Diagnosing Urologic Cancers: Dr. Mistry and Donna Lee Discuss Options and Related Conditions
Donna Lee:
The Armor Men’s Health Hour is brought to you by Urology Specialists. For questions during the week, call us at (512) 238-0762 or visit our website at armormenshealth.com. The Armor Men’s Health Hour is a show dedicated to providing information on a variety of medical topics, some of which may include sensitive subject material about penises. All cases discussed have been done with the permission of the people involved and their penises.
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Welcome to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.
Dr. Mistry:
Hello and welcome to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, here with my cohost as always the wonderful and ever happy Donna Lee.
Donna Lee:
Hello everybody. I’m so happy.
Dr. Mistry:
I am a board certified urologist. This is a men’s health show and one that we are so happy and proud to be delivering to you. You know, we’ve hit over 7,500 downloads on our podcast.
Donna Lee:
I’m still wondering who these people are. Where..is it my mom? I don’t understand.
Dr. Mistry:
Is she just clicking over and over again?
Donna Lee:
Or maybe it’s the people who help us with it? They have to listen to it over and over.
Dr. Mistry:
I’m pretty sure half the listeners are just other urologists learning a thing or two.
Donna Lee:
Ooh, ouch.
Dr. Mistry:
Probably not anymore though. Our show is brought to you by the practice that we started in 2007, NAU Urology Specialists. We are made up of 4 urologists. We have two physician assistants, 1 absolutely amazing nurse practitioner, Leonora Brown. We have a nutritionist on staff, pelvic floor physical therapy, we do sleep apnea testing and sleep testing here in the office, we have a sex therapist in the office, and it is unlike any other urological experience that you’re likely to have had if you’re looking for a unique urologic experience.
Donna Lee:
Oh, that’s right.
Dr. Mistry:
Well maybe one that you didn’t have to pay full price for at least.
Donna Lee:
Well, that’s true. We are the second largest in town.
Dr. Mistry:
We are the second largest urology group in town and Donna Lee, why don’t you people about our offices and how to get ahold of us?
Donna Lee:
Right. You can call us at (512) 238-0762. We’re located in Round Rock, North Austin, South Austin and Dripping Springs. We have a brand new location right there on South Congress and William Cannon where the homeless people were not there, and now they’re back. So come on and visit… You’re looking at me like I’m crazy.
Dr. Mistry:
Well, this Corona quarantine is gonna create a whole bunch of new housing opportunities right under our awning.
Donna Lee:
That’s true. It’s just too much. You can send us your questions to armormenshealth@gmail.com, or you can go to our website and send your questions, or just check out our smiling faces at armormenshealth.com.
Dr. Mistry:
Well, questions and engagement from our listeners are absolutely important to the continuation of this show. I really appreciate all the engagement from people. If you have questions but are maybe, you know, not wanting to engage us through questions, you know, on our email, you certainly can feel free to make an appointment with our office.
Donna Lee:
Oh, I hadn’t even thought about that for a while.
Dr. Mistry:
That’s right. If you have a problem, you can come in and you can be seen. We do that. We actually do that. And we have a whole like panoply of prior episodes that are available on our podcast platform.
Donna Lee:
What was that word? Panoply?
Dr. Mistry:
Don’t even use it. It’s like monopoly, but panoply. It’s available wherever you get your podcasts from. It is Armor, A-R-M-O-R, armormenshealth.com. And not to get confused, you know, men’s health is only a component of what a urologist does and makes up, although an important component of what we do in our urology practice. We do take care of women for any number of things from urinary incontinence to interstitial cystitis, to pelvic pain, to kidney stones, to renal masses, any sorts of things that can affect a woman, we will treat urologically. And it just, we felt years ago it was important that men’s health issues are given a special consideration in, within urology. Just like how a gynecologist often does some aspects of primary care for women, we as urologists do think that there might be some aspects of general wellness and care that we could handle and do it for men because so many, so often men just don’t seek out this care on their own.
Donna Lee:
That’s true. And the, everything’s connected to the hip bone. I don’t know. It’s all connected, is what we’re trying to say.
Dr. Mistry:
Yes, yes, yes. The most important bone in the body, to say…
Donna Lee:
Yeah, winky winky.
Dr. Mistry:
Maybe I’m more like an orthopedic surgeon than you might have thought I was. But your questions please keep them coming, and I think Donna Lee, you have one for us?
Donna Lee:
We have a really good one. I was intrigued by this one and I can’t wait to hear your answer. And these are always a surprise for Dr. Mistry. It’s like a board game that we play. I try to trick you…
Dr. Mistry:
Panoply.
Donna Lee:
Panoply…but I can never stump you. But here it goes from a patient the other day: “Dear Dr. Mistry, I am 57 years old and just found out that I have lymph nodes in my lower stomach and the left wall of my pelvis. My doctor has referred me to an oncologist and a urologist. I have had a problem maintaining an erection for a couple of years now, and my question is, can these lymph nodes be putting pressure on my prostate?”
Dr. Mistry:
That’s a great question. I think we’ll take it in a couple different ways. The first question is what can cause increase lymph node size or something called lymphadenopathy in the pelvis, which is usually inside the pelvis where you can only see it by cat scan or on the surface, like in the groin area? And I think the reason that you are referred to both types of doctors is because the most common cause of these lymph nodes, if it’s not an infection, would be some type of cancer. Now lymph nodes usually drain or what goes through a lymph node comes from an area close to the lymph node. So when we look at lymph nodes in the pelvis, we’re thinking about, you know, the colon, we’re thinking about the prostate or the bladder–these are things close to those lymph nodes. And prostate cancer and bladder cancer specifically spread to these lymph nodes and can cause them to enlarge. When it comes to lymph nodes, you can feel in your groin, one of the things that can spread there is penile cancer. Now, most of the time, most men can tell if they have penile cancer, it’s not going to be a surprise to them. They’ll have a big ugly something on their penis. But a urological evaluation, that case is also completely warranted. Most of the time, if an infection isn’t suspected, then these lymph nodes can be biopsied. They can show some types of lymph node cancer or lymphoma. And that’s why an oncologist’s inappropriate person to be involved there. Next you get to the erectile dysfunction. 57 year old men, 50% chance of having erectile dysfunction. They could have no relationship to one another. And the lymph nodes themselves are unlikely to be leading to any pressure on the nerve leading to erectile dysfunction. However, if I just took it a step further and said, what if a person did have some underlying cancer, like a lymphoma or a bad prostate cancer or something that spread, then absolutely their body’s reaction to that cancer could lead to a decrease in testosterone, it could lead to a decrease in some factors that can lead to maintaining and keeping a rigid erection. There are certain kinds of cancers that could immediately impact a man’s ability to have an erection. More often though it’s going to be the treatment for those cancers that’s going to affect the erection, not the cancer itself. So just a wonderful question. I’m really hoping and praying that it isn’t some form of cancer and hopefully just some easy to explain thing causing those lymph nodes to be enlarged. But the erectile dysfunction is probably going to need a separate and complete evaluation. In our office, an evaluation for erectile dysfunction would certainly include a physical exam, also a hormonal exam. If you’re young, even 57, kind of qualifies, we would sometimes do a nerve test as well, something called a penile laboratory test, and then some blood chemistries. We want to make sure that your cholesterol is not too high. Your blood sugar is normal, because that’s what we would consider to be kind of a, you know, an all-in kind of evaluation for erectile dysfunction.
Donna Lee:
Right, and we do all that on site.
Dr. Mistry:
Absolutely.
Donna Lee:
Even blood work.
Dr. Mistry:
Yeah, and if you have lymph nodes that are enlarged, we have wonderful partners that can biopsy them, either in the hospital setting or the outpatient setting. And, these kinds of atypical presentation are things that we specialize in. So, if you’ve got that stumped somebody else, please come in and, you know, it’s something that we would love to help you navigate and something we have a lot of experience with.
Donna Lee:
Is it more important than he sees the oncologist first or the urologist first or does it matter?
Dr. Mistry:
That’s a great, that’s a great question. I don’t think it really matters. I think that the, if the main strategy is to go with biopsy the lymph node, it’s not even going to be either of those two people that does it. It’s going to be a radiologist that does it, believe it or not. If it’s just an isolated lymph node in the groin, then the urologist can remove it and the oncologist really can’t do anything until there’s tissue diagnosis. So, if I’m the urologist then I should see you first, but I’m not so sure that all urologists would be as kind of proactive to order these things before an oncologist sees them. But certainly in our practice we would feel very comfortable getting these things biopsied because we’d like to know what we’re dealing with because if it’s not cancer, then the oncologist is probably the wrong person to see next.
Donna Lee:
Oh, well that was an insightful answer. It’s like you’ve been to the Baylor School of Medicine or something.
Dr. Mistry:
It’s called Baylor College of Medicine. They’re going to kick me off the alumni association if you say it wrong again.
Donna Lee:
Oh, I’m sorry. The Baylor College of Medicine…
Dr. Mistry:
You know, they haven’t reached out to me once. I’ve got to be a pretty good like…something for them. I was once fired as a tour guide there.
Donna Lee:
Stop it.
Dr. Mistry:
That’s right.
Donna Lee:
Tell me more.
Dr. Mistry:
I was studying too hard. I couldn’t make it to my tours.
Dr. Mistry:
Oh, I thought maybe you were overzealous on your tour guiding. He just didn’t show up.
Donna Lee:
No, I was studying too much. Wow. Let’s just go with that one.
Donna Lee:
“Studying,” air quotes.
Dr. Mistry:
Donna Lee, why don’t you tell people how to get ahold of us.
Donna Lee:
You can call us and ask all about Dr. Mistry’s college life at (512) 238-0762. We’re located in Round Rock, North Austin, South Austin, and Dripping Springs. Our website’s armormenshealth.com and you can send us questions to armormenshealth@gmail.com. Remember, it’s armormenshealth@gmail.com and we will ask those, answer those questions on air anonymously. We’ll be right back after these messages.
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Dr. Mistry wants to hear from you. Email questions to armormenshealth@gmail.com. We’ll be right back with the Armor Men’s Health Hour.