Dr. Michael Lutz welcomes Dr. Craig Rogers to On Call for Men’s Health for a conversation about prostate cancer detection, access, and how the field has changed. Dr. Rogers is chair of the Department of Urology at the Vattikuti Urology Institute at Henry Ford Health, and his work is personal. Family experiences with kidney cancer and prostate cancer helped lead him toward urologic oncology, even before he fully understood what urologists did.
The conversation starts with service and community. Dr. Rogers talks about his time in Japan, first as a student and later as a missionary, and how that shaped his ability to listen, serve, and stay with difficult work. He connects that same mindset to men’s health outreach in Detroit. Screening events in churches, mobile health efforts, and programs like Stand Up for Men’s Health help bring care to men who may not otherwise seek it out.
A major theme is that PSA screening is not the problem by itself. A PSA test is information. The real issue is how physicians use that information. Years ago, an elevated PSA often led straight to a random biopsy. Today, doctors have better tools, including PSA velocity, PSA density, age specific PSA, blood and urine biomarkers, MRI, micro ultrasound, targeted biopsy, and transperineal biopsy. These tools can help reduce unnecessary biopsies while improving the chance of finding clinically significant cancer.
Dr. Rogers also explains how prostate cancer care has become more individualized. Some cancers can be watched through active surveillance, but that approach can create anxiety for patients. He says peace of mind is also part of quality of life. Some men are comfortable monitoring the disease. Others may need more support or a different path.
The episode also covers the need to shorten the timeline from abnormal PSA to answers. Dr. Rogers compares the current prostate cancer pathway to breast cancer care, where abnormal imaging often leads to a quicker diagnosis. He believes prostate care can improve through better logistics, better testing, and more consistent standards.
The second half of the conversation turns personal. Dr. Rogers shares his own health wake up call after collapsing during a 5K, which led him back to fitness, biking, and marathon running. He also talks about mentorship, faith, innovation, family, music, and legacy. His goal is to be remembered as a physician who was open minded, innovative, committed to patients, and invested in the next generation.
(00:00) Intro
(02:00) A personal connection to kidney and prostate cancer
(03:54) Patient gratitude and the gift of time
(05:01) How Japan and missionary work shaped his career
(09:26) Democratizing PSA screening and access
(11:49) The controversy around population based screening
(14:26) How biopsy decisions have changed
(16:11) Micro ultrasound and prostate MRI
(21:09) Using better tools in the PSA grey area
(23:40) Helping men after a prostate cancer diagnosis
(25:43) Active surveillance and peace of mind
(30:45) Standardizing prostate cancer care
(34:24) Dr. Rogers’ personal health wake up call
(37:43) Qualifying for the Boston Marathon
(40:54) Mentoring residents through fishing
(41:54) Innovation, discovery, and Dr. Patrick Walsh
(45:42) Paying mentorship forward
(47:07) Faith, medicine, and service
(49:55) Legacy, ownership, and patient care
On Call for Mens Health - Dr Craig Rogers - PSA on PSA Version
Speakers: Dr. Michael Lutz & Dr. Craig Rogers
[Music Playing]
Dr. Michael Lutz (00:08):
Welcome to the On Call for Men's Health, a PSA on PSA, and I'm Dr. Michael Lutz. After decades in urology, I've seen how a single blood test, a difficult conversation, or the right next step can change the course of a man's life.
And if there's one thing I've learned, is that prostate cancer detection is not as simple as one test or one number. It requires judgement, context, communication, and increasingly better tools to help us make better decisions.
In this limited series, I'll be joined by colleagues and leaders in men's health for honest conversations about how we can improve prostate cancer detection, from access and awareness, to emerging technologies in the future of testing.
So, consider this our PSA on PSA, a public service announcement about what physicians, patients, and communities need to know now. This is On Call for Men's Health.
And I'd like to take a moment here to welcome Dr. Craig Rogers. Dr. Rogers is an individual who attended Stanford University School of Medicine (one of my absolute favorite colleges and medical schools), did his urology residency at Johns Hopkins, and then a urology fellowship at the National Cancer Institute in Urologic Oncology.
He's presently the chair of the Department of Urology in the Vattikuti Urology Institute at Henry Ford Health in Detroit, Michigan, and now, proudly a board member of the Michigan Men's Health Foundation.
Craig, welcome.
Dr. Craig Rogers (01:40):
Thank you, Michael. It's an honor to be here.
Dr. Michael Lutz (01:42):
Oh, it's an honor to have you. One of the things about you is that you're a dedicated physician and you talked about how sometimes being a dedicated physician is oftentimes very personal. So, what kind of issues in your family or personal life led you to become an expert in kidney and prostate cancer?
Dr. Craig Rogers (02:00):
So, these are diseases that affect me personally. I've had family members with prostate cancer, and I've also had family members with kidney cancer, both diseases that I treat now.
Interestingly, at the time when I was a teenager driving my mom to the Mayo Clinic for advanced treatments for a very advanced kidney cancer, I had no idea what a urologist was. And when my grandparents, grandfathers, had prostate cancer, and I would hear a little bit about treatment, really didn't know anything. I didn't know that a urologist was the person that treated that.
I knew I was going to be a physician. I knew I wanted to be a surgeon. No one in my family's a physician, but I just knew that that was my passion. But I didn't make that connection that the type of physician that treats those diseases as a urologist until I was in medical school, almost halfway through medical school, and I was going through my surgical rotations at Stanford shopping around, "What kind of surgeon am I going to be?"
And this intern in surgery came up to me one day and said, "I just finished a urology elective and it's amazing. You really should look into that." So, I tried it and I'm like, "Oh my gosh, this is the very type of disease that affected my family, and this is the type of surgeon I want to be because it's dealing with diseases that are so impactful, so common in men, of prostate cancer."
So, I'm thrilled that my journey led me to a way that I could deal with diseases that are so personal to me.
Dr. Michael Lutz (03:46):
Well, there's nothing like notes of gratitude from patients and their families, and you've actually talked about that. How does that affect you on a daily basis?
Dr. Craig Rogers (03:54):
These notes just give me perspective. I have a bulletin board in my office, and I will pin up the selected notes from patients where they would talk about a connection that was made between us, and gratitude of having their lives back. Or the one that really gets me is when they talk about the gift of time that they were given, and I just feel such a privilege to have been a part of their care.
So, when I walk by that every day and I can look at, especially if you've got a day that's just a tough day in the OR, a tough day, whatever, administratively, and you can look at that and get perspective of what this is all about, why we do this, and get that passion for why we became doctors.
Dr. Michael Lutz (04:45):
Earlier in your life, you lived in Japan as a high school student. It had to impact your life in so many ways. And then later on, you served as a missionary. Can you share a little bit about what it's like to be a missionary and how that prepared you to become a physician and caregiver?
Dr. Craig Rogers (05:01):
So, my experience in Japan really just shaped my life at an early age. When I was there as an exchange student, I lived with my host family, he was an orthopedic surgeon. That was one of my first glimpses of medicine.
I got to go into the OR with him, and I tried to learn Japanese, although my host family all spoke English and they would scold me when I would be studying and they're like, "You don't need to learn Japanese, you're just here to have fun." But I tried to learn anyway.
And then when I made a decision to do some volunteer service as a missionary, you put in an application, you don't get a pick where you go, but they do ask on the application, "Do you speak any languages?" So, I said, "Well, a little bit of Japanese." I didn't know if I would go there, but I was so thrilled when I got assigned to Japan, and I was in the Kyoto and Kobe area.
So, two years there, and it's kind of sink or swim. You're paired with somebody that has been there a while, they know the language, and you're just total immersion, and learning that language but also a perspective. I had grown up in a small town in Iowa. That was my first time out of the US and a perspective of just different ways that people do things and think.
And it was just such a welcoming culture, and that just such gracious people there, I really fell in love with the country. My favorite foods are Japanese, just from living there, but (it) really shaped me also coming out of that experience.
I had taken one year of college and sort of a sabbatical and then came back, and just a renewed desire to do the best that I could coming out of that to go into medicine. So, really formative years of my life.
And also, you get used to sort of rejection, I guess, because you're there. I was there as a missionary, but you're doing public service, which just going out in the community serving. So, there's a proselyting aspect, but there's also just a general service aspect, and serving those people, but also you'd have people that would have no interest and they'd say, "No, thank you, " and you move on.
It's really just- people seek you out if they had interest in what you're doing, but you have to get used to just sticking with something, learning a language, persevering, and being willing to see the best in everything and in everyone and move on, and find joy in different aspects of the journey. And so, that really helped give me perspective in the tough years of medical school and residency.
Dr. Michael Lutz (07:49):
Well, it's obvious you like to work in the community, and we've spoken many times of how you want to care for the men's health community. How do you see your role in fulfilling this opportunity?
Dr. Craig Rogers (07:59):
I think there's a responsibility. These are things that we treat and there are many people out there that need information that they may not have the information they need to make decisions about their own health, and there's a responsibility we have.
And I look to you as a model of all you've done with the Michigan Men's Health Foundation, and I've been thrilled that we've been able to partner together. When I think of participating in the men's health event that you do every year, what an amazing service that provides to the community, your mobile health mission, and just out of the box ways that we partner together.
I really love that recent event we did at the Comedy Club, “Stand Up for Men's Health,” a way to find men where they're at, to find ways where they can in a relaxed, comfortable situation, learn more about their own health and be inspired to say, "Hey, I'm going to go get tested, do what I can to improve my health." So, I really enjoy being part of those events and partnering with you on those.
Dr. Michael Lutz (09:07):
Well, we enjoy working with you, and trying to serve communities that are underrepresented is always a challenge to engage and get them involved. And the key statement that we would say is, how do we democratize this? How do you envision that we can actually democratize screening for underserved or underrepresented communities?
Dr. Craig Rogers (09:26):
Well, access is one thing. So, we've done some PSA screening events in our own department going into the different churches, and I think your foundation has definitely been an amazing example of that, going out to the communities, educating, getting testing for them, and this is a free service that people can get.
And then once that's done, encouraging them if necessary to see a specialist, to get to see a professional in that area if something's identified. So, really a privilege to be able to partner and be involved. This is the community we serve as physicians. So, you look at the community, I'm a physician in the Detroit community and there's a need in that community. This is our obligation to help them.
Dr. Michael Lutz (10:17):
Do you think we need to kind of reassess how we engage or create awareness?
Dr. Craig Rogers (10:22):
Yeah, I think it's easy to live in sort of a bubble of medicine, especially, I'm dealing with very complex surgeries in a very tertiary, quaternary center with specialist referrals. And yet it's refreshing to be able to take a step back and say, "Look, let's go all the way to the beginning of this journey. There are people that aren't even getting tested, that don't even have the information to make a decision yet."
And to be able to be a part of that, to stand up and say, "Hey, this is important to us, we're committed as an individual physician, as a department, as a foundation, as a group, as a group of physicians."
It was refreshing at that comedy club event that we did, “Stand Up for Men's Health,” that there were so many physicians from different health systems that, theoretically, could be competitors and yet they were united for a common cause to come together to help the community to raise awareness. And I think that's what's needed, a collective sort of agnostic approach to doing this.
Dr. Michael Lutz (11:29):
Because the community is whole. It's not divided into healthcare systems.
Recently, there's been some controversy regarding population-based prostate cancer screening. How can we do better, and how can we change that message to be more important and more relevant?
Dr. Craig Rogers (11:49):
Now, by controversy, are you meaning like the US Preventative Task Force, or dialing back who gets-
Dr. Michael Lutz (11:55):
They talk about versus patient-directed. When we go out into a general population, we just screen a mass population of men. There's a concern that maybe that doesn't really change the needle in prostate cancer detection, and maybe we're over-screening an unneeded population. Do you think that there's a way that we can address its value and in other directions?
Dr. Craig Rogers (12:16):
Yeah, I mean, I think back to controversies about just screening in general that we dealt with years ago, and they came from, I think, good intentions initially, of concerns of overdiagnosis and overtreatment that would potentially bring side effects that might not change survival if treatment was done in men with very low risk cancer- that might not have affected their lifespan.
But I think what's changed or what I've seen evolve over time is that the PSA test, the screening in and of itself brings no innate harm to a patient. That's just information. It's what you do with that information once it's done.
Now, if everybody with an elevated PSA goes on and gets a biopsy and gets a prostatectomy or something, that's definitely overtreatment, over diagnosis, but now times have changed. We have now identified a group of men that can be safely followed, and you know they have cancer and it's almost like a chronic disease that is just followed safely, and still that information lets them know that makes them aware of their health.
We have targeted ways of doing things like imaging and better ways of doing biopsies now. It's not just a whole gland treatment. There's even areas of focal therapy that are out there that can ... the menu of options that are open for patients now is greatly expanded and there are less invasive treatments out there.
So, I think now it's okay to have someone at least get a baseline testing if it's at the appropriate age group, and then give them the information to make decisions to move forward. So, I don't have a concern with the population-based screening as long as the information that comes from that is being used responsibly.
Dr. Michael Lutz (14:08):
I agree so much. When I first went into practice, it was a knee-jerk reaction to an elevated PSA to go ahead and get a biopsy. How has your thinking, say, over the years changed with regards to biopsy, when to monitor, or when to order additional tests?
Dr. Craig Rogers (14:26):
Yeah. I mean, we used to train in the era of your PSA is over four, and that's like a magic number, and now you have to go get a biopsy. And the biopsy was what we called a random biopsy, which you just put needles in, and you hope you hit something.
And wow, how times have changed now, how there are better tests out there, which you've introduced today. There are so many nuances to the PSA test and ways that you can look at PSA velocity, and PSA density, and age-specific PSA, and different types of blood and urine tests and tests that are out there to hopefully increase the information and accuracy of the information that you can get to guide that patient to say, "Alright, do I need to take this to the next level? Do I need a biopsy?"
There's imaging as well. You can get an MRI of the prostate where you can actually see clinically significant cancers. Then you know where to aim when you're doing a biopsy. It's no longer a random biopsy. You can actually pinpoint specific areas.
The biopsy itself has improved. What used to be called the transrectal approach, we now have to reduce infection risk, options for transperineal biopsies, biopsies now that can be done under sedation to enhance the targeting.
So, I think the whole journey has improved, the testing, the biopsy itself, and then the downstream management options for those patients once the biopsy is done.
Dr. Michael Lutz (16:03):
I see you've also added micro-ultrasound to your armamentarium. How does that compare to multiparametric or bi-parametric MRI?
Dr. Craig Rogers (16:11):
Yeah. So, we added that thanks to a generous contribution from a grateful patient who knew a lot about prostate cancer and recognized that there are … although the prostate MRI has really emerged as an important part of our diagnostic pathway, there are some people who can't get an MRI.
Maybe they have a pacemaker or they're just claustrophobic, and they can't do an MRI. And so, we were trying to decide what can we offer for those patients? And then we learned more about this technology called micro-ultrasound, which is a much more powerful ultrasound, a higher resolution.
So, the ultrasounds that we use for a biopsy, low frequency, lower resolution, you're just trying to see the outline of the prostate so you know the needle's going into the prostate, but this resolution with micro-ultrasound, is hundreds of times more powerful to the point where it even rivals the accuracy of an MRI. And there are even head-to-head reports that have shown that micro-ultrasound and experienced hands can give similar diagnostic information as an MRI.
So, if I have a patient that has an MRI, let's say I'm suspicious based on a rising PSA and other testing that they may need something and I get an MRI, but that is negative, and you can have a false negative MRI in roughly 15% of the time.
So, maybe I suspect that the MRI might've missed a clinically significant cancer and I'm going to do a biopsy anyway. Well, I would do that biopsy with micro ultrasound because I may actually pick up things on micro-ultrasound that the MRI missed, and then I'm right there and I can guide the biopsy accordingly.
Dr. Michael Lutz (18:06):
These advances in imaging technologies are incredible, but in parallel over the last 10 years, there've been significant advances in liquid biopsy technology. How have you applied those to your clinical everyday practice?
Dr. Craig Rogers (18:21):
And it's interesting the patients know about these. Patients will come in and ask, "Are you going to get this test or this test?" And we have several different blood tests that are out there and they'll know it by name and they'll ask, "Are you going to order this one?" And if a patient comes in and has heard about this and has done their reading about it, sure, we will offer that and say, "Yeah, this is one of several tests and we can offer that for you."
And I'll let them know that many of these tests may be based on the PSA and the free PSA, and the PSA density, which are sort of a given. We all get that if we're getting an MRI and we're getting a PSA and a free PSA, but I'm like, "If you want more than that, we can order this other test."
And then the urine tests that are out there, which many of these tests can actually now just be sent to the patient's home. So, I can put an order in and the patient just gets a package at home and they pee in a cup and send it back with a label on it, and then in a few weeks, I get those results back.
So, they don't even all have to come into the hospital anymore and to the clinic. And what is this doing for the digital rectal exam? This is another area of controversy where I used to get calls from primary care physicians, a few, and they would say, "Hey, I'm worried about this doctor, this urologist, because I sent my patient and they didn't do a rectal exam. What kind of urologist is that?"
And I would look into it for them and I'd look at the visit, and I'd see that they ordered multiple tests, and they got an MRI of the prostate, and I said, "Look, that MRI of the prostate is giving way more information of the entire prostate, the parts that I could never touch with my finger, the backside."
If I know I'm getting an MRI, then I will explain to that patient, "Hey, I am fine with doing a digital rectal exam if you want me to, but I can spare you the discomfort and torture if you've decided you're going to get a prostate MRI."
And so, anyway, this whole paradigm of what we do, and I think that has relaxed some men where that used to be one of the biggest hangups of going to see the doctor like, "Oh, it's so embarrassing, it's uncomfortable."
Well, maybe the Super Bowl commercial, the last Super Bowl that came out, "relax your tight end," which cracked me up where it was essentially saying, "It's just a blood test, that's all you need. And hopefully, that will get more people to come out."
Dr. Michael Lutz (20:57):
And that's what we need. So, what role do you think these new biomarkers, advanced imaging technologies play in helping you make a better, more confident individualized decision?
Dr. Craig Rogers (21:09):
It helps with that grey area. You can get a test, and there are all these false negatives with an elevated PSA. Have they had sexual activity within the last 48 hours? Did they ride a bike recently? Is there something that you can blame that's not cancer that may be muddying the waters here?
And so, now you have tests that add a greater specificity to this whereas you're more likely to know, "Hey, I'm more suspicious this is cancer based on these follow-up tests that we got." And so, then you're doing actually fewer prostate biopsies, but when you do them, you're more likely to detect the cancers that you need to find.
Dr. Michael Lutz (21:50):
If a younger urologist or perhaps one of the residents with whom you teach asks you how you talk to patients about uncertainties in prostate cancer detection, what advice would you give them? How do you talk to patients?
Dr. Craig Rogers (22:02):
Yeah, I mean, so I've told patients … look, I have some patients that just want to get a PSA every three months and they're fixated on the PSA and it may go up a few tenths of a point and down a few tenths of a point, and I'll tell them, "Look, we can get a PSA until we're blue in the face here, but it is not going to answer the definitive question of, am I at risk? Do I have cancer?"
And I'm like, "So, that definitive answer is going to be through a biopsy, but we don't all want to go get a biopsy. So, are there intermediary steps between just a PSA and a biopsy that will help clarify who needs to go that route?"
And that's where these advanced blood tests, urine tests, imaging with an MRI, exact view, even a diagnostic exact view can all lend clarity, especially when that patient is struggling with, "What am I going to do?" Because there's always going to be some degree of uncertainty, and you have to assess that patient's willingness to accept uncertainty.
Some patients are like, "I'm just going to ride this out for a while. I'm glad I have a baseline, I'm not ready to go down this route." And I can say, "Look, this is their decision ultimately. We're just here to provide information." But I feel like I'm giving better information to say, "Hey, I am a little worried about you. It may be time to start thinking about getting more testing here."
Dr. Michael Lutz (23:31):
And once a man is diagnosed with prostate cancer, they're going to look to you. They're going to look to you for the next steps. How do you approach that conversation?
Dr. Craig Rogers (23:40):
So, I'll do a biopsy and they usually come back to see me within one to two weeks when the biopsy results are back. And now, these patients can access their own records, and you can always tell who's gone on MyChart and has seen their biopsy the day before.
You come in and they're usually there with a significant other spouse and there's that anxiety, either, "I don't know yet, what is he going to say to me? " Or, "I just read it and I saw the word cancer, but I don't know what that means."
And so, the first I think duty or obligation we have is to reassure them to say, "Look, you had a biopsy. The whole purpose was to make sure you didn't have something that could potentially cause harm. We have now found information that's necessary that you can use to make a decision to help you move forward."
And if they're found to have cancer, it's usually a reassurance that, "Hey, we've got this. You found it out, this is very curable. In some cases, it doesn't even need to be cured. This is something we can monitor and you're going to be okay, and here are some options and let's walk through it together."
So, to establish a partnership, get them relaxed to let them know that there are options because this is doom and gloom, right? "Oh, the C word, I have cancer."
Dr. Michael Lutz (25:11):
And that active surveillance conversation is sometimes even more difficult than a treatment conversation because in the United States, we believe if you have a cancer, it gets treated. Again, it's that reflex. And also, there's an association of anxiety and depression that not only comes with the prostate cancer diagnosis, but even more so with men who are managed on active surveillance.
So, my question is, do you think there's a role for psychological evaluation and assessment of patients once they're diagnosed with their prostate cancer?
Dr. Craig Rogers (25:43):
Yeah, that's a good point. There definitely is a psychological component to this. If you think about what is the goal of active surveillance, it's all about quality of life where you have people that value their erections and their continence, and they want to avoid the side effects of treatment, so they're willing to accept a degree of uncertainty to preserve that functional outcome.
Well, peace of mind is also a quality of life metric, and you have to do an assessment. I mean, I'm no psychologist by any means, but you can tell in a conversation when I can talk to them all about how safe, active surveillance is with their one core of focal microscopic Gleason six cancer, that the likelihood of dying of this is so extremely low.
And if you had to have cancer, this is the one you would want to have because you've essentially already beat it because it's not going to kill you. And yet you can see that there are occasionally patients that you know that they are going to perseverate about this, and it's more of a personality issue. And to them, they are going to achieve no peace of mind until there is treatment.
So, for them, I'm thinking, well, I would ordinarily not offer treatment. I would say, look, this is not something we would treat. There are rare occasions where a patient will say," I get it, I totally understand. But for me, the only way I am going to have that peace of mind is to treat it."
And so, it does make me wonder, could that patient benefit from other counselling, other patients, people to give ... I'll tell them that, look, active surveillance, we tell patients that if we follow someone on active surveillance long enough, a certain percentage are going to eventually go on to get treatment.
Either they just got tired of following it or they had progression on a biopsy. And I tell them, I don't view that as a failure of active surveillance, I actually view it as a success- that over two thirds of patients avoided treatment entirely, and roughly the third that progressed, they are able to go on to get treatment with the same cure rate as if they had had it before.
If you're following it well, it just delayed those side effects. And so, I'll try to get that message to everyone. And some people will gravitate to that and be like, "Oh, that's awesome. I don't have to make a decision right now; I can punt the football." And others are like, " No, that's not for me."
And so, to your point, I think having a more structured, organized way that I could refer them to someone would be a great service.
Dr. Michael Lutz (28:26):
What do you think we can do to improve our prostate cancer pathways such as genetic testing or in a holistic men's health clinic? Are there things that we can do to actually step up and improve the pathway for patients?
Dr. Craig Rogers (28:40):
I mean, one just logistical thing of the pathway is (and we're working on this) at a time where access and healthcare is challenging, just trying to approach this with a shortened timeline between an abnormal PSA, that referral, to how long it actually takes to go through all these steps and get someone to where they have a definitive answer.
If you think about a woman with breast cancer that gets a mammogram and there's an abnormal finding, that's usually a matter of a week or two where it's all done. You've got the test, you've got the biopsy, you've got the results.
So, one part of the pathway is how can we streamline it so there aren't as many steps in between of deciding we'll do this test, this test, this test, we'll get imaging, now we'll do a biopsy, and it's going to be a few weeks, and you've got to wait to get in? So, we're working on the logistical part. But I think adding in these other tests to the pathway also offers a greater accuracy, peace of mind, help with those patients in making a decision.
I think these tests now are beginning to almost be used as a litmus test even by physicians and the public because they're savvy. They know about these, and they're like, "Oh, does my urologist offer this test? Oh, they don't even know about it. They don't offer it? Maybe this urologist isn't current. Oh, they're not doing imaging? They don't do targeted biopsies? They don't do transperineal biopsies."
I'm surprised at how many patients will come in with their list of questions, whether they got it from AI or what, but they're viewing this as a quality control for their surgeon, for their practice.
Dr. Michael Lutz (30:25):
And I think that's good on patients.
Dr. Craig Rogers (30:27):
Yeah, absolutely.
Dr. Michael Lutz (30:27):
And that's the way it should be.
Dr. Craig Rogers (30:30):
Yeah.
Dr. Michael Lutz (30:31):
So, this is my second opinion segment. What is one thing in prostate cancer care you believe we need to rethink? Anything from how we screen or how we communicate risk, or how we guide men through the next step following an elevated PSA?
Dr. Craig Rogers (30:45):
Well, I mean, all the things I just mentioned of these different technologies out there, there's a lot of variability in our field. So, there's a quality improvement collaborative in Michigan called Music where different physicians from all over the state get together. And what's striking when different physicians get together and compare how they do things is the variability in how many people offer these different tests, how many people do different ways of doing a biopsy, different ways they counsel patients.
So, on part of this is just trying to standardize our message at a space that's so busy right now. There are so many different ways or new diagnostic tools that are coming out, and there isn't just one clear cut, randomized control, pole position, this one is the distinct leader.
Everyone's trying to do what they think is going to offer the best treatment for their patient, but it means we have to communicate and as one test, as different tests start to seem to offer more of an advantage to share that with the different physicians, but also with the patients. So, part of this is standardization, I think will help.
Dr. Michael Lutz (32:00):
Previously we spoke about how your personal life exemplifies your commitment to care. And I know that besides the Michigan Men's Health Foundation, one of your favorite charities is the American Cancer Society. What service does ACS provide that uniquely garners your support?
Dr. Craig Rogers (32:17):
Many people, when they go online, when they're Googling for help, they've been diagnosed with cancer that many of them end up getting information from the American Cancer Society. And so, that may give them knowledge of what age range is appropriate for screening, what options are out there.
And this isn't just for prostate cancer, but for many different types of cancers. I think of this one of the reasons I joined with the American Cancer Society (and I'm running the New York Marathon this fall with them with their team). A very personal story, but we had a family acquaintance where he really got into running, and at a time where he had developed obesity and other medical issues, and really committed to health and he lost all this weight, and really had a dream to run his first marathon.
And he got into the New York Marathon lottery, which is almost impossible to do, but he managed to get in. And then he was diagnosed with high-risk advanced prostate cancer, and had to go under treatment. And he was allowed to defer till the next year. And unfortunately, that disease for him progressed and he lost his life.
And now, I think this was a race that he never got to run, and to think that I can run it in honor of someone that died of prostate cancer that wanted to do that run, and for a charity that commits themselves to helping to educate men like him to encourage people to get tested and to get information when they do get testing.
And our goal is that there won't be situations like that where someone finds in an advanced stage and dies of cancer that we can pick these up early and prevent those people from dying of cancer.
Dr. Michael Lutz (34:13):
To run in honor of somebody is truly the ultimate honor, and so I give you God speed on that.
Dr. Craig Rogers (34:19):
Thank you.
Dr. Michael Lutz (34:19):
What was your health wake-up call, which happened about 15 years ago?
Dr. Craig Rogers (34:24):
So, in my late 30s, I was a busy clinician. I was convinced that I had all these responsibilities and surgery and clinic, and I let myself go and get into this pattern of behaviors where I wasn't eating right, I wasn't sleeping, I wasn't getting the right amount of sleep. Stress levels just had all built up over this slow, cumulative, years and years of increasing practice responsibilities that I didn't even know it was happening.
And my friends, I have some friends outside of medicine called me and said, "Hey, we're doing a 5k on Saturday. Why don't you come join us?" Now, I knew that these guys had been jogging together in the morning over the summer. And I used to run in high school and ran a marathon in college, and at one point, I was more fit and just didn't really hit me how much I had fallen until it was a perfect storm of events- where I had been on call that week.
So, I'd been really busy, hadn't eaten appropriately the day of the race, hadn't hydrated. It was something like 88 degrees outside, and I start running with this group and I feel myself getting more and more winded.
But then as I was running along and I realized, "Gosh, I'm really tired, I fell back a little bit." Then I see this kids yelling at me, "Hey, there's only a quarter mile to go." And I'm thinking a quarter mile, well, that's just one lap, I'm going to sprint. I'm hurting, I just want to be done." And so, I sprint for the end.
Well, the next thing I know I'm blacked out at the finish line, and I hear an ambulance siren coming and I'm taken to the emergency room, and I was probably in severe heat exhaustion, dehydration. My wife just rolls her eyes at me, is like that look of "You idiot, what is wrong with you?"
And I remember being in that ambulance as I threw up the three bean salad that I had had in the hospital cafeteria two hours earlier, and I'm like, " Gosh, this could be the end. What an idiot I am. I haven't been taking care of myself." And I decided right then and there that that was never going to happen again.
I didn't have the time not to do that. And right around that time, another friend called me from college and said, "Hey, we're doing this big bike ride in about six months, can you join us?" Well, I got a bike. I didn't own one, and it was a way that even being about 60 pounds overweight, I could lose weight, and the pounds fell, and that allowed me to run more, and then I got into marathon running, and now it's a part of my health that is very valuable to me.
And not only do you feel better, but just I feel more connected with my patients. How can I take care of a patient if I'm not taking care of myself? So, it was a wake-up call.
Dr. Michael Lutz (37:34):
Well, one of the things is impressive for me is the fact you qualified for the Boston Marathon. What was your time that you used to qualify?
Dr. Craig Rogers (37:43):
So, Michael, the secret to qualifying for the Boston Marathon isn't necessarily to get faster, it's just you’ve got to get older, because they spot you more time. And so, I was looking at all these qualifying times and I would run a marathon and I'd miss it by like two or three minutes, and I'm like, darn it, how am I going to do this? And then I'm like, wait, when you turn 45, they give you 10 more minutes. It's now or never!
And so, I just trained like crazy, and ran the Detroit Marathon, again, with a charity and sort of a team event where we did it together. That definitely helped me. And then I qualified for Boston, and so it was a family affair. The whole family comes out to Boston, and we're like a mile to go, and right outside the baseball stadium. And I see my family, my wife's holding this sign that says "Boston Marathon bucket list" and it has a check on it.
And so, I run in, and it was a perfect day, I ran a really good race, and I look at my time and I'm like, huh, I just qualified for Boston again. This is probably not the time to tell my wife that it's not a one and done. But then about a month later, I'm like, "Yeah, I think I might actually run it again." She's like, "Well, that's good, you're on your own on this one."
But I kept doing it. It just kept being a goal, it was fun to run. It's fun to be with other people. I really enjoy running as a way … like we have a community run group where I can run with people that aren't in medicine. I mean, I jogged this morning with a group in my neighborhood, and they're talking about taxes and finances and this and that.
And every once in a while, a medical question will come up. So, while we're running, they're like, "Well, Dr. Rogers, what do you think about this?" And you can tell that this is on everybody's mind. And so, then I can talk about screening. And so, it makes me realize these community events make a difference. People are thinking about it.
Dr. Michael Lutz (39:41):
It brings people together. Most people, including myself, believe that running is not just physical exercise. It's a chance to mentally reflect, organize your thoughts. Of all your hobbies: running, biking, fishing, what gives you your greatest sense of inner peace?
Dr. Craig Rogers (39:57):
Oh, that's the problem, I have too many hobbies. But I definitely like it when you're in the groove of running that monotonous pace where you can think. I love when I'm biking, being able to see nature when I'm ... I'll bike to work some days. From where I live, it's about 20, 25 miles.
And when I'm going early in the morning and you see a deer or a turkey on the road or something, I just feel connected with nature. And fishing, I've always loved to fish. I take our chief residents on a fishing charter each year, and that's just fun. That's something I grew up with. So, a lot of different ways to connect.
Dr. Michael Lutz (40:39):
So, when you take your residents, I think that's an amazing story because not many chairmen are that connected to the residents, and you take them on a fishing trip. So, just out of curiosity, do you have a favorite conversation or moment you can share? (Chuckles).
Dr. Craig Rogers (40:54):
Well, so look, I have ulterior motives here. It's a fishing trip, but they're also prisoner on a boat and they can't escape. So, I can indoctrinate them at the beginning of the year on the values of a good physician and a good doctor and what's expected and how they're going to be successful.
Look, it's not all just business talk, but it's a way in a casual conversation that you can point out things that are going to help them be successful in this year as a resident, as a physician. So, these trips are special, they're a lot of fun.
Not everybody's into fishing. And it doesn't matter if we catch a fish or if we don't catch a fish. Any day on the water, it's a beautiful day. If you catch fish, it's icing on the cake.
Dr. Michael Lutz (41:42):
It's been oftentimes said that ordinary people can do extraordinary things, and I don't think you're ordinary. So, I just want to know what makes you strive to perform the extraordinary?
Dr. Craig Rogers (41:54):
I have had very good mentors that have inspired me to do the same. I mean, I think back, I had a very good mentor when I was a resident at Johns Hopkins, the chair of the department at the time, Dr. Patrick Walsh, has a book on prostate cancer, had dedicated his whole life to this disease, was one of the most prominent surgeons, and was passionate about excellence and discovery.
And he would get others, just would develop a fire in their belly to do the same of this passion for discovery. He used to tell us — because he had discovered things like the nerves of erection and how to adapt the surgery to help do nerve sparing. And many of the techniques we do even today are based on his work.
And one saying that he hit home to me was, "We make important discoveries by working on important problems." And many of those problems that we seek to solve come from listening to our patients. When a patient just asks you a question and you got to think back, or a resident, "Well, why do we do that?" Yeah, the resident's asking why we do that.
And so, then you can start to think out of the box, and say, "Well, can I find this answer? Can I do something differently?" And then he would say that when you do innovation and discovery to those that sail uncharted waters, comes the responsibility to make those charts.
So, it was really indoctrinated in me early that we have a duty, we have a responsibility where much is given, much is required. And sure, we can just go along and just do everything the way we've always done it, or we can continue to think of how can we do things better, and how can we message that to our patients? How can we teach each other in the field and always improve?
I mean, even at that time where I was at a center of discovery, changes were occurring about halfway through my residency, where I was learning open prostatectomy, which at the time was at the premier place of open. And I started hearing rumors, this buzz as a resident about this thing called robotic surgery. And I started hearing about Michigan and Henry Ford.
And I remember the team came to Hopkins to demonstrate a robotic surgery. And now, you would think this would be a warm homecoming of the team coming back to demonstrate this, and yet even then, you could see skepticism, comments like, "Oh, I don't think this is going anywhere."
And this isn't a knock on Hopkins. I learned so much there and I have so much respect, but you realize that people can do one thing and get set in their ways, and you can lose the ability to think out of the box. And even now, we're trying to do different ways of doing nerve sparing and approaching the surgery differently. And occasionally, I'll have physicians now that had to deal with those sceptics when robotics was starting, and now, I'm like, "Hey, have you become that same person? Are you able to think out of the box to always try to be innovative?"
I feel like I've been blessed to be around people in my life that inspired me to continue to think out of the box to embrace discovery and innovation.
Dr. Michael Lutz (45:28):
And there's no question Dr. Patrick Walsh at Johns Hopkins has truly impacted and guided your career. Has this also impacted your personal life?
Dr. Craig Rogers (45:37):
You mean what I do as a physician, or-
Dr. Michael Lutz (45:41):
Some of his guidance.
Dr. Craig Rogers (45:42):
Oh yeah, absolutely. He would take time off, even his vacation time, he was so passionate about this- where he would watch himself do videos and he would record how to do things better. Now, I try to make sure I'm balancing the personal life of my own personal health, but also devoting time to my patients, but also just this idea of mentorship.
I try to take time. I think of people who have mentored me in my life like Dr. Walsh, and that was a conscious decision that he's like, "Well, I'm going to invest in leaders of tomorrow, and I feel a need in my own personal life to pay that forward. How can I be a mentor to someone else? How can I take time?"
Even if it's taken somebody fishing, investing time in maybe a junior resident or a time with someone who is trying to get into residency and is doing a research fellowship. These are times where you can work with them and say, "Hey, this is where your future could go" and help guide them and mentor them.
So, in my own personal life, just having had so many mentors that have guided me, it's made me realize the importance of paying that forward.
Dr. Michael Lutz (47:01):
It's really evident that you're also a man of faith. Do you think that's played a role in your career or your personal life?
Dr. Craig Rogers (47:07):
Definitely has. And that's another area actually where Dr. Walsh inspired me. He was very much guided by his personal faith. He viewed medicine as a mission, that people are given talents and abilities and are put in life in different positions, and that there's an expectation of what you've done with that, and an accounting of when you serve other people, you're serving God. And I feel that same idea, that when we're in the service of our fellow human beings, we're serving God, and that I have a duty and obligation to do both.
Dr. Michael Lutz (47:43):
Do you think that's also been impactful on your children and the careers they've chosen?
Dr. Craig Rogers (47:47):
I hope so. I mean, I have three sons and they are great people, and they've all taken ... they're very different people. My oldest is an engineer and you knew from the beginning he was going to be an engineer. He was always tinkering, that is what he loved to do.
My middle son is an accountant, and it was clear early on that he loved numbers and crunching and the analytics, and it's the perfect job for him. And then my youngest son who just graduated from Michigan State is really into public policy, epidemiology, and is going to pursue an MPH. And it brings joy as a parent to just see your children doing things that they love and enjoy that brings them joy.
Dr. Michael Lutz (48:33):
So, when you play piano for the children at church, who enjoys it more? You or the children?
Dr. Craig Rogers (48:38):
Oh, definitely me. I mean, yeah, what an awesome job I get at church where I get to play the piano for these little kids that will make the funniest comments. They're trying to give a little message to the kids, and they'll raise their hand and make some totally irrelevant comment about a new toy they got. And there's just such purity there and enthusiasm and joy.
And I definitely get a lot of just keeping a simple message that I get to be a part of that. So much fun. I get to hide behind the piano and see all this fun stuff they're doing and get their excitement. I have a keyboard in my office, so I have to practice. I'm not a really good pianist. So, I'm like, "Well, I have to play for the songs this Sunday at church." And so, I'll be playing some of them in between.
Nobody else has any idea what I'm playing, but I do. And these are messages that are relaxing, soothing, give you perspective that really help me out day to day. So, I definitely get a lot out of this.
Dr. Michael Lutz (49:41):
There comes a time and each realize when we reflect upon our lives and our purpose, and how we want to be remembered. And I know that you're still way too young to have this thought or go there, but do you have any personal thoughts regarding your own personal legacy?
Dr. Craig Rogers (49:55):
Yeah, I hope I can be viewed as someone that was open-minded and innovative, that was able to make an impact in my field by embracing discovery, but also someone that made a difference to others where they can look to me as a mentor, a teacher and an example. And then from a patient standpoint, that patients will be able to view me as someone that really helped them at a difficult time in their life and was able to be there for them.
I think of things that I'd want to … messages that I really would want to sink into my trainees, and it's the idea of ownership, that we have taken ownership of your patients and attention to detail, and those things make you a more successful doctor person. And hopefully, I would be viewed as someone that did both of those things.
Dr. Michael Lutz (50:54):
And I'm sure you will. I just want to say so much thanks to Dr. Craig Rogers for being our guest and a great conversation, and thank you for joining us. I'm Dr. Michael Lutz, urologist and founder of the Michigan Men's Health Foundation. And it's through our events, our resources, and this podcast we're dedicated to men's health advocacy and awareness.
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We're focused on education, research and the treatment of prostate cancer and men's health related issues. And for more information about the work that we do and how you can get involved, visit us online at www.michiganmenshealthfoundation.org.