but good for them
for doing it that often.
So there's no relationship-- people ask, like,
if I ejaculate more, if I'm more or less sexually active,
does that cause prostate cancer?
We don't think there's any association there.
LIAM MAYCLEM: Yeah, Doctor, I want
to remind our friends watching we
thank you all for being with us, and jump in with any questions.
Right there, there's the Chat there,
so pop your question there.
We'll put it to the doctor.
He's here for you today, so any questions you have,
now is your opportunity.
As we continue, Doctor, should someone like myself
be diagnosed with prostate cancer, today,
what are my treatment options?
RAJESH SHINGHAL: Yeah, another complex, great question,
and hopefully that never happens to you, Liam.
So prostate cancer treatment really
is tailored to A, the man, his partner,
and, of course, the cancer that we have.
Going back 30 years ago, we said, oh, you
have prostate cancer.
We need to do something about it and basically have to treat it.
We've learned a lot over time now, and so, recall
I talked about those very slow-growing prostate cancers?
One of the treatment options is actually to do nothing.
And that's a treatment protocol called active surveillance.
Now we're not doing nothing.
We're watching things, but we're making sure
that this cancer doesn't get any worse and following it.
So if you have a low-grade prostate cancer, which
is about 50% to 55% of all the prostate cancers diagnosed
in the United States, our current thing
at Palo Alto Medical Foundation--
our current recommendation is to go on active surveillance.
This involves following your PSA, getting another MRI test,
and potentially doing another biopsy to follow the cancer
and make sure that it doesn't get worse.
It's a very successful protocol because it watches
the cancer closely yet avoids some of those side effects
that you can have with treatment,
and that's very appealing for a variety of reasons.
We're very proud at Palo Alto Medical Foundation.
We analyzed our data, and we showed that over 85% to 90%
of men who were eligible for active surveillance
actually are offered and go through
with active surveillance here at Palo Alto Medical Foundation.
We're very proud of that number.
That's on par with any academic institution in the country,
and it's something that we really
espouse because we want to do the right thing and the best
thing for the patient.
Now if you have one of those more aggressive prostate
cancers, treatment can be surgery,
which involves removal of the entire prostate
gland, radiation treatment, where we use strong X-ray beams
from outside the body to go ahead and treat the prostate.
And there has been some real advances in that.
In fact, our philanthropy group has
helped support bringing in some of the latest radiation
technology here at Palo Alto Medical Foundation, where
we can decrease the number of treatments
we have to give and literally wrap an X-ray
beam around the prostate, literally tailor it like you're
shrink-wrapping it around the prostate to kill the tumor
and avoid damage to other organs.
And then a third method is using radioactive seeds
that you can put inside the prostate that very
effectively treat the cancer.
So that's a 10,000-foot overview of treatment options,
all of which have different side effects,
which can include urinary side effects and sexual side effects
too.
LIAM MAYCLEM: You've given some great examples there
of the technology, the latest, that you're using
to combat prostate cancer.
Are there any more recent developments
in combating it that you're especially excited about?
RAJESH SHINGHAL: Yeah, so the introduction of MRI
has been game-changing.
So that is one thing that allows us to literally pinpoint
where we're going to biopsy.
Again, thanks to our generous community support,
we've been able to introduce MRI fusion biopsy,
where we take an MRI--
we can pinpoint it here in the office and go nail--
go ahead and biopsy that particular spot.
And it's led to much more accurate biopsies
and much better diagnosis of prostate cancer earlier.
So that's a program that we've been very excited about
and integrated across all of Palo Alto Medical Foundation's
footprint over the last four to five years.
Another thing that we have been--
that's been introduced over the last 10 years--
and we just have some fantastic surgeons-- is, of course,
robotic surgical technology, which
allows a surgeon-controlled, minimally-invasive robot
to make small incisions to allow removal of the prostate gland
minimally invasively and preserving
functional characteristics, such as sexual function and urinary
control well, so a lot of advances there.
LIAM MAYCLEM: Yeah, and Doctor, what can I
do to prevent prostate cancer?
RAJESH SHINGHAL: Right, so this is a great question,
and you hear a lot of different things out there about it.
The most important thing is to maintain your overall health--
good cardiovascular health in terms of exercise,
in terms of eating a healthy diet.
We talk about the Mediterranean diet, focus on legumes, nuts,
fruits, vegetables-- have your four to five servings of fruits
and vegetables a day--
lean proteins, avoiding fried foods.
All of these things create a lower inflammatory burden
in the body and, in general, are beneficial in preventing
cancer.
Conversely, lots of fried food, lots of red meat,
lots of sugary sweets, those things
tend to create more of a pro-inflammatory environment.
People also ask, just in general,
should I go all plant-based or all vegan
to prevent prostate cancer?
No data to suggest that, but if you move towards diets like
that-- it doesn't have to be to the extreme--
it does create a better environment for your body
overall in terms of preventing cancer.
Finally, people have heard a lot about tomato sauce.
There is something called lycopene in tomato sauce,
and there was a study that was in Italy that showed that
if you eat a certain portion of tomato sauce--
and they do that in Italy every now and then--
it lowered the risk of prostate cancer.
Lycopene can also be found in things like guava as well.
So you can take lycopene pills.
I don't like that.
I like doing it naturally with diet, and, hey,
what's wrong with a little bit of well-made tomato sauce,
right?
LIAM MAYCLEM: Yeah, and if you have a low PSA,
does that rule out the possibility of prostate cancer?
RAJESH SHINGHAL: It definitely lowers the risk of that,
and it depends on the level.
There's a study if you're 65 years old
and your PSA is less than 1, the chances
of you dying from prostate cancer is nearly 0%.
That came out of Johns Hopkins.
LIAM MAYCLEM: Yeah, which is good to hear.
How can a family member support a spouse
who's been diagnosed with prostate cancer?
If you're a partner or wife, how can you best support?
What can you do?
RAJESH SHINGHAL: Yeah, I think being present for the person
and being supportive, which-- of course, we assume
every spouse would be there.
I think it's incredibly important
to have your spouse at the visits that you go to.
We find a lot of men A, don't want to go to the doctor, B,
are terrified once they get the diagnosis of cancer.
I mean, there's a machismo we have.
We don't want to admit we're vulnerable.
I'm guilty of that.
I'm a terrible patient.
But bringing your spouse to the visits for an extra set
of ears--
some of the best questions we get
are from the partner or the family member,
not from the man, who kind of--
with that initial couple visits-- may just be in a mode
where they're not thinking through everything.
And the spouse can be there to hear everything.
Plus, this is a decision that has impacts
on the entire couple as well.
So I'm always a big fan of being there for the visits
and participating.
We really welcome that.
LIAM MAYCLEM: Yeah, and, Doctor, what about this question?
If, you know, I'm someone with an enlarged prostate
and have troubles with urination,
what are some of the treatment options for me, for example?
RAJESH SHINGHAL: Yeah, so enlarged prostate, not cancer,
is a very common problem, and we often
find that men kind of push it off to the side.
But if you start noticing that you're getting up
a few times at night, more difficulty urinating,
I'd recommend you talk to your primary care doctor
or come see a urologist.
Some of the treatment options can include simply
modifying fluid intake.
We often find that people drink a lot of fluid before bedtime,
and that can aggravate things.
Too much caffeine-- that large Star--
tall, or Venti, Starbucks that has 300 milligrams of caffeine
will irritate your bladder and prostate
like you wouldn't believe, so some behavioral changes.
There's medications, of course, that we
can give that have relatively few side effects
and can definitely improve symptoms.
And then we've introduced some minimally-invasive techniques
that allow us to inject steam or water vapor into the prostate
and can cause the prostate to shrink over
time-- that's a procedure called Rezum that we perform here
at Palo Alto Medical Foundation-- or a new procedure
called UroLift, where we can actually
insert small, tiny implants that open the prostate up by putting
these clips in the prostate, so a number of different options.
And the field is continuing to improve over time.
The bottom line is come talk to your doctor.
We love seeing you.
LIAM MAYCLEM: Yeah.
A few more questions, and thanks to everyone
for getting these questions in.
Doctor, can hormone therapy help with a prostate cancer
diagnosis?
RAJESH SHINGHAL: Yeah, so hormone therapy
is based on the fact that prostate cancer feeds
on the male hormone testosterone.
So in 1942, a guy named Huggins, I think,
won the Nobel Prize for discovering
that if I take away testosterone,
the prostate cancer will shrink.
They used to do that by removing a man's testicles.
Now we have medications that can do that.
And so hormonal therapy, by lowering
the man's testosterone, does shrink prostate cancer.
It does not cure it.
So we typically use this in cases
where the prostate cancer has spread
or temporarily when we're doing radiation therapy.
So it's a method to slow cancer growth,
but not necessarily cure it.
LIAM MAYCLEM: And then you mentioned radiation there.
I had another question.
Are there some long-term side effects
of radiation stay therapy?
RAJESH SHINGHAL: Yeah, so I tell every prostate cancer patient
that I talk to, with cancer, you're
going to be a cancer survivor.
You're going to live through this--
I mean, really high percentages of cure with everything
that we do.
But there are going to be side effects.
Like any survivor, there are going to be side effects.
So with radiation, the long-term side effects
can include more frequent urination,
urgency to go to the bathroom, and waking up at night
to urinate, sometimes more frequent bowel movements
because the rectal area gets irritated,
and that can be long-term.
There is a theoretical risk of--
slightly higher risk of prostate cancers--
sorry, not prostate, sorry--
colorectal or bladder cancers.
And then there can be some effects on erections long term.
With surgery, which has a much bigger effect on erections
initially, we see that impact right away.
With radiation, it's kind of more
of a slow dwindle over the next five to seven years
where you can start to see some impact where
maybe erections were not as robust as they were before.
But radiation is an excellent treatment for prostate cancer
in the right patient.
LIAM MAYCLEM: Yeah.
Another question here.
Is HIFU being used more here in America,
and have you had experience with using
HIFU to treat prostate cancer?
RAJESH SHINGHAL: Great questions from our audience,
cutting-edge questions here.
So HIFU stands for High-Intensity Focused
Ultrasound, and it's based on the idea
that you're delivering these very strong sound waves-- not
radiation but sound waves-- onto the prostate cancer.
This is very popular in Europe, where they've been doing it
for over 10 years.
They initially used to treat the whole prostate gland.
Those results are not quite as good,
and they created a lot of side effects.
Now they're doing more of what we call MRI-focused HIFU,
or "Hi-Fu," as we call it.
The literature looks good on that.
I certainly-- I have had a couple patients who
were good candidates for it.
There are some particular things about it.
You can really only have cancer in kind of one spot.
If you have cancer in multiple spots,
it doesn't work because you're focusing in on certain areas,
so you can't treat it that way.
It's better off to just get radiation or surgery
in that case.
If you have an enlarged prostate,
often it can aggravate the urinary symptoms,
so that might not be the best choice.
And then you still need follow-up.
You still need to do biopsies and everything afterwards.
I think HIFU is a promising technology.
Like multiple different focal therapy technologies out there,
it has to be on the right patient,
and it has to be for setting the appropriate expectations
for that particular person.
LIAM MAYCLEM: Yeah, last couple of questions here, Doctor--
if the prostate has been removed for BPH,
would you still be at risk for prostate cancer?
And then, of course, explain what BPH is.
RAJESH SHINGHAL: Yeah, so BPH is the condition
we talk about with enlargement of the prostate,
and the surgical treatments that we
do for enlargement of the prostate
are different than the surgeries that we do for prostate cancer.
If you've had surgery for BPH--
and there are a couple of different forms.
The most common one is something called a TURP,
or Transurethral Resection of the Prostate.
That removes the enlarged portion
of the prostate that's on the inner portion of the prostate.
However, it does not remove the outer aspect of the prostate
on the edges where the majority of the cancer is formed.
So the answer is you should continue
to get screened for prostate cancer
even if you've had a surgery for enlargement of the prostate.
LIAM MAYCLEM: Yeah, and curious to know-- another question
here, is there a ethnic group or a specific group
in particular that is more prone to prostate cancer?
I mean, how do--
yeah, what group does it hit hardest, I guess,
is the question.
RAJESH SHINGHAL: Yeah, great question.
And I should have mentioned this about asking
who should get a PSA and when.
African-American men are at higher risk
for prostate cancers that are more aggressive
and occur at an earlier age.
So multiple organizations recommend
for African-American men or African descent,
you should start getting a PSA between the ages of 40 and 45.
The second group is men with a family
history of prostate cancer.
Men with a family history of prostate cancer
do have a higher risk as well.
That would be a first-degree relative, either your father
or your grandfather.
In those cases, you should also start getting a PSA test
and screened for prostate cancer around the ages of 40 to 45
as well.
And if you are both African-American
and have a family history, definitely
start that screening at 40.
That's a very important thing to do.
LIAM MAYCLEM: And, Doctor, I'm just curious to know personally
how often should you get screened or tested, so
every couple years, every year during your annual checkup?
What do you advise?
RAJESH SHINGHAL: So the data on this bounces back and forth.
It's easier for people to remember
to get a test every year.
But much of the data supports that if your PSA is low,
you could probably get a PSA every other year,
and it would be perfectly fine.
So either of those are fine.
It doesn't need to be done more often than once a year,
and if every other year works-- you know,
the nice thing is we have the electronic record that can
ping you about those reminders.
And as long as you listen to the reminders, unlike yours truly,
you'll get your testing done.
LIAM MAYCLEM: And last couple of questions--
Doctor, can you speak to us about aggressive prostate
cancer, the treatment and also the outcomes?
RAJESH SHINGHAL: Yeah, so the more high-risk prostate cancers
are definitely more worrisome.
The outcome still can be quite good overall.
So with aggressive prostate cancers--
and this depends on the age of the patient--
for our younger patients, we offer surgery
to remove the prostate gland, and then
also go ahead and remove lymph node tissue around the prostate
gland, sometimes followed by radiation to go ahead and treat
any areas around the edges of the prostate.
For men who are a little bit older,
maybe over the age of 65 or 70-- that's not old, just older--
we offer-- one of the better techniques
is doing a combination of putting radioactive seeds
into the prostate that treat the prostate itself
and then doing radiation to treat the lymph nodes
around the prostate as well.
And that has a very high success rate even
in aggressive prostate cancer.
There was an article published in JAMA a few years ago
that showed in the worst case scenarios,
the aggressive prostate cancers, the cure rates at 10 years
were still on the order of 70% to 80% if--
I'm going off memory there.
But they're are still quite good overall
in terms of being able to say, have I
died of prostate cancer or not?
So there are definitely options that we have.
We also do hormonal therapy in addition to that,
as well-- so lots of different options.
Of course, the numbers I give are general.
It would really depend-- when we say aggressive prostate cancer,
it's very specific to a particular individual's biopsy
and results.
LIAM MAYCLEM: Yeah, and Doctor, I'm not sure
if you answered this earlier.
I think you touched on it, but I'm
going to just ask you one more time
if you can describe an overactive bladder
and whether or not that correlates
with prostate cancer.
RAJESH SHINGHAL: Yeah, so overactive bladder
is where your bladder sends a signal to your brain
to tell you that you need to go to the bathroom more often,
and where the bladder is more irritable,
where you get spasms of your bladder,
and where you may leak some urine.
We do see that sometimes in men.
It does not increase your risk of prostate cancer, thankfully.
LIAM MAYCLEM: Yeah, good to know.
These are, I mean, great questions.
I want to thank everyone for your contribution--

[INAUDIBLE] to me.
You've inspired me to actually call my doctor after this call,
and I'm going to set up my appointment for a check.
It is time.
So, Doctor, I think we'll move to our Tasty Questions.
You know, I know you have teenage boys.
I know you have passions outside your medical work.
So here we go.
Ladies and gentlemen, get to know your doctor
beyond the coat--
Five Tasty Questions.
So, Dr. Shinghal, if not a doctor, in a second life,
you come back as something else, what would your profession be?
RAJESH SHINGHAL: Yeah, so in that second life,
if I got reincarnated into a 7-foot body,
then I would want to be an NBA player,
but that's probably not going to happen.
So most likely, the thing I would do
is I would probably be a teacher.
I really do love teaching.
I love giving talks like this.
I really enjoy educating people and patients,
and I think I would do that in other fields as well.
LIAM MAYCLEM: If you could sing with one artist--
one pop star or rock band, who would it be,
and what would be your song of choice?
RAJESH SHINGHAL: Yeah, this one's a good one.
So I grew up in South Dakota, and, of course,
the late artist Prince was from Minnesota.
So I actually was a relatively early-on Prince fan,
maybe even earlier than before he hit the mainstream in 1984
with "Purple Rain."
So Prince would probably be the person.
I just think he's a musical savant.
I mean, he can play instruments, he sings, he--
just incredible-- one of the best guitarists ever.
The song I would sing would probably
be the song that's one of my go-tos for Karaoke, which
is "Little Red Corvette."
That is definitely one.
LIAM MAYCLEM: Oh, my gosh.
RAJESH SHINGHAL: Yeah, exactly.
LIAM MAYCLEM: Good choice there, Doctor.
What may we be surprised to learn about you?
RAJESH SHINGHAL: So, you know, me growing up
in South Dakota was a bit unique-- definitely got lucky
coming out here for Stanford.
But one of our current things that I'm
doing now that you probably wouldn't guess
is one of my wife's hobbies.
So my wife hit 50 years old and said, I
want to do something a bit different.
And so we have a very small farm up in the North Bay in Petaluma
where we're just starting to try to get things sorted out,
and so we're raising chickens there.
We have a couple pigs.
These are mostly pet animals.
We're not killing anything, but we're getting eggs.
We're trying to grow a few grapes for some pino,
and playing in the dirt.
So I'm certainly learning a lot about the land
and enjoying the time outdoors.
It's definitely been fun.
LIAM MAYCLEM: I love that.
If I was to go to your fridge and open it, what would I find?
What's always in your fridge?
RAJESH SHINGHAL: Great question.
So I am--
I'm a butter snob.
So I always love getting great butter.
When I went to France once, I just
couldn't believe the difference in quality in butter so--
LIAM MAYCLEM: Le beurre, le beurre.
RAJESH SHINGHAL: Yeah, so some great Kerrygold or even
the Trader Joe's Brittany--
I think they have a Brittany salted butter that's
actually quite tasty.
It reminds me of some of the French butter.
And then the one other thing we have in our pantry,
we pretty much always have some Nutella open.
When I've had a long day, Nutella
is my friend that gives me a little hug
when I come home, on a cookie or a banana
It just makes me feel just a little bit better
from the inside.
LIAM MAYCLEM: Yeah, well I love that.
Finally, you mentioned food there.
You touched on it.
For your last supper, you can have
a couple of guests at the table, famous or infamous,
dead or alive, but no family members.
Who would they be, and what would you eat and drink?
RAJESH SHINGHAL: Boy, this is a tough one.
So I'm split between either Italian,
because a great red sauce or a great pizza would be great,
versus something Japanese.
And I'm going to hedge and say, can I do fusion and do both,
or can I split the meal--
LIAM MAYCLEM: Of course you can.
RAJESH SHINGHAL: --or is that cheating?
LIAM MAYCLEM: Anything goes
RAJESH SHINGHAL: Thank you for letting me cheat, yeah.
So I would love a great red sauce for pizza
and then something from Japan.
I mean, they're just masters at ingredients.
I enjoy it so much.
Who would I eat with?
So I would probably say I would love to meet President Obama.
I think that would be just an incredible guest.
That would be someone that I would really learn
an incredible amount from.
And then probably the other person that I would think about
is actually one of my teachers from high school
that inspired me.
They kind of really pushed me to achieve a bit more.
Mr. Thomas, who's--of course, he passed away.
But he's someone that really kind of drove
my juices and academics and everything too.
And I don't know how he and Obama would get along,
but it would be fun to kind of shoot the breeze with him
again.
LIAM MAYCLEM: Dr. Shinghal, Five Tasty Questions Q&A--
thank you so very much for your precious time.
Keep up the great work, and thank you for all you do.
We thank you so very, very much.
All right.
Thank you, and friends, thank you for watching today.
And if you would like to watch this seminar again,
the Q&A again, you can.
We'll be posting a link.
There will be another session that we
will have, Beyond the Coat, before the end of the year,
and we'll notify you when that will be.
Thanks for your precious time today,
and for more info and to perhaps learn more, go to pamf.org.
That's pamf.org.
Thank you for watching.
Cheers.