In Your Pants with Dr. Susie G - Keeping your prostate healthy w/ Craig Allingham

Episode Date: June 25, 2019

On today's show we're going all the way down under talking about prostate health and how to keep it healthy with professor, author, and men's health physiotherapist, Craig Allingham. Here's what you'll learn on today's episode: - The role of the prostate and how it functions - Curative treatment options for prostate cancer - Complications that may occur with curative treatments - What to expect post-prostate surgery - The importance of pelvic floor physical therapy pre and post prostate surgery - Ways to train your pelvic muscles to help with continence control - Active surveillance for prostate cancer - How you can sabotage prostate cancer and stack the decks in your favor - The effects of stress, diet, lifestyle on your prostate health - How frequent ejaculation influences prostate health

You're listening to In Your Pants with Dr. Susie G, the physiotherapist for your private, helping you get in the know down below. Hey guys, it's Dr. Susie G here and welcome to another In Your Pants podcast. I'm so glad that you're here to join us today. On today's show, we're going all the way down under talking about prostate health and how to keep it healthy with professor, author, and men's health physiotherapist, Craig Ellingham. After a successful career in high-performance sports science and medicine, including four Olympic Games as part of the Australian team medical support, Craig focused his skills

on men's health. Sadly, this was prompted by his dad's death from prostate cancer and observing the lack of knowledge in how men can manage both the disease and the side effects of treatment. Craig developed a program for restoring continence and erectile activity for men following prostate surgery with the idea that these men were now pelvic floor athletes and need a high-performance program to achieve their goals. His book Prostate Recovery, MAP, Men's Action Plan, has been a great resource for thousands of men in Australia and overseas. In response to the trend towards active surveillance, which is deferring treatment for low-risk prostate cancers, Craig identified a

group of men who are well-monitored but not advised on how to reduce the chances of their prostate cancer progressing. His new book, The Prostate Playbook, is a strategic guide for men to suppress, undermine, and sabotage their existing prostate disease, or better yet, reduce the chance of having cancer in the first place. So we have a jam-packed episode for you guys here. And what you'll learn on today's episode is a few things, actually. The role of the prostate and how it functions. What are some curative treatment options for your prostate cancer? You'll learn about some of the complications that may occur with curative treatments. What to expect with your recovery post-prostate surgery. The importance of pelvic floor physical

therapy pre- and post-prostate surgery. You'll learn ways to train your pelvic muscles to help with continence control. You'll learn about active surveillance for prostate cancer, how you can sabotage prostate cancer and stack the decks in your favor. You'll learn about the effects of stress, diet, lifestyle on your prostate health, and how frequent ejaculation influences prostate health. I know that I get that question asked a lot and we will definitely be covering it in today's show. So I hope you enjoy today's episode. I'm so glad you're here again and let's get to it. Hi, Craig. Thank you so much for being on the show today. Susie, it's an absolute pleasure and thank you for the invitation.

No problem. I mean, it's all the way from Australia. As you can tell from my accent. Yes, all the way from Australia where it's a beautiful, probably 28 degrees here at eight o'clock in the morning and you're in a polar vortex. I am not as bad as my friends in the Midwest, Chicago area, Wisconsin, Michigan. I'm in Asheville, So the temperature is a little bit milder, but nonetheless, not sunny and shining and I'm not wearing my flip-flops. Well, very good. Well, today's show is all about the prostate, the penis, the testicles, men's health.

And I kind of want to just start off the bat with having you tell us what are some of the common issues that men face after prostate cancer? well many um but before we get to that let's revisit what the prostate gland is actually there for because in my experience a lot of men have no idea one that they've got one until it kicks up a fuss and secondly what its actual role is and a lot of the pelvic physios i talk to who are brilliant women's health physios who've come across and now embrace this new new field of men's health pelvic health don't actually know what it does they know where it is they know it's the size of a walnut but it's a it's a curious beast um it's an exogenous gland as opposed to an endogland

so it that means it it secretes a fluid via a duct to an external exit point so what it makes is is for delivery externally to the body and obviously that's going to be uh the semen and it is just a vehicle it's a nutritional substance so the testicles will manufacture the sperm the sperm are then lodged in the epididymis of the testicle uh where it is a an acidic environment which keeps them inactive and then they are gradually migrated to the seminal uh through the the vas deferens up through this towards the seminal vesicles and the seminal vesicles contribute some uh seminal fluid as well and finally it gets in through the ejaculatory duct into the prostate so it's a long manufacturing storage logistics exercise just to get these

tadpoles into the delivery gate and there they wait for their moment of glory when uh when when they are delivered via the external duct with the seminal fluid now the seminal fluid provides two things one a liquid environment for the tadpoles to uh to navigate in and secondly a nutritional substance that they can absorb nutrition as they go because it takes some time and these little sperm cells are not particularly big they don't have a lot of on-board energy nutrition so they need to refuel as they go and the seminal fluid provides that um so it's a fabulous little thing and so they get into the into the prostate gland and then there is a process of and they can live in there for a short period of time and then they start to not get not not go toxic but there's a

use by date you know you want you don't want your your your genetic material to be stored for too long before it goes and starts to mix it with an egg so there is an expectation that once it's there it will be moved on fairly quickly and as all young men discover uh one morning when they wake up um it's an automatic process so uh with with nocturnal emissions and it's a bit of a surprise so but that process would continue if a man wasn't to be regularly emptying his prostate for recreational or or functional reasons throughout his life so nature evolution wherever you want to go with this has got a system of moving it on and restocking moving on restocking good the the prostate gland itself is not just a gland it's a muscular gland it's a muscular gland

with gates so it's quite a complex structure and the muscularity of the gland the muscle fibers in are to pump the ejaculate to pump the semen and and the the sperm cells actively into the male urethra for obviously transmission out through the meatus of the penis to to fertilize an egg eventually on a perfect mission the so it's a muscular gland and it's got a gate and one of the gates the critical gate is at the back gate where the prostate joins with the bladder and just prior to ejaculation that gate is slammed shut so that any muscular pumping of the ejaculate is directed in a forward direction and none of the retrogrades back into the bladder so ideally that's how it all should work but after treatment for prostate cancer a lot of these

things don't work so well as they used to do and that is a big issue for for many men in the we have to say prostate cancer in its own right is not a big health problem it's not fatal it's when prostate cells leave the prostate gland and set up camp elsewhere in other organs and create a secondary tumour. Then it becomes life-threatening. So prostate cancer that stays within the gland and just bubbles away for many, many years and doesn't get particularly aggressive or large

can be asymptomatic and certainly not create any health problems. And we'll maybe talk about that in the lower risk guys down the track. But the question you did ask me some time ago before I got distracted was, what problems do they have with prostate cancer well they don't they have the problems with the treatment the side effects

of curative treatment for prostate cancer now curative treatment can include removal of the prostate gland a radical prostatectomy which can be done as an open procedure as a laparoscopic procedure or as a robotic assisted laparoscopic procedure an ralp which is a little less i guess traumatic for the abdominal organs and the pelvic organs and the pelvic wall but the end result is the prostate is removed that creates a gap um and that gap has to be accommodated by pulling the bladder down and the urethra up to join the urine evacuation system back in place you need that working from the bladder to the penis you need to be able to get the urine out so if you take the section of the urethra that is enclosed within the prostate gland and there's a varying

degree even though the surgeons are trying to salvage as much of that as possible and they're particularly trying to salvage the back gate of the prostate where it butts up against the bladder because that's where the sphincter the gate is and it's also where there's some muscular control aspects autonomic which means unable to be voluntarily controlled by the man but a muscular system there to control urine release as well so they try and preserve that that base of the prostate against the bladder and dissect out the remaining urethra and prostate together and that goes to pathology for analysis and now you've got to join the tubes again.

So there's an anastomosis or a suture joint that goes in between pulling the outer part of the urethra up towards the bladder, drawing the bladder down, suturing that together and then the guy gets a catheter put in so that there's a splint, if you like, an internal splint around which this wound can heal. That could last anywhere from five to 10 to 14 days, depending how things travel with him. So his prostate's gone,

but his urinary system has been messed about with. So one of the major complications following prostate surgery is incontinence or lack of continence control. Maybe not total incontinence, but certainly episodes of being unable to control urine leakage. other treatments apart from surgery would include radiotherapy which can be external

beam radiotherapy or internal insertion of of radioactive beads into the prostate around the tumor site which is brachytherapy to slowly radiate and and and inhibit the prostate cancer growth there can be other other aspects of chemotherapy particularly if the prostate cancer has already started to metastasize or spread or externalize beyond the margins of the prostate. Chemotherapy, which will expose the prostate tumor cells wherever they are in the body to the chemotoxin. Hormone therapy to damp down the testosterone driver. Testosterone that men produce from their testicles doesn't cause prostate cancer, but if you have a prostate cancer, it can drive it and feed it a bit so reducing the testosterone production can help with that

against suppressing the growth of the prostate tumor and the newest field of course is immunotherapy where the genetic code of the man is looked at and and related to his immunosuppression strategies that his body prefers and in the future we're going to see a huge amount of development in this immunotherapy for all cancers and that will be quite exciting i think because it will be custom tailored treatment for each man's genetic predisposition to prostate cancer so that's still a few years away but it's going to be a very exciting time for men who have prostate cancer and and sons of men who have prostate cancer who will probably be the main beneficiaries at this time frame so that's a incontinence not so bad with radiotherapy brachytherapy certainly not um

chemotherapy doesn't cause incontinence and the hormone therapy doesn't interfere with continence but they have other side effects as well um uh feminization due to the hormone therapy issue mood swings uh temperature regulation issues for the guys which you might say yes but you haven't got cancer anymore. No, but these things are quite unpleasant and unexpected. And I'll tell you why they're unexpected in a moment. The other big side effect that impacts on men far more than most of them anticipate is erectile dysfunction. Now, I'm sure you've talked about this in your podcast before. I had Joe Melios on the show. Oh, Joe talked about it. Excellent. Joe did that. So that's fabulous and that's that's a huge area for men because they don't listen that's not true

tell me more wait a second my husband my husband would disagree well yes they don't listen but sometimes they don't even hear uh but let me let me put this to you here's a man he's he's had his psa done he's had a digital rectal examination done he may even had a biopsy done and and and he's come into the urologist's office and the urologist says, I'm sorry, sir, you have got a cancer in your prostate and it is a Gleason score of three, four equals seven. And your PSA is 20.3. And in my experience, this needs to be removed and the likelihood we need to do that in the next month or so uh to get it early and you will need to have you know a month off work and you will probably have a period of incontinence following the catheter removal and there's uh and

you will you will most definitely have erectile dysfunction and may not be able to get another erection for the rest of your life after this cancer removal um and you may have some fatigue and depression issues he doesn't hear any of that bit after the word cancer right you have got a cancer in your prostate well that rocks his world okay because no matter what the earlier tests and indications might have suggested every man goes into that final meeting with his urologist thinking it'll happen to some other bloke it won't be me i'll be fine this is just an enlarged prostate this is just an anomaly in the pathology results but when they finally get that positive diagnosis that they cannot ignore or argue about everything after that everything that

the urologist lips are still moving but there's not a lot getting through and yes there is informed discussion but it's a one often a one-way thing that the guy's just not taking it all in because the most important thing in his mind at the moment is i've got cancer cancer kills people i need to have this cancer cut out of my body everything else is subordinate to that and that works great until he's had the treatment and then he hasn't got cancer in his mind the first psa comes back in three months at you know 0.01 undetectable psa he thinks he's cured that's fabulous his wife is happy for kids are happy everyone's happy but he's still incontinent and he still has erectile dysfunction

and he might only be 58 years old or 53 years old or 80 years old. It doesn't matter. If he had erectile function before, he will miss it. And this is a huge shock. The third side effect that I see most commonly is depression. And imagine one day you are completely continent, have fabulous fabulous erectile function two weeks later you're incontinent and have zero prospects of erectile function for the rest of your life any man who doesn't get depressed with

that there's a superman or he's got some fabulous coping strategy i haven't learned about so these huge changes to quality of life and this has been documented in the research quality of life questionnaires and validated reliable for men after prostate cancer treatment show a significant decrease in their reported quality of life for the rest of their life so there is a huge cost to treating your prostate cancer particularly with surgery but radiotherapy bowel damage burning scarring feminization from the hormone therapy each of them has got a risk a side effect there's no perfect gold standard do no harm removal of prostate cancer yet i hope to live to see it in my day but it's not there yet right so they're the problems gosh that was a long discussion we've

only covered that's okay that's okay that's okay so based on all that you know that sounds like very doom and gloom what what should men expect during their recovery post-surgery all right they should expect it to be difficult and they should expect that they have to work at it and i think that's the most important message we can give them pre-op is that this is going to be the biggest challenge you've ever faced not just health-wise but lots of things your your relationship issues your your ability to work your your your the cost the financial cost of the time out of the workplace and stage recovery the financial cost of of incontinence pads unexpected you know every month another 30 40 dollars that wasn't budgeted for bang on

on the continence pads how long is this going to go on for can't tell you um some men permanently some men none at all i had a guy one of my patients and he's like how we can make this happen every time he was a younger fellow got diagnosed and and he had the catheter removed and went home and had sex with his girlfriend that night quite successfully no leaking no erectile dysfunction nothing i said well you have got a good surgeon and he said no i've got a good girlfriend oh well that's true um so the range of outcomes is huge and other men are not going to achieve that sort of outcome and it's not there's no is there's no so what you're saying is that there's perhaps no pattern or no rhyme or reason there are some factors that might

predispose one to having great success and other factors based on the individual and the context of it all not as great success well that is exactly true and and the urology urological surgeons will tell you that that they go in every every operation adventure for them is a nerve sparing expedition this concept of i had nerve sparing surgery in other words the nerves that run around the the fibrous capsule of the that that envelop and constrict the prostate gland ultimately will be related to our function so any damage to those nerves during the surgical procedure will at least temporarily and possibly permanently damage the capacity of the the hydraulic system of the penis to become erect but every surgeon goes in looking to spare those

nerves and it's it's so every surgery is is as nerve sparing as possible it's just not always possible. If the tumor is up against the nerve web, then the nerves will have to be sacrificed to ensure that the margins of the tumor are fully removed without any rogue prostate cells sort of escaping into the tissues. So surgeons do a fabulous job and they try to preserve the muscle and the sphincter and as much of that they'll leave as possible, but it's not always possible. And they don't know that even with ultrasound guided MRIs and biopsies and everything, they still don't know exactly where the prostate cancer extends to and from until they look at it till they're in there dissecting they think okay that whole thing's going to come out but

i'm going to take this nerve i can leave the one on the other side or no they've both got to go i'd love to leave the sphincter at the bladder but that's got to go too because it's up in the base of the prostate so whatever so they do the best they can every time because they want to get a good result um but those outcomes are beyond their control by the very nature of the disease Right. And realistically, those surgeons will obviously communicate that to the patient saying, you know, this is the situation, this is how much I was able to salvage, and this is what we needed to do. And these are the potential outcomes based on what I needed to do. Okay. and by that stage he's listening he's getting all that on board now he's got through the initial barrier the cancer has been dealt with and now he's ready for that second level of information um the what i'm particularly interested in when i'm dealing with men and and this doesn't just

apply to their pelvic health post prostate care is is how they process information from health professionals and it's it's quite interesting how men receive this message and and if for any professionals that are watching this who work in men's health or treatment in any capacity whether it's for sports injuries or occupational health or whatever it's it's useful to to put yourself in their place and say this is you think you're doing a fabulous communication job but is it getting through how do you make those messages stick so i'm just gonna if that's okay if we can just briefly run over this this is the processing and this is based on research that's been done on how messages are received by men in 2013 in a paper in health psychology

when men get incoming health information from you from me from the television from their gp from their physician from from whatever source public health messages whatever the first thing they do is a risk assessment and they do it on two levels first of all how severe does this sound okay well cancer is pretty severe they've sort of got that bit um um so they do a severity risk so if this is true what i'm being told how severe it is so if it's a warning about sunburn they think oh that's not so severe so they filter that out to some degree um so that's the first risk assessment yeah this is a really nasty condition so prostate cancer rates for that the second risk assessment they process is it's really nasty but is it really nasty for me am i susceptible

so they do a risk assessment on their personal susceptibility and they don't do this at a cognitive level they're not thinking oh how much is this going to affect me it's it's the subliminal processing of of this information coming through for example my dad died from prostate cancer so i know i am really susceptible another man whose father his family history has no prostate cancer in there may know that prostate cancer is nasty but it may not apply to him because there's no family history therefore i'm not susceptible therefore i no longer need to listen to health messages because i'm not susceptible and you can see how this applies in nutrition cardiac health respiratory smoking messages all this sort of stuff people will find a way to find their out

point that doesn't apply to me every man believes he is the best driver on the park so how does that work uh it's a risk assessment so if if he rejects if he rejects the risk assessment said either it's not severe enough for me to be concerned or it doesn't really apply to me he closes his filter i call it the ego filter i didn't make it up but that's what i call it the ego filter to preserve his status quo preserve his his equilibrium in the world i don't need to know about this stuff i'm going to close my filter and you can blather on all you like um it's nothing to do with me. And once the filter's closed, he'll have three coping strategies. One of which is denial. No, doesn't apply to me. Second one is avoidance. He doesn't expose himself to the

messages anymore. The third one is withdrawal. He just goes into himself and doesn't process anything. You'll see this happen with your husband on many occasions. I have, yes. I was just going to say you're reading my mind. We can use it for all sorts of things. Yeah, you're reading my mind. this is good this is this is this is going to help me in my in my marriage this is entire global raising children that are boys anything um so so that's the risk is said but however if the risk assessment scares the parents off to him enough that it's nasty and he's susceptible he's still listening and he goes through a second filtering process on efficacy the efficacy is the efficacy of what's being the first stage what's being recommended for treatment so i'll stay with the

prostate cancer story i'm being recommended to have radiotherapy that's great doc now tell me how likely is that to cure my cancer um does it make sense do i understand the relationship relationship between zapping my prostate tumor with radioactive waves and how that kills the cancer that makes sense to my basic male science brain so this efficacy of treatment sounds good cutting out the cancer having a prostatectomy that makes really good sense to me because the cancer is removed because the prostate's removed and it's a prostate cancer goodbye so the response is rated as highly efficacious high efficacy and then he screens it again to say can i do it what's my self-efficacy what's my self is am i prepared to do 30 sessions of radiation can i take the time

off work can i afford it is insurance going to cover it there's a whole lot of other things going on but can he and maybe his immediate family unit did he's got the strength the power the skills and again the second filter of efficacy uh on the incoming health information if he rates it very low he says that the treatment makes no sense to me or i don't think i can do that i can't handle the incontinence or the erectile dysfunction so it's not for me is there an option he stops listening can we keep talking keep telling him keep trying to convince him but he's already filtered that out to preserve his psychological equilibrium and being comfortable with himself however if he is confident that what we're recommending for the treatment is likely to work

gives him a good option and he has got the resources to do it he's still listening and the next level is action when do we have a doc when do we start this pelvic floor training program When do I improve my nutrition? Whatever it might be that's the recommended treatment plan, he's ready now. He's filtered and we've passed it. So when we're communicating health messages to men, we need to make sure we cover the severity.

We don't talk it down. Oh, it's prostate cancer. And I see this in the forums of prostate cancer patients. Oh, some people say, well, it's the lucky cancer. You can remove the prostate and it's gone. No, no, no, no. This is a nasty boy. cancer and being lucky oh they write this and the guys don't write it it's partners or you know

i don't know there is a lucky cancer but the it's oh you can just have a cut out oh yeah but there's some consequences right so so so the when we're talking we need to say this is nasty this is really going to you're going to be have problems with continence not not play it down so you're You know, one in 12 men have problems with continence. They don't. They all have a challenge with continence when the catheter comes out. Some have a rapid recovery. Some have no recovery.

Some respond really well to physiotherapy treatment, pelvic floor training. Some don't respond as well for a whole range of reasons. But I do notice that even those, they all get some benefit from it. Even the ones that don't become fully continent, they become less incontinent to some degree so we can offer always i'm always happy to say you're going to get some improvement but i can't tell you how much yet when we're starting a program and it will depend not only on the surgery but how hard you work and throw it back to them because

we've got to get this self-efficacy you're really going to drive this you're going to have i can't do your pelvic floor exercises for you you have to you're going to mine are good i do them every day because i'm demonstrating and nobody ever sees um but uh and i train myself i i i'm bizarre i i you know i i go to bed at night the last thing of course you do you empty your bladder and your bladder feels slowly overnight because of your your serotonin release and a whole lot of things change so your kidneys works more slowly overnight so you you're designed to have a longer period of uninterrupted sleep because your bladder doesn't get as full as quickly overnight as it does through the day so I test myself okay for the hour before bed no going to the toilet and I'm

going to sleep through I'm going to go 10 hours what kills me but man it's a good weight lifting exercise for your pelvic floor come getting out of bed in the morning let me tell you that's right advocating this well while you're an olympic this is an olympic bladder I hear that you were an olympian in your day uh an olympic physio yes not a competitor and that's it's exactly the same it's a training program because the pelvic floor muscles are muscles like any other muscle any other skeletal muscle in the body and they're trainable that's right well tell us a little bit about that craig what should a guy expect during physiotherapy physical therapy and is pre-rehab necessary or does it help with the outcomes post surgery

in my experience and from the research and from talking to colleagues every time yes a pre-program at least for four weeks even up to six is enough uh but four weeks the last four weeks before surgery if that guy can learn to do his pelvic floor exercises correctly and that is to find the right muscles to activate the right muscles at the right degree of intensity and to do that frequently enough to create a training program he can become a pelvic floor master in that time and and become quite proficient at isolating and then not only isolating but also isolating why he's talking isolating while he's walking uh these pelvic floor lift contractions um and the reason that we like to do it beforehand is because there is everything's

normal he's he's still continent the pelvic floor muscles are operating he may not be at all aware of them but there must be in there doing something because he's not leaking every day um so we've just got to find his voluntary connection his mental connection to them so he can train them because the next time when he comes back after surgery everything's going to be a bit different he won't have the sphincter muscles in the prostate gland anymore to help him out he will be dependent on the three male pelvic floor muscles that he has voluntary control over to to reinforce his continence control so being able to teach him that when there's no pain from surgical incisions or internal things or complications from infections or catheter friction

or anything else that sort of – because pain makes it hard to work a muscle in the painful area. We know that from all over the body. So being able to train them in a pain-free state and to take a really positive view that this is not rehab. This is pre-season training. This is getting ready for the ball season or the football season. It starts on operation day, but you're in pre-season training.

And guys get that analogy. You're in pre-season work. So this is your strength and conditioning phase. you need to work on this so that come game day you're ready to play um so we we like to to work the film we work on the two the endurance long-term holds are up to 40 50 60 second holds while breathing uh and also the rapid fire contractions for the fast twitch fire so we train all components of the male pelvic floor pre-operatively and keep telling him this is for your continence this is for your erectile function post-surgery because he has no incentive to do

these exercises yet because he's fully continent and he has got erectile function and and that's important too because one of the uh key indicators of the likelihood of having erectile function return after prostatectomy is the fact you had erectile function before the surgery if you have and there's a whole lot of reasons cardiovascular psychological lack of opportunity out of habit whatever a diabetes a lot of reasons why a man may not have erectile function well having a prostatectomy is not going to cure that right let's be realistic you're not suddenly going to wake up with a raging heart on and think wow that was i didn't expect that and neither you should expect that it's not going to happen so erectile function erectile activity

is part of the pre-op program as well as training the pelvic floor muscles so the message is to the man and if his partner if he or she is interested um you can get on board this as well but the more you can exercise the organ and it doesn't necessarily mean to full ejaculation but just getting the erectile cycle refreshed and and the the the hormone connections and the nerve connections all built in and the arousal bit in the in the brain as well which is so important the main organ the main organ right between the ears it is forget about that it determines the success of everything um well they talk about the big brain and the little brain and uh the big brain's the key one yes that's right it's where all the magic happens

it does because even even with they all rely on arousal you still need to be excited yes without that oh what would be the point really so that's it so when should when should when should a fella start post-surgical rehab when would it be safe to start doing okay um after the catheter is removed okay you said that could be 5 to 14 days yep it varies according to the surgical procedure and the challenge of the of the anastomosis i think at the surgical part of it so the that will be determined and also how efficiently the catheter functions in place how well the balloon blocks off so there's no leaking there's no irritation of the wound site with the the acidic urine leaking around it so a lot of things can change

that duration but ideally an infection would be one ideally uh 10 days is about the norm could be a little more could be a bit longer depending on the case but once uh but there's not much point working the pelvic floor because it will rub against the catheter so your internal urethra will be abrading against so it's just asking for irritation and you're not going to get full closure anyway because the catheter will split the urethra open so you in terms of specificity of training we're not in the right length tension relationship so yes it might be useful for the mental connect to refresh that that engram but we just have 10 days off have 10 you've got enough on your plate for a while that's right catheter bag you're trying to work

around the shower you're trying to move around the house you there's a lot happening i want to see you a couple of days when after your catheter is removed perfect so then we revisit yeah great so craig tell us you're currently working on another book called the prostate playbook what should readers expect from this new book well my first book prostate recovery map is all about the the the pelvic floor retraining for guys after they've had surgery or any other treatment for their prostate cancer so i feel like i've got that box ticked but there's a lot more diagnosis of younger men with less aggressive prostate cancers now who have early stage low volume slow-growing prostate cancer, PSA rising quite slow, not doubling in the five-year double

window, but still increasing. But it's not urgent that they receive any actual treatment. And they go into a program called active surveillance. And I was at the American Urological Association conference a year or so ago, and this active surveillance was talked about a lot by the urologists and the radiotherapists and the men's health physicians and everyone who was there on the podiums giving their papers and they were all very, very good on the surveillance. They knew about the PHIs and the P2 tests and the P8 tests and this test and that test and they would, the biopsies

and the ultrasound guided, focused, whatever's brilliant, brilliant on all the surveillance, but none of them spoke about the active part. what can a guy do to suppress to sabotage undermine a prostate cancer he's already being diagnosed with that is a slow grower that he may die with but not from how can he stack the deck in favor of dying of a stroke or cardiovascular or killed by a jealous husband so some other way of going the if he can find a way of suppressing or taking measures in his lifestyle decisions to suppress that, he has a better chance of avoiding treatment

and therefore avoiding incontinence and erectile dysfunction and depression and all the side effects from the treatment, radiation burns, whatever. So it's about quality of life decisions and if he is offered that just deal with the active, the surveillance part, but he's got to take responsibility for the active. So this new book, The Prostate Playbook, covers three areas of lifestyle where he can stack his deck in his favor so it covers managing stress

to preserve your immune system efficiency so we cover mindfulness training we look at yoga tai chi various other ways of controlling the hassles in your life and you've got a new one you've just been diagnosed with cancer that's going to be stressful so how are you going to manage that how are you going to take the emotion take the energy away from cancer and i really get this is a personal thing no no no research on this but i i hate this concept of fighting their cancer fighting takes energy fighting fighting is like saying giving respect to your opponent it's it's not this is a parasite is it it's it's just you don't want it there but don't give it the dignity of an opponent don't give it the dignity of a fight don't give any emotion to

it at all it's just something you are going to ride with now it's something that's in you that is part of you and you are going to slowly sabotage it and stifle it by being smarter than it you're going to outlast it that's the goal outlast prostate cancer so mindfulness mental stress relief secondly nutrition hugely important there is ample evidence that adjusting your your intake your input of food and drink can make a huge difference so moderate alcohol consumption coffee coffee turns out to be good for us for prostate cancer and you know some studies say yeah eight cups a day is fine and it doesn't matter it's decaf or caffeinated because it's not the caffeine that does the job it's some some other chemicals in coffee that actually help

control prostate cancer growth so enjoy your coffee that's good news must have some good news here you go i'll cheers to that there you go yeah i guarantee suzy you'll never get prostate cancer if you drink that coffee has it that i am a hundred percent sure i believe you i believe you there's not much that's certain in this world but that one is um for certain yes the um so dairy is another one um increased dairy consumption particularly full cream dairy is associated with higher all-cause mortality cardiovascular as well as kidney disease and other gastrointestinal disease and also prostate cancer so dairy in moderation and often go for the low fat um if you want to um the low fat is not a significant improvement it's more about

reducing your overall dairy consumption so your creams your butters your yogurts your milk um and the adding of things adding of those so if you you drink your coffee but it'll be healthier black um for your prostate um anti-inflammatory nutrition really critical because so many health states and prostate cancer is one of them aggravated or promoted once established by an inflammatory environment and there are lots of foods that that are inflammation general talking global body inflammation not local injury inflammation so poor choices would be processed meats so your salamis pepperonis pizza meat um bacon uh etc so where the meat is being processed uh sugary drinks absolute disaster

so sodas and pop and anything that's got sugar in it and it has a lot of sugar in it um trans fats or fried foods certainly a worry um so these are foods that generate inflammation white breads and pastas um and the better choices funnily enough fruit and vegetables who would have thought Go figure. As they say, garbage in, garbage out. One of the biggest surprises to these guys, I tell them that your prostate is not as old as you are. They say, what?

I say, no, you were born with a prostate. Yes, I know that, but it's not as old as you because your prostate cells have been replaced through your lifetime. They don't live forever. They die off and you rebuild them. You die off and you rebuild them. So your prostate cells are probably only, at best, five years old. But they have been rebuilt based on what you eat.

Your environment. You can only rebuild with the ingredients you put on board. So the better your quality of nutrition, the better your building products are for replacing all the cells in your body, which is happening every day, millions of a time. So cruciferous vegetables are really important. they're the ones that are the that everyone loves broccoli cauliflowers bock cabbage brussels sprouts all of those um

they are better than ordinary vegetables they are the super vegetables for prostate cancer cruciferous group the ones that have a cross in their flower structure beans lentils avocado coconut walnuts pistachios and the best nut of all brazil nuts brazil nuts are high in lots of things they're anti-inflammatory they've got lots of things in there are really prostate cancer suppressing so a handful of those every day doesn't go astray either so cold water fish red meat in moderation okay but do not cremate it it must not be grilled too well done because it's the it's the carbonization of the meat that makes it

cancergenic carcinogenic so if you eat meat red meat and no more than once or twice a week rare to medium medium rare is okay medium you're starting to push it but enjoy your meat but buy better quality and don't cook the stuffing out of it smaller amounts yeah so so there are lots of things this is all in this new book all the nutrition advice based on research um and then the final section is on physical activity it's on what you do yeah so we look at walking we look at weight training resistance training cardiovascular training yoga tai chi again so um and ejaculation as a physical activity yes to detox to detoxify your your prostate gland so the this is basically as i said it's a

playbook it's a it's a it's a strategic manual for men who want to avoid prostate cancer or the treatment for prostate cancer that's beautiful they're a bit neglected now this is not rocket science it's exactly what their mothers told them eat your fruit and vegetables drink your water go out and play all the good messages you have when you're a kid but when you grow up you lose that and you make your own decisions and in a lot of ways the smart decisions prostate cancer is the end game of all the decisions you ever made that's right oh craig this has been so amazing and i'm sure our listeners are just in awe of the wisdom that you just dropped here on our conversation so how can they connect with you if they wanted to learn

more and sure um uh the the prostate recovery map website www.prostaterecoverymap.com all small case one word one long three words packed in together is good um i also have a personal website craigallingham.com.com and you can move that on to other sites from there because I also cover other enterprises as well. But that's for men's health. Yeah, start there. That'll be good. The book is available online.

The book is available in the UK. Yeah, I think so. Well, it's online. It's available everywhere. We do have it available in the States as well through Amazon. That's right. That's right. I get it.

Awesome. Yes, good. And the new one will go the same way. It'll be online first and it's in all the bookshops in Australia and New Zealand, but it's hard to get distributorship rights beyond that at this stage. But it's a huge market, 17,000 new diagnoses this year in Australia alone.

I hate to think what it's going to be in the States. Every one of those men is either going to have treatment and require the Recovery Map book. That will help you. It doesn't require it. They may have good care elsewhere, but it might help. And those that choose not to have treatment yet, defer or avoid treatment, they'll benefit from the other books.

I'm trying to cover these guys so that they have got a go-to resource at home that they can flick through. They're only short 60, 80 pages. There's some jokes in there. There's some pictures. It's not too hard to read, man. No, it's not, guys. It's a great read.

And it is a recommended, required read for my patients that I'm working with who are going through something like this. So honestly, it is. it has been a wonderful resource. And I, again, Craig, I can't thank you enough for your wisdom and your witty humor. It was such a great conversation and I'm sure that will help many, many men and their spouses and their friends and their fathers and their sons to many years to come. So thank you so much, Craig, for again,

being on the show today. We really appreciate it. Thank you for this opportunity, Susie. It's been a delight. Thank you. Thanks for listening to today's episode. Be sure to head on over to drsuzyg.com where you can get more information, show notes, and related articles on today's topic. Also, if you like what you're hearing, head on over to iTunes, subscribe to the podcast, and leave us a rating and review. We'd love to hear your feedback. Thanks again.

Here you go. All cheers to that. There you go.