Prostate cancer awareness takes on new meaning through the story of Murray Keith Wadsworth, a man who turned his own diagnosis into a mission to educate and empower others. In this eye-opening conversation with Daniel Weinberg, Murray shares his journey from a shocking PSA test result at 47 to years of navigating misdiagnoses, missed tumors, and major life decisions about treatment. Drawing from his book Prostate Cancer: Sheep or Wolf, he reveals what every man should know about early testing, over- and under-treatment, and becoming an advocate for their own health. His honesty, humor, and determination remind listeners that awareness isn’t just about prevention—it’s about living with courage, curiosity, and choice.
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Prostate Cancer – Sheep Or Wolf: The Patient Detective With Murray Keith Wadsworth
On this week’s show, we kick off our Movember series. Movember is a global movement that runs each November to raise awareness and funds for men’s health issues, specifically prostate cancer, testicular cancer, and mental health and suicide prevention. On this week’s show, we go through the journey of prostate cancer with Keith.
November & Prostate Cancer: The Silent Threat
Keith, it’s so good to have you on the show.
Daniel, thanks for having me.
Welcome. We are in the month of November, otherwise known in the men’s health world as Movember, which brings awareness to such men’s health issues as prostate cancer, one of the biggest. We’re going to get you to really dig into this whole prostate cancer space. I thought I would open up by giving a little bit of factual information to the audience. On prostate cancer, I personally know very little about it.
The most I know and men around me, my peer group, know is that once you get to a certain age, circa 50, they say you should start getting yourself checked for it because as you get older from the ages of 50 up, the probability increases of men getting prostate cancer. What that means and the effects of it are, I have very little knowledge other than some brief conversations I’ve had with you, Keith.
It’s super important that men become way more up to date on their knowledge with regard to this space. The risk of getting prostate cancer, about one in eight men will be diagnosed with prostate cancer during their lifetime. Each man’s risk of prostate cancer can vary based on age, race, ethnicity, and all other factors. For example, prostate cancer is more likely to develop in older men.
About 6 in 10 prostate cancers are diagnosed in men who are 65 or older. It’s quite rare in men under 40. The average age of men when they are first diagnosed is about 67. Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer. About 1 in 44 men will die of prostate cancer. It can be a serious disease, but most men who are diagnosed with prostate cancer do not die from it.
In fact, more than three and a half million men in the United States today have been diagnosed with prostate cancer at some point and are still alive, which I found a fascinating statistic. One of the things when you look up prostate cancer, what they talk about, is the concept of overdiagnosis and over-treatment. I really want to get into this. Says, “Because of screening, some men may be diagnosed with a prostate cancer that they would never have known about otherwise.
It would never have led to their death or even caused any symptoms. Finding a disease like this that would never cause problems is known as overdiagnosis.” The problem with overdiagnosis in prostate cancer is that many of these men might still be treated with surgery or radiation, either because the doctor cannot be sure how quickly the cancer might grow and spread because the man is uncomfortable knowing he has cancer that isn’t being treated.
Again, basically, you can have it. If you do nothing about it, nothing will happen to you. Yet we make the mistake of jumping in and doing radical things like surgery, etc. You have the over-treatment. The treatment of a cancer would never have caused any problems known as over-treatment. The major downside of this is that even if a treatment like surgery or radiation wasn’t needed, it can still cause urinary, bowel, and or sexual side effects that can seriously affect a man’s quality of life.
There’s a lot to get into. I think what’s better than speaking to my guest, who has not only experienced this firsthand but decided to go down the deep rabbit hole of what this all means and became extremely well-informed. So much so that he’s written a book on the subject to hosts a podcast on the subject, and we’re going to get right into it now. It’s best to start with how that whole journey began. What did you have symptoms of? How did you even know that this was an issue for you in your life?
My Prostate Cancer Journey: Early Diagnosis & PSA Tests
Again, Daniel, thank you for having me. A lot of questions you’ve raised and a lot to talk about. How did I get into this? At the age of 47.
That’s young.
Too young for prostate cancer. Don’t worry about it. I was having a good time in my life. I was very fit. I was very sexually active. I had a wonderful girlfriend. I was also a solo parent of my two children. I had a Monday morning physical coming up, my annual physical. Because I was a solo parent of my two children, so provider, I wanted to make sure nothing was going to go wrong with me.
The weekend preceding, Monday morning, physical, my kids are doing sleepovers. I get to see my girlfriend. I had chosen a lifestyle where I did not bring her into my house much. I did do sleepovers. I did do sleepaways. Monday morning, I go get my physical and a lot of tests. This is all self-directed. I come back with an elevated PSA, a value known as 20.4 nanograms per ml. I had no idea.
The PSA is done, as what my understanding goes, you get a blood test for a PSA.
It’s a blood test.
In the blood, some markers can show you whether there is a higher likelihood that you have something like inflammation, infection, or what is it exactly?
As with all things, we get checked with our blood, your glucose, your glycogen, your hemoglobin, there’s our normal range. If you are outside of the normal range, then it requires more investigation. That’s all it means. It doesn’t mean anything is wrong. The normal range is in low single-digit numbers. I came back 20.4, immediately sent to a urologist. That urologist told me to prepare to die.
To prepare to die?
I had at that high of a PSA level, and I had prostate cancer. I’m 47 years old, sole provider for my two children. The mother’s not really around. Who’s going to take my kids? We will do a biopsy. The biopsy comes back benign. No cancer. I’m like, “Why would we’ve just gone through all of this?” I started reading. One of the things I read was not to ejaculate soon before you have a PSA test because that activates the prostate gland.
It can inflame it a little bit. It excites it, and your PSA value might go up. You also read, “Don’t ride a bicycle,” or “Don’t ride a bicycle.” My kids were away for the two days prior. There was a lot of ejaculation, and I was also a pretty big cyclist, and I had written double digits two days in a row, and also the morning before the morning of the physical. I shared all of this with the doctor, and I shared with them one other thing.
I said, “I’ve also read about prostate stimulation.” My wonderful girlfriend would do prostate stimulation. That’s essentially a finger-up directive. You can stimulate the prostate and achieve greater erections and more ejaculate. He just had to tell me how lucky I was. We dismissed it right after that. I then had no sex. I didn’t get on my bike. Two weeks later, we test the PSA, and it’s dropped all the way back down to normal. Fascinating. Cool. I don’t have to worry.
This is the old man’s disease. Let’s take a moment and talk about the old man’s disease and the idea that most men die with prostate cancer and not from it. First of all, keep in mind, you’re dying from something else. If you hadn’t died from something else, you might well have died from prostate cancer.
The unique thing in the cancer world about prostate cancer is that it can be very slow-growing. When we hear cancer, we fear. I’m eleven years since my diagnosis and doing very well. I’m also now dealing with metastatic melanoma. It progressed from my back to my liver. Now it’s a different cancer. Now, all hands on deck. Melanoma does not take long to kill. Fortunately, I’m in very good shape for my treatment. We may have it cured.
I don’t like that word, but we can discuss it. Prostate cancer is a slow cancer. I go back to testing periodically my PSA. For 10 years, it goes up and it goes down. Every time it goes down, we’re thrilled, and then there are explanations. “You might have an increased prostate size. It’s growing a little bit. It might be a slight irritation or a slight infection.” It’s dismissed. I get the digital rectal exam. The finger up the rectum.
How often are you supposed to have that?
The Digital Rectal Exam: A Missed Diagnosis
There’s no guideline. There really are. We try once a year because once a year sounds good for everything. Mine were always clear. You hear the word clearly. We’re just going through ten years of this. This is from 47 to 57. I’m now living over in England, working over there, and my PSA has gone back up again. I’m thinking it’s time to see a urologist. I debate, “Do I fly back to the States or do I meet one here in England?” I had a friend who was a doctor, and I said, “Can you find me a urologist who’s ahead of thinking?” We did. I once saw the urologist, and we talked about my history and my fluctuating PSA. He said, “Let’s do a DRE.” I said, “Okay.”
What’s that?
The DRE, the Digital Rectal. Finger up the bottom. I did what I had been doing for more than ten years. Turn around, put my back to the doctor, drop my pants, and put my elbows on the table. Did you have one of these?
I’ve had it once before, yes.
The doctor laughs, and he says, “You Americans.” He says, “Take your pants off.” He says, “You’re going to get up on the table. I’m going to be here for a while.” He says, “You’re going to get an erection because I’m getting a prostate massage. We’re going to bring your knees up alternately to your chin, and we’re going to roll you left and right.” He wants to rotate the gland a little bit, and he finds the lesion that had been missed.
Turns out the doctor I had been seeing urologist for a good number of years, with very small fingers. This doctor, very big fingers. If you’re getting a digital rectal exam, size matters. I didn’t think of that. He found the tumor. We had missed it for the longest time. I start reading and I find out that digital rectal exams miss most early-stage prostate cancer. Of course, the doctor puts on a rubber glove, gets some gel, and goes up quickly.
Digital rectal exams miss most early-stage prostate cancer. Share on XHe doesn’t want to be there. You don’t want him to be there. I want my girlfriend to be there for a long time, but you don’t want the doctor there. What’s more important, the sexual achievement or let’s find this cancer early? Now at 57, I have a tumor. The doctor in England says, “We’ve got to get you to an MRI.” I said, “Huh?” I got to do an MRI.
For ten years, no one in the US had talked to me about MRIs. We did them, but we don’t do them. I get my MRI and sure enough, it’s cancer. I go down the rabbit hole of how to treat. All of the things you spoke about in the beginning, these words we hear, I wrote them all down so we can cover them. “It’s going to affect your sex life. There’s overdiagnosis, there’s over-treatment.” Let’s jump into that, as I’m 57. The cancer was probably there for 5 to 10 years at least already.
Can I tell them?
By size, yes. By how much did it spread? Yes. Mine was rated a low-intermediate risk cancer. That was probably an underscore. That was probably intermediate risk on the genomic testing that was done. I’m intermediate risk, but mine had actually spread quite far. We came to learn. This is at 57.
I mentioned in the beginning that the average age they find it is 67, still very young.
Yes. I’m 69 now, and let me tell you how I’m 68. Let me tell you how young 67 is. Let’s take that for a moment, Daniel. Throw that out. Throw that out as an idea. Average means the average, the middle between the low and the high. We are not screening men on a regular basis. If we screened all men, we’d find men in their 40s and their 50s with prostate cancer. That average age would come down. Also, in that average is a lot of old men who are in their 70s.
It brings up the average.
They’re not going to die from prostate cancer because they may have the 10 or 15-year prostate cancer disease, and they’ve got four other diseases. It brings the number up. It’s a very false misrepresentation of what’s true. Men need to get that out of their heads. I spent a year trying to figure out how to treat this thing.
Navigating Treatment Options: Surgery, Radiation, Or Drugs?
What are the doctors telling you at this stage when they’ve done all this? You say, “I’ve spent a year then working on what to do.” It’s like, aren’t they telling you, you need to get chemo, you need to get your prostate cut out? Aren’t they telling you what you need to do?
You hear everything. You hear everything. After the MRI, I came back to the States and went to meet with my urologist, the man I’d been with for ten years. He says, “I want to do surgery.” I said, “I have an opening next week. No.” I took a year from that point. I went back to Europe a couple of times.
Can I ask you, how are you physically and mentally feeling when you’re told you’ve got this and you’re not doing anything about it? Are you not sleeping? Is this occupying your mind all day, every day? Does it distract you? Do you feel lethargic, or are you not feeling any different?
I felt very different. I was angry because we had missed it. I’m deeply worried for my children. I had a wonderful life. Now that looks like that might end. If you get into it, it’s the slow disease. If I’ve had it for 5 or 10 years, I’ve already taken a chunk of that slow time.
It makes sense.
I did a quick dive into the drugs that are used for this disease. ADT, Androgen Deprivation Therapy. This essentially stops testosterone and raises estrogen. I was a weekend athlete, a weekend triathlete. All of that’s probably going to come to an end. Sexual activity is going to end. You’re now going to watch chick flicks. Kissy movies, as my granddaughter calls them. You’re going to cry. I did spend a year on a drug called bicolutamide, and I didn’t care for it at all.
What does that do?
It blocks testosterone.
Does it make you feel what’s weaker? Does it make you feel lethargic, weaker, muscle strength?
The only nice thing I got out of it was really big man boobs. One of the ways I describe it, that when I was on the drug for a year, I went up to the mountains and I was a campground host in this little campground up in the high mountains of the Sawtooth in Idaho. Every day, I had this beautiful hike up to a place called Alice Lake.
I didn’t want to do it. I’d be on the trail, and all I wanted to do was take a nap under a tree. This was a triathlete, a weekend triathlete, not a professional by any means, just having a good time. I would watch chick flicks and cry. Genuine happens. Absolutely happens. You put on weight. Anyhow, so we go back to this year, where I’m trying to figure out what to do. I’m afraid of surgery, which is the treatment I ended up having because of all the fear-mongering. I went to Europe to look at some treatments that were not available in the US at that time.
Those doctors, all looking at my MRI, said, “Your only choice is surgery.” Now you almost never hear this, but they’re looking at the tumor location and they’re saying, “There’s not enough safety margin or space between your tumor and critical urinary bits. You sphincter valves. That if we try any treatment, radiation, HIFU, we’re going to hurt those parts. Your best chance is precision robotic surgery.” I ended up having surgery, and I will say that my continence improved.
Life After Prostate Removal: What To Expect
Surgery is not the removal of your prostate.
That’s the removal of the prostate.
The whole prostate?
The whole prostate’s gone.
Now explain that whole story.
The removal of the prostate or afterwards?
The afterwards. What happens when your prostate, as we had in our early discussion, I brought up what my understanding of the effects of having your prostate removed, I understood was that you had issues with your continence, with your bladder. You had issues sexually. I want to hear all about when a man has their prostate gland removed, what he can expect as some of the effects or functionality for the man.
What I want to do is, Daniel, take a step back and say, “What are the risks or the side effects if a man treats prostate cancer?” Our treatment options are surgery, radiation of various flavors. A variation of that being called focal treatment, focal meaning very localized, HIFU is one. I looked at that over ten years ago in England. You couldn’t get it in the US at that time. The other one is the drugs.
All of them can harm your urinary system. All of them can harm your sexual function. Surgery will have an immediate effect. Radiation will typically have the slowest effect. The drugs can be fairly quick as well. They start blocking your testosterone right away. If you’re a healthy man and you decide to do the drugs and your testosterone is 900, it might go to zero in a matter of a month or two.
That has a huge effect on a man to effectively remove one of the key ingredients of what makes a man a man.
That’s correct. What I want to say this for is that this is what we need to understand. Treating prostate cancer has risks. It doesn’t matter which one you do. We have all this anti-surgery focus, and we ignore the drugs and their effects. We ignore the effects that could come from radiation. I went into my surgery. It’s my only choice for longevity. If I end up in diapers, I want longevity. If I end up with erectile dysfunction, I’ll figure that out. I had had a decent sex life, and I was willing to give it up. My focus was on my kids.
Your focus is ultimately choosing life.
Choosing life. I wasn’t focused. I was interested in listening to your child with Leonard. He had a wild sex life. Mine could be in that category as well. I was like, done with it. I wanted to live. I still had these two younger children. I enjoy so many things in life. I love the outdoors. I love traveling. I went into the surgery with an enlarged prostate.
Does that mean when they say it’s like a bloated, what does it mean?
Bloated is fine. It just gets bigger.
Why? Because of what?
It’s just what they do. There has not been a real scientific reason as to why, and can we stop it? It’s a gland that, if you’re sexually active at a high level, or not sexually active at all, it’s still a sexual gland.
Also, one of the readings that I come across a lot is that they talk about some of the things you should do in terms of preventing prostate cancer, and they say things like ejaculation.
Bullshit. There’s no evidence. There’s a lot of talk about what scientific evidence is. Let you and me do a study, okay? Let’s pretend I don’t have prostate cancer, and let’s pretend everything’s healthy. We’re going to do a test, Daniel. We’re going to do a study, you and I. Which one of us is going to stop masturbating?
You want to masturbate. You can do the masturbation part.
Which one of us is going to stop sex?
Not me.
How are we going to do the study? We’re going to choose you, Daniel, as a random participant.
Do you mean the control is very difficult to find the control?
Yeah, exactly. Come on. We’re really not going to do that. If we’re going to do it with five men, the whole rest of the world is going to rely on the results from five men. It’s all garbage. It’s cancer. Cancer comes. My enlarged prostate made urination more difficult.
Early Detection & Post-Surgery Realities: Don’t Wait For Symptoms
This is what I want to talk about. This one I’m going to do with the symptoms of as you know, because of the test, this PSA story from the beginning of actually getting into it. There are a lot of men who don’t. It doesn’t get picked up. I don’t know any of this stuff, but symptoms arrive. Tell me the symptoms that men can be aware of that, if they experience them, they should really pursue a proper checkup.
I think you should think men should start screening with the PSA test long before there are any symptoms. I’m going to give you a patient answer. This is a non-medical answer in two parts. You don’t want symptoms of cancer. Once you have symptoms, you’re in trouble. When we found my metastatic melanoma last year in my liver, we stumbled on it because I was looking for prostate cancer. If I had waited until the symptoms, my liver would be gone. If my liver’s gone, I’m gone. You don’t. The symptoms that occur when the cancer leaves the prostate will be in your bones. That’s pain. If it goes into an organ.
You don't want symptoms with cancer. Once you have them, you're in trouble. Share on XWhat if it’s isolated just in the prostate? What are you experiencing? You’re experiencing like your urinary flow is like you lose pressure?
There’s not a lot of indication that it affects urinary flow. This is anecdotal from talking with other men. Doctors don’t know. I will tell you that just before my diagnosis, a new girlfriend complained about my lack of ejaculate. Her concern was that she wasn’t satisfying me. I’m like, “No, this is great. I’ve been having a good time. You should be happy that I can go 20, 30 minutes running.”
I have now learned, anecdotally talking to a good number of men, this reduction in ejaculate seems to be an indicator, but you won’t find that in medical journals. That’s about number one. The other one has the sexual drive or the ability for your erection to come off at all? Most of the guys I talked to don’t seem to have that. We seem to see just ejaculate dropping.
Libido is not really affected.
Not really. I had a high libido, but the prostate makes the ejaculate.
That’s right.
I was having difficulty with that. I have to say it’s anecdotal because the medical books won’t tell you that that’s an indicator. You don’t want symptoms. Symptoms are bad with cancer. After my surgery, my large prostate’s removed and I urinate fabulously.
You’re not a fake. That’s not the case for everyone.
No. Let’s talk about that. There are a couple of things that we have to be honest about. I have no doubt that a lot of the men who come out of treatment, let’s say surgery, and they say, “I have erectile dysfunction.” I bet you had it before you went in. You hear in the States on the radio, we do a lot of pharmaceutical advertising here. Half of the men in their 40s will start to have erectile dysfunction.
I had a urologist on my show a couple of months back, and that’s a big thing.
All the men who have surgery were stallions before the surgery, and suddenly they’re not? No, how about they maybe had a problem before the surgery, and now they’re blaming it on the surgery, so they can say, “I’m a stud, it’s not my fault.” Let’s be candid about that. Urination. I’m going to be blunt here. Things I’ve learned. If you’re obese, you probably already have urination problems.
Is it the bag for urination?
You carry one for a few weeks after surgery. That’s not a big deal. That’s a catheter.
There are no men who have that ongoing sex.
There are some men. Some men lose their continence. Some men do. There’s a gentleman I mentioned at the front end of my book. He lost his continence completely. His cancer had spread into his sphincter valves. You want to get rid of the cancer, you’re going to give up urinary function. What’s your choice? Die with some good urinary function, die sooner, or wear diapers and live longer. It’s a choice. If the cancer’s in the urinary bits, you’ve got a problem. Good imaging will help the doctor see that or the surgeon will see that under the procedure.
If you have radiation, if the tumor is near the urinary bits, guess what’s getting radiated? The urinary bits. They’ll try and reduce the amount of radiation they get, but that’s the safety margin that’s in there. Again, when I was diagnosed and my doctors were looking at my MRIs, they said, “Your tumor is too close to the valves. We cannot get it with radiation because we need a wider margin to be sure we get all the cells.” I came out of the surgery fine.
Penile Rehab: The Road To Recovery After Prostate Cancer Treatment
What happens with the erectile functionality?
I recovered in a year. Now, what I did not know ten years ago that I wish I knew now, and it’s being discussed ever so slightly, is if you, particularly if you do surgery, but I also know men who do this to get radiation, is that you get a penile pump.
Penile pump, not implant.
Pump. Pump it up.
Why?
It’s because essentially it’s a muscle, and we need to work the muscle. We need to exercise the muscle. Now that you’ve done some damage to it. You really need to rehab it.
Do things like Cialis or Viagra help with that?
Yes. I now wish I had done that as well.
Explain. You’re saying just having a low dose of those.
It affects the blood flow, which is what we need.
I think that Brian Johnson guy, the guy is like that longevity addict. He takes about 2.5 kilograms of Cialis on a daily basis, something like that.
I don’t do that, but I’m aware of people who do. I think it’s always worth looking into. If you’re post-surgery in particular, but I also know men who are post-radiation, which I also was post-radiation because that was my second treatment. I would now tell a man having surgery, “Get your penile pump and get your Cialis or similar low dose and get into rehab for your penis.”
What does that mean?
Rehab it. You pump it up with the pump every day.
You mean like literally put your penis on this pump thing, and it’s like just a standard penis pump.
Just think about it. Standard penis pump. Yep. Like what a porn star would use. Exercise it. It’s a different exercise than intercourse or masturbation. There are now therapists getting involved with this. They’re learning about it. That’s the thing to go do. I know several men who have done it, and they recovered within months. I took a year naturally. The recovery is good enough for intercourse, firm enough. Fuck a year for me. “I did it naturally.” Let’s say I recovered at 87.2%. Maybe I would have recovered at 97%.
Understood.
It’s important to do. You’re ashamed or embarrassed by it, we’ll deal with that. It’s rehab from surgery or rehab from radiation. After my surgery, I did not get all the cancer. It had already spread. Now this is the game changer. I contemplated for a year what to do. I chose to do radiation to the prostate bed only. That’s the space where the prostate used to be. We had no imaging. We didn’t at that time, we’re talking about years ago, have much of a way to look at it. We did the radiation, and we missed again.
The cancer had already spread further than the field. Now this is an intermediate risk answer. Now I’m talking about now being maybe close to ten years in with this disease. Yes, it’s slow, but I’m still in my early 60s, young man. I still want to hike and bike and do all the things that I do. I tie in here some of the things that you brought up in the opening, where we talk about the risks being 1 or 8, or they vary, the average ages, or the number two cancer death, or 3.5 million men are still alive. Here I have now had my second treatment. I’m still alive.
How old are you?
I am 68.
You’re 21 years in from the original PSA test you did?
Yeah, could be. I could be that long that I’ve had this cancer. That’s what’s unique about it. That’s what’s also struggling with it. Am I overtreated, or am I undertreated? What’s the rest of my health outlook? My health outlook is amazing. I don’t have heart issues. All my other blood work is great. I’m now over a year into my immunotherapy, which is like chemo for my melanoma. My blood work’s amazing.
How do you feel? Sleep-wise, energy-wise, how would you rate how you feel?
From the immunotherapy chemo.
All of them from how you’re feeling with what you’re currently doing?
I feel great because I look at all the men who are not great. Compared to many men, I am fortunate. I am grateful. I am lucky. I can be tired. I lack energy sometimes, and I’ll go for a hike and I’ll do 10 or 15 miles in the mountains, but I lack energy.
That’s big.
I’ll ride my bike 50 miles, but I lack energy. I do have to get up and go sometimes. When I started this immunotherapy for the melanoma, I could sleep 10 or 12 hours a day. Now that’s healthy. Everyone thinks it’s good. If you sleep twelve hours, that’s half of your day. If you take an hour to do all your pre-bed things, and then an hour after you wake up, there are fourteen hours.
You have 40% of your day left.
Beyond Standard Care: Advanced Imaging & Treatments
It’s like I left. That’s quite impactful. There is the mental drain. It’s not easy walking around with cancer. I do quite well with it. If I keep a focus elsewhere, I keep a focus on my adult children. I keep a focus on my grandchildren, and I’m in the fight. I want to beat this. After my radiation failed, now what do you do? The standard protocols were at that time something called the stampede trial, which is chemotherapy and the hormone-blocking drugs.
It's not easy walking around with Cancers—there's the mental drain. Share on XThe side effects are horrible. It’s going to be worse than the surgery, worse than the radiation. I didn’t want to do it. I found my way over to the Netherlands for imaging, something called the ferritin nanoparticle MRI, and a PSMA PET CT. The PSMA PET CT was a new type of imaging, more sensitive. It was on trial in the US. Here, I want to talk about a bit of misinformation for men worldwide. It’s in trial at two universities in California. Leading-edge technology, bullshit. They’ve been in use in Europe for a number of years.
The US is like, “Look at us.” It’s like, “That’s crap.” I go over to Europe and I get the gallium-68 PSMA PET. I could not get it in the US. I applied for the trials, and they denied me because they said my PSA was too low. They wanted to have success. You hear a lot of men say, this is after your treatments, “You need your PSA to be higher. The PSA is now indicating cancer because you’ve been treated after you were diagnosed. The longer you wait, the better the chance of the imaging finding the cancer. Let’s wait until I have more of it.” That’s ridiculous.
That’s counterintuitive.
What the doctors will tell you is, “We need to wait.” I went over for this experimental imaging called the ferritin nanoparticle MRI. It found multiple suspicious pelvic wimp notes. Suspicious in that it’s not diagnostic, suspicious in that it’s not a biopsy, but they are quite confident it’s cancer. However, this gallium-68 PSMA PET, brand new in the US in trials at two major universities, didn’t find anything.
The PSMA PET is now standard in most countries, yet mine found nothing, whereas this other one found multiple 5 to 8-count pelvic lymph nodes. I came back to the US, and they all said, “We want to put you back on the stampede trial, chemotherapy, and ADT.” I said, “No, I’m not doing that.” I found some papers about what was called salvage lymph node surgery.
Now they go in and they take out the lymph nodes using the frozen section pathology method, mouthful of words. I went to Belgium to have this done. Here I am in America, and going to Belgium. No one in the States will do it. I contacted many centers. No, we won’t do that.” The frozen section is that they start with what they call the common iliac lymph nodes, take them out immediately, they’re frozen, and pathology is done. If cancer is found, then the surgeon knows what to do. We go for more.
Every lymph node comes out, and they check it immediately. If it’s full of cancer, they keep going. Once they don’t have cancer, then they go, “Let’s not go too many more. We don’t need to take out more than we need to facilitate the process.” It left me in fabulous shape. That was seven years ago now. Not done in the US, not in Europe, fairly common. I don’t think of myself as cured once the cancer has gotten out. It can be out in senescent cells.
I need to keep monitoring this, but like you can just have a really good period basically.
I have seven years now.
Patient Detective: Taking Control Of Your Health Journey
You went down the rabbit hole in your journey, just like rejecting what you’re being told. The issue is that for most people, when they are in this situation is when they’re at their most vulnerable, when they’re at their most fearful. They’re going to take guidance from doctors and professionals, and domain experts, more likely than not. What you seem to have taken to stay, “I’m just going to be a part of my French, but I’m just going to be a stubborn asshole on this thing,” just like, “I don’t care what you tell me.” I know there are different answers out there. You’re just not digging hard enough. You did.
I wrote about this in the book, patient-detective, patient-scientist.
Sheep Or Wolf: Understanding Your Prostate Cancer
I got a patient detective. I want to know for the audience, I guess there’s a good segue into there’s the book, which I really want to talk to you about, which is the Sheep or Wolf. I want to understand, explain what you mean by sheep or wolf, and you’ve got the podcast series on prostate cancer. What is the best resource for men when this thing drops? Where should they go? What should they do? Let’s start off with Sheep or Wolf. Explain it like when you built this title, what’s your meaning? What’s the messaging you’re trying to get across when you’re a sheep or wolf?
Sheep are cute and loving, except that sheep can be mean. Wolves are wolves. We hear, “This is the good cancer. This is the slow cancer. Most men with it don’t die from it. It’s a slow cancer.” “What about the men who die? I don’t want to be one of those.” That’s the lesser number. It’s 100% for those who die. An interesting statistic. When I was diagnosed in 2014, some 27,000 American men died from this disease.
Last year, 35,700 souls. The death rate has been rising. Now, you hear advocates say, “That’s because there are more older men.” If we’re accomplishing everything we’re accomplishing, the death rate really should be going down a lot more. It used to be higher 20 or 30 or 40 years ago, but we’ve come a long way. I’d like to read something to you here that just came out the other day, and this will get back to your question.
This is from the Prostate Cancer Foundation. This is perhaps the biggest charity research firm in the world. This is their CEO, this is their ad. Push me on Facebook. This is Gina Carrithers, President and CEO’s quote, “Through our efforts, which I translate to send us more money, I am confident that we are moving toward a future. A future that’s not today, where prostate cancer is detected earlier, treated more effectively, and ultimately defeated.” Here’s what she’s saying, “Send us money. We are not detecting it early enough today, and we’re actually not treating it effectively.”
Be honest about it. How did I become this patient-detective, patient-scientist? Go back to when I’m 47. I’m told I’m going to die. I get a biopsy, which isn’t fun, and then I’m told I’m fine. I’m like, “Doc, how come you didn’t ask me how my sex life has been the last 48 hours? Why didn’t you ask me if I haven’t worked out a lot? Why didn’t you ask me if my girlfriend does prostate massage? If you asked me those questions, I would have said, I did all of that.” They would have said, “Chill out. Don’t do anything for a couple of weeks, and we’ll retest the PSA number. It would have gone way down.”
Shouldn’t they do that as a default anyway? Once you get tested, you can have some false flags. “Let’s do it again in two weeks and see if you repeat.”
It’s like a simple thing to do.
Daniel is the beginning of my going, “What are these doctors doing here? What are these doctors telling me?
When my urologist, whom I had trusted, but had missed the tumor, because his fingers were small and he did quick DREs, and he never mentioned MRI to me, he had them available. He didn’t do them. I become more untrusting. That was the start of it. I go over to England, back to England, and the doctors there are entirely different. Now here’s a unique thing. I had a company in England, and I had employees, and they were on the national health.
Here in the US, we talk about all the harms of socialized medicine. I don’t think the program’s as bad as we think it is. I had provided my staff with private health insurance. You see the same doctors, and the way I explain it to people is look under socialized medicine, the doctor works 8:00 to 5:00. They see so many patients, they don’t see any extra patients because they don’t get paid. If the doctor wants to make more money, they now go into private practice, and after five, you’re nodding, so you know this.
They took their time with me. They weren’t pressured like we are in the US. We call it throughput. The doctor’s got to see a lot of patients every day to get their money markers. They took time with me, they sat down with me, and they looked at the MRI. When you have a doctor whom you’re going to pay money to private funds? I tell you, “Don’t use my procedure, I think you should do surgery.” I had two of England’s top doctors, one in radiation and one in HIFU, say, “You need to go get surgery.”
“Don’t do my thing.”
I’m going, “Huh, but my surgeon, my urologist, he never really looked at the MRI and talked to me.” He wasn’t my surgeon. I fired him.He just said, “Let’s do it next week.” I came back to the States, and there were a couple of HIFU doctors here, and they had to go out of the country to do the treatment. We couldn’t do it in the US, so we went down to Mexico. They’re like, “We can do it. It’ll be great.”
One of the leaders in the world said, “It wouldn’t be great, but you’re telling me it’d be great because I’m going to pay you privately to go down to Mexico and do this for me.” There was another radiation technique that I looked at in England that was just beginning to be used here in the US. That doctor, the Royal Marsden, a top center in England, said, “Don’t do this technique.” A US doctor said, “It’d be great. I’m good at this.”
Further misinformation. I ended up doing the surgery. I find out after surgery, “There’s this great discussion about what PSA value you want to test. There’s something called ultrasensitive testing. A lot of people don’t use it.” They say, “Wait until you’re at a PSA value of 0.1 or 0.2.” Point two is the US guideline, almost the international guideline for what they call recurrence. I go, “How does it recur? My prostate’s been removed.” “It was there, you missed it.”
They want to use the word recurrent. “We’re sorry to tell you, Dan, your cancer has recurred. No, it was always there. We missed it.” That raised further doubts in my mind. What is the theme here? “We want to put you on the drugs now.” I started doing a deep dive into the drugs, and my daughter is a pharmacist and does some other things in neurology. She’s like, “Dad, these are pretty serious drugs. This is what’s going to happen to you.”
I start talking to men who are on these drugs. Now, if you are, and I’m going to be crude and rude, if you’re an overweight couch potato, you may not notice it as much. If you’re fit and active, it’s going to alter your life in a huge way. That began to raise my doubts and my questions. That put me into the patient-detective, patient-scientist. You’ve got to choose your poison. This isn’t an easy decision, but you need to choose it carefully and wisely.
The sheep or wolf, if this is a wolf cancer, if this is an aggressive cancer, I don’t have much time. Metastatic melanoma is a wolf. Right. Months to a year or two if we don’t treat it. I had a sheep. I had a mean sheep, but it meant I had time. When I found that out, so another quick thing. This is early on in me, but still, the first year of trying to decide what to treat. I learned in England about a test called genomic testing. What’s that?
It’ll give us an idea of how aggressive your cancer is going to be. I talked to my doctor in the US. He’s like, “Yeah, we do those. We have them, but we don’t do them. They’re not approved.” It’s an American company. They’re in use in England, even under socialized medicine. They’re in use, but not available in the US because they’re not approved.
I had it. I did it on my own. It got approved a year later, by the way, which is interesting. That’s what they said, low intermediate risk. I mentioned that first, but I turned out to be intermediate risk. How’d that happen? The genomic testing comes from the biopsy. We missed the worst bits. I was underscored. That changes things. I had a mean sheep, which meant I had time. For a year, back to your question about what I did in that timeframe? I wanted to do the right treatment. My focus became to do this right.
I had time. As I got to the end of the year, a couple of the doctors I talked to said, “You’ve had time. We think it’s probably already escaped, but it wouldn’t take much longer, became the advice.” I didn’t, and I had it removed. Let’s talk about overdiagnosis under treatment. How do we know? Here we are again, and you and I are going to be in this big study. We both have prostate cancer. “Daniel, we’re not going to treat you out of fear of over-treatment.” “Keith, we’re going to treat you. Let’s see how you both do. Sorry, Daniel, we should have treated you.”
That’s another hard thing to gauge.
It’s a hard thing.
Only in Harry Hindsight.
There is some indication now that some of what might still be called cancer, prostate cancer, and maybe it shouldn’t be called prostate cancer, there’s a debate in this area called the Gleason score. We don’t have to go there. That’s a debate, tricky area. Again, compared to metastatic melanoma, there’s no doctor who suggests I should wait. I found all these disparities on prostate cancer, and you can find them on the internet. If you go to Google, you will find all these disparities on melanoma. You have metastatic melanoma. We’re sorry.
Universal.
Around the world, universal. Without these immunotherapy treatments, you are going to die soon. It looks like the immunotherapy has worked well for me. It doesn’t work well for everybody. In prostate cancer, disparities exist left and right and up and down. What’s over treatment? My cancer advanced to what’s called the periodic lymph nodes, my third treatment, that salvage lymph node surgery with the frozen section pathology.
The periodic’s are about as far as it can go. What sits next to those is the lungs, essentially. Would my cancer have stopped there? Maybe. Maybe he was going to go there and stop because prostate cancer is not understood. It’s not melanoma. Prostate cancer. It’s not colon cancer. You have colon cancer. We don’t wait. You have lung cancer. We do not wait. Prostate cancer might take twenty years to kill you.
Maybe I was over-treated. I don’t know. Maybe mine was just going to stop. I have a PSA level now on the ultra-sensitive testing of 0.03x, the x meaning in the thousands digit. My PSA value goes up and down. Doctors don’t know what to do with this. You hear all these excuses. “It might be prostate cells left over.” No, that was ten years ago. It’s not that. It might be senescent cells. Those are like sleeper cells sitting there waiting.
Stem cells, cancer stem cells. It’s a new area, the new horizon of understanding all cancers. They kept at bay, and we’re not sure why. I don’t necessarily care why. If they just sit there and I do annual imaging and I get annual liquid blood biopsies and nothing shows, so there’s no evidence of disease, it can sit there and I’m happy as a lark.
Basically, post having it removed, let’s put the other cancer aside for a second. Do you have to focus much on prostate cancer-related issues?
What do you mean by issues?
It’s been removed. The secondary cancer you have is a different cancer. You don’t have any more prostate-related issues anymore because it’s removed, no?
No, I don’t. Other than I don’t have ejaculate, I do just fine.
Intimacy After Prostate Cancer: A New Perspective
Are you in a relationship now?
No. The last relationship was five years ago. I had a wonderful sweetheart in Europe, and COVID separated us. I got kicked out. I had my nice long stay visas, but I was told to leave. Carol came down with metastatic breast cancer. I actually don’t know if she’s alive or not today. She’s a breast cancer specialist. That was her career. It hit her very hard. It had missed her cancer.
That’s wild.
Hers went to her liver. She withdrew. She withdrew to her two children. I have not heard now in nearly a year, respected her wishes, and show up on her heart. I’ve just sat quietly. You do give up your ejaculate if you have surgery. You cannot get over that. That’s a big focus. We talked about this briefly earlier. You did a great episode with Leonard. If you want to mention it, that was titled The Cliff. He talked about having orgasms without ejaculation. Sounds crazy, but when you can no longer ejaculate because you don’t have a prostate, but you can have sex, you still have orgasms.
That’s interesting. You still have orgasms, just without the ejaculate.
They’re better.
Because?
Heightened sensitivity, heightened awareness.
Interesting.
Leonard did. He spoke about ejaculating into a dirty sock. I thought that was hilarious. We all know what that means, right?
Yes.
We all, as men anyway, we get it. We understand it. We understand masturbation, and we understand the ejaculate and wiping it all up. If we get too focused, that’s what we think the success is. This is where Leonard talked about getting to a higher level. You get to a higher level. You get to a different sensitivity. You get to a different intimacy. It’s a big change because we measured it. We measured it by law.
If you’re in your 50s or in your 60s and you had sex in your teens or your early 20s, maybe it’s time for a different approach. Maybe it’s time for a different experience. Maybe elevate your experience. It’s wonderful. If your partner is like, “I understand you don’t do this anymore, and I’ll work around it.” They can elevate their level of experience. It’s a wonderful thing.
It's time for a different, elevated experience. Share on XFive Quick Questions: Life Lessons & Superpowers
Amazing. Keith, so great to have you on the show. When I usually finish up the episodes, I ask a set of five questions, which I want to throw. Give me just your natural response. Don’t try to overthink them. Don’t over-treat them more. The first one is, who would you like to say sorry to, given the chance?
That’s a deep subject. That’s probably more than one person, but it would be my son.
Your son.
My son is in a bad place in life. He was born with very serious birth defects. I did my best to raise him. He struggles with psychosis and mental illness. Although I don’t blame myself. I could have done a lot more.
What are you proud of being or doing in your life?
I’m proud of how I’ve taken care of my own health. I’m proud of the information I’m trying to share with other men.
Which is amazing. When did you receive kindness while needing it most and expecting at least?
From Carol, former sweetheart. We met on a ski trip. I was sitting in the hotel lobby studying medical books. This is prior to my surgery, my first treatment. She came over to talk to me, and she’s a doctor. She asked what I was doing, and I told her, and that started our relationship. She was with me through all three treatments.
That’s amazing.
Very amazing. A huge loss for me and bigger for her.
What did your mother or father teach you that you frequently remind yourself of?
Not to live beyond my means.
Finally, what is your superpower?
This is interesting. Just a few weeks ago, I went to my 50th high school reunion. It was a wonderful experience, and I met some classmates and some boys I had admired. They all told me how much they admired me. I didn’t remember that. I didn’t think that. They said, “You had so much self-confidence in high school.” I’m like, “I did?” It’s my self-confidence.
Really nice. Keith, what a pleasure. Your energy is amazing, given the journey that you’ve been through. I feel that a lot of dealing with these major challenges in life. The response one has and the mindset that one applies to it have a huge effect on how they’re dealt with and how you experience it. From my discussions with you, I really feel like you have just the right mindset.
Firstly, the determination to beat it, but also I think the ability to push the other, the medical practitioners, to do better, to like, “No, there are other options. You’re not digging hard enough. You’re not looking at the options. You’re not seeing what’s going on here. Your patient detective, your sheer determination, I think, has done you a lot of wonders, and it’s something I think we can take a lot from. I just want to say thank you and giving us your time and sharing your story of the journey you’ve been on. Thank you.
Thank you, Daniel. My pleasure.
Important Links
- Murray Keith Wadsworth on Facebook
- Prostate Cancer: Sheep or Wolf
- Daniel Weinberg on Facebook
- Daniel Weinberg on Instagram
- Mens Anonymous on Apple Podcasts
About Murray Keith Wadsworth
When Keith heard the words “prostate cancer” he was 57, healthy and moving between Texas and the UK. What started as a routine check-up became a diagnosis that could have defined the rest of his life. Instead of accepting the first answer, Keith began asking questions.
He wanted to know which treatments actually worked, why so much information was confusing or incomplete, and how patients could make decisions without feeling rushed. That search turned into a three-year journey across two continents and eventually into his book Sheep or Wolf?, where he helps men spot the difference between good guidance and bad advice.
In this episode Keith joins Daniel Weinberg to talk about taking ownership of your health, refusing to be a passive patient and why men need to get better at advocating for themselves and the people they love.
