Podcast Summary

Podcast: Rena Malik, MD Podcast
Episode: Do Supplements Like Selenium and Vitamin E Help or Harm Prostate Health?
Host: Dr. Rena Malik (A)
Guest: Dr. Scott Egnor (B), Chair of Urology at UCLA
Release Date: February 6, 2026

Episode Overview

This episode delivers a comprehensive, evidence-based discussion on prostate cancer prevention, diagnosis, and treatment—focusing on the real impact of supplements like selenium and vitamin E. Dr. Rena Malik and her mentor, Dr. Scott Egnor, explore the nuances of risk assessment, lifestyle choices, overdiagnosis, modern treatment approaches, patient psychology, and evolving terminology in prostate cancer care. They also touch upon testicular and kidney cancer, the pitfalls of screening, and global health perspectives.

Key Discussion Points and Insights

1. Prostate Cancer: Scope, Risk, and the Importance of Screening

[00:00–05:32]

• Prostate cancer is highly prevalent; most diagnosed never die from it, but it remains the second leading cause of cancer death in US men.
• Many men live—and ultimately die—with prostate cancer, not from it.
• “For almost all men with Gleason 6...the likelihood of you dying from prostate cancer is 1% or less.”
  —Dr. Egnor [00:44]
• There's a measurable (though small) increase in suicide risk after a diagnosis, due to anxiety over a cancer that is usually low risk.

2. Preventing Prostate Cancer

[05:32–09:20]

• Risk factors: Family history, African ancestry, genetic mutations (BRCA1/2, ATM, CHEK2).
• Unsexy but evidence-based advice:
  • “Eat real food, probably not too much. Alcohol is a carcinogen. Exercise—especially high-intensity interval training (HIIT)—shows promising data.” —Dr. Egnor [06:49]
• Observational studies suggest exercise, even frequent walking, reduces risk.

3. Supplements and Diet: What Actually Works?

[09:22–14:38]

• Strong emphasis on the difference between observational and clinical trial data.
• The SELECT trial found vitamin E increased prostate cancer risk and selenium increased diabetes risk, offering zero preventive benefit.
  • “If you took vitamin E, you had a slightly higher likelihood of getting prostate cancer. If you took selenium...you had a higher likelihood of getting diabetes." —Dr. Egnor [10:16]
• Other “healthy” foods (soy, pomegranate, broccoli, cooked tomatoes/lycopene) show promising associations in observational studies, but NOT proven in randomized trials.
• Calcium supplements may be harmful; vitamin D shows no benefit; fish oil data is mixed.
• Key takeaway:
  • “Observational data did not translate in randomized controlled trials...that’s why supplements are such a scary sort of area.” —Dr. Malik [13:07]

4. Medications: Finasteride, Dutasteride, and PSA

[14:38–18:57]

• Finasteride/dutasteride (5-ARIs) lower prostate cancer diagnosis rates by ~25%, but may slightly increase detection of aggressive cancers.
• No evidence that an enlarged prostate (BPH) increases prostate cancer risk, but it can elevate PSA, leading to unnecessary biopsies.

5. Ejaculation, Sexual Activity, and Testosterone

[18:57–25:35]

• Frequent ejaculation may reduce prostate cancer risk (observationally).
  • No guilt if you do or don’t ejaculate often; it's not harmful.
• Baseline testosterone doesn't predict risk; supplementing to normal levels (especially transdermal testosterone) appears safe.
• Urologists now treat men on active surveillance with testosterone replacement for appropriate indications, reflecting a shift in evidence and attitudes.

6. Prostate Cancer Screening: Who, When, and How?

[25:35–32:21]

• Start with a risk discussion; use shared decision-making.
• PSA screening has reduced prostate cancer mortality by about 50%, but also led to significant overtreatment and side effects.
• Modern guidelines recommend individualized screening intervals, not annual blanket screening.
• Stopping PSA screening: Typically age 69 or when life expectancy is <10–15 years.
  • “You don't want to screen someone unless you're fairly confident they'll live 10–15+ years.” —Dr. Egnor [31:18]

7. Elevated PSA: Next Steps

[33:10–36:33]

• After an elevated PSA, physicians gather more data to reduce unnecessary biopsies:
  • Repeat PSA, prostate exam for size/density, free PSA tests.
  • Ancillary biomarker blood/urine tests (Prostate Health Index, 4K, SelectMDX, ExoDx, etc.).
  • MRI is increasingly used but must be interpreted with context; quality and reader matter.

8. Biopsy Innovations and Risk Stratification

[41:03–44:53]

• Standard prostate biopsy is now mostly transperineal (less infection risk vs. transrectal).
• MRI-targeted biopsies can be done with “fusion” technology or even cognitive targeting.
• Emphasis on the importance of not rushing to biopsy and using less invasive methods when possible.

9. Treatment Paradigms: Surveillance vs. Aggressive Therapy

[44:53–56:33]

• Major shift: Many low-grade (Gleason 6/Grade Group 1) cancers are now managed with active surveillance—treatment only if/when cancer progresses.
  • “For almost all men with Gleason 6...the likelihood of you dying from prostate cancer is 1% or less.” —Dr. Egnor [49:48]
  • Yet, 40% of US men with low-grade cancers are still overtreated.
• Surveillance involves regular monitoring (less frequent biopsies than before).
• Decisions must be individualized; there's rarely urgency with low-grade diagnoses. Second opinions are highly encouraged.

10. Surgery vs. Radiation: Outcomes, Side Effects, and Counseling

[58:29–67:49]

• Surgery and radiation have similar cancer control; side effects differ:
  • Surgery: 30% never leak urine, 70% have initial leakage, 95% dry by 12 months. Erectile dysfunction is common (true return to baseline is 75-80% max); possible reduction in penile length/infertility/dry orgasm.
  • Radiation: Lower risk of incontinence and erectile dysfunction early on but risk rises over time/with testosterone blockers. Some urinary and bowel irritation is possible.
• Emphasize patient counseling:
  • “Under promise and over deliver rather than setting really high expectations...”
    —Dr. Egnor [65:17]
• Brachytherapy (internal seeds) is still used for select, early-stage patients.
• Focal therapy is emerging but still investigational—seek trials, beware of single-solution providers.

11. Financial Incentives & Patient Empowerment

[80:56–85:29]

• Acknowledge some doctors lean towards treatments with financial incentives, mostly subconsciously.
• “Anyone who gets upset at you for getting a second opinion, that is a huge red flag.” —Dr. Malik [84:40]
• Seek multiple opinions, trust your gut, and look for providers who offer ALL options.

12. Testicular Cancer: Detection and Prognosis

[85:45–88:41]

• Rare, but most curable solid tumor—self-exams from puberty onward advised.
• “If there’s ever a lump, a bump, a peculiarity...get it checked out.” —Dr. Egnor [86:22]
• Younger men at highest risk; be cautious of alternative “miracle” cures.

13. Kidney Cancer, Imaging, and Screening

[88:41–93:58]

• Slight rise in kidney cancer, largely due to increased imaging ("incidentalomas").
• No general population screening; exceptions for known high-risk syndromes.
• “Full body scans are like gambling...you only hear about the winners.” —Dr. Egnor [91:49]
• Excessive testing can create more problems than it solves.

14. Future Directions: Noninvasive Treatment, AI, Global Health

[94:09–97:44]

• Promise in noninvasive therapies and implementation of AI for imaging/pathology—but both are still in early days.
• Dr. Egnor discusses his work with IVU in global health, teaching local surgeons and improving access in resource-limited settings.

Notable Quotes & Memorable Moments

• On exercise:
  “If you could put exercise into a capsule… it would literally be the first trillion or quadrillion dollar pill.”
  —Dr. Egnor [08:48]
• On the psychology of diagnosis:
  “There's a measurable...increase in suicide among men diagnosed with Gleason 6...all for something that has a 1% chance or less of ever causing them a problem.”
  —Dr. Egnor [00:44]
• On supplements:
  “The SELECT trial… in a disappointing way, is they were both more harmful than helpful.”
  —Dr. Egnor [10:16]
• On shared decision-making and bias:
  “It’s so disturbing that your advice should be based on the training of the person.”
  —Dr. Egnor [58:29]
• On changing medical truths:
  “50% of what you and I learned in surgical training was wrong. The hard part is distinguishing which 50%.”
  —Dr. Egnor [53:17]
• On patient empowerment:
  “There is no rush. …you owe it to yourself to get a second opinion…”
  —Dr. Malik [54:39]
• On future directions:
  “If there’s some pill or noninvasive something… it would be gloriously good if I didn’t have to work anymore.”
  —Dr. Egnor [93:17]

Important Timestamps

• [04:31] — Most important takeaway about prostate cancer
• [06:49] — Data on exercise and cancer risk
• [09:29] — Vitamin/supplement evidence (SELECT trial discussed)
• [14:38] — Medications: Finasteride/dutasteride and risk
• [18:57] — Ejaculation frequency and risk
• [21:50] — Testosterone therapy and cancer risk
• [25:35] — Modern PSA screening recommendations
• [36:33] — Biomarker and MRI testing in diagnosis
• [44:53] — Active surveillance for low-grade cancer
• [58:29] — Comparing surgery and radiation
• [65:17] — Managing expectations on side effects
• [80:56] — Financial incentives & seeking second opinions
• [85:45] — Testicular cancer exam and detection
• [88:41] — Imaging and “incidentalomas” in kidney cancer
• [91:49] — Pitfalls of whole-body scans
• [97:44] — Volunteering, global health perspectives

Additional Touchpoints

• Orgasm/Ejaculation after Prostatectomy:
  Men won’t ejaculate after surgery but can still have orgasms; loss may be psychologically impactful for some. [75:56]
• Climacturia:
  Urinary leakage with orgasm after prostatectomy—affects up to 10-20% of men [79:59].
• PSMA PET & Theranostics:
  New imaging and targeted therapy are in development [99:21], but most are not yet standard.

Main Takeaways for Listeners

• Focus on proven lifestyle changes (exercise, diet) over supplements for prevention.
• Supplements like vitamin E and selenium have been shown not to prevent and may harm prostate health.
• Most low-grade prostate cancers are not life-threatening and can be safely monitored—overtreatment is still common.
• PSA screening saves lives but needs individualization to avoid unnecessary biopsies and treatments.
• Surgery and radiation both work; the most important part is understanding side effects, priorities, and seeking multiple, unbiased opinions.
• Patient empowerment, honest conversations, and skepticism towards “too good to be true” solutions (incl. supplements, screenings, or single-procedure clinics) are essential.
• Broader perspective: Many of medicine's “truths” eventually change—don’t be afraid to ask questions and challenge dogma.

Further Resources

• UCLA Urology
• American Cancer Society: Prostate Cancer Info
• Prostate Cancer Foundation: Resources and Guidelines

For the full episode, search "Rena Malik, MD Podcast" and look for "Do Supplements Like Selenium and Vitamin E Help or Harm Prostate Health?"