#1

I’m asking for some specific advice to determine my physical (cell-level age) versus chronological age.
About a month ago, almost accidentally, I found that I had an extremely high PSA (Prostate Specific Antigen). I’ve had a multi-parametric MRI and have had 12 18 ga. Hollow needles shoved in me to take samples. Not one person has said: You have cancer, yet.

Yet, I can read the MRI results and indeed, not only do I have prostate cancer the MRI shows its quite invasive and has spread beyond the prostate into adjacent structures. In short, I have Stage IV metastasized cancer. Boo hoo…now that’s all the self-misery I’ll give myself, I’ll live quite a while longer.

Let me now explain:

Every doctor that I see or will see has ONE task and that is: cure the cancer. End of story.

Ethically, and from a legal POV that is their task, and they are all eager to do that.

Here is the other side of the story: “We’ll cut your prostate out, give you some radiation and put you on a few injections, and you’ll be cured. By the way there might be some side effects, you might have erectile dysfunction that will be (un uh…) temporary, and you might be incontinent for a while and you might get some hot flashes.”

Here’s a reality that no doc will say: “Yes, we have the means of curing you, for sure. But you may well turn into a fat, weak, feeble-minded, feeble-bodied eunuch, that can’t find his way out the door and whose mental state is such that he doesn’t care, of course when his bones collapse—we’ll we have some meds for that.” And yes, you may never regain erectile function or libido, but well, you won’t care.” Now, I’d actually love to hear that from a doc.

Alternate realities exist amid an amazing, ever-changing landscape of options, and I mean amazing.

Four years ago, PMSA-PET scans were approved by FDA. This now scans from your toes to your scalp and searches for any cancer that has spread to distant sites—wow. (with 80% accuracy) 15 years ago there was really only two types of radiation therapy and both were akin to torture. Today, there’s maybe 8-10 types and often with minor adverse effects.

So, you see, it’s all about making choices. Do I go for prostate removal, high-lever radiation, and become chemically castrated—and be cured, but become a hollow shell of what I once was or take a bit higher risk and stay who I am with a chance of it killing me later.

To make a wise choice, I (and really, every cancer victim must make) is first, estimate how many years I have left on this world.

If my actuarial expectations are low (let’s talk life-time smoker, diabetic, and a life that makes a sloth happy) why choose a brutal cure, to likely die half-way through treatment—in misery.
If my actuarial expectations are high (as most of us here are) then, if my life-span is 20 years, well, that makes a difference in choices.

So, first I must estimate, as best as I can my remaining actuarial life-span.

I would appreciate it if those with an opinion and/or experience might suggest what they think is the most precise, accurate and validated method of determining just how old I am from a cellular point of view. I’m thinking things like Glycanage (which I know little about) and wonder if the $350 price is well-validated and there are others, this is an area I know nothing about.

I know that many, if not all of us here have wondered, really and in a truly validated way, how old we are from a cellular POV, after all, that’s why we take Rapamycin.

Thanks all.

7 Likes
#2

You need the discussion of whether you will die of prostate cancer or with it. Even then - what quality of life will you have with treatment and will that actually increase your healthspan or decrease it?

You need that discussion with a physician who views life how I do - hopefully you find one in your area.

The Epigenetic stuff isn’t ready for prime time, despite them pushing it. It has no prospective data … and for good reason - but I’ve personally received results 17 years discrepent between tests that are supposed to have very little error. Also, when people can do some intervention for 3 months and suddenly “be younger” by years … that isn’t real. They stop that intervention and then is that sustained, is it real? No, not at all.

I’d be happier just doing something like Inside Tracker as at least having some validity and likely prediction. TruDiagnostic seems to have very solid science - but we did a couple of those each and they resulted quite differently, and also remarkably differently than lab based predictions that integrate lifestyle.

I’d simply not hand my hat on anything those tests claim at this point.

10 Likes
#3

I remember this podcast with Peter Attia and Dr, Edward Schaeffer, an expert at NorthWestern university, being very good and covering many of the issues you have identified. I recommend you listen to it if you haven’t already:

How to catch, treat, and survive prostate cancer

  • Ted’s unique path to get his PhD [5:15];
  • The exciting transition in science during Ted’s PhD in the 1990s [15:30];
  • Ted’s advice to MD-PhD students, and why he choose urology and Johns Hopkins [23:45];
  • History of prostate surgery, and Pat Walsh’s legendary work in prostate cancer [36:15];
  • Prostate surgery and the risks involved with treatment [53:00];
  • Screening for prostate cancer [58:00];
  • The “mass screening” controversy [1:12:45];
  • Biopsies and MRI: important things to know [1:25:30];
  • Why urology is such a great field of medicine, and why Peter wants a goat [1:34:45];
  • Ted’s work with Ben Stiller [1:39:00];
  • Gleason grading system [1:43:45];
  • Testosterone, DHT and the prostate cancer controversy [1:53:15];
  • The metabolism of the prostate [2:03:00];
  • The most exciting areas of research in prostate cancer [2:08:00];
  • Benign issues involving the prostate: pelvic pain, infections and treatments [2:11:15];
  • Video of Ted’s surgeries, the latest technology, and males contraceptive options [2:18:00];
DR. EDWARD SCHAEFFER

Edward (Ted) M. Schaeffer, MD, PhD is an internationally recognized physician-scientist with expertise in urologic oncology. He is Professor and Chair of the Department of Urology at the Feinberg School of Medicine and Northwestern Memorial Hospital and Director of the Genitourinary Oncology Program at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

A respected clinician with expertise in open, laparoscopic, and robotic treatments of urologic malignancies, Dr. Schaeffer previously served as Director of the Prostate Cancer Program, Director of International Urology, and Codirector of the Prostate Cancer Multidisciplinary Clinic at Johns Hopkins Medicine. He was also a member of the James Buchanan Brady Urological Institute and the Sidney Kimmel Comprehensive Cancer Center, where he participated in multidisciplinary approaches to the treatment of genitourinary cancers. Dr. Schaeffer was the R. Christian B. Evensen Professor of Urology, Oncology, and Pathology at the Johns Hopkins School of Medicine, and Founder and Chief Medical Officer of the Prostate Cancer Foundation of Norway.

Dr. Edward M. Schaeffer’s discoveries have greatly advanced the basic scientific understanding of prostate cancer and clinical care pathways. His groundbreaking research emphasizes at-risk populations, diagnosis, treatment outcomes, and the molecular biology of lethal prostate cancer.

Dr. Edward M. Schaeffer’s laboratory, which has been funded by the National Institutes of Health, the Howard Hughes Medical Institute, the U.S. Department of Defense, and the Prostate Cancer Foundation, specifically focuses on the molecular biology of locally aggressive prostate cancers and the impact of race on the biology of prostate cancer. [dr-schaeffer.com]

11 Likes
#4

For me, knowing I have cancer, however benign, would decrease my quality of life and cast a pall over my mood. I would have it removed ASAP.

My 77 yo father had his removed when he was 74. It spread to his bladder and he needed radiotherapy. 3 years later there is no sign of it. However he cannot get an erection anymore. He was incontinent for a few months but is now back to normal. He is the vibrant personally I knew before the cancer.

5 Likes
#5

If this were me I would give some exogenous citrate and melatonin a go (like quite a bit of melatonin not trival amounts) and see whether that does any good as well as rapamycin. Prostate cancer is heavily affected by splicing variants.

3 Likes
#6

Quite surprising. Yet, by your own personal reading of the MRI, it is stage IV.

Are you expecting word from the physicians? When?

2 Likes
#7

Thank you doctor Fraser, that does answer what I was seeking quite precisely. My take from what you’ve said is there is no validated, reliable way, at least, as of yet, that truly defines my age at a cellular level.

Then I’ll have to go with the actuarial that looks at age of death of mother/father + lifestyle, such as smoking, drinking, education, working out and stuff like that.

I was hoping to find at least one that was truly validated–but that does not seem to exist (yet).

Therefore I’ll make an educated guess that I’m likely to live (absent the effect of any cancer) to mid to upper 90’s, and that does not include any effect of the Sirolimus I take.

3 Likes
#8

Thank you Rapadmin. I’ll look at that.

I’m an RN (Occupational Health), and often deal with wellness issues. I’ve always deferred to CDC’s advice and The U.S. Preventive Services Task Force (USPSTF)'s advice. For instance I get checked for colorectal cancer with one of those poop in a can tests. Decades ago I’ve “walked the walk,” and changed, for instance my triglycerides from 400 to 40, and have a “brilliant” lipid profile. Excellent BP and I work out 5/7 days a week.

And at age 69, I stopped getting a PSA test, as advices. And, as it appears, a tumor started growing merrily, un-noticed. Quite frankly I think the USPSTF’s advice stinks. To sum it up, I think it translates to: “Hey, we don’t want to cause you worry, old man, WTF, you ain’t gonna live that long anyway, so don’t bother.”

Now, to be fair, I did have the “talk with provider.” Anyone ever have prostate cancer in your family? (nope) then why bother. The day I looked at the PSA of 54.4 (a 5 would raise eyebrows) I started reading and found the cause of my PCa.

The summer of 1971, I took a job spraying herbicide under power lines. As I was reading about PCa caused by Agent Orange, the 2-4-5-T caught my eye, and I could remember from 50 years ago the label on the 55 gallon drums that we used which read 2-4-5… So, in fact I was “at risk.”

3 Likes
#9

Thank you De Strider. I do find it interesting that it does not (at least to any great extent) affect my mood. I’m pissed off at whoever made the herbicide I sprayed but I’m not a sort of glass half-full guy.

It’s nice to see that your dad recovered. As far as getting laid, maybe he doesn’t care anymore. If he does he can get a penis pump. They install two bladders in the penis with a squeeze to pump bulb that resides in the scrotum. Surgical recovery is not easy, but those who have this seem quite happy with it.

It’s nice that he is the “vibrant personality,” you knew before. I’d be curious, did he do ADT (androgen deprivation therapy) usually Lupron? If there’s one thing I fear it’s the ADT.

2 Likes
#10

Well, if you are planing on living another 20+ years … prostate cancer could be a limiting factor on that. It’ll require a solid understanding of pros and cons of any treatment and what ways the treatment would decrease your quality of life and to what degree and with what certainty it would increase your length of life.
Also understanding what is likely to happen if you do nothing. It’d be a lot easier answer if you only had 8 more years to live as you’d be in the group where you’d die with not from this. Having aspirations to live much longer has to calculate into the decision making and the balance between quality and quantity of life. Doing nothing will typically result in adverse quality of life issues also … just a different set of them.
Prostate cancer is a real monster … and it is unfortunate that most treatments have a predictable and real negative impact on quality of life.

7 Likes
#11

Thank you John. I’ve been using melatonin but not the huge amounts that some use for fear of shutting down the pineal gland. Cortisone shuts down the adrenals. Now, I admit, I haven’t a clue so if anyone can direct me to a high-quality evidence based article, that’d be good.

I know nothing about “exogenous citrate,” and do not understand “splicing variants,” so if you care to, please elaborate.

1 Like
#12

Perhaps not that surprising. At my last job, it was at a Sysco Opco in Plympton, MA. I built, from the ground up, an occupational health clinic for 1200 workers. 950 Sysco employees and about 250 contract employees (well, it wasn’t for them but I still welcomed them if they had issues).

I’m not a Practitioner, merely a RN but I’m pretty good at what I do. Once I told a fellow (who told the Director of Safety) that he had fracture of the Navicular bone in his forefoot. I gave the fellow a pencil-drawing of the way his bone was fractured. I wanted him to leave and get a radiograph. The powers that be thought he was “just a whiner.” I was ridiculed, that is until the radiograph came back with the bone fracture exactly as drawn. (Really, much of medicine is cookbook) His break was classic.

But, what I’m getting at is that docs can tell, in a glance, what kind of person you are. And as I would expect, many, if not most here, would be very proactive, and quite educated about medical possibilities so I don’t hold it against any of the three Practitioners that I’ve dealt with. They knew I was moderately educated, that I was an inquisitive (which can sometimes be perceived as impertinence) RN. In reality, they did not need to explain anything.

How can I tell it’s Stage IV? In reality, I can’t, maybe the MRI’s “off.” But when I see that it’s invaded the R neurovascular bundle and that the R margin between the prostate and the adjacent pelvic sling is not detectable, I’ll take that to mean that it’s spread outside the prostate and thus it’s Stage IV.

I do hope that it’s “within the pelvis.” If “beyond the pelvis” for instance, to the lungs, or liver, or the tip of my pinkie, well, that’s a whole different ball of wax.

Last Wednesday, they poked a dozen hollow 4" needles into my prostate trans-perineal (not through the rectum). Those needles will be expressed and analyzed by a pathologist and it will be graded based upon the deviation from normal cells (meaning do they look like “a bit strange cells,” or do they look like mutants from the green lagoon." That gives me a Gleason Score. It also gives me other data.

On Thursday, I sit down and discuss “my path.”

3 Likes
#13

I have encountered this attitude several times especially from younger doctors.

I am now seeing a doctor that specializes in gerontology. He is great, but there are still limits as to what I talk about with him.

A little rant: every doctor I have ever had got immediately pissed off if I questioned their advice.
None were willing to discuss their opinions.

The most common reply was: "If you don’t like what I am saying, I suggest you find another doctor.

My own observation of people I know, they lived decades after their diagnoses.

I hope you find some answers to your questions.

6 Likes
#14

Absent the PCa, yes, I was planning on living another 20 years, and hoping to be able to still walk through the woods when I was age 95 to collect wild edible mushrooms.

If I do nothing, then within a few years I’d have painful bone cancer, and would then be in the sort of 50% survival over 3 years sort of group. Nothing, is not an option for me.

Yet, the common, “cut it out, radiate the hell out of it, and put you on Lupron for 3 years,” hopefully, is not the path that I must follow, for in my book, that’s a path to hell.

PCa is a real monster, one’s own cells who somehow mutated throwing off major genomic pathways creating a fast-replicating cell with no self-limitations. The cause here undoubtedly was dioxin, a contaminant in the defoliant that I got covered with, all summer.

It would be much easier if I only expected to live another 5 years.

Yet, it’s a great time to have PCa (if one must have it). Just 4.5 years ago FDA approved the use of PSMA-PET scans so now I’ll be able to (in several weeks, I hope) tell if the PCa is within the pelvis, or has it spread to distant areas such as bone, liver or lung. Just 5 years ago it was: “We must assume it has spread and treat you accordingly.” That is a huge change. (PSMA-PET is accurate about 80% of the time. ~20% there may be tumors that are microscopic that will show up a year later.)

Additionally, radiotherapy has changed enormously. It’s become very precise with far less adverse effects.

All this depends upon where the PCa has spread to, and how aggressive (sort of like, what variant) it is. Time will tell that.

I was hoping to be able to use one of the touted “tests” to tell my “cellular level age,” but alas, that seems more merchandizing than reality. I’ll make a decision based upon “expected to live to age 95.”

3 Likes
#15

Thanks desertshores,

sigh I’ve found that attitude especially in the older docs.

I work as RN part-time (24-30 hours/week). I’m contracted to US DOL and I’m a “field nurse,” assisting injured federal workers, mostly USPS, some Homeland Security, FDA and Navy (civilians). I handle 20-40 cases.

It’s astonishing out there. Covid had an enormous effect on our health system—enormous. Efficiency has dropped, back-office staff (hugely important) often has this “don’t care,” attitude and many really, really great docs (the ones that on Healthgrades.com have +100 5-star reviews) are tired, overworked and near burnt-out.

Part of me can empathize and sometimes, even being empathetic, I’ll still say to an injured worker: “consider finding another doc (or PT person). 30-years ago a doc could spend an hour with you. Today their billing limits them to perhaps 15-minutes. The PA’s and the ANP’s (advanced practice nurses) can be incredible, or horrific.

In my case, if the PCa is w/in the pelvis and has not metastasized distant I think I’ll return to school and become an adult-gerontologist APRN. Now, that’d be fun and specialize in gerontologic health span extension.

I had $45,000 in school loans, and at my last job at Sysco I was paying (quite happily, I’ll say) $550 a month. Today, I have $5,000 and am paying zero which I think is quite stupid. (That $40,000 has been “forgiven.)” If I return to attain a Masters’ degree, I have no issue paying back even 20% of my income. Today, I think it maxes out at 10% and that’s “disposable income.”
The answers will materialize, eventually.

#16

I am in the pub quite drunk ATM hence i will respond in detail later. I have written about this in this forum previously, however.

2 Likes
#17

Second Dr Fraser’s good advice to have this conversation with an expert. I’d also ask about immune checkpoint blockade therapy in combination with a keto diet and supplementing with betahydroxibuturate, which has been shown in early trials to overcome the checkpoints’resistance to therapy. i’d also ask a knowledgeable provider if its ok to stay on sirolimus.

3 Likes
#18

My father is not on Lupron. He is not taking anything else for his prostate cancer now that it is cured. Thank God.

He is taking Rapamycin and a bunch of longevity meds though!

4 Likes
#19

I take perhaps around a gram of melatonin each night. I don’t think it affects the amount of pineal melatonin taken. However, if it is taken during the day then I think it may temporarily affect melatonin produced.

When genes are transcribed it is possible for less than the whole gene to be transcribed. This is called a different splice of the gene. Often this is driven at least in part by levels of nuclear acetyl-CoA.

acetyl-CoA is produced in a number of ways the main two perhaps are using the enzyme ACCS2 from acetate and ACLY from citrate.

Endogenous citrate mainly comes from the mitochondria, but it can come in relatively small amounts from serum as well. The body maintains serum citrate at a level of something like 50-100 microMolar, but if you consume some (exogenously - ie from outside the body) then it can push up serum citrate concentrations for a short period of time.

3 Likes
#20

https://www.nature.com/articles/s41388-024-03036-x

Abstract

Prostate cancer (CaP) remains the second leading cause of cancer deaths in western men. CaP mortality results from diverse molecular mechanisms that mediate resistance to the standard of care treatments for metastatic disease. Recently, alternative splicing has been recognized as a hallmark of CaP aggressiveness. Alternative splicing events cause treatment resistance and aggressive CaP behavior and are determinants of the emergence of the two major types of late-stage treatment-resistant CaP, namely castration-resistant CaP (CRPC) and neuroendocrine CaP (NEPC). Here, we review recent multi-omics data that are uncovering the complicated landscape of alternative splicing events during CaP progression and the impact that different gene transcript isoforms can have on CaP cell biology and behavior. We discuss renewed insights in the molecular machinery by which alternative splicing occurs and contributes to the failure of systemic CaP therapies. The potential for alternative splicing events to serve as diagnostic markers and/or therapeutic targets is explored. We conclude by considering current challenges and promises associated with splicing-modulating therapies, and their potential for clinical translation into CaP patient care.

5 Likes