WEBVTT 1 00:00:01.760 --> 00:00:06.839 Initialize sequencing coming to you live from Houston, Texas, home 2 00:00:06.879 --> 00:00:08.560 to the world's largest medical center. 3 00:00:09.160 --> 00:00:19.120 Phrase everything. 4 00:00:09.759 --> 00:00:23.239 Look, this is your Health First, the most beneficial health 5 00:00:23.280 --> 00:00:26.960 program on radio with doctor Joe Bellotti. During the next hour, 6 00:00:27.039 --> 00:00:30.359 you'll learn about health, wellness and the prevention of disease. 7 00:00:30.800 --> 00:00:33.520 Now here's your host, doctor Joe Bellotti. 8 00:00:40.280 --> 00:00:41.799 Well, the good Sunday evening to everybody. 9 00:00:41.799 --> 00:00:46.200 Doctor Joe Gillotti, thanks for tuning in this Sunday evening. 10 00:00:46.439 --> 00:00:49.439 And if you're new to this program, you're new to 11 00:00:49.520 --> 00:00:52.479 k tr H, or you're new to the iHeartRadio app. 12 00:00:52.520 --> 00:00:55.799 We are here every Sunday evening between seven and eight 13 00:00:55.799 --> 00:01:01.880 pm Central Time, broadcasting from our home headquarters in Houston, 14 00:01:01.920 --> 00:01:07.879 Texas and the Texas Medical Center, Broadcasting not only here 15 00:01:07.879 --> 00:01:11.680 in Texas, but across the globe on the iHeartRadio app. 16 00:01:12.280 --> 00:01:13.120 Make sure you. 17 00:01:14.599 --> 00:01:19.799 Set your calendar and schedule every Sunday at seven pm 18 00:01:20.159 --> 00:01:25.000 Central Time to tune into the program and become a 19 00:01:25.000 --> 00:01:29.519 better consumer of healthcare. Raise your Health IQ, And as 20 00:01:29.560 --> 00:01:31.959 we've been saying for all these twenty plus years that 21 00:01:32.000 --> 00:01:35.040 we've been on the radio every Sunday night, we are 22 00:01:35.079 --> 00:01:38.760 going to provide you with actionable information that you can 23 00:01:39.239 --> 00:01:43.840 hear it right now and act on it immediately. This 24 00:01:43.920 --> 00:01:49.840 is not some sort of theoretical, too difficult to digest 25 00:01:50.400 --> 00:01:53.560 information that we was sharing with you. It is actionable 26 00:01:53.920 --> 00:01:57.439 on the spot to follow along with all of us 27 00:01:57.480 --> 00:02:01.480 our website doctor Joegalotti dot com, our j O E. G. A. 28 00:02:01.719 --> 00:02:04.040 L A t I dot com, Sona for all of 29 00:02:04.079 --> 00:02:08.560 our social media there, follow us along. We're on Instagram, 30 00:02:08.599 --> 00:02:13.240 We're on TikTok, we are on YouTube. It's all there, 31 00:02:13.280 --> 00:02:16.080 Doctor Jogilati dot com and especially Sona for our weekly 32 00:02:16.120 --> 00:02:20.840 newsletter that goes out on Saturday mornings across the country. 33 00:02:21.479 --> 00:02:23.639 All right, so on the program tonight, we are going 34 00:02:23.680 --> 00:02:27.960 to be continuing our discussion on prostate cancer. We have 35 00:02:29.280 --> 00:02:32.120 on the phone a little later this evening, a true 36 00:02:32.280 --> 00:02:37.639 expert in prostate cancer, doctor Brian Miles, who is at 37 00:02:37.680 --> 00:02:41.800 Houston Methodist Hospital here in the Texas Medical Center, a 38 00:02:41.919 --> 00:02:46.479 pioneer and not only robotic surgery for prostate cancer, but 39 00:02:47.280 --> 00:02:51.719 the approach to patients with prostate cancer. And certainly with 40 00:02:52.439 --> 00:02:57.800 the revelation of what was disclosed about President Biden a 41 00:02:57.800 --> 00:02:59.759 couple of weeks ago in his prostate we're going to 42 00:02:59.800 --> 00:03:03.840 get an opinion or suggestion of what may have actually 43 00:03:03.879 --> 00:03:08.639 happened with President Biden and learn about that. The one 44 00:03:08.639 --> 00:03:11.080 thing I want to chat about is and this really 45 00:03:11.080 --> 00:03:13.919 gets into prostate cancer or any cancer where you're getting 46 00:03:13.919 --> 00:03:18.439 a second opinion. The New York Times had an article 47 00:03:18.879 --> 00:03:25.080 talking about logging on for a second or third opinion, 48 00:03:25.159 --> 00:03:28.560 so logging on meeting, going to Google or somewhere on 49 00:03:28.599 --> 00:03:31.840 the internet for a second opinion. And I have always 50 00:03:31.879 --> 00:03:35.439 been a big advocate of getting a second opinion. So 51 00:03:35.520 --> 00:03:39.199 many of the patients that I see, I am seeing 52 00:03:39.240 --> 00:03:42.479 them as a second, third, or even a fourth opinion. 53 00:03:42.639 --> 00:03:47.240 So it is important that you if you're confronted with 54 00:03:47.479 --> 00:03:51.800 a diagnosis, whether it's life threatening or not life threatening, 55 00:03:52.000 --> 00:03:55.560 that you consider getting a second opinion. But in this 56 00:03:55.919 --> 00:04:00.039 day and age, so many people are going online and 57 00:04:00.280 --> 00:04:02.439 looking for a second opinion. 58 00:04:02.639 --> 00:04:06.879 And the amount of Google. 59 00:04:06.759 --> 00:04:11.439 Searches that have to do with health and wellness is 60 00:04:11.520 --> 00:04:15.680 really quite predominant. And this is what we are all 61 00:04:15.719 --> 00:04:18.839 doing now. It is a good thing. I'm not going 62 00:04:18.879 --> 00:04:23.439 to say don't do it, but I would believe that 63 00:04:24.399 --> 00:04:29.800 there is information that you can get that is inaccurate, 64 00:04:30.519 --> 00:04:36.000 and so you don't want to search thinking that you're 65 00:04:36.040 --> 00:04:38.639 going to find information that's going to be helpful to you, 66 00:04:39.319 --> 00:04:42.040 but then at the end of the day end up 67 00:04:42.600 --> 00:04:43.839 penalizing yourself. 68 00:04:44.399 --> 00:04:45.680 So the. 69 00:04:48.920 --> 00:04:52.199 Current strategy out there is that so many people that 70 00:04:52.399 --> 00:04:56.600 have a particular disease, whether it's prostate cancer, whether it's 71 00:04:56.680 --> 00:05:01.879 multiple sclerosis, whether it is breast cancer, people are posting 72 00:05:02.040 --> 00:05:08.000 information about their own case, their own treatment, their own 73 00:05:09.040 --> 00:05:13.680 sort of follow up after surgery. And by creating this 74 00:05:13.800 --> 00:05:19.600 community around a certain disease, there is a benefit to this. 75 00:05:19.720 --> 00:05:23.439 There is the opportunity to see what other people went through, 76 00:05:23.480 --> 00:05:26.399 but you have to keep it in the context of 77 00:05:26.959 --> 00:05:32.040 your own case, your own particulars with regard to your 78 00:05:32.639 --> 00:05:36.800 health and wellness, and have a really healthy conversation with 79 00:05:36.959 --> 00:05:41.839 your physician. But when you look at the different websites 80 00:05:41.879 --> 00:05:48.600 that you could look at, there are basically five categories 81 00:05:48.720 --> 00:05:51.199 of websites that you want to look at. The first 82 00:05:51.199 --> 00:05:56.279 would be general interest websites, something like WebMD or even 83 00:05:56.319 --> 00:06:02.680 the New York Times health site. It is of value 84 00:06:03.000 --> 00:06:05.439 and so this is where you're going to get information 85 00:06:05.600 --> 00:06:13.279 about a particular disease, news and lifestyle advice, and learn 86 00:06:13.399 --> 00:06:18.519 from medical institutions like Mayo clinics, so that's a general interest. 87 00:06:18.560 --> 00:06:22.639 The second is a medical research site. So if you 88 00:06:22.800 --> 00:06:26.959 want to learn about what is being done or published 89 00:06:27.920 --> 00:06:30.839 within research, you're going to have to go to a 90 00:06:30.879 --> 00:06:37.959 website like PubMed, which is done which is really organized 91 00:06:38.360 --> 00:06:41.199 under the National Library of Medicine, but if you just 92 00:06:41.279 --> 00:06:45.120 type in PubMed you will find out. The other is 93 00:06:45.519 --> 00:06:51.160 a website called Clinicaltrials dot gov, which will track various 94 00:06:51.680 --> 00:06:54.560 research protocols, and you can actually type in a disease 95 00:06:54.959 --> 00:06:59.199 and where you live and it will narrow down something 96 00:06:59.240 --> 00:07:03.759 that's in your particular neighborhood. Then there are a number 97 00:07:03.800 --> 00:07:08.519 of patient sites, and this is really what is booming. 98 00:07:09.680 --> 00:07:16.199 There's the Association of Cancer Online Resources. There is something 99 00:07:16.240 --> 00:07:23.399 called epatients dot net, as well as a site patients 100 00:07:23.519 --> 00:07:27.920 like me and Trusira t r U s e r 101 00:07:28.040 --> 00:07:32.120 a dot com which provides a bit of a Facebook 102 00:07:32.839 --> 00:07:38.079 style like social connection for patients. Then you get into 103 00:07:38.160 --> 00:07:42.399 the disease specific sites, which would be American Heart Association, 104 00:07:42.519 --> 00:07:47.759 American Cancer Society, American Diabetes Association, which will sort of 105 00:07:47.839 --> 00:07:53.800 target a particular disease. And then lastly there are web 106 00:07:53.879 --> 00:08:01.680 tools that will help you learn about nutrition, disease risk, factors, 107 00:08:02.160 --> 00:08:07.079 certain medications that you will be on. So there's a 108 00:08:07.120 --> 00:08:11.240 lot there. I'm going to post this article on the 109 00:08:12.240 --> 00:08:14.759 Facebook page which is at doctor Joe Galotti. 110 00:08:15.920 --> 00:08:17.759 But it's interesting. So again, we. 111 00:08:17.759 --> 00:08:21.240 Don't want you to not search online. I believe you 112 00:08:21.399 --> 00:08:27.319 have to be a good consumer and open to all 113 00:08:27.360 --> 00:08:29.680 of this information and trying to sort of out. All right, 114 00:08:29.680 --> 00:08:32.720 we're going to take a quick break right now. You 115 00:08:32.799 --> 00:08:35.279 tuned into your health First. Every Sunday between seven and 116 00:08:35.360 --> 00:08:40.639 eight pm, visit doctor Joegalotti dot com for more information 117 00:08:40.720 --> 00:08:44.679 about me, our team and our Livid Disease practice. Doctor 118 00:08:44.720 --> 00:08:47.159 Brian Miles talking about prostate cancer coming up in just 119 00:08:47.200 --> 00:08:49.919 a minute before all right, Well, as I've been saying 120 00:08:49.919 --> 00:08:53.879 this evening, we have a true expert and need I 121 00:08:53.919 --> 00:08:57.279 say a legend in the world of urology is a 122 00:08:57.399 --> 00:09:03.159 very modest gentleman, doctor Brian Miles, who his credentials are 123 00:09:03.360 --> 00:09:07.000 impeccable where he is the vice chair of Urology at 124 00:09:07.000 --> 00:09:10.120 Euston Methodist Hospital, He's a professor of urology, he's the 125 00:09:10.159 --> 00:09:14.279 director of Robotic Surgery at Houston Methodist Hospital and truly 126 00:09:14.879 --> 00:09:19.399 an individual that in the field of medicine when you 127 00:09:19.440 --> 00:09:23.080 talk about prostate cancer. Doctor Brian Miles's name comes up, 128 00:09:23.120 --> 00:09:26.480 So Dodtor Miles. So great to have you on the 129 00:09:26.480 --> 00:09:27.720 program this evening. 130 00:09:27.600 --> 00:09:30.240 Jill, thank you so much for including me, and this 131 00:09:30.320 --> 00:09:33.799 is a wonderful opportunity to talk about something that is 132 00:09:34.559 --> 00:09:37.759 foremost in many men's minds in this time. 133 00:09:38.159 --> 00:09:42.519 Yes, for sure, and certainly with the revelation of President 134 00:09:42.600 --> 00:09:46.720 Biden and his diagnosis, it's raised questions but also some 135 00:09:46.759 --> 00:09:50.120 confusion as to what I should do, and we will 136 00:09:50.120 --> 00:09:55.000 certainly get to that. So you know, the basic issue 137 00:09:55.159 --> 00:10:00.919 is every man over fifty, let's say, know what their 138 00:10:01.519 --> 00:10:05.399 PSA is, prostate specific antigen. And even this has become 139 00:10:05.720 --> 00:10:10.960 a little controversial. So what is your explanation everybody tonight 140 00:10:11.039 --> 00:10:12.080 about PSA? 141 00:10:12.559 --> 00:10:13.440 Who should get it? 142 00:10:13.519 --> 00:10:16.799 And how much weight do we put on it if 143 00:10:16.840 --> 00:10:17.960 it is indeed elevated? 144 00:10:18.360 --> 00:10:22.799 Well, PSA is an important screening tool. There's no other 145 00:10:24.960 --> 00:10:29.960 wonderful blood test like this for any other cancer, breast 146 00:10:29.960 --> 00:10:32.559 cancer or colon cancer. Could find a blood test like this, 147 00:10:33.080 --> 00:10:37.159 it would be a huge help. But PSA just gives 148 00:10:37.200 --> 00:10:39.799 us an idea that someone might be at increased risk 149 00:10:40.360 --> 00:10:44.000 right now. The guidelines say you should start at age fifty, 150 00:10:44.159 --> 00:10:48.600 and they tend to say stop at age seventy five. 151 00:10:49.759 --> 00:10:52.559 If you have a family history of prostate cancer or 152 00:10:52.639 --> 00:10:56.000 you're African American, I believe you need to start getting 153 00:10:56.000 --> 00:11:00.559 tested at age forty because your risk is substantially higher. 154 00:11:01.799 --> 00:11:05.080 I would also add it, I my Joe, that PSA 155 00:11:05.159 --> 00:11:08.720 is a screening tool. If someone has an elevated PSA, 156 00:11:09.480 --> 00:11:12.960 I don't rush to biopsy. In the old days, we would. 157 00:11:13.679 --> 00:11:16.600 What I do now is another specialized test. There are 158 00:11:16.639 --> 00:11:19.519 many varieties, but the one I use is called a 159 00:11:19.559 --> 00:11:23.679 four K test that looks at all aspects of PSA 160 00:11:23.759 --> 00:11:26.919 and one of the proteins of the Cali crime family. 161 00:11:27.039 --> 00:11:30.159 That PSA is a part of that family. That helps 162 00:11:30.240 --> 00:11:33.759 us predict whether someone has a true risk of cancer. 163 00:11:34.240 --> 00:11:37.600 Right if someone has a mildly elevated PSA, Joe, chance 164 00:11:37.639 --> 00:11:40.240 of having cancer is twenty eight to thirty percent, you know, 165 00:11:40.279 --> 00:11:44.240 I mean between four and nine. But I'm biasing one 166 00:11:44.279 --> 00:11:46.120 hundred men to find those. If I do a four 167 00:11:46.200 --> 00:11:48.799 K test, I only have to do I only have 168 00:11:48.840 --> 00:11:51.639 to buy the sixty men to find the same number 169 00:11:51.799 --> 00:11:54.240 the same thirty. It's a very helpful test. 170 00:11:54.720 --> 00:11:58.440 So I would say over the past ten years or so, 171 00:11:58.639 --> 00:12:03.080 or maybe fifteen years. Organizations like the American Cancer Society 172 00:12:03.200 --> 00:12:07.360 have come out somewhat to the chagrin of experts like you, 173 00:12:07.480 --> 00:12:10.799 that maybe we don't need to check PSA. Too many 174 00:12:10.840 --> 00:12:14.879 biopsies are being done. What do you say to that today, 175 00:12:15.080 --> 00:12:16.799 with the knowledge that you all. 176 00:12:16.639 --> 00:12:23.200 Have, that's wrong. That's wrong. We found when the US 177 00:12:23.279 --> 00:12:28.039 Prevented the Task Force came out with their recommendations, like 178 00:12:28.120 --> 00:12:31.960 the American Cancer Society, five years later, we found that 179 00:12:32.080 --> 00:12:37.200 the increase in people presenting with metastatic disease like President 180 00:12:37.240 --> 00:12:42.200 Biden shot almost straight up as you would predict. Five 181 00:12:42.279 --> 00:12:45.320 years is about the time it takes from inception of 182 00:12:45.360 --> 00:12:50.159 a disease that's fairly aggressive to metastatic disease, so that 183 00:12:51.039 --> 00:12:55.200 they're wrong. And you know, it's hard for many of 184 00:12:55.279 --> 00:13:01.000 us to admit, perhaps we were wrong, but this was wrong. Unfortunately, 185 00:13:01.039 --> 00:13:06.080 it is still in the mindset of some primary care doctors. 186 00:13:07.200 --> 00:13:11.000 But I think that with President Biden, we should all 187 00:13:11.039 --> 00:13:11.600 wake up. 188 00:13:12.240 --> 00:13:15.000 Yeah, yeah, And I would say you're right that sometimes 189 00:13:15.039 --> 00:13:19.240 when these these new rules come down or suggestions, it 190 00:13:19.360 --> 00:13:22.759 becomes the word of the land, and it is more 191 00:13:23.200 --> 00:13:27.399 difficult and more problematic to unravel that thinking you almost 192 00:13:27.399 --> 00:13:32.600 have an entire generation of physicians trained that PSA really 193 00:13:32.679 --> 00:13:36.159 isn't that important and they're not getting it done. 194 00:13:36.440 --> 00:13:38.080 I couldn't agree more. Couldn't agree more. 195 00:13:38.200 --> 00:13:42.519 Yeah, Now, with regard to risk factors for prostate cancer, 196 00:13:42.799 --> 00:13:46.600 you mentioned African American and that certainly is significant. But 197 00:13:46.679 --> 00:13:48.840 what are some of the other risk factors, be it 198 00:13:49.440 --> 00:13:53.519 obesity or diabetes, smoking, alcohol, things like that. 199 00:13:54.919 --> 00:13:58.320 Well, it's certainly family history is the next big one 200 00:13:58.519 --> 00:14:05.399 after AfOR race being African American, But obesity, for instance, 201 00:14:05.480 --> 00:14:13.279 there's really not an increase in prostate cancer disease so 202 00:14:13.399 --> 00:14:15.879 much as there is an increased risk of being more 203 00:14:15.919 --> 00:14:20.240 aggressive disease. Meaning if you're diabetic it doesn't or obese 204 00:14:20.279 --> 00:14:22.399 it doesn't mean you have a higher risk of getting it, 205 00:14:22.440 --> 00:14:24.559 but if you do get it, there's a higher risk 206 00:14:24.600 --> 00:14:28.919 that it's a much more aggressive cancer. Diet Diet is always, 207 00:14:28.960 --> 00:14:35.240 as you know, everything in life eventually comes down to 208 00:14:35.399 --> 00:14:38.919 diet because diet is what can we as individuals do 209 00:14:39.200 --> 00:14:47.320 to modify our risk. And unfortunately there's no real good 210 00:14:47.440 --> 00:14:50.600 data on this. I will tell you that in this country, 211 00:14:51.360 --> 00:14:59.200 people spend over one trillion dollars on nutraceuticals meaning vitamins 212 00:14:59.360 --> 00:15:04.480 and very substances to help modify their risk of cancer, 213 00:15:04.919 --> 00:15:08.039 prostate cancer being very high on that list, and yet 214 00:15:08.080 --> 00:15:10.679 none of them have really been studied well enough to 215 00:15:10.720 --> 00:15:13.679 show what the true benefit is. So there's nothing you 216 00:15:13.720 --> 00:15:17.200 can really do there. Keep your weight good, be active, 217 00:15:17.559 --> 00:15:20.320 keep your immune system good, so even if you get 218 00:15:20.360 --> 00:15:22.519 prostate cancer, it'll be easily managed. 219 00:15:22.960 --> 00:15:27.919 Right, right, And that's so general for everything, cardiovascular disease, 220 00:15:28.120 --> 00:15:30.679 liver disease, lung diseases. 221 00:15:30.759 --> 00:15:31.039 Got it. 222 00:15:31.080 --> 00:15:35.480 You want to have a healthy diet, stay active, and 223 00:15:35.519 --> 00:15:38.559 keep your weight down. Now, symptoms of prostate cancer, because 224 00:15:38.600 --> 00:15:41.159 a lot of people will say, well, gee, my PSA 225 00:15:41.279 --> 00:15:45.759 may be elevated, but I feel fine. What are the 226 00:15:45.799 --> 00:15:50.600 symptoms that may be very mild and nonspecific, and what 227 00:15:50.679 --> 00:15:53.720 are the absolute red flags to say you need to 228 00:15:53.720 --> 00:15:57.519 get in see an expert like yourself with regard to 229 00:15:57.600 --> 00:15:58.559 their prostate health. 230 00:15:58.960 --> 00:16:01.320 None. 231 00:16:01.440 --> 00:16:04.600 Okay, that's that's very easy. 232 00:16:04.759 --> 00:16:08.200 Because when we ask questions, we always ask questions like 233 00:16:08.720 --> 00:16:10.720 are you getting up too often at night? Is your 234 00:16:10.919 --> 00:16:13.720 stream week? Are you having urgency? These are signs of 235 00:16:13.799 --> 00:16:18.799 benign growth of the prostate, but any they are not 236 00:16:19.000 --> 00:16:23.759 signs of someone having increased risk of prostate cancer. Fact 237 00:16:23.840 --> 00:16:27.399 the matter is that, as in most cancers that you 238 00:16:27.480 --> 00:16:31.559 know of, Joe, if you get symptoms that are directly 239 00:16:31.639 --> 00:16:34.759 related to that cancer, it is most likely already. 240 00:16:34.519 --> 00:16:38.840 Spread, right right, Yeah, exactly. So again it gets back 241 00:16:38.879 --> 00:16:42.759 to early intervention and really awareness. Would you would you 242 00:16:42.840 --> 00:16:45.519 say that when you look at prostate and if you 243 00:16:45.799 --> 00:16:48.960 just want to compare it to breast cancer, which certainly 244 00:16:49.720 --> 00:16:52.120 everybody is aware of, it's on everyone's mind, do you 245 00:16:52.120 --> 00:16:56.679 find that the general awareness of men and prostate cancer 246 00:16:56.840 --> 00:16:57.399 is lacking? 247 00:16:57.919 --> 00:17:02.840 Oh? Absolutely, Men. Breast cancer, by the way, and prostate 248 00:17:02.879 --> 00:17:05.920 cancer a fairly similar. Breast cancer tends me a little more, 249 00:17:06.359 --> 00:17:09.039 a little more aggressive, but also found a little later. 250 00:17:10.079 --> 00:17:13.440 It doesn't have blood tests, it doesn't have that PSA test. 251 00:17:14.079 --> 00:17:19.279 But men are still historically fairly stoic and at some 252 00:17:19.400 --> 00:17:21.839 level whims I don't want to go to the doctor, 253 00:17:21.880 --> 00:17:23.480 They don't want to go to the doctor that I have, 254 00:17:24.240 --> 00:17:27.200 and they certainly don't want me examining their prostate rect right. 255 00:17:28.599 --> 00:17:31.720 But women are much more proactive. I think this comes 256 00:17:31.759 --> 00:17:35.200 from motherhood and all of those things. Perhaps where you're 257 00:17:35.240 --> 00:17:38.440 taking care of the family, a caregiver, and the family's 258 00:17:38.440 --> 00:17:43.680 mom and breast cancer and women coordinate better they you know, 259 00:17:43.759 --> 00:17:47.200 the breast cancer walks are so important. You won't find 260 00:17:47.279 --> 00:17:51.720 much of that. And men it's it's but women tend 261 00:17:51.720 --> 00:17:54.160 to take care of their husbands. Nine times out of 262 00:17:54.160 --> 00:17:56.799 the ten. A guy coming in to see me, if 263 00:17:56.799 --> 00:17:59.079 he doesn't have an elevated PSA already, is because his 264 00:17:59.160 --> 00:18:00.519 wife wants me to examine it. 265 00:18:01.359 --> 00:18:04.000 Yeah, excited, you know, speaking of the examination. 266 00:18:04.359 --> 00:18:08.359 And you know, we've gotten so much more technology and 267 00:18:08.440 --> 00:18:13.599 scanning and fancy blood works. Is the digital rectal exam 268 00:18:14.079 --> 00:18:18.759 a dead item or should we still be Should we 269 00:18:18.799 --> 00:18:23.680 still be doing these on our man and encouraging primary 270 00:18:23.720 --> 00:18:26.519 care physicians to do a rectal exam to say, on 271 00:18:26.599 --> 00:18:30.119 that digital exam, you may find a prostate cancer. 272 00:18:30.160 --> 00:18:31.079 What do you think? 273 00:18:32.599 --> 00:18:35.720 Well, you know, this becomes generational. I'm a bit older, 274 00:18:35.759 --> 00:18:39.000 So I was raised with a digital rectal exam. PSA 275 00:18:39.160 --> 00:18:42.519 came out just after I finished residency, and so we 276 00:18:42.640 --> 00:18:46.920 only found prostate cancer through the digital rectal exam, right, 277 00:18:47.000 --> 00:18:50.559 And so that's what would lead to a biopsy. But 278 00:18:50.640 --> 00:18:53.200 back then, fifty percent of the de men already had 279 00:18:53.279 --> 00:18:57.599 advanced disease beyond the prostate So thank god with PSA 280 00:18:57.720 --> 00:19:02.440 that's changed dramatically, and so I still recommended yours little 281 00:19:02.440 --> 00:19:05.480 rectal exam. But is it critical. No, if you have 282 00:19:05.519 --> 00:19:09.720 an equivocal PSA, I think it's very important. But if 283 00:19:09.720 --> 00:19:12.519 you've got to do one test, do the PSA not 284 00:19:12.640 --> 00:19:13.599 directly right? 285 00:19:13.720 --> 00:19:16.440 Exactly? All right, We're going to take a quick break. 286 00:19:16.480 --> 00:19:20.319 We're talking with doctor Brian Miles, a world renowned urologist 287 00:19:20.400 --> 00:19:24.400 and prostate cancer expert, on your Health First this Sunday 288 00:19:24.400 --> 00:19:24.759 evening on. 289 00:19:24.839 --> 00:19:25.720 Doctor Joe Galotti. 290 00:19:25.759 --> 00:19:29.279 Don't forget doctor Jogalotti dot com is our website. Stay 291 00:19:29.279 --> 00:19:35.559 tuned more prostrate discussion in a moment. Welcome back everybody, 292 00:19:35.559 --> 00:19:38.599 doctor Joe Glotti, thanks for tuning in on this glorious 293 00:19:38.680 --> 00:19:42.160 Sunday evening to your Health First. We hear every Sunday 294 00:19:42.160 --> 00:19:45.279 between seven and eight pm bringing you. 295 00:19:45.839 --> 00:19:47.200 The best in health and wellness. 296 00:19:47.240 --> 00:19:49.799 We want to raise your health IQ, make you better 297 00:19:49.960 --> 00:19:55.000 consumers of healthcare, making sure that you have all of 298 00:19:55.000 --> 00:19:58.000 the facts you need to stay healthy, to stay on 299 00:19:58.240 --> 00:20:02.920 top of your health and all of the important topics 300 00:20:02.920 --> 00:20:06.720 such as prostate cancer, which sometimes is just in a 301 00:20:06.880 --> 00:20:10.200 black box that we just don't want to talk about things. 302 00:20:10.240 --> 00:20:13.640 But tonight on the program, we have been chatting with 303 00:20:13.680 --> 00:20:18.079 doctor Brian Miles, a true expert in prostate cancer here 304 00:20:18.079 --> 00:20:22.319 in Houston, Texas at Houston Methodist Hospital where he is 305 00:20:22.480 --> 00:20:27.680 the Professor of Urology and the director of the Division 306 00:20:27.720 --> 00:20:31.680 of Robotic Surgery. And it's so great to have him 307 00:20:31.720 --> 00:20:34.400 on the program tonight explaining to us what we need 308 00:20:34.440 --> 00:20:37.680 to know about prostate cancer. So take me through a 309 00:20:38.359 --> 00:20:43.400 sixty year old gentleman that has on routine screening PSA 310 00:20:43.480 --> 00:20:47.000 is elevated, and maybe over the last five years the 311 00:20:47.039 --> 00:20:49.960 PSA was sort of in the normal range and this 312 00:20:50.039 --> 00:20:54.160 year it jumped up a little bit and either the 313 00:20:54.200 --> 00:20:57.880 primary care or the guy's wife said, wait a second, 314 00:20:58.599 --> 00:21:00.519 we have to get this worked up. They come and 315 00:21:00.559 --> 00:21:05.160 see you or some other eurologic expert, and what is 316 00:21:05.240 --> 00:21:09.160 the plan of care. How do you approach a patient 317 00:21:09.279 --> 00:21:09.519 like this? 318 00:21:11.599 --> 00:21:15.559 Well, as I said said earlier, besides doing a digital 319 00:21:15.599 --> 00:21:18.480 rec exam, I also do the four K tests and 320 00:21:18.599 --> 00:21:23.079 advanced test that is looking at total PSA, free PSA, 321 00:21:23.319 --> 00:21:28.680 complex PSA and HK two that protein within the calikrin 322 00:21:28.839 --> 00:21:31.960 family that PSA is a part of. That tells me 323 00:21:33.039 --> 00:21:38.440 whether this person really has an increased risk of prostate cancer, 324 00:21:38.559 --> 00:21:41.319 or whether it's just related to the genetics of his 325 00:21:41.440 --> 00:21:44.599 family and his age. As we get older, the PSA 326 00:21:44.680 --> 00:21:49.599 tends to go up within families. There are PSA patterns. 327 00:21:50.039 --> 00:21:51.880 I can think of a family I once that with 328 00:21:52.160 --> 00:21:56.640 six brothers, and they all as each brother got to 329 00:21:56.720 --> 00:22:00.640 age sixty, their PSA got to ten of a big number. 330 00:22:01.799 --> 00:22:04.720 None of them ever had positive cancer. So there is 331 00:22:04.720 --> 00:22:08.400 a familial trend to some of these things, and you 332 00:22:08.480 --> 00:22:10.559 have to fit that into the pattern of what you're 333 00:22:10.599 --> 00:22:14.519 doing with the patient. But a sixty year old I'm 334 00:22:14.559 --> 00:22:16.440 going to get a four K test of it shows 335 00:22:16.480 --> 00:22:20.160 an intermediate elevated risk, I'll get an MRI of the prostrate. 336 00:22:20.759 --> 00:22:22.920 If it's elevated risk, they're going to get a biopsy. 337 00:22:23.000 --> 00:22:26.079 Whether the MRI is positive or not. If the four 338 00:22:26.160 --> 00:22:30.680 K test says intermediate risk for aggressive disease or disease, 339 00:22:30.720 --> 00:22:34.160 it should be treated. The MRI is negative, I'll watch 340 00:22:34.200 --> 00:22:38.920 them for intermediate group. So you know, you don't want 341 00:22:38.920 --> 00:22:40.720 to be you don't want to be doing what the 342 00:22:40.759 --> 00:22:44.720 American Cancer Society said, we were always doing, over diagnosing, 343 00:22:44.839 --> 00:22:47.480 over biopsing, this sort of thing. You want to do 344 00:22:47.519 --> 00:22:51.200 it with some thought process that has value for the 345 00:22:51.240 --> 00:22:55.599 patient without putting them in harm's way by scaring them 346 00:22:55.640 --> 00:22:59.000 because they have a really low grade disease, or by 347 00:22:59.119 --> 00:23:03.000 a scaring them the all negative bio scenes. But are 348 00:23:03.079 --> 00:23:05.519 still wonder to be harboring cancer. 349 00:23:05.200 --> 00:23:10.359 There right right now, you have been one of the pioneers. Gosh, 350 00:23:10.359 --> 00:23:13.799 it's probably been twenty plus years with robotic surgery on 351 00:23:14.000 --> 00:23:17.559 the prostate. And what is the current state of affair 352 00:23:18.240 --> 00:23:21.319 with regard to prostate surgery? Because I would think that 353 00:23:21.480 --> 00:23:25.799 men are petrified of having that prostate cut out. They 354 00:23:25.799 --> 00:23:30.119 may have trouble with impotence and urinary incontinence, and they 355 00:23:30.119 --> 00:23:32.720 would almost well, I can't speak for them. They would 356 00:23:32.720 --> 00:23:36.480 almost say, forget about it, this is not for me. 357 00:23:36.640 --> 00:23:40.880 I'll take chemo, I'll take radiation. Where are we at 358 00:23:40.920 --> 00:23:46.319 with state of the art prostate cancer technology? 359 00:23:47.039 --> 00:23:52.799 Well, I would say that with appropriate informed consent, which 360 00:23:53.160 --> 00:23:59.240 form consent means you expose the patient to risk. What's 361 00:23:59.240 --> 00:24:04.680 the potential for risk, So risk knowledge and then risk 362 00:24:04.799 --> 00:24:09.920 acceptance and whether you get Chemotherapy has no role in 363 00:24:10.000 --> 00:24:15.039 prostate cancer till very late. So your choices are doing radiation, 364 00:24:15.839 --> 00:24:18.720 having me remove the prostrate or having me treat the 365 00:24:18.759 --> 00:24:22.480 prostrate with what are called a BLATI of therapies like 366 00:24:22.599 --> 00:24:29.119 high intensity focused ultra scenography or cryosurgery. Right, those localized 367 00:24:29.200 --> 00:24:39.359 treatments all have risk impotence, incontinence, and problems with the 368 00:24:39.440 --> 00:24:43.680 rectum or bladder depending on the treatment options. And the 369 00:24:43.680 --> 00:24:49.640 fact of the matter is that they are generally minor 370 00:24:49.720 --> 00:24:55.359 minimal if you will accept for impotence. Impotence is the 371 00:24:55.359 --> 00:24:58.480 one thing where you know, at least the third of 372 00:24:58.599 --> 00:25:02.039 men will in general depending on age, but in general 373 00:25:02.720 --> 00:25:07.160 we'll have problems getting back to normal rectile capacity. We're 374 00:25:07.200 --> 00:25:10.599 still studying that. I have. I've created what's called a 375 00:25:10.640 --> 00:25:15.160 survivorship clinic for my patients, trying to find ways to 376 00:25:15.480 --> 00:25:20.319 get their erections back if they were sexually potent and 377 00:25:20.880 --> 00:25:26.640 and interested remain interested in being intimate with their partner, Okay, 378 00:25:26.680 --> 00:25:30.759 And so there's a lot going on there because that 379 00:25:30.880 --> 00:25:33.920 is that is the key. I don't want to cure 380 00:25:34.000 --> 00:25:38.880 cancer and yet create another disease us, and so we 381 00:25:39.000 --> 00:25:40.039 have to focus on that. 382 00:25:40.720 --> 00:25:46.039 Yeah, So with removal of the prostate, the rates of 383 00:25:46.240 --> 00:25:49.880 cure are very good, would you say that? 384 00:25:50.839 --> 00:25:53.160 Yeah? I mean, you know, they're not one hundred percent 385 00:25:53.480 --> 00:25:57.799 whether you're radiated or remove it. But the thing I 386 00:25:57.880 --> 00:26:02.920 always catch it early and treat the primary disease. The 387 00:26:03.039 --> 00:26:07.880 chance of death from prostate cancer is very unusual. 388 00:26:08.519 --> 00:26:12.400 So now that segues into the recent news a week 389 00:26:12.519 --> 00:26:16.839 or so ago with President Biden, this revelation out of 390 00:26:16.920 --> 00:26:20.079 nowhere that he has prostate cancer, let alone it is 391 00:26:20.279 --> 00:26:25.119 advanced to his bones apparently. So there's all kinds of 392 00:26:25.160 --> 00:26:29.640 speculation and we are not here to create some political 393 00:26:30.519 --> 00:26:35.440 chaos and be controversial. But what do you think went 394 00:26:36.079 --> 00:26:39.799 on there from a professional standpoint. 395 00:26:39.599 --> 00:26:46.759 Well, it is really hard to explain that It's easy 396 00:26:46.799 --> 00:26:49.319 to judge, but you have to be careful having not 397 00:26:49.519 --> 00:26:52.039 been there and what you were allowed to do or 398 00:26:52.119 --> 00:26:58.039 not allowed to do. Possibly the person who's taking care 399 00:26:58.160 --> 00:27:01.880 of the president. The primary care doc was a firm 400 00:27:01.920 --> 00:27:05.440 believer that when you're older, you don't need to get 401 00:27:05.440 --> 00:27:09.440