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2009-09-30 Mark Scholz MD Prostate Cancer

KIRK HAMILTON: Welcome to Staying Healthy Today, a health-oriented radio show committed to bringing you key experts in the fields of nutrition, prevention and integrative medicine.

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Today's show topic is "Learning How To Live Fully And Treat Cancer As A Chronic Disease - One Oncologist's Perspective." Our guest today is Dr. Mark Scholz, a board certified internist, oncologist and medical director of the Prostate Oncology Specialists in Marina del Rey, California. Dr. Scholz earned his medical degree from Creighton University in Omaha, Nebraska and completed his internal medicine internship and medical oncology residency at the University of Southern California Medical Center. He is a past president, co-founder and executive director of the Prostate Cancer Institute (PCRI), a nonprofit educational and resource organization that focuses on disseminating information regarding the diagnosis, staging and treatment of prostate cancer. He is an expert on the management and treatment of prostate cancer using hormone intervention, immunotherapy, chemotherapy and angiogenesis, as well as vitamin, herbal and other forms of lifestyle counseling. He resides in Los Angeles, California with his wife and three children.

So Dr. Scholz, I want to welcome you and thank you so much for taking time out of your busy schedule to be on the show today.

DR. MARK SCHOLZ: Thanks so much for having me.

KIRK HAMILTON: Again I think the greatest compliment a physician can get is when they're referred for whatever reason for their credibility and their clinical acumen to be an expert in their field, and you were referred by a patient of yours to be on this show as the expert to give, kind of the best overview of how to approach prostate cancer in a medical way, but also in the least invasive way and get the patient involved. So how did you get involved in your prostate cancer journey? Were you an oncologist first and then got involved with prostate cancer or did you do it the other way around?

DR. MARK SCHOLZ: Oncologist first. Well that's a good opening acutally for discussing how the field of prostate cancer is unusual in that the primary care doctors, the urologists are trained as surgeons. All the other cancers if you think of the common ones like colon cancer, breast cancer, lung cancer and on and on are all managed by medical oncologists. Doctors with internal medicine and medical oncology training to act as the captain of the ship for people with these complex illnesses. But due to tradition the urologists have been in the decision making role now for over 100 years and they've sort of grandfathered into this position. So the whole field of prostate cancer is influenced by the idea that surgery first, well they call it the gold standard in their field. As a medical oncologist, and my sense is that there's probably less than a hundred medical oncologists in the United States that specialize just in prostate cancer, and to this day at USC where I trained, or at UCLA here in Los Angeles, they still do not train medical oncologists in the management of early stage prostate cancer.

KIRK HAMILTON: What got you interested in focusing on prostate cancer?

DR. MARK SCHOLZ: Probably mostly serendipitous. I happened to be working in private practice with another medical oncologist and about 20% of his practice was prostate cancer, which was quite unusual. And when he retired, it was very natural for me to join up with another medical oncologist Dr. Stephen Strum, who at that time, probably about half of his practice was prostate cancer. Within a year of working with Dr. Strum we both made a mutual decision to just specialize exclusively in prostate cancer. It's a natural thing to do. We live in a large megalopolis and the idea of specialization to improve quality was sort of a no-brainer so that was about 13 year ago.

KIRK HAMILTON: When did you think there was a different to approach prostate cancer than starting with surgery and going from biopsies to surgery right away? When did you think that there was a different way to do it?

DR. MARK SCHOLZ: Well the PSA was invented in 1987 and it soon became apparent that hormone treatments like Lupron, Casodex, Zoladex and the like, could cause the PSA to drop down to zero usually within a couple of months. If men came into the office and you could feel a bump on their prostate via digital rectal exam the bump would go away within a couple of months. So we were certainly very impressed with those results and that was probably the thing that opened our eyes the most. Subsequently, I had patients come into the office with cancer coming back after surgery who flatly stated they would only treat their condition with diet and placed themselves on stringent macrobiotic diets. I was rather surprised to see that they could stabilize or sometimes even reverse their disease with these, what I would consider surprising tools, just with using diet alone.

KIRK HAMILTON: So did you start incorporating diet at that point, or just kind of gathering data, or how did you find out that diet aside from those clinical observations played a role?

DR. MARK SCHOLZ: It's pretty much homegrown observations and when you see good results and there are sometimes not any other good alternatives we definitely started encouraging our clients to pursue a healthy diet, vegetarian type diet. Subsequently there was a book published by Dr. Colin Campbell from Cornell University called "The China Study" which summarized a lot of work funded by our own National Cancer Institute over in China looking at diet and illness, and they also confirmed a very substantial anticancer effect from vegetarian diets.

KIRK HAMILTON: Let's get back to screening a male for prostate cancer and prostate health. What do you recommend someone do when they get to their 40s or 50s? How ideally would you set up a screening program?

DR. MARK SCHOLZ: Sure. As you know, there's a lot of controversy because it's clear now that much of the prostate cancer being diagnosed is not life-threatening, and the treatments can be quality of life threatening, so there's this big giant conflict about what's right and wrong. I think, it's my personal position it's better to know and for that reason I do advocate that men undergo PSA screening starting in their 40s, not because we expect to find illness in that age group, but that allows people to find out what the normal PSA is for them prior to the normal enlargement of the prostate that occurs when men get into their 50s. And then men can use those numbers, those normal numbers that they get in their 40s as a comparison for as they get older, to find out what's normal for them. Otherwise you just have to compare your PSA to a population which is a very imprecise comparison.

KIRK HAMILTON: Can you tell me about inflammation in the prostate gland and how inflammation eventually, or does it leads to cancer?

DR. MARK SCHOLZ: It certainly does lead to cancer. There have been many questions about what causes cancer and it appears that inflammation is the cause. Probably the main inciting cause are repeated low grade infections in the prostate gland which most of us guys aren't ever aware that we had, but is easily visible when we do a scan of the prostate. You can see areas of scarring and calcification from previous infections in almost every man that we see. So that's part of it. Then there's certainly a contribution as you're probably aware that being overweight and having large fat stores contributes to inflammation in our bodies as well. And so a combination of these two things, poor diet and repeated low grade infections is the likely cause, almost certainly the cause for most prostate cancers.

KIRK HAMILTON: What is the best way to get a PSA screen? What I mean by that is...I personally don't do a digital rectal exam before the PSA. I get the blood work first. Some people say abstain from sex for a night, don't ride your bicycle. Is that true? Can that throw off a PSA level?

DR. MARK SCHOLZ: The digital rectal exam has been both ways. But since you have a choice we usually do the blood test first. But the idea that sexual activity within a day or two of the blood test is very valid and we see that all the time. Those people that have been sexually active their PSA can go up a couple of points and really raise a concern. So when people are getting PSA testing they need to be aware of several things, those that you already mentioned and also the fact that different PSA machines are not calibrated so if you want to compare your old PSA with your new PSA looking for a change, you want to compare on the same machine. Yes indeed, you would like to abstain from any sexual activity for a day or two beforehand and then if there are any symptoms suggestive of burning urination or anything like that the doctor needs to be made aware of that because low grade infections can cause the PSA to go up and certain type of bicycle seats, the ones that sit right in your crotch can increase PSA, so we advise our clients to sit on the more broad-based seats where your behind, where your weight is supported on your tush.

KIRK HAMILTON: Have you ever seen a prostate cancer in a new patient with a PSA of less than 1?

DR. MARK SCHOLZ: Yes. This is a good entry point to mention that prostate cancer is definitely not one illness. It's literally hundreds of different variations. With some similarities, but often times many marked differences. And one of them is that some prostate cancers, perhaps about 5% of them, don't make much PSA, and that doesn't necessarily mean that they are low grade. They can be a higher grade type of cancer so if people want to be real careful about this, in addition to doing a PSA, it's prudent to have a digital rectal exam as well.

KIRK HAMILTON: So let's say you do a digital rectal exam and you feel a nodule. What is the next step? Do you go into an ultrasound, and I know you do 3D ultrasound, 3D Doppler ultrasounds. Can you explain the difference in those ultrasounds, and then when would you do a biopsy?

DR. MARK SCHOLZ: Certainly. Up to the last couple of years, people just automatically jumped into a biopsy because it was generally believed that every form of prostate cancer was life-threatening. We now know this is not true. And we now that many people are being harmed by being diagnosed with very small amounts of prostate cancer that will never hurt them so we've adopted a little more of a stepwise approach rather than just simply jumping into a biopsy at the first sign of any problem. We will do a high resolution color Doppler ultrasound. As you mentioned if you can feel a bump we can look in that area to see if there's something that looks as if it's cancer or if it's something benign like just some area of calcification which would not warrant any biopsy whatsoever. And so we look at that. We look at how much the PSA has been changing over the previous years. If it's rising in a continuous fashion that would probably warrant a biopsy. We do a new urine test called PCA3 which tests for urine RNA, cancer related RNA in the urine, and it kind of functions like a PSA. A higher number is more worrisome, a low number is more reassuring. And then lastly when you do the ultrasound you can measure the size of the prostate gland. And men with bigger prostates are allowed to have a somewhat higher PSA because the prostate gland makes some PSA as well. So all these factors are used to try and determine who needs a biopsy and who doesn't. So men that have too much PSA, PSA that's rising too quickly, high PCA3 levels, and men that have something suspicious when we do the color Doppler ultrasound, are all people that we would consider doing a biopsy on. However, if all those things look fairly benign we might simply watch the situation realizing that when you start sticking needles in the prostate you may find a little speck of cancer that you really don't want to know about.

KIRK HAMILTON: Is the 3D Doppler ultrasound the same as the color? Is that the same?

DR. MARK SCHOLZ: Yes, but we don't use the 3D component. We reconstruct the 3D from 2D. The image resolution is a little sharper if you use the 3D in a 2D mode. But there are some people, and it's sort of how your training works, but it is pretty much the same thing.

KIRK HAMILTON: So if a patient was going out and they say, and a urologist or whoever is not familiar, and you say I would like to get a color Doppler ultrasound, do you have to have someone who is skilled in reading it? I mean that's what I got from...

DR. MARK SCHOLZ: Very much so. And here in the state of California there's only about six or seven of these that have been out there, so if people would like to get a scan before having a biopsy what they can do is request an endorectal MRI, which also gives good quality images of the prostate. The two flagship facilities here in California are at UCLA, and at the University of California San Francisco. So that would be one alternative, or there are a few centers such as ours that do color Doppler. But the common urology offices use a sort of a ‘dumbed down' form of ultrasound, which is really to find the outer borders of the prostate so that they can randomly stick needles into the prostate.

KIRK HAMILTON: Can you repeat slowly the something rectal MRI? I didn't catch the...

DR. MARK SCHOLZ: Yes. It's called an endorectal MRI and the two facilties I trust the most are at UCLA and UC San Francisco.

KIRK HAMILTON: So let's talk about biopsies now. I remember I was down at the conference that you were at, and you and Dr. Bahn were talking, and I saw the slides of you...you use the color Doppler ultrasound also to get a more accurate biopsy. Is that correct?

DR. MARK SCHOLZ: That's right. When most urologists do a biopsy, they use sort of a grid pattern and they just jab randomly across the surface of the gland. The capacity to see lesions or see spots that could be cancerous enables the biopsy to be much more accurate. They've shown that you can find cancer more frequently with less needles when you use the color Doppler ultrasound. So instead of doing a dozen needle biopsies, you can get by with maybe a half dozen and even increase your confidence that you're going to find the cancer if it's there.

KIRK HAMILTON: But you can also miss a cancer by not using it. It seemed like that's what I saw when you guys showed those slides.

DR. MARK SCHOLZ: Yes indeed. You can certainly miss it and I will be honest with you. You can also miss it on color Doppler. One of the frustrating things about the whole field of prostate cancer that all these tools that we've talked about so far - PSA and PCA3 and color Doppler and even biopsies. None of them are 100% accurate so what a skilled physician does is he kind of constructs a picture of what he thinks is going on by looking at all these factors and summing them together. The example I use is like if you have a new neighbor move in across the street and you're wondering is this going to be a good or a bad person. You look at indirect factors like the color selection on the house or whether they bring the trash in. You know, with all these different things you start building a picture of what's going on and over time you have a good idea of who you're dealing with.

KIRK HAMILTON: How do you decide if you have a bad prostate cancer? If it's contained within the prostate is there a problem?

DR. MARK SCHOLZ: Well, it depends on what...any cancer you could argue that needs treatment is a bad prostate cancer because these days it's very rare for men to die of prostate cancer. But it's very common for men to become impotent from the treatment of prostate cancer, and this is obviously a big concern for men that they may lose their sexual function. So you could say look at it as the type of cancers that are so benign they don't need treatment. The type that are not life-threatening, but people judge do need treatment, and then perhaps an even more serious type, that if not handled properly over a number of years could become life-threatening. Those are fairly uncommon. Probably only about 5% of prostate cancers fall into that latter category. So most men are dealing with the scare from treatment rather than the scare from the disease.

KIRK HAMILTON: The biopsy. Can it spread prostate cancer? Or can it spread...you're gonna poke needles in the prostate gland and obviously some cells will come out and that's through the rectum. Can you spread infection?

DR. MARK SCHOLZ: You certainly can spread infection. The risks from a biopsy appear to be 1 to 2% risk of a serious infection requiring hospitalization, a 1 to 2% chance of severe bleeding requiring a transfusion, and studies now are also showing that there is a risk of sexual problems, erectile dysfunction from a biopsy that usually clears up after a month or two but not always. Now the concern about spreading cancer is discussed frequently and I have never run across a reputable cancer expert that believed that the biopsy spreads cancer, and I know that there may be some preconceived notion that since these people are doing biopsies...obviously I don't believe this...but I try and comfort people that if cancer is being spread it is not happening frequently because with early stage favorable risk prostate cancer when it's treated, about 90 to 95% of men get cured and we have to remember every one of those men had a biopsy. So if cancer is being spread it's only happening quite rarely.

KIRK HAMILTON: We're talking to Dr. Mark Scholz, M.D. He's an oncologist from Prostate Oncology Specialists in Marina del Rey, California, and they focus on treating prostate cancer, assessing prostate cancer, and a term called active surveillance. Can you describe to us what active surveillance means?

DR. MARK SCHOLZ: Yes. We're seeing a flood of men now that are going through biopsies. Usually their PSA is up because they have an enlarged prostate, not because their cancer is causing any problems. But because of the medical legal situation people are biopsied and there's about 1.5 million biopsies done every year in the United States. This inevitably uncovers small amounts of low grade prostate cancer which historically have all been treated but we now know really never did need treatment. So as an alternative to toxic treatment like surgery or radiation, many men are deciding to simply monitor the situation closely and studies show that about 80% of men that are appropriately selected and placed on an active surveillance program, that is just PSA testing every three months, an ultrasound every six months, possibly a repeat biopsy every couple of years, that about 80% of these men will still have no evidence of any cancer change or growth five years later. And of course they are quite pleased that they were able to forestall any type of treatment and the studies are showing that the type of men that do need treatment, the minority where there is some cancer growth or change over time, that those men have very good results and are still able to undergo treatment for cure just as if they'd done it right at the time of diagnosis.

KIRK HAMILTON: If someone gets a diagnosis of prostate cancer and they want to get a second opinion, what time frame do they have? I think one of the biggest things about cancer just in general is people feel like they have to rush and get on kind of a ‘conveyor belt' of treatment. What kind of time frame does the average diagnosis of prostate cancer patient have before they need to make a decision about which direction to go to?

DR. MARK SCHOLZ: Well, months and months. That's probably the most simple answer. What's not realized is that it's better to have the worst type of prostate cancer than the best type of any type of cancer. The high grade prostate cancer, what are called high-risk prostate cancers treated - there was a study out of the Mayo Clinic in several thousand men who were treated for what we call high risk prostate cancer, that means PSAs over 20, large lumps that could be felt with a finger, or Gleason's scores in the 8, 9, 10 category, that means high grade Gleason scores. The 10 year survival rate for men properly treated was 95%. So there was only a 5% risk of mortality with high risk prostate cancer and the studies indicate that the 10 year survival rates are close to 100% with low or intermediate risk prostate cancer. So first and foremost, we always need to be thinking in terms of the type of cancer we're discussing. But remember that even the worst prostate cancers are usually much much less dangerous that other common cancers that we think of like lung or pancreas, stomach, bone, brain, these things which can kill people within a matter of months. So this is like a completely different condition.

KIRK HAMILTON: When do you decide to look outside the prostate for cancer spreading? You know that's the big concern. If it's contained within the prostate, then it's in the prostate.

DR. MARK SCHOLZ: That's an excellent question because it's sort of surprising to people when...if they come in and their PSA's less than 10 and their Gleason score is 6, maybe even a 7, that the doctors don't even recommend looking outside the prostate because the chances of finding something is much smaller than the scan showing a false positive. Far, far less than 1%. So, I'd say the thresholds are typically when the PSA starts to get up around 15 maybe, when the Gleason scores are in the 8, 9, 10 range. Then the doctors start thinking maybe we should do some scans, although honestly in most cases those scans will be clear.

KIRK HAMILTON: Tell me about some of your...I don't know what the correct word is... ‘favorite' traditional treatments. The top two or three that you use the most.

DR. MARK SCHOLZ: Well I'll tell you far and away active surveillance is my favorite treatment because every other treatment, radiation, surgery, cryotherapy, hormone treatments, chemo treatments, they all have side effects. So if men can fit the profile for active surveillance we usually treat those men. Try to get them on a good diet. We may give them a little bit of Proscar which improves the accuracy of the PSA and inhibits cancer growth slightly and that...that's the winner. The other options...they all have their advantages and disadvantages. They're all effective, but they all come at a very high price usually affecting sexual function in the most dramatic fashion.

KIRK HAMILTON: I remember at the conference one of the most moving lectures and I forget...I want to say Mueller. I can't remember his name from Canada.

DR. MARK SCHOLZ: Probably Dr. Mulhall.

KIRK HAMILTON: Mulhall. I mean that talk about preserving sexual function and all the treatment that he had to do after the fact was incredibly powerful! You know. That was quite powerful that talk.

DR. MARK SCHOLZ: Yes, he came from Memorial Sloan-Kettering. Probably the preeminent expert in this area and you can see how passionately concerned he is. He had a lot of denigrating things to say about the existing medical system. He himself is a surgeon. So he was obviously deeply concerned about people who are suffering unnecessarily from the treatments.

KIRK HAMILTON: Let me ask you about more specifically. Let's talk about your active surveillance. So diet. Can you go into the diet you recommend and then also some of your top five favorite nutritional supplements if there is any?

DR. MARK SCHOLZ: Certainly. Well we generally try to advocate a vegan diet and this is based on our own experience seeing the results in men that elected to follow with what they call macrobiotic diets which are very stringent vegan diets, and of course based on that book I mentioned written by Colin Campbell called "The China Study" which documents the effectiveness of this type of diet. That is...we recommend that people do regular exercise and resistance training and then in terms of supplements we certainly check vitamin D levels. Vitamin D deficiency is very common, and there is a number of studies showing much better general health, energy, bone strength, even anticancer effects from normal or high normal vitamin D levels. Beyond vitamin D, the other common thing that we recommend is fish oil. The omega-3 fatty acids are not only heart healthy but also have a favorable impact on the immune system so we recommend perhaps a gram or 1 to 4 grams a day of fish oil. Those two are probably the most solid ones. If you go down the list quickly with prostate cancer you usually will hear about antioxidants like selenium and lycopene and there may be a modest benefit and those are on our list of suggested additives. Vitamin E has also been shown to have some benefit, but there's also been some questions raised about a conflict with common cholesterol pills like Lipitor, Crestor and Zocor. Those sorts of medicines. So we've always tried to emphasize the heart healthy things first because most prostate cancer patients will never die of prostate cancer, but the age group, men in their 60s and 70s, are at very high risk for coronary artery disease. Very very big concern. So anything that is contrary to good cardiovascular health, and it just makes no sense at all for prostate, so we emphasize low blood pressure, screening for heart disease, regular exercise, and those things help the milieu for inhibiting prostate cancer growth as well.

KIRK HAMILTON: You know you said something... because I... somebody asked you at the conference if you know give me the top three things, and you said a vegan, vegetarian diet, resistance training and mind/body spiritual stuff. And I wanted to go back to strength training because I have a lot of my older patients work on building lean body mass. But I think you said this and correct me if I'm wrong. That the benefit might be you've never seen a cancer go to muscle... Was it?

DR. MARK SCHOLZ: Well that's absolutely true. It seems...I'm suspicious...well there's a lot of ...remember a lot of survival, there's been a number of survival studies in breast cancer and colon cancer showing that greater fitness makes people live longer and then the same thing has been proven in healthy people as well. There's a New England Journal study where they looked at 60-year-old, people in their 60s, and they found that people who exercised and smoked lived longer than nonsmoking sedentary people. In other words, it's more dangerous to not exercise than it is to smoke, if you're looking at it as just pure survival. So the reason for that is debatable. I think one thing that we're finding now is that, and you may have heard this before, that the impact of diet is probably or largely a result of lowering our serum insulin levels. Insulin is, people think of it in terms of blood sugar, but really what insulin is is a growth hormone. And whenever we eat a high sugar, high processed food diet our insulin levels go up and that stimulates cancer growth. Now when you build up your muscles, the muscles act as a giant reservoir and suck the blood sugar right out of your blood stream and they lower your insulin levels. So it may be one of the reasons that fitness translates into better outcomes is through just the lowering of insulin.

KIRK HAMILTON: Do you have a favorite mind/body practice or spiritual practice because you put that in your triad of things for prostate cancer?

DR. MARK SCHOLZ: Well, I personally am a Christian and I don't...you know I know everyone has to find their own way though. So I think in my day to day practice aside from any theological stuff is what I notice is that any way we can somehow rid ourselves of unnecessary anxiety and fear. As you know, the word cancer strikes tremendous and deep fear into people. About half of my work, aside from giving counseling about medical care and the right types of pills is trying to calm people down and encourage them and get them to relax a little bit because all that anxiety does, is it drives the release of high levels of cortisone from our adrenal glands. Probably most people are aware that when they treat people with cortisone for rheumatoid arthritis or what-not, is it tremendously suppresses the immune system. We need to think of our immune system, as you know, fighting the good fight for us and the last thing we want to do is hobble or cripple it by increasing the cortisone level in our blood through all these fears and concerns that are so natural to us.

KIRK HAMILTON: I know you spend a great deal of your time not only educating health professionals but educating the public. Could you describe a bit about what the Prostate Cancer Research Institute (PCRI) is that put on that conference?

DR. MARK SCHOLZ: Sure. This is a nonprofit foundation founded by my old partner Dr. Strum and myself 11, 12 years ago. We saw a need as I mentioned before. This is an unusual field in that it is run and dominated by surgeons rather than internists and there just wasn't much education happening. Of course this is also prior to the advent of the internet and people had tremendous trouble finding information. So this was created through a grant from the Daniel Freeman Foundation, and funded for the first five years. Now it is self-supporting through patient donations and some federal support. But our primary goal is to, as experts working in this field you can kind of get a sense of what's coming around the corner, and of course this is what everyone needs to know. No one wants to have yesterday's treatment for today's problems. The treatments just aren't good enough to be dealing with yesterday's treatments so our job, we feel, is to take the latest information, try and make it understandable to lay people, and then it gets put on our website or shared at these conferences. We have a free newsletter that goes out quarterly called "Insights" which if anyone wants to go to the website, PCRI, Prostate Cancer Research Institute. PCRI.org. They can sign up for a free newsletter.

KIRK HAMILTON: I am going to make a plug for this organization because I went to the conference and first of all, all my professional colleagues should have gone to the conference because they would have learned a heck of a lot, but I tell you it's one thing to be there. I'm 52 and I was probably one of the youngest people there to be with people 55 to 70, 75 years of age. Many with their spouses who have active disease and asking just incredible questions. I thought it was a great seminar and I want to acknowledge you and the people that put it together.

DR. MARK SCHOLZ: Thank you very much. It's really wonderful. Even though the field has lagged behind the other cancers, I think primarily because it's not being handled by cancer experts unfortunately. There's been a very strong support group system and many very educated lay people have sort of stepped in and they've brought some great support groups across the country. There's a wonderful support group system called "Us Too" that coordinates a lot of these meetings for men, and yes you'll find that some of the lay people have become very educated and could be a big assistance to people.

KIRK HAMILTON: Can people come see you? I'm going to refer a couple of people to you because I actually referred people to urologists who were open to this farther across the country, so this is a hop, skip and a jump from Sacramento. How do people come see you if you want a second opinion or to be actively surveyed, so to speak?

DR. MARK SCHOLZ: Sure. You can visit our website at ProstateOncology.com, and that has all our information there, or you can call us at 310-827-7707 and Linda or Kiley will take your phone call and tell you what the next step would be.

KIRK HAMILTON: I would refer patients down there, but I saw that you have a place for patient entry on your website. Let's say a patient has just got diagnosed by his primary care (physician) and he doesn't know where to turn. Could he go to you without being referred by specialists or primary care?

DR. MARK SCHOLZ: Oh certainly. In fact probably 80% of our clients are self-referred.

KIRK HAMILTON: Wow, that's just a fabulous service and it just takes the pressure off people where they can get some great answers.

Well, I'm going to have to wrap this up Dr. Scholz. It's been awesome and I am so thankful that you came on today because this is an area that I have answers to the questions I've had on, and I've struggled to get people to practitioners or urologists or to professional cancer-treating people for this condition aside from the traditional, quick surgery approach, and it's been very frustrating for me. I've had to send people quite some distances so I was thrilled to find out that you were there. So thank you very much for coming on the show today.

DR. MARK SCHOLZ: Well thank you, and I just want to say that what your doing educating people so that they can make decisions prior to being forced into an irreversible decision like surgery or radiation is so important, and you're encouraging people to go slow, get the information first and educate themselves. I think that's the take-home message. That people shouldn't be ‘corralled' by excess fear into making an irreversible decision prior to really knowing what they're doing. So thank you so much for this show that allows people to get the information they need.

KIRK HAMILTON: I want to thank Dr. Scholz, and I want to thank you the audience for listening today on this edition of Staying Healthy Today Radio. And remember until next time, Stay and Be Well.

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