Member Roundtable Discussion - YouTube

Round Table Discussion July 20, 2024

Informed Prostate Cancer Support Group

Meeting Summary

Overall Summary:

This July 20^th meeting of a prostate cancer support group was the first in person meeting of the IPCSG in the newly refurbished Sanford Burnham Prebys Medical Exploration Auditorium. The session included presentations from three speakers who shared their personal experiences with prostate cancer, treatment approaches, and insights into managing the disease. The meeting also addressed the importance of self-advocacy, staying informed, and maintaining a positive outlook while dealing with prostate cancer.

Contributions:

1. Bill Manning:

Bill shared his journey with active surveillance over 15 years. He emphasized the importance of regular testing and monitoring, including PSA tests, MRIs, and biopsies. Bill discussed how he avoided unnecessary treatment by carefully tracking his condition and making informed decisions. He also highlighted the potential benefits of dietary changes, particularly adopting a vegan diet based on "The China Study."

2. Mike McCary:

Mike presented his seven-year journey with prostate cancer, focusing on an integrative approach combining Western and alternative medicine. He discussed his treatment history, including surgery and radiation, and shared his experiences with various supplements and lifestyle changes. Mike emphasized the importance of research, stress management, and emotional well-being. He provided practical tips for coping with the psychological aspects of cancer, such as visualization techniques and the "60-second rule" for managing negative thoughts.

3. Herschel Kagan:

Herschel shared his experience with more advanced prostate cancer, including his diagnosis and treatment with hormone therapy and radiation. He discussed his decision to switch medications and his goal of eventually stopping hormone treatment. Herschel also provided insight into the U.S. Preventive Services Task Force's recommendations regarding PSA testing and how these recommendations may have impacted his diagnosis. He raised important questions about the balance between over-diagnosis and catching cancer early.

The meeting concluded with a Q&A session where attendees could ask the speakers questions about their experiences and approaches to managing prostate cancer. The overall message emphasized the importance of being proactive, well-informed, and maintaining a positive attitude while dealing with prostate cancer.

Welcome and Introduction by Aaron Lamb

During this segment, Aaron Lamb, director and facilitator of the meetings, welcomes everyone to the members' roundtable discussion. He introduces the key people involved in the organization, including Bill Lewis, Gene van Vleet, Steve Pendergast, Bill Manning, and himself. Aaron mentions that the meeting is recorded and available on YouTube, and invites newcomers to fill out a profile form to receive information and support. He also mentions the organization's social media presence and various resources available, including PSA testing, gene-based testing, and exercise programs. Additionally, Aaron apologizes for canceling the previous meeting and invites volunteers to help with various tasks, such as meeting facilitation, newsletter editing, and accounting assistance, highlighting the importance of teamwork and support within the organization.

Bill Manning

Patient Empowerment through Knowledge Sharing

The selected segment discusses the importance of patient empowerment through knowledge sharing, specifically in the context of prostate cancer treatment. The speaker, Bill Manning, shares his personal experience with active surveillance and the importance of seeking multiple opinions when navigating treatment options. He highlights the role of support groups, such as IP CSG, in providing educational resources and emotional support to patients. Bill also emphasizes the need for patients to be proactive in their healthcare, advocating for themselves, and seeking out alternative treatment options, including Western and alternative medicine approaches.

Low-Risk Prostate Cancer Management through Active Surveillance

The speaker shares his personal experience with low-risk prostate cancer, undergoing active surveillance for 15 years. He highlights the importance of PSA density score, which is a ratio of prostate gland volume to PSA score. The speaker emphasizes the need for patient empowerment and informed decision-making in prostate cancer treatment. He also discusses the challenges of overdiagnosis and overtreatment and urges attendees to be proactive in their healthcare and seek multiple opinions to make informed choices. Additionally, he explains the role of support groups in providing emotional and educational resources, emphasizing the need for patient advocacy and a positive outlook in navigating this journey.

Mike McCarey

Importance of Prostate Cancer Testing and Treatment Options

The speakers discussed the importance of getting a PSA test if you experience symptoms that lead you to visit a urologist, and the importance of getting an MRI before undergoing a biopsy. They also emphasized the need for patient education and empowerment, highlighting the role of support groups in providing emotional and educational resources. The speakers shared their personal experiences with prostate cancer treatment, including using integrative approaches that combine Western medicine and alternative medicine.

Empowerment Through Informed Decision-Making and Holistic Approach

The speaker shares his personal experience with prostate cancer treatment, emphasizing the importance of being an active advocate in one's healthcare. He discusses how seeking multiple opinions and remaining open to alternative approaches, such as sSRT radiation and bio care hospital's alternative medicine programs, helped him make informed decisions and achieve the best possible outcomes. The speaker also highlights the importance of being proactive, seeking second opinions, and considering the benefits of both Western and alternative medicine approaches in navigating the complex and often uncertain journey of prostate cancer treatment.

Emotional Survival and Stress Reduction Techniques

In this segment, the speaker shares his personal experiences and strategies for emotional survival and stress reduction while living with prostate cancer. He emphasizes the importance of being proactive in one's healthcare, educating oneself about treatment options, and seeking multiple opinions to make informed decisions. He also discusses the benefits of journaling and keeping a "cancer resources" document, which can help individuals keep track of their medical history, test results, and treatment plans. Additionally, he shares five emotional tips to reduce stress, including being positive, rearranging one's thinking, eliminating stress, visualization, and controlling the "dark place" by processing negative thoughts and emotions.

Herschel Kagan

Prostate Cancer Diagnosis and Treatment: A Personal Journey

The speaker shares his personal experience with prostate cancer, from being diagnosed with BPH to being referred to a urologist and eventually undergoing a biopsy and receiving a Gleason score of 4+5. He discusses his treatment journey, including radiation therapy and hormone-suppressing drugs. The speaker also expresses his concerns about the limitations of the US Preventive Services Task Force recommendations for PSA testing and the risks of overdiagnosis and overtreatment.

Q&A Discussion

Prostate Cancer Screening and Treatment: The Role of PSA Testing and Patient Empowerment

The discussion highlights the complexities of prostate cancer screening and treatment, particularly the role of PSA testing. Bill Manning shares his personal experience with active surveillance and how his PSA score changed over time, emphasizing the need to consider patient preferences and professional judgment. The conversation also touches on the challenges of overdiagnosis and overtreatment, and the importance of integrating Western and alternative medicine approaches.

Supplements and Sleep Management

The speaker discusses the importance of sleep management and recommends certain supplements such as apnine, l-theanine, and magnesium glycinate to help relax and improve sleep. He also shares his personal experience with sleep and how he uses cannabis-based products to aid in sleep. The speaker emphasizes the importance of experimenting with different approaches to find what works best for individual needs.

Edited Transcript

Good morning and welcome, everyone. Thanks for coming out today to the new SBP Auditorium. Once again, it's great to see you all in person. I know it's been a couple of months. Special thank you to Sanford Burnham Prebys Medical Discovery Institute for the use of this brand new auditorium. Everything has been upgraded in the last year. It's wonderful we can have people online - they can hear us, we can hear them. Hopefully, you can all hear me.

I'd like to introduce the principals of the organization. I hope you all know Bill Lewis - he's right here. He's our president, and he does the newsletter summaries. He sets up all of the speakers, he does the luncheons, he does so much. I really hope that you appreciate the job that Bill does for this organization. Thank you.

We have Gene Van Vleet, our director and treasurer. Steve Pendergast is not with us personally today, but he's our secretary and does the newsletter editing. We have Bill Manning, our director and videographer, although we now have Patrick who's also going to be doing videography for us. Myself, Aaron Lamb, director and facilitator of the meetings. We have John Tassi, our webmaster, Bill Bailey, our librarian, and of course, there are well over 900 members. Everyone is a volunteer, and you can be too.

Are there any people new here today for the very first time? Just raise your hand. Did the three of you get this newcomer packet when you came in? The newcomer packet should have a profile form on the cover sheet. Please fill that out and hand it in either to Bill or myself before leaving today.

This information kit will have a lot of information that is very useful, especially to people recently diagnosed. It will get you in touch with articles and booklets and so forth. Filling out that cover sheet will get you contacted, hopefully within the next week, to discuss your personal situations, see where you are in your treatment, see what other information we might be able to get to you for assistance. You'll get to talk to one of the guys that's had a lot of experience with treatment. It's really extremely useful. It'll also get you signed up for our mailing list for the newsletters and announcements for the meetings.

So, an all-hands welcome. Who's here for the first time? We saw three gentlemen already here for the first time. How many have been recently diagnosed, you know, perhaps in the last few months? Haven't really started treatment but looking into stuff? How many have had prostate cancer for less than one year? Go ahead and raise your hand. Alright, a couple of guys.

One to four years? Yeah. Five to 10 years? I know I'm getting up there. 10 to... sorry, 11 to 15 years? Quite a few. And longer? Gene, 21? 23? 23.

The point of this little survey was, especially for you newcomers, to realize that even though cancer can be very daunting, you have a long life ahead of you. There's no better time to get prostate cancer than today because the treatments are literally phenomenal compared to what they were even when I had it seven years ago.

Now another survey, and especially for you newcomers, look around and see who raises their hands during these questions. If you have specific questions about certain types of treatment, these are going to be the people that you want to go up to and ask questions about their experience.

So, who has been on active surveillance? Alright. Who has had surgery? Who's had radiation, whether it's proton, X-ray, brachytherapy? Alright. ADT and hormone therapy? These are all very common treatments. Who's had chemotherapy? We have a couple of members here who have had new treatments such as HIFU, laser, cryofocal therapies, immunotherapies, Pluvicto. All of the above? All of the above - he's the man!

How many people have had recurrence? Yeah, that's why some of us are here, looking for what's the next treatment. And who is undecided about future treatment? Pretty much everyone might be raising their hand here, right?

Okay, I want to note that we are on Instagram. We are up over a thousand followers. Please do check us out at instagram.com/ipcsg3. So do follow us, click on some posts, and like them. Bill Lewis has done a fantastic job of getting our message out there. This helps us get all of this information that we share here out into the web, giving access to a lot of other people by way of Instagram as well as YouTube. All of our meetings are recorded and available, and we get a lot of people that watch these programs later on.

Now, our support to you comes in the way of our website, which I hope you're all familiar with. We are also on YouTube, as I said. "Prostate Cancer Support" is the name of the channel you can subscribe to. We have our meetings on the third Saturdays of every month, but not December, and we have the newsletter on the website, by email, or mail. You can get them, and there's a hotline number. Bill Lewis is taking calls on the hotline number.

You know, for those of you recently diagnosed, I know when I was, I was just absolutely scared and paranoid and didn't know what to do or where to turn. Especially back then, if I had known about this hotline number, that is the perfect number to call when you're in that situation - what do I do next?

We do have additional support for you, or I should say others have additional support for you. There's very low-cost PSA testing by Ulta, with the link there. You can also find this information on the website. PROMISE is a germline DNA saliva-based testing which is free. And I also wanted to mention the YMCA Livestrong prostate cancer therapy exercise program, which I believe is still free as well through the YMCA. It's very important when you're on hormone therapy to remain very active, and this is probably one of the best programs to be a part of during that time.

There is an upcoming conference I'd like to advertise. The PCRI conference, which is up in LA, is going to be September 7th and 8th, and we are lucky enough to have gotten a 50% discount code. Not that it's really that expensive to go to anyway. The code is PCRISG, and thank you to Bill Manning for getting us that.

All right, so how many people were a bit surprised and disappointed when we canceled the June meeting? Again, going back to the survey. Yes, I've got to personally apologize for that. I failed to set up a backup meeting facilitator for that meeting. The key thing is that the guys running this organization have been doing it for a long time. You know, we've effectively been working as backups, understudies if you will, to each other. But once in a while, like two of us might not be able to help out for that particular meeting, and that was kind of the case last month.

So it's time that we look for additional people to volunteer for the organization. It's time to bring on a few understudies to each of us here because we can't always cover for each other, unfortunately. That involves, basically - I have the list of Bill Lewis's responsibilities here, you know, in addition to us, but take a look at what Bill is essentially doing a lot of times here. We would really like some help signing up meeting guests, you know, doctors, roundtable speakers such as today, etc. Taking over the meeting luncheons - you might remember a couple years ago, or I'm not even sure if we did it before COVID. Certainly didn't do it before the first meeting back. It's been years now, yeah.

We've been having these wonderful free lunches, folks. I mean, all you have to do to get the free lunches is have prostate cancer. But you know, years ago we did not have these lunches, and these lunches have been very useful for us to be able to chat after the meetings about topics of our own needs as well as the meeting info. We could use some additional help with that.

I really would appreciate somebody volunteering to be the backup meeting facilitator, just one or two times a year. I was on vacation last month, and that's pretty much why we lost that meeting. If we had somebody I could directly go to to be the backup, I would really appreciate it, and that wouldn't happen. I mean, imagine if we had to do that for Dr. Lam or Dr. McKay or the Department of UCSD Radiology when they come in. That would really be a loss to everybody. So think about what that loss would mean just to you and see if volunteering one or two hours, coming up at a meeting that you're planning to attend already, and you know, stand here and essentially do what I do - it would benefit everybody.

Now, I was not part of volunteer organizations before this group. I was paranoid the first time I was going to be meeting facilitator. I mean, come on, I'm an engineer and supposedly antisocial and trip over my words and stutter and everything else. But I've figured out how to do it. What's that? And, you know, I stumbled through it at first, and you know, I get a lot of compliments for running these meetings. It's not that hard. We don't have to be perfect, and please, if one of you would volunteer to just back me up once in a while, please just see me and let me know.

We could also use some assistance with the newsletter - whatever editing, proofreading is needed. Accounting assistance with Gene, as well as taking hotline calls. And so, you know, I can't emphasize how important this is right now. There will likely be significant changes to the organization if we don't have more volunteers, and that could mean anything from, you know, we might have to go to only having meetings every other month, or we might have to merge with another organization to have the support that we need. And the meetings are not going to be the same as they have been. I mean, this organization is, you know, touted across the country for how wonderful it is at getting information to patients, not just in the room but on the web and stuff. So please, if you're willing to volunteer, please raise your hand right now.

And thank you. And why don't you... My spot! Excellent. This gentleman? Yes, that's right. And I think I saw one more hand? Yes, going to go facilitator. You know, having two would help me out because honestly, we also are missing our greeter today, and having a backup greeter would be great. Somebody that can put out the signs and bring them in and so forth. It would really help out. So please come up and see me, make sure I write your names down, contact information, you know, so we can... About Bill, I also want to mention that there's a little urgency with regard to my position where my family's under heavy pressure to move to join our children in Utah. Yeah, so Bill, as the president of this organization, will not be taking care of all these responsibilities come November, and we have to fill in for that. So again, if you're questioning in your mind whether you can help out, the answer is yes, you can help out. Come and talk to us, please.

All right, okay. So, reminder of our support group purpose: We share patient-focused experience on becoming your own case manager through informing, networking, and caring. We are a group of experienced participants, but we are not medical professionals, and any sharing by anyone of our group may not be a substitute for your medical counsel.

And we do need your support, specifically your financial support. We are a 501(c)(3) nonprofit organization. Can I get a couple of volunteers to take some of the baskets around? Donations to our organization are tax-deductible. There are no medical or religious affiliations. Our largest costs are in terms of running our website, our advertising, our mailings, you know, video, etc. Please do make a donation online via PayPal - that can work - or you can send a check to the P.O. box address that you see here. That address is also available on the web.

Excuse me, there was one more thing I wanted to mention about that. You know, just to go back to this other slide for a moment. This first line item, signing up other doctors. You know, a lot of us - I was extremely lucky that I had a very wide network for my insurance that allowed me to go to any doctor that I wanted to. That's not the case for a lot of you out there. How many people would like to go and talk to Dr. McKay or talk to Dr. Lam? Yes, absolutely, right? If your insurance is not willing to cover that cost, you know, you're looking at upwards of $500 to $1,000 for that visit. But it's free when we get those doctors to walk in the door here.

So if there is a doctor that you personally really would like to have come talk, that you want to specifically ask questions of, this is the chance to, please, you know, sign up to help bring doctors like that in. You know, it's not that hard to call up their offices. A lot of them are familiar with our organization or want to come and talk to us to show us, you know, doctors love to show off what they've learned and researched and so forth. And so, you know, please be willing to sign up for that task.

All right, so upcoming meetings. We do have some exciting upcoming meetings. I know that Dr. McKay will be coming in the fall, but next month we're going to have Telix Pharmaceuticals. They're going to give the results of the PROSTACT global trial. You might remember that Telix was here a year and a half ago or so. They are pursuing what you might have heard of, you know, the PSMA-based radiation therapy, right? That's. Pluvicto is the one that essentially Telix is doing a modified version of for earlier treatment, right? This Pluvicto treatment, it's the smart bomb that finds the individual cancer cells and destroys them. It's fantastic, but right now it's only for very advanced cases. Telix is trying to bring that much earlier into the treatment timeline. So this is a fantastic trial to learn about. This is going to be part of the wave of the future.

For today, though, we have our member roundtable. We're going to start out with Bill Manning, who's joining us via Zoom today. Then we'll have Mike McCary and Herschel Kagan. So let me turn it over to Bill. Go ahead and share your screen, and hopefully the audio is still working.

Bill Manning: Yes, can you hear me okay?

Moderator: Can everyone hear Bill okay? Yes? Okay, we got a yes here.

Bill Manning: Okay, let me share my screen. Well, thanks everybody. Before I start on my story, I just want to say a few quick words about me personally. As you notice, I'm on Zoom instead of shooting video, and that is going to be the future course of action on my behalf. I'm not going to be attending the meetings physically anymore. Circumstances have come up that make that very difficult.

So I will still be editing the videos. My very trusted videographer friend and accomplice, Patrick Espinosa, will be filling in for shooting the meetings. As I said, I'll be editing, putting them on YouTube.

And then another quick word I would like to say regarding the videos: I did my first IPCSG video back in January of 2010, so I've been recording our meetings basically for the last 14-plus years. Prior to COVID, we used to make DVDs. We actually distributed quite a few of them, and basically, technology and COVID put an end to that, and so now we're on YouTube.

So it's been a pretty remarkable time doing all of these meetings, and I just wanted to give a special shout out to Lyle LaRosh, who passed away a few years ago, and Gene Van Vleet. Those two men were founders of IPCSG, and all the work and effort that they have put into growing the organization and making it what it is today, and then also what it meant for me personally.

Bill Manning

So with that, I'm going to go ahead and get started on my journey on active surveillance.

In 2009, I was getting a routine health test for life insurance, and I came back with a PSA of 4.1. At that time, I had no idea what a PSA even was. The insurance rejected me and said, "Nope, 4.0 is normal, and you are not. So sorry, Charlie."

I thought I would show them, and a few months later, I went back and got another test at my HMO. Surprise! It was 6.1. So that basically put me on the immediate path for a biopsy. Again, I was operating in the dark here. I was just doing what I was told.

They came back with 12 cores, 5% 3+3 Gleason in one of the 12 cores, and then I was recommended for surgery, being told that I was a great candidate for it. Well, of course I was a great candidate - I was in good health, I was 57, and you know, what could go wrong? So that was the beginning of my journey.

I immediately started into an education process, and this was a process that I shared with my wife because she was very concerned at the time that I was not jumping into treatment. But she was very willing to let us do some more research.

One of the major influences for me at that time was a book called "The China Study." After reading that, it made a pretty profound impact on me. That was part one. I was being seen at Kaiser at that time, and a gentleman at Kaiser told me about this group called IPCSG, that I had to go see one of their support meetings.

So in September of '09, I attended my first meeting, met Gene, got a lot of information, and found out about this doctor up in Ventura called Dr. Bond, who did a test called the color Doppler ultrasound. Basically, it was a rather unique high-end ultrasound that was done in color as opposed to the low-res grayscale ultrasound you get when you get your biopsy done.

He did the ultrasound, and results came back negative. He said there were a few suspicious cells, but he wanted me to come back in six months, and I said, "Okay, no problem." He recommended active surveillance.

Now, taking a half-step back, my urologist said, "Yes, there is this thing called watchful waiting." And watchful waiting at that time was basically you watched and you waited. You waited for symptoms to manifest to the point where you knew something was wrong. And unfortunately, because of the treatments 15 years ago, by the time symptoms manifested themselves, you were in serious trouble. So that wasn't really a good path for me. But active surveillance was gaining speed. It had actually started many years before but was still not really recognized by most urologists.

So I declined the surgery. Then in 2010, I went back, got a second ultrasound. Everything looked fine. He said that basically the problem was I had BPH. Well, big surprise there - my gland was 67cc at the time. He also added another test called the PCA3 test, which came back negative. Now, I might mention that that test by itself, over time, became less and less used. Its results were not as conclusive as they had originally hoped, but ultimately it has become part of a test that is commonly used now called the ExoDx test, and the PCA3 is one component of it.

So basically, I started on my new diet. My weight and cholesterol dropped. My PSA had dropped back down to 4.13 - remember it was 6 before, now it's back to 4.13. Then it went up to 5.2. My DRE was negative. Then between 2011 and 2012, I got biannual PSA tests. You can see the results kind of jumped around a bit: 4.8, 5.4, back down to 4.3, up to 4.5. Got another DRE, it was negative.

I went back in 2012 to Dr. Bond for my third ultrasound color Doppler. He said everything looked fine except for BPH, and my prostate gland was now 80cc's.

So, another interesting fact was in 2012, I discovered a piece of family history. I discovered that my birth parents had both died of cancer at 64 and 65, and also had an uncle that died of prostate cancer, though his age was unknown, circumstances were unknown. For some, they would have found this a very alarming fact. You know, I took note of it and continued to move on.

So in 2013, PSAs again: up to 5, down to 4.8. DRE negative again. Now I went for my fourth ultrasound, and by this time Dr. Bond was really saying he wanted to do a targeted biopsy. I told him that I did not want any more biopsies unless there was a compelling reason. Well, he did his ultrasound and said, though not compelling, he did find an area that was kind of suspicious, and he really recommended doing it. So I gave in. He did a targeted biopsy. He did seven cores in that area, and the results came back negative - as in negative. So I sent those samples out for a second opinion, and they were confirmed, meaning that in those seven samples, they couldn't find any cancer period.

Okay, so now to 2014 and 2015. My PSAs continued to rise. It hit a new high of 7.5, down to 6.1 in 2015. It was in the 6 area, back up to 7.1. DRE was negative. And with Dr. Bond, we were at a critical juncture at this point. MRIs up to that point had not been very useful, but they had improved to the point where using a multi-parametric technique, where they're taking multiple images with software analyzing the imaging in different ways, was becoming very popular and very important.

In fact, Dr. Ross Schwartzberg from Imaging Healthcare Specialists came to speak to IPCSG back in either 2015 or 2016 to basically inform us of this new protocol. So I went and got my first MRI. The results came back negative, and I was given a PI-RADS grade of two.

Now, I might point out that there are five grades of PI-RADS. PI-RADS is a methodology much like the Gleason score, which gives a map of how radiologists should look at their MRIs. Prior to that, it was all over the map, kind of the Wild West as far as how one radiologist would say, "Here's a problem," another one would say, "No, there isn't," and you never knew exactly why they were grading it that way. So now with the PI-RADS system, it kind of put everybody in more of a box where everybody was playing from the same page.

A PI-RADS 1 is the lowest you can get, a PI-RADS 5 is the highest. And again, what we are talking about here is risk. In other words, it's not the fact that you're going to, that you do have this, it's the risk of having advanced prostate cancer versus low-risk. Remember, I'm in the low-risk category.

So now my gland volume again was 80cc's, and I was given a rating of PSA density of 0.1. Now, what that means is it's a ratio that has been developed over the years, basically taking the size of your prostate gland and then dividing it by your PSA score. The reason for doing that is that one of the most common reasons for your PSA score going up is your prostate gland is increasing in size. There is a direct correlation between the two.

So that kind of hearkens back to the old, you know, 4.0 PSA being "normal." Well, normal is very different between men, and your PSA gland or your prostate gland volume is going to have a direct relation on what that actually comes out to. So a PSA density score of 0.15 or below is considered sort of the safe zone, the low-risk zone. Now, above that doesn't mean that you absolutely have a problem, but it means that you have to take into account more tests and research to see whether you are in fact more at risk.

In 2016 and 2017, again the PSA test bounced from 5.9 up to a new high of 8.7, went back to 7.7 and 6.8. Again, I got my second MRI at Imaging Healthcare Specialists. Again, results were negative except for BPH. Again, a grade of PI-RADS 2. My prostate had grown to 99cc's by this time, and that actually dropped my PSA density score down to 0.07.

In 2018-2019, again I had PSA down as low as 5.6, as high as 7.9, but then in 2019, I started taking dutasteride for trying to shrink my prostate. And that's kind of a mixed bag because there are side effects with taking that medication, which I discovered later. And after taking it for a year and seeing no real drop in my PSA and not seeing basically any improvement in my urination or anything like that, I decided to drop it and switch over to Flomax, which I still take to this day.

I got a third MRI in December 2019. Results again negative, again a PI-RADS 2 designation. My gland volume was 97 at that point, PSA density of 0.06.

2021, my PSA started rising again because I had stopped taking the Avodart, and the 6.4 to 7.8 was getting back to more my normal range. By '21, it was back up to 8.9 and 9.1. I got my fourth MRI at Imaging Healthcare. Results were negative, and this time I asked to have Dr. Schwartzberg himself personally review the MRI, and he did. And it came back at PI-RADS 1. Prior PI-RADS 2, now a PI-RADS 1. So even better news. The not-so-good news was my gland had grown again, now to 111cc's, and PSA density of 0.088.

In 2022, I hit a new high of a PSA of 10. In 2023, though it dropped back down into the 8 range again. And this was when my urologist recommended that I take an ExoDx genetic test. So I took my first one in 2022, and it came back 44.4. Now, that is above the range that the people who do the test feel that you're at no risk of advanced cancer. I think the cutoff was 15. So basically, 15 and below, everything, you know, don't worry. Above that, but it can go all the way up to 100. So he was a little concerned about that, and he wanted to repeat the test again in 2023, which we did, and it was at 41.2 - not an appreciable difference, but he definitely wanted to have another MRI.

So I got a fifth MRI. Again, the results came back negative. Again, PI-RADS 1. Again, the opinion was by Dr. Schwartzberg. And the other not-great news is my prostate had grown to 124 by this time, which gave me the good news of a PSA density of 0.07.

So now we have 2024. My test earlier this year came back 8.3, and my next PSA will be in October. And obviously, all of this is to be continued.

So I'd just like to make a couple of quick points, and then we'll turn it over to the next speakers. And I'm going to stick around for any questions that anybody has, but please wait until the next speakers have their opportunity to talk.

I've been on active surveillance for 15 years. Had I followed the urologist's suggestion of getting surgery back then, I very possibly could have suffered some very bad side effects, a deterioration of my quality of life, and for no reason at all. I may have been stuck with incontinence, I may have been stuck with ED, or both. But the important thing is that it would have been unnecessary, and that's really the core of where active surveillance is.

It's determining who amongst all of the almost 300,000 guys that will be diagnosed with prostate cancer this year - at least half of them will fall in the low-risk category. But because of lack of knowledge or the priorities of the urologist or pressure from family, or even just anxiety from themselves, they may elect to go ahead and have treatment and really not need it.

Now, one of the big questions that comes up is, "Well, okay, you have 3+3 Gleason. Aren't you worried about that turning into or metastasizing into more advanced cancer down the road?" And that's been a big question hanging over active surveillance for many, many years. Basically, in 2024, the answer to that question is no. That 3+3 Gleason cancer is not going to metastasize into more advanced cancer.

Now, that's not me, a non-doctor, saying this. This is not some individual on Facebook that thinks they're a medical expert throwing this stuff out. If you were to ask this question to Dr. Laurence Klotz in Canada, or Peter Carroll of UCSF, or even our local Dr. Mark Scholz from PCRI - if you were to ask any of them that question, all three of them would say no, that 3+3 is not going to metastasize.

Now, is it impossible that that would never happen? Well, of course not. There's always that microscopic chance that that could, in fact, metastasize. But we're talking microscopic. We're talking very, very, very rare cases of that ever happening.

But what can happen is that you can grow a new cancer. That happens often, where you have maybe a lesion in one part of the prostate, and then maybe a year, two, five years later, all of a sudden you find a new one. Well, it's not so much that that original one grew into a second one, but a new one grew. So that's where the "active" part of active surveillance comes in.

Knowing the fact that at one time you were diagnosed with some cancer, low-risk cancer, it doesn't mean you're completely out of the woods. But what it does mean is you can take fear off the table, take anxiety off the table, and do regular testing that basically can give you peace of mind that you're not being at risk. Your risk of dying from heart disease is 10 times what it is for prostate cancer. So, you know, if you really want to look at risk, you should look at your lifestyle and what you do and what you eat and all of these kinds of issues that will have a far bigger impact on someone with low-risk cancer.

Obviously, advanced cancer is a completely different animal. Biologically, it's completely different, and it acts completely differently. So that's a whole different ball game. But for those of us in the low-risk category, active surveillance is a very, very viable alternative. And I have 15 years to show for that.

So with that, I'm going to stop sharing my screen, and I'm going to turn it back over to Aaron. And again, I'll be around later in the meeting if there's any questions for me.

Aaron: Thanks, Bill. Before you mute yourself, just one quick question. So all of this data is by way of diagnostics that perhaps somebody would not realize their prostate is growing as yours has. What physical symptoms did you experience over this time that you know would help somebody understand that BPH is going on if they're not otherwise getting all these diagnostic tests?

Bill: Well, as far as your prostate size, you know, what usually gets this whole process going is you're having urinary problems or maybe you might have a little blood in your urine or something like that that sends you to the urologist. And so that's what really gets the train going.

Now, the symptoms can be, again, usually they're urinary-focused - either frequency or just, you know, your volume goes way down, or getting up five times at night. You know, all these kinds of issues that basically don't equal cancer, they equal a urinary problem.

So once you go to the urologist, then it's really up to them to start narrowing down the list of what things it could be. And one of the things that they will do, of course, is give you a PSA test if you haven't already had one. And then hopefully make an informed decision from that point as far as what your next course is if your PSA is low.

Now again, without an MRI, you don't really know how big your prostate is, although if they do a biopsy, they can get a pretty good idea of size from that because they are using an ultrasound. So basically, whether it's prostatitis, an infection treated with antibiotics, whether it's BPH - which, you know, the jury's out on that. There are no real good answers for BPH. They're working on it. There's a lot of people that put out information on supplements like saw palmetto, for example. There's no evidence that shows that that works. There's some men who anecdotally say it has helped them, and maybe for some reason it did, or maybe something else helped them and they're taking that stuff and they think that that's what helped them. It's hard to say.

But basically, it's those kind of symptoms that get you to the urologist, which then get you a PSA test. The one thing I will say that's really important, and thanks for asking that question, Aaron, it is now become protocol - though it's still not widely used or accepted - that if the urologist feels that you need a biopsy, let's say your PSA is 10, which depending on your prostate size may not be that unusual, but for a lot of people that is a high number - before you get that biopsy, you get an MRI.

Bill: Even the AUA, the American Urologic Association, has finally accepted that as a proper protocol to do prior to a biopsy. Because unfortunately, once you get the biopsy, you know, you may get on a train that's hard to get off of. If you get an MRI and they literally can find nothing but, say, cell structure that pretty much dictates you probably have BPH or possibly infection, then you don't have to go the biopsy route. You can immediately go do something else. So that's really an important point that needs to be made here.

Aaron: Excellent, excellent. Well, thank you very much, Bill, for the presentation. Very, very informative. Yeah, and as Bill pointed out, let's hold all the additional questions - sorry that I put in with one - but we'll hold those to the end to let all the speakers speak. So next up, we've got Mike McCary.

Mike McCary: I guess I'm done. Thank you.

Aaron: Yeah, real... Why did that go all the way to the end? I'm so sorry about that. Let's try this again. There, there you go. You're alright.

Mike: Thanks, buddy. So everybody can hear me okay? Great. First off, it's great to be here. I love this organization. The fact that sharing helps so many people calm the nerves, lift the education - I've watched it over my seven years. So we're approaching a seven-year journey, and as I talk to other men that are starving for some kind of emotional relief and understanding about the whole prostate cancer process, I see their faces change whenever I tell my story to them. And I share with them and say, "You know, my answers may not be your answers, but if you share this with other people yourselves, you're going to help other people." So it doesn't have to happen just here. Please do this on a one-on-one basis as much as you can.

So I'm just a common guy that came down with prostate cancer. I'm not a doctor, I'm not a scientist, I'm not an engineer. I don't have any of that kind of education. But I have, through my journey, formed a lot of opinions about the direction that would help me, and so I wanted to share all of that with you. And so with that, we will get started. Sometimes I have to see back on... Try it now just to see if it goes forward. There it does. Awesome.

Mike: Alright, so here's going to be our agenda this morning. First off, who am I? I'll tell you a little bit about my background because you want to put that with my prostate cancer history together. We'll hit the history, and then I use an integrative approach of Western medicine and alternative medicine and try to be wise about that. I'm going to share with you some of the resources and some of the things that I've put together.

I am an absolute believer that, for the very reasons you're here, education is the key to two survival pathways. One is our physiology - getting the right treatments at the right times in the right direction and being wise about when and why we make selections and agreements with our physicians about getting those treatments. And secondly, our emotional survival. If you have the right education and you have informed decisions, we're going to talk about how that can lower stress. And what does lower stress do? It helps your immune system by having less cortisol going on, and it just makes you feel a lot more calm about this little journey that we're on.

So here I am. I guess you can tell I'm Caucasian. I'm not anything but that. I'm an Irish guy with light eyes and light skin. 73 years old. I'm married to my lovely wife of 36 years, Terry, over in the corner. She keeps me straight. I'm almost retired. I started an employee benefits business about 23 years ago. I sold off about 97% of it, but I wanted to keep... First off, I loved what I did for 23 years, loved it, loved going to work every day, which was kind of cool. Wasn't like that prior to that time. So I sold off about 97% of it, and I've kept a couple of customers. It just kind of keeps me engaged, and it keeps me motivated, and it makes a little bit of mad money so Terry and I can go have a lunch or a dinner someplace whenever we would like to, within reason.

I'm very active physically, always have been. It's just been a lifestyle. Currently, I surf three or four times a week if I can. Terry and I took up sailing about a year ago, something we can do together as I ease my way into retirement. I love to go hiking. I've got a friend, we go up to the Sierras once, at least, if not a couple times a year, and go on a nice trail hike or rock climbing. And then once a year, I go to Utah with my son. We go deer hunting, sleep in a tent for 10 days at 10 degrees or down to 0 degrees, and I'm still asking myself why I do that every year. But it's because I can be with my son, so yeah, it's pretty awesome.

I used to fly a lot. Rock climbing and, I know I look like it today, pro rodeo. That's how I grew up for 25 years - cowboy boots, cowboy hat. Had to give it up just because I was moving on to other things that satisfied my adrenaline lifestyle.

Watchful diet - I can't say enough about this. So what cures prostate cancer? It's not one thing. There's not a pill to swallow, there's not a bullet to step in front of. I guess if you did that, you might cure its life, but you know, we're not going to go that pathway. Your immune system does. And if my immune system was not operating perfectly, I wouldn't be standing here today because I wouldn't have prostate cancer, right? And I would probably offer that is the same with most of the men in this room. If your immune system and mine were operating perfectly and we needed no outside assistance to boost that immune system or shore it up or give it a lift, etc., we wouldn't be here.

Diet is number one. It's the fuel that you put into your machine. So Terry and I both, and it's wonderful to have a mate, a companion who shares your eating lifestyle because it just makes it that much easier. You're not cooking two different types of meals. So organic everything. We reduced red meat and chicken. We took up juicing again. It used to be we started it, but it was really, really hard. We had this noisy machine that was almost a two-hour exercise to try to clean it, and frankly, we kind of drifted away from it. But we recently bought a new one. If you want to know, it's called a Hurom. This thing is a marvel of engineering science. I mean, it is really cool. It's quiet. In and out, we can make juice, I'd say, and clean up in what, 20 minutes? Yeah, and we're good. Look into that.

Lots of salads, veggies, no sugar, no starch. And when we... the foods that we eat are all low glycemic foods. No packaged foods, no processed meats. If you're watching anything and reading, etc., you're going to find that these are the things that prohibit your immune system from functioning as well as it should.

The next big one - repair in your body goes on at night during sleep. You have to take care of sleep. If you like to stay up real late to watch a nice Netflix series, etc., we do too. But you know, my wife might stay up and watch and finish an episode or something like that. 9:30, this little fat boy is going to bed because I know that I'm going to wake up. My body cadence has driven me to wake up at like, this morning, 4 to 6. I wanted to sleep later because we got in at 11:00 from going out with friends for dinner last night. Not as much sleep as I wanted, but so I have to regulate the time I go to bed. Then I know that I've got the other pillar taken care of, which is sleep management. And I want to make sure all of you do that too.

Mike: Negative bracket test: My father had prostate cancer diagnosis at 78, but he died of natural causes at 92. He was a real, real live cowboy. He was a really fun guy. My brother and I just loved him to death. Mother, no cancer, passed at 92 of natural causes. I have a brother, he has BPH but no cancer. My father was married once before, so I have a half-sister. She had breast cancer, but she cured it and she's spunky at 84 today. There's my family history, and there's me. So that's the body that has been presented to you and is talking today.

My oncologist is Dr. McKay. How many people have Dr. McKay? She is unbelievable. She's unbelievable. Seriously, she's one of the smartest, most progressive, forward-thinking... Wow, I just can't say enough about her. So if you're trying to make up your mind about an oncologist and who you're going to go visit and select first, I would say get several opinions. Don't drink from - you're going to hear this a couple times from me - don't drink from one fountain. Drink from several. Interview her. You'll be impressed.

And I already mentioned it. Yes, sir?

Audience Member: Dr. McKay will talk to us in October.

Mike: Awesome. Everybody got that? Awesome.

All right, so let's get to my history, and I'm going to start moving a little bit faster. I tried to have some fun here and give you a little bit of emoji reactions to some of the events that took place.

So I went in to get... My wife and I were going to head to Europe, and so I always travel with Ciprofloxacin whenever I go out of the country because if I get a GI thing, I can pop 500 milligrams of Cipro and then that'll help me out until I can get to a physician. And then off we go.

I went to go see him and I say, "By the way, we had 2.6 on my PSA score last year, and it's been probably four to five years since we've done a DRE, so let's do a DRE today." So he straps on the stuff and grabs the gel, and off we go. And he says, "I feel it's too firm, and I feel a nodule. It's lumpy, it's... you know, it shouldn't be there. So go to Europe, come back, and then let's set it up so that when you come back, you see a specialist."

We did that. Well, what do you think I'm doing every spare minute while I'm in Europe and in Italy and on the cruise ship? I've got my face in a tablet or a phone, and I'm learning about prostate cancer because I knew this much until that point. That much. It was terrifying.

Mike: Came back, saw my specialist. He did a second check, a second DRE. PSA came back at 3.8, and he said, "Hey, you've only got a 15% chance of having prostate cancer. Let's check your PSA in 6 months."

Well, the truth is, I had scared the crap out of myself for the last 10 days in Europe reading everything I was reading and not knowing what to pay attention to and what not to pay attention to. So I had a very aggressive position of trying to say, "Look, we're moving through this. We're going to do some testing right away." I don't like the word "delay" on anything. I don't like it at work, I don't like it in decision-making, and I didn't want the word "delay" used in the medical progression of this thing that was scaring the crud out of me.

So he says, "Let's check your PSA in six months," and I literally leaned forward and smiled and said, "Check yours in six months. I want an MRI-guided biopsy next week or an MRI next week." We did the MRI the next week. There's three lesions in there, two of them were benign, one was highly suspicious. Four days later, we did an MRI-guided biopsy, and that gave me the 3+4 Gleason score, or a 7. And like the little icon says, I'm going, "Oh my God, what do we do?"

So long story short, we watched it from May until August, and the PSA kept rising. So I had the, again, aggressive stance. I wanted this out of me. It scared me. It was too much that I didn't know about. So we did a radical prostatectomy in August of '17. Started feeling really good.

We did find out, though, that prior to surgery, the MRI showed that the lesion was encapsulated within the gland. And so in the parlance that the doctor told me, he said, "Gland out, cancer out. You're good to go, and that'll be that." Well, in the three months that transpired between - three and a half months between diagnosis and the actual surgery - we do the surgery, pathology comes back, and it has extended beyond the margin. So it had already left the gland, and it came back with a tertiary score of five.

And somebody's going to ask me about what tertiary score is. I'm not positive, but the way he explained it to me, my surgeon did, he said tertiary score runs from one through five - least aggressive, most aggressive. Thank you very much. Mine was five. Well, that redoubled my concern about no delay, learn, make good decisions, etc.

So after surgery, for seven months, my PSA fell to zero. Whoop whoop, life is good. The following August, or 7 months later, started to rise again. So here we go, the concern flag. What's going on?

Mike: We tracked it until August of '18, and I said, "All right, done." It's growing now. From zero, it had gone up to 0.18. And I know you're all thinking, "Oh my God, that is so low." It is. It's an absolute PSA that's extremely low. But the trend line was like Apple stock in, you know, many years ago. It wasn't doing this, it wasn't oscillating at all. The trend line was always up.

So I interviewed several physicians. And by the way, I want to insert something here. You're going to hear me focus at the end about being your own advocate. Don't stand there like a guppy waiting for somebody to dump some food in the aquarium so you can eat. Excuse me, so you can have some advice. Talk to several surgeons, and if one says this opinion and another one has an entirely different opinion, you've got a tiebreaker. You've got to take up... How can you proceed with one of those when you have two opposing opinions about the progression of your treatment plan, right? So you need to go see a third person. And in my mind, I was looking for commonality between at least two opinions.

In the end, my wife and I interviewed five different physicians before I had surgery. We went... After surgery, we interviewed two more. We'd already interviewed one for radiation. And so my point is, every time I selected a direction to move forward in, I felt confident that that was making the right decision.

So after interviewing five surgeons prior to surgery, they're shaving my belly and they're taking the blood pressure cuff, and you know, I'm getting all ready for surgery and everything. And the nurse takes my blood pressure and comes back like 121 over 64, and she goes, "You know why you're here, right?" I said, "Yeah, but I've done everything I can do. Talk to five people. That's between God and my surgeon, and off we go," right?

So gain a lot of information. It just takes a little bit of time and maybe the cost of a second opinion, you know, with your physician or through your medical plan.

38 treatments of photon radiation, October 18th through December 28th of '18. It left me with radiation cystitis and radiation proctitis. We'll talk about that in just a second.

I remained at a PSA of less than... of zero to 0.1 until November of 2022, and then it started to rise. And then so that's November of '22. July of 2023, it's gone to 0.4. So we're starting this Apple stock curve again. November of '23, the PSA is at 0.06.

Mike: And about that time, I'm having, you know, trouble with my back. So I went to an orthopedic surgeon, and I asked for an MRI of my back and my left hip because the hip was feeling weird too. Calls me back in after that's all done, and he says, "Listen, I need to share something with you that's a little spooky." And he pulls up the image of the MRI of my left femur. Six inches down from the head of the left femur was a 1.7 cm image of what looked like it could be a metastasis in my bone.

Well, I was like freaking out, but that doesn't jive with a 0.06 PSA, okay? And was like, something doesn't seem right. So anyway, I run to Dr. McKay. She orders a bone scan right away. She ordered a PSMA PET scan right away. The bone scan was done first, got the results back right away. It was negative. Life is good, all right? That's it. Hasn't moved to the bones.

PSMA PET scan came back, and I had a 2 mm metastasis in the left perirectal lymph node region. That is about the size of a BB. I mean, it's really, really tiny. And you might think, "Eh, why worry about it?" Well, you need to worry about it.

So talk to her about what we should do, and she says, "Hey, SBRT radiation is a new procedure that's really out. So instead of 38 treatments, you get five." They call them fractions. Each treatment is a fraction.

We discussed where to get it done. So UCSD had SBRT radiation that they could perform, and that would have been my first choice. But while all this is going on, in the ever-present pursuit of more knowledge and, you know, solid decision-making, I ran across a PowerPoint presentation put on by a guy at UCLA named Dr. Amar Kishan. And he talked about an MRI-guided automatic or auto border-sensing SBRT radiation. So the radiation part of it was exactly the same, but what guides the beams to the exact spot in your body is what was different.

So the UCSD side didn't have that technology yet. They probably... they will soon. So in conversations with Dr. Kishan, Dr. McKay, I wanted heavy targeting because I got left with radiation proctitis and cystitis from the first 38 treatments, and I didn't want to repeat any of that. And the fact that with SBRT, they can control with each one of the fractions that come through to the target spot in the center, they can control the amount of radiation for each one, which allows the physician to control the damage that might be caused to peripheral tissues around that metastasis. Did that all make sense? Cool. Awesome.

Mike: So I go up to UCLA in March, five fractions of SBRT. I'm hoping for like a 0.2, 0.3, or yeah, or a zero. And it came back at 0.08. Looks like I'm bummed, but it wasn't 0.1 or 1.0, etc. It was the same, right?

So what was the solution? What was happening? What was happening was it was either that they missed the metastasis - and frankly, it was really, really tiny - and they assured me that these size of metastases with SBRT radiation at UCLA and in UCSD, they do all the time. They go in, they can get them, they can eradicate them, remove them from the equation and move on, okay, with the next step, whatever that might be.

So it was either that they missed it, or they got it partially and another one has cropped up. We'll have to wait and see. This is our game, as we know. We live from test to test and result to result. So my next PSA is for September 19th, and we'll find out. It's going to be a PSMA PET scan, and we'll find out if there is something else going on in there, or did my body take longer than the traditional 90 days to respond to the deterioration in that metastasis, which is normal. So it's normally 90 days after radiation that you see the full effect. It could be that my physiology is a little different. I've always been told I'm a little different, and we'll see. I'll cross my fingers and hope that's the case.

Let's move on. With no issues with bladder incontinence, this was wonderful. I was so fearful of that. So ever since surgery, I didn't have to wear pads. I don't have any issues with continence, either the GI tract or the urinary tract. So compliments to my surgeon, who was Dr. Timothy Wilson at Providence St. John's in Santa Monica.

Everybody wonders about, "Are you going to lose sexual function?" And I did. I lost about half of it. So half wasn't good enough to get the whole job done by itself, so it was going to need a little bit of help. And so the route that we chose to take, my wife and I, was an injectable called Trimix. Dude, just like the little smiley guy here next to that, works fine. So if you're worried about loss of sexual function, don't worry about it. There are things that are out there and techniques that can help you move on through it. Put that in the back of your mind. Don't worry about it today. Worry about other things in your care.

I did have five events of hematuria - that's blood in the urine - in February, and I had a couple early this year. But that's from the radiation cystitis. All we can do is just kind of watch it. If it got worse, there are things that can be done, but it didn't.

Mike: And then the radiation proctitis, which affects the rectal area. So what happened in the first 38 treatments of radiation - the rectum collects all the fecal matter that comes down from the large intestine. And just like a balloon, the rectum expands, and then when you finally go to the bathroom, of course you void that and you get rid of it, and the rectum recedes back to its original size.

Well, with radiation proctitis, you scar the rectum and it cannot expand as much. So it takes less fecal matter to get into my rectum that signals my body and says, "Hey Mike, it's time to go to the little boy's room." So I might go to the bathroom two, three times, four times before 8:00. It's just smaller amounts each time. It's just the way it is. It's the new normal. Life goes on, and I'll take it. It's better than having a worse symptom, okay?

All right, let's keep going. That's not that direction. So I talked about alternative medicine, and I use integration of both. I want to start moving faster. I'm giving too much detail. I have a tendency to do that. My wife says, "If you ask Mike what time it is, he'll tell you how to make a watch." And it's really true.

I do believe, because of all the research and reading - I have a constant diet of that - that there is an integrated approach between using Western medicine and alternative medicine. And what's funny is, if you talk to Western medicine physicians, they'll say, "You what? You're talking or even considering alternative medicine?" And if you talk to the alternative medicine practitioners, they'll say, "Don't dare let the Western medicine practitioners touch your body. You got to go our way."

Look, we're the consumer. It's up to us to look at both sets of solutions that are available, make smart selections to either pass or utilize, or to what degree you're going to put that solution into effect, and move on.

So what I've chosen to do is I've got a... there's a Biocare hospital located in Tijuana. And everybody goes, "Mexico." Listen, there are 21 clinics in Mexico that practice alternative medicine, and they have wonderful programs. A buddy of mine and I did the research. We went down and interviewed the final two. We interviewed them both in one day, and we ended up selecting Biocare.

I find those people to be respectful. They're loving, they're there for your care. They're not... they're chasing your pocketbook. And I'm one of those suspicious folks that every time I sit in the lunchroom, I talk to the other patrons that are there and I ask them how long they've been coming and how they heard about it, etc. And I have yet to hear a medium to negative opinion.

So my strongest endorsement, if you want to pursue that path, give these folks a call. Check them out. I find them to be wonderful.

Mike: What I've done since my surgeries and radiation and all that kind of stuff to keep boosting my immune system is I go down there once a quarter and I spend the day. First thing I do is I get in their hyperbaric chamber. Hyperbaric chamber is a pressurized chamber. They raise it to about 1.4 atmospheres. There's a lot written in science about this in the NIH and PubMed, etc. You can find it. It promotes healing because it hyper-oxygenates your body, and when you hyper-oxygenate your body, you are boosting your body's ability to use its immune system to the fullest potential.

I go from there and they pop in an IV. It's vitamin C, glutathione, and some heavy metal chelation agents. So it kind of aggregates the heavy metals and you just void them through your urinary tract. So I do that for 5 days once a quarter. And actually, because my PSA number's starting to rise, I'm considering going once every two months. But I just did this a week and a half ago, so going to give that some thought and then I'll move on from there.

I also did a lot of research on saunas and cold plunges. I used to go to a business and I joined it, but then I looked at the cost of the membership and I found that I could buy a, you know, an inexpensive sauna and an inexpensive single-person cold plunge. Cold plunge - so I get in there and the water's about 47 degrees. Anybody want to come to my house and try it this afternoon? No?

I seriously believe in this because it does - if you read the research, and we don't have time for me to go into all of that stuff with each one of these topics today, so I'm going to, you know, leave you with the slides and my statement that I dig into everything that I have put into play - this is great for your body. It's great for your immune system. And when you do a cold plunge, for about four hours you've got a dopamine lift and you just feel wonderful. Not buzzed, not buzzed. You feel wonderful. You just feel great.

Audience Member: Four minutes?

Mike: Four minutes, yeah. Three is about the minimum they say. 55° or less, and I do about five. I love it. Yeah, and then you feel... For hours, you feel like you just... you just feel great. You feel like you woke up with the best night's sleep going, you know? And I try to do it at 1:00 in the afternoon if I can.

I take supplements. I take a bunch of them. You're going to see the list in a few minutes, and we'll get to the supplement meeting. Juicing, we talked about already. We added juicing because there's a long history of the Gerson Clinic using juicing as well as other supplements in their program to help boost your body's ability to fight the invaders.

Mike: Research, research, research, research, research, research, research. Why? Well, to find the cure and to stay on top of it. I get really, really comfortable when I hear my physician give me some advice and I've read a little bit about that, or I go home and I read about it and it reconfirms maybe some other physicians' opinions.

So listen, the big things I would say is listen selectively. When you listen to a podcast, keep a notepad by you. If they give you the name of a drug or if they give you a protocol, if they give you the name of a physician, an information resource, write it down. Follow up on it.

She... It's funny, I thought you were holding your hand in the air. I was going to stop for a question. Sorry about that.

If you are educated about your decisions, you have low stress. And if you make low-stress decisions, they are typically better decisions, okay? You don't have panic involved with them. You don't have last-minute involved with them, and you don't have pressure because you've educated yourself.

For me, everything is about boosting my immune system and reducing stress. That's my life now. Still go out and enjoy everything that I do, but those are the two things that I want to do.

The other thing I would suggest, if you don't do this, I found it really, really helpful: Open up a Google account if you don't have one. All you need is an email with Google Gmail account. Start a Word document. Start two of them. One of them says "My Cancer Journal," which are all the things that happen to you. And when you go to the doctor, when you read something, or when you have a test result that comes back, you just put in a few notes. Or if you run into an article that was part of the protocol that you did, you copy and paste that hyperlink to the article or to the video, etc., and you just keep that. But that's your journal, the things that happen to you.

The second Google Document is "My Cancer Resources." You can access these on your phone or your tablet or your PC or in a hotel in Greenland because all you have to do is log into your Google account. Super easy.

I've got 45 pages now in this resources document, and I've got stuff that goes back six years. So all of a sudden, I'll be in my house one day and I'll go, "Oh man, man, I remember that so-and-so said something about..." I can't remember it exactly, but I can search on keywords, just something close. Boom, there it is. All your resources, all your notes. If you need your history for some reason, it's right there. So I strongly suggest that you keep a journal and keep a resources document because we get so much thrown at us.

Mike: I'll talk with you and I'm going to show you information on the supplements I believe next. And I want you to know that all of these resources that you see right here, when I hear about something or if somebody tells me, "Hey Mike, take Curcumin 95," I don't just go run out and buy it because some guy told me I should take Curcumin 95. I'm going to go to the NIH right here, NIH, or the Moss report.com, New England Journal of Medicine, etc., etc., etc., and confirm that there's some validity to the claim that taking that supplement can either control PSA or help create a hostile environment for prostate cancer to proliferate in my body. That's the goal.

So let's move on. There's my list. There are 16 of them. And by the way, I'm going to give you a sheet at the end of the meeting. I brought 50 copies. It is that list, so you don't have to take a picture because you can get the sheet.

I didn't start all of these all at once. I started, you know, I... This is the list that has built so far. And I may add one. If I feel like I'm taking too many at some point, I might say, "Okay, right in ranking of importance, which one am I going to drop off my list because I'm going to replace it with the one that appears to have better predicted results," etc.

So we could talk 10 minutes on each one of these. We don't have that time. So I'm just going to say take this list. I'm giving you the resource where I buy it, what it costs, how many pills are in it, etc., on this worksheet. And please sit down and look into each one of these.

I truly believe... Well, actually, I think I have a slide that says this, so I don't get ahead of myself. Yes. Are the supplements working? I couldn't look at God and say, "Yeah, the supplements are working." I know that my PSA has risen, if you... risen ever so slowly. I'm still sub-0.1, still below that. I've been taking all those supplements for five years, the majority of them. Take them three times a day.

I believe that if I stopped taking those supplements, I would see a steepening of the line for the increase in my PSA. I truly believe that. So I don't want to stop taking them. I'm going to keep going, and I'm going to keep doing research. I'll keep double-checking. I'll go back and say, "Is there new science written about one of those or any of them?" And if I don't feel comfortable with it, off the list it goes. I'll replace it with something else if it makes sense.

Mike: Let's keep going. All right, so second part of our life is emotional survival. Because there's just... it's no fun laying in bed at night when you're trying to go to sleep and your movie's going. It's no fun waking up in the morning and your wife or your partner is still asleep and you're trying to be quiet and all you do is think about your movie, you know? Or in the middle of the day, it just... there's just too much stress.

So I've got five emotional tips, things that at different times made their way to me and my front of mind. So I try to practice these to keep stress low so I can survive and I can enjoy life. I mean, let's face it, I'm standing in front of you today. I've got a little color in my skin because I've been surfing four times in the last week. I want to make sure that I'm enjoying that part of my life while I still have this military-grade focus on what's in front of me, okay?

So the first one: be positive. If it requires rearranging the way you think, damn it, do it. It's not something you're going to do overnight, but you can find the positive in everything. I think my wife and my family would tell you that I am the ever-present, ever-smiling, always cracking a joke guy. So yeah, it's part of my personality, but I know that anybody can find the positive in something.

Resist the negative. In other words, if for example, if you open up a test on Tuesday, a test that you're like, "Uh oh, God, what's going to be in there?" It's going to give you a result. That test could have a result that was worse than that. Maybe that's the positive for that test. You've got to rearrange the way you think.

And by the way, don't forget to thank our Lord Jesus Christ and Savior because if you pray, praying helps calm your nerves. It gives you hope and it gives you strength, okay?

Eliminate stress wherever you can. Stress promotes cortisol in your body. Cortisol is deleterious to your immune system's ability to fight. So if it takes some help to help you find a way to organize or organize the way you think, organize work, organize family, whatever it takes, or reduce workload, try to get things organized so you reduce stress. You just got to do it.

Last thing I want to tell you here on this page was visualization. So how many people here have seen stories on Olympic athletes and they use visualization to help calm their heart rate, calm their nerves, slow down, focus, etc.?

Mike: So anyway, I'm... I was going through the typical "Oh my God, I've got this PSA test coming," you know, and I... I would... My mouse would hover over the hyperlink that's going to open it and go, "Okay God, you know, you got to give me a good test here because I've really been good, you know? I did good things this week and last week," etc. And then you open it and then you have to deal with the result.

And that result is always one of three conditions. It's either great, it's a great result. Well, whoop whoop, nothing to worry about, right? Or it's medium, or just right in the center, which means it may not be positive, it's not negative, etc. But the third one is the killer, and that's the one that we worry about. It's the one that we give ourselves stress about.

So I don't know, this hit me about a year ago. I was like, "Oh, wait a minute." In pro rodeo, believe it or not, I used to use visualization to try to help me when I was competing, to see myself in that event and, you know, performing and doing what I was supposed to do. And it helped me do better, it really did. So why don't I do that now?

So what I do today, and I've been doing for a year, is when I go get a test, I... as soon as I get the test, I start this visualization where it's this middle one, which is mediocre and the center one, or the far right, which is a negative. I literally watch myself in my mind's eye opening the test result. I know that I've done all my homework, I've done everything I can, I've talked to my physician, they've given me the best advice they can, and it may be good news and it may be bad news.

And I see myself opening it. I don't worry about the first two. Good news? Who cares, man. This life is good, right? It's what we wanted. Middle one? Okay. But this one over here, when I open it and if I see in my visualization, if I see that it's a negative number, I see me calmly responding to that.

So what did I just do? I took the surprise out of the event that's going to occur in one or two or three days.

Audience Member: Thank you.

Mike: Thank you. I... I can't... You're a believer. I can't tell you what a difference this made for me. My wife and I sat side by side when I got this last PSMA test a couple of months ago. I was hoping, fingers crossed, legs crossed, eyes crossed, everything, for a, you know, a zero or a 0.1, 0.2. And it opened up at 0.08, the exact number I had when I went in and got it done. It was not the number I wanted. I had done my movie. I knew how I was going to react when I opened it. And I'm telling you now, God is my witness, my heart rate didn't elevate. Not a bump, not one.

Mike: My wife immediately, not knowing I'd done my movie, says, "Are you okay? Are you... are you all right?" She's concerned, she loves me. I was fine. I said, "We're good. I know what we're going to do from here." You know, I have a plan. I just took the surprise out. So please try that. It really works.

Control the dark place. So I don't know, about four years ago this one hit me. And we all do this - all of a sudden the big cloud comes over us and we see ourselves in the final days of this horrific death. We've lost 90 pounds, we look like a Halloween movie. Who... what family members are coming to my funeral? How are they going to talk about it? My... I mean, it's just like... it's just horrible. And we all know what that feels like.

Like, the reality is we need to process these thoughts, okay? We really, really do because that's going to give you strong mental health, and you need that as you progress through this journey.

So one day I'm driv... I know exactly where I was in Camarillo when it happened. Driving down the road and all of a sudden it hit me. I thought, "Hey, 60-second rule." So when the dark place comes, you'll look at your watch or your phone, whatever gives you the time. You look at the second hand and you go, "All right, let's dive in. 60 seconds of dark place. Let's go. Let's give it... Let's go at it, man."

And I'm telling you, can you hear me? Oh right on. You go to the dark place and you go hard, just get after it. 60 seconds later, "All right, we're done. Moving on." And you move on.

Now I might get another dark place moment 7 minutes later. Guess what happens? 60-second rule. And then I find that the more I... I found that the more I did this, the less frequent my dark place moments occurred. And I honest to God, today I hardly, hardly ever get one. But when it does, even though I've been doing it three or four years, you'd think like, "Hey, no second hand." 60 seconds later, it's out of here and I'm moving on with my life because I have a lot to celebrate, okay? So give that... give that a try.

Audience Member: You got it.

Mike: And actually, that's kind of where we are. Okay? Yeah. The other thing is, once a prostate cancer patient, always a prostate cancer patient. Accept it, move on.

It finally occurred to me... I was having some dark place moments that if I was a soldier in Afghanistan and I came back with one leg, I'm not a lizard. My leg ain't growing back. And for me to sit around and hope that my leg was going to grow back, a lot of wasted energy, right? A lot of emotional energy being poured into it for no reason.

Mike: So what does a good soldier do that loves their life? They say, "I've got one leg. Let's go find some things I can do with one leg," and they make the most out of their life. Off they go. So do the same thing. It ain't going to go away. You're always going to be monitoring and learning and talking to your physicians so you can make the best out of your life and keep everything under control. Accept it and move on, and you'll find that you have far less, far less stress.

Here's the big one: be your own advocate. Aaron talked about this early on in the presentation today. He talked about be strong, be your own advocate. Don't stand there like a guppy in the aquarium with their mouth open going, "I hope my guy comes by and drops a little bit of food." And it's the only... You need to drink from several sources. Move it forward. Don't wait for somebody to call you. If you've got a question, get on the phone, get on the computer, etc. So move forward.

It's easier than you think. If it's not your personality - like me, I'm Mr. Go-getter - if that's not your personality, you can make this particular element in your life, in this prostate cancer pursuit, you can make it work for you.

Did I go the wrong way here? It is. Wrapping it up. So this is a complete healthy prostate cancer patient: education, diet, medical support - both Western and alternative integrated in the right way, have a positive low-stress outlook, be your own advocate.

Peer support: find yourself an accountability partner, find somebody you can talk to, find somebody you can do research with, share articles, share fears, somebody you can call and if you need to cry with them. It works, it does.

And I told you there was a sheet that I was going to give you. I've got a bunch of them up here. We're going to put about half of them out there on the thing. I'll leave you with this. Thank you very much. I really enjoyed it.

[Applause]

Aaron: Thank you Mike, that was a fantastic presentation. Let's go on to Herschel . Make sure I got the first slide here.

Herschel Kagan.

Herschel : I had BPH, as previous speakers had mentioned, and I was on Avodart for about nine years. And with the dribbling, I went to see my primary care physician and got a referral to a urologist. And the urologist talked to me and said, "Well, now we'll try Flomax," as somebody, one of the speakers, had already mentioned.

And then I was about to leave, and she said, "Drop your pants and underwear." Oh, I got the urologist handshake. And she then said, "I'm scheduling you for a biopsy," which reminds me of the patient who went to see the urologist, and the urologist had two fingers with covers. And the patient said, "Why two?" And the urologist replied, "That's my second opinion."

So I get to go for the biopsy and get back with a Gleason score of 4+5, a nine. It does... a 10 is a rarity. So nine is high as you can go.

So the urologist starts me on Lupron and Zytiga in February. And then I go for a Dexa scan, that's just the bones, and a mpMRI. And I get back the results, and there was a word I heard one of the presenters made - it's suspicious. Oh, so I didn't like that "suspicious" either. There is a metastasis, or there isn't.

So I then requested a PSMA PET scan. That revealed I was oligometastatic, which is five or less metastases. For those of the Greek origin, "oligo" just means small in number.

And then I had a genetics test, which didn't reveal anything out of the ordinary. I started reading literature about prostate cancer and felt I wanted something more. I just didn't want to remain on the testosterone-suppressing drugs. I wanted remission.

Or so I made inquiries about radiation and made an inquiry at the UCSD Moores Cancer Center. And by luck, I got Dr. Mundt, who has spoken to this group more than... what, three, four times every year since 1912? Okay. One of the most spectacular, caring doctors I've ever come across.

So then I went through a program of radiation of the prostate, the IMRT, that lasted I think about six weeks. Looking back at it, there was now I think a humorous note, but at the time it wasn't. One of the requirements for radiation of the prostate is you have a full bladder. Now with BPH, that can be a little bit difficult. So if I drank too much water, coffee in the morning, out it would go. And I'd be lying there... Beep. "Come back in 20 minutes." If there was too much, "When's this going to be over? When's this gonna be over?" But after about two, three weeks, I figured out just how much liquid I could have in the morning before going in.

Herschel: In October, I decided to switch drugs. The reason for switching from Zytiga to enzalutamide was there's some evidence, it's weak, that enzalutamide is better. There's also, to me, a little something - if you take Zytiga, you have to take prednisone with it to reduce inflammation and calm an overactive immune system. So I prefer to take a hormone-suppressing drug which didn't require the prednisone.

The other switch was from Lupron to Reloxafin, or otherwise brand-named Orgovyx. The former is an injection which I got once every 3 months, but it remains in the body. And with the Orgovyx, it goes away in about a month. My goal was to stop the hormone drugs and see what happens, see if the testosterone comes back and see if the PSA remains at 0.1.

In early 2024, I stopped both the drugs. And I negotiated with the medical oncologist - if the PSA should go to 4, I would resume the hormone treatment, and I would also request a PSMA PET scan. Right now, the PSA is still at 0.1. From what I've gathered from my readings, anything below 0.1 is interesting but not significant.

Now we're going off what appears to be a tangent, and it isn't. I had had my PSA test in around 2012, and it was 2.5 - nothing to be concerned with. I had a PSA test right after I saw the urologist, and it was 14.5. So what's going on? How come I never had any PSA test in the intervening 10 years? The primary care physician didn't order it. What happened?

So I found out the U.S. Preventive Services Task Force was responsible for this. So just some background on the Preventive Services Task Force: It consists of 16 doctors who volunteer their time, and it was started by the NIH in 1984. The group makes recommendations. So they make recommendations in the area of breast cancer - when it, what age should you start, how often should you have it. In prostate cancer, in colonoscopy.

So how does the Preventive Services Task Force come up with these conclusions, or not conclusions, recommendations? They look at clinical trials and they look at the result of research papers, and then they come up with a decision. A lot of this, to me, is highly judgmental. If you're trying to evaluate what's the problem with - well, not problem - yeah, what are the risks of overdiagnosis? What are the risks of overtreatment? It's quite difficult. I've been looking at the sources that they've used, and I come out confused. The clinical trials aren't that perfect. The research papers conflict. And so it comes down to a judgment call.

Herschel : The task force made its first recommendation in 2012, and they came up with a grade D. I'll come back to that. And then in 2018, they said for men over 70, grade D, and then for men age 50 to 69, a grade C.

So okay, ready for the next one? Here's the... That's it. Okay, you want to start with D? Yeah, we'll start with the D. We can ignore the I. The D is what they first came out with, and that was saying primary care physicians, which is to whom their recommendations go, don't do any testing. No PSA testing. How many here think there should be no PSA testing? I'm talking to the choir.

They did this because they felt, well, there wasn't that much advantage to testing then. Okay, now we go to the other. Okay, then these are the other three categories. The opposite of the D would be the A - we're sure about it, everybody gets tested. And B is, well, we're not that positive, but we think everybody should be tested. And then C, we're not that sure.

And to me, the part that got me was "patient preferences and professional judgment." And I had this imaginary scene: You're going to the doctor for your annual physical. You've spent 18 minutes talking about blood pressure, heart problems with the hip. You've got two minutes left. "Let's talk about whether the pros and cons of the PSA." It's not going to happen. The doctor either has decided beforehand you're going to have the PSA, or the doctor's following the recommendation of the task force and saying there isn't going to be a discussion.

I picked this report out because it well, it showed what I felt. We'll come to the sentence in the second paragraph: "For men 75 and older, the incident rate decreased from 2004 to 2011, then increased 43% from 2011 to 2018. For both age groups, the increases were across all races." This is for metastatic prostate cancer, which was what I have. So they're saying without the PSA testing, the number of men who were found to have metastatic prostate cancer went up 43%. When I read this, my feeling was, "Thank you, task force."

I'll read the last paragraph: "The researchers note that these increases stand in contrast to the decreasing trends in incidence of metastatic prostate cancer between 2004 and 2009, before the task force stopped recommending routine PSA screenings for men." As I mentioned earlier, the task force later came back and went from the D rating to the C rating, in which the individual discussed it with the professional and the patient preference was taken into account.

Herschel : This is an attempt to put things in perspective. If you started out with a thousand men who are going to be screened, 240 would have a positive PSA result. That is perhaps misleading. As you get older, your prostate grows, and the PSA for indicating possible prostate cancer keeps going up. So there is no one number. We heard something like if it's above four - I think a previous speaker mentioned it was 4.1 that couldn't get insurance because it was 0.1 above. It's a continuum. The higher the PSA goes, the more likely it is prostate cancer. If you have a PSA of 50, it's close to 100%.

So if a patient is talking to the doctor, the doctor should come back and say, "This is your PSA adjusted for your age, prostate size, and it's seven. The probability of you having prostate cancer is a certain percentage." And then you as a patient can say, "Well, the probability is 5%. I don't want to do any further testing." Or it comes up, it's the probability of prostate cancer is 85%. "Quick, I want something done. I can't wait."

And let's look at the next one. So out of the thousand men, five will die of prostate cancer. And then the men who avoided dying of prostate cancer: 1.3. And this was perhaps a basis for the task force issuing their ruling of saying if 1.3 men out of a thousand avoids dying, we shouldn't be going around testing.

We're getting into here a calculus of life. If I come up with a drug that will save one out of a million, should the drug be approved by the FDA? If it's one out of 100,000, should it be approved? If it's one out of 100, one out of 10, one out of five, what's the cutoff?

I do not know the answer to that, but my conclusion was I was... I am collateral damage. The task force saying no PSA testing allowed my prostate cancer to become metastatic. Could... Was the task force... Do I think they were wrong? I don't know. It's a much too complex area. It's one based upon research papers, clinical trials, and mostly judgment.

Aaron: Thanks a lot, Herschel . I too am one of those collateral damage individuals, and so I sympathize. And this is definitely a good emphasis that you could... you should be your own advocate and not rely upon the doctors. You know, things have changed in the profession a lot in the last 20, 30 years. We no longer just walk into a doctor and let them do, you know, whatever the hell they please, whatever they think is best. They even push the decisions off to us to make them. And you know, hopefully, we don't have situations like this in the future, but what solves that is being our own advocates.

So let's have a general round of applause for every speaker today. We really did have a great group here. I'm not sure if Bill Manning is still online or not. Looks like he is. And why don't I have both Herschel and Mike come up to the podium. I'm going to run around with the microphone for questions, and guys, you know, speak up, step up to the mic so that we'll be able to get the response as part of the recordings.

Aaron: I got two questions here to start with. This one's real easy. Herschel , I forgot, maybe I missed it - what is your current age today?

Herschel : 86.

Audience Member: My question is for Bill Manning. You know, it was very interesting, your story about your PSA journey and with all the tests you've run through. Can you really definitively say you have prostate cancer, or you know, give me an idea - do you have it or not?

Bill Manning: Well, that's a great question, and I guess the answer to that would be technically no. In other words, I've had 10 years of MRIs and the - well, originally the color Doppler ultrasounds, and basically with five MRIs, the... Granted, the last biopsy I had was, you know, over 10 years ago. But I'd say the short answer to that is no.

And as an adjunct to that answer, you might say, "Well then, what the hell am I doing here?" And that would be a good question. And the reason is because I feel duty-bound to share my story amongst guys who do not get exposed to some of the information regarding low-risk prostate cancer and, you know, what the alternatives are and how much has changed over the last 15 years.

Aaron: You know, one thing to add about that too is that everything that Bill Manning has done has potentially avoided him having prostate cancer, if in fact the answer is that he doesn't have it. You know, a lot of these techniques with active surveillance... I mean, let's face it, none of us had prostate cancer at 20, did we? Did we do things along the way that, you know, resulted in a higher chance of us getting cancer besides just, you know, genetic type of stuff? And potentially the, especially the dietary changes that Bill took on... You know, a lot of these things do impact the progression of the cancer developing.

And I know that for me initially, they said, "Oh, you're too young. You don't have cancer. Maybe it's just prostatitis," right? Something that can cause an irritation that will potentially result in prostate cancer developing. And so, you know, these are great techniques that Bill followed that essentially allowed him to avoid any treatment.

Bill Manning: Thanks, Aaron. And that is a very, very valid point. And you know, to make one extension on that, if and when the time comes that I do develop prostate cancer again and/or it turns into to be an advanced version, then of course I would seek treatment. Being on active surveillance doesn't mean that you're anti-treatment. It means you're anti-unnecessary treatment.

Bill Manning: And if I could take 30 seconds real quick, I forgot one slide. I'll make it fast. It's a graphic that I think you might find interesting. This is my PSA journey. So on the far left is the year 2000. On the far right is the year 2024. That big straight line all the way up to 2005, I think it is, is basically because I only had one test way back when that I discovered by accident. Then the second one was a deliberate test. And then the zigzag seesaw all the way up through today is my PSA up and down journey.

So it shows you how radically your PSA score can change. The second to the top right line here, this is the number 10. So you see I did hit up number 10 once and pretty close to it, and then right on it once. This was when I was on that drug. And here's the size of my prostate as it's grown over time, as has my PSA. So sorry for forgetting that slide, but I thought you might be interested to see what 24 years of PSAs look like.

Audience Member: I have two questions for Herschel . The first question is this - I'm not... I'm not a plant, but it seems like I am. Could... What do you recommend for people who have sons who have metastatic prostate cancer? And also, could you give some of the people your background so they know how you were able to find a lot of the stuff that you found?

Herschel : As soon as I found out what was happening, I immediately informed my son: get a PSA every year. Second answer, the second question - I have a... excuse me, certificate in biotechnology, and I've worked in Laboratory Information Management Systems. So reading the technical papers was at times challenging because of the jargon, but by and large, I understood what they were all about.

Audience Member: This is a question for Mr. McCary. You mentioned the importance of sleep management. Do you take any supplements to aid you in this quest?

Mike McCary: I do, and I think it's because of my personality that I even need it. I'm pretty amped up most of the time, as my wife would tell you. And so when I go to bed, it's interesting - I can lay down and I'm asleep, I'm gone in 3 to 5 minutes. That's it. I don't care what's going on. That's it. But 2:00, 3:00, somewhere along in there, then I wake up, go to the bathroom once and come back. Then the movie starts, and it's about carrots, it's about mortgage, it's about solar power, it's about my car. I mean, it's... I rarely think about... So anyway, I use three different supplements. One's called apigenin (A-P-I-G-E-N-I-N). The second one is L-theanine (T-H-E-A-N-I-N-E). And the last one is magnesium L-threonate (T-H-R-E-O-N-A-T-E).

Mike McCary: They are not opiates. I... No, I tried Ambien one time and I turned into a psycho, and second or third day I was just like, no. But these are nice supplements that just help you relax. They really... And they've been... I learned about them through a guy named Andrew Huberman. He has a wonderful podcast. It's all about science, and I started taking them and they're just awesome. And I don't wake up with a big hangover, and you know, the... When you take sleeping pills, etc...

Audience Member: You use cannabis?

Mike: I do. I have a CBN and a THC. It's half and half, 10 milligram, and I bite it in half and I do that about every fourth night.

Audience Member: So you know how 2:00 in the morning when you're... can't go back to it...

Mike: Rarely. No, I don't take anything in the middle of the night because I'm afraid that if I start it then, I'm going to be dealing with it till 10:00 in the morning, 12:00. I don't... I don't want that. I'd rather be tired. Tired, I get tired, I can manage. But I don't want a medication hangover, you know? Just my personal choice. So if I take anything, it is right before I go to bed.

Aaron: For those not familiar with CBN, it is, I believe, a synthesized version of either THC or CBD, which are the more commonly referred to chemicals. But CBN is much more related to helping you sleep. So it is an interesting one to try.

A couple things I want to jump in here with. First of all, lucky that you can fall asleep, because I'll sit there forever and not be able to fall asleep because my movie starts at like 10:00 at night, not 2 o'clock in the morning. So I'm very jealous.

Sleep is definitely... It was on my mind years ago. I have always slept terribly. That very well could be why I developed cancer earlier than I might have otherwise. I know that some studies have actually said that use of melatonin has been linked to an increased chance of getting cancer. I would almost say it's one of these false correlations, not that I know, but it's like, hey, wouldn't people that are having problems with sleep, you know, try melatonin, yet also be on track really for premature prostate cancer anyway?

So I think that in general, it is very important to get help with sleep. Shoot, there was one more thing I was going to say about the sleep. Oh, have you experimented with having a little extra protein just before you go to bed? I also wake up at 2:00 in the morning, not just to go to the bathroom, but my acupuncturist, who is, you know, meticulous on like what is going on with their body at every moment... She's aware of some situations where in the middle of the night, your body triggers an adrenaline response because it's out of protein, basically. And that ends up waking you up at something like 2 or 3:00 in the morning. Sometimes a little bit of protein can help you essentially not wake up. And I could also see that adrenaline also being like, hey, did you worry about this? Did you worry about that? You know, causing some of that type of mental activity as well.

Mike: I'll take that on. Thank you.

Aaron: Anyone else for questions here? Yeah, and he had a question as well. Gentlemen, you got your question answered, right? Oh, that's right, you were... I saw your hand earlier.

Audience Member: I had a question for our first speaker about The China Study. Could you say a little more about that?

Bill Manning: Sure. The China Study was done by Dr. Colin Campbell. He wrote it, I think it was back in 2000... Well, anyway, around 2010. And basically, it's... He was a doctor that worked for a very large corporation that was studying the effects of protein on different populations. It... I strongly suggest you look up the book and see the description of it. So I'll just be short about it, but basically what he discovered through scientific study was the effects of animal protein on cancer, and most specifically breast cancer and prostate cancer.

And the book goes into a considerable amount of detail. Since the book's publication, and it's had a second publication not that long ago, they founded the Nutritional Studies Foundation, a nonprofit for researching dietary effects on cancer. And then also the Forks Over Knives book and movie, another one I could recommend.

But the bottom line is, what the book recommends is a vegan diet. And that's what I have done for the last 15 years, with one minor tweak, and that is that my wife and I do have some egg whites for breakfast occasionally. Otherwise, it is a vegan diet.

Now, the one thing I would put out for a lot of the general population that don't like that idea: My suggestion is that you don't have to do something like this cold turkey. You can always dedicate some of your time to doing a plant-based diet for several days a week, maybe increase it if you see favorable results. But the big goal is to do something that is sustainable.

Where a lot of people have trouble or fail in making such a strong dietary U-turn is that they don't have good advice. They don't have research. Having a dietitian helping with that, which actually the Campbell Institute can do, with recipes and explaining the nutritional value of all these different recipes that they have... The problem that some people have is that they go into this without enough preparation and high expectations. And then within a week or two, you know, their energy level is down, they feel terrible, they think this is, you know, a waste of time, and that's the end of that.

So that's what The China Study book is all about.

Aaron: Yeah, and I believe we have a copy of The China Study on the library table out up front, or you can ask Bill Bailey. He might be able to locate it for us. But with that, I know that there are a couple more questions I didn't get to, but why don't we ask those to the speakers over our luncheon and wrap up the meeting from here.

Thank you so much for attending. I expect all those people that raised their hands about volunteering to come up and talk to me right now as well. Thanks a lot for joining us today, and again, how about a round of applause for all of our speakers?

[Applause]

Aaron: Thank you. Thanks, Bill.

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