THIS PROGRAM IS MADE BY MPT TO SERVE ALL OF OUR DIVERSE COMMUNITIES AND IS MADE POSSIBLE BY THE GENEROUS SUPPORT OF OUR MEMBERS.

THANK YOU.

LIVE FROM MARYLAND PUBLIC TELEVISION, THIS IS "DIRECT CONNECTION" WITH JEFF SALKIN.

*] >> JEFF: GOOD EVENING AND WELCOME TO YOUR "DIRECT CONNECTION."

TONIGHT, AS FORMER PRESCRIBE BEGINNINGS TREATMENT FOR AN AGGRESSIVE CASE OF PROSTATE CANCER WE GET ANSWERS TO YOUR QUESTIONS ABOUT THE TOUGH DECISIONS THAT FACE MANY PATIENTS.

JOINING US TO DISCUSS YOUR HEALTH IS DR. MOHUMMAD MINHAJ SIDDIQUI, DIRECTOR OF UROLOGIC ONCOLOGY AND ROBOTIC SURGERY AT THE UNIVERSITY OF MARYLAND CANCER CENTER AND THE UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE.

DOCTOR GOOD TO HAVE YOU BACK ON MPT.

>> THANK YOU.

>> Jeff: IT IS MEN'S HEALTH MONTH A GOOD TOPIC TO COVER APART FROM SKIN CANCER THIS IS THE NUMBER ONE CANCER IN MEN?

TELL US WHAT MEN NEED TO KNOW.

>> THAT IS ABSOLUTELY RIGHT.

THERE IS A LOT TO KNOW.

AND I THINK THAT IT ALL STARTS WITH BEING PROACTIVE.

THIS IS A DISEASE IN WHICH THERE IS A LOT YOU CAN DO TO SEE WHAT YOUR RISKS ARE AND ALSO GET SCREENED AND CHECK THAT IF THIS IS SOMETHING THAT IS GOING TO AFFECT YOU.

AND THE MOST IMPORTANT THING WITH PROSTATE CANCER WE'VE COME A LONG WAY AND THERE IS A REASON TO BE PROACTIVE.

>> Jeff: THE NUMBERS ARE CRAZY.

I READ IN A STUDY OF AUTOPSIES, OF PEOPLE WHO DIED FOR OTHER REASONS CAR CRASH OR WHATEVER MEN IN THEIR 80s IF THEY TOOK A LOOK AT THE PROSTATE ABOUT HALF THE TIME THERE WAS CANCER THERE.

>> YES.

NO, I MEAN WE'VE COME A LONG WAY WITH PROSTATE CANCER UNDERSTANDING THE DISEASE.

IT TURNS OUT THAT MOST MEN WILL GET DIAGNOSED WITH THIS CANCER IF YOU WAIT LONG ENOUGH.

>> Jeff: IF YOU LIVE LONG ENOUGH.

>> A DISEASE OF AGING.

WE'VE COME TO APPRECIATE OVER THE YEARS THAT NOT EVERYONE THAT GETS PROSTATE CANCER HAS TO BE TREATED FOR PROSTATE CANCER.

WE'VE BECOME MORE DISCERNING ABOUT WHO WE CHECK FOR PROSTATE CANCER AND WHEN WE CHECK THEM AND WHEN TO BE MORE PROACTIVE BECAUSE WE CAN CURE THE DISEASE OR ACTUALLY BACK OFF BECAUSE IT'S NOT SOMETHING THAT IS GOING TO CAUSE ANY KIND OF MEANINGFUL IMPACT ON THE LONGEVITY OF A PERSON.

>> Jeff: PEOPLE DO DIE OF THIS EVERYDAY.

IT IS A SMALL NUMBER COMPARED TO THE NUMBER OF PEOPLE DIAGNOSED.

LIKE 300,000 PEOPLE DIAGNOSED AND 30,000 DIE OF IT.

THE LAST TIME YOU WERE HERE, ABOUT FIVE YEARS AGO, WHEN MIKE MILLER WHO WAS THE PRESIDENT OF THE STATE SENATE DIED OF PROSTATE CANCER.

BECAUSE IT'S SLOW GROWING AND COMMON DOESN'T MEAN IT CAN'T BE SERIOUS.

>> ABSOLUTELY.

I THINK THIS IS IMPORTANT.

SOMETIMES AS YOU SAID, 90% OF PROSTATE CANCER DIAGNOSES ARE NOT LETHAL.

BUT 10% ARE.

AND BECAUSE OF JUST THE SHEER NUMBERS OF PEOPLE THAT GET THESE CANCERS, EVEN THOUGH IT'S 10% IT IS A SMALL PERCENT OVER A PROGNOSIS IS EXCELLENT IT ENDS UP BEING A LOT OF PEOPLE WHO PASS AWAY FROM THE DISEASE.

THE THIRD MOST COMMON CAUSE OF CANCER DEATH IN MEN.

>> Jeff: AND LOOKING AT SOMEBODY'S PARTICULAR RISK, FAMILY HISTORY PLAYS A ROLE.

ETHNIC HISTORY PLAYS A ROLE.

PEOPLE OF AFRICAN ANCESTRY HAVE HIGHER NUMBERS, RIGHT?

>> THERE ARE A COUPLE OF RISK FACTORS THAT YOU SHOULD BE AWARE OF.

AND THESE INFLUENCE HOW PROACTIVE YOU ARE ABOUT GETTING CHECKED.

CERTAINLY, BLACK MEN, BLACK MEN ARE TWO TO THREE-FOLD HIGHER RISK OF GETTING AGGRESSIVE CANCERS.

ALSO HIGH-RISK ARE MEN WHO HAVE HAD ONE FAMILY RELATIVE WHO HAD AGGRESSIVE LETHAL PROSTATE CANCER.

BREAST CANCER ON THEIR MOTHER'S SIDE AT A YOUNG AGE, 50 AND YOUNGER.

OVARIAN CANCER OR PANCREATIC CANCER OR FAMILIES WITH ANY PROSTATE CANCER DIAGNOSIS, BROTHERS, UNCLES AND FATHERS.

AND THOSE ARE ALL CONSIDERED IN THE HIGH-RISK CATEGORY.

>> Jeff: PSA IS THE COMMON SCREENING TECHNIQUE.

WHAT IS IT AND HOW DOES THAT WORK.

>> PSA IS A BLOOD TEST AND PSA IS NOT A TOXIN IT IS NOT DANGEROUS SOMETIMES GET THE HIGH PSA AND WORRY HOW DO I GET THE NUMBER DOWN?

NOT THAT THE PSA IS DANGEROUS IT'S MADE BY NORMAL PROSTATE AND MADE BY CANCER AND CANCER MAKES MORE OF IT.

IF YOU HAVE A HIGH PSA IT MAYBE BECAUSE OF PROSTATE CANCER AND IT CAN BE OF INFLAMMATION.

THERE'S REASONS WHY PSA IS HIGH.

BUT IT IS A BLOOD TEST TO CHECK TO SEE IF YOU MIGHT HAVE PROSTATE CANCER.

>> Jeff: TRICKY THING IS WHO GETS CHECKED IT IS NOT EXPENSIVE OR INVASIVE IF YOU ARE GETTING LABS IT'S NOTHING.

BUT THEN YOU GET INTO THESE QUESTIONS OF WHAT TO DO ABOUT IT.

WHAT IS YOUR BEST ADVICE THESE DAYS?

>> THIS IS AN AREA I'M GLAD WE'RE BRINGING THIS UP THIS IS AN AREA THAT EVOLVED OVER THE LAST FEW YEARS.

AND SO I HAD THE PLEASURE OF BEING ON YOUR PROGRAM FIVE YEARS AGO AND IF YOU PLAY WHAT I SAID, THEN AND WHAT I SAID TODAY, IT'S EVOLVED.

THE GUIDELINES THERE'S MAJOR GUIDELINES NCCN, NATIONAL CONFERENCE OF CANCER NETWORK, THEY'VE CHANGED THE GUIDELINES IN THE LAST YEAR.

AND AT THIS POINT, THE GUIDANCE IS TO GET STARTED CHECKING EITHER AT THE AGE OF 40 OR 45.

MUCH YOUNGER THAN IT USED TO BE.

AND 40 IF YOU ARE A HIGH-RISK CATEGORY BASED ON THE THINGS I MENTIONED EARLIER WITH RACE OR FAMILY BACKGROUND.

45 OTHERWISE.

JUST TO GET A BASELINE.

IF THE BASELINE IS ELEVATED GREATER THAN THREE WHICH IS A DIFFERING NUMBER THAN IT USED TO BE FOUR, THEN TO GET IT WORKED UP OR DO MORE REGULAR CHECKS.

AND IF IT'S LOW, THEN TO DO LESS FREQUENT CHECKS.

THERE IS A LOT MORE ADJUSTMENT GOING ON NOW.

>> Jeff: THE FAMOUS QUOTE BY JOHN WHO STARTED THE DEPARTMENT STORE IN PHILADELPHIA THIS IS MAYBE A CENTURY AGO HE KNEW THAT HALF OF HIS ADVERTISING BUDGET WAS WASTED HE SAID.

BUT HE DIDN'T KNOW WHICH HALF.

A LITTLE LIKE THAT WITH PROSTATE CANCER.

YOU WINDUP TAKING OUT A LOT OF PROSTATES SOME OF WHICH MIGHT HAVE KILLED SOMEBODY BUT SOME WOULD NOT.

AND WE DON'T KNOW AT THIS POINT, DO WE?

>> I THINK WE'RE STILL WORKING ON IT.

BUT THAT'S PART OF SOME OF THE CHANGES THAT HAVE TAKEN PLACE IN THE LAST 10 YEARS.

SO WE NOW HAVE SO MANY MORE TOOLS.

WE HAVE ADVANCED IMAGING, WE HAVE MRI IMAGING AND PET SCANS, AND GENOMICS AND BIOMARKERS AND THEY COME TOGETHER.

AND THE CULTURE OF TRYING NOT TO DO THE MOST RADICAL TREATMENTS AND DOING LESS INVASIVE TREATMENTS FOCAL THERAPY ROBOTIC SURGERY, AND YOU KNOW, HIGHLY TARGETED RADIATION THERAPY ALL OF THESE THINGS HAVE REALLY IMPROVED DECREASING SIDE EFFECTS, AND ACTIVE SURVEILLANCE.

MINIMIZING TREATMENT ON PEOPLE WHO DON'T NEED IT OR MINIMIZING SIDE EFFECTS ON PEOPLE THAT NEED INTERMEDIARY TREATMENT OPPOSED TO AGGRESSIVE TREATMENT.

>> Jeff: TO OUR VIEWERS IF YOU HAVE QUESTIONS SEND AN E-MAIL TO LIVE QUESTIONS AT MPT.ORG.

ONE OF THE THINGS ABOUT THE BIDEN CASE, IS THAT THEY'VE DISCLOSED THE FORMER PRESIDENT HAS A GLEASON SCORE OF 9.

WHAT DOES THAT MEAN?

>> SO ONCE ONE IS DIAGNOSED WITH PROSTATE CANCER, WE TRY TO FIGURE OUT HOW AGGRESSIVE IS IT.

AND THAT HELPS CATER THE TYPE OF TREATMENT WE OFFER THAT PERSON.

THERE'S A GLEASON SCORE AN AGGRESSIVENESS SCORE AND IT IS AN UNUSUAL NUMBER IT GOES 6-10 HIS BEING 9 PUTS HIM INTO THE HIGH-RISK AGGRESSIVE CATEGORY.

>> Jeff: THE OTHER MYSTERY OF THE BIDEN CASE SOME PEOPLE WERE SUSPICIOUS THAT IT WAS DIAGNOSED AT A LATE STAGE SORT OF OUT OF THE BLUE FROM SOMEBODY WHO HAD REGULAR CHECKUPS AS PRESIDENT.

BUT IN THE SCREENING REGIMENT THAT WE WERE TALKING ABOUT SOMEBODY WHO IS 82 NOW, IN THE LATE 70s, THEY WOULDN'T NECESSARILY HAVE SCREENED FOR IT.

>> YES.

AND THERE IS A NUMBER OF FACTORS THAT COME INTO PLAY.

FROM WHAT I'VE SEEN IN THE PRESS REPORTS HE HAD THE LAST SCREENING DONE IN 2014, 10 YEARS AGO MORE OR LESS.

WHICH WOULD HAVE MADE HIM IN THE EARLY 70s, 72, 71 WHERE HE STOPPED SCREENING.

AND 2014 THAT WAS THE GUIDELINE TO STOP SCREENING WHEN YOU HIT 70.

THERE WAS MORE OF A DEBATE TO STOP SCREENING ALTOGETHER FOR PROSTATE CANCER.

THE PENDULUM SWUNG TO THE POINT PEOPLE WERE SAYING THAT PSA SHOULD NOT BE DONE AND IT'S COME BACK BECAUSE WE HAVE WAYS TO CATER TREATMENTS AND CATER WORK UP.

BUT WHEN THE DECISION WAS MADE FOR HIM TO STOP SCREENING THAT WAS PART OF IT.

THAT WAS THE BEST ADVICE AT THE TIME.

EVEN TODAY, PAST 75, THERE'S A LOT OF ADJUSTMENTS MADE ON WHETHER SCREENING SHOULD CONTINUE OR NOT.

AND IT'S ALSO WORTH NOTING BECAUSE HE HAS BEEN DIAGNOSED WITH AN AGGRESSIVE CANCER IT IS A CANCER THAT TENDS TO TAKE 10 YEARS TO BE LETHAL FOR 82-YEAR-OLD MAN IT PUTS HIM IN HIS 90s AND COMPETING RISKS OF DEATH PLAY A FACTOR.

IT IS UNCLEAR WHETHER THIS WILL TRULY HAVE A LONG-TERM IMPACT ON HIS LONGEVITY.

>> Jeff: THE NEXT DILEMMA FOR SOMEBODY THAT DECIDED TO GET A PSA CHECK AND NEED A BIOPSY AND LET'S SAY IT'S FOUND AN AVERAGE LEVEL OF AGGRESSIVENESS, WHAT DO YOU DO?

DO YOU GO TO SURGERY TO HAVE THE PROSTATE REMOVED?

DO YOU GO TO RADIATION TO SLOW IT DOWN OR KILL THE CELLS?

OR DO YOU DO SOMETHING CALLED WATCHFUL WAITING NICKNAMED WATCH FOR WORRYING.

WHAT DO YOU TELL PATIENTS?

>> THIS IS WHERE YOU NEED TO BUILD YOUR TEAM.

THERE'S PEOPLE OUT THERE TO HELP YOU WITH THIS.

AND WHETHER -- THE MOST IMPORTANT THING I TELL PATIENTS NEWLY DIAGNOSED WITH PROSTATE CANCER, IS TO GET THE OPINIONS, GO TO A UROLOGIST, ONCOLOGIST, AND SOME CASES YOU MAY WANT TO SEE A MEDICAL ONCOLOGIST AND LEARN ABOUT THE DISEASE.

IT IS NOT A DISEASE WHERE YOU HAVE TO MAKE A DECISION IN A WEEK OR TWO WEEKS.

YOU DO HAVE TIME WITHOUT CAUSING CHANGE IN YOUR OUTCOMES.

AND LEARN ABOUT WHAT IT MEANS TO GET SURGERY AND RADIATION.

IN SOME SITUATIONS YOU WILL BE TOLD THAT THERE IS A RIGHT ANSWER SURGERY IS THE BEST ANSWER, RADIATION IS THE BEST ANSWER, ACTIVE SURVEILLANCE AND OTHER SCENARIOS IS THE RIGHT ANSWER.

AND OTHER SITUATIONS YOU WILL BE TOLD YOU HAVE TWO OPTIONS OR THREE OPTIONS.

AND THEN YOU HAVE TO UNDERSTAND WHAT THEY MEAN, WHAT THEY MEAN TO YOU, AND BASED ON YOUR VALUES AND YOUR PREFERENCES WHAT IS THE BEST CHOICE FOR YOU.

>> Jeff: LET'S LOOK AT E-MAIL QUESTIONS.

THIS IS PAUL WHO ASKS IS THERE ANY RELATIONSHIP BETWEEN AN ENLARGED PROSTATE ANOTHER TOPIC, AND PROSTATE CANCER?

I THINK IT WAS KING CHARLES IN ENGLAND WHO WENT TO SURGERY FOR AN ENLARGED PROSTATE AND THEY FOUND ANOTHER CANCER BUT I DO NOT BELIEVE IT WAS PROSTATE.

FORGET THE KING LET'S TALK ABOUT ENLARGED PROSTATES AND DOES IT LEAD TO CANCER?

>> THIS COMES UP A LOT.

AND THE QUICK ANSWER IS THAT TYPICALLY NOT.

ENLARGED PROSTATES CAN CAUSE YOUR PSA TO COME BACK HIGH SO THERE'S CONFUSION WHEN A HIGH PSA COMES UP.

ENLARGED PROSTATES CAUSE URINARY PROBLEMS.

AND THERE ARE SURGERIES TO REMOVE PART OF THE PROSTATE TO MAKE IT EASIER TO URINATE.

PROSTATE CANCER REQUIRES REMOVAL OF THE ENTIRE PROSTATE.

>> Jeff: CAN DIET AND EXERCISE HELP KEEP SOMEONE'S PSA IN THE HEALTHY RANGE?

>> YOU KNOW, THE KEY UNDERLYING ASPECT OF THIS QUESTION IS NOT SO MUCH KEEPING THE PSA IN HEALTHY RANGE BUT PREVENTING PROSTATE CANCER.

PSA DETECTS CANCER AND IT IS NOT DANGEROUS BUT YOU WANT TO MAKE SURE YOU DON'T GET PROSTATE CANCER.

AND GENERALLY SPEAKING THERE IS EMERGING RESEARCH TO SAY THAT PEOPLE WHO LIVE HEALTHIER LIVES WHO MAINTAIN HEALTHIER BODIES PROBABLY DO PREVENT SOME CANCERS.

POTENTIALLY INCLUDING PROSTATE CANCER BUT THERE IS NO DEFINITIVE ANSWER OR DIETS AND WHATNOT.

BUT JUST AS BEING HEALTHY NOT OVERWEIGHT, OBESE IS GOOD FOR YOUR GENERAL HEALTH IS GOOD FOR CANCER PREVENTION AS WELL.

>> Jeff: ANNE WRITES TO SHARE HER HUSBAND DIED OF THIS DISEASE AND ASKS WHY CAN'T YOU REMOVE THE PROSTATE BEFORE IT'S AN ISSUE?

AND THERE ARE SIDE EFFECTS?

>> YES, THAT IS WHAT IT COMES DOWN TO.

THE CHALLENGE IS THAT PROSTATE CANCER TREATMENT ITSELF DOES HAVE SIGNIFICANT SIDE EFFECTS IN THE URINARY AND SEXUAL DOMAINS.

AND THESE CAN AFFECT YOUR QUALITY OF LIFE SIGNIFICANTLY.

IT'S NOT TYPICALLY SOMETHING WE HAVE DONE PRO FLACKLY INSTEAD WHAT WE RECOMMEND IS BEING PROACTIVE ABOUT SCREENING.

MONITORING FOR PROSTATE CANCER AND TRYING TO CATCH IT EARLY IF IT AFFECTS YOU.

>> Jeff: ONE PERSONAL NOTE ON THIS SUBJECT, I HAD THE SURGERY IN 2022 AND WAS REALLY FORTUNATE BECAUSE IT WAS A YEAR OR TWO AFTER YOUR LAST APPEARANCE TO CALL YOU UP AND ASK YOU AND MAKE AN APPOINTMENT AND ACTUALLY SEE YOU PROFESSIONALLY.

SO THANK YOU NUMBER ONE.

IS THAT REALLY WON'T FIND ANYBODY OUT THERE WITH BETTER COMBINATION OF CREDENTIALS AND COMMUNICATION SKILLS THAN DR. MOHUMMAD MINHAJ SIDDIQUI AND HIS TEAM AT MARYLAND.

THANK YOU NUMBER TWO, IS A GUEST WHO WAS ON THIS SHOW 20 SOMETHING YEARS AGO WHEN WE STARTED DOING "DIRECT CONNECTION" WE HAD PATRICK WALSHE PROFESSOR AT HOPKINS THE INVENTOR OF THE NERVE SPARING PROSTECTOMY AND A HERO TO MEN EVERYWHERE I RECOMMEND HIS BOOK ON LIVING WITH PROSTATE CANCER THERE'S INFORMATION EVERYWHERE BUT HIS BOOK PUT IT IS ALL IN ONE PLACE.

THE THIRD THANK YOU IS THAT THERE IS A VIDEO OUT THERE WITH CAL RIPKEN THIS IS MAYBE FOUR OR FIVE YEARS OLD TALKING ABOUT HIS EXPERIENCE WITH PROSTATE CANCER.

HIS DECISION TO GO TO SURGERY.

AND YOU KNOW, CAL RIPKEN IS SOMEBODY EVERY MAN IN AMERICA LOOKS UP TO CAL RIP KIB TO HEAR HIM TALKING ABOUT GOING THROUGH THE PROCESS, MAKING A DECISION HE ELECTED SURGERY AS DID I.

HAD A GOOD RESULT.

AND I THINK HELPS A LOT OF PEOPLE BECAUSE DOCTOR PEOPLE STRUGGLE WITH THE COMPLEXITY OF THIS ISSUE WHETHER YOU ARE GOING TO GET SCREENED IF A PROBLEM IS FOUND WHAT DO YOU DO?

AND IT IS A TOUGH ONE.

>> YEAH.

YOU KNOW, I MEAN I TRULY COMMEND YOU FOR BEING PUBLIC WITH YOUR HISTORY AND YOUR DIAGNOSIS.

I THINK IT REALLY HELPS.

IT REALLY HELPS MEN.

I THINK THAT YOU SEE PEOPLE THAT YOU CAN RELATE TO, WHETHER CAL RIPKEN OR YOURSELF MENTIONING THIS, I THINK HAVING THAT RELATABILITY REMINDS MEN BE PROACTIVE, GO OUT THERE AND GET CHECKED YOU CAN DO WELL.

IT'S GREAT TO SEE YOU DOING SO WELL AND OTHERS CAN DO IT'S A MATTER OF GETTING CHECKED.

>> Jeff: THE OTHER THING I SEE JUST STAYING IN TOUCH WITH THE PUBLIC MEDIA AND THE RESEARCH ON THE TOPIC IS HOW FAST THINGS CHANGE.

IT'S STUNNING.

AND WE TALKED BEFORE THE PROGRAM HOW IT'S GOOD TO HAVE A CONDITION THAT A LOT OF PEOPLE HAVE BECAUSE THERE IS A TON OF RESEARCH WE HAVE NOT TALKED ABOUT THE NEW MRI TECHNOLOGY.

IT'S RIGHT ON THE MONEY AT LEAST IT WAS IN MY CASE.

>> I MEAN, WE'VE GONE IN MY TRAINING, WE'VE GONE FROM WHEN WE WERE BLINDLY GUESSING WHERE THE CANCER MIGHT BE KIND OF LIKE A BATTLE SHIP STYLE TO NOW TARGETING WITHIN A MILLIMETER OR TWO THE AREA THAT LOOKS CONCERNING AND BEING MUCH MORE PRECISE AND ACCURATE.

THERE'S STILL MORE AND MORE COMING OUT.

AND SO IT'S I THINK, OUTCOMES ARE ONLY GOING TO GET BETTER AND ALL THE MORE REASON TO STAY PROACTIVE ABOUT THIS.

>> Jeff: ONE OF OUR VIEWERS HAD A QUESTION ABOUT HYPOFRACTIONATED RADIO THERAPY.

NEWER TECHNIQUE?

>> I THINK IT'S BEEN AROUND AND MORE OF A RADIATION ONCOLOGIST AREA.

I LIVE MORE ON THE SURGERY SIDE OF THIS.

ESSENTIALLY, GETTING RADIATION USED TO MEAN GOING FIVE DAYS A WEEK FOR TWO MONTHS TO GET RADIATION TREATMENT.

HYPOFRACTIONATEED ALLOWS YOU GOING FOR LESS TREATMENTS AND MAKES IT LESS ONEROUS TO GET THE TREATMENT.

>> Jeff: SOMEBODY TOLD ME IN MY PROCESS AND I WAS FORTUNATE TO HAVE GOOD INSURANCE AND GOT MULTIPLE SECOND OPINIONS ON THIS STUFF.

AND THIS WAS AN ONCOLOGIST WHO SAID IF YOU AND MY SITUATION WAS IT WAS JUST PAST BEING ABLE TO DO THE WATCHFUL WAITING THING.

IT WAS GOING TO BE SURGERY OR RADIATION.

WOUND UP CHOOSING SURGERY BUT THE ADVICE WAS IF YOU CHOOSE SURGERY, GET THE BEST SURGEON IF YOU CHOOSE RADIATION GET THE BEST MACHINE.

I DON'T KNOW IF THE RADIATION PEOPLE SEE IT THAT WAY.

BUT IF SOMEBODY IS AT THAT STAGE OF THE PROCESS, HOW DO YOU DECIDE WHO TO SEE?

ANY UROLOGIST CAN TECHNICALLY DO THE PROCEDURE HAS DONE THE PROCEDURE?

>> YES.

ALTHOUGH I THINK THAT THERE'S SOME BENEFIT TO GOING TO CENTERS WHERE THERE'S EXPERTISE WHERE THERE'S MULTIDISCIPLINARY CARE.

WHERE YOU WILL BE ABLE TO MEET THE VARIOUS SPECIALISTS INVOLVED.

I THINK THAT GOING TO A SURGEON WHO DOES THIS RECURRINGLY NOT ONCE A YEAR, IS BENEFICIAL.

I THINK YOU GET GOOD AT WHATEVER YOU DO REPEATEDLY.

AND A LOT OF IT IS NUANCED.

I THINK THAT THERE'S PLENTY OF SURGEONS WHO DO A FEW OF THE PROCEDURES.

ULTIMATELY YOU WANT TO ALSO MEET THE DOCTOR.

AND FEEL TRUST IN THAT DOCTOR.

FEEL BECAUSE IT IS A JOURNEY IT IS NOT A ONE-TIME ENCOUNTER.

>> Jeff: WELL, LET'S SEE WHAT WE HAVE HERE.

THAT ONE MAYBE TOO COMPLICATED.

HERE IS A QUESTION.

HOW DOES REGULAR OR IRREGULAR SEXUAL FUNCTIONING PLAY INTO THE CAUSE OR PREVENTION OF PROSTATE CANCER?

THAT WAS DECADES AGO ARGUMENT IN TERMS OF THE AMOUNT OF LET'S SAY ACTIVITY BEING SOMEHOW PROTECTIVE AGAINST DEVELOPING PROSTATE CANCER.

>> THERE HAVE BEEN STUDIES ON THIS T HASN'T BORN OUT.

THAT IS THE QUICK ANSWER ON THIS.

THAT THERE MAYBE INDIRECT ASSOCIATIONS RELATIONSHIPS THAT ARE UNCOVERED BY LOOKING AT THE SEXUAL ACTIVITY AND CANCER OUTCOMES.

BUT AT THE END OF THE DAY IT IS NOT CAUSATIVE THAT ONE DOESN'T CAUSE THE OTHER THEY CLUSTER TOGETHER.

AT THE END OF THE DAY, THERE'S NO MEANINGFUL UNDERLYING RELATIONSHIP THERE.

>> Jeff: WE TALKED EARLIER ABOUT THE LEBS BEING SUBSTANTIALLY HIGHER AMONG MEN OF AFRICAN DESCENT DO WE HAVE ANY REASON WHY?

AND HOW DOES IT CHANGE THE SCREENING RECOMMENDATIONS?

>> THIS IS VERY WELL STUDIED AND -- AND YET STILL NOT UNDERSTOOD.

SO THE FACT THAT BLACK MEN HAVE A HIGHER RISK OF GETTING AGGRESSIVE PROSTATE CANCER IS WELL-KNOWN.

ONE IN SEVEN OR EIGHT MEN GENERALLY IN THE UNITED STATES WILL GET PROSTATE CANCER, AMONGST BLACK MEN IT'S CLOSER TO ONE IN FIVE THE RISK.

SO WHY IT'S PROBABLY SOME DEGREE OF GENETICS.

THE GENES THAT EXIST AMONGST THAT COMMUNITY.

MAY PREDISPOSE THEM TO GETTING MORE OF THIS CANCER.

WE KNOW THAT GENETICS PLAYS A ROLE IN MANY PEOPLE NOT JUST BLACK MEN.

PEOPLE FAMILIES THAT TEND TO INHERIT PROSTATE CANCER PASS IT ON TO THEIR KIDS.

AND SO WHICH GENE SPECIFICALLY HAS ELUDED THE SCIENTIFIC FIELD EVEN TO THIS DAY.

>> Jeff: DOES THE LEVEL OF AGGRESSIVENESS DIFFER AT ALL?

>> THEY TEND TO BE MORE AGGRESSIVE, TOO.

WE SO ACCORDINGLY, THE GUIDELINE RECOMMENDATIONS ARE FOR BLACK MEN TO START SCREENING AS A BASELINE ENTRY LEVEL PSA AT 40.

WHICH IS DIFFERENT THAN THE GENERAL POPULATION WHICH IS 45.

>> Jeff: UNIVERSITY OF MARYLAND MEDICAL CENTER CANCER CENTER IN A BIG CITY ENVIRONMENT HOW CAN YOU HELP THE COMMUNITY IN BALTIMORE, IN YOUR PART OF WEST BALTIMORE DEAL WITH THESE DISPARITIES AND MAKE SURE WHATEVER IS GOING ON IT'S NOT BECAUSE OF A LACK OF ACCESS TO QUALITY HEALTHCARE?

>> YEAH.

THAT'S A GREAT QUESTION.

I THINK THAT IS VERY MUCH PART OF THE MISSION OF THE MEDICAL CENTER AND I KNOW THERE ARE TEAMS AND I'VE BEEN INVOLVED WITH HELPING THEM, WHICH HAVE TRIED TO BUILD TIES WITH THE COMMUNITY.

TIES WITH UNDERSERVED POPULATIONS WITHIN THE CITY AND THE STATE ITSELF.

SETTING UP SCREENING DRIVES, SETTING UP AWARENESS CAMPAIGNS AND WHATNOT.

AND I THINK THAT ALL OF THESE PROGRAMS LIKE THIS AND OUR RELATIONSHIP UNIVERSITY OF MARYLAND'S RELATIONSHIP WITH THIS PROGRAM AND GETTING THE WORD OUT ON UNDERSTANDING THAT CERTAIN POPULATIONS ARE AT HIGHER RISK AND WHAT YOU CAN DO ABOUT IT AND HOW YOU CAN DO WELL IT ALL HELPS.

>> Jeff: MOST OF THE TIME WHEN WE INTERVIEW YOUR COLLEAGUES, THE SCHOOL OF MEDICINE AND THE MEDICAL CENTER ONE OF THE QUESTIONS I HAVE TO ASK IS WHAT ARE THE SYMPTOMS OF THIS CONDITION?

AND IN THIS CASE, WHAT I'VE READ IF YOU ARE HAVING SYMPTOMS IT'S ALREADY LATE.

YOU WANT TO CATCH IT BEFORE YOU HAVE SYMPTOMS.

BUT WHAT WOULD THE SYMPTOMS BE?

AND COULD THEY BE SOMETHING ELSE OTHER THAN CANCER IN THE PROSTATE?

>> THIS IS IS QUITE TIMELY I WAS PRESIDENT BIDEN CAUGHT THROUGH SYMPTOMS.

HE WAS HAVING URINARY PROBLEMS AND IT LED TO THE DIAGNOSIS OF ADVANCED STAGE PROSTATE CANCER.

THIS IS VERY MUCH, I THINK, A VISIBLE CASE IN POINT THAT ADVANCED CANCER PRESENTS WITH SYMPTOMS EARLY STAGE CANCER DOES NOT.

PEOPLE WHO SAY I FEEL FINE I DON'T FEEL ANY PAIN OR ANY PROBLEMS, SEXUAL PROBLEMS, PAIN, THAT'S BECAUSE EARLY STAGE CANCER DOESN'T PRESENT WITH THOSE ISSUES BUT LATE STAGE PROSTATE CANCERS DO AND THOSE SITUATIONS YOU CAN GET DIFFICULTY URINATING, BONE PAIN, IF IT'S SPREAD.

WEIGHT LOSS ALL THESE TYPES OF THINGS.

TYPICALLY IT IS NOT CURABLE AT THAT POINT.

>> Jeff: SO THE FORMER PRESIDENT IN IN THAT SITUATION IT IS AN OPPORTUNITY TO RAISE AWARENESS AND HALF A MINUTE WHAT DO YOU WANT OUR VIEWERS TO KNOW ABOUT PROSTATE CANCER?

>> I THINK THAT YES, THERE ARE A COUPLE THINGS.

IN HIS SITUATION IN PARTICULAR EVEN THOUGH IT'S NOT CURABLE IT IS TREATABLE.

AND THERE'S MANY EFFECTIVE TREATMENTS THAT CAN MAINTAIN A GOOD QUALITIED OF LIFE.

QUALITY OF LIFE.

AND FOR PEOPLE IN THE EARLIER STAGE OF THEIR LIFE IN THEIR 40s AND 50s AND 60s, THE MAIN THING IS TO BE PROACTIVE ABOUT YOUR HEALTH, GET CHECKED.

AND TRY TO CATCH THIS THING IF YOU ARE GOING TO GET IT CATCH IT EARLY WHERE YOUR OUTCOMES ARE EXCELLENT.

>> Jeff: DR. MOHUMMAD MINHAJ SIDDIQUI UNIVERSITY OF MARYLAND MEDICAL CENTER AND THE UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE, DOCTOR GREAT TO SEE YOU AGAIN.

THANK YOU FOR YOUR TIME.

>> THANK YOU FOR HAVING ME.

>> Jeff: THAT IS "DIRECT CONNECTION" WE'RE BACK FRIDAY WITH "STATE CIRCLE" AND THE LATEST ON MARYLAND POLITICS.

JOIN US FOR THAT FRIDAY EVENING AT 7:00 P.M. FOR ALL OF US AT MPT THANK YOU FOR WATCHING "DIRECT CONNECTION" AND HAVE A GOOD NIGHT.