WEBVTT 1 00:00:06.160 --> 00:00:08.679 Bill cunning In. The Great American Reds Baseball kicks off 2 00:00:08.759 --> 00:00:12.439 this afternoon about five forty with Eddie and the Rock. 3 00:00:12.800 --> 00:00:14.560 They've won like four or five in a row. They 4 00:00:14.560 --> 00:00:18.199 look unbeatable. They sweep the Ohio Cup as if anyone cares, 5 00:00:18.399 --> 00:00:21.600 but it means three great wins against Cleveland. Tito Francona 6 00:00:21.719 --> 00:00:24.640 loved that because he's the former manager of the Cleveland 7 00:00:24.719 --> 00:00:27.239 then Indians. So we'll see what happens there. But there 8 00:00:27.280 --> 00:00:29.960 was a bombshell dropped over the weekend in which ex 9 00:00:30.039 --> 00:00:34.880 President Joe Biden was diagnosed with stage four metastastic cancer 10 00:00:35.439 --> 00:00:38.200 of the prostate. And for those men over the age 11 00:00:38.240 --> 00:00:40.960 of forty five or fifty, this is a shock because 12 00:00:41.000 --> 00:00:44.200 I had assumed that if you get your PSA done 13 00:00:44.200 --> 00:00:47.439 all the time, and that's an indicator and DRE digital 14 00:00:47.479 --> 00:00:50.759 rectal exam, you're kind of inoculated in a sense. So 15 00:00:51.159 --> 00:00:53.520 we all would like to know as Americans, can we 16 00:00:53.560 --> 00:00:56.119 see the last five to ten year history, when did 17 00:00:56.159 --> 00:00:59.000 the PSA spike? Did it happen during his presidency and 18 00:00:59.079 --> 00:01:02.119 he kept it secreted he was the president until January 19 00:01:02.200 --> 00:01:04.480 of this year, And how bad a shape is it? 20 00:01:04.560 --> 00:01:06.920 So joining you and I now is doctor Stephen Kappa. 21 00:01:07.239 --> 00:01:11.000 He's with the Urology group here in Cincinnati, and doctor Kappa, welcome, 22 00:01:11.040 --> 00:01:13.200 I think for the first time to the Bill Cunningham Show. 23 00:01:13.239 --> 00:01:15.840 And this is something I'm sure you followed over the weekend. 24 00:01:15.920 --> 00:01:18.159 So just give us a general view as to the 25 00:01:18.239 --> 00:01:20.799 medical condition right now of ex President Joe Biden. 26 00:01:22.319 --> 00:01:22.519 Yeah. 27 00:01:22.640 --> 00:01:25.719 No, Bill, I'm thrilled to be here, happy to review 28 00:01:25.799 --> 00:01:28.519 the detail to this case, and really to emphasize to 29 00:01:28.560 --> 00:01:31.040 your listeners, to your men out there, the bottom line 30 00:01:31.079 --> 00:01:33.640 is it's important to get screened, to have these discussions 31 00:01:33.640 --> 00:01:37.319 about prostate cancer and prof stay cancer prevention and screening 32 00:01:37.840 --> 00:01:40.480 early on so you can hopefully avoid you know, this 33 00:01:40.680 --> 00:01:45.040 unfortunate diagnosis that former President Biden received. So yeah, what 34 00:01:45.079 --> 00:01:47.200 we know just and this is just from his personal 35 00:01:47.200 --> 00:01:49.640 office relief, is that he was diagnosed with an aggressive 36 00:01:49.680 --> 00:01:53.280 form of prostate cancer. They mentioned Gleason nine disease or 37 00:01:53.319 --> 00:01:57.079 Great Groups five disease. They mentioned actually also that it 38 00:01:57.159 --> 00:01:59.719 presented with urinary symptoms, and we. 39 00:01:59.719 --> 00:02:00.319 Do see this. 40 00:02:00.480 --> 00:02:04.239 Sometimes prostate cancer is typically silent, it's like you mentioned, 41 00:02:04.680 --> 00:02:09.360 diagnosed with PSA blood tests, but also sometimes with examination. 42 00:02:09.560 --> 00:02:13.360 The statement release indicate that there was a prostate nodule. 43 00:02:13.840 --> 00:02:16.639 That's likely what started the biopsy process, which gives you 44 00:02:16.680 --> 00:02:20.000 the formal diagnosis. And you know what is also unfortunate 45 00:02:20.080 --> 00:02:23.759 in his case, former President Biden's cases, it's metastasized or 46 00:02:23.960 --> 00:02:28.599 spread to the bone. I don't have many details beyond that. Again, 47 00:02:28.639 --> 00:02:31.319 we can go into more discussion about the specifics of 48 00:02:31.599 --> 00:02:34.840 men like him who present with aggressive disease, but that's 49 00:02:34.840 --> 00:02:37.039 what we know so far. It's I don't want to 50 00:02:37.080 --> 00:02:40.599 sugarcoat it's a very serious condition. But I also want 51 00:02:40.599 --> 00:02:43.000 to mention that for men, even like him, who are 52 00:02:43.039 --> 00:02:46.280 diagnosed with advanced prostate cancer, we have very good treatments 53 00:02:46.280 --> 00:02:49.960 that can focus on quality of life and slowing down 54 00:02:50.039 --> 00:02:50.560 the disease. 55 00:02:51.039 --> 00:02:55.039 And doctor Kappa, he's had cancer's polyps removed from his calling, 56 00:02:55.479 --> 00:02:59.400 he's had skin cancer, he's had stroke symptoms. He's elderly. 57 00:03:00.159 --> 00:03:02.759 One doc I saw today said that Biden has about 58 00:03:02.800 --> 00:03:05.680 a thirty percent chance of living five years from this 59 00:03:05.719 --> 00:03:10.080 point on. This is serious, I guess is that accurate 60 00:03:10.120 --> 00:03:12.000 that if you catch it at this level in your 61 00:03:12.039 --> 00:03:14.800 early eighties, your time frame is quite limited? 62 00:03:16.439 --> 00:03:16.680 Yeah? 63 00:03:16.759 --> 00:03:19.520 No, I mean so for prostate cancer, it's the most 64 00:03:19.560 --> 00:03:22.400 common cancer in men. One in eight men will get 65 00:03:22.439 --> 00:03:26.120 diagnosed with prosta cancer in their lifetime. It's the second 66 00:03:26.240 --> 00:03:29.319 most common killer in terms of procetaly in terms of 67 00:03:29.319 --> 00:03:33.120 cancer for men. But we fortunately find this in early 68 00:03:33.199 --> 00:03:36.039 stages and men can actually do very well with appropriate treatment. 69 00:03:36.360 --> 00:03:40.039 So of all the men who are diagnosed with prosta cancer, 70 00:03:40.199 --> 00:03:42.879 only three percent will die from their disease, and your 71 00:03:42.879 --> 00:03:46.560 statistic there is absolutely true. So for men who present 72 00:03:46.599 --> 00:03:50.280 with advanced stage disease spread to other parts of the body, 73 00:03:50.639 --> 00:03:53.319 the five year survival is much lower at thirty seven 74 00:03:53.360 --> 00:03:56.159 percent according to the most recent data. So you know, 75 00:03:56.240 --> 00:04:00.280 there's a big wide spectrum in terms of how we 76 00:04:00.319 --> 00:04:02.879 treat and see these cases. But for the more advanced 77 00:04:03.479 --> 00:04:06.560 cases it is more difficult, no doubt. But again the 78 00:04:06.599 --> 00:04:09.719 anshasis will be is that he still has treatment options. 79 00:04:09.719 --> 00:04:11.840 I don't know the exact details of his case, but 80 00:04:12.439 --> 00:04:15.319 I do believe in trust will get excellent medical care 81 00:04:15.360 --> 00:04:15.919 from here. 82 00:04:16.079 --> 00:04:19.920 Doctor Kappa. As far as releasing more information, I think 83 00:04:19.959 --> 00:04:23.839 it is required of a public official who was recently 84 00:04:23.879 --> 00:04:27.160 the president in January of this year, to release to 85 00:04:27.240 --> 00:04:30.560 the public the last five or ten years of PSA 86 00:04:30.600 --> 00:04:34.759 and drees to see when this metastasized. Is it fair 87 00:04:34.800 --> 00:04:38.160 to say that this did not happen after January when 88 00:04:38.160 --> 00:04:41.759 he left office, this thing was present months or years before. 89 00:04:43.839 --> 00:04:47.959 Well, typically prote cancer can be slow growing, and it's 90 00:04:48.040 --> 00:04:50.680 really hard for me to speculate on that. What we 91 00:04:50.800 --> 00:04:55.600 know is that his presentation was obstructive urinary symptoms and 92 00:04:55.639 --> 00:04:59.199 that's what prompted the physical exam, the nodule, the work up, 93 00:04:59.240 --> 00:05:02.680 the biopsy, and the imaging that will ultimately led to 94 00:05:02.720 --> 00:05:05.920 the information that we have available. We do see some 95 00:05:06.040 --> 00:05:09.439 cases where men have lower PSAs and have more aggressive 96 00:05:09.480 --> 00:05:13.199 forms of disease. PSA screening, as you mentioned, it is 97 00:05:13.240 --> 00:05:16.240 a really important thing, and the recommendations now and then 98 00:05:16.279 --> 00:05:18.279 this is just for all your listeners. At the age 99 00:05:18.279 --> 00:05:20.600 of fifty, you got to get in get your blood checked. 100 00:05:20.639 --> 00:05:23.360 It's a very simple blood draw and a physical exam. 101 00:05:23.839 --> 00:05:27.240 For higher risk men like black men, those who have 102 00:05:27.240 --> 00:05:30.079 a family history of prosta cancer, the recommendations that are 103 00:05:30.079 --> 00:05:33.360 to get screened even earlier. Your question really was about, 104 00:05:33.399 --> 00:05:35.480 you know, he's eighty two years old, what are his 105 00:05:35.600 --> 00:05:38.600 PSAs before? I don't have any information about that. 106 00:05:38.800 --> 00:05:39.439 Unfortunately. 107 00:05:40.040 --> 00:05:42.759 Well the thought is, you know, I hate to talk 108 00:05:42.759 --> 00:05:46.399 about politics when it's biology. But if he knew he 109 00:05:46.480 --> 00:05:49.839 had this cancer the last couple of years of his presidency, 110 00:05:49.639 --> 00:05:53.439 why wasn't that made public? Every time he had a 111 00:05:53.560 --> 00:05:57.160 yearly medical exam, the doctor said he was in tip 112 00:05:57.199 --> 00:06:00.399 top shape. He could solve a Rubik's cube in about 113 00:06:00.439 --> 00:06:03.680 nine seconds, sharp as attack. This guy's in great health. 114 00:06:03.800 --> 00:06:06.199 And I'm thinking, well, he's in great health, but he's stumbling, 115 00:06:06.279 --> 00:06:09.399 mumbling and fumbling, and now he's got an aggressive, former 116 00:06:09.480 --> 00:06:12.920 proceday cancer that most certainly was present in the last 117 00:06:13.079 --> 00:06:15.480 one to three years of his presidency that we weren't 118 00:06:15.519 --> 00:06:18.879 notified of. What was this a cover up? And secondly, 119 00:06:19.040 --> 00:06:22.600 talk about the symptoms. Most men like tell me they 120 00:06:22.600 --> 00:06:24.560 get up once or twice a night. I know yours 121 00:06:24.560 --> 00:06:27.879 surely does in order to urinate. What are the urinary 122 00:06:27.920 --> 00:06:32.079 symptoms that he had that would indicate that more aggressive 123 00:06:32.079 --> 00:06:34.319 treatment was indicated. What kind of symptoms are they? 124 00:06:36.040 --> 00:06:36.240 Yeah? 125 00:06:36.360 --> 00:06:38.959 No, Your point's are really important one, which is you know, 126 00:06:39.079 --> 00:06:43.120 how can prostac cancer present I mentioned it's usually a 127 00:06:43.240 --> 00:06:47.519 silent presentation, just identified by a laboratory screen test, the 128 00:06:47.560 --> 00:06:50.800 PSA tests. But we do see, I mean I see 129 00:06:50.839 --> 00:06:53.720 patients with prostay cancer every week, and we do see 130 00:06:53.720 --> 00:06:57.079 patients who unfortunately present with urinary symptoms. That's that's what 131 00:06:57.160 --> 00:07:00.600 was released in the statement by his personal office. Obstructive 132 00:07:00.720 --> 00:07:01.600 urinary symptoms. 133 00:07:01.600 --> 00:07:02.120 That's one. 134 00:07:02.480 --> 00:07:05.399 Number two can be pain in the back or other 135 00:07:05.439 --> 00:07:09.439 areas of the bone, unintentional weight loss, blood in the urine. 136 00:07:09.680 --> 00:07:13.120 So these these are unfortunately signs of more advanced disease. 137 00:07:13.120 --> 00:07:15.480 And that's the information that we have for him, and 138 00:07:15.759 --> 00:07:19.560 you know that is fortunately less common. Usually we catch 139 00:07:19.639 --> 00:07:23.279 this much earlier and we can treat it effectively. So 140 00:07:23.399 --> 00:07:25.759 again it's it's hard to know exactly what happened in 141 00:07:25.800 --> 00:07:29.040 his case, but a very small percentage and then will 142 00:07:29.040 --> 00:07:32.480 actually present with symptoms like this and present with metastatic 143 00:07:32.600 --> 00:07:34.519 or disease outside of the prostate. 144 00:07:34.879 --> 00:07:37.560 As far as the Gleasian score of nine, it goes 145 00:07:37.600 --> 00:07:40.560 one to ten. Nine is about as bad as it gets. 146 00:07:40.360 --> 00:07:44.959 Correct, yes, sir, yeah, there, it's a little confusing. And 147 00:07:45.199 --> 00:07:48.519 the gleas And score is the historic grating that we 148 00:07:48.720 --> 00:07:51.959 use for cancer of the prostate. So basically, you know, 149 00:07:52.000 --> 00:07:55.040 for your listeners, we take a biopsy sample of the prostate, 150 00:07:55.120 --> 00:07:57.000 we look at it under the microscope, and we give 151 00:07:57.040 --> 00:08:01.199 it a Gleas and score. So it's confusing because it's six, eight, nine, ten. 152 00:08:01.360 --> 00:08:01.800 Do you mention? 153 00:08:01.920 --> 00:08:04.639 Yeah, nine is aggressive. That's that is about as bad 154 00:08:04.680 --> 00:08:08.279 as it gets. So there's another classification, a newer one 155 00:08:08.319 --> 00:08:11.920 called great group one, two, three, four, five. So it 156 00:08:12.040 --> 00:08:16.360 gets confusing. But historically you'll see Gleason score used. That's 157 00:08:16.360 --> 00:08:19.160 what we commonly share with patients and Gleason nine. I 158 00:08:19.199 --> 00:08:21.120 would think of this on a scale of six to ten. 159 00:08:21.600 --> 00:08:26.160 He's nine on that scale, which represents a more aggressive 160 00:08:26.199 --> 00:08:27.360 form of process cancer. 161 00:08:27.639 --> 00:08:32.120 Doctor Stephen Kappa, Eurology Group here in Cincinnati. Lastly, as 162 00:08:32.159 --> 00:08:34.799 far as a man, let's say a man like yours 163 00:08:34.799 --> 00:08:40.039 truly sees once a year, I go to the Eurology group. 164 00:08:40.440 --> 00:08:44.039 I have relatively low PSAs below four. I have that 165 00:08:44.159 --> 00:08:47.440 digital rectal exam, which is, shall we say, disconcerting. I 166 00:08:47.519 --> 00:08:51.080 tell doctor Eric Coon, while you're up there, you got 167 00:08:51.120 --> 00:08:54.039 ten seconds enjoy yourself. But I don't want any more. 168 00:08:55.320 --> 00:08:59.039 What at risk is a guy that low PSA, but 169 00:08:59.120 --> 00:09:05.679 say below four and drees are negative. How much risk 170 00:09:05.799 --> 00:09:07.039 is yours truly at. 171 00:09:08.360 --> 00:09:08.399 No? 172 00:09:08.559 --> 00:09:10.600 I think you're doing all the right things. I appreciate 173 00:09:10.679 --> 00:09:12.240 you sharing that personal. 174 00:09:11.879 --> 00:09:12.879 Message with the audience. 175 00:09:13.000 --> 00:09:15.480 Yeah, here's kind of the bottom line. When I would 176 00:09:15.480 --> 00:09:18.240 advise men who are listening to this program, one and 177 00:09:18.320 --> 00:09:21.159 eight men get diagnosed with prostate cancer in their lifetime, 178 00:09:21.200 --> 00:09:23.679 and you know, I think about this, this is your 179 00:09:23.679 --> 00:09:28.440 lifetime risk of prostate cancer is more than the likelihood 180 00:09:28.480 --> 00:09:30.039 of your car breaking. 181 00:09:29.679 --> 00:09:30.240 Down this year. 182 00:09:30.240 --> 00:09:33.480 And everybody gets their oil change, their car check, you know, 183 00:09:33.799 --> 00:09:35.480 all the maintenance done in their car. But a lot 184 00:09:35.480 --> 00:09:37.600 of guys won't come in to see their doctor. So 185 00:09:37.639 --> 00:09:40.200 you mentioned the things that you got to do. Start 186 00:09:40.279 --> 00:09:42.840 at age forty to forty five if you're higher risk, 187 00:09:42.919 --> 00:09:45.200 fifty at the latest. For all men, you get your 188 00:09:45.320 --> 00:09:48.480 PSA done. The exam has an important role as well, 189 00:09:48.480 --> 00:09:50.679 but I wouldn't let guys let that scare guys off. 190 00:09:50.679 --> 00:09:52.759 It's really not that. 191 00:09:52.679 --> 00:09:53.840 Big of a deal to get done. 192 00:09:53.840 --> 00:09:56.440 But at a minimum, we want that blood test, the PSA. 193 00:09:56.759 --> 00:10:00.440 We want to individualize, personalize your care to your own 194 00:10:00.559 --> 00:10:03.039 risk factors. So that's what happens on that discussion, and 195 00:10:03.240 --> 00:10:05.240 I have this discussion again every day with men. It's 196 00:10:05.399 --> 00:10:08.480 it's about the risks and the benefits of screening and treatment, 197 00:10:08.840 --> 00:10:11.120 and we walk through that journey with you for your 198 00:10:11.159 --> 00:10:12.840 case it sounds like you're doing all the right things. 199 00:10:12.879 --> 00:10:15.879 You're getting your checks, you're you're having that discussion with 200 00:10:16.000 --> 00:10:18.000 your doctor every year, and so I would just encourage 201 00:10:18.000 --> 00:10:18.720 all guys. 202 00:10:18.440 --> 00:10:18.879 To do that. 203 00:10:19.000 --> 00:10:21.399 You know, you get your oil changed, you don't hesitate 204 00:10:21.399 --> 00:10:23.559 that you have a lower risk of your car breaking 205 00:10:23.559 --> 00:10:25.840 down than you do of getting prostate cancer in your lifetime. 206 00:10:25.879 --> 00:10:28.320 So definitely, you know, I think that this story really high. 207 00:10:28.480 --> 00:10:31.399 It's an unfortunate story, and we hope the former president 208 00:10:31.480 --> 00:10:33.559 does well. But you know what I would say is 209 00:10:33.559 --> 00:10:34.960 this can be a wake up call for all the 210 00:10:34.960 --> 00:10:37.440 guys listening. Don't ignore those symptoms, like if you have 211 00:10:37.519 --> 00:10:40.799 those obstructive urinary symptoms, you have blood in your urine, 212 00:10:41.480 --> 00:10:43.440 If you haven't seen your doctor in a long period 213 00:10:43.480 --> 00:10:46.759 of time, start that conversation today. Make that appointment today, 214 00:10:46.799 --> 00:10:48.559 because it can really save your lives and you can 215 00:10:48.559 --> 00:10:50.960 be around healthier and longer for your family. 216 00:10:51.559 --> 00:10:55.159 Is it possible that ex President Joe Biden had low 217 00:10:55.240 --> 00:10:59.840 PSA and had digital rectal exams on a regular base. 218 00:11:00.240 --> 00:11:03.480 He's at risk patient, not just the president, but at 219 00:11:03.600 --> 00:11:06.600 risk all the cancers that he's had. Is it possible 220 00:11:06.679 --> 00:11:09.799 this thing developed after January? The twentieth of this year, 221 00:11:10.039 --> 00:11:13.120 although here was the president like four months ago. He's 222 00:11:13.159 --> 00:11:16.799 got the awesome power. And is it possible all these 223 00:11:16.799 --> 00:11:19.200 things developed in the last one hundred and twenty days. 224 00:11:20.919 --> 00:11:21.120 Yeah. 225 00:11:21.279 --> 00:11:23.679 Again, it's it's really hard for me to speculate on 226 00:11:23.720 --> 00:11:27.080 that because please do please do the medical record. But 227 00:11:27.240 --> 00:11:32.080 is Nephew by no, And as I understand the question 228 00:11:32.320 --> 00:11:35.200 very well, and it's so hard. I mean, the question 229 00:11:35.360 --> 00:11:37.960 is is do we see patients who come in for 230 00:11:38.039 --> 00:11:40.840 the first time who have an advanced diagnosis that they 231 00:11:40.879 --> 00:11:43.879 didn't know about or they may have had recent conceptive symptoms. 232 00:11:44.080 --> 00:11:46.919 Could they have a fast growing cancer that's aggressive. 233 00:11:46.960 --> 00:11:47.120 Yes? 234 00:11:47.399 --> 00:11:50.200 Do we see patients who have low PSA who have 235 00:11:50.639 --> 00:11:56.039 unfortunately aggressive forms of prostate cancer other types of we 236 00:11:56.159 --> 00:11:59.000 call them histologic subtypes, but you know, different forms of it. 237 00:11:59.159 --> 00:11:59.320 Yes? 238 00:11:59.600 --> 00:12:00.320 Are these rare? 239 00:12:00.600 --> 00:12:00.799 Yes? 240 00:12:00.960 --> 00:12:03.799 Again, real hard to speculate in this individual case. But 241 00:12:04.200 --> 00:12:06.519 you know what I would say is, you know, this 242 00:12:06.679 --> 00:12:10.519 case really highlights the importance of early screening, early intervention, 243 00:12:10.600 --> 00:12:12.960 because you don't want to come in with obstructive symptoms 244 00:12:13.679 --> 00:12:17.440 and a prostate nodule and a really high PSA, a 245 00:12:17.559 --> 00:12:20.480 really high glease and score and spread of disease to 246 00:12:20.519 --> 00:12:22.960 your bones. You know, some men will experience pain in 247 00:12:23.000 --> 00:12:26.000 their bones. It's really a difficult quality of life's concern. 248 00:12:26.159 --> 00:12:28.840 And so yeah, I would just again emphasize the importance 249 00:12:28.879 --> 00:12:31.600 if you want to catch it early. Early screening saves 250 00:12:31.679 --> 00:12:35.159 lives and process cancer is the most common common cancer 251 00:12:35.240 --> 00:12:37.840 for men. Really hopefully a wake up calls, all your listeners, 252 00:12:37.879 --> 00:12:38.720 get in, get checked. 253 00:12:38.840 --> 00:12:41.279 Well, there's no guarantees in life. You get guarantees from 254 00:12:41.320 --> 00:12:44.639 Midas Muffler and that's about it. But assuming you have 255 00:12:44.720 --> 00:12:47.879 a low PSA, you have digital rectal exams, you still 256 00:12:47.960 --> 00:12:50.120 can catch it, but you catch it early. On the 257 00:12:50.159 --> 00:12:52.720 other hand, you can have no PSAs and no digital 258 00:12:52.799 --> 00:12:55.200 and you're fine, good to go. So the fact you 259 00:12:55.279 --> 00:12:59.200 have a low PSA and nothing on the dres, the 260 00:12:59.320 --> 00:13:00.720 only way to do to cardman if you have it 261 00:13:00.840 --> 00:13:03.279 or not is through a biopsy, and you don't want 262 00:13:03.320 --> 00:13:05.759 to go through that unless there's some other indicator. Is 263 00:13:05.799 --> 00:13:06.200 that true? 264 00:13:07.679 --> 00:13:07.879 Yeah? 265 00:13:07.919 --> 00:13:11.039 Absolutely, Yeah, you're put your I love the question because 266 00:13:11.120 --> 00:13:12.720 you know what we do is we have other tools. 267 00:13:13.120 --> 00:13:15.799 We start with the screening, you know, the risk factors, 268 00:13:15.879 --> 00:13:18.720 the family history, the PSA, the exam, but we have 269 00:13:18.759 --> 00:13:20.679 a lot of other tools, and what's been amazing about 270 00:13:20.720 --> 00:13:23.639 prostate cancers. We have new imaging tools, so MRI I 271 00:13:23.799 --> 00:13:26.879 have the prostate for example. We have other non invasive 272 00:13:26.919 --> 00:13:30.840 tests that we can do to individualize your risk, genetic testing, 273 00:13:31.279 --> 00:13:33.840 there's a whole bunch of things that we employ to 274 00:13:33.960 --> 00:13:36.960 counsel patients. You know, before they make that biopsy decision. 275 00:13:37.000 --> 00:13:39.720 We don't make that flippantly at all. And then you know, 276 00:13:39.840 --> 00:13:43.639 even beyond that, ways to image the entire body. There's 277 00:13:43.679 --> 00:13:46.159 a brand new pet scan it's called a PSM, a 278 00:13:46.279 --> 00:13:49.879 PET scan that allows us to better identify exactly where 279 00:13:50.279 --> 00:13:53.279 prostate cancer is. So uh, it's been encouraging not just 280 00:13:53.360 --> 00:13:56.759 to see how we can better diagnose and manage patients, 281 00:13:56.840 --> 00:13:59.240 tell them about their risk, but also treat them a 282 00:13:59.399 --> 00:14:02.120 rapid devio of treatments over the last five to ten years. 283 00:14:02.200 --> 00:14:04.440 So there really is a message of hope too, not 284 00:14:04.639 --> 00:14:07.440 just early screening, but even if you do unfortunately get 285 00:14:07.480 --> 00:14:11.399 a prostate cancer diagnosis, they're excellent treatments available for you, all. 286 00:14:11.360 --> 00:14:13.519 Right, But in his case, his age, et cetera, it's 287 00:14:13.559 --> 00:14:16.240 a difficulty. Hi, I like that, wouldn't it be good 288 00:14:16.279 --> 00:14:19.960 in your profession to have Biden make clear his medical 289 00:14:20.039 --> 00:14:22.600 records the past five years to put at rest those 290 00:14:22.960 --> 00:14:24.759 who think I'm doing all the right stuff. If he 291 00:14:24.840 --> 00:14:27.120 did all the right stuff and this thing erupted after 292 00:14:27.720 --> 00:14:31.600 January the twentieth, that'd be extremely unusual. But it's possible. 293 00:14:31.679 --> 00:14:34.200 It's possible. And the nodule could it be the size 294 00:14:34.200 --> 00:14:35.679 of a grain of sand, or it could be the 295 00:14:35.759 --> 00:14:37.320 size of a pee? Is that correct? 296 00:14:38.679 --> 00:14:38.879 Yeah? 297 00:14:39.159 --> 00:14:41.159 I mean, and we do these exams, and again it's 298 00:14:41.440 --> 00:14:45.240 uncommon that we find cancer this way on physical exam. 299 00:14:45.120 --> 00:14:45.679 But we do. 300 00:14:46.000 --> 00:14:48.279 And they can be small nodules. Usually the prostate I 301 00:14:48.279 --> 00:14:52.039 would think it's smooth. And you know, some men actually 302 00:14:52.039 --> 00:14:54.639 experience just enlargement, so they don't have cancer, but they 303 00:14:54.720 --> 00:14:56.799 just have an enlarged profitate. So it can be an 304 00:14:56.840 --> 00:14:59.200 informative test. But yeah, it can just be whatever you 305 00:14:59.240 --> 00:15:00.639 find a novel, you do definitely got to get a 306 00:15:00.639 --> 00:15:03.159 BIA scene. That's what sounds like happened in his case. 307 00:15:03.200 --> 00:15:06.919 And you know, I think he shared with the public 308 00:15:07.039 --> 00:15:10.080 that cancer affects everybody. That's absolutely true. So you know, 309 00:15:10.080 --> 00:15:13.440 another thing is just in terms of prostate cancer prevention, 310 00:15:13.559 --> 00:15:16.200 I always emphasize the importance of healthy lifestyles. You know 311 00:15:16.279 --> 00:15:18.440 you're asking that, Hey, I'm getting my PSA, I'm getting 312 00:15:18.440 --> 00:15:18.799 my exam. 313 00:15:18.879 --> 00:15:19.559 What else can I do? 314 00:15:19.919 --> 00:15:24.320 There are very basic things about nutrition and exercise and sleep, 315 00:15:24.360 --> 00:15:28.360 avoiding smoking, other substance use. There are basic things that 316 00:15:28.440 --> 00:15:32.120 you can do from a men's health perspective to optimize 317 00:15:32.159 --> 00:15:35.080 your health and and do everything you can to stay 318 00:15:35.120 --> 00:15:38.759 healthy and happy for your family and to enjoy enjoy life. 319 00:15:39.039 --> 00:15:40.519 Well, I'll come in again. I'm going to come in 320 00:15:40.600 --> 00:15:42.639 in September to see doctor Eric Koon. I'm going to 321 00:15:42.679 --> 00:15:45.399 tell him again about our conversation. Why don't you talk 322 00:15:45.440 --> 00:15:47.600 to him about the Great American? Tell him the Great 323 00:15:47.639 --> 00:15:50.039 American once come in earlier got me spooked a little 324 00:15:50.080 --> 00:15:53.240 bit here because I assume I've got the best medical 325 00:15:53.279 --> 00:15:57.679 care in the world, and he got stage four metastastic 326 00:15:58.240 --> 00:16:00.399 cancer and the spread to the bone, and I guess 327 00:16:00.440 --> 00:16:03.080 he's done everything possible and it's still happened. I need 328 00:16:03.200 --> 00:16:06.720 more facts. But doctor Stephen Kappa, Eurology Group, thanks for 329 00:16:06.799 --> 00:16:09.080 coming on the Bill Cunningham Show. We'll talk again soon, 330 00:16:09.159 --> 00:16:10.200 and Doc, thank you very much. 331 00:16:11.440 --> 00:16:13.679 No, I appreciate the time and thank you very much 332 00:16:13.720 --> 00:16:14.159 for having me on. 333 00:16:14.519 --> 00:16:17.240 God bless America. Let's continue with more. I think it 334 00:16:17.360 --> 00:16:22.080 is absolutely incumbent upon Joe Biden to act responsibly and 335 00:16:22.200 --> 00:16:25.519 to relate precisely the number of times he's ad PSA 336 00:16:25.679 --> 00:16:28.480 and drees to give us an idea that there's a 337 00:16:28.559 --> 00:16:31.679 way of helping to diagnosis ahead of time, which is 338 00:16:32.519 --> 00:16:34.320 not going on, and we get nothing. I like to 339 00:16:34.399 --> 00:16:38.080 know more information, wouldn't you. Let's continue with more. Bill Cunningham, 340 00:16:38.120 --> 00:16:42.679 News Radio seven hundred WLW. Bye Billy Cunningham, the Great 341 00:16:42.679 --> 00:16:45.600 American Joa and you and I now is doctor Lastmi Somarco, 342 00:16:45.679 --> 00:16:48.960 Hemna County Corner and doctor Samarco. Welcome again to the 343 00:16:49.000 --> 00:16:51.480 Bill Cunningham Show. And first of all, doctor can you 344 00:16:51.600 --> 00:16:55.080 tell the American people your preliminary findings and what caused 345 00:16:55.080 --> 00:16:58.519 the death of Ryan Hinton on May first of this year. 346 00:17:00.759 --> 00:17:03.559 Yeah, Willie, thanks for having me on the show. Just 347 00:17:03.840 --> 00:17:05.759 you know, I had the press conference to make sure 348 00:17:05.880 --> 00:17:11.640 that the facts were given accurately to the public. So 349 00:17:11.839 --> 00:17:17.559 he had a soft tissue wound to the left forearm 350 00:17:18.440 --> 00:17:24.480 and entrance wound and exit wound. Then he had the 351 00:17:24.640 --> 00:17:29.480 lethal wound was to the side left lateral which is 352 00:17:29.559 --> 00:17:35.720 the side of the chest. And that did deflect and 353 00:17:36.599 --> 00:17:40.839 injure one of the ribs and then went traveled through 354 00:17:40.880 --> 00:17:45.799 the left ventricle and exited near the sternum. 355 00:17:46.279 --> 00:17:48.200 So, as far as the may I use the term 356 00:17:48.319 --> 00:17:53.160 kill shot, can you relative to the left armpit, how 357 00:17:53.240 --> 00:17:56.960 many inches below the left armpit did the bullet enter 358 00:17:57.359 --> 00:17:59.000 and what part of the body did it exit? 359 00:18:00.920 --> 00:18:05.200 It didn't, I mean, it's not interesting. So if if 360 00:18:05.359 --> 00:18:07.680 you were wearing a if he had been wearing a 361 00:18:07.720 --> 00:18:10.559 bra like a woman, would it would be bralined basically, 362 00:18:11.559 --> 00:18:16.160 and it exited by the sternum. 363 00:18:17.720 --> 00:18:20.359 Is there any indication at this point whether there were 364 00:18:20.519 --> 00:18:23.599 three shots fired or two that hit the body. 365 00:18:24.960 --> 00:18:28.839 That's a great question. What we do is describe entrance 366 00:18:28.920 --> 00:18:33.079 and exit wounds, and so there are actually three entrance wounds. 367 00:18:34.400 --> 00:18:38.519 The reason we don't make a comment about whether it's 368 00:18:38.519 --> 00:18:41.079 the same bullet or not is we don't know. 369 00:18:42.680 --> 00:18:43.359 But it is. 370 00:18:43.599 --> 00:18:49.519 Possible that the left form and left lateral chest wound 371 00:18:50.279 --> 00:18:53.079 could have been caused by the same bullet. That is possible. 372 00:18:54.039 --> 00:18:57.680 The videotape shows Ryan Hinton running, so if the arm 373 00:18:57.839 --> 00:19:00.119 was in the downward position and the right arm in 374 00:19:00.160 --> 00:19:03.119 the upward position as he was running, it's possible the 375 00:19:03.200 --> 00:19:06.759 bullet would have entered the forearm as he was running, 376 00:19:06.799 --> 00:19:08.720 and that the same bullet is the one that went 377 00:19:08.799 --> 00:19:11.680 through the chest and exit out the startam Is that correct? 378 00:19:12.599 --> 00:19:16.079 That's yeah, the left form. Yes, that is correct. It's possible. 379 00:19:16.319 --> 00:19:17.680 What was that bullet recovered? 380 00:19:19.160 --> 00:19:22.359 No, no, there were only small pieces of it that 381 00:19:22.440 --> 00:19:23.279 were recovered. 382 00:19:23.359 --> 00:19:23.599 But no. 383 00:19:24.559 --> 00:19:27.960 Now, you also made the comment, at least at the 384 00:19:28.000 --> 00:19:30.799 news conference in the media, that you received the grand 385 00:19:30.920 --> 00:19:33.400 jury subpoena from the prosecutor's office. It was the first 386 00:19:33.440 --> 00:19:36.640 time in thirteen years that has happened. Why is that unusual? 387 00:19:40.640 --> 00:19:43.240 Well, I mean, you got me. I mean, this is 388 00:19:43.279 --> 00:19:46.839 the first time I've ever gotten one, So I don't 389 00:19:48.079 --> 00:19:52.119 I was unaware. In fact, I kind of asked the 390 00:19:53.519 --> 00:19:56.519 some of the more experienced people that had retired from 391 00:19:56.599 --> 00:20:00.200 that office in the past, has that ever happened in 392 00:20:00.359 --> 00:20:03.160 Hamilton County? And one of them, who had been there 393 00:20:03.240 --> 00:20:08.200 over forty years, said no. So I was not familiar 394 00:20:08.359 --> 00:20:13.680 with that happening and why, And so I asked that question, 395 00:20:13.799 --> 00:20:16.079 and like I said, I had to. I canceled it. 396 00:20:16.240 --> 00:20:19.240 But it was basically in my mind of postponement because 397 00:20:20.400 --> 00:20:23.160 I just needed to gather the facts and information and 398 00:20:23.480 --> 00:20:27.519 find out, you know, what was needed and what needed 399 00:20:27.559 --> 00:20:31.440 to happen. And once I got all my ducks in 400 00:20:31.480 --> 00:20:36.359 a row to understand what the implications were of the 401 00:20:36.759 --> 00:20:40.559