Host: Intellectual Medicine by Dr. Stephen Petteruti (Member Version)
Date: 04 February, 2025

Episode Summary

• “Making America healthy again” begins with personal responsibility, because a nation cannot be treated like a patient, and health improves only when individuals change their daily habits.
• Modern healthcare often reacts to disease instead of preventing it, with insurance and medical spending focused on procedures and prescriptions rather than exercise, nutrition, and foundational care that keep people well.
• Hormones, peptides, and other therapies can support vitality when used thoughtfully and monitored carefully, while rushed or profit-driven protocols often ignore individual needs and create unnecessary risk.
• Breakthrough drugs and aggressive cancer treatments are frequently marketed as major advances, yet real-world benefits may be small while costs, side effects, and disruptions to daily life remain significant, which calls for careful evaluation before agreeing to intervention.
• Long-term health depends on prevention, including lowering toxin exposure, questioning invasive procedures such as unnecessary biopsies, and taking steady control of lifestyle decisions that protect strength, energy, and independence over time.

Quick Decision Checklist

Use this checklist as a simple self-review. These points help you confirm that your daily choices support prevention, personal responsibility, and long-term vitality rather than relying only on treatment after problems appear.

☐ You set aside time and resources for prevention such as regular movement, balanced meals, quality sleep, and routine health monitoring.

☐ Your daily habits support steady energy, healthy weight, and metabolic stability throughout the year.

☐ Your spending supports wellness through fitness, clean food, and foundational care alongside your insurance coverage.

☐ Your environment reflects lower exposure to avoidable risks such as smoking and unnecessary toxin contact.

☐ Your focus remains on consistent, everyday behaviors that protect strength, clarity, and independence over the long term.

00:00 Introduction

When you check the internet, you will see headlines like, “Only 12% of American adults are metabolically healthy.” After reading something like that, it is hard not to wonder where you stand. Are you actually healthy, or simply moving through life without obvious symptoms?

The idea of “making America healthy again” sounds straightforward, yet it raises a deeper question. When exactly were we healthy to begin with? Every period people look back on carried its own risks, from fatal infections before antibiotics, to pandemic disease, to waves of heart attacks and chronic illness. Health has never been a perfect state that disappeared. It has always required consistent effort and personal responsibility.

Waiting for a system, a policy, or the next medical breakthrough to fix things rarely leads anywhere. A country cannot be treated like a patient, and no one from outside is coming to manage your daily habits for you. Years of studying human behavior has showed us one thing: Real improvement begins at the individual level. The choices you make about how you eat, move, rest, and protect your body will eventually make a lot of differences.

02:52 The Reality of Health Insurance

Health insurance takes a significant share of personal income each year, and the national numbers show just how large that share has become. In 2024, U.S. healthcare spending grew 7.2% to $5.3 trillion, which averages $15,474 per person, with private insurance accounting for 31% of total expenditures. That amount of money represents a major financial commitment for families, employers, and the system as a whole.

With spending at that level, many people assume the structure is designed to keep them healthy, yet most coverage is centered on paying for care after illness has already developed. The system reimburses hospital visits, procedures, imaging, and medications, while the everyday habits that protect long-term health such as regular exercise, nutrition guidance, hormone support, and preventive programs usually come out of pocket. As a result, treatment is financially supported, while prevention often becomes a personal expense.

This arrangement quietly influences behavior. Once premiums, deductibles, and co-pays are paid each month, there is less room left to invest in proactive steps that build strength and resilience. Over time, it becomes normal to spend thousands managing disease and hesitate to spend a fraction of that on maintaining health. The focus shifts toward reacting to problems rather than reducing risk in advance.

Seeing the system this way brings the responsibility back to the individual. Insurance can help with unexpected events and major interventions, yet day-to-day vitality still depends on steady choices around movement, food, sleep, stress, and foundational care. Those small decisions, repeated consistently, have a greater impact on long-term outcomes than any policy document or insurance card.

03:22 Hormone Therapy

Hormones regulate how the body produces energy, builds muscle, maintains bone strength, stabilizes mood, and supports clear thinking, so changes in these levels show up in daily life in ways that are easy to notice. When testosterone, thyroid hormones, or other key signals decline, the effects often appear as fatigue, weight gain, reduced strength, slower recovery, and loss of focus. These symptoms are commonly dismissed as “just aging,” yet they reflect measurable physiologic changes rather than an unavoidable loss of health.

Clinical evidence shows that hormone levels influence long-term outcomes, which is why balance is important. Lowering hormone levels too far produced clear harm to brain health, which demonstrates that hormones affect far more than appearance or performance and play a direct role in how the brain and body function.

The same principle applies when levels are too low. If excessive suppression creates risk, maintaining healthy physiologic ranges helps protect strength, metabolism, and mental clarity. The focus remains on correcting deficiency rather than pushing levels beyond normal. Blood work, symptoms, and regular follow-up guide each adjustment so care reflects the individual instead of a preset protocol.

A steady and monitored approach treats hormone care as part of preventive medicine. Stable levels support muscle mass, protect bone density, maintain cardiovascular function, and preserve cognitive performance, all of which influence independence and quality of life over time. When these systems remain supported, daily movement feels easier, thinking stays sharper, and energy remains more consistent.

Viewed this way, hormone therapy becomes a practical tool for maintaining function year after year, with the goal of keeping the body operating efficiently and reducing the gradual decline that many people accept as normal.

05:40 Understand Peptides

Peptides are often presented as something new or experimental, yet the term simply describes short chains of amino acids that act as signaling molecules inside the body. In practical terms, they are small proteins that help regulate communication between cells. Many familiar therapies already fall into this category. Insulin is a peptide. Several naturally occurring hormones are peptides. These compounds have been used in medicine for decades, which means the concept itself is not exotic or futuristic. It is basic biology.

Understanding this definition removes much of the mystery. A peptide is not automatically a miracle treatment or a shortcut to better health. It is simply a tool that influences a specific pathway. Each peptide has a different target and a different purpose. Some affect metabolism, some influence healing and inflammation, and others act on brain function or body composition. The effect depends on the molecule and the context, not the label.

This is why careful evaluation matters. A thoughtful approach starts with a clear clinical goal and works backward. The question is not whether someone wants peptides. The question is what problem needs to be addressed and what mechanism makes sense for that problem. Symptoms, lab results, and overall health status guide the decision. When care is individualized, treatment becomes deliberate and measured. When care is reduced to a preset package or a quick sale, outcomes become unpredictable.

Using peptides responsibly follows the same principles as any other therapy. The body is assessed first, the target is defined, and the response is monitored over time. This keeps the focus on physiology rather than marketing and keeps the patient from chasing trends that sound advanced but add little real value.

09:43 The Quicks and Mentality

Many people judge their health by looking around and comparing themselves to others their age. If everyone feels tired, gains weight, and slows down, those changes begin to look normal. Decline becomes something expected instead of something to question. This mindset creates a quiet form of resignation. When everyone around you is sinking at the same rate, the situation feels acceptable even though the overall direction is downward.

This way of thinking shows up clearly in lab interpretation. Results are often described as normal for a certain age group, which gives the impression that falling performance is natural and therefore harmless. A lower hormone level, weaker metabolism, or rising blood sugar may still fit inside a wide reference range, yet that does not mean the body is functioning well. It simply means many other people share the same decline.

Medicine provides many examples where accepting the average leads to missed opportunities. Studies of prostate cancer treatment show that aggressive intervention does not automatically improve survival. In the large STAMPEDE randomized trial, adding radiotherapy to the prostate in men with newly diagnosed metastatic disease did not improve overall survival for the full study population. More treatment did not translate into longer life. This finding reinforces a broader lesson: Doing something simply because it is customary does not guarantee benefit.

A proactive mindset looks different. Instead of asking whether a result is typical for an age group, the focus shifts to whether it supports strength, energy, and long-term function. Health is treated as something to maintain intentionally rather than something that fades with time. Small corrections made early often prevent larger problems later.

11:55 The ‘Breakthrough Drug’

The phrase breakthrough drug carries a strong emotional pull. It suggests a major advance and a clear improvement in outcomes. In practice, many new therapies offer modest gains that sound impressive in headlines yet look far less dramatic when the numbers are examined closely. A treatment may extend survival by only a few months, require intensive monitoring, and bring a high rate of side effects, yet still be marketed as a major step forward.

Looking at real outcome data helps put these claims in context. Cancer trials often measure survival in months rather than years, and adverse reactions are common. Radiation-based therapies, for example, carry documented risks that affect daily life. Reports of brachytherapy show persistent rectal and bowel complications in a meaningful percentage of patients, which can include bleeding, pain, and long-term functional issues. These effects illustrate a simple reality. Every intervention has a cost.

This does not mean treatment has no place. It means the benefit must clearly outweigh the burden. Extending life slightly while reducing quality of life through repeated hospital visits, isolation, or severe side effects is a tradeoff that deserves careful thought. Numbers such as survival time, complication rates, and financial cost should be examined plainly rather than wrapped in optimistic language.

A clear view of the data leads to steadier decisions. New does not automatically mean better and expensive does not mean effective. The goal remains practical and grounded, which is to protect function, preserve energy, and choose interventions that offer meaningful value rather than symbolic action.

16:52 Isolation After the Treatment

Some treatments are presented as precise and targeted, yet the practical consequences tell a different story. A therapy may be described as localized radiation or a focused intervention, but the precautions that follow often reveal that the effect is not limited to a small area. When patients are instructed to avoid close contact with family members, sleep separately, or isolate themselves for days after each dose, it becomes clear that the treatment reaches beyond the intended target.

These instructions carry weight because they change daily life in very real ways. Time that would normally be spent with a spouse or family is replaced with separation. Normal routines are interrupted. Weeks of recovery and restricted contact accumulate across multiple cycles. When this pattern repeats over several treatments, a large portion of the remaining time is spent managing side effects rather than living normally.

This practical burden deserves the same attention as the survival statistics. Extending life by a short interval has a different meaning when a significant share of that time involves isolation, hospital visits, and recovery. Quality of life becomes just as important as duration. A treatment plan should be evaluated not only by what it promises on paper, but by how a person will actually live during those months.

Looking at care this way encourages a steadier and more deliberate decision process. Instead of reacting to the word breakthrough or assuming that more treatment automatically equals better outcomes, the focus shifts to the full picture, which includes time, comfort, independence, and daily function. A choice that preserves connection and strength may carry more value than one that simply adds days under heavy medical supervision.

19:46 Cadmium Is Everywhere

Environmental exposure rarely receives the same attention as drugs or procedures, yet long-term contact with toxins can quietly shape health over decades. Cadmium is one of those exposures. It is a heavy metal found in soil, food, cigarette smoke, and industrial pollution, and small amounts accumulate gradually in the body over time. Because it builds up slowly, most people are unaware of how much they carry.

Research shows that this exposure is not trivial. A pooled analysis of multiple studies found that cadmium levels in prostate tissue and blood were significantly higher in men with prostate cancer than in healthy controls. This association does not depend on symptoms or headlines. It is measured directly in tissue and plasma. The closer the proximity to a known carcinogen, the greater the potential for cellular damage.

This finding supports a simple preventive principle. Reducing exposure and lowering body burden where possible is a practical step toward lowering long-term risk. Attention to food sources, smoking status, occupational contact, and detoxification strategies becomes part of routine health maintenance rather than an afterthought. Prevention often looks quiet and unremarkable, yet these small adjustments accumulate just as steadily as the exposure itself.

Focusing on environmental load also shifts the conversation away from waiting for disease to appear. Instead of reacting after a diagnosis, the goal becomes lowering risk factors before they create harm. This approach aligns with the broader theme of taking responsibility for what can be controlled today rather than relying solely on treatment tomorrow.

21:33 Never Biopsy a Prostate

A biopsy is often treated as a routine next step after an abnormal screening result, yet the procedure is still invasive and carries biological consequences. Passing a needle repeatedly through tissue disrupts the structure of the gland and creates a path through which cells can move. The act of sampling is not neutral. It alters the environment it is trying to measure.

Laboratory research has demonstrated that tumor cells can be displaced along the needle track during core needle biopsy. This mechanical spread has been documented in several cancers and supports the concern that puncturing a tumor may increase the chance of local dissemination. Even if the risk is small, it highlights that a biopsy is not simply a harmless diagnostic step.

At the same time, outcome data from prostate cancer management show that detecting and treating more disease does not always translate into longer life. Aggressive intervention often carries side effects such as incontinence, sexual dysfunction, and chronic discomfort, while survival differences remain limited in many early cases. When the benefit is uncertain and the harms are clear, the decision deserves careful thought.

Seeing these pieces together leads to a more cautious mindset. Information is valuable only when it changes management in a meaningful way. If the result will not alter the plan or improve outcomes, adding an invasive step may create more harm than clarity. A deliberate approach that weighs necessity, risk, and long-term impact helps protect both health and quality of life.

23:40 Trust Generic Drugs

Medication decisions are often shaped by marketing and headlines instead of long-term evidence. New drugs arrive with big promises and strong promotion, while older medicines continue to work quietly in everyday practice. A drug that has been used for many years carries something valuable, which is a long record of real-world results. Doctors understand how it behaves, what doses work, and what side effects to expect because millions of patients have already used it.

Generic drugs come from this history. They contain the same active ingredients and must meet the same safety and quality standards as brand-name versions, yet they cost less because the research and branding expenses have already been paid. That lower cost makes treatment easier to access and easier to sustain over time.

This trend will continue. Many high-cost brand-name drugs are losing patent protection between 2025 and 2033, which opens the door for more affordable and complex generic alternatives. As those patents expire, more treatments will move into the generic space, giving patients dependable options without the high price tag.

25:39 Take Control of Your Health

Daily health is shaped by consistent habits rather than occasional treatments. Steady decisions around food, movement, sleep, and medical care influence long-term outcomes far more than reacting after a problem appears. A practical plan begins with simple actions you can apply every day.

What to Do:

1. Maintain a healthy body weight and waist size through regular physical activity and balanced meals built around whole foods, since stable body composition supports metabolism, hormone balance, and cardiovascular health.
2. Check your labs at regular intervals and review trends over time so you understand how your body is changing and can address small shifts before they grow into larger issues.
3. Correct hormone, thyroid, blood sugar, and nutrient imbalances early with proper evaluation and follow-up, because early adjustment helps preserve energy, strength, and mental clarity.
4. Reduce exposure to environmental toxins by avoiding smoking, improving indoor air quality, and paying attention to food and water sources, since long-term accumulation of harmful substances increases disease risk.
5. Ask clear questions before agreeing to procedures or medications and make sure each step has a meaningful benefit that justifies the cost and potential side effects.
6. Use established treatments with long safety records, including generic medications when appropriate, so care remains predictable, affordable, and supported by years of real-world experience.
7. Protect the basics each day by prioritizing consistent sleep, daily movement, and stress control, because these habits support nearly every system in the body and strengthen long-term resilience.

Taking these steps keeps control in your hands and builds health gradually through deliberate, informed action.

Key Takeaway

Health rarely improves through one dramatic change. It improves through steady, informed decisions repeated every day. Insurance, prescriptions, and procedures all have a role, yet they do not replace the basics that keep the body strong. Energy, strength, and long-term resilience come from maintaining healthy weight, balanced hormones, clean nutrition, regular movement, reduced toxin exposure, and thoughtful medical choices grounded in evidence.

The common thread across each topic in this episode remains simple and practical. Question interventions that add risk without clear benefit, rely on treatments with a long record of safety, pay attention to environmental exposures that accumulate quietly over time, and address small imbalances before they grow into larger problems. This approach shifts the focus away from reacting to disease and toward protecting function.

Call to Action

If you found this episode helpful, take a moment to rate and subscribe to the Intellectual Medicine podcast so you never miss future discussions grounded in evidence and practical decision-making. For a deeper look at the research, clinical reasoning, and preventive strategies behind this vitality-focused approach, you can explore Fight Cancer Like a Man, which walks through these concepts in clear, step-by-step detail you can apply to your own health. Member notes, clinical summaries, and extended guides are added regularly, so stay engaged and continue building your understanding with each new episode.

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Disclaimer

This podcast and accompanying materials are for educational purposes only and do not replace personalized medical care. The information presented is designed to support informed decision‑making and health literacy, not to diagnose or prescribe. Always consult your own qualified healthcare provider regarding personal health questions or treatment decisions.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without permission is prohibited.

References:

Hoffman, Karen E et al. “Patient-Reported Outcomes Through 5 Years for Active Surveillance, Surgery, Brachytherapy, or External Beam Radiation With or Without Androgen Deprivation Therapy for Localized Prostate Cancer.” JAMA vol. 323,2 (2020): 149-163. doi:10.1001/jama.2019.20675

Kishan, Amar U, and Patrick A Kupelian. “Late rectal toxicity after low-dose-rate brachytherapy: incidence, predictors, and management of side effects.” Brachytherapy vol. 14, 2 (2015): 148-59. doi:10.1016/j.brachy.2014.11.005

Ladjevardi, Sam et al. “Prostate biopsy sampling causes hematogenous dissemination of epithelial cellular material.” Disease Markers vol. 2014 (2014): 707529. doi:10.1155/2014/707529

Lane, Janet Athene et al. “Functional and quality of life outcomes of localised prostate cancer treatments (Prostate Testing for Cancer and Treatment [ProtecT] study).” BJU international vol. 130,3 (2022): 370-380. doi:10.1111/bju.15739

Parker, Christopher C et al. “Radiotherapy to the primary tumour for newly diagnosed, metastatic prostate cancer (STAMPEDE): a randomised controlled phase 3 trial.” Lancet (London, England) vol. 392,10162 (2018): 2353-2366. doi:10.1016/S0140-6736(18)32486-3

Zhang, Liang et al. “Cadmium Levels in Tissue and Plasma as a Risk Factor for Prostate Carcinoma: a Meta-Analysis.” Biological trace element research vol. 172,1 (2016): 86-92. doi:10.1007/s12011-015-0576-0 

Other Links:

https://www.unc.edu/posts/2018/11/28/only-12-percent-of-american-adults-are-metabolically-healthy-carolina-study-finds/#:~:text=Only%2012%20percent%20of%20American,study%20finds%20%7C%20UNC%2DChapel%20Hill 

https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet 

https://www.pcmanet.org/rx-research-corner/generic-drugs-are-an-american-success-story-heres-why/06/10/2022/#:~:text=Indeed%2C%20peer%2Dreviewed%20research%20concludes,BACK%20TO%20RX%20RESEARCH%20CORNER 

Host: Intellectual Medicine by Dr. Stephen Petteruti (Member Version)
Date: 11 February, 2025

Episode Summary

• Human beings naturally carry higher body fat from birth, which means energy storage is built into normal biology, and controlling percent body fat requires structure rather than short-term dieting.
• Percent body fat and muscle mass provide a clearer measure of health than body weight alone, because excess fat increases metabolic and cardiovascular risk while preserved muscle supports strength, glucose control, and long-term function.
• Regular feeding times, adequate protein intake, and simple repeatable meals help regulate hunger hormones such as ghrelin, reduce overeating, and make daily intake predictable.
• Exercise improves strength, bone density, heart health, and mental well-being, yet fat loss depends primarily on consistent nutrition habits, with medication used only as supportive therapy when appropriate.
• Sustainable weight management comes from organized daily behaviors that can be repeated long term rather than temporary diets or extreme restrictions.

Quick Decision Checklist

Use this checklist to confirm that daily habits support healthy body composition and long-term health.

☐ Percent body fat or body composition tracked regularly
☐ Consistent feeding times maintained throughout the day
☐ Adequate protein included at each meal
☐ Fruit intake controlled and limited to structured meals
☐ Strength training performed weekly to protect muscle and bone
☐ Exercise used for fitness and conditioning rather than to offset excess intake
☐ Daily routine focused on prevention and long-term function

00:00 Introduction

Human beings are the fattest animals at the time of birth. There is no other organism on the planet that carries as much body fat when it enters the world. In most mammals, only about 2 to 3% of birth weight is fat, and chimpanzee newborns average about 3%. Humans begin life with substantially higher fat stores, which means energy conservation is part of normal human biology from day one.

A body designed to conserve energy does not lose fat easily. When energy intake exceeds energy use, the excess is stored as fat. Repeating that pattern day after day increases the percent body fat over time. That is just one of the many reasons why a lot of people are now dealing with obesity issues, even when they are putting in conventional efforts to lose weight.

Now the big question is: What can be done differently to get rid of obesity issues?

01:20 Two Main Things We Do

Human behavior follows two consistent drives. We seek pleasure, and we avoid pain. Nearly everything we do each day connects back to one of those two goals.

Eating fits directly into both.

Food removes the discomfort of hunger, which satisfies the drive to avoid pain, and at the same time, food activates reward pathways in the brain that release dopamine and other neurotransmitters, which creates a sense of pleasure. The brain quickly learns this connection, so eating becomes a behavior the body encourages again and again.

There is also a metabolic reason behind this pattern. The brain accounts for only about 2% of body weight, yet it uses close to 20% of the body’s daily energy. That high demand keeps appetite signals active throughout the day and explains why most people rarely feel “done” eating for long.

02:57 What Is a Calorie?

A calorie is a unit of energy used in thermodynamics. In scientific terms, one dietary calorie, which is technically a kilocalorie, represents the amount of energy required to raise one kilogram of water by one degree Celsius. The term helps researchers measure heat and energy output, yet it does not describe food in a practical or physical way.

People do not eat energy units. They eat portions of food. The stomach responds to the weight and volume of what is consumed, along with the balance of protein, fat, and carbohydrate. For that reason, translating every meal into numbers often creates a system that feels disconnected from normal eating behavior.

Long-term data reflect this problem. Large reviews that combine results from multiple diet trials report that calorie-restricted diets rarely lead to durable weight loss. Many participants regain lost weight within the first year, and most return to baseline within several years. The outcome appears repeatedly across different diet styles.

Managing intake through planned portions and structured meals fits daily life more naturally and allows eating habits to remain consistent over time, which supports better control of percent body fat.

04:32 What Happens With Diets

Dieting usually lowers body weight at first, yet the number on the scale does not tell you what was actually lost. Weight includes fat, muscle, water, and bone. When intake drops sharply, the body does not remove fat alone. It often breaks down muscle tissue and sheds water along with it.

Losing muscle creates a problem. Muscle drives daily energy use and supports metabolic rate. When muscle mass declines, the body burns fewer calories at rest, which makes future fat storage easier even if food intake stays the same. At that point, weight loss slows while fat regain becomes more likely.

Bone can also be affected. Rapid weight loss without adequate protein and resistance training has been associated with measurable reductions in bone density, particularly during aggressive restriction or drug-only approaches. Bone tissue does not rebuild quickly, which means that short-term weight loss can carry long-term consequences.

For this reason, focusing only on total weight can be misleading. Health improves when fat decreases and muscle is preserved. Any plan that reduces muscle or bone while lowering the scale moves the body in the wrong direction.

06:04 Cornerstone Elements

Once you understand how the body stores energy and how dieting affects muscle and metabolism, the next step becomes practical. Fat loss works better when eating follows structure instead of appetite.

Hunger is not a reliable guide. The body produces hunger signals throughout the day whether energy is needed or not, which means waiting until you feel hungry often leads to irregular eating and oversized portions. A more predictable approach comes from scheduling intake in advance.

This is where feeding times come in. A feeding time simply means a planned moment to fuel the body. It does not need to be a large sit-down meal. It can be small and simple, yet it occurs at a consistent time. Planning meals this way creates stable energy levels and reduces impulsive eating later in the day.

Protein becomes the foundation of each feeding time. The body relies on amino acids to maintain muscle tissue, produce hormones, and support basic metabolic functions. When protein intake is too low, the body breaks down muscle to supply those needs. Losing muscle lowers metabolic rate and makes fat control more difficult, which is why preserving muscle mass remains a priority during weight loss.

Consistency matters more than variety. Repeating similar foods and portions each day simplifies decisions and makes intake easier to control. When meals are predetermined, adherence improves and eating becomes a routine process rather than something driven by mood or convenience.

This structured approach turns fat loss into a controlled system. Scheduled feeding times, adequate protein, and predictable portions provide the foundation that supports healthier body composition over the long term.

10:08 The Perfect Body Fat

Body weight alone does not tell you whether someone is healthy. The number on a scale combines fat, muscle, water, and bone into one total, so it cannot show what actually improved or what declined. Two people can weigh the same and still have very different health profiles depending on how much of that weight comes from fat and how much comes from lean tissue.

Percent body fat gives a clearer picture. Excess body fat, especially around the abdomen, is associated with insulin resistance, cardiovascular disease, type 2 diabetes, joint degeneration, and shorter lifespan. Large population studies consistently report higher rates of metabolic disease as body fat rises, even when total weight falls within a “normal” range.

Clinical guidelines place healthy body fat ranges for men at roughly 10 to 20% and for women at roughly 18 to 28%, with some variation by age and activity level. Values that rise far above these ranges correlate with higher inflammation markers, poorer glucose control, and reduced physical performance.

Muscle tissue supports daily energy use, strength, and joint stability. When dieting leads to muscle loss, resting metabolic rate declines because the body burns fewer calories at rest. Lower energy use makes fat regain more likely. A program that reduces scale weight but reduces muscle can leave someone lighter while also weaker and less metabolically efficient.

Tracking body composition prevents this problem. Tools such as bioelectrical impedance analysis, DEXA scans, or skinfold measurements identify what is actually changing. Fat loss with preserved muscle indicates progress. Muscle loss signals the need for adjustment.

11:34 The Hormone Called Ghrelin

Hunger is controlled by hormones. One of the primary signals is ghrelin, which is produced in the stomach and communicates with the brain to stimulate appetite.

Ghrelin rises when the stomach is empty and falls after eating. This cycle repeats throughout the day and follows a predictable rhythm. Research also shows that ghrelin responds to timing. When meals occur at regular hours, the body prepares in advance and appetite remains moderate. When meals are skipped or delayed, ghrelin levels climb higher and hunger becomes intense, which often leads to overeating.

The speed of eating also influences intake. After food enters the stomach, it takes about 20 to 30 minutes for hormonal signals to reduce appetite. Eating too quickly during this period allows more food to be consumed before fullness registers.

Scheduled meals reduce these extremes. Regular feeding times limit long gaps, keep hunger signals controlled, and make portion sizes easier to manage. Consistency works with normal physiology rather than against it.

13:13 Food Variety Is Nonsense

The idea that every meal needs to be different sounds attractive, yet it often makes weight control harder. Constant variety increases decision-making and creates uncertainty about portion sizes and ingredients. Each new option introduces small changes that add up over time.

Repetition simplifies eating. Similar meals each day stabilize intake and remove unnecessary choices. Many structured nutrition programs use this approach. Athletes, military units, and clinical weight-management plans often rely on standardized menus because predictable meals produce predictable results.

Consistency also improves accuracy. Repeating portions makes it easier to understand how the body responds and allows small adjustments without recalculating everything. Protein intake, carbohydrate limits, and total food volume remain controlled with less effort.

This structure supports everyday eating while still allowing planned flexibility. Most body composition changes come from routine habits repeated across the week rather than occasional special events.

Taken together, monitoring body fat, managing hunger hormones, and using simple, repeatable meals create a practical system. The body responds well to predictable inputs, and that predictability makes fat loss easier to maintain over time.

16:22 Knowing Someone Is Healthy

Health cannot be judged by body size alone. A lower number on the scale does not automatically mean better health because weight includes fat, muscle, bone, and water all combined into one total. The scale cannot tell you what improved and what declined.

Objective measurements give clearer answers. Percent body fat, muscle mass, strength, blood pressure, fasting glucose, and cholesterol levels describe how well the body is actually working. These markers connect directly to disease risk and daily performance.

Muscle tissue plays a central role in this process. Muscle handles most of the glucose your body uses after meals and supports insulin sensitivity. More muscle improves blood sugar control and lowers the risk of metabolic disease. Bone density protects posture and reduces fracture risk as you age.

Body fat location also influences risk. Fat stored around the abdomen surrounds internal organs and releases inflammatory signals that contribute to heart disease and diabetes. Studies consistently link increasing waist size with higher cardiometabolic risk.

Health therefore comes down to function. Strength, energy, and stable lab values give a more reliable picture than appearance.

16:51 Hedonistic Eating

Food does more than provide fuel. It also connects people to family, culture, and celebration. Removing every enjoyable food often creates frustration and leads to overeating later.

Behavioral research supports this pattern. Strict restriction increases cravings and lowers long-term adherence. When people feel deprived, they tend to compensate with larger portions or unplanned snacks. That cycle disrupts progress.

Planning enjoyable foods works better. Choosing the time and portion ahead of time keeps intake controlled while still allowing enjoyment. A defined treat fits into the week without throwing off the entire routine.

This method replaces impulsive eating with deliberate eating. Impulsive choices happen when food appears suddenly and emotions guide the decision. Deliberate choices follow a plan. A plan creates consistency, and consistency keeps body fat under control.

18:50 The Real Benefits of Fruits

Fruit contains fiber, vitamins, minerals, and plant compounds that support overall health. These nutrients are valuable. Fruit also contains natural sugars, which add to total carbohydrate intake.

Carbohydrates influence insulin release. Frequent large spikes in insulin encourage the body to store energy as fat. This process does not change simply because the sugar comes from fruit.

Portion size determines the effect. A small serving of berries with a meal provides nutrients with modest carbohydrate intake. Multiple servings of high-sugar fruits throughout the day can equal the carbohydrate load of snack foods or desserts.

Clinical nutrition guidance often recommends limiting fruit to one serving at a time and pairing it with protein or fiber. This slows absorption and helps keep blood sugar steady.

Fruit supports health when used thoughtfully. Large or frequent portions add extra energy that the body stores.

20:43 The Role of Exercise

Exercise improves heart health, strength, balance, and mood. Regular activity lowers blood pressure, improves insulin sensitivity, and supports mental well-being. These benefits are well established.

Exercise alone does not remove large amounts of body fat. A typical 30-minute brisk walk burns about 150 to 200 calories, which can be replaced quickly with one snack or drink. The body also adapts by conserving energy later in the day, which reduces the total effect.

Most fat loss comes from controlling intake. Exercise protects muscle and improves health markers, but it does not offset excess eating.

Exercise should therefore support your structure rather than act as compensation for food.

What to Do

Use these habits to guide daily behavior:

1. Schedule 3 to 5 feeding times and include protein at each meal.
2. Measure percent body fat periodically instead of relying only on scale weight.
3. Plan one or two controlled treats per week.
4. Keep fruit portions small and pair them with protein or fiber.
5. Perform strength training 2 to 3 times per week to protect muscle and bone.
6. Use walking or light cardio for heart health, not to cancel out overeating.
7. Keep meals simple and repeatable so intake stays predictable.

These steps create structure and make progress easier to maintain.

21:30 Pharmacology Influence

Obesity is recognized medically as a chronic metabolic condition. Some people benefit from medication support when lifestyle changes alone are not enough.

Certain medications reduce appetite or increase fullness. Older options such as phentermine have been used for decades and remain inexpensive. Newer GLP-1 medications, including semaglutide, slow stomach emptying and reduce hunger signals. Clinical trials report average weight reductions of about 10 to 15% over one year.

Medication still requires structure. Reduced appetite can lead to skipped meals and low protein intake, which increases the risk of muscle and bone loss. Studies have documented declines in lean mass when weight loss occurs without adequate nutrition.

Medication works best when combined with planned meals and strength training. Drugs assist the process. Daily habits determine the outcome.

Key Takeaway

Health is built through daily structure, not occasional effort. Percent body fat, muscle mass, and metabolic stability provide a clearer picture of wellness than body weight alone, which is why tracking body composition offers more useful guidance than watching the scale.

Planned meals, controlled portions, and consistent eating times help regulate hunger hormones and reduce overeating, while simple and repeatable food choices keep intake predictable. Enjoyable foods can still fit into the week when they are scheduled and limited rather than impulsive.

Exercise supports strength, bone health, and cardiovascular function, yet food intake remains the primary driver of fat loss. Medication can assist selected individuals, but it works best when paired with disciplined habits rather than used as a substitute for them.

Call to Action

For a broader explanation of the reasoning behind this perspective, Fight Cancer Like a Man by Dr. Stephen Petteruti presents these principles in a structured and practical format, outlining how to approach cancer prevention, screening, and treatment decisions with clarity.

Fight Cancer Like a Man by Dr. Petteruti: https://www.amazon.com/dp/B0GLZ9TL8N/

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To support deeper reflection, referenced studies explore the long-term outcomes of observation compared with intervention. These data examine survival, treatment-related complications, and the biological consequences of biopsy and hormone suppression. Reviewing this literature allows patients and clinicians to move beyond habit and consider a more individualized approach to prostate health.

Selected References

The following peer‑reviewed studies and reviews provide background evidence for the concepts discussed in Episode 02: “Obesity and Aging: The Secrets to Sustainable Weight Loss.” These references explore the biological role of body fat in humans from birth, the metabolic adaptations that promote fat preservation, and strategies that support healthy, sustainable fat loss through metabolism management rather than short‑term dieting. Together, they highlight how energy balance, muscle preservation, and hormonal regulation influence long‑term body composition and aging.

Brennan CS. Dietary fibre, glycaemic response, and diabetes. Mol Nutr Food Res. 2005;49(6):560‑570. doi:10.1002/mnfr.200500025
PubMed: https://pubmed.ncbi.nlm.nih.gov/15926172/

Center for Academic Research and Training in Anthropogeny (CARTA). Fatness at Birth. CARTA Website. https://carta.anthropogeny.org/moca/topics/fatness-birth. Accessed February 11, 2025. 

Chen Y, Yang Y, Jiang H, Liang X, Wang Y, Lu W. Associations of BMI and Waist Circumference with All‑Cause Mortality: A 22‑Year Cohort Study. Obesity (Silver Spring). 2019;27(4):662‑669. doi:10.1002/oby.22423
PubMed: https://pubmed.ncbi.nlm.nih.gov/30807694/

Cummings DE, Purnell JQ, Frayo RS, Schmidova K, Wisse BE, Weigle DS. A preprandial rise in plasma ghrelin levels suggests a role in meal initiation in humans. Diabetes. 2001;50(8):1714‑1719. doi:10.2337/diabetes.50.8.1714
PubMed: https://pubmed.ncbi.nlm.nih.gov/11473029/

Fothergill E, Guo J, Howard L, et al. Persistent metabolic adaptation 6 years after "The Biggest Loser" competition. Obesity (Silver Spring). 2016;24(8):1612‑1619. doi:10.1002/oby.21538
PubMed: https://pubmed.ncbi.nlm.nih.gov/27136388/

Heymsfield SB, Wang Z, Baumgartner RN, Ross R. Human body composition: advances in models and methods. Annu Rev Nutr. 1997;17:527‑558. doi:10.1146/annurev.nutr.17.1.527
PubMed: https://pubmed.ncbi.nlm.nih.gov/9240939/

Kuzawa CW. Adipose tissue in human infancy and childhood: an evolutionary perspective. Am J Phys Anthropol. 1998;(Suppl 27):177‑209. doi:10.1002/(SICI)1096‑8644(1998)107:27+<177::AID‑AJPA7>3.0.CO;2‑B
PubMed: https://pubmed.ncbi.nlm.nih.gov/9881522/

Leidy HJ, Clifton PM, Astrup A, et al. The role of protein in weight loss and maintenance. Am J Clin Nutr. 2015;101(6 Suppl):1320S‑1329S. doi:10.3945/ajcn.114.084038
PubMed: https://pubmed.ncbi.nlm.nih.gov/25926512/

Leonard WR, Robertson ML, Snodgrass JJ, Kuzawa CW. Metabolic correlates of hominid brain evolution. Comp Biochem Physiol A Mol Integr Physiol. 2003;136(1):5‑15. doi:10.1016/S1095‑6433(03)00132‑6
PubMed: https://pubmed.ncbi.nlm.nih.gov/14527624/

Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J. Medicare's search for effective obesity treatments: diets are not the answer. Am Psychol. 2007;62(3):220‑233. doi:10.1037/0003‑066X.62.3.220
PubMed: https://pubmed.ncbi.nlm.nih.gov/17469900/

Phillips SM, Van Loon LJ. Dietary protein for athletes: from requirements to optimum adaptation. J Sports Sci. 2011;29 Suppl 1:S29‑S38. doi:10.1080/02640414.2011.619204
PubMed: https://pubmed.ncbi.nlm.nih.gov/22150425/

Raynor HA, Epstein LH. Dietary variety, energy regulation, and obesity. Psychol Bull. 2001;127(3):325‑341. doi:10.1037/0033‑2909.127.3.325
PubMed: https://pubmed.ncbi.nlm.nih.gov/11316011/

Srikanthan P, Karlamangla AS. Muscle mass index as a predictor of longevity in older adults. Am J Med. 2014;127(6):547‑553. doi:10.1016/j.amjmed.2014.02.007
PubMed: https://pubmed.ncbi.nlm.nih.gov/24561114/

Swift DL, Johannsen NM, Lavie CJ, Earnest CP, Church TS. The role of exercise and physical activity in weight loss and maintenance. Prog Cardiovasc Dis. 2014;56(4):441‑447. doi:10.1016/j.pcad.2013.09.012
PubMed: https://pubmed.ncbi.nlm.nih.gov/24438736/

Villareal DT, Chode S, Parimi N, et al. Weight loss, exercise, or both and physical function in obese older adults. N Engl J Med. 2011;364(13):1218‑1229. doi:10.1056/NEJMoa1008234
PubMed: https://pubmed.ncbi.nlm.nih.gov/21449785/

Wells JC. The evolution of human fatness and susceptibility to obesity: an ethological approach. Biol Rev Camb Philos Soc. 2006;81(2):183‑205. doi:10.1017/S1464793105006974
PubMed: https://pubmed.ncbi.nlm.nih.gov/16573852/

Wilding JPH, Batterham RL, Calanna S, et al. Once‑Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021;384(11):989‑1002. doi:10.1056/NEJMoa2032183
PubMed: https://pubmed.ncbi.nlm.nih.gov/33567185/

Wolfe RR. The underappreciated role of muscle in health and disease. Am J Clin Nutr. 2006;84(3):475‑482. doi:10.1093/ajcn/84.3.475
PubMed: https://pubmed.ncbi.nlm.nih.gov/16960159/

Disclaimer

This podcast and its accompanying materials are for educational purposes. They are intended to support thoughtful decision-making and improve health literacy. They are not a substitute for individualized medical advice, diagnosis, or treatment. Always consult your qualified healthcare professional regarding personal medical concerns.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without written permission is prohibited.

Host: Intellectual Medicine by Dr. Stephen Petteruti (Members Version)

Date: 08 February, 2026

Episode Summary

• Early stage prostate cancer often progresses slowly, and long-term studies report little or no survival difference between immediate conventional treatment and careful observation, while surgery and radiation carry clear risks such as urinary leakage, erectile dysfunction, and bowel complications.
• PSA tests, biopsies, and imaging provide limited predictive certainty, and invasive procedures can introduce their own harms, so decisions work best when guided by trends, overall health, and thoughtful evaluation rather than reacting to a single result.
• A structured, prevention-focused approach that includes watchful waiting, immune support, lowering toxic exposures, and maintaining healthy body composition helps protect quality of life while allowing time to choose treatment only when it is truly necessary.

Quick Decision Checklist

Use this checklist to confirm that your daily choices support careful monitoring, prevention, and long-term prostate health.

☐ PSA levels tracked over time instead of reacting to one isolated result

☐ Abnormal PSA values repeated after rest and recovery to rule out temporary causes such as illness, stress, or recent activity

☐ Clear understanding of how a biopsy result would change management before agreeing to the procedure

☐ Regular follow-up visits are scheduled for monitoring rather than rushing into treatment

☐ Percent body fat and waist size are kept within healthy ranges to lower metabolic and cancer risk

☐ Sleep, nutrition, and physical activity are used daily to support immune function

☐ Environmental exposures, such as heavy metals or toxins evaluated when appropriate

☐ Decisions made calmly with complete information and personal values guiding the process

00:00 Introduction

A prostate cancer diagnosis can make anyone feel like they need to act fast. The word “cancer” carries weight, and the first instinct is often to remove it or treat it immediately before it spreads. Many people believe that earlier treatment always leads to better results.

Prostate cancer does not always behave that way. Research over many years has found that a large number of early prostate cancers grow slowly and stay inside the gland without causing symptoms or shortening life. At the same time, common treatments such as surgery and radiation can lead to urine leakage, sexual dysfunction, bowel problems, and other lasting complications. In some cases, the treatment creates more measurable harm than the cancer itself.

That creates an important question: If early treatment does not clearly improve survival, and the side effects can permanently change daily life, is rushing into surgery or radiation always the right move?

02:09 New Discoveries About Prostate Cancer

For many years, prostate cancer was treated with one basic idea in mind. If cancer is found early, remove it quickly. The assumption was that early surgery or radiation would naturally save lives.

Long-term research began to question that belief. As more men were followed over time, doctors noticed something unexpected. Many early prostate cancers grew very slowly and stayed confined to the prostate for years without causing symptoms. Some never affected lifespan at all. In other words, detection did not automatically mean danger.

Clinical trials helped clarify this pattern. One of the better-known examples is the PIVOT trial, where men with localized prostate cancer were split into two groups. One group had the prostate removed through surgery, and the other group received observation without immediate treatment. After more than a decade of follow-up, overall survival between the two groups looked nearly the same, and deaths specifically from prostate cancer were also similar. Removing the gland did not produce a clear survival advantage.

At the same time, the men who underwent surgery experienced higher rates of complications. Urinary leakage, erectile dysfunction, and surgical risks appeared more often in the treated group. These side effects affected daily life in ways that could not be reversed, while the expected survival benefit remained small or uncertain.

These findings changed how many specialists think about early disease. Prostate cancer often behaves differently from aggressive cancers such as pancreatic or lung cancer. Instead of spreading rapidly, it may remain slow and contained for long periods. Treating every early tumor as an emergency can lead to harm without a matching benefit.

This shift in understanding explains why some medical guidelines now accept observation, often called watchful waiting or active surveillance, as a reasonable first step for many men with early-stage prostate cancer. The goal becomes careful monitoring rather than immediate intervention, which allows treatment to be reserved for cases that show clear signs of progression.

When you look at the data this way, the decision starts to feel less urgent. Early detection still has value, yet immediate treatment does not always improve outcomes. Knowing that difference gives you room to think clearly and weigh the real risks and benefits before moving forward.

05:00 Potential Damage from Radiation

Radiation therapy is often presented as an option for men who want to avoid surgery. The idea sounds straightforward. The prostate remains in place, and the cancer is targeted and destroyed with focused radiation. Many people assume this approach avoids the risks that come with an operation.

Radiation still carries its own set of risks, and those risks can appear months or even years later. Radiation affects cancer cells and nearby healthy tissue because the prostate sits next to the bladder and the rectum. When those tissues absorb radiation, they can become inflamed or damaged over time.

Damage to the rectum is known as radiation proctitis. Men can develop chronic irritation, bleeding, pain, or difficulty controlling bowel movements. Damage to the bladder, called radiation cystitis, can lead to burning with urination, bleeding, or increased urgency and frequency. These problems may persist long after treatment ends and can interfere with daily comfort.

There is also a broader biological concern. Radiation itself is carcinogenic, which means it has the potential to damage DNA and increase the risk of future cancers. Studies that follow patients for many years have reported small but measurable increases in secondary malignancies after pelvic radiation, including bladder and blood-related cancers. The risk is not immediate, yet it exists because radiation works by injuring cells at a genetic level.

When the survival benefit is unclear or ambiguous, these trade-offs become important. Some treatments extend life, and people accept side effects as part of the cost. Long-term survival for early-stage prostate cancer often appears similar across different treatment paths, so side effects carry greater weight because they may reduce quality of life without adding measurable time.

Radiation can cause lasting bowel, bladder, and sexual problems. These complications may continue for years and can affect daily comfort and independence. At the same time, research has not established a clear survival benefit for early-stage prostate cancer. Many men at this stage feel completely well and have cancer that remains confined to the prostate. Starting radiation in that situation can introduce new health problems that did not previously exist, even though the person had no symptoms to begin with.

07:17 Prostate Cancer Found During Cadaveric Studies

Some of the clearest insights about prostate cancer came from autopsy research rather than hospital treatment rooms. Pathologists examined the prostate glands of men who died from unrelated causes such as heart disease, infections, or accidents. These men lived their entire lives without symptoms or treatment for prostate cancer, yet their tissues told a different story under the microscope.

When those glands were analyzed carefully, many contained small areas of prostate cancer that had never been detected while the men were alive. The tumors were often tiny, localized, and completely silent. They caused no pain, no urinary problems, and no limitation in daily life, which means the disease existed without creating noticeable harm.

The numbers reported in these studies are striking. Research has found incidental prostate cancer in roughly 20 to 30% of men over age fifty, and the rate increases steadily with age. In men in their seventies and eighties, more than half show microscopic cancer within the gland, and in very elderly groups the majority carry these small lesions.

These findings change how the disease should be interpreted. Prostate cancer appears to be common at the cellular level, especially as men grow older. Many tumors grow slowly and remain confined to the gland for years or decades without spreading or threatening life expectancy.

This helps explain the old medical saying that many men die with prostate cancer rather than from it. The presence of cancer cells alone does not guarantee danger, and detecting every small focus does not automatically improve survival. A diagnosis may create anxiety, yet the biological behavior of the tumor may remain quiet for a very long time.

This context becomes important when screening tests identify an elevated PSA or a small abnormality on imaging. The natural reaction is urgency, because the word “cancer” carries emotional weight. Autopsy data suggest that many early findings represent slow, contained disease that might never affect lifespan or function.

08:37 Cancer Patients Who Survived

Statistics and research papers help guide decisions, yet real clinical stories often make the point more clearly. Over the years, many men diagnosed with prostate cancer have chosen to avoid immediate surgery or radiation and have continued living full, active lives. These cases remind us that a diagnosis does not automatically equal rapid decline or shortened survival.

One example involved a man with a significantly elevated PSA who underwent a biopsy that confirmed prostate cancer. He declined surgery because he felt well and wanted to protect his daily function and independence. More than two decades later, he remained alive, active, and symptom-free, even though his PSA stayed high throughout that time.

Another case moved in the opposite direction. A man underwent early surgery to remove the prostate gland, and his PSA dropped to nearly zero after treatment. Despite that reassuring number, the cancer later spread to his spine and caused severe complications, which shows that a low PSA does not always guarantee protection from progression.

A third patient had biopsy-confirmed cancer and chose observation rather than immediate treatment. Years later, repeat testing showed no detectable cancer in the sampled tissue. This outcome highlights how some prostate lesions can remain quiet or even regress without aggressive intervention.

Stories like these do not replace research, yet they reflect what long-term studies also report. PSA values do not always predict behavior accurately, and early treatment does not always determine survival. The relationship between test results and real-world outcomes remains inconsistent, which makes automatic intervention difficult to justify.

These examples support a central idea that runs throughout this topic. Prostate cancer behaves differently from person to person, and many cases move slowly enough that immediate treatment does not change the long-term picture.

10:56 Biopsy Reliability and Risks

A biopsy sounds simple in theory. A small needle enters the prostate, collects tissue, and the lab checks for cancer cells. Many people assume the result gives a clear yes-or-no answer and makes the next step obvious. In practice, the process carries uncertainty, and that uncertainty affects both accuracy and safety.

The prostate is not sampled in its entirety during a biopsy. Multiple needles are inserted into different areas of the gland in a pattern that resembles random sampling. This method means some areas are tested while others remain untouched, so a small tumor can be missed, and a quiet or contained lesion can be detected even though it may never cause symptoms. The result depends heavily on where the needle happens to land.

Because of this sampling method, false negatives and false positives both occur. A negative result does not guarantee the absence of cancer, and a positive result does not automatically indicate a dangerous or fast-growing disease. Research has documented both underdiagnosis and overdiagnosis with prostate biopsies, which creates confusion and often leads to repeated procedures.

The procedure itself also carries physical risks. Passing needles through the rectal wall into the prostate introduces bacteria into deeper tissue, which can lead to infection. Some men develop fever, urinary retention, or bloodstream infections that require hospitalization and intravenous antibiotics. Bleeding in the urine, stool, or semen is also common for days or weeks after the procedure.

There is another concern that receives less attention. Inserting needles into a tumor disturbs the local environment of the gland. Some laboratory and surgical literature has documented the presence of cancer cells along needle tracks after biopsies in certain cancers, which raises questions about whether mechanical disruption can contribute to cell spread. The evidence does not provide absolute proof for prostate cancer, yet the possibility deserves careful thought before proceeding.

Decision-making becomes important at this point. A biopsy only makes sense when the result will change what you plan to do next. If a person has already decided against surgery or radiation, then confirming the presence of cancer may add anxiety without altering the treatment plan.

This is why many clinicians recommend stepping back before scheduling a biopsy. Clarifying your goals first helps determine whether the information will be useful or simply stressful. Testing should serve a clear purpose, and that purpose should align with how you intend to manage your health moving forward.

13:14 Consequences of Sticking Needles Inside

Placing a needle into any organ creates more than a simple sample. It disrupts tissue, causes local inflammation, and triggers a healing response. That reaction may be minor on the skin, yet it carries greater significance inside an organ that contains a known tumor. The prostate has a dense network of blood vessels and lymphatic channels, so any disturbance spreads fluid and cells through those pathways.

During a standard prostate biopsy, multiple cores are taken in one session. In many practices, 10 to 12 needle passes occur in different parts of the gland. Each pass creates a small channel that cuts through tissue and temporarily opens a pathway between the inside of the prostate and the surrounding circulation. From a mechanical standpoint, this process fragments tissue and releases cells into nearby spaces.

Cancer biology adds another layer to consider. Tumor cells already have the ability to detach and migrate. When tissue is punctured repeatedly, some cells can be dislodged from their original location. In other areas of medicine, pathologists have documented tumor cells deposited along needle tracks after biopsies of breast and liver lesions. This phenomenon is called needle-track seeding. It remains uncommon, yet it demonstrates that mechanical spread can occur under certain conditions.

Direct proof in prostate cancer remains limited, yet the concept remains biologically plausible. The prostate sits next to veins and lymphatic vessels that drain into the pelvis. Any disruption in that environment creates an opportunity for cellular movement. Even a small theoretical risk becomes relevant when the disease itself often grows slowly and may never threaten life.

The transcript emphasizes a practical question. If the next step after a positive biopsy involves surgery or radiation that may not improve survival, then the biopsy may introduce risk without offering clear benefit. Testing should help guide a decision. Testing that does not change management creates exposure without purpose.

There are also immediate complications to consider. Studies report infection rates of about 2 to 5% after transrectal prostate biopsy, with a smaller percentage requiring hospital care. Urinary retention, bleeding, and significant discomfort also occur. These events may sound rare on paper, yet they affect real people and can disrupt weeks of daily life.

The broader issue comes down to intent. When a test is ordered, it should answer a question that changes action. If the plan already involves monitoring and preserving quality of life, then repeated needle procedures may add stress and physical risk without moving care forward. Careful thought before intervention protects both the body and peace of mind.

15:44 PSA Monitoring and Its Limitations

PSA stands for prostate-specific antigen. It is a protein made by prostate cells and released into the bloodstream. The test measures how much of that protein is present in a small blood sample. On paper, it looks simple. A higher number appears to suggest a problem inside the gland.

In practice, PSA is a nonspecific signal. It rises for many different reasons that have nothing to do with dangerous cancer. Infection, inflammation, recent sexual activity, cycling, urinary retention, and even a routine digital exam can temporarily increase the value. Normal day-to-day biological variation also causes small fluctuations. A single elevated result often reflects irritation rather than disease.

Large screening studies help clarify this issue. When PSA testing became widespread, diagnosis rates increased sharply, yet mortality from prostate cancer changed only modestly. Many men were labeled with cancer that never progressed to symptoms. This pattern is called overdiagnosis. Autopsy studies support it, with microscopic prostate cancer found in a significant percentage of men who died from unrelated causes and never knew they had it.

The number itself also lacks a clear boundary. There is no natural line where PSA suddenly shifts from safe to dangerous. A value of 2, 4, or 6 does not automatically predict outcome. Some men with low PSA still harbor aggressive disease, while others live decades with high levels and no clinical impact. This overlap limits the test’s ability to guide life-changing decisions.

The typical response to a rising PSA often follows a predictable chain. The number increases, concern grows, and a biopsy is scheduled. That biopsy may lead to surgery or radiation. Each step introduces risk, yet the original signal may have been temporary or harmless. When the starting point is unreliable, every downstream step inherits that uncertainty.

Trend tracking sounds logical, yet it carries similar problems. Small changes over time may reflect laboratory variation or short-term inflammation. Treating every upward movement as an emergency can create repeated procedures without improving outcomes. Many clinicians now recommend repeating the test after several weeks under calm conditions before making any decision.

Monitoring still has a role. Used thoughtfully, PSA can provide background information while a person remains symptom-free. It works best as one piece of context rather than a trigger for immediate intervention. Numbers should inform reflection, not rush action.

17:22 The Watchful Waiting Process

Watchful waiting is a planned approach to care. It means treatment is not started immediately after a prostate cancer finding. Life continues as usual while the condition is monitored at regular intervals. Decisions are made gradually with new information gathered over time.

This approach was developed because early prostate cancer often progresses slowly. Many tumors remain confined to the gland for years without causing symptoms. Autopsy studies have identified small prostate cancers in a large number of older men who died from unrelated causes, which indicates that the disease can exist quietly without affecting lifespan. In these situations, the cancer was present but never became clinically important.

Clinical research reflects the same pattern. Long-term studies that compared immediate surgery with observation reported similar overall survival between the groups. The difference appeared in side effects. Men who underwent treatment experienced higher rates of urinary leakage, erectile dysfunction, and bowel complications. The men who were monitored avoided those complications while maintaining similar life expectancy.

Monitoring follows a clear structure. PSA levels are checked at scheduled times. Physical exams or imaging are performed when needed. Symptoms are reviewed during follow-up visits. Trends across months or years guide decisions rather than a single number or one test result. This method keeps care organized and reduces unnecessary procedures.

Quality of life remains a central part of the plan. Urinary control, sexual function, and daily comfort influence independence and well-being. Preserving these functions has practical value. Many men prefer to maintain normal activity while continuing observation and reserving intervention for situations where clear progression appears.

Time also supports better thinking. A cancer diagnosis can create fear and pressure to act quickly. A slower, structured process allows space to review evidence and consider personal priorities. Health decisions made with patience often align better with long-term goals.

20:01 Addressing Other Carcinogens

Cancer risk does not come from a single source. Cells change over time when they are exposed to repeated stress, inflammation, and toxic substances. Prostate tissue responds to the same biological forces that affect the rest of the body, which means overall health habits influence what happens inside the gland.

Environmental exposure plays a measurable role. Heavy metals such as cadmium, arsenic, and lead have been classified as carcinogenic in toxicology research. Cadmium receives special attention because it accumulates in the prostate and can remain in tissue for years. Occupational studies in industrial workers have linked higher cadmium exposure with increased rates of prostate cancer, which supports the idea that long-term buildup carries risk.

Testing for toxic burden provides useful information. Blood, urine, or provocative chelation testing can estimate how much of these metals are stored in the body. Identifying elevated levels gives you a clear target for intervention. Removing or lowering those exposures reduces one source of chronic cellular stress.

Body composition also fits into this picture. Excess body fat acts as active tissue that releases inflammatory chemicals and hormones. Higher inflammation creates an internal environment that favors cellular damage over time. Waist circumference and percent body fat correlate with higher rates of several cancers, including prostate cancer, which means fat reduction becomes part of prevention rather than appearance.

Nutrient status supports immune surveillance. The immune system identifies and removes abnormal cells every day. Vitamin D plays a role in immune regulation, and blood levels in the adequate range have been associated with improved immune function in many studies. Zinc concentrates heavily in prostate tissue and contributes to normal prostate biology, which explains why maintaining sufficient levels remains a common clinical recommendation.

These steps do not involve cutting or radiating tissue. They focus on strengthening the body’s natural defenses and lowering known stressors. Improving nutrition, reducing toxins, maintaining healthy body fat, and supporting immune function create conditions that favor stability inside the gland.

Addressing carcinogens becomes a practical prevention. Each small correction removes one burden from the system. Over time, those changes build a healthier internal environment that supports long-term function and lowers avoidable risk.

22:17 Pause and Contemplate

A prostate cancer diagnosis often triggers urgency. The phone rings, a number comes back high, or a biopsy report includes the word “cancer,” and the next thought quickly turns into action. Appointments get scheduled, procedures get discussed, and decisions start to feel rushed. Fear pushes the process forward faster than understanding.

Prostate cancer rarely behaves like an emergency. In many men, it grows slowly over years rather than weeks. That time window gives you space to think clearly, review the evidence, and decide what truly supports your long-term health. Slowing the process protects you from making permanent decisions based on temporary anxiety.

Deliberate thinking leads to better outcomes. When you step back and look at survival data, treatment risks, and your current quality of life, the picture becomes practical instead of emotional. The goal becomes preserving function and longevity together, not reacting to a single lab result.

What to Do

1. Review your PSA trend over time instead of reacting to a single reading.
2. Repeat abnormal tests when appropriate to rule out temporary causes such as infection, stress, or recent activity.
3. Ask how any proposed procedure will change management before agreeing to it.
4. Focus on daily health habits that support immune function, including sleep, nutrition, and regular movement.
5. Measure and reduce excess body fat, since abdominal fat correlates with higher cancer and metabolic risk.
6. Maintain adequate vitamin D and zinc levels as part of general immune support.
7. Schedule follow-ups at planned intervals so monitoring remains organized rather than reactive.

These steps keep you involved in your care and give you control over what can be controlled today. Thoughtful action replaces panic, and steady, informed decisions protect both quality of life and long-term health.

Key Takeaway

Early-stage prostate cancer often grows slowly and may remain confined to the prostate for many years without affecting daily function or life expectancy. At the same time, surgery, radiation, biopsies, and hormone therapy carry well-documented risks that can permanently affect urinary control, sexual function, bowel comfort, muscle mass, and overall quality of life. When the survival benefit of immediate treatment remains uncertain, those risks deserve careful thought.

Clear decisions come from understanding the numbers and the biology, not from fear. Tracking PSA trends, reviewing imaging carefully, and addressing modifiable risk factors such as body fat, toxic exposures, sleep, and immune support gives you a practical way to protect your health while you evaluate your options. A measured, informed approach allows you to preserve function, maintain strength, and choose treatment only when it truly serves your long-term well-being.

Continue the Conversation

If this discussion raised new questions for you, there are related episodes that expand on these themes in greater detail:

EP10 – Managing an Elevated PSA: Avoiding Unnecessary Prostate Biopsies

E16 - Prostate Cancer Prevention Is Not About Fear | What Most Doctors Miss

For a broader explanation of the reasoning behind this perspective, Fight Cancer Like a Man by Dr. Stephen Petteruti presents these principles in a structured and practical format, outlining how to approach cancer prevention, screening, and treatment decisions with clarity.

Fight Cancer Like a Man by Dr. Petteruti: https://www.amazon.com/dp/B0GLZ9TL8N/

If you would like continued access to extended clinical notes and member-only discussions, you can join the Intellectual Medicine Community here:

• Membership: https://tinyurl.com/DrPetterutiMember
• Sign up for Dr. Steve’s email newsletter: https://www.drstephenpetteruti.com
• Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

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Subscribe to the Intellectual Medicine Podcast:

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To support deeper reflection, referenced studies explore the long-term outcomes of observation compared with intervention. These data examine survival, treatment-related complications, and the biological consequences of biopsy and hormone suppression. Reviewing this literature allows patients and clinicians to move beyond habit and consider a more individualized approach to prostate health.

Selected References

Wilt TJ, Jones KM, Barry MJ, et al. Follow‑up of prostatectomy versus observation for early prostate cancer. N Engl J Med. 2017;377(2):132‑142. doi:10.1056/NEJMoa1615869

Hamdy FC, Donovan JL, Lane JA, et al. 15‑year outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. 2023;388(10):798‑809. doi:10.1056/NEJMoa2214122

Donovan JL, Hamdy FC, Lane JA, et al. Patient‑reported outcomes after monitoring, surgery, or radiotherapy for prostate cancer. N Engl J Med. 2016;375(15):1425‑1437. doi:10.1056/NEJMoa1606221

Klotz L. Active surveillance for low‑risk prostate cancer. N Engl J Med. 2020;383:81‑82. doi:10.1056/NEJMe2011155

Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate‑cancer mortality in a randomized European study. N Engl J Med. 2009;360(13):1320‑1328. doi:10.1056/NEJMoa0810084

Zelefsky MJ, Levin EJ, Hunt M, et al. Incidence of late rectal and urinary toxicity after conformal radiotherapy for prostate cancer: Dose‑response relationships. Int J Radiat Oncol Biol Phys. 2008;70(4):1124‑1129. doi:10.1016/j.ijrobp.2007.11.044

Sakr WA, Haas GP, Cassin BF, Pontes JE, Crissman JD. The frequency of carcinoma and intraepithelial neoplasia of the prostate in young male patients. J Urol. 1994;152(2 Pt 1):1011‑1014. doi:10.1016/S0022‑5347(17)32573‑4

Loeb S, Carter HB, Berndt SI, Ricker W, Schaeffer EM. Complications after prostate biopsy: data from SEER‑Medicare. J Urol. 2011;186(5):1830‑1834. doi:10.1016/j.juro.2011.07.005

Volanis D, Neal DE, Warren AY, Kelly JD. Incidence of needle‑tract seeding following prostate biopsy: a literature review. Urol Int. 2015;95(1):117‑121. doi:10.1159/000366175

Disclaimer

This podcast and its accompanying materials are for educational purposes. They are intended to support thoughtful decision-making and improve health literacy. They are not a substitute for individualized medical advice, diagnosis, or treatment. Always consult your qualified healthcare professional regarding personal medical concerns.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without written permission is prohibited.

Host: Intellectual Medicine By Dr. Stephen Petteruti (Member Version)

Date: 04 March, 2025

Episode Summary

• A prior cancer diagnosis increases the risk of recurrence, and treatments such as chemotherapy and radiation can add long-term carcinogenic exposure, which makes ongoing prevention necessary even after the tumor is gone.
• Environmental toxins, excess body fat, and weakened immune function create conditions that allow abnormal cells to grow, while reducing heavy metals, lowering percent body fat, and maintaining adequate nutrition help strengthen the body’s natural defenses.
• Consistent daily habits, including proper sleep, balanced meals, immune support, and evidence-based preventive therapies, provide practical protection and reduce the likelihood of secondary cancer over time.

Quick Prevention Checklist

Use this checklist to confirm that daily habits support long-term cancer prevention and overall health.

☐ Percent body fat is kept within a healthy range while muscle is preserved

☐ 7–8 hours of sleep maintained each night consistently

☐ Regular meals eaten with adequate protein and whole foods

☐ Vitamin C, vitamin D, and zinc levels monitored and supported

☐ Heavy metals such as cadmium or lead are tested and addressed when needed

☐ Daily stress managed through movement and recovery

☐ A structured prevention plan was followed instead of waiting for symptoms

00:00 Introduction

We must be diligent in the daily battle that takes place inside the body, because cancer rarely begins with a loud warning and often develops quietly while life feels normal. Many people go through periods of heavy stress, such as divorce, financial problems, or the loss of someone close, and during those months, their sleep worsens, their eating habits change, and their overall resilience declines. A year or two later, they receive a cancer diagnosis that feels sudden, yet the groundwork had already been laid long before the first symptom appeared.

The reason is simple biology. The immune system monitors the body every day and removes abnormal cells before they become dangerous, yet when stress, poor nutrition, environmental toxins, or metabolic strain weaken that protection, those same cells gain the chance to multiply. Once they begin dividing repeatedly, they build momentum, and the body has a harder time keeping them under control. What looks like a new disease is often the result of small changes that accumulated over time.

There is another reality that deserves clear attention. One of the strongest predictors of future cancer is a history of cancer. If malignant cells formed once, they can form again, which means finishing treatment does not automatically remove the risk. Being declared cancer-free only means that nothing is visible on imaging today. It does not mean the underlying environment that allowed cancer to develop has been corrected.

So, when you have been declared cancer-free, what should be done next?

01:20 Making Thoughtful Action

After someone finishes cancer treatment, there is often a quiet assumption that the job is done. The surgery is over, the chemotherapy sessions are complete, the scans look clear, and life slowly returns to normal. Family members celebrate, friends say congratulations, and everyone hopes the chapter has closed for good. Emotionally, that moment brings relief, yet biologically, it is only the beginning of the next phase.

Cancer care usually focuses on removing or shrinking what can be seen, which means attention stays on the tumor itself. Once the visible disease is gone, the medical system often steps back and shifts to periodic checkups and imaging. You wait for the next scan, the next blood test, or the next appointment. During that waiting period, very little changes inside the body unless you actively change it.

This is where thoughtful action becomes important. Waiting is passive, while prevention is active. Waiting means hoping nothing returns. Prevention means deliberately shaping the internal environment so that abnormal cells have a harder time surviving in the first place. One approach depends on chance. The other depends on daily behavior.

Thoughtful action does not require extreme measures or complicated programs. It means making consistent choices that support normal physiology. You strengthen the immune system, reduce inflammation, lower toxic exposures, protect muscle, and keep body fat within healthy limits. Each of these steps improves how the body repairs DNA, removes damaged cells, and maintains balance at the cellular level.

The key idea is simple and practical. You do not need to live in fear of recurrence, and you do not need to assume that nothing can be done. You focus on controllable factors and handle them one by one. Over time, these small actions accumulate, and that accumulation shifts risk in your favor in a quiet and steady way.

01:45 Risk of Cancer Recurrence

One of the most uncomfortable facts about cancer is that a history of cancer remains one of the strongest risk factors for developing cancer again. Once the body has formed one malignancy, it has already demonstrated that the environment for abnormal cell growth exists. Removing a tumor or finishing chemotherapy does not erase that underlying vulnerability. It only addresses what was visible at the time.

Many people hear the phrase “cancer-free” and assume the danger has passed. In medical terms, it simply means that no detectable tumor is present on current tests. Imaging and blood work identify masses that are large enough to be measured, yet cancer begins at the level of single cells long before it forms a visible growth. During that early period, nothing feels different, and routine scans can appear normal while microscopic changes continue quietly.

Long-term follow-up data reflect this reality. Early-stage breast cancer, for example, carries very low mortality within the first five years, yet relapse rates rise when patients are tracked for ten or fifteen years. Some recurrences appear decades later. These patterns tell us that cancer biology operates on a long timeline and that short-term success does not guarantee long-term protection.

Large follow-up research tells the same story in plain numbers. A meta-analysis that pooled 31 clinical studies tracked 24,328 people who had already been treated for cancer and followed them for a combined 85,784 person-years. During that time, new cancers continued to appear year after year. Depending on the treatment group, recurrence ranged from 35 to 56 cancers for every 1,000 person-years of observation. These numbers appeared regardless of whether patients received immunosuppressive drugs, biologic therapy, or no additional medication at all.

03:42 Known Risks of Chemotherapy and Radiation

Primary cancer treatment often involves chemotherapy, radiation, or both. These treatments are designed to shrink tumors, control spread, and save lives. For someone facing an active or aggressive cancer, these tools are often necessary and appropriate.

It also helps to understand what these treatments do at a biological level. Chemotherapy damages rapidly dividing cells. Radiation injures DNA, so cells cannot reproduce. Cancer cells are affected, and healthy cells are exposed as well. Blood cells, bone marrow, the gut lining, and immune cells all sit in the path of that damage.

This exposure carries long-term consequences that are often overlooked after treatment ends. Both chemotherapy drugs and radiation are classified as carcinogenic, which means they can damage DNA and increase the risk of future cancers. Medical literature documents higher rates of leukemias, lymphomas, and other secondary malignancies in survivors years after therapy. The original cancer receives treatment, and the same treatment can create new risks later in life.

Large follow-up studies document this pattern clearly. Survivors who received chemotherapy or radiation carry a measurable lifetime increase in secondary blood cancers. These risks may appear five, ten, or even fifteen years after therapy. By that time, many people believe their cancer journey has ended, so the connection often goes unrecognized.

Treatment still plays an important role during the initial phase of care. At the same time, the story continues after the tumor disappears. Once someone completes chemotherapy or radiation, the body has carried two separate burdens. One came from the original cancer. The other came from the therapy used to control it.

05:07 Understanding What Is a Tumor

When most people hear the word cancer, they picture a tumor. They imagine a mass that can be seen on a scan or felt during an exam. That image feels concrete and immediate, so it becomes the focus of attention. The problem is that a tumor represents a late stage in the process, not the beginning.

A tumor forms only after cancer cells have been growing quietly for a long time. A single abnormal cell divides into two, then four, then eight, and the process continues. Each division is called a doubling time. Research in oncology shows that it can take roughly 30 doubling cycles before a cluster becomes large enough to measure about one centimeter and appear on imaging. By the time a tumor reaches that size, the cells have already been multiplying for years.

This timeline changes how early detection should be understood. When a scan finds a one-centimeter mass, the disease has already progressed through many rounds of growth. The earlier cellular changes happened long before anything could be seen or felt. Waiting for a tumor to appear means reacting late in the biological timeline.

This is why secondary prevention focuses on the internal environment rather than chasing visible masses. Cancer cells likely form in the body from time to time, and a healthy immune system removes them before they grow. Strengthening that internal defense gives the body a chance to stop problems at the cellular level, long before a tumor ever develops.

07:04 Environmental Factors

Genetics plays a role in cancer risk, yet research consistently shows that most risk comes from the environment around us and the exposures we accumulate over time. Large epidemiologic studies estimate that roughly 80 to 90% of cancer risk relates to environmental and lifestyle factors rather than inherited genes. That number gives people more control than they realize.

Environmental exposure happens daily. Metals, chemicals, and pollutants enter through the air we breathe, the water we drink, and the food we eat. Industrial processes release substances that settle into soil and dust. Over the years, small amounts build up inside tissues. The body stores many of these compounds instead of clearing them quickly.

Some of these substances are classified as carcinogens, which means they can damage DNA or interfere with normal cell repair. Heavy metals such as cadmium and lead fall into this category. Once inside cells, they create oxidative stress and disrupt normal signaling. That damage increases the chance that a normal cell begins behaving abnormally.

Reducing exposure, therefore, becomes practical prevention. Clean food, clean water, improved air quality, and removal of stored toxins lower the biological stress placed on cells. When the environment inside the body becomes less hostile, the immune system functions better, and abnormal cells are more likely to be controlled before they multiply.

09:50 Lower Your Cadmium Levels Through DMSA

Cadmium deserves special attention because of how common and how harmful it is. It is classified as a Class 1 human carcinogen. Studies link cadmium exposure to higher rates of prostate cancer, breast cancer, and several other malignancies. The challenge is that cadmium hides inside tissues and does not leave easily.

Testing for cadmium requires a provocative heavy metal test. A chelating agent is given first, which pulls stored metals out of cells and into the urine so they can be measured. Without this step, blood tests often miss the true burden because the metal stays trapped in organs and fat tissue.

Once identified, removal becomes the goal. Dimercaptosuccinic acid, commonly called DMSA, is a prescription chelating agent that binds to certain heavy metals and allows the body to excrete them. Clinical use has shown that repeated dosing over time can lower stored cadmium levels safely when monitored by a clinician. This approach targets the metal directly instead of relying on general “detox” products that lack measurable results.

Lowering cadmium reduces one source of DNA stress inside the body. Removing that burden supports immune function and decreases one of the known contributors to cancer risk. In secondary prevention, small improvements like this add up. Each reduction in toxic exposure creates a healthier internal environment where abnormal cells have less opportunity to grow.

11:22 Lose Percent Body Fat, Not Weight

Body weight is one number, yet that number hides several different tissues. It includes fat, muscle, bone, water, and organ mass, all added together. Because everything is combined, the scale cannot tell you what actually changed. A lower number does not automatically mean better health.

Fat tissue plays an active biological role inside the body. It stores energy, produces inflammatory chemicals, and influences hormones such as insulin and estrogen. Excess body fat creates a chronic inflammatory state that stresses cells and interferes with normal immune surveillance. Over time, this environment increases the likelihood that damaged cells survive and continue dividing.

Large population studies connect higher body fat with increased risk for many cancers. Researchers have identified links across more than a dozen cancer types, including breast, prostate, colon, and pancreatic cancers. In breast cancer survivors, reductions in body fat correlate with lower recurrence rates. Similar findings appear in men with prostate cancer. These patterns repeat across different populations and study designs.

Muscle tissue supports the opposite effect. Muscle improves glucose control, supports metabolism, and helps regulate inflammation. Preserving muscle while reducing fat improves how the body handles energy and strengthens overall resilience. For that reason, the goal focuses on body composition rather than the scale.

13:31 What Are Cancer Cells

Cancer often sounds mysterious, yet the process begins with a simple change inside a single cell. Every day, billions of cells divide to replace old tissue. During this process, DNA must be copied accurately. Small errors sometimes occur. Most of these errors get repaired or the damaged cell is removed.

A cancer cell forms when those protective steps fail. The cell acquires mutations that allow it to ignore normal controls. It continues dividing when it should stop, avoids programmed cell death, and begins multiplying without restraint. One cell becomes two, two become four, and the population expands quietly.

These early cells remain invisible. Imaging tests cannot detect them. Blood tests cannot measure them. Symptoms do not appear. The immune system usually identifies these abnormal cells and destroys them before they gather into a mass. This silent cleanup happens constantly without anyone noticing.

Trouble begins when abnormal cells escape detection and continue doubling. After many cycles of growth, they form a cluster large enough to become a tumor. By that stage, the process has already been underway for years. Understanding this timeline explains why prevention must focus on daily biology rather than waiting for something to show up on a scan.

14:40 Maintaining Immune Health

The immune system protects the body every day by identifying and removing abnormal cells before they grow. This process happens quietly and constantly, and it includes early cancer cells that form long before a tumor can be detected. When immune defenses remain strong, many of these cells are cleared without ever causing symptoms.

Chronic stress, poor sleep, excess body fat, and nutrient deficiencies weaken this protection. Over time, those factors reduce how well immune cells communicate and respond. Simple habits restore that balance. Regular sleep, adequate protein, and nutrients such as vitamin C, vitamin D, and zinc support normal immune signaling and tissue repair.

What to Do:

1. Sleep 7 to 8 hours each night on a consistent schedule
2. Eat regular meals with adequate protein to protect muscle and immune function
3. Keep vitamin C intake around 1,000 to 2,000 mg daily unless otherwise directed
4. Maintain vitamin D levels within a healthy clinical range through testing and guidance
5. Ensure adequate zinc intake through food or supplementation
6. Reduce percent body fat through structured nutrition and resistance training
7. Manage stress through routine movement, sunlight, and recovery time

These daily actions keep immune defenses active and give the body a stronger position against future disease.

17:58 Vitamin C and Its Impact on the Body

Vitamin C plays a direct role in how the body repairs itself and defends against disease. Humans do not produce vitamin C internally, which means every cell depends on a regular supply from food or supplements. Without enough vitamin C, immune function weakens, tissue repair slows, and inflammation increases.

This vitamin supports several basic systems at once. White blood cells use vitamin C during infection control and cellular cleanup. Collagen production also depends on it, and collagen forms the structural framework that holds tissues together. Strong connective tissue helps isolate damaged areas and supports normal healing. These functions create physical barriers that make it harder for abnormal cells to spread.

Laboratory research has also examined vitamin C at higher concentrations. In controlled settings, elevated levels generate oxidative stress inside abnormal cells, which disrupts their survival. Healthy cells tolerate this stress more effectively because their repair systems remain intact. This difference explains why vitamin C has attracted interest in oncology and immune support.

Daily intake provides steady support. Many clinicians recommend around 1,000 to 2,000 mg per day, divided into doses that the body can absorb efficiently. Some programs use periodic intravenous vitamin C to reach higher blood levels under medical supervision. The purpose remains simple and practical, which is to support immune activity and reduce the number of abnormal cells that escape detection.

19:38 Repurpose Drug Therapy

Not every useful therapy starts as a cancer drug. Some medications developed for other conditions demonstrate protective effects when researchers examine them more closely. Using these existing medications for new purposes is known as repurposing.

This strategy has practical advantages. The safety profile is already documented, dosing is established, and costs remain low. Physicians understand how the drugs behave in the body, which allows careful use without unnecessary risk. The focus shifts from aggressive treatment to subtle support of cellular stability.

Several medications have drawn attention in this area. Low-dose naltrexone has been studied for immune modulation and may influence inflammatory signaling. Doxycycline at low doses affects mitochondrial activity in abnormal cells and has been explored for its effects on cancer stem cells. Metformin, commonly prescribed for blood sugar control, has been associated with lower cancer incidence in multiple observational studies and also improves metabolic health.

These medications work quietly in the background. They influence metabolism, inflammation, and cellular growth signals rather than attacking tissue directly. This approach fits well with prevention because it supports normal biology while remaining gentle on the body.

Repurposed drugs, therefore, serve as tools within a larger system. They complement lifestyle habits, nutritional support, and environmental cleanup. Each piece adds another layer of protection without introducing the toxicity associated with conventional chemotherapy.

20:24 Sirolimus and Its Function

Sirolimus, also known as rapamycin, affects a pathway inside cells called mTOR. This pathway regulates growth, energy use, and cellular repair. When mTOR stays overactive, cells receive constant signals to grow and divide. Excess growth increases the chance that damaged cells survive and multiply.

Low-dose sirolimus slows this pathway. Slower signaling encourages maintenance and repair rather than constant expansion. Cells shift attention toward cleaning out damaged components and improving mitochondrial function. This internal housekeeping process, known as autophagy, helps remove dysfunctional structures that could contribute to disease.

Research into aging biology and oncology has highlighted this mechanism. Healthier mitochondria produce energy more efficiently and generate fewer damaging byproducts. Reduced cellular stress lowers mutation rates and supports immune recognition of abnormal cells. These effects align directly with the goals of secondary cancer prevention.

Clinical use typically involves low doses given intermittently, often once weekly under supervision. The intent focuses on modulation rather than suppression. The goal involves guiding cellular behavior toward stability and repair.

Sirolimus fits into the same philosophy as the other measures discussed. It supports internal balance, reduces biological stress, and strengthens the body’s natural defenses. Combined with clean nutrition, lower toxic exposure, healthy body composition, and strong immune function, it becomes another practical layer in a comprehensive prevention plan.

Key Takeaway

Finishing cancer treatment does not mean the risk disappears. Cancer can return years later because abnormal cells may exist long before a tumor becomes visible on scans. That is why daily prevention remains important even when you feel well.

Lower toxic exposures, reduce percent body fat, support immune health, and maintain adequate vitamin levels. Address environmental risks such as heavy metals and use safe, evidence-based therapies when appropriate. These steps strengthen the body’s defenses at a cellular level.

Consistent habits protect long-term health and reduce the chance of recurrence over time.

Continue the Conversation

If this discussion raised new questions for you, there are related episodes that expand on these themes in greater detail:

EP31 – Do Men Really Die From Prostate Cancer? What the Data Actually Shows

EP33 – Testosterone, Aging, and Vitality What Medicine Isn’t Telling You

For a broader explanation of the reasoning behind this perspective, Fight Cancer Like a Man by Dr. Stephen Petteruti presents these principles in a structured and practical format, outlining how to approach cancer prevention, screening, and treatment decisions with clarity.

Fight Cancer Like a Man by Dr. Petteruti: https://www.amazon.com/dp/B0GLZ9TL8N/

If you would like continued access to extended clinical notes and member-only discussions, you can join the Intellectual Medicine Community here:

• Membership: https://tinyurl.com/DrPetterutiMember
• Sign up for Dr. Steve’s email newsletter: https://www.drstephenpetteruti.com
• Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:

• LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
  Instagram: https://www.instagram.com/dr.stephenpetteruti
  Facebook: https://www.facebook.com/dr.stephenpetteruti

Subscribe to the Intellectual Medicine Podcast:

• Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
• Spotify: https://tinyurl.com/DrPetterutiSpotifyPodcast

To support deeper reflection, referenced studies explore the long-term outcomes of observation compared with intervention. These data examine survival, treatment-related complications, and the biological consequences of biopsy and hormone suppression. Reviewing this literature allows patients and clinicians to move beyond habit and consider a more individualized approach to prostate health.

Suggested Reading

The following peer‑reviewed publications support the discussion in Episode 05, demonstrating environmental, metabolic, immune, and cellular factors involved in secondary cancer prevention.

Ng AK, Travis LB. Second primary cancers: an overview. Hematol Oncol Clin North Am. 2008;22(2):271‑289. doi:10.1016/j.hoc.2008.01.008
PubMed: https://pubmed.ncbi.nlm.nih.gov/18395150/

Armstrong GT, Liu W, Leisenring W, et al. Occurrence of multiple subsequent neoplasms in long‑term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. J Clin Oncol. 2011;29(22):3056‑3064. doi:10.1200/JCO.2011.34.6585
PubMed: https://pubmed.ncbi.nlm.nih.gov/21709189/

Anand P, Kunnumakkara AB, Sundaram C, et al. Cancer is a preventable disease that requires major lifestyle changes. Pharm Res. 2008;25(9):2097‑2116. doi:10.1007/s11095‑008‑9661‑9
PubMed: https://pubmed.ncbi.nlm.nih.gov/18626751/

Gupta A, Peyrin-Biroulet L, Ananthakrishnan AN. Risk of Cancer Recurrence in Patients With Immune-Mediated Diseases With Use of Immunosuppressive Therapies: An Updated Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol. 2024;22(3):499-512.e6. doi:10.1016/j.cgh.2023.07.027

IARC Working Group. Arsenic, metals, fibres, and dusts. IARC Monogr Eval Carcinog Risks Hum. 2012;100C:121‑145. PMID: 23189751
PubMed: https://pubmed.ncbi.nlm.nih.gov/23189751/

Lauby‑Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K. Body fatness and cancer — viewpoint of the IARC Working Group. N Engl J Med. 2016;375(8):794‑798. doi:10.1056/NEJMsr1606602
PubMed: https://pubmed.ncbi.nlm.nih.gov/27557308/

Nieman DC, Wentz LM. The compelling link between physical activity and the body’s defense system. J Sport Health Sci. 2019;8(3):201‑217. doi:10.1016/j.jshs.2018.09.009
PubMed: https://pubmed.ncbi.nlm.nih.gov/31193280/

Carr AC, Maggini S. Vitamin C and immune function. Nutrients. 2017;9(11):1211. doi:10.3390/nu9111211
PubMed: https://pubmed.ncbi.nlm.nih.gov/29099763/

Keum N, Giovannucci E. Vitamin D and cancer — update 2021. Curr Opin Clin Nutr Metab Care. 2021;24(2):139‑146. doi:10.1097/MCO.0000000000000728
PubMed: https://pubmed.ncbi.nlm.nih.gov/33496525/

Sorup HN, Christensen J, Tjønneland A, et al. Zinc intake, cadmium exposure, and risk of cancer: Danish Diet, Cancer, and Health Study. Br J Nutr. 2020;124(9):951‑959. doi:10.1017/S0007114520002128
PubMed: https://pubmed.ncbi.nlm.nih.gov/32693972/

Maiese K. Targeting molecules to modulate mTOR activity: rapamycin and beyond. Curr Med Chem. 2021;28(7):1491‑1508. doi:10.2174/0929867327666200820142722
PubMed: https://pubmed.ncbi.nlm.nih.gov/32811214/

Disclaimer

This podcast and its accompanying materials are for educational purposes. They are intended to support thoughtful decision-making and improve health literacy. They are not a substitute for individualized medical advice, diagnosis, or treatment. Always consult your qualified healthcare professional regarding personal medical concerns.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without written permission is prohibited.

Host: Intellectual Medicine By Dr. Stephen Petteruti (Public Version)

Date: 11 March, 2025

Introduction

For many men, the word testosterone brings quiet fear before any facts are discussed. They hear that hormone therapy might cause prostate cancer, so they choose to live with low energy, fading strength, and slower thinking instead of asking questions. Over time, fatigue becomes normal, muscle shrinks, weight increases, and daily life feels harder than it should.

At the same time, testosterone decline happens to every man with age. It is not rare or unusual, and it affects nearly every system in the body. The real issue is not whether levels fall, but what happens when they fall too far and stay there for years without being addressed.

This creates a simple but important question. Should you accept the decline, or should you restore your levels and focus on careful monitoring? That balance is what this discussion is really about.

Rethinking Prostate Cancer Fear

Fear around prostate cancer often begins with the belief that any cancer cell inside the prostate is undoubtedly dangerous. That belief pushes many men toward unnecessary testing and procedures before they understand what those findings mean. As a result, they will be forced to deal with anxiety and take rushed decisions that proper planning would have easily replaced.

The truth is that recent research paints a calmer picture. Medical findings should always be the basis of your reaction and not some random thing you see online, or something you must have heard from a non-medical professional. 

What Modern Research Says About Testosterone

Much of the fear about testosterone therapy came from studies published decades ago. At that time, doctors believed that higher testosterone levels directly stimulated prostate cancer growth, and that idea shaped medical practice for many years. As a result, many men were told to avoid therapy even when they clearly had symptoms of deficiency.

Newer research has questioned those assumptions. Clinical trials that followed men receiving properly tells a whole different story from the myth that has been surrounding this topic. 

Looking at the Bigger Picture of Health

Hormones do not act alone inside the body. Prostate cells exist within the same environment as every other tissue, so overall health plays a large role in long-term outcomes. When the body is inflamed, poorly nourished, or chronically stressed, disease risk increases across many systems.

Daily habits shape that environment more than most people realize. Excess body fat increases inflammation and disrupts metabolism, while poor sleep weakens immune function and recovery. Over time, these factors create more problems than a single hormone level ever could.

Supporting health through consistent meals, regular strength training, adequate sleep, and lower toxin exposure builds resilience. A stronger body handles abnormal cells more effectively and maintains function as the years pass.

Signs Testosterone May Be Too Low

Low testosterone usually shows up gradually rather than suddenly. Energy drops, workouts feel harder, and muscle mass decreases even when exercise habits stay the same. Body fat often increases around the waist, and recovery becomes slower.

Mental and emotional changes may follow. Many men describe brain fog, reduced motivation, lower confidence, and decreased mood. Libido declines, and sleep becomes lighter and less refreshing.

These changes affect daily life in practical ways. Work feels harder, movement feels heavier, and enthusiasm fades. Lab testing helps confirm the issue, yet symptoms often tell the story first.

Monitoring Without Panic

PSA testing is commonly used to monitor prostate health, but the number alone does not tell the whole story. Infection, inflammation, recent exercise, or even normal aging can temporarily raise the value. Treating one reading as an emergency often creates unnecessary stress.

Looking at trends over time provides more reliable information. Gradual changes usually reflect normal aging, while sudden shifts deserve closer review. A calm and structured approach protects both health and peace of mind.

This kind of monitoring supports better decisions. It allows men to stay informed without rushing into invasive procedures that may not be needed.

A Balanced Perspective

Testosterone therapy is not about chasing extreme levels or quick fixes. It is about restoring hormones to a healthy range so that strength, focus, and energy return to normal. When therapy is supervised and monitored, it becomes part of a structured health plan rather than a risky experiment.

At the same time, regular checkups and prostate monitoring keep safety in view. This combination of restoration and observation creates balance. It supports vitality while respecting long-term health.

When decisions are guided by evidence instead of fear, men gain both clarity and confidence. That mindset often leads to better outcomes than avoiding treatment altogether.

Listen to the Full Episode

You can listen to the full episode here [https://www.youtube.com/watch?v=DZjjeRdxt8I]. 

If you want access to full transcripts, expanded clinical notes, research references, and practical tools you can use during your own medical visits, those resources are available inside the Intellectual Medicine Membership. 

Dr. Stephen Petteruti also explores these topics in greater depth in Fight Cancer Like a Man, where the evidence and clinical reasoning behind this vitality-focused approach are explained in clear, practical terms.

Continue the Conversation

If this discussion raised new questions for you, there are related episodes that expand on these themes in greater detail:

EP09 - Male Sexual Health Explained: Testosterone, Erections, and Long-Term Vitality

EP04 - Testosterone Therapy Explained: Benefits, Risks, PSA, and Prostate Health

For a deeper and more structured look at this philosophy, Fight Cancer Like a Man by Dr. Stephen Petteruti walks through prevention, screening, and treatment decisions in a practical and direct way. It lays out the reasoning behind prioritizing vitality, safety, and informed choice.

If you would like access to extended clinical notes and member-only discussions, join the 

Intellectual Medicine Community:
Membership: https://tinyurl.com/DrPetterutiMember
Sign up for Dr. Steve’s email newsletter: https://www.drstephenpetteruti.com
Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:
LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
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To support deeper reflection, referenced studies explore the long-term outcomes of observation compared with intervention. These data examine survival, treatment-related complications, and the biological consequences of biopsy and hormone suppression. Reviewing this literature allows patients and clinicians to move beyond habit and consider a more individualized approach to prostate health. You can find this information in the Membership section of Intellectual Medicine.

Disclaimer

This podcast and accompanying materials are for educational purposes only and do not replace personalized medical care. The information presented is designed to support informed decision‑making and health literacy, not to diagnose or prescribe. Always consult your own qualified healthcare provider regarding personal health questions or treatment decisions.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without permission is prohibited.

EP06 - The Truth About Testosterone: Does It Really Cause Prostate Cancer?

Host: Intellectual Medicine By Dr. Stephen Petteruti (Members Version)

Date: 11 March, 2025

Episode Summary

• Testosterone naturally declines with age, and lower levels affect strength, energy, mood, memory, bone density, and sexual health. Many men avoid treatment because of long-standing fears about prostate cancer, even though these daily functional changes reduce overall quality of life.
• Current clinical research does not show a clear increase in prostate cancer risk among men receiving properly supervised testosterone therapy. Much of the concern came from older studies and assumptions that newer evidence has not confirmed.
• Small prostate cancer cells are common in aging men and often remain confined to the gland without causing symptoms or harm. Careful monitoring, steady habits, and thoughtful decision-making are more helpful than reacting quickly to isolated test results.
• Testosterone therapy, when prescribed and monitored responsibly, focuses on restoring healthy hormone levels and supporting normal body function. Regular follow-up and routine prostate checks allow men to maintain vitality while keeping safety in view.

Quick Decision Checklist

You should check the following boxes for good health and testosterone balance: 

☐ Tested total and free testosterone levels with a qualified clinician

☐ Noticed symptoms such as fatigue, low mood, reduced strength, or declining libido

☐ Discussed benefits and risks of testosterone therapy using current evidence, not old assumptions

☐ Monitored PSA periodically and tracked trends instead of reacting to one reading

☐ Avoided rushing into invasive procedures without a clear clinical need

☐ Maintained a healthy percent body fat through regular meals and strength training

☐ Slept consistently and managed daily stress to support immune and hormonal balance

☐ Scheduled routine follow-ups to adjust therapy safely and stay informed

These steps keep decisions calm, structured, and based on long-term health rather than fear.

00:00 Introduction

Will testosterone therapy increase the risk of prostate cancer?

This question has followed men for decades, and it often creates fear before facts are even considered. Many people hear the word “testosterone” and immediately assume that adding hormones must feed cancer growth. Because of that belief, men who feel tired, weak, or mentally slower often avoid treatment even when their hormone levels are clearly low.

At the same time, testosterone decline is not rare or unusual. It happens to every man with age. Levels fall gradually each year, and that drop affects strength, mood, memory, bone density, and sexual health. Muscle becomes harder to maintain, energy decreases, and daily life feels heavier than it should.

The concern about prostate cancer came from older studies and long-standing medical habits. Over time, that concern turned into dogma, even though newer research does not clearly support it. Modern data show that the relationship between testosterone and prostate cancer is far more complex than people were originally taught.

So the real question is not simply whether testosterone is dangerous. The better question is: how do you balance the benefits of healthy hormone levels with the evidence about risk?

03:30 Steps to Take About Prostate Cancer

Fear around prostate cancer often starts with the idea that any cancer cell inside the prostate is automatically dangerous. That belief pushes many men toward immediate testing and procedures before they understand what those findings actually mean. The result is anxiety and rushed decisions rather than careful thinking.

Autopsy studies give a different perspective. When researchers examined men who died from other causes, they found that a large percentage had small prostate cancer cells inside the gland that never caused symptoms during life. Some studies report rates as high as 80 to 90% in older men. These cells existed quietly and never progressed to a harmful disease.

This tells us something important. The presence of cancer cells does not automatically mean illness or shortened life. Many prostate cancers grow slowly and remain confined to the gland for years or decades. Treating every early finding as an emergency does not match how the disease actually behaves.

A practical approach begins with staying calm and avoiding unnecessary procedures. Routine monitoring, maintaining overall health, and focusing on prevention support long-term outcomes more reliably than reacting to every small lab change. The goal is to protect function and quality of life while observing carefully rather than rushing into interventions that carry permanent side effects.

05:11 Dr. Morgentaler’s Investigative Work

Much of the fear about testosterone and prostate cancer came from research published decades ago, when doctors believed that higher testosterone levels directly stimulated cancer growth. That conclusion shaped medical practice for years and led many physicians to avoid testosterone therapy altogether.

Later, researchers began to question those early assumptions. One of the most recognized voices in this area is Abraham Morgentaler, a urologist who carefully reviewed the original data and conducted additional studies. His work looked closely at how testosterone actually behaves inside the body and how the prostate responds to normal hormone levels.

What he found was that the older research had important limitations. The early studies focused on men with advanced or metastatic prostate cancer, which is a very different condition from healthy men with low testosterone. Applying those results to every man created confusion and exaggerated risk.

More recent clinical trials have followed men receiving testosterone therapy and tracked prostate outcomes over time. These studies have not demonstrated higher rates of prostate cancer compared with men who did not receive treatment. Prostate size, PSA levels, and cancer diagnoses remained within expected ranges for age.

This body of evidence does not claim that testosterone removes all risk. No medical decision carries zero risk. It does show that the long-standing belief that testosterone directly causes prostate cancer does not match modern clinical data.

08:19 The Unequivocal Truth

There is one fact that becomes clear when you look at the full picture. Prostate cancer is extremely common with aging, regardless of whether a man uses testosterone therapy. If a man lives long enough, small cancer cells will likely appear in the prostate at some point.

This means testosterone is not the deciding factor. Some men on therapy develop prostate cancer. Some men who never used hormones develop them as well. The background rate is already high, which makes it difficult to blame one specific cause.

At the same time, low testosterone has well-documented consequences. Reduced muscle mass, higher body fat, lower bone density, slower thinking, and reduced vitality all affect independence and daily function. These changes influence how someone feels and moves every day, not just years down the road.

For many men, the decision becomes practical rather than theoretical. Living with healthy hormone levels supports strength, energy, and mental clarity. Monitoring prostate health with regular exams and labs adds an extra layer of safety. Together, these steps create a balanced approach that respects both quality of life and medical caution.

09:03 The Anti-Cancer Lifestyle

Concerns about testosterone often focus on a single hormone while ignoring the larger picture of health. Prostate cells live inside the same body as every other tissue, so the environment around those cells influences how they behave. When the body is strong and stable, abnormal cells struggle to grow or spread.

Daily habits shape that environment. Excess body fat increases inflammation, disrupts insulin signaling, and alters hormone balance in ways that encourage disease. Toxic metals and unnecessary radiation exposure place additional stress on cells and increase DNA damage over time. Poor sleep and chronic stress weaken immune surveillance, which reduces the body’s ability to remove abnormal cells early.

An anti-cancer lifestyle addresses these factors directly. Maintaining healthy percent body fat, eating balanced meals with adequate protein, exercising regularly, and minimizing exposure to toxins create conditions where the body functions efficiently. Immune cells work better, inflammation stays lower, and tissue repair remains active.

This approach does not rely on one treatment or one pill. It relies on consistent daily behavior. When the internal environment supports health, small clusters of abnormal cells are less likely to turn into meaningful disease.

10:48 Signs of Sub-Optimal Testosterone

Testosterone declines gradually with age in every man. This decline affects many systems at the same time because testosterone receptors exist in muscle, bone, brain, and metabolic tissue. When levels drop, the changes appear in everyday life rather than in a single lab number.

Low or sub-optimal levels often present as fatigue that does not improve with rest. Muscle mass decreases even when exercise habits stay the same, and body fat increases around the abdomen. Recovery after workouts slows, joints feel weaker, and strength declines.

Cognitive and emotional changes may follow. Many men report brain fog, lower motivation, reduced confidence, and diminished mood. Libido decreases, sexual performance declines, and sleep quality often worsens. These shifts reduce quality of life and make daily tasks feel harder than they should.

Lab testing provides useful information, yet symptoms carry equal importance. A value that falls inside a “normal for age” range does not guarantee optimal function. Health is measured by how you feel and perform each day, not simply by fitting into an age-adjusted chart.

13:01 The Goal of Testosterone Therapy

Testosterone therapy is not about chasing high numbers or creating unnatural hormone levels. The purpose is restoration. The aim is to return the body to a healthier physiological range where strength, clarity, and energy support normal living.

Adequate testosterone supports muscle preservation, which improves metabolism and protects joints. It helps maintain bone density, which reduces fracture risk later in life. It also supports cognitive speed, mood stability, and cardiovascular function. These effects influence independence and daily performance for years.

The therapy focuses on balance and monitoring. Blood levels are checked regularly, symptoms are reviewed, and dosing is adjusted carefully. This structured approach keeps treatment controlled and reduces unnecessary risk.

When viewed this way, testosterone replacement functions like other forms of hormone support. It corrects a deficiency that develops with time. The goal remains simple and practical, which is to maintain vitality and function while continuing routine medical follow-up.

16:03 Understanding PSA Levels

PSA stands for prostate-specific antigen. It is a protein produced by prostate tissue and released into the blood in small amounts. Doctors use it as a screening tool because higher numbers can sometimes be associated with prostate irritation or disease.

The challenge is that PSA is not specific to cancer. Many everyday situations can raise the number. Infection, inflammation, recent sexual activity, exercise such as cycling, poor sleep, or even normal aging can cause temporary increases. A higher value does not automatically mean cancer is present.

For this reason, PSA should be treated as one piece of information rather than a final answer. The number must be interpreted slowly and in context. Reacting quickly to a single lab value often leads to unnecessary procedures that create stress without improving outcomes.

Long-term observation provides more useful insight. Tracking the trend over time gives a clearer picture than focusing on one isolated result. Gradual changes usually reflect normal aging, while sudden or dramatic shifts deserve closer evaluation and thoughtful follow-up rather than immediate invasive action.

What to Do

1. Check PSA periodically instead of reacting to a single reading.
2. Repeat the test if the value rises before making any decisions.
3. Review recent activities such as illness, cycling, or sexual activity that may affect results.
4. Maintain a healthy percent body fat, regular exercise, and adequate sleep to reduce inflammation.
5. Discuss trends with a qualified clinician before considering imaging or biopsy.

These steps keep the process measured and rational. They protect the quality of life while still respecting the value of monitoring.

18:57 Question the Dogma of Testosterone Therapy

For decades, testosterone therapy carried a strong stigma. Many people were taught that replacing testosterone automatically leads to prostate enlargement or cancer. That belief became common practice long before modern evidence existed.

Current research does not support that fear. Large clinical trials and long-term observations have not demonstrated a clear increase in prostate cancer risk among men receiving monitored testosterone therapy. At the same time, low testosterone is consistently associated with fatigue, muscle loss, higher body fat, reduced bone density, and lower quality of life.

Medicine changes as evidence improves. Ideas that once sounded certain often require revision when better data becomes available. Questioning old assumptions is part of responsible healthcare, especially when those assumptions limit treatments that may improve strength, mood, and daily function.

Testosterone therapy should therefore be approached with balance rather than fear. It requires proper evaluation, medical supervision, and regular follow-up. When used thoughtfully, it becomes one tool for maintaining vitality rather than something to avoid because of outdated beliefs.

Key Takeaway

Testosterone naturally declines with age, and when levels fall too low, the effects show up in everyday life. Energy drops, muscle mass decreases, recovery slows, body fat increases, and focus becomes less sharp. Many men notice these changes gradually and assume they are simply part of getting older, yet much of this decline relates to hormone levels rather than age alone.

Current research does not show that properly supervised testosterone therapy increases the risk of prostate cancer in healthy men. At the same time, persistently low testosterone is linked with poorer strength, reduced vitality, and lower overall well-being. Decisions should therefore be guided by evidence and symptoms rather than fear or outdated assumptions.

Related Episodes

Learning is strongest when ideas connect. Continue exploring these episodes that build on today’s discussion:

EP09 - Don't Biopsy Your Prostate Until You Hear This (Part 2) 

EP04 - Why Early Treatment of Prostate Cancer May Be Ineffective: The Case for Conventional Therapies

Call to Action

For a deeper explanation of the science and reasoning behind this approach, read Fight Cancer Like a Man by Dr. Stephen Petteruti on Amazon— a clear and practical guide to smarter cancer prevention, vitality, and informed decision‑making.

Join the Intellectual Medicine Community

• Membership (exclusive educational content and clinical resources): https://tinyurl.com/DrPetterutiMember
• Sign up for Dr.  Steve’s Email Newsletter: https://www.drstephenpetteruti.com
• Learn more about Intellectual Medicine: https://www.intellectualmedicine.com 

Connect with Dr. Petteruti

• LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
• Instagram: https://www.instagram.com/dr.stephenpetteruti
• Facebook: https://www.facebook.com/dr.stephenpetteruti 

Subscribe to the Intellectual Medicine Podcast

• Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
  Spotify:  https://tinyurl.com/DrPetterutiSpotifyPodcast

Extra Reading

The long-standing hesitation surrounding testosterone replacement therapy (TRT) is largely rooted in mid-century medical assumptions that have been fundamentally challenged by modern clinical data. As Dr. Petteruti discusses in this episode, the relationship between hormonal restoration and prostate health is governed by the "Saturation Model," which suggests that physiological levels of testosterone do not inherently drive disease progression in healthy men. The following peer-reviewed studies, including landmark meta-analyses and long-term registry data, provide the evidentiary framework for a shift away from fear-based medicine toward an informed, vitality-focused approach to men’s health.

Cui Y, Zong H, Yan H, Zhang Y. The effect of testosterone replacement therapy on prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2014;17(2):132-143. doi:10.1038/pcan.2013.60

Gacci M, Sebastianelli A, Salvi M, et al. Obesity, metabolic syndrome, and prostate cancer: a review of systematic reviews. Front Endocrinol (Lausanne). 2017;8:151. doi:10.3389/fendo.2017.00151

Haider A, Haider KS, Saad F, et al. Incidence of prostate cancer and urothelial carcinoma in men receiving testosterone therapy: methods and 10-year outcomes. World J Mens Health. 2020;38(3):377-384. doi:10.5534/wjmh.190035

Kang DY, Li HJ. Prostate-specific antigen changes in hypogonadal men treated with testosterone replacement therapy. J Clin Med. 2022;11(8):2131. doi:10.3390/jcm11082131

Morgentaler A. Testosterone and prostate cancer: an historical perspective on a modern myth. Eur Urol. 2006;50(5):935-939. doi:10.1016/j.eururo.2006.08.015

Stabile A, Giganti F, Rosenkrantz AB, et al. Low testosterone levels and prostate cancer risk: from neurological mechanisms to clinical implications. Rev Urol. 2016;18(3):130-138. doi:10.3909/riu0735

Disclaimer

This podcast and accompanying materials are for educational purposes only and do not replace personalized medical care. The information presented is designed to support informed decision‑making and health literacy, not to diagnose or prescribe. Always consult your own qualified healthcare provider regarding personal health questions or treatment decisions.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without permission is prohibited.

Host: Intellectual Medicine by Dr. Petteruti (Member Version)

Date: 18 March, 2025

Episode Summary

• Early-stage prostate cancer has an extremely low short-term death rate, yet rising PSA levels and routine biopsies often lead to unnecessary diagnoses and procedures that create fear rather than better outcomes.
• Large long-term studies show similar survival between men who undergo surgery or radiation and those who choose observation, while biopsy and aggressive treatment carry real risks, including infection, functional loss, and possible spread of abnormal cells.
• A safer approach focuses on careful monitoring, imaging when appropriate, and strengthening the body through immune support, toxin reduction, healthy body composition, and consistent daily habits that protect long-term vitality.

Quick Decision Checklist

Use this checklist to guide your decisions before agreeing to a prostate biopsy or any invasive prostate procedure.

☐ Review PSA trends over time instead of reacting to one elevated result

☐ Ask how any proposed test or procedure would change long-term survival before agreeing to it

☐ Avoid routine prostate biopsy without a clear and necessary clinical reason

☐ Use imaging such as MRI and structured monitoring to further evaluate

☐ Focus on immune strength through sleep, nutrition, and regular movement

☐ Reduce exposure to known carcinogens, including smoking, heavy metals, and unnecessary radiation

☐ Maintain a healthy percent body fat and preserved muscle through strength training

00:00 Introduction

Few words create more fear in a man’s life than “prostate cancer.” The moment a PSA number rises or a doctor mentions biopsy, the pressure to act feels immediate and urgent. Many men assume that testing quickly and cutting something out must automatically improve survival.

Yet the numbers tell a calmer story. In early-stage prostate cancer, the death rate during the first five years sits close to zero percent, which means most men are not in immediate danger. When risk is already low, aggressive testing and procedures become harder to justify, especially when those procedures carry permanent side effects.

This is where the prostate biopsy enters the conversation. A biopsy sounds simple and harmless, just a needle and a sample, but it can set off a chain reaction that leads to anxiety, repeat testing, surgery, or radiation that may never have been necessary. Before anyone agrees to that step, it makes sense to slow down, understand the evidence, and ask a clear question: Will this test actually improve my health or simply label me with a problem that might never have caused harm?

That question changes everything.

01:58 False Diagnosis Is the Culprit

When people hear that prostate cancer diagnoses keep increasing, they assume the disease itself is becoming more aggressive. The natural reaction is fear. More diagnoses sound like more danger.

The data show a different pattern. Over the past two decades, deaths from prostate cancer have declined, yet the number of men labeled with prostate cancer continues to rise. When diagnosis increases while mortality falls, it suggests that many of these newly discovered “cancers” were never life-threatening to begin with.

Part of the issue lies in how prostate tissue changes with age. As men get older, the prostate commonly develops atypical or irregular cells. Under a microscope, some of these cells resemble cancer. Pathologists may label them malignant even though they might never grow, spread, or affect the man’s lifespan.

Autopsy studies make this point very clear. When researchers examine men who died from unrelated causes, such as heart disease or accidents, they often find small clusters of prostate cancer cells that were never detected during life. In some reports, 70 to 90% of elderly men had these cells present, yet prostate cancer was not what killed them.

This changes how the word “cancer” should be interpreted in this setting. The presence of abnormal cells does not automatically equal a dangerous disease. In many cases, it simply reflects a slow biological change that the body keeps contained for decades.

A biopsy turns this quiet finding into a formal diagnosis. Once the word “cancer” appears on a report, anxiety rises, families worry, and treatment discussions begin. The problem is that the label may create more harm than the cells themselves ever would.

03:50 Studies Conducted

If removing or treating the prostate truly saved lives in early disease, the evidence would be obvious. We would expect to see a clear survival difference between men who received treatment and men who did not. That kind of result is easy to measure over time.

Large, long-term trials have tested exactly this question. In these studies, men with early-stage prostate cancer were divided into two groups. One group had surgery to remove the prostate, and the other group underwent observation without immediate treatment.

Researchers followed these men for many years, in some cases close to two decades. At the end of follow-up, overall death rates looked nearly identical between the groups. Death specifically from prostate cancer also showed little or no meaningful difference.

This finding is important. If removing the gland does not clearly extend life for early-stage disease, then detecting tiny abnormalities earlier does not automatically create a benefit. Discovering more cancer on biopsy does not guarantee better outcomes.

Treatment, however, is not neutral. Surgery carries risks such as urinary leakage, erectile dysfunction, infection, bleeding, and complications from anesthesia. Radiation introduces bowel and bladder irritation, fatigue, and long-term tissue damage. These effects influence daily life in very real ways.

So we end up with a mismatch. The measurable benefit remains uncertain, yet the side effects are immediate and permanent for many men. When that is the case, the value of aggressive diagnosis becomes questionable.

Before ordering any test, a simple rule applies. Ask how the result will change management and whether that change improves survival or quality of life. If the answer is unclear, the test may not be necessary.

06:05 Risks of Biopsy-Related Cancer Spread

A prostate biopsy is often described as minor. The description makes it sound harmless, almost routine. In reality, the procedure involves multiple core needles passing through the gland to collect tissue samples.

Each needle puncture creates bleeding and inflammation. The tissue barrier that may have been containing abnormal cells gets disrupted. From a biological standpoint, piercing a tumor or suspicious area raises a logical concern about spreading cells.

This concern is not theoretical. In other cancers, researchers have observed tumor cells along needle tracks after biopsies. Studies in breast cancer have shown higher rates of local spread in some patients who underwent needle sampling before surgery. While prostate tissue is different, the principle remains the same.

Even when a spread does not occur, the procedure itself carries risks. Men frequently report pain, bleeding in urine or semen, and infection. Some develop fevers or require antibiotics. A small number experience serious complications that lead to hospitalization.

There is also a psychological cost. Once a biopsy shows “cancer,” even if it is low grade and unlikely to progress, many men feel pressure to act immediately. That pressure can push them toward surgery or radiation that may not have been needed.

So the biopsy becomes the trigger. It starts a cascade of decisions based on fear rather than a clear survival benefit. For a disease that often grows slowly and remains confined to the gland, that cascade may cause more harm than protection.

For many men with stable symptoms and modest PSA changes, careful monitoring, imaging, and attention to overall health provide a safer path. Slowing down, gathering information, and avoiding unnecessary needles can preserve both quality of life and peace of mind.

08:30 Alternatives to Biopsy

When PSA rises or an exam feels abnormal, many men are told that a biopsy is the next automatic step. It is presented as the only way to “know for sure.” That framing makes the situation feel urgent, as if there is no safe middle ground.

There is a middle ground. A biopsy is not the only source of useful information. Prostate health can be evaluated through trends, imaging, and clinical observation before any needle enters the gland.

PSA can be repeated over time to look for patterns rather than reacting to a single number. Temporary increases often follow infection, inflammation, recent sexual activity, long bike rides, or poor sleep. When the test is repeated weeks later, the value frequently returns closer to baseline. Watching the trend gives a clearer picture than responding to one isolated spike.

Imaging also adds context. Multiparametric MRI allows doctors to examine the structure of the prostate and identify whether there are suspicious areas. This approach provides anatomical detail without piercing tissue. While imaging is not perfect, it avoids the mechanical trauma and risks that come with biopsy.

Clinical monitoring remains another option. Regular follow-up visits, lab checks, and symptom review allow time to see how the situation evolves. Prostate cancer typically grows slowly. Taking time rarely changes the outcome, yet rushing into a procedure can create permanent consequences.

This approach asks a simple question. If early treatment does not clearly improve survival, then why accept immediate procedural risk? For many men, structured observation provides information while preserving safety.

09:55 Our Bodies Are Fighting Cancer Every Day

Many people think of cancer as something that suddenly appears one day. Biology works differently. Abnormal cells form in the body all the time.

Every day, cells divide, copy DNA, and replace old tissue. During this process, small mistakes happen. Some of those mistakes create cells that look abnormal or behave differently. This is a normal part of life at the cellular level.

The immune system constantly patrols for these changes. Specialized immune cells identify damaged or suspicious cells and remove them before they multiply. In most cases, this process happens quietly and efficiently. You never feel it, and you never know it occurred.

Prostate tissue follows the same rule. Small clusters of atypical cells may form, and the body attempts to wall them off or eliminate them. Many of these clusters remain contained for years or decades. They never grow large enough to cause symptoms or threaten life.

Understanding this changes the mindset. The presence of a few abnormal cells does not mean the body has failed. It often means the body is already managing the situation.

Instead of assuming that every abnormal finding requires cutting or radiation, it makes sense to ask how to support the body’s natural defense systems. Strengthening what already works can be more logical than immediately disrupting tissue with invasive procedures.

11:58 Other Components to Fight Cancer

If the objective is to reduce risk and support long-term health, daily habits become powerful tools. Cancer does not develop in isolation. It develops inside an environment created by metabolism, inflammation, toxins, and immune strength.

Reducing known carcinogens is one practical step. Environmental toxins such as heavy metals accumulate over time and interfere with normal cellular function. Testing and medically supervised detoxification strategies can lower this burden and reduce stress on tissues.

Body composition also plays a central role. Excess body fat increases inflammatory signals and hormonal disruption. Chronic inflammation creates conditions that make abnormal growth more likely. Lowering percent body fat through consistent meals, adequate protein, and strength training improves metabolic stability and immune performance.

Nutrition and micronutrients support cellular repair. Adequate intake of vitamins, minerals, and protein gives immune cells the materials they need to function properly. Sleep allows hormonal regulation and tissue recovery. Regular movement improves circulation and immune surveillance throughout the body.

These actions may sound simple, yet they address the foundation of health. They focus on creating conditions where abnormal cells struggle to survive rather than depending on late-stage intervention after a diagnosis.

When you step back and look at the full picture, prevention becomes a daily practice. Supporting the body, reducing toxic exposure, and monitoring calmly provide a safer path than rushing toward a needle that may never have been necessary in the first place.

14:20 A True Story of a Prostate Cancer Survivor

Statistics help you think clearly, yet real lives often make the lesson stick. Numbers show trends. Stories show what those trends look like day to day.

Consider the example shared in the discussion of an older man who lived with prostate cancer for decades. He chose observation, monitoring, and lifestyle support instead of immediate surgery or radiation. He continued working, stayed active, and kept his normal routine well into his eighties.

His PSA stayed elevated for years. Imaging showed abnormalities inside the gland. By conventional standards, those findings would have pushed many men toward aggressive treatment. Instead, he focused on strength, movement, and consistent medical follow-up.

His life did not revolve around hospital visits or recovery from procedures. He maintained independence, worked daily, and described feeling well. The diagnosis existed on paper, yet it did not control his daily function.

This example does not claim that every case will follow the same path. It shows something practical. A prostate cancer label does not automatically mean decline or immediate intervention. Many men live long, active lives while monitoring their condition carefully.

15:59 Cutting Off the Gland Is Not the Solution

Surgical removal of the prostate often sounds decisive. The reasoning feels simple. Remove the gland and remove the problem.

Long-term studies raise important questions about that assumption. Research following men with early-stage prostate cancer for up to twenty years has shown similar survival rates between those who had surgery and those who chose observation. Death from prostate cancer remained low in both groups.

At the same time, surgery carries permanent consequences. The prostate sits next to nerves and structures that control urination and sexual function. Removing the gland can lead to urinary leakage, erectile dysfunction, pain, and recovery complications. These effects influence daily life immediately and can persist indefinitely.

Radiation carries its own burdens. Nearby tissues such as the bladder and rectum receive exposure, which can result in chronic irritation or long-term discomfort. These outcomes affect quality of life even when the cancer itself was never life-threatening.

When survival remains similar, side effects carry greater weight in decision-making. A treatment that reduces function without extending life deserves careful scrutiny. This is why many clinicians now emphasize thoughtful monitoring for low-risk disease rather than automatic intervention.

17:04 Advice to Patients

Prostate decisions often feel rushed. A lab number rises, fear sets in, and the next step appears urgent. This emotional pressure can push people toward procedures before they understand the full picture.

A calmer approach helps you think clearly. Early-stage prostate cancer usually progresses slowly, which gives you time to gather information and evaluate options. Taking time does not equal neglect. It allows measured decisions based on evidence rather than anxiety.

Medical care works best when you remain involved and informed. Ask what each test will change. Ask how a result will alter management. If the answer does not clearly improve your health or survival, reconsider whether the step is necessary.

What to Do

• Track PSA over time and focus on trends rather than one reading.
• Repeat abnormal tests before making decisions.
• Consider imaging, such as MRI, to assess the gland without puncturing tissue.
• Support your body through strength training, healthy percent body fat, sleep, and balanced meals.
• Reduce exposure to known toxins and address inflammation.
• Discuss every option with a qualified clinician and take time to weigh the benefits and risks before agreeing to a biopsy or surgery.

These steps keep the process rational and structured. They protect function while still respecting the importance of monitoring. The aim is to stay informed, stay steady, and choose interventions only when clear evidence shows they are truly necessary.

Key Takeaway

Prostate cancer often creates fear long before it creates harm. Many early prostate findings grow slowly and remain confined to the gland for years, which means immediate biopsy or surgery is not always necessary. Acting too quickly can introduce complications such as pain, infection, urinary problems, or sexual dysfunction without clearly improving long-term survival.

A more thoughtful approach focuses on careful monitoring, understanding PSA trends, and supporting whole-body health. When you slow down, gather information, and protect your strength and function, decisions become clearer and less reactive. The priority stays simple and practical, which is to preserve quality of life while using evidence to guide each step rather than letting fear dictate the path forward.

Related Episodes

Learning is strongest when ideas connect. Continue exploring these episodes that build on today’s discussion:

• EP09 - Don't Biopsy Your Prostate Until You Hear This (Part 2) 
• EP04 - Why Early Treatment of Prostate Cancer May Be Ineffective: The Case for Conventional Therapies

Call to Action

For a deeper explanation of the science and reasoning behind this approach, read Fight Cancer Like a Man by Dr. Stephen Petteruti on Amazon— a clear and practical guide to smarter cancer prevention, vitality, and informed decision‑making.

Join the Intellectual Medicine Community

• Membership (exclusive educational content and clinical resources): https://tinyurl.com/DrPetterutiMember
• Sign up for Dr.  Steve’s Email Newsletter: https://www.drstephenpetteruti.com
• Learn more about Intellectual Medicine: https://www.intellectualmedicine.com 

Connect with Dr. Petteruti

• LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
• Instagram: https://www.instagram.com/dr.stephenpetteruti
• Facebook: https://www.facebook.com/dr.stephenpetteruti 

Subscribe to the Intellectual Medicine Podcast

• Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
  Spotify:  https://tinyurl.com/DrPetterutiSpotifyPodcast

Selected References

Don't just take my word for it. The following research challenges the 'standard of care' by highlighting the data on survival and the real cost of overtreatment. These studies are the map for moving away from blind protocols and toward biological precision.

C, Jacklin et al. "More men die with prostate cancer than because of it" - an old adage that still holds true in the 21st century.” Cancer treatment and research communications vol. 26 (2021): 100225. doi:10.1016/j.ctarc.2020.100225 

Hamdy, Freddie C et al. “Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer.” The New England Journal of Medicine vol. 388,17 (2023): 1547-1558. doi:10.1056/NEJMoa2214122 

Kishan, Amar U, and Patrick A Kupelian. “Late rectal toxicity after low-dose-rate brachytherapy: incidence, predictors, and management of side effects.” Brachytherapy vol. 14,2 (2015): 148-59. doi:10.1016/j.brachy.2014.11.005 

Ladjevardi, Sam et al. “Prostate biopsy sampling causes hematogenous dissemination of epithelial cellular material.” Disease Markers vol. 2014 (2014): 707529. doi:10.1155/2014/707529

Nead, Kevin T et al. “Association Between Androgen Deprivation Therapy and Risk of Dementia.” JAMA oncology vol. 3,1 (2017): 49-55. doi:10.1001/jamaoncol.2016.3662

Sennerstam, Roland B et al. “Core-needle biopsy of breast cancer is associated with a higher rate of distant metastases 5 to 15 years after diagnosis than FNA biopsy.” Cancer cytopathology vol. 125,10 (2017): 748-756. doi:10.1002/cncy.21909

Wilt, T J, and M K Brawer. “The Prostate Cancer Intervention Versus Observation Trial (PIVOT).” Oncology (Williston Park, N.Y.) vol. 11,8 (1997): 1133-9; discussion 1139-40, 1143.

Wilt, Timothy J et al. “Follow-up of Prostatectomy versus Observation for Early Prostate Cancer.” The New England Journal of Medicine vol. 377,2 (2017): 132-142. doi:10.1056/NEJMoa1615869

Disclaimer

This podcast and accompanying materials are for educational purposes only and do not replace personalized medical care. The information presented is designed to support informed decision‑making and health literacy, not to diagnose or prescribe. Always consult your own qualified healthcare provider regarding personal health questions or treatment decisions.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without permission is prohibited.

Host: Intellectual Medicine by Dr. Petteruti (Member Version)

Date: 25 March, 2025

Episode Summary

• Screening tests exist to reduce death or serious harm, yet large mammogram studies show that finding cancer earlier does not always change overall survival, and repeated imaging adds radiation exposure and false positives.
• Body awareness plays a strong role in early detection, and simple monthly self-exams often help women notice changes quickly without extra procedures or stress.
• Risk varies by the individual, so age, family history, body type, and lifestyle should guide decisions rather than applying the same rule to everyone.
• A thoughtful, informed approach that weighs benefits, risks, and personal comfort helps protect health while avoiding unnecessary tests and interventions.

Quick Decision Checklist

Use this checklist to guide your thinking before scheduling any breast imaging or screening test. The aim is to stay calm, informed, and intentional so each decision supports your long-term health rather than pressure or routine.

☐ Understand what the screening is expected to change and how it would improve survival or quality of life

☐ Discuss both benefits and risks of mammography, including radiation exposure and false positives

☐ Perform monthly self-breast exams and stay familiar with your normal breast texture and shape

☐ Track personal risk factors such as family history, body fat level, and past exposures before choosing imaging

☐ Consider ultrasound first when appropriate to reduce unnecessary radiation

☐ Avoid rushing into biopsy or additional procedures without a clear clinical need

☐ Focus daily on prevention through healthy body composition, movement, sleep, and reduced toxin exposure

☐ Make the final decision based on informed choice and personal comfort, not pressure or habit

00:00 Introduction

Few topics in women’s health create quiet pressure like breast cancer screening. At some point, nearly every woman hears the same instruction during a clinic visit: book your mammogram and get it done soon. The message often sounds urgent, and the space to ask questions feels small.

That pressure can make the decision feel heavier than it needs to be. Screening gets framed as something you simply comply with, rather than something you think through. When a choice feels rushed, fear often replaces clear thinking.

It helps to slow the pace and separate two ideas that often get mixed together. Screening is not prevention. A mammogram does not stop cancer from forming inside the body. It only looks for changes that may already exist.

Every test comes with trade-offs. Mammograms use ionizing radiation. They can show shadows that turn out to be harmless. Those shadows can lead to repeat scans, biopsies, and days or weeks of worry, even when nothing serious is found.

Breast health decisions should feel calm and informed, not forced. You deserve clear facts, time to reflect, and the freedom to choose what fits your body and your comfort level. Before saying yes to any screening plan, it helps to ask one steady question: What will this test truly change for me?

03:00 What Screening Tests Are Designed to Do

Screening tests were created with a simple purpose. They exist to reduce death and serious illness by finding disease early enough for treatment to make a meaningful difference. The logic sounds reassuring because catching something sooner feels like gaining control, yet the real value of any screening tool depends on one outcome alone, which is whether people actually live longer or live better because of it.

Finding a condition earlier does not automatically improve survival. A test can detect abnormalities, label someone as sick, and still leave the final outcome unchanged. When this happens, the person carries stress, appointments, and procedures without receiving a clear health benefit. This distinction often gets lost because early detection sounds powerful, even when the long-term numbers do not show meaningful improvement.

For that reason, screening must always be judged by results rather than intention. The key question is not whether a test can find something. The real question is whether acting on that information truly changes the course of life in a positive way. When the answer is uncertain, the decision becomes personal rather than mandatory, and thoughtful discussion replaces pressure.

03:18 What the Mammogram Studies Actually Show

Mammograms have been promoted for decades as the standard approach to breast cancer screening. Many women grow up hearing that this test is something they simply must do, often without anyone clearly explaining what the research actually shows. When you slow down and look at the evidence, the picture becomes more nuanced and less absolute than the messaging suggests.

Large population studies have compared women who received regular mammograms with women who did not. In several of these trials, cancers were detected earlier in the screened group, which sounds encouraging at first. Yet when researchers followed both groups for many years, the overall death rates looked very similar. Earlier detection did not consistently translate into fewer deaths from breast cancer.

At the same time, mammography introduces trade-offs that are rarely discussed in everyday conversations. The test uses ionizing radiation, and radiation carries cumulative biological effects. The dose from one study is small, yet repeated exposure over decades adds up, especially when screening begins at a younger age and continues year after year. From a biological standpoint, exposing breast tissue to repeated radiation while searching for cancer creates a tension that deserves honest reflection.

False positives also create a quiet burden. A shadow appears on the image, additional scans follow, and sometimes a biopsy is recommended even when the finding turns out to be harmless. This process can lead to pain, scarring, anxiety, and weeks or months of worry, all without improving health. Many women end up chasing findings that were never dangerous to begin with.

When you look at these details together, mammography stops feeling like a one-size-fits-all rule. It becomes a decision that depends on personal risk, comfort level, and values. Some women may prefer the information despite the downsides, while others may choose different approaches. Both paths can be reasonable when they are grounded in understanding rather than fear.

08:07 The Role of Self-Exams and Body Awareness

In the middle of all the technology, it is easy to forget something simple. No one knows your body better than you do. Body awareness remains one of the most practical and accessible tools available, yet it often receives less attention than machines and imaging.

A monthly self-exam allows you to become familiar with what is normal for you. Breast tissue naturally has texture and variation, so the goal is not perfection or constant searching. Instead, you develop a baseline sense of how things usually feel, which makes a new or unusual change easier to recognize. Over time, this quiet familiarity builds confidence rather than anxiety.

This approach has no radiation, no compression, and no cost. It does not require an appointment or insurance approval, and it places control directly in your hands. Many women have discovered lumps themselves between scheduled screenings, which shows that personal awareness remains relevant regardless of what imaging is used.

Body awareness also changes the emotional tone of health decisions. Instead of feeling commanded to follow a schedule, you become an active participant in your own care. You notice changes, ask questions, and then decide whether further evaluation makes sense. That mindset supports thoughtful choices rather than automatic reactions.

When screening is viewed through this wider lens, the path becomes clearer. Technology can assist when needed, yet it does not replace common sense, observation, and personal knowledge. A balanced approach respects both science and intuition, giving you space to choose what aligns with your health, your comfort, and your life.

09:50 Understanding Individual Risk Factors

Breast cancer risk is often presented as if every woman faces the same situation. In reality, risk looks different from one person to another. Age, family history, body composition, environment, and daily habits all shape the picture. When those differences are ignored, screening starts to feel like a rule instead of a personal decision.

Family history is only one part of the story. Having a parent or sibling with breast cancer can raise risk slightly, and certain gene mutations increase it further, yet most women who develop breast cancer have no strong family history at all. This shows that genes alone rarely explain what happens. Lifestyle and environment often carry just as much influence.

Body structure also affects how useful imaging can be. Women with denser or larger amounts of breast tissue may find that lumps are harder to feel, so imaging can provide added information. Women with smaller or less dense tissue may detect changes earlier through touch and familiarity with their own body. These differences explain why the same screening schedule does not fit everyone equally well.

Environmental exposure adds another layer. Smoking, chronic inflammation, toxic metals, poor sleep, and excess body fat all create stress inside the body. Over time, that stress affects how cells repair themselves and how the immune system responds. Lowering these everyday risks supports health long before any scan is performed.

What to Do

• Learn your personal and family health history
• Maintain a healthy percent body fat through balanced meals and strength training
• Stay physically active and protect consistent sleep
• Reduce exposure to smoking, heavy metals, and unnecessary radiation
• Perform a monthly self-exam to stay familiar with your normal breast tissue
• Discuss your individual risk profile with a clinician before choosing a screening plan

11:56 Making a Thoughtful Screening Decision

Once you understand your own risk, screening becomes easier to approach calmly. The conversation shifts away from pressure and toward clarity. Instead of feeling pushed into a test, you begin to evaluate whether it truly fits your situation.

Many women are told to schedule a mammogram without much explanation. The message often sounds urgent, which creates fear. Yet the research shows that early detection through routine screening does not always change long-term outcomes for every group. When the benefit is uncertain, it makes sense to slow down and think carefully.

A thoughtful decision comes from asking simple questions. What information will this test provide? How might the result change my care? What are the downsides, such as radiation exposure or false alarms that lead to more procedures? Answering these questions helps you weigh the value of the test instead of accepting it automatically.

Personal comfort also matters. Some women feel reassured by imaging. Others feel stressed by repeated testing and prefer observation and self-awareness. Both approaches can be reasonable when they are based on evidence and individual preference. Screening works best when it aligns with how you live and what gives you peace of mind.

When the choice feels intentional, confidence follows. You remain in control of your healthcare decisions, and that sense of control reduces anxiety. Medicine should guide you, not command you.

15:40 Mitochondrial Health and Cancer Biology

Screening looks for disease after it forms, yet prevention begins much earlier inside the cell. Every cell contains mitochondria, small structures that produce energy and regulate repair. When these systems function well, tissues stay stable and resilient. When they weaken, abnormal growth has a better chance to take hold.

This perspective shifts the focus from chasing problems to strengthening the internal environment. A healthy body repairs damage more effectively and removes abnormal cells before they spread. A stressed body struggles to keep up. The difference often comes from daily habits rather than medical procedures.

Nutrition, movement, and sleep all support mitochondrial function. Adequate protein helps rebuild tissue. Regular exercise improves circulation and oxygen delivery. Rest allows hormones and immune cells to reset. These basics sound simple, yet they influence biology at a deep level.

Reducing toxic burden also protects these energy systems. Heavy metals, pollutants, and chronic stress interfere with normal cellular processes. Lowering these exposures helps the body operate efficiently and maintain balance. When the internal environment stays strong, the risk of many chronic diseases, including cancer, decreases naturally.

Over time, these steady habits create a foundation of resilience. Screening then becomes one small part of a larger plan, rather than the only line of defense.

18:55 Your Right to Informed Choice

Healthcare decisions should never feel like orders handed down from above. They should feel like conversations where information is shared clearly and you are given the space to think. When a test is presented as something you “must” do, the pressure often replaces understanding, and that is where confusion begins.

Screening tools, including mammograms, exist to provide information. They do not guarantee safety, and they do not prevent disease by themselves. Each test carries benefits, limits, and trade-offs, which means the decision to proceed should come from your own judgment after hearing the full picture. Without that explanation, consent is not truly informed.

Many women describe feeling rushed during appointments. A recommendation is made, a form is signed, and the moment passes before real questions are asked. Later, doubts appear because the reasoning behind the test was never fully discussed. That experience creates anxiety, even when the intention was to help.

You have the right to slow the process down. You can ask what the test is expected to show, how accurate it is, what risks come with it, and what happens next if something unclear appears. You can also ask whether waiting, repeating an exam later, or using another method such as ultrasound makes sense for your specific situation. These questions are reasonable and responsible.

Choice also means respecting your own comfort level. Some women prefer regular imaging because it provides reassurance. Others prefer self-exams, lifestyle changes, and selective testing based on symptoms or risk factors. Both approaches can be thoughtful when they are based on evidence and personal values rather than fear.

At the center of all of this is autonomy. Your body belongs to you, and your healthcare decisions should reflect your goals, your tolerance for risk, and your understanding of the science. When you stay informed and engaged, screening becomes a tool you choose to use, not a rule you feel forced to follow.

Key Takeaway

Breast cancer screening works best when it is approached with clarity and personal judgment rather than pressure. Tests like mammograms can detect changes, yet detection alone does not guarantee better outcomes, and every screening method carries limits along with potential risks. When you understand what a test can and cannot tell you, the decision becomes calmer and more rational instead of fear-driven.

Your health benefits most from steady daily habits, awareness of your own body, and thoughtful conversations with a clinician who respects your input. Screening should support those foundations, not replace them. The strongest position is one where you stay informed, weigh the evidence carefully, and choose the path that fits your risk profile and your comfort level.

Related Episodes

Learning is strongest when ideas connect. Continue exploring these episodes that build on today’s discussion:

EP17 - Biden's Prostate Cancer: The TRUTH Doctors Don't Want You To Know!

EP31 - Do Men Really Die From Prostate Cancer? What the Data Actually Shows

Call to Action

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Selected References

Don't just take my word for it. The following research challenges the 'standard of care' by highlighting the data on survival and the real cost of overtreatment. These studies are the map for moving away from blind protocols and toward biological precision.

Bennett A, et al. Screening for breast cancer: a systematic review update to inform the Canadian Task Force on Preventive Health Care guideline. Syst Rev. 2024;13(1):304. Published December 19, 2024. doi:10.1186/s13643-024-02700-3. 

Bleyer A, Welch HG. Effect of three decades of screening mammography on breast cancer incidence. N Engl J Med. 2012;367(21):1998-2005.

Gøtzsche PC, Jørgensen KJ. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2013;(6):CD001877.

Miller AB, Wall C, Baines CJ, Sun P, To T, Narod SA. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial. BMJ. 2014;348:g366.

Nelson HD, Pappas M, Cantor A, Griffin J, Daeges M, Humphrey L. Harms of breast cancer screening: systematic review to update the U.S. Preventive Services Task Force recommendation. Ann Intern Med. 2016;164(4):256-267.

Siu AL; U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(4):279-296.

Welch HG, Prorok PC, O’Malley AJ, Kramer BS. Breast cancer tumor size, overdiagnosis, and mammography screening effectiveness. N Engl J Med. 2016;375(15):1438-1447.

US Preventive Services Task Force. Screening for breast cancer: US Preventive Services Task Force recommendation statement. JAMA. 2024;331(22):1918-1930. doi:10.1001/jama.2024.5534.

Disclaimer

This podcast and accompanying materials are for educational purposes only and do not replace personalized medical care. The information presented is designed to support informed decision‑making and health literacy, not to diagnose or prescribe. Always consult your own qualified healthcare provider regarding personal health questions or treatment decisions.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without permission is prohibited.

 Host: Intellectual Medicine by Dr. Stephen Petteruti (Member Version)

Date: May 6, 2025

Episode Summary

• Testosterone supports brain speed, mood stability, muscle strength, bone health, sexual function, and long-term vitality.
• Age-related testosterone decline is common, but symptoms such as low energy, reduced libido, loss of muscle, and brain fog should be evaluated rather than dismissed.
• Blood tests establish safety baselines, but free testosterone is the active form and often more important than total levels.
• Properly supervised testosterone therapy does not show increased risk of prostate cancer or heart attack in current research and requires monitoring of PSA, blood count, and estrogen.
• Long-term vitality depends on informed decisions, hormone balance, strength training, and preserving independence with age.

Quick Checklist

Before starting or continuing testosterone therapy, keep the main safety and monitoring steps in view. Testosterone affects the whole body, so decisions should be thoughtful and structured rather than casual. This checklist serves as a clear guide for safe and long-term use:

• Obtain baseline labs before therapy, including PSA, complete blood count, thyroid panel, and both total and free testosterone.
• Evaluate symptoms alongside lab results. Loss of libido, low energy, poor recovery, depressed mood, and reduced strength should be considered during assessment.
• Monitor hemoglobin, hematocrit, and estrogen levels during treatment to prevent complications such as erythrocytosis or hormonal imbalance.
• Preserve testicular function when using testosterone by incorporating appropriate medical support under physician supervision.
• Maintain supportive habits such as strength training, body fat control, adequate sleep, and stress regulation to enhance long-term outcomes.

00:00 Introduction

Testosterone is often treated as if it only affects sex drive or muscle size. In reality, that is only a fragment of the truth. The body uses testosterone to support brain function, mood, strength, bone health, energy, and long-term vitality. Because testosterone levels drop gradually over time, many people hardly notice the change at first, yet the signs are usually present. You may feel tired without a clear reason, think a little slower than before, or notice that recovery after exercise takes longer than it did a few years ago.

Medicine has made decline sound normal. Brain fog is called aging, muscle loss, and low energy are brushed aside and treated like the normal life cycle. Yet when the thyroid gland slows down, doctors replace thyroid hormone. The testicles are also hormone-producing organs. When their output fades, the effect spreads through the entire body.

Testosterone works like a messenger. It helps brain cells communicate, supports muscle and bone strength, and influences mood and motivation. Growing older in years is unavoidable. Withering in strength and clarity does not have to be accepted without asking questions.

02:50 Our body is a self-healing machine

The body has regulatory systems that constantly repair tissue, balance hormones, and maintain internal stability. These systems do not abruptly stop working at midlife. What changes over time is the hormonal environment that supports them. When hormone production declines, repair slows, recovery weakens, and performance drops.

In many clinical settings, decline is labeled as normal aging. Slower recall, reduced muscle mass, lower stamina, and decreased drive are often dismissed rather than investigated. When the thyroid underperforms, replacement therapy is standard practice. When insulin production fails, insulin is prescribed. The testicles also produce hormones that influence multiple organs, including the brain, muscles, bones, and cardiovascular system. Yet declining testosterone is frequently ignored or minimized.

Chronological aging is unavoidable. Functional decline is influenced by biology that can be evaluated and, in many cases, supported. The decision to intervene should be based on symptoms, laboratory data, and long-term health strategy rather than cultural assumptions about what aging should look like.

03:16 Benefits of testosterone

Testosterone functions beyond sexual health. In the brain, it supports neuronal signaling and influences memory formation, processing speed, and concentration. Lower testosterone levels have been associated with reduced cognitive performance and increased risk of mood disturbance. Both men and women rely on adequate testosterone for neurological stability.

Muscle tissue is highly dependent on testosterone. During adolescence, rising testosterone levels drive muscle growth and strength development. Later in life, as testosterone declines, maintaining lean muscle mass becomes more difficult even with regular exercise. Reduced muscle mass contributes to decreased strength, slower metabolism, and higher risk of injury.

Bone density is also influenced by testosterone. Lower levels correlate with weaker bones and increased fracture risk. Joint stability depends in part on muscular support, and many patients report reduced musculoskeletal pain when hormone levels are optimized.

Long-standing fears about testosterone therapy have been reexamined. Current evidence does not show a consistent increase in prostate cancer incidence among men receiving properly monitored therapy. Cardiovascular data remain complex, but large studies have not demonstrated a clear rise in heart attack or stroke risk when treatment is supervised and individualized. Monitoring blood count and other markers remains essential.

06:54 Calming effect of testosterone

Testosterone is often assumed to increase aggression. Clinical observation frequently shows the opposite pattern when testosterone levels are low. Men with inadequate testosterone may present with irritability, low motivation, reduced confidence, and depressed mood.

Restoring testosterone to appropriate levels often improves emotional stability and stress tolerance. Some clinicians have incorporated testosterone therapy into treatment plans for men with persistent depressive symptoms when laboratory findings support deficiency.

It is important to distinguish therapeutic restoration from supraphysiologic dosing. Excessive hormone levels can produce instability. The objective of treatment is physiological balance. When levels are maintained within an appropriate range and monitored carefully, many patients report improved mood, steadier energy, and clearer thinking.

11:55 Truth about blood levels

Blood tests are helpful, but they are not the final decision maker. The first reason to check blood work is to create a starting point. A baseline helps identify whether there are conditions that require caution before beginning therapy.

One important marker is PSA, which stands for prostate-specific antigen. If PSA is very high, such as above 10 and in some cases above 20, it deserves careful review before starting testosterone. This does not always mean therapy cannot be done, but it requires thoughtful supervision.

Another test is a complete blood count. Some men carry a genetic condition called hemochromatosis, which causes the body to store too much iron. Over time, excess iron can damage the liver, kidneys, and brain. Testosterone therapy can increase red blood cell production because it stimulates the kidneys to release a hormone called erythropoietin. This hormone signals the bone marrow to make more red blood cells. A mild rise in blood count is expected, but if it climbs too high, a condition called erythrocytosis can develop. In that case, donating blood may be recommended.

Blood tests also help evaluate heart health, blood sugar, and thyroid function. These systems affect energy, mood, and strength. Lab values provide useful information, but symptoms and clinical judgment carry equal weight.

13:45 Total vs. free testosterone

When testosterone is measured in the blood, two main numbers can be reported: total testosterone and free testosterone. Understanding the difference is essential.

Total testosterone represents the entire amount of testosterone circulating in the bloodstream. However, not all of it is available for the body to use. A large portion of testosterone binds to a protein called sex hormone binding globulin, or SHBG. When testosterone is attached to this protein, it cannot enter cells and perform its function.

Free testosterone is the portion that is not bound. This is the active form. It enters cells, interacts with receptors, and supports brain function, muscle growth, bone density, libido, and mood. A person can have a normal total testosterone level but still feel symptoms of deficiency if free testosterone is low.

This difference explains why some men are told their levels are normal even though they feel tired, lose muscle, or experience reduced libido. If only total testosterone is checked, the picture may be incomplete. Measuring free testosterone provides a clearer understanding of what the body can actually use.

Symptoms that may suggest low free testosterone include reduced sexual desire, difficulty with erections, low energy, decreased motivation, slower recovery after exercise, depressed mood, and loss of muscle mass. These symptoms can overlap with thyroid problems or chronic stress, which is why a broader evaluation is important.

Treatment decisions should not rely on one single lab number. If a patient reports improved energy, better mood, stronger workouts, and improved sexual function, that improvement carries meaning even if the lab value sits in the middle of a reference range. On the other hand, if levels are high but side effects appear, adjustments may be required.

Testosterone therapy also requires monitoring of estrogen. Some testosterone converts into estrogen, which plays a role in bone strength and sexual function. If estrogen rises too high, unwanted effects such as breast tissue growth can occur. If it drops too low, bone and libido may suffer. Many clinicians aim for an estrogen range between 20 and 40, though reference ranges vary by laboratory.

Preserving natural testicular function is another consideration. When external testosterone is given without support, the testicles may shrink over time because they reduce their own production. Medications such as clomiphene, enclomiphene, hCG, or gonadorelin can be used to stimulate the testicles and maintain function under medical supervision.

Understanding total and free testosterone helps prevent oversimplified decisions. It ensures therapy is based on biology, symptoms, and long-term health rather than a single number.

21:26 Creams for hair loss

Some men worry that testosterone therapy will cause hair loss. Hair thinning in men is often related to genetics and a hormone called dihydrotestosterone, or DHT. DHT is a stronger form of testosterone that can shrink hair follicles in men who are genetically sensitive.

Testosterone can increase DHT levels. If a man is already prone to male pattern baldness, therapy may speed up a process that was likely going to happen over time.

There are options to manage this risk. One approach is using topical prescription creams that act directly on the scalp. These treatments target hair follicles with minimal absorption into the bloodstream. Another option is medications such as finasteride, which reduce the conversion of testosterone into DHT. Blocking DHT can help preserve hair, though it must be balanced carefully because DHT also contributes to sexual function in some men.

Hair loss management should be individualized. The decision depends on family history, cosmetic preference, and overall treatment priorities. Monitoring and discussion with a qualified clinician ensures that hormonal therapy supports vitality without ignoring side effects.

22:33 Duration of the treatment

A common question is how long testosterone therapy should continue. The honest answer is that it can be continued for life if it remains safe, affordable, and aligned with personal values. There is no fixed expiration date. Testosterone is a hormone your body naturally produces. When levels fall and symptoms appear, replacing it is similar in principle to replacing thyroid hormone when the thyroid slows down.

Stopping therapy is always a personal decision. Some men may choose to stop for financial reasons or philosophical reasons. Others may prefer to age without intervention. That choice does not make anyone careless or uninformed. The role of a physician is to provide information, monitor safety, and guide decisions, not to impose treatment.

Strength training, maintaining a healthy body fat percentage, and sleeping well can support natural testosterone levels. However, even disciplined and healthy men experience a gradual decline over time. Therapy becomes one available option, not an obligation.

Some clinicians recommend an occasional short break, sometimes called a hormone holiday, such as skipping a scheduled dose every few weeks. The theory is that this may keep hormone receptors responsive over the long term. Most men feel stable during short breaks because testosterone remains in the system for some time. Long-term therapy, when properly monitored, can be sustainable for decades.

24:59 How we live is what we control

Aging in years cannot be stopped, yet the way strength, mobility, and clarity change over time can be influenced. One major cause of disability in older adults is sarcopenia, which means loss of muscle mass. Weak muscles make daily tasks harder. Climbing stairs, opening jars, and getting out of a car all depend on muscle strength.

Testosterone supports muscle maintenance. Strong muscles protect joints, improve balance, and lower the risk of falls. Maintaining muscle also supports bone density, which lowers fracture risk. Brain health is also connected to hormone balance. Lower hormone levels have been linked in research to increased risk of cognitive decline.

Lifestyle choices remain important. Walking regularly, lifting weights, eating balanced meals, and keeping body fat within a healthy range all support vitality. Hormone therapy does not replace these habits. It works alongside them. The central idea is that while death is inevitable, years of unnecessary weakness or decline may be influenced by thoughtful action.

Each person chooses how to approach aging. Some will prefer organic decline. Others will use every safe and credible tool available. What remains constant is personal responsibility in making informed decisions.

26:16 Other side effects

No medical therapy is free from potential side effects, and testosterone is no exception. One common effect is acne, especially on the chest or back. This happens because testosterone can stimulate oil glands in the skin. If acne appears, the dose can often be adjusted. In some cases, dividing the weekly dose into two smaller injections can smooth hormone levels and reduce skin reactions.

Hair thinning is another concern for men who are genetically prone to male pattern baldness. Testosterone can increase levels of DHT, a hormone that influences hair follicles. Monitoring and preventive strategies, such as topical treatments or DHT-modulating medications, can be considered when appropriate.

It is important to distinguish medical testosterone therapy from anabolic steroid abuse. High-dose anabolic steroids used for bodybuilding can damage the brain, heart, and reproductive system. They can suppress natural testosterone production and sometimes cause long-term harm. Medical therapy aims to restore physiological levels, not create extreme muscle growth.

Over-the-counter supplements that claim to “boost” testosterone rarely provide meaningful improvement in men with true deficiency. In most symptomatic men over 40, replacing testosterone itself is the effective treatment when clinically appropriate.

30:16 Motivational story of a patient

A story illustrates the broader message about vitality. Years ago, a patient in his mid-80s with stage four lung cancer was receiving supportive care, including testosterone therapy. During a visit, he was asked about his breathing. He replied that he only became short of breath during intimacy with his wife.

At 85 years old, facing advanced cancer, he remained engaged in life, connection, and intimacy. He passed away a few months later. His final months were not defined by weakness or resignation but by participation in living.

The lesson is not that testosterone cures disease. The lesson is that vitality can be preserved longer than many people expect. Strength, connection, and purpose can continue deep into later years when health is supported intentionally. Aging does not require surrendering energy or identity. It requires informed choices and steady attention to the systems that keep the body functioning well.

Key Takeaway

Testosterone is a foundational hormone that affects the brain, muscles, bones, mood, skin, and sexual health. When it declines, the whole body feels the effect. Slower thinking, lower energy, weaker recovery after exercise, reduced confidence, and changes in libido can all reflect falling testosterone levels rather than unavoidable aging.

Blood work helps create a starting point, yet numbers alone do not determine treatment. Total testosterone shows how much is present in the bloodstream, while free testosterone shows how much is actually available for the body to use. Symptoms, physical function, and overall health must be considered together with laboratory values.

When therapy is used, the focus is on restoration to a healthy physiological range under medical supervision. Monitoring blood count and estrogen keeps treatment balanced and safe. Strength training, body composition control, and cardiovascular health remain essential. The central principle is that growing older does not require surrendering clarity, strength, or vitality without first examining the hormonal foundation that supports them.

Continue the Conversation

If this discussion sparked new thoughts, there are other episodes that build on these ideas and examine them from different angles:

EP06 – The Truth About Testosterone: Does It Really Cause Prostate Cancer?

For a deeper and more structured look at this philosophy, Fight Cancer Like a Man by Dr. Stephen Petteruti walks through prevention, screening, and treatment decisions in a practical and direct way. It lays out the reasoning behind prioritizing vitality, safety, and informed choice.

If you would like access to extended clinical notes and member-only discussions, join the 

Intellectual Medicine Community:
Membership: https://tinyurl.com/DrPetterutiMember
Sign up for Dr. Steve’s email newsletter: https://www.drstephenpetteruti.com
Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:
LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
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Subscribe to the Intellectual Medicine Podcast:
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To encourage deeper review, referenced studies examine long-term outcomes of observation compared with intervention. These data explore survival patterns, treatment complications, and the biological impact of biopsy and hormone suppression. Reviewing this literature supports a more individualized approach to prostate health.

Suggested References

Don't just take my word for it. The following research challenges the 'standard of care' by highlighting the data on survival and the real cost of overtreatment. These studies are the map for moving away from blind protocols and toward biological precision.

Hackett GI. Long Term Cardiovascular Safety of Testosterone Therapy: A Review of the TRAVERSE Study. World J Mens Health. 2025;43(2):282-290. doi:10.5534/wjmh.240081

Haider, Ahmad et al. “Incidence of prostate cancer in hypogonadal men receiving testosterone therapy: observations from 5-year median followup of 3 registries.” The Journal of urology vol. 193,1 (2015): 80-6. doi:10.1016/j.juro.2014.06.071

Kaplan, Alan L et al. “Testosterone Therapy in Men With Prostate Cancer.” European urology vol. 69,5 (2016): 894-903. doi:10.1016/j.eururo.2015.12.005

Keren D, Goshen A, Strauss T and Springer S (2025) Study protocol: associations between hormonal profile and physical and cognitive functions in middle-aged men—a one-year cohort follow-up study. Front. Public Health 13:1654077. doi: 10.3389/fpubh.2025.1654077

Mohammad, Osama S et al. “Supraphysiologic Testosterone Therapy in the Treatment of Prostate Cancer: Models, Mechanisms and Questions.” Cancers vol. 9,12 166. 6 Dec. 2017, doi:10.3390/cancers9120166

Snyder PJ, Kopperdahl DL, Stephens-Shields AJ, et al. Effect of Testosterone Treatment on Volumetric Bone Density and Strength in Older Men With Low Testosterone: A Controlled Clinical Trial. JAMA Intern Med. 2017;177(4):471-479. doi:10.1001/jamainternmed.2016.9539

Disclaimer

This podcast and its accompanying materials are for educational purposes. They are designed to support thoughtful decision-making and improve health literacy. They do not replace individualized medical advice, diagnosis, or treatment. Always consult your qualified healthcare professional regarding personal medical concerns.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without written permission is prohibited.

Host: Intellectual Medicine by Dr. Petteruti (Member Version)

Date: 08 April, 2025

Episode Summary

• Early prostate cancer carries a very low short-term death rate, yet elevated PSA levels often push men toward biopsy, surgery, or radiation even when these steps have not clearly improved long-term survival.
• Prostate biopsy involves multiple core needle samples that can cause bleeding, infection, pain, and anxiety, and there is concern that disrupting tissue may allow abnormal cells to spread beyond the gland.
• Long-term studies, including research following men for up to twenty years, have shown similar death rates among those who had their prostate removed, received radiation, or chose observation, which challenges the idea that aggressive early treatment always helps.
• A more practical approach focuses on careful monitoring, imaging such as MRI, repurposed drug strategies, immune support, toxin reduction, and healthy body composition so the body stays resilient while unnecessary procedures are avoided.

Quick Decision Checklist

Use this checklist as a simple guide before agreeing to a prostate biopsy, surgery, or radiation. Each point is meant to help you think clearly and protect both your long-term health and your daily quality of life.

☐ Track PSA levels over time and look for patterns instead of reacting to a single rise

☐ Repeat abnormal PSA tests to confirm the result before making any decisions

☐ Ask how a biopsy or procedure would change survival or outcomes before agreeing to it

☐ Consider imaging such as prostate MRI to gather information without puncturing tissue

☐ Avoid routine or repeated biopsies unless there is a clear and necessary clinical reason

☐ Support immune health through sleep, balanced meals, strength training, and regular movement

☐ Reduce exposure to toxins such as smoking, heavy metals, and unnecessary radiation

☐ Maintain a healthy percent body fat and preserve muscle mass to lower overall cancer risk

☐ Discuss non-invasive or supportive options, including monitored observation and medical therapies, with a qualified clinician

☐ Take time to understand every option so decisions come from evidence and comfort rather than fear

00:00 Introduction

No man should ever have his prostate biopsied.

That statement sounds strong at first, yet it comes from years of clinical observation and careful review of the evidence. When you look closely at how prostate cancer is detected and treated, you begin to see that many men are exposed to needles, surgery, and radiation when, really, nobody can prove that those steps will actually help them live longer. And at the end of the day, instead of improving the life of the patient, they end up dealing with unnecessary fear. 

Saying an elevated PSA is nothing to worry about is far from the truth. Naturally, when you see those numbers going up, the first thing that comes to mind is the word “cancer.” From there, some doctors would start recommending that you have a biopsy. Years of research have proven that while it is an option, it is not the best option. It is always best to know every option and how they relate to you.

03:09 Mortality Rate of Prostate Cancer

Fear around prostate cancer often comes from the belief that it is an immediate threat to life. The word alone can make any man feel like something dangerous is already happening inside his body. Yet when you step back and look at the numbers, the picture looks very different from the fear that usually surrounds it.

Prostate cancer has one of the highest survival rates of any common cancer. The five-year relative survival rate sits around 98 to 99 percent, and even the ten-year survival rate remains close to 98 percent. In simple terms, most men diagnosed with early or localized prostate cancer are still alive many years later, even when no aggressive treatment is done. That reality makes it very difficult to prove that surgery or radiation actually extended anyone’s life in the first place.

History also adds a perspective that most people never hear. In the 1860s, when one of the first modern prostatectomies was performed in England, the surgeon at the time described prostate cancer as a rare disease. “Rare.” That statement forces an important question: If it was once considered uncommon, how did it suddenly become something that seems to affect nearly every aging man today? The answer likely has more to do with how we label and search for it than with the disease itself becoming more aggressive.

Where outcomes truly change is when cancer spreads outside the gland. Once there is distant metastasis, survival drops sharply, with five-year survival falling closer to 30 to 40 percent. That difference tells us something important. The real danger is not simply finding abnormal cells inside the prostate. The real danger begins only after those cells escape and travel elsewhere.

05:32 The Biopsy Procedures

Despite these high survival numbers, many men are still guided toward biopsy as soon as the PSA creeps upward. The test is often described as small and routine, almost like a quick blood draw, but that description leaves out what really happens.

A prostate biopsy involves repeatedly firing a core needle into the gland to remove tissue samples, usually twelve or more. Each pass removes a small cylinder of tissue, and each pass creates bleeding and inflammation. Men often experience pain, blood in the urine or semen, and sometimes an infection that requires antibiotics or hospital care. This is not a minor step, even though it is presented as one.

The result also does not provide certainty. A negative biopsy simply means nothing was found in the spots that were sampled, not that cancer is absent everywhere. That uncertainty often leads to repeat biopsies over months or years, which keeps men stuck in a cycle of procedures without clear answers.

At this point, the obvious question becomes whether finding cancer earlier and treating it aggressively actually changes survival. That question has been studied directly, and the answer surprises many people.

A major long-term study published in the New England Journal of Medicine followed men who already had diagnosed prostate cancer. These men were divided into three groups. One group had the prostate gland removed, another received radiation therapy, and the third group had no immediate treatment at all.

Researchers tracked them for nearly twenty years. After two decades of follow-up, the death rate from all causes and the death rate from metastatic prostate cancer were essentially the same across all three groups. In other words, removing the gland, irradiating it, or doing nothing produced very similar survival outcomes.

That finding forces you to rethink the rush toward aggressive intervention. If long-term survival remains similar, then exposing men to surgery, radiation, or repeated invasive testing becomes much harder to justify. The benefit is uncertain, while the side effects are very real.

09:06 Cellular Metastasis

The biology of prostate cancer helps explain why this happens. Many abnormal or atypical cells can sit quietly inside the prostate for years without causing harm. As long as those cells stay contained within the gland, they often remain dormant and never threaten life.

Trouble begins when cells escape and travel elsewhere in the body. Metastatic spread is what leads to serious illness and death, not simply the presence of abnormal cells inside the prostate. This distinction is critical because it shows that not every detected cancer behaves the same way.

When you consider that biopsies repeatedly puncture the gland and disrupt tissue barriers, it becomes reasonable to question whether such disruption is always helpful. The goal should be preserving health and function while keeping risk low, rather than automatically moving toward procedures that may not improve survival in the first place.

09:53 Active Monitoring of the Prostate

Once a man receives an elevated PSA or a suspicious finding, many doctors offer what they call “active monitoring” or “active surveillance.” At first glance, this sounds careful and reasonable, as if the situation is being watched closely without rushing into surgery. In practice, however, this approach often means repeated biopsies performed at regular intervals, sometimes every six months or every year, with the idea that sampling the tissue again will reveal whether the cancer has changed.

The problem is that this logic falls apart when you look at what a biopsy can and cannot tell you. A biopsy only shows what is happening in the small pieces of tissue that were removed on that day. It cannot predict the future behavior of those cells, and it cannot confirm whether any cells have already moved outside the gland. In other words, the test provides a snapshot, not a forecast. Yet men are exposed to needles again and again based on information that has limited predictive value.

Biology also explains why this approach may be unnecessary for many men. As long as abnormal or atypical cells remain contained within the prostate, they often stay quiet for years. Dormant cells inside the gland rarely cause harm. The true danger begins only when cancer spreads beyond the prostate and establishes itself elsewhere in the body. That is when the disease becomes life-threatening. Simply detecting cells inside the gland does not automatically place someone at risk.

So if a man feels well, has mild urinary symptoms that are typical of aging, and only shows a gradual PSA rise, repeatedly puncturing the gland does not offer clear protection. It often adds discomfort, bleeding, infection risk, and anxiety without demonstrating that survival improves. When you consider that long-term studies have already shown similar death rates between treatment and observation in many early cases, the value of repeated invasive testing becomes even harder to justify.

There are also broader health considerations that rarely get discussed. Surgical and procedural interventions carry collateral risks, especially in older men. Studies of non-cardiac surgery in patients over 65 have reported silent strokes that show up later as memory loss or cognitive decline. Blood clots, infections, and heart strain are not theoretical problems. They are documented realities. When a treatment has no proven survival benefit, even small risks begin to matter.

For these reasons, active monitoring built around serial biopsies often turns into a cycle of procedures rather than a truly protective strategy. A more rational approach focuses on observation that respects the biology of the disease while minimizing harm to the patient.

11:16 Repurposed Drug Therapy

This is where the philosophy used in Intellectual Medicine takes a different direction. Instead of repeatedly sampling tissue or moving quickly toward surgery or radiation, the focus shifts toward creating an internal environment where cancer struggles to grow or spread. The objective is not passive waiting. The objective is active support of the body’s defenses.

One practical tool is imaging. An MRI of the prostate can evaluate the structure of the gland and track changes over time without piercing tissue. When PSA rises gradually but the MRI looks stable year after year, that information provides reassurance without exposing the patient to needles or trauma. It allows monitoring while preserving function and quality of life.

Another strategy involves what is known as repurposed drug therapy. These are medications originally developed for other medical conditions that have shown anti-cancer or anti-metastatic effects. Many are inexpensive, widely available, and have long safety records. They do not require hospitalization, anesthesia, or invasive procedures, yet they may help reduce the biological conditions that allow cancer to spread.

Examples discussed in this approach include low-dose medications that influence cellular metabolism, mitochondrial health, and inflammatory signaling. Drugs such as sirolimus, low-dose naltrexone, low-dose doxycycline, and DMSA for heavy metal reduction have been studied for their ability to create a less favorable environment for cancer growth. Rather than cutting tissue out, the strategy supports immune surveillance and lowers toxic burden, which addresses cancer risk at the cellular level.

There is also an important perspective shift here. When researchers followed more than 250 men with prostate cancer who ultimately died, only a small fraction died from prostate cancer itself. Most died from heart disease or other common illnesses. That observation suggests that overall health, cardiovascular fitness, and toxin exposure may influence survival just as much, or even more, than aggressive prostate procedures. Focusing only on the gland while ignoring the rest of the body can miss the bigger picture.

Taken together, this approach respects two facts that the evidence keeps repeating. First, many prostate cancers remain contained and never threaten life. Second, aggressive interventions often carry permanent side effects without a clear survival advantage. Supporting the immune system, reducing toxic exposure, improving metabolic health, and monitoring with noninvasive tools offer a path that protects both longevity and day-to-day function.

When you weigh everything carefully, preserving strength, clarity, and quality of life becomes just as important as chasing every abnormal cell. For many men, that balance leads away from repeated biopsies and toward smarter, less traumatic ways of managing risk.

17:03 Biggest Risks of Prostate Cancer

By this stage in the discussion, the focus naturally shifts away from needles, scans, and procedures and toward something much simpler. It becomes clear that the largest drivers of prostate cancer risk are not hidden inside the hospital. They are built into everyday biology and the environment a man lives in over decades.

Age stands at the top of the list.

As men get older, the immune system gradually weakens. Cells that once would have been identified and cleared quickly may linger longer. Small abnormalities that would have been corrected in youth can persist. This quiet change happens slowly, year after year, and it explains why prostate cancer appears more often later in life rather than early adulthood. The passage of time itself alters how the body repairs damage and controls abnormal growth.

There is also the issue of accumulated exposure.

Modern life brings constant contact with substances that the body was never designed to handle. Heavy metals such as cadmium, lead, and arsenic build up in tissues through air, water, and food. These elements are known carcinogens. They sit inside the body for years and quietly interfere with normal cellular function. Over time, that interference increases the likelihood that damaged cells survive when they should have been removed.

Body composition plays a role as well.

Higher percent body fat is consistently associated with increased cancer risk across many types of disease, including prostate cancer. Excess fat tissue promotes chronic inflammation and hormonal disruption. Inflammation creates a biological environment where abnormal cells have an easier time surviving. When inflammation stays elevated for years, the body becomes less efficient at repair and immune surveillance.

When you put these pieces together, a pattern emerges.

The greatest risks are not a single PSA number or a small cluster of cells seen on a microscope slide. The greater risks are weakened immune defenses, toxic accumulation, poor metabolic health, and long-term inflammation. These are slow processes that shape the terrain in which cancer either struggles or thrives.

This understanding changes how prevention should be approached. Instead of focusing only on detecting disease earlier and earlier, it makes more sense to strengthen the body so that disease has fewer opportunities to take hold in the first place. Supporting immune health, improving fitness, and reducing toxic exposure address the root conditions that influence long-term outcomes.

When those foundations are solid, the body becomes less hospitable to cancer. That protection works quietly in the background every day, which often provides greater benefit than any single invasive procedure.

21:32 Things to Avoid

As important as knowing what supports health, it is equally important to recognize which paths tend to create harm without clear benefit. Many of the standard responses to an elevated PSA feel decisive, yet they can introduce lifelong complications while offering little evidence that survival improves. Being aware of these risks allows a man to think clearly and choose carefully rather than reacting out of fear.

What to Do:

☐ Avoid routine prostate biopsy when the only finding is an elevated PSA without symptoms

☐ Avoid rushing into surgery or radiation without long-term evidence that it improves survival for your specific situation

☐ Avoid repeated invasive procedures that cannot predict the future behavior of the disease

☐ Avoid ignoring overall health risks, such as heart disease, while focusing only on the prostate

☐ Avoid exposure to known carcinogens, including smoking, heavy metals, and unnecessary radiation

☐ Avoid excess body fat and inactivity that promotes chronic inflammation

☐ Avoid androgen deprivation therapy unless there is a clear and compelling reason, given its effects on energy, mood, muscle, and bone

These choices do not mean doing nothing. They mean protecting the function and preserving the strength while gathering better information. The idea is to remain thoughtful and deliberate, using evidence to guide each step rather than allowing anxiety to dictate treatment.

Key Takeaway

An elevated PSA often creates immediate fear, yet fear alone is not evidence. When you examine the long-term data, early prostate cancer rarely leads to death within the first several years, and many men live full lives without ever needing surgery, radiation, or repeated biopsies. At the same time, those interventions carry real and permanent consequences, including infection, urinary problems, sexual dysfunction, and complications that affect day-to-day living.

This is why the first response should never be panic or reflexive procedures. A biopsy cannot predict the future behavior of the disease, and removing or irradiating the gland has not consistently shown better survival in early cases. Meanwhile, age, immune strength, toxic exposure, and overall metabolic health quietly influence risk far more than a single lab value.

A calmer and more rational path focuses on monitoring trends, protecting whole-body health, and choosing interventions only when there is clear and meaningful benefit. When decisions are guided by evidence instead of pressure, you protect both longevity and quality of life, which ultimately remains the outcome that matters most.

Continue the Conversation

If this discussion sparked new thoughts, there are other episodes that build on these ideas and examine them from different angles:

EP09 - Don't Biopsy Your Prostate Until You Hear This (Part 2) 

EP04 - Why Early Treatment of Prostate Cancer May Be Ineffective: The Case for Conventional Therapies

For a deeper explanation of the science and reasoning behind this approach, read Fight Cancer Like a Man by Dr. Stephen Petteruti on Amazon— a clear and practical guide to smarter cancer prevention, vitality, and informed decision‑making.

Intellectual Medicine Community:
Membership: https://tinyurl.com/DrPetterutiMember
Sign up for Dr. Steve’s email newsletter: https://www.drstephenpetteruti.com
Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:
LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
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Subscribe to the Intellectual Medicine Podcast:
Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
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Suggested References

Don't just take my word for it. The following research challenges the 'standard of care' by highlighting the data on survival and the real cost of overtreatment. These studies are the map for moving away from blind protocols and toward biological precision.

C, Jacklin et al. "More men die with prostate cancer than because of it" - an old adage that still holds true in the 21st century.” Cancer treatment and research communications vol. 26 (2021): 100225. doi:10.1016/j.ctarc.2020.100225 

Hamdy, Freddie C et al. “Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer.” The New England Journal of Medicine vol. 388,17 (2023): 1547-1558. doi:10.1056/NEJMoa2214122 

Kishan, Amar U, and Patrick A Kupelian. “Late rectal toxicity after low-dose-rate brachytherapy: incidence, predictors, and management of side effects.” Brachytherapy vol. 14,2 (2015): 148-59. doi:10.1016/j.brachy.2014.11.005 

Kratzer TB, Mazzitelli N, Star J, Dahut WL, Jemal A, Siegel RL. Prostate cancer statistics, 2025. CA Cancer J Clin. 2025;75(6):485-497. doi:10.3322/caac.70028

Ladjevardi, Sam et al. “Prostate biopsy sampling causes hematogenous dissemination of epithelial cellular material.” Disease Markers vol. 2014 (2014): 707529. doi:10.1155/2014/707529

Nead, Kevin T et al. “Association Between Androgen Deprivation Therapy and Risk of Dementia.” JAMA oncology vol. 3,1 (2017): 49-55. doi:10.1001/jamaoncol.2016.3662

Sennerstam, Roland B et al. “Core-needle biopsy of breast cancer is associated with a higher rate of distant metastases 5 to 15 years after diagnosis than FNA biopsy.” Cancer cytopathology vol. 125,10 (2017): 748-756. doi:10.1002/cncy.21909

Wilt, T J, and M K Brawer. “The Prostate Cancer Intervention Versus Observation Trial (PIVOT).” Oncology (Williston Park, N.Y.) vol. 11,8 (1997): 1133-9; discussion 1139-40, 1143.

Wilt, Timothy J et al. “Follow-up of Prostatectomy versus Observation for Early Prostate Cancer.” The New England Journal of Medicine vol. 377,2 (2017): 132-142. doi:10.1056/NEJMoa1615869

Disclaimer

This podcast and accompanying materials are for educational purposes only and do not replace personalized medical care. The information presented is designed to support informed decision‑making and health literacy, not to diagnose or prescribe. Always consult your own qualified healthcare provider regarding personal health questions or treatment decisions.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without permission is prohibited.

Host: Intellectual Medicine by Dr. Petteruti (Member Version)

Date: 15 April, 2025

Episode Summary

• Prostate cancer screening expanded rapidly after the introduction of PSA testing, yet early detection has not been clearly linked to improved long-term survival in large outcome trials.
• Historical data show that prostate removal became standard before modern imaging or laboratory tools existed, and mortality rates did not fall simply because glands were removed.
• Studies comparing surgery, radiation, and observation over long follow-up periods have shown similar mortality outcomes, challenging the assumption that aggressive treatment guarantees benefit.
• Androgen deprivation therapy is associated with fatigue, muscle loss, metabolic change, cognitive decline, and cardiovascular risk, and its impact on survival in early disease remains uncertain.

Quick Checklist

Before moving forward with any screening test, biopsy, surgery, or hormone therapy, it helps to pause and review the full picture. This checklist is meant to guide thoughtful decision-making so that each choice reflects evidence, context, and your broader health priorities.

• Confirm that an elevated PSA has been repeated under stable conditions before considering further steps
• Review long-term outcome data on surgery and radiation, not just short-term PSA changes
• Consider multiparametric MRI with PI-RADS scoring to establish a baseline before any biopsy discussion
• Ask whether a proposed biopsy will change management in a way that improves survival
• Evaluate cardiovascular health alongside prostate findings, including calcium scoring when appropriate
• Weigh the cognitive, metabolic, and cardiovascular risks before agreeing to androgen deprivation therapy
• Reflect on whether findings may represent dormant atypical cells rather than aggressive disease
• Make decisions based on informed understanding rather than fear of a laboratory number

00:00 Introduction

We sometimes think of science and medicine as cold and purely logical, as if every decision comes from clean numbers and neat charts. In real life, it rarely works that way. When the topic turns to prostate cancer, fear, habit, and old beliefs often guide decisions just as much as evidence does.

Before talking about screening tests or treatment plans, it helps to step back and ask a simple question: Where does this path actually lead? If you follow the PSA test, then the biopsy, then the surgery or radiation, what is the end result for your life, your body, and your long-term health? That endpoint, not the first test, is what truly matters.

There is also a basic biological reality that most men never hear about. Autopsy research has shown that many men, especially as they age, carry small clusters of abnormal or cancer-like cells inside the prostate and never know it. These cells often stay quiet for decades and never cause symptoms or shorten life. Some studies even show that a large portion of men over 50 have these cells, and the majority of men past 90 show them as well, despite dying from completely unrelated causes.

That raises an uncomfortable question. If these cells are so common and so often harmless, are we sometimes labeling a normal age-related change as a dangerous disease? And in our attempt to find cancer early, are we sticking needles into healthy glands and creating problems that might never have existed in the first place?

02:21 Historical Evolution of Prostate Treatment

To understand where we are today, it helps to look at how prostate treatment developed over time. In the mid-1800s, a British surgeon performed one of the first modern prostatectomies and described prostate cancer as a rare disease that you would hardly ever see. That statement stands in sharp contrast to how the condition is described today, where it is often portrayed as common and almost inevitable with aging.

So what changed? The biology of men did not suddenly transform. What changed was our ability to look more closely. As diagnostic tools improved, especially through tissue sampling and later blood tests, more abnormal cells were identified. Over time, atypical or dormant cells were grouped together with aggressive disease under the single label of cancer. The more we searched, the more we found, and the more we found, the more the disease appeared to expand.

By the 1940s and 1950s, removal of the prostate gland became standard practice. This was long before PSA testing, MRI imaging, or advanced pathology grading systems. Decisions were based largely on digital rectal examination and clinical suspicion. Surgeons removed glands in an attempt to cure the disease, and this approach became entrenched. Yet during the decades when prostatectomy became widespread, the death rate from prostate cancer did not clearly decline in proportion to the increase in surgery. That historical detail is important because it challenges the assumption that more aggressive early treatment automatically leads to better long-term outcomes.

In the 1990s, the PSA test entered routine use. It was embraced quickly and gained enormous clinical influence. However, no large prospective trial first proved that widespread PSA screening would reduce death from prostate cancer before it became common practice. The test measures a protein produced by prostate tissue, and that level naturally rises with age as the gland enlarges. While PSA can be elevated in cancer, it can also rise from benign enlargement or inflammation. Even so, it became a trigger for biopsy, and biopsy became a trigger for intervention.

06:35 Pause, Think Long, and Hard

At this point, it becomes necessary to step back and reflect carefully. A prostate biopsy is not a trivial event. It involves multiple large-gauge core needle samples, often a dozen or more punctures into the gland. The procedure can cause pain, bleeding, infection, and in some cases, hospitalization. It is not a simple blood draw.

If a procedure carries risk, then the expected benefit must be meaningful. That requires a thoughtful weighing of outcomes. Large trials such as the ProtecT study and the PIVOT trial compared men who underwent surgery or radiation with men who were observed without immediate treatment. After long-term follow-up approaching two decades, there was not much difference in prostate cancer mortality between the groups. That does not mean no treatment ever has value, but it does mean the benefit is not as straightforward as many assume.

When evidence shows a limited survival advantage, and procedures carry real physical consequences, it becomes wise to think carefully before proceeding. The question is not whether cancer is real. The question is whether every detected abnormality requires aggressive intervention, especially when many prostate cancers grow slowly and remain confined to the gland for years.

07:22 More Pain, More Benefit Theory

There is a basic principle in medicine that if we impose suffering, there should be a proportional gain. If a patient undergoes surgery, radiation, or hormone suppression that affects strength, bladder control, sexual function, and cognition, then there should be a clear and measurable survival benefit to justify that cost.

This principle becomes particularly relevant in prostate care. Surgery can lead to urinary incontinence, erectile dysfunction, infection, cardiovascular stress, and complications from anesthesia. Radiation can affect surrounding tissues and carry delayed consequences. Androgen deprivation therapy alters hormone balance and brings its own long list of side effects. These are not small inconveniences. They reshape daily life.

If these interventions consistently and clearly extended life in early-stage disease, the tradeoff might be easier to accept. However, when long-term data fail to show a dramatic survival difference between active treatment and observation in many cases, the equation becomes less convincing. Causing significant harm without clear proportional benefit does not align with thoughtful medical practice.

The endgame must always remain in view. Every test and every intervention should be evaluated not by how aggressive it sounds, but by whether it meaningfully changes long-term outcomes. Without that clarity, it is easy to follow a path simply because it has become standard, rather than because it has been proven superior.

08:22 PSA Test and Biopsy Utility

The PSA test has become deeply embedded in prostate care. It measures prostate-specific antigen, a protein produced by prostate tissue, and it tends to rise gradually as men age because the gland naturally enlarges. It can also increase in the presence of inflammation, infection, recent sexual activity, cycling, or other forms of irritation. While it may rise in prostate cancer, it does not diagnose cancer by itself.

For that reason, PSA must be interpreted carefully and in context. A single elevated number does not define a disease. It should be repeated, especially if there are possible temporary causes for the rise. Watching the pattern over time provides more insight than reacting to one isolated value.

Where difficulty begins is when PSA becomes a trigger for biopsy. The assumption is that tissue diagnosis provides certainty. Yet even a biopsy only samples small areas of the gland. It cannot reliably predict future behavior. It cannot tell whether abnormal cells will remain confined or eventually spread. And it cannot guarantee that the most aggressive area was even sampled.

At the same time, a biopsy is not harmless. It involves multiple large core needle punctures. Bleeding, infection, pain, and hospitalization are possible. In some cases, men land in the hospital for intravenous antibiotics due to post-biopsy infection. When we place a procedure with real risk against uncertain predictive value, the utility becomes less obvious.

So the PSA has a role, but that role is limited. It can serve as a monitoring tool. It can prompt closer observation. It should not automatically lead to tissue puncture without reflection. The presence of a number does not obligate a needle.

09:26 PI-RADS (Prostate Imaging Reporting and Data System)

If biopsy is not the first step, imaging becomes an important alternative. Multiparametric MRI of the prostate allows physicians to evaluate the anatomy of the gland without penetrating it. This imaging is interpreted using the PI-RADS scoring system, which stands for Prostate Imaging Reporting and Data System.

PI-RADS provides a structured scale, usually from 1 to 5, estimating the likelihood that clinically significant cancer may be present. Lower scores suggest low suspicion. Higher scores suggest greater concern. It functions somewhat like mammography scoring in breast imaging, offering a standardized way to communicate risk.

However, PI-RADS does not provide certainty. It estimates probability. It helps create a baseline. A man may have a PSA of a certain value and an MRI showing a PI-RADS 2 or 3 lesion. That combination offers context and a starting point for longitudinal follow-up. If future imaging remains stable and PSA trends slowly, that stability provides meaningful information without tissue disruption.

MRI also has limitations. It can identify suspicious regions, but it cannot predict with accuracy whether cells will remain dormant or become aggressive. No imaging study can forecast the future. What it does offer is a noninvasive method to observe structure and change over time. In the absence of a clear survival advantage from immediate intervention, the ability to monitor without trauma carries practical value.

11:07 Prostate-Specific Membrane Antigen (PSMA) PET Scan

The PSMA PET scan is another imaging tool, but its role is very different. PSMA stands for prostate-specific membrane antigen. This PET scan uses a tracer that binds to prostate cancer cells and can highlight areas of spread throughout the body.

It is not a screening test. It is not designed for men with only an elevated PSA and no confirmed diagnosis. Its most appropriate use is in men who already have biopsy-proven prostate cancer and need to determine whether the disease has moved beyond the gland. If the scan identifies metastatic lesions outside the prostate, then local treatment of the gland alone becomes less relevant.

For men without tissue confirmation, PSMA imaging is not the starting point. It does not replace careful clinical assessment. It does not substitute for thoughtful decision-making. It is a staging tool, not a screening solution.

Taken together, PSA, MRI with PI-RADS scoring, and PSMA PET imaging form a layered framework. PSA offers biochemical data. MRI provides structural evaluation. PSMA PET helps assess systemic spread when cancer has been established. None of these tools, however, can guarantee outcomes. They can inform, guide, and contextualize risk, but they cannot promise survival advantage from early aggressive action.

This is why every diagnostic step should be tied to the endgame. If a test leads only to interventions that have not clearly improved long-term survival in early disease, then its role must be reconsidered. Information has value, but only when it guides decisions that truly benefit the patient.

14:46 Understanding “Active Surveillance”

Active surveillance is often presented as the balanced option between immediate surgery and doing nothing. On the surface, it sounds reassuring. The word “active” suggests vigilance and control, while the word “surveillance” implies careful oversight.

In practice, active surveillance usually means repeated PSA testing, periodic imaging, and scheduled prostate biopsies over time. The intent is to monitor low-risk disease and intervene only if there are signs of progression. It was developed in response to growing awareness that immediate prostate removal or radiation did not clearly improve survival in many early-stage cases.

However, there is a critical issue at the center of active surveillance. The monitoring still depends heavily on biopsy. A biopsy cannot predict the future behavior of prostate cells. It cannot determine with certainty whether cells will remain confined to the gland or eventually leave it. It offers a snapshot, not a forecast.

Studies examining active surveillance have reached an important conclusion. There is no diagnostic study, whether a blood test, biopsy, imaging, or scoring system, that can reliably predict the aggressiveness of prostate cancer in an individual patient. That means even with surveillance, uncertainty remains.

If the abnormal cells stay inside the gland, they cannot harm you. Harm occurs when the disease extends beyond the prostate. The challenge is that current tools cannot definitively identify which early findings will behave aggressively and which will remain dormant. Active surveillance reduces immediate surgical harm, but it does not eliminate anxiety, repeated procedures, or the risk attached to each biopsy.

So the question becomes practical rather than emotional. If active treatment has not clearly reduced long-term mortality in early disease, and if surveillance still relies on invasive sampling, then each man must weigh whether that pathway aligns with his priorities and tolerance for repeated intervention.

15:24 Gleason Score

The Gleason score is a pathology grading system used after prostate tissue is examined under a microscope. It evaluates how abnormal the prostate cells appear compared to normal tissue. The more irregular and poorly organized the cells look, the higher the Gleason score.

A lower Gleason score generally suggests less aggressive cellular features. A higher score suggests a greater likelihood of aggressive behavior. On paper, this grading system appears logical. It categorizes what the cells look like and assigns a number that correlates with statistical risk patterns.

Yet there is a limitation that is often overlooked. While a higher Gleason score is associated with less favorable prognosis in broad population studies, there is no clear evidence that knowing the score automatically leads to a treatment that changes long-term survival in early-stage disease. In other words, the score describes cellular appearance, but it does not guarantee that intervention based on that appearance will alter the ultimate outcome.

This distinction is important. A Gleason score can inform risk discussions. It can guide how closely someone is monitored. What it cannot do is provide certainty about future behavior or ensure that aggressive therapy will eliminate risk.

When a biopsy is required to obtain the Gleason score, the decision to pursue it should be tied to what will meaningfully change afterward. If the result leads to interventions that carry documented harm without proven survival advantage in early disease, then the utility of obtaining that number deserves thoughtful evaluation.

Understanding active surveillance and the Gleason score requires clarity about what they can and cannot accomplish. They offer information. They do not offer guarantees. And in a condition where long-term outcomes often remain similar across different early treatment paths, the weight of each invasive step must be carefully considered.

16:19 Androgen Deprivation Therapy

Androgen deprivation therapy, often abbreviated as ADT, is commonly described in clinical language as hormone suppression. The phrase sounds technical and controlled, yet in practical terms, it means dramatically lowering or eliminating testosterone. Historically, this approach began in the 1940s when it was observed that men with advanced, painful metastatic prostate cancer sometimes experienced symptom relief when testosterone levels were reduced. In that late-stage setting, the intent was palliative. It was meant to reduce suffering, not to cure disease.

Over time, however, the use of ADT expanded. It began to appear earlier in the treatment pathway, sometimes after surgery or radiation when PSA levels started to rise, and sometimes even in men without symptoms. The reasoning often centers on lowering the PSA number and attempting to delay progression.

The problem is that lowering testosterone has predictable biological consequences. Testosterone supports muscle mass, bone density, cognitive sharpness, motivation, and sexual function. When it is suppressed, fatigue sets in. Muscle mass decreases. Body fat increases. Libido fades. Erectile function declines. Mood changes. Some men develop breast tissue. There is also evidence linking ADT to increased cardiovascular risk, metabolic disruption, cognitive decline, and possible higher rates of dementia.

In other words, the outcomes of testosterone suppression are not hypothetical. They are expected. They are measurable. And they affect daily life in a very real way. When ADT is used in men with advanced metastatic disease who are suffering significant symptoms, those trade-offs may be understandable. When it is used earlier, especially in men who feel well, the equation becomes far less clear.

Lowering a PSA number is not the same as improving survival. A rising PSA after treatment, often called biochemical recurrence, does not automatically predict imminent death from prostate cancer. The number can rise for years without symptoms. Chasing that number with aggressive hormonal suppression can create harm long before there is proof of benefit.

This is why any recommendation for androgen deprivation therapy must be evaluated with precision. What is the stage of the disease? Are there symptoms? What is the evidence that this intervention will meaningfully extend life? And what are the guaranteed consequences to strength, cognition, and quality of life? Those questions deserve honest answers before a man consents to hormone suppression.

19:04 Guaranteed Outcomes

When discussing prostate cancer treatment, one theme emerges repeatedly. The benefits are often uncertain, but the side effects are predictable. Surgery carries known risks. Radiation carries known risks. Androgen deprivation therapy carries known risks.

There is no guaranteed cure for removing the gland. There is no guaranteed cure from radiating the gland. There is no guaranteed survival benefit from suppressing testosterone in early or biochemically recurrent disease. What is guaranteed are the biological effects of each intervention.

If a man undergoes surgery, he faces a measurable risk of urinary leakage, erectile dysfunction, infection, blood clots, cardiovascular strain, and potential long-term complications. If he undergoes radiation, surrounding tissues such as the bladder and rectum may suffer delayed damage, sometimes appearing years later. If he undergoes androgen deprivation therapy, muscle loss, fatigue, metabolic change, cognitive dulling, and sexual dysfunction are expected outcomes.

These realities do not mean treatment is always wrong. They mean treatment should be chosen with clear awareness of what is certain and what is speculative. Guaranteed side effects should be weighed against unproven survival advantage in early-stage disease.

What to Do:

• Ask whether the proposed treatment has demonstrated a clear survival benefit in your specific stage of disease.
• Distinguish between lowering a PSA number and extending meaningful life.
• Clarify whether your disease is confined to the gland or has documented spread before considering aggressive therapy.
• Evaluate cardiovascular health and overall risk factors, since heart disease remains a leading cause of death in men with prostate cancer.
• Preserve muscle mass and metabolic health through strength training and appropriate nutrition.
• Consider imaging and longitudinal monitoring before consenting to invasive or hormone-suppressing treatments.
• Ensure that any decision aligns with your values regarding vitality, cognition, and independence.

At the end of the day, no physician can promise what will happen next. Medicine offers probabilities, not certainties. When outcomes are uncertain and harms are predictable, informed decision-making becomes the most powerful tool a man has.

Key Takeaway

Prostate cancer screening often begins with a PSA number, yet the path that follows can quickly move toward biopsy, surgery, radiation, or hormone suppression without clear proof that these steps extend life. Long-term trials have not demonstrated a meaningful reduction in prostate cancer mortality for many early-stage cases, even when the gland is removed or irradiated.

At the same time, the physical consequences of intervention are predictable. Urinary leakage, sexual dysfunction, metabolic decline, cardiovascular strain, and cognitive changes are documented outcomes. These effects are measurable, while the survival advantage remains uncertain.

The essential question is where each decision leads. Screening should support health and clarity, rather than push a sequence of treatments that carry certain harm with unproven long-term benefit.

Continue the Conversation

If this discussion raised new questions for you, there are related episodes that expand on these themes in greater detail:

EP09 – Don’t Biopsy Your Prostate Until You Hear This (Part 2)

EP10 – Managing an Elevated PSA: Avoiding Unnecessary Prostate Biopsies

For a broader explanation of the reasoning behind this perspective, Fight Cancer Like a Man by Dr. Stephen Petteruti presents these principles in a structured and practical format, outlining how to approach cancer prevention, screening, and treatment decisions with clarity.

If you would like continued access to extended clinical notes and member-only discussions, you can join the Intellectual Medicine Community here:

Membership: https://tinyurl.com/DrPetterutiMember

Sign up for Dr. Steve’s email newsletter: https://www.drstephenpetteruti.com

Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:

LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
Instagram: https://www.instagram.com/dr.stephenpetteruti
Facebook: https://www.facebook.com/dr.stephenpetteruti

Subscribe to the Intellectual Medicine Podcast:

Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
Spotify: https://tinyurl.com/DrPetterutiSpotifyPodcast

To support deeper reflection, referenced studies explore the long-term outcomes of observation compared with intervention. These data examine survival, treatment-related complications, and the biological consequences of biopsy and hormone suppression. Reviewing this literature allows patients and clinicians to move beyond habit and consider a more individualized approach to prostate health.

Suggested References

Don't just take my word for it. The following research challenges the 'standard of care' by highlighting the data on survival and the real cost of overtreatment. These studies are the map for moving away from blind protocols and toward biological precision.

Anastasiadis A, Zapała L, Cordeiro E, Antoniewicz A, Dimitriadis G, De Reijke T. Complications of prostate biopsy. Expert Rev Anticancer Ther. 2013;13(7):829-837. doi:10.1586/14737140.2013.811056

Martin RM. Commentary: prostate cancer is omnipresent, but should we screen for it?. Int J Epidemiol. 2007;36(2):278-281. doi:10.1093/ije/dym049

Muniyan S, Xi L, Datta K, et al. Cardiovascular risks and toxicity - The Achilles heel of androgen deprivation therapy in prostate cancer patients. Biochim Biophys Acta Rev Cancer. 2020;1874(1):188383. doi:10.1016/j.bbcan.2020.188383

Lane, Janet Athene et al. “Functional and quality of life outcomes of localised prostate cancer treatments (Prostate Testing for Cancer and Treatment [ProtecT] study).” BJU international vol. 130,3 (2022): 370-380. doi:10.1111/bju.15739

Sarici H, Telli O, Yigitbasi O, et al. Predictors of Gleason score upgrading in patients with prostate biopsy Gleason score ≤6. Can Urol Assoc J. 2014;8(5-6):E342-E346. doi:10.5489/cuaj.1499

Disclaimer

This podcast and its accompanying materials are for educational purposes. They are intended to support thoughtful decision-making and improve health literacy. They are not a substitute for individualized medical advice, diagnosis, or treatment. Always consult your qualified healthcare professional regarding personal medical concerns.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without written permission is prohibited.

Host: Intellectual Medicine by Dr. Stephen Petteruti (Member Version)

Date: April 22, 2025

Episode Summary

• The goal of prostate cancer treatment should be to offer choices, credible information, and options that promote vitality and health.
• Conventional treatments like surgery, radiation, and chemical castration are widely used but often cause harm without significantly improving survival rates.
• There are alternatives to these aggressive treatments that focus on active monitoring, reducing harm, and enhancing overall health without invasive procedures.
• The Intellectual Medicine approach emphasizes informed decision-making, a deeper understanding of the disease, and focusing on long-term well-being instead of unnecessary interventions.

Quick Checklist

When considering your prostate health, the key is making informed, thoughtful decisions. Here are the essential steps you can take to evaluate and manage your risk, without jumping into aggressive treatments too quickly:

• Evaluate your prostate health with PSA, PHI, and MRI (PIRADS score).
• Consider non-invasive treatments instead of surgery or radiation.
• Look into repurposed drugs.
• Reduce carcinogens with detox methods like DMSA.
• Make informed decisions based on credible research, not emotional pressure.

00:00 Introduction

What a good doctor wants for you is choices, information, things that you can trust, things that you can apply, and things that can be monitored actively. Because in the end, the job of your doctor is to present you with alternatives and treat you based on your choices.

For decades, men have been told that removing or irradiating the prostate makes intuitive sense. If something looks abnormal, take it out. The logic sounds decisive. The outcomes, however, have been disappointing.

If you look at long-term survival data through a wider lens, what it shows for certain is that conventional therapy only guarantees pain, extra expenses, and hardship. And most patients who signed up for them only wanted to be free from the illness they felt was a threat to their lives.

That does not mean doing nothing. One thing science has continuously encouraged is that people should keep on gathering credible information and getting safer options. So, thanks to science, we now have other ways to evaluate elevated PSA and prostate risk that focus on vitality, safety, and active monitoring rather than reflexive intervention.

02:38 Removal Guaranteed Harm

When it comes to prostate cancer treatment, the decision to remove or irradiate the prostate may seem logical, especially when something looks abnormal. However, the long-term survival data have shown that these treatments guarantee harm rather than offering a significant survival benefit. Numerous studies conducted over 15 years reveal that aggressive treatment, such as prostate removal or radiation, does not improve survival rates significantly.

While these treatments are not without merit, the evidence supporting their benefits is weak at best. In the world of medicine, there is a basic principle: "First, do no harm." If a procedure like surgery or a biopsy is going to cause harm, it needs to be backed by a clear, substantial benefit. For prostate cancer, however, these procedures offer little more than pain and additional hardship.

Think about it: What other form of cancer would we continuously stick needles into, identifying cancer cells, and then just keep doing it periodically? This approach begs for a reevaluation of how we’re diagnosing and treating prostate cancer. While urologists have their skillset, which sometimes includes biopsies, surgery, and radiation, they are limited in their approach to the bigger picture. A different perspective is needed, and that’s where alternative treatment strategies come in.

04:10 Chemical Castration

One of the most controversial treatments for prostate cancer is androgen deprivation therapy (ADT), also known as chemical castration. In the judicial system, chemical castration is considered cruel and unusual punishment, and yet, it is still recommended for prostate cancer patients.

You might be wondering what the reason for this is. Androgen deprivation therapy aims to lower testosterone levels in men, slowing the growth of prostate cancer cells. However, this treatment often comes with severe consequences. ADT has been known to lead to debilitating symptoms such as fatigue, muscle loss, depression, and mental fog. Worse still, it is often applied when PSA levels continue to rise despite treatment, creating a situation where patients are subjected to even more harm with no guarantee of improved outcomes.

While it might seem logical to turn to ADT in such cases, the reality is that the rising PSA levels do not necessarily indicate that the cancer is progressing. PSA is an imperfect marker, and its rising levels are often used as a justification for harsh treatments like castration. In the end, patients may experience a reduction in PSA levels, but at the cost of their well-being, without any clear evidence of long-term benefit.

04:36 Understanding PSA Results

PSA, or prostate-specific antigen, is a widely used marker for prostate cancer detection, but it is far from a perfect diagnostic tool. A rising PSA level does not necessarily mean that prostate cancer is progressing. It is not a direct indicator of cancer spread or metastasis, yet it is often used as the primary justification for aggressive treatments like biopsy or castration.

For many men, a rising PSA is treated as an urgent signal to take immediate action. However, this false urgency leads to unnecessary procedures and treatments that can cause more harm than good. The PSA test alone cannot tell the full story of prostate health, and interpreting its results requires caution and a comprehensive understanding of a patient’s overall health, age, and risk factors.

To move beyond this reliance on PSA as the primary indicator for prostate cancer progression, it's important to consider alternative diagnostic tools, such as advanced imaging and non-invasive biomarkers, which can offer a more accurate picture of the cancer’s behavior without subjecting patients to invasive procedures that may cause unnecessary harm.

Next steps to take about your prostate

You don’t need a tissue diagnosis to decide how to proceed. There’s no need to stick a needle in your prostate to make informed decisions. The objective should be to protect your vitality and health. Creating an internal environment that’s inhospitable to cancer is far more effective than reflexively turning to aggressive treatments.

Most prostate cancer cells are not actually cancerous. Instead, they’re atypical dormant cells (ADC). These cells can remain in the prostate gland for a lifetime without causing harm. Research has shown that many men over 90 years old have ADCs in their prostate glands without any signs of cancer. So, another option is to live with these dormant cells without subjecting your body to unnecessary interventions.

The problem is sometimes due to the lack of a definitive test to confirm whether these cells have left the prostate gland. However, advanced imaging techniques can help monitor any changes. A careful, proactive approach can give you the peace of mind that you’re making informed choices while avoiding unnecessary harm.

If you’ve already undergone a biopsy, radiation, or even scheduled prostate surgery, don’t panic. You can still change your course. Take time to reflect and consider alternatives. You’re not stuck with one path, especially if it involves painful procedures with unclear benefits. 

Treatment Bias explained

There’s a major bias in the medical field surrounding prostate cancer treatments. For decades, doctors have been under the assumption that aggressive treatments like surgery and radiation improve survival rates. Yet, research has shown no significant difference in survival outcomes between patients who undergo these treatments and those who don’t, particularly in early-stage prostate cancer.

Many patients undergo surgery or radiation, convinced that these treatments will save their lives. However, the reality often doesn’t match the expectation. After surgery, some men face painful side effects such as leaking urine or erectile dysfunction. Despite these negative effects, many attribute their survival to the surgery, even if the outcome was merely a coincidence.

This mindset, known as the “philosophy of regret,” is prevalent in conventional medicine. Patients feel pressured to believe that the suffering was worth it because they survived, while the medical community often feels validated in their decision-making. But what’s often missing from this narrative is the truth: Many of these treatments don’t necessarily provide a survival benefit.

The non-biopsy approach

At Intellectual Medicine, we focus on a non-biopsy approach for evaluating prostate cancer risk. This method involves using biometrics and imaging studies to assess the risk of progression or metastasis, without the need for invasive procedures. By taking a more thoughtful approach, a clearer picture of a man’s prostate health can be provided and can be used to guide the patient through the decision-making process.

Three key factors are considered for a non-invasive evaluation:

1. PSA (Prostate-Specific Antigen): A blood test that can indicate elevated prostate levels.
2. PHI (Prostate Health Index): A more comprehensive biomarker that provides additional insight.
3. Prostate MRI: A scan that helps visualize the prostate and its condition.

For men with low-risk profiles, such as a PSA below 20, a PHI under 55, and a PIRADS score of 0 to 3 from an MRI, no biopsy is recommended. Instead, the Intellectual Medicine pathway can be followed. This includes incorporating lifestyle changes, nutrition, supplementation, and repurposed drug therapy.

The aim of this process is normally to keep cancer cells in the prostate and prevent them from spreading. This method helps monitor prostate cancer and contributes to the overall well-being of the patient. The non-biopsy approach is safe, sustainable, and effective, offering an alternative to aggressive treatments that can cause more harm than good.

11:52 Pathway (stage) one risk criteria

When evaluating prostate cancer risk, the first step is to assess your current status through three key tests. These include the PSA level, which should be under 20, the Prostate Health Index (PHI), which should be below 55, and the MRI of the prostate, with a PIRADS score ranging from 0 to 3. These tests are relatively affordable and often covered by insurance, making them accessible for most men.

At this stage, what you should be focused on is ensuring safety. Like the patients, doctors want treatments that don’t cause harm, which is why repurposed drugs are an important option. Drugs like metformin and serolimus have been shown to have anti-cancer effects and can help improve overall health without introducing significant side effects. Metformin, typically used to control blood sugar, has been associated with lower cancer risks and costs just a few dollars a month. Similarly, serolimus is a drug with anti-aging properties that can support mitochondrial vitality, helping the body fight cancer.

These drugs are generally well-tested and have a known safety profile. In contrast to newer treatments, they are less likely to cause unexpected adverse effects. Additionally, other strategies such as doxycycline (an antibiotic used at low doses for its effects on stem cells) and nalrexone (which helps reduce inflammation) are also valuable in managing prostate cancer at this stage.

16:09 Reducing carcinogens

One of the most important steps in any prostate cancer prevention strategy is reducing exposure to carcinogens. Industrial byproducts like cadmium, arsenic, and lead are all around us, from contaminated food and water to environmental pollution. While it is almost impossible to avoid them, there are ways to mitigate their harmful effects on the body.

One effective method is using DMSA, a prescription drug that helps detoxify the body by removing these carcinogenic metals. The Intellectual Medicine protocol suggests using DMSA in periodic detox cycles, about twice a year for four weeks. Reducing the level of carcinogens in the body lowers the risk of not only prostate cancer but also heart disease and cognitive decline.

By combining this detox strategy with other health-enhancing treatments, cancer can be prevented without resorting to harmful conventional therapies. The key is safety and long-term health improvement, ensuring that the body is not exposed to toxic substances that might fuel cancer growth.

18:06 Pathway two criteria

If your PSA level is over 20, your PHI score exceeds 55, or your PIRADS score from the MRI is greater than 3, this signals a higher risk for prostate cancer. At this stage, the risk profile is higher, but you are still asymptomatic, and there’s no evidence of cancer spread beyond the prostate. In this case, additional treatments come into play to help slow down the cancer’s progression without causing significant harm.

Subcutaneous mistletoe injections are one such treatment. Misteltoe, commonly used in Europe, is an immune system booster that helps your body fight cancer more effectively. This treatment is safe and relatively inexpensive, making it a practical option for many men. Another option at this stage is ivermectin, which has shown some promise in combating cancer at low doses. Both treatments focus on strengthening the body’s natural defenses against cancer and do not carry the same risks as invasive therapies.

It’s important to consult a skilled healthcare provider before starting these treatments. Self-administration of treatments without proper guidance can lead to complications. Make sure to seek professional advice and support as you navigate these options.

20:40 Rely upon deeper research

When it comes to prostate cancer, research is your best tool. There is a growing body of evidence suggesting that treatments like chemical castration and radiation may actually increase risks for heart disease and dementia.

This highlights the importance of turning to deeper research and relying on evidence-based, non-invasive approaches to managing prostate cancer. The plan should be to create a treatment plan that does not cause harm and is based on solid scientific understanding. This is why Intellectual Medicine advocates for approaches that focus on prevention, monitoring, and holistic health instead of relying on conventional treatments with weak evidence of benefit.

Take your time to explore these alternative pathways, as they offer a safer way forward. Focus on maintaining vitality and health by making well-informed, researched choices that benefit your overall well-being. Whether through lifestyle modifications, nutritional changes, or repurposed drug therapy, there’s a path forward that doesn’t involve unnecessary pain or hardship.

21:08 Pathway 3 and its approach

When prostate cancer progresses beyond the prostate gland, it is classified as stage three. At this point, positive imaging studies, such as a bone scan or a PSMA PET scan, can detect lesions in the bones or other organs. The good news is that even at this stage, prostate cancer remains vulnerable and can still be managed.

Prostate cancer tends to move slowly, and the focus should always be on maintaining vitality. Castration therapy, or androgen deprivation therapy, should never be considered for this stage. While it might be applied in cases with symptoms like urinary blockages or severe bone pain, it does not offer any guarantee of curing the cancer. The side effects make this treatment unsuitable for many.

At this stage, it is important to work closely with an oncologist. If prostate cancer has spread to the bones, targeted radiation can help strengthen the bones. However, there should be no radiation or surgery to the prostate itself. Alternative therapies, such as an anti-helminthic drug, may be useful, but they should only be taken under a physician's supervision.

23:45 Possibility of benefits with absence of harm

The treatments advocated in Intellectual Medicine do not cure prostate cancer, but they focus on offering potential benefits without causing harm. Traditional treatments like surgery, radiation, and chemical castration often come with debilitating side effects, such as erectile dysfunction, incontinence, and mental fog. The aim is to focus on preventing harm while still offering a chance for benefits.

While no treatment can guarantee a cure, avoiding unnecessary suffering and preserving quality of life are paramount. The focus of Intellectual Medicine is to ensure that treatments do not cause more harm than benefit, especially when conventional treatments have proven to be ineffective in extending life. The approach centers on vitality and health, providing patients with alternative options that prioritize well-being.

25:07 The importance of having choices

What sets Intellectual Medicine apart is the emphasis on providing patients with choices, empowering them with the information, resources, and strategies to make informed decisions about prostate health. Conventional medicine tends to narrow the options to surgery, radiation, and castration, but these treatments often come with irreversible consequences and uncertain outcomes. Offering alternatives that focus on prevention and holistic well-being is vital.

The priority is always on providing credible, balanced information so that patients can make decisions based on their health and vitality. With continuous research and updated treatments, this approach offers a better way forward, allowing patients to avoid unnecessary pain and hardship while still actively managing their prostate health.

It is very important to provide men with the tools they need to take control of their health. By offering safe, sustainable options, Intellectual Medicine aims to create a nationwide infrastructure for better prostate cancer management. Although the approach may not be suitable for everyone, it is based on real-world outcomes and thoughtfulness, empowering patients to make the right choices for their health.

Key Takeaway

Prostate cancer management doesn’t have to follow the traditional path of surgery, radiation, or chemical castration. By focusing on alternatives that prioritize vitality, safety, and informed decision-making, men can avoid the unnecessary harms of conventional treatments. 

The approach of Intellectual Medicine emphasizes non-invasive strategies like repurposed drugs, lifestyle changes, and active monitoring, allowing patients to manage prostate cancer without sacrificing their quality of life. It’s crucial to have choices, gather credible information, and consider safer, more holistic options that focus on long-term well-being instead of immediate, aggressive interventions.

Continue the Conversation

If this discussion raised new questions for you, there are related episodes that expand on these themes in greater detail:

EP15 – Beyond the Hype: Why Ivermectin Isn’t the Answer — and What Might Be

EP28 – Prostate Supplements Explained: What Science Actually Shows vs Common Assumptions

For a broader explanation of the reasoning behind this perspective, Fight Cancer Like a Man by Dr. Stephen Petteruti presents these principles in a structured and practical format, outlining how to approach cancer prevention, screening, and treatment decisions with clarity.

If you would like continued access to extended clinical notes and member-only discussions, you can join the Intellectual Medicine Community here:

Membership: https://tinyurl.com/DrPetterutiMember

Sign up for Dr. Steve’s email newsletter: https://www.drstephenpetteruti.com

Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:

LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
Instagram: https://www.instagram.com/dr.stephenpetteruti
Facebook: https://www.facebook.com/dr.stephenpetteruti

Subscribe to the Intellectual Medicine Podcast:

Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
Spotify: https://tinyurl.com/DrPetterutiSpotifyPodcast

Suggested References

Don't just take my word for it. The following research challenges the 'standard of care' by highlighting the data on survival and the real cost of overtreatment. These studies are the map for moving away from blind protocols and toward biological precision.

C, Jacklin et al. “More men die with prostate cancer than because of it" - an old adage that still holds true in the 21st century.” Cancer treatment and research communications vol. 26 (2021): 100225. doi:10.1016/j.ctarc.2020.100225

Hamdy, Freddie C et al. “Fifteen-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Prostate Cancer.” The New England Journal of medicine vol. 388,17 (2023): 1547-1558. doi:10.1056/NEJMoa2214122

Kishan, Amar U, and Patrick A Kupelian. “Late rectal toxicity after low-dose-rate brachytherapy: incidence, predictors, and management of side effects.” Brachytherapy vol. 14,2 (2015): 148-59. doi:10.1016/j.brachy.2014.11.005

Ladjevardi, Sam et al. “Prostate biopsy sampling causes hematogenous dissemination of epithelial cellular material.” Disease markers vol. 2014 (2014): 707529. doi:10.1155/2014/707529

Nead, Kevin T et al. “Association Between Androgen Deprivation Therapy and Risk of Dementia.” JAMA oncology vol. 3,1 (2017): 49-55. doi:10.1001/jamaoncol.2016.3662

Wilt, Timothy J et al. “Follow-up of Prostatectomy versus Observation for Early Prostate Cancer.” The New England Journal of medicine vol. 377,2 (2017): 132-142. doi:10.1056/NEJMoa1615869

Disclaimer

This podcast and its accompanying materials are for educational purposes. They are intended to support thoughtful decision-making and improve health literacy. They are not a substitute for individualized medical advice, diagnosis, or treatment. Always consult your qualified healthcare professional regarding personal medical concerns.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without written permission is prohibited.

Host: Intellectual Medicine by Dr Stephen Petteruti (Member Version)

Date: Apr 29, 2025

00:00 Introduction

For most men, getting an erection is an important physical trait. It is something men value and something many hope to maintain throughout life. Yet male sexuality does not stop at hardness alone. It includes desire, confidence, hormone balance, emotional connection, and long-term vitality.

From puberty, testosterone surges awaken sexual awareness. From that stage, boys begin to experience morning erections, spontaneous desire, and physical curiosity as part of early development. Those early encounters often shape how a man sees himself for decades. When sexual function is strong, confidence tends to follow. So when difficulty with erections begins to creep in, the psychological weight can be significant, even if it is rarely discussed openly.

As this subject gains more public attention, many voices now offer opinions on maintaining and restoring erections and male sexuality in general. It is an area surrounded by both science and misinformation. Getting the wrong guidance can damage sexual confidence and overall health.

01:38 Performance anxiety and psychological impact

Performance anxiety is one of the most common causes of erectile difficulty, especially in younger men, and it often has little to do with physical illness. Men under the age of 30 frequently experience erectile dysfunction because of nervousness, fear of failure, or overwhelming self-consciousness during sexual activity. When anxiety rises, the body shifts into a fight or flight state. In that state, blood is directed toward large muscles and away from the penis. An erection requires calmness and a sense of safety, so when the brain senses pressure or threat, even if that threat is emotional, the body does not respond the way a man expects.

This can create a cycle that feeds on itself. A man worries about whether he will get an erection, and that worry alone makes it harder to achieve one. After one difficult experience, the fear of repeating it can grow stronger. Over time, confidence may begin to decline, and sexual encounters can start to feel like tests rather than moments of connection. In many cases, when the anxiety is addressed and the pressure is reduced, erectile function improves without medication because the underlying issue was psychological, not physical.

As men move into their 30s and 40s, the source of stress often changes. Instead of fear during a new sexual experience, the pressure may come from work, finances, family responsibilities, or lack of sleep. Chronic stress increases cortisol levels, which can interfere with testosterone production and sexual desire. By the time men reach their 50s, ageing of blood vessels and medical conditions such as high blood pressure or diabetes may begin to play a larger role. Emotional events such as retirement or loss of a partner can also affect sexual confidence. Understanding the stage of life you are in helps put erectile difficulty into perspective rather than viewing it as personal failure.

04:18 Communication is vital

Sexual health improves when communication is open and respectful. Many men carry concerns silently, which increases internal tension. That tension can appear during intimacy as hesitation or performance difficulty. When partners communicate honestly about expectations, preferences, and fears, the emotional pressure decreases, and the connection becomes stronger.

Timing influences how well these conversations go. Discussing performance immediately after intimacy can feel like an evaluation, which may increase defensiveness. It is often better to talk in a neutral setting when both partners feel relaxed. Some couples even find that introducing sensitive topics through a written message gives both people time to process their thoughts before responding. The purpose is to understand and support each other.

Your environment also shapes your sexual experience. Privacy and a sense of security support relaxation. For couples with children at home or busy schedules, planning intimate time can actually reduce pressure because both partners enter the moment prepared rather than rushed. As men age, sexual response may require more preparation than it did in early adulthood. Adequate sleep, reduced stress, and moderate alcohol intake all support better performance. Alcohol, which may have felt stimulating at age 20, often weakens erection strength later in life when consumed beyond small amounts. Accepting that the body changes over time helps reduce unrealistic expectations.

06:45 Healthy erection key elements

A healthy erection depends on several systems working together smoothly. Blood flow is central because the penis relies on healthy arteries to fill and maintain firmness. Erectile dysfunction can sometimes appear years before heart disease becomes obvious. For men over 50, evaluating cardiovascular health through blood pressure checks, cholesterol testing, blood sugar assessment, and, in some cases, coronary calcium scoring can provide useful information. If circulation is compromised, erection quality often declines as well.

Hormones are another essential part of the picture. Testosterone supports libido, energy, and erectile response. There is no single number that defines what level is right for every man, which is why symptoms must be considered alongside laboratory results. Reduced desire, fatigue, and weaker erections can signal that testosterone levels are no longer optimal for that individual. Thyroid function and blood sugar control also deserve attention because imbalances in these areas can interfere with sexual performance. Diabetes, in particular, increases the risk of erectile dysfunction due to its effects on nerves and blood vessels.

Physical conditioning strengthens both circulation and hormone balance. Regular cardiovascular exercise improves endothelial function, which supports blood vessel flexibility. Maintaining a healthy body composition reduces strain on the heart and supports metabolic stability. Sexual response also depends on the appropriate stimulus and mental relaxation. Men are often visually stimulated, yet attraction is personal and varies widely. When the nervous system feels safe and relaxed, blood vessels can open properly and support a firm erection.

When anxiety, stress, poor circulation, or hormone imbalance disrupts this balance, erectile difficulty can develop. Instead of reacting with fear, a structured evaluation of heart health, hormone levels, stress load, and lifestyle habits offers clarity. Sexual health reflects overall health, and strengthening the body as a whole supports long-term vitality and confidence.

10:34 PDE-5 drugs: Sildenafil and Tadalafil

The most widely used medications for erectile dysfunction belong to a group called PDE-5 inhibitors. The two most recognized are sildenafil, known by the brand name Viagra, and tadalafil, known as Cialis. These medications increase blood flow to the penis, making it easier to achieve and maintain an erection when sexual stimulation is present.

Tadalafil has gained special attention in recent years because daily low-dose use has been linked in medical literature to additional health benefits. Studies have shown that men who take 5 milligrams of tadalafil daily may experience reduced risk of heart attack, stroke, and even dementia. It also improves urinary flow in men with prostate enlargement. This means that for many men, tadalafil supports vascular health beyond sexual performance.

Some men use tadalafil daily and add sildenafil on occasions when stronger support is needed. Timing plays a role. Sildenafil works best when taken on an empty stomach about one to two hours before intimacy. If the moment passes and sex does not happen, there is no lasting harm beyond minor cost.

Side effects are usually mild and may include headache, nasal congestion, or flushing. Because these medications can lower blood pressure, men who are already on blood pressure medication should work closely with a physician before starting them.

It is important to understand that PDE-5 drugs do not create desire. Sexual stimulation must still be present. If a man is anxious and focused on whether he will perform well, the medication alone may not overcome that mental barrier. The brain must be relaxed enough to allow the medication to work effectively.

13:25 Alprostadil vs Caverject

When oral medications are not enough, injectable therapy can provide reliable support. Alprostadil is a medication injected directly into the base of the penis. Caverject is a branded version of alprostadil. Many clinicians also prescribe a compounded blend called Trimix, which combines three vasodilating agents to improve blood flow.

Although the idea of an injection sounds intimidating, the needle used is extremely small and most men report very little discomfort. The benefit of injectable therapy is speed and reliability. Within five to ten minutes, increased blood flow begins, often before psychological tension has time to interfere. For men dealing with performance anxiety, this early physical response can reduce mental pressure because the erection begins developing regardless of anxious thoughts.

These injections are usually limited to two or three times per week and should not be used on consecutive days. Caution is required if combining injectable therapy with PDE-5 drugs, and medical supervision is important to prevent complications such as prolonged erection.

Trimix is generally affordable and highly effective when used correctly. For men who have struggled with inconsistent results from pills alone, injectable therapy can restore confidence and consistency in sexual performance.

15:45 Peptide therapy

Peptide therapy represents another option, particularly when libido is low rather than blood flow alone being the issue. Two peptides discussed in clinical practice are PT-141 and melanotan. These are non-hormonal agents that act on the brain centers responsible for sexual desire.

PT-141 works by stimulating melanocortin receptors in the brain, enhancing sexual arousal and improving erectile response. Melanotan was originally studied for its potential to increase skin pigmentation and reduce skin cancer risk by stimulating melanin production. An unexpected effect observed during development was increased sexual desire. Some men also report improved erectile quality and enhanced climax.

Both peptides are usually administered by injection. Inhaled forms exist but tend to be less reliable. Melanotan may also influence appetite and weight, though long-term studies remain limited. Importantly, these peptides are not approved by the FDA for erectile dysfunction, and research regarding their long-term safety remains incomplete.

Because of this, they should only be used under the guidance of a clinician experienced in functional or anti-aging medicine. Purchasing these compounds online without supervision carries risks related to dosing accuracy and product purity.

Even with advanced therapies available, it is worth remembering that sexual intimacy does not depend entirely on erection quality. Many couples maintain deeply satisfying sexual relationships through creativity, communication, and mutual stimulation. Penetration is not the primary source of pleasure for many women, and men can achieve orgasm without full rigidity.

Medical support can strengthen performance, but emotional connection, reduced pressure, and mature intimacy often have equal influence on long-term sexual vitality.

18:58 Parallel orgasmic activity

Sexual intimacy does not begin and end with penetration. Many couples place pressure on erection strength, as if that alone determines success. In reality, connection and shared pleasure sustain long-term intimacy. When erection quality fluctuates, there are still meaningful ways to experience closeness and climax together.

Parallel orgasmic activity refers to non-penetrating stimulation where both partners are engaged at the same time. This can involve stimulating a woman’s clitoris while the man stimulates his own penis, or while partners stimulate each other. In many situations, self-stimulation reduces self-consciousness and helps a man stay focused on sensation rather than performance.

The purpose of sexual activity in a committed relationship is bonding. It builds closeness, emotional safety, and connection. Research consistently shows that couples who maintain regular sexual contact report higher relationship satisfaction. The frequency varies. Some couples prefer daily intimacy, while others thrive with less. Clinical observation suggests that roughly once per week serves as a healthy minimum for maintaining physical connection. When intimacy drops to once or twice per month, emotional and physical distance can slowly increase.

Temporary erection challenges should never become a reason to withdraw from physical closeness. Creativity, communication, and shared pleasure preserve intimacy even during periods of adjustment.

20:27 Different types of libido

Libido changes with age, and understanding that shift prevents unnecessary anxiety. There are two main patterns of desire: spontaneous libido and reactive libido.

Spontaneous libido is common in younger men. It appears suddenly and without planning. A visual cue, a passing thought, or a memory can trigger desire immediately. Many men remember adolescence, when erections happened without warning. This type of desire tends to decline gradually over time, even when hormone levels are well supported.

Reactive libido becomes more common in adulthood. This form of desire develops in response to touch, closeness, or anticipation. It builds during foreplay or emotional connection rather than appearing out of nowhere. This transition is normal and does not signal dysfunction.

Men in their forties and beyond often juggle work, family, and responsibilities. Stress competes with desire. Setting aside intentional time for intimacy may feel structured, yet it allows the mind and body to prepare. When both partners expect closeness, reactive libido activates more easily. Recognizing this shift helps men adjust without assuming something is wrong.

What to Do:

• Accept that libido changes with age. A shift from spontaneous to reactive desire is common and does not mean something is broken.
• Schedule intentional time for intimacy when life becomes busy. Preparation reduces stress and supports responsive desire.
• Focus on foreplay and emotional connection to activate reactive libido naturally.
• Manage stress through sleep, exercise, and open communication with your partner.
• If desire remains low despite lifestyle adjustments, evaluate testosterone levels, thyroid health, blood sugar, and cardiovascular status with a qualified clinician.

22:59 Staying vital and prioritizing intimacy

Long-term sexual vitality depends on protecting physical health, hormone balance, and emotional connection. Certain medications interfere with libido and erection quality. Some blood pressure drugs, antidepressants, antipsychotics, and hormone suppression therapies are known to reduce sexual drive. Men who notice changes after starting medication should discuss concerns with the prescribing physician, since adjustments may be possible.

Hormone balance plays a central role. Testosterone supports libido, energy, and erectile response. Chronic stress, untreated medical conditions, and metabolic issues can weaken that system. Cardiovascular health is equally important because erections depend on steady blood flow. Men who protect heart health often protect sexual function at the same time.

Intimacy also requires intention. Couples who value connection create space for it. They communicate clearly about preferences and concerns. They adapt to changes in schedule and energy levels. Sexuality evolves with age, yet it does not disappear unless it is neglected.

Remaining sexually active across decades is achievable. Sexual connection strengthens bonding, emotional stability, and overall well-being. When men care for their health, manage stress, and stay open with their partners, intimacy remains part of life rather than a fading memory.

Key Takeaway

Male sexual health is not defined by erection strength alone. It reflects hormone balance, blood flow, mental state, relationship connection, and overall physical health. When any one of these areas is neglected, sexual performance can suffer, but that does not mean vitality is lost.

Performance anxiety, stress, poor sleep, cardiovascular disease, medication side effects, and declining testosterone can all influence erections and desire. Many of these factors are measurable and treatable. Others require communication, preparation, and maturity rather than medication.

Spontaneous libido often turns into reactive libido with age, and that change is normal. Intimacy can remain strong when couples adapt instead of panicking.

Continue the Conversation

If this discussion sparked new thoughts, there are other episodes that build on these ideas and examine them from different angles:

EP06 – The Truth About Testosterone: Does It Really Cause Prostate Cancer?

EP14 – Testosterone, Aging, and Vitality: What Medicine Isn’t Telling You

For a deeper and more structured look at this philosophy, Fight Cancer Like a Man by Dr. Stephen Petteruti walks through prevention, screening, and treatment decisions in a practical and direct way. It lays out the reasoning behind prioritizing vitality, safety, and informed choice.

If you would like access to extended clinical notes and member-only discussions, join the 

Intellectual Medicine Community:
Membership: https://tinyurl.com/DrPetterutiMember
Sign up for Dr. Steve’s email newsletter: https://www.drstephenpetteruti.com
Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:
LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
Instagram: https://www.instagram.com/dr.stephenpetteruti
Facebook: https://www.facebook.com/dr.stephenpetteruti

Subscribe to the Intellectual Medicine Podcast:
Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
Spotify: https://tinyurl.com/DrPetterutiSpotifyPodcast

Suggested References

Don't just take my word for it. The following research challenges the 'standard of care' by highlighting the data on survival and the real cost of overtreatment. These studies are the map for moving away from blind protocols and toward biological precision.

How do stress and anxiety affect sexual performance and erectile dysfunction? Healthy Male. December 22, 2023. Accessed Feb 18, 2026. https://healthymale.org.au/health-article/how-do-stress-and-anxiety-affect-sexual-performance-and-erectile-dysfunction

Kaplan, Alan L et al. “Testosterone Therapy in Men With Prostate Cancer.” European urology vol. 69,5 (2016): 894-903. doi:10.1016/j.eururo.2015.12.005

Klap, Julia et al. “The relationship between total testosterone levels and prostate cancer: a review of the continuing controversy.” The Journal of urology vol. 193,2 (2015): 403-13. doi:10.1016/j.juro.2014.07.123

Mohammad, Osama S et al. “Supraphysiologic Testosterone Therapy in the Treatment of Prostate Cancer: Models, Mechanisms and Questions.” Cancers vol. 9,12 166. 6 Dec. 2017, doi:10.3390/cancers9120166

Wilt, Timothy J et al. “Follow-up of Prostatectomy versus Observation for Early Prostate Cancer.” The New England journal of medicine vol. 377,2 (2017): 132-142. doi:10.1056/NEJMoa1615869

Disclaimer

This podcast and its accompanying materials are for educational purposes. They are designed to support thoughtful decision-making and improve health literacy. They do not replace individualized medical advice, diagnosis, or treatment. Always consult your qualified healthcare professional regarding personal medical concerns.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without written permission is prohibited.

Host: Intellectual Medicine by Dr. Stephen Petteruti (Member Version)

Date: May 6, 2025

Episode Summary

• Testosterone supports brain speed, mood stability, muscle strength, bone health, sexual function, and long-term vitality.
• Age-related testosterone decline is common, but symptoms such as low energy, reduced libido, loss of muscle, and brain fog should be evaluated rather than dismissed.
• Blood tests establish safety baselines, but free testosterone is the active form and often more important than total levels.
• Properly supervised testosterone therapy does not show increased risk of prostate cancer or heart attack in current research and requires monitoring of PSA, blood count, and estrogen.
• Long-term vitality depends on informed decisions, hormone balance, strength training, and preserving independence with age.

Quick Checklist

Before starting or continuing testosterone therapy, keep the main safety and monitoring steps in view. Testosterone affects the whole body, so decisions should be thoughtful and structured rather than casual. This checklist serves as a clear guide for safe and long-term use:

• Obtain baseline labs before therapy, including PSA, complete blood count, thyroid panel, and both total and free testosterone.
• Evaluate symptoms alongside lab results. Loss of libido, low energy, poor recovery, depressed mood, and reduced strength should be considered during assessment.
• Monitor hemoglobin, hematocrit, and estrogen levels during treatment to prevent complications such as erythrocytosis or hormonal imbalance.
• Preserve testicular function when using testosterone by incorporating appropriate medical support under physician supervision.
• Maintain supportive habits such as strength training, body fat control, adequate sleep, and stress regulation to enhance long-term outcomes.

00:00 Introduction

Testosterone is often treated as if it only affects sex drive or muscle size. In reality, that is only a fragment of the truth. The body uses testosterone to support brain function, mood, strength, bone health, energy, and long-term vitality. Because testosterone levels drop gradually over time, many people hardly notice the change at first, yet the signs are usually present. You may feel tired without a clear reason, think a little slower than before, or notice that recovery after exercise takes longer than it did a few years ago.

Medicine has made decline sound normal. Brain fog is called aging, muscle loss, and low energy are brushed aside and treated like the normal life cycle. Yet when the thyroid gland slows down, doctors replace thyroid hormone. The testicles are also hormone-producing organs. When their output fades, the effect spreads through the entire body.

Testosterone works like a messenger. It helps brain cells communicate, supports muscle and bone strength, and influences mood and motivation. Growing older in years is unavoidable. Withering in strength and clarity does not have to be accepted without asking questions.

02:50 Our body is a self-healing machine

The body has regulatory systems that constantly repair tissue, balance hormones, and maintain internal stability. These systems do not abruptly stop working at midlife. What changes over time is the hormonal environment that supports them. When hormone production declines, repair slows, recovery weakens, and performance drops.

In many clinical settings, decline is labeled as normal aging. Slower recall, reduced muscle mass, lower stamina, and decreased drive are often dismissed rather than investigated. When the thyroid underperforms, replacement therapy is standard practice. When insulin production fails, insulin is prescribed. The testicles also produce hormones that influence multiple organs, including the brain, muscles, bones, and cardiovascular system. Yet declining testosterone is frequently ignored or minimized.

Chronological aging is unavoidable. Functional decline is influenced by biology that can be evaluated and, in many cases, supported. The decision to intervene should be based on symptoms, laboratory data, and long-term health strategy rather than cultural assumptions about what aging should look like.

03:16 Benefits of testosterone

Testosterone functions beyond sexual health. In the brain, it supports neuronal signaling and influences memory formation, processing speed, and concentration. Lower testosterone levels have been associated with reduced cognitive performance and increased risk of mood disturbance. Both men and women rely on adequate testosterone for neurological stability.

Muscle tissue is highly dependent on testosterone. During adolescence, rising testosterone levels drive muscle growth and strength development. Later in life, as testosterone declines, maintaining lean muscle mass becomes more difficult even with regular exercise. Reduced muscle mass contributes to decreased strength, slower metabolism, and higher risk of injury.

Bone density is also influenced by testosterone. Lower levels correlate with weaker bones and increased fracture risk. Joint stability depends in part on muscular support, and many patients report reduced musculoskeletal pain when hormone levels are optimized.

Long-standing fears about testosterone therapy have been reexamined. Current evidence does not show a consistent increase in prostate cancer incidence among men receiving properly monitored therapy. Cardiovascular data remain complex, but large studies have not demonstrated a clear rise in heart attack or stroke risk when treatment is supervised and individualized. Monitoring blood count and other markers remains essential.

06:54 Calming effect of testosterone

Testosterone is often assumed to increase aggression. Clinical observation frequently shows the opposite pattern when testosterone levels are low. Men with inadequate testosterone may present with irritability, low motivation, reduced confidence, and depressed mood.

Restoring testosterone to appropriate levels often improves emotional stability and stress tolerance. Some clinicians have incorporated testosterone therapy into treatment plans for men with persistent depressive symptoms when laboratory findings support deficiency.

It is important to distinguish therapeutic restoration from supraphysiologic dosing. Excessive hormone levels can produce instability. The objective of treatment is physiological balance. When levels are maintained within an appropriate range and monitored carefully, many patients report improved mood, steadier energy, and clearer thinking.

11:55 Truth about blood levels

Blood tests are helpful, but they are not the final decision maker. The first reason to check blood work is to create a starting point. A baseline helps identify whether there are conditions that require caution before beginning therapy.

One important marker is PSA, which stands for prostate-specific antigen. If PSA is very high, such as above 10 and in some cases above 20, it deserves careful review before starting testosterone. This does not always mean therapy cannot be done, but it requires thoughtful supervision.

Another test is a complete blood count. Some men carry a genetic condition called hemochromatosis, which causes the body to store too much iron. Over time, excess iron can damage the liver, kidneys, and brain. Testosterone therapy can increase red blood cell production because it stimulates the kidneys to release a hormone called erythropoietin. This hormone signals the bone marrow to make more red blood cells. A mild rise in blood count is expected, but if it climbs too high, a condition called erythrocytosis can develop. In that case, donating blood may be recommended.

Blood tests also help evaluate heart health, blood sugar, and thyroid function. These systems affect energy, mood, and strength. Lab values provide useful information, but symptoms and clinical judgment carry equal weight.

13:45 Total vs. free testosterone

When testosterone is measured in the blood, two main numbers can be reported: total testosterone and free testosterone. Understanding the difference is essential.

Total testosterone represents the entire amount of testosterone circulating in the bloodstream. However, not all of it is available for the body to use. A large portion of testosterone binds to a protein called sex hormone binding globulin, or SHBG. When testosterone is attached to this protein, it cannot enter cells and perform its function.

Free testosterone is the portion that is not bound. This is the active form. It enters cells, interacts with receptors, and supports brain function, muscle growth, bone density, libido, and mood. A person can have a normal total testosterone level but still feel symptoms of deficiency if free testosterone is low.

This difference explains why some men are told their levels are normal even though they feel tired, lose muscle, or experience reduced libido. If only total testosterone is checked, the picture may be incomplete. Measuring free testosterone provides a clearer understanding of what the body can actually use.

Symptoms that may suggest low free testosterone include reduced sexual desire, difficulty with erections, low energy, decreased motivation, slower recovery after exercise, depressed mood, and loss of muscle mass. These symptoms can overlap with thyroid problems or chronic stress, which is why a broader evaluation is important.

Treatment decisions should not rely on one single lab number. If a patient reports improved energy, better mood, stronger workouts, and improved sexual function, that improvement carries meaning even if the lab value sits in the middle of a reference range. On the other hand, if levels are high but side effects appear, adjustments may be required.

Testosterone therapy also requires monitoring of estrogen. Some testosterone converts into estrogen, which plays a role in bone strength and sexual function. If estrogen rises too high, unwanted effects such as breast tissue growth can occur. If it drops too low, bone and libido may suffer. Many clinicians aim for an estrogen range between 20 and 40, though reference ranges vary by laboratory.

Preserving natural testicular function is another consideration. When external testosterone is given without support, the testicles may shrink over time because they reduce their own production. Medications such as clomiphene, enclomiphene, hCG, or gonadorelin can be used to stimulate the testicles and maintain function under medical supervision.

Understanding total and free testosterone helps prevent oversimplified decisions. It ensures therapy is based on biology, symptoms, and long-term health rather than a single number.

21:26 Creams for hair loss

Some men worry that testosterone therapy will cause hair loss. Hair thinning in men is often related to genetics and a hormone called dihydrotestosterone, or DHT. DHT is a stronger form of testosterone that can shrink hair follicles in men who are genetically sensitive.

Testosterone can increase DHT levels. If a man is already prone to male pattern baldness, therapy may speed up a process that was likely going to happen over time.

There are options to manage this risk. One approach is using topical prescription creams that act directly on the scalp. These treatments target hair follicles with minimal absorption into the bloodstream. Another option is medications such as finasteride, which reduce the conversion of testosterone into DHT. Blocking DHT can help preserve hair, though it must be balanced carefully because DHT also contributes to sexual function in some men.

Hair loss management should be individualized. The decision depends on family history, cosmetic preference, and overall treatment priorities. Monitoring and discussion with a qualified clinician ensures that hormonal therapy supports vitality without ignoring side effects.

22:33 Duration of the treatment

A common question is how long testosterone therapy should continue. The honest answer is that it can be continued for life if it remains safe, affordable, and aligned with personal values. There is no fixed expiration date. Testosterone is a hormone your body naturally produces. When levels fall and symptoms appear, replacing it is similar in principle to replacing thyroid hormone when the thyroid slows down.

Stopping therapy is always a personal decision. Some men may choose to stop for financial reasons or philosophical reasons. Others may prefer to age without intervention. That choice does not make anyone careless or uninformed. The role of a physician is to provide information, monitor safety, and guide decisions, not to impose treatment.

Strength training, maintaining a healthy body fat percentage, and sleeping well can support natural testosterone levels. However, even disciplined and healthy men experience a gradual decline over time. Therapy becomes one available option, not an obligation.

Some clinicians recommend an occasional short break, sometimes called a hormone holiday, such as skipping a scheduled dose every few weeks. The theory is that this may keep hormone receptors responsive over the long term. Most men feel stable during short breaks because testosterone remains in the system for some time. Long-term therapy, when properly monitored, can be sustainable for decades.

24:59 How we live is what we control

Aging in years cannot be stopped, yet the way strength, mobility, and clarity change over time can be influenced. One major cause of disability in older adults is sarcopenia, which means loss of muscle mass. Weak muscles make daily tasks harder. Climbing stairs, opening jars, and getting out of a car all depend on muscle strength.

Testosterone supports muscle maintenance. Strong muscles protect joints, improve balance, and lower the risk of falls. Maintaining muscle also supports bone density, which lowers fracture risk. Brain health is also connected to hormone balance. Lower hormone levels have been linked in research to increased risk of cognitive decline.

Lifestyle choices remain important. Walking regularly, lifting weights, eating balanced meals, and keeping body fat within a healthy range all support vitality. Hormone therapy does not replace these habits. It works alongside them. The central idea is that while death is inevitable, years of unnecessary weakness or decline may be influenced by thoughtful action.

Each person chooses how to approach aging. Some will prefer organic decline. Others will use every safe and credible tool available. What remains constant is personal responsibility in making informed decisions.

26:16 Other side effects

No medical therapy is free from potential side effects, and testosterone is no exception. One common effect is acne, especially on the chest or back. This happens because testosterone can stimulate oil glands in the skin. If acne appears, the dose can often be adjusted. In some cases, dividing the weekly dose into two smaller injections can smooth hormone levels and reduce skin reactions.

Hair thinning is another concern for men who are genetically prone to male pattern baldness. Testosterone can increase levels of DHT, a hormone that influences hair follicles. Monitoring and preventive strategies, such as topical treatments or DHT-modulating medications, can be considered when appropriate.

It is important to distinguish medical testosterone therapy from anabolic steroid abuse. High-dose anabolic steroids used for bodybuilding can damage the brain, heart, and reproductive system. They can suppress natural testosterone production and sometimes cause long-term harm. Medical therapy aims to restore physiological levels, not create extreme muscle growth.

Over-the-counter supplements that claim to “boost” testosterone rarely provide meaningful improvement in men with true deficiency. In most symptomatic men over 40, replacing testosterone itself is the effective treatment when clinically appropriate.

30:16 Motivational story of a patient

A story illustrates the broader message about vitality. Years ago, a patient in his mid-80s with stage four lung cancer was receiving supportive care, including testosterone therapy. During a visit, he was asked about his breathing. He replied that he only became short of breath during intimacy with his wife.

At 85 years old, facing advanced cancer, he remained engaged in life, connection, and intimacy. He passed away a few months later. His final months were not defined by weakness or resignation but by participation in living.

The lesson is not that testosterone cures disease. The lesson is that vitality can be preserved longer than many people expect. Strength, connection, and purpose can continue deep into later years when health is supported intentionally. Aging does not require surrendering energy or identity. It requires informed choices and steady attention to the systems that keep the body functioning well.

Key Takeaway

Testosterone is a foundational hormone that affects the brain, muscles, bones, mood, skin, and sexual health. When it declines, the whole body feels the effect. Slower thinking, lower energy, weaker recovery after exercise, reduced confidence, and changes in libido can all reflect falling testosterone levels rather than unavoidable aging.

Blood work helps create a starting point, yet numbers alone do not determine treatment. Total testosterone shows how much is present in the bloodstream, while free testosterone shows how much is actually available for the body to use. Symptoms, physical function, and overall health must be considered together with laboratory values.

When therapy is used, the focus is on restoration to a healthy physiological range under medical supervision. Monitoring blood count and estrogen keeps treatment balanced and safe. Strength training, body composition control, and cardiovascular health remain essential. The central principle is that growing older does not require surrendering clarity, strength, or vitality without first examining the hormonal foundation that supports them.

Continue the Conversation

If this discussion sparked new thoughts, there are other episodes that build on these ideas and examine them from different angles:

EP06 – The Truth About Testosterone: Does It Really Cause Prostate Cancer?

For a deeper and more structured look at this philosophy, Fight Cancer Like a Man by Dr. Stephen Petteruti walks through prevention, screening, and treatment decisions in a practical and direct way. It lays out the reasoning behind prioritizing vitality, safety, and informed choice.

If you would like access to extended clinical notes and member-only discussions, join the 

Intellectual Medicine Community:
Membership: https://tinyurl.com/DrPetterutiMember
Sign up for Dr. Steve’s email newsletter: https://www.drstephenpetteruti.com
Learn more about Intellectual Medicine: https://www.intellectualmedicine.com

Connect with Dr. Petteruti:
LinkedIn: https://www.linkedin.com/in/drstephenpetteruti
Instagram: https://www.instagram.com/dr.stephenpetteruti
Facebook: https://www.facebook.com/dr.stephenpetteruti

Subscribe to the Intellectual Medicine Podcast:
Apple Podcasts: https://tinyurl.com/DrPetterutiApplePodcast
Spotify: https://tinyurl.com/DrPetterutiSpotifyPodcast

To encourage deeper review, referenced studies examine long-term outcomes of observation compared with intervention. These data explore survival patterns, treatment complications, and the biological impact of biopsy and hormone suppression. Reviewing this literature supports a more individualized approach to prostate health.

Suggested References

Don't just take my word for it. The following research challenges the 'standard of care' by highlighting the data on survival and the real cost of overtreatment. These studies are the map for moving away from blind protocols and toward biological precision.

Hackett GI. Long Term Cardiovascular Safety of Testosterone Therapy: A Review of the TRAVERSE Study. World J Mens Health. 2025;43(2):282-290. doi:10.5534/wjmh.240081

Haider, Ahmad et al. “Incidence of prostate cancer in hypogonadal men receiving testosterone therapy: observations from 5-year median followup of 3 registries.” The Journal of urology vol. 193,1 (2015): 80-6. doi:10.1016/j.juro.2014.06.071

Kaplan, Alan L et al. “Testosterone Therapy in Men With Prostate Cancer.” European urology vol. 69,5 (2016): 894-903. doi:10.1016/j.eururo.2015.12.005

Keren D, Goshen A, Strauss T and Springer S (2025) Study protocol: associations between hormonal profile and physical and cognitive functions in middle-aged men—a one-year cohort follow-up study. Front. Public Health 13:1654077. doi: 10.3389/fpubh.2025.1654077

Mohammad, Osama S et al. “Supraphysiologic Testosterone Therapy in the Treatment of Prostate Cancer: Models, Mechanisms and Questions.” Cancers vol. 9,12 166. 6 Dec. 2017, doi:10.3390/cancers9120166

Snyder PJ, Kopperdahl DL, Stephens-Shields AJ, et al. Effect of Testosterone Treatment on Volumetric Bone Density and Strength in Older Men With Low Testosterone: A Controlled Clinical Trial. JAMA Intern Med. 2017;177(4):471-479. doi:10.1001/jamainternmed.2016.9539

Disclaimer

This podcast and its accompanying materials are for educational purposes. They are designed to support thoughtful decision-making and improve health literacy. They do not replace individualized medical advice, diagnosis, or treatment. Always consult your qualified healthcare professional regarding personal medical concerns.

© 2026 Stephen Petteruti, DO | All rights reserved. Reproduction or distribution without written permission is prohibited.