Welcome to Paging Dr. Gupta, one of my favorite times of the week. Thanks so much for joining us. I get a chance to hear from you, which I really enjoy. I also get a chance to try and answer the health questions that you've been thinking about. And I just wanna say thank you for sending in so many thoughtful, personal questions, timely questions. For example, you've probably seen the sad headlines, former president Joe Biden, diagnosed with an aggressive form of prostate cancer, stage four prostate cancer. Cancer that has already spread to his bones. It's tough news for sure. And he and his family were thinking a lot about them. We know that they are reviewing treatment options right now. It has generated a lot of questions about prostate cancer and no surprise. I mean, one in eight men will be diagnosed in their lifetime. It is the second leading cause of cancer death in American men. So let's try and get to as many of these questions as we can. Kyra, who are we hearing from first?

Hey, Sanjay! First up, our question is coming from Robert in Seattle, asking: who should screen for prostate cancer and when?

Okay, Kyra, thank you, and Robert from Seattle, thank you. This is really the crux of the whole issue, who should be screened and when, and a lot of major medical organizations don't necessarily agree with each other when it comes to these recommendations in terms of when to start screening, and perhaps most importantly, when to stop screening as well. Now the U.S. Preventative Task Force, they basically say stop screening after age 70. That's the recommendation. Why? Couple reasons: one is that, you know, typically prostate cancers are slow growing. So if you're already in your seventies, the question is, will this prostate cancer be likely to grow fast enough to be a problem in your lifetime? That's sort of how they approach this. The second thing I think is the fact that the PSA test, the screening blood test, is not a perfect test. It as a high rate of false positive results, up to 70%, according to the American Neurological Association. Someone whose results show elevated levels may then need a procedure, a biopsy, to rule out cancer. And most of those patients, the biopsy will come back negative. To give you some context, for people who get a biopsy of their prostate, because of an elevated PSA, only about a quarter of them, 25%, will subsequently be found to have cancer, okay? So that means for a lot of people, they got a procedure that really was not necessary, and they had a lot concerns and anxiety and worry as well. But that is sort of an explanation as to why the Preventative Task Force says 70 years Now, as I said, a lot organizations don't necessarily agree with that. When we looked at all the various recommendations, I think the way that we sort of landed on this was to say that screening should start at age 50 for men who are at average risk prostate cancer and should continue to the point where you're expected to live at least 10 more years. Now, obviously, that's a hard thing to know, and that's why you should talk to your doctor about this. But if you still have at least ten years of life, if you get into your 70s and you're healthy, no heart disease and no other cancers or dementia, you may say, look, I think I could live a long time still, or at least more than 10 years, I should continue get screened. It's complicated when it comes to prostate cancer, but worth talking to your doctor about it. When it comes Biden, for example, keep in mind that he's 82 years old. Average life expectancy for a man in the United States is about 76, but if you go into your 70s and you're pretty healthy, you may wanna consider the screening. Now the screening typically involves a physical exam, a PSA blood test. We know in the case of President Biden, he also had imaging which showed that the prostate cancer had actually gone to his bones as well. But again, just to reiterate, for most men, Robert, starting around age 50 and continuing till at least the point where you have 10 years of additional life expectancy. Hope that helps.

All right, stick around because right after the break, we're gonna answer more of your questions, including how family history factors in and what role your diet may play in lowering risk.

All right, let's check that next page, Kyra?

So we have Noel here who said, my father had prostate cancer. Does this increase my risk of getting the disease?

'All right, Noel, the short answer is yes, it does. Having a father or brother with prostate cancer more than doubles a man's risk of developing this disease. The risk is higher for men who have a brother with the disease than it is for those who have father with it. But the risk is even higher though if you have several affected relatives, particularly if those relatives were young when the cancer was found, okay? So age, this cancer is rare in men younger than 50 years of age. So if you have somebody who's diagnosed early, it does increase the risk for other family members. Race, more often in black men than in white men. Hormones, testosterone is changed into a chemical that's important for normal prostate growth, but it can also cause the prostate to get bigger, and that could play a part in the development of prostate cancer. If you are at higher risk, so in those cases probably want to start the screening even earlier, age 45 for example, for men at high risk of developing prostate cancer and age 40 for men who are at even higher risk, meaning you have more than one first-degree relative with prostate cancer at an early age. One thing I should point out, for example, with regard to President Biden, they learned that the cancer cells were hormone sensitive, okay? Now what does that mean? That means they have these hormone receptors on the cancer cells, which means these hormones are probably fueling the cancer, causing it to grow. By blocking the hormones, hormone therapy, you could actually start to treat the cancer or at least stop it from growing. You combine that with chemotherapy and radiation, and the radiation is specifically for the component that's in the bones of this cancer. That might be the sort of treatment that ultimately he gets. All right, Kyra, I think we've got time for one last question.

Okay Sanjay, this last one is coming from Jeff in Niceville, Florida, wanting to know if there are any dietary foods that can help reduce the risk of prostate cancer.

'Niceville, Florida, I love it! What a great name. Diet, okay, so let me preface by saying this, food studies when it comes to preventing cancer or increasing the risk of cancer are really hard to do. Quick, what did you have for dinner last Tuesday? Right...My point is that most people don't remember what they ate. They don't journal their food. It is hard to sort of look at food as a specific sort of thing and say, here are the foods that increase your risk or lower your risk. Having said that, when it comes to prostate cancer, there is something that a lot of studies do focus on and that is foods high in folate. It's a kind of vitamin B that occurs naturally in some foods, green vegetables, beans, orange juice. And there's pretty good evidence that folate can actually lower your risks of prostate cancer. One thing I do wanna note though is that folic acid is a man-made form of folate which is found in vitamin supplements and certain foods, but it's not a good substitute when it comes to reducing your risk of prostate cancer. There was a study from the Journal of the National Cancer Institute that found that the risk of prostate cancer was lower in men who had enough folate in their diets. However, the risk for prostate cancer was actually increased in men who took 1 mg supplements of folic acid. Unclear why. It could be that people who take folic acid are also less likely to get enough folate in their diet, thinking, hey I'm supplementing, why do I need to take more folate? That's not a good approach. You really want to get your folate in your diet if you're thinking about reducing your risk of prostate cancer, and you want to make sure you're doing it from real food. So green vegetables, beans are really good, spinach, broccoli, and black-eyed peas. Hope that helps. We should all be getting more folate in our diet, whether we're concerned about prostate cancer or not.

'Thanks to everyone who reached out with questions. Again, we got a lot of really personal questions, a lot stories of your families. And I just wanna say that we listen to these questions. We pay attention. Hopefully we're able to provide some good answers for you today. I really do enjoy hearing what's on your mind. If there's something you've been wondering about when it comes to health, here's the place to come. Don't keep it to yourself! Record a voice memo, email it to asksanjay@cnn.com, or give a call at 470-396-0832, leave a message. Thanks for listening, we'll be back next Tuesday. Chasing Life is a production of CNN Audio. Our podcast is produced by Eryn Mathewson, Jennifer Lai, Grace Walker, Lori Galaretta, Jesse Remedios, Sofía Sánchez, and Kyra Dahring. Andrea Kane is our medical writer. Our senior producer is Dan Bloom. Amanda Sealy is our showrunner. Dan Dzula is our technical director and the executive producer of CNN Audio is Steve Lickteig. With support from Jamus Andrest, Jon Dianora, Haley Thomas, Alex Manasseri, Robert Mathers, Leni Steinhardt, Nichole Pesaru and Lisa Namerow. Special thanks to Ben Tinker and Nadia Kounang of CNN Health and Wendy Brundige.