How To Live Longer, Better with Prostate Cancer: Dr. Mistry Explains How Urologists Evaluate and Treat Prostate Cancer
Speaker 1:
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, a board certified urologist, here with my certifiable office manager practice administrator amateur sound engineer, Donna Lee.
Donna Lee:
Hi. My stomach is growling and then you sat down with food. So thanks.
Dr. Mistry:
This is very professional.
Donna Lee:
It’s going to make a great segment.
Dr. Mistry:
The Armor Men’s Health Hour is brought to you by our practice that we started in 2007, it’s called NAU urology specialists. We are a full service urology specialty organization, and by full service, we mean that we take care of all of you, when it comes to your urologic complaints. We take, you know, our new tagline, it’s going to be, “We put the ‘U’ in urology.” Specialized care individualized to you with a whole host of practitioners that you may not even imagine exists in a urology office. We have sex therapy, pelvic floor physical therapy. We really recognize the importance that sleep apnea plays on a number of urologic conditions, including low testosterone and frequent nighttime urination, so we test for that right out of our office. We have full supplement lines, so that if you’re taking something that you saw on late night television for your prostate, you know that what we have is exactly what we think he should have. We have treatments for…
Donna Lee:
The ads are cheaper at night, probably.
Dr. Mistry:
Maybe that’s what it is. Remember that everybody–you’re watching the ads of people that really couldn’t afford the morning ad. We have treatments for premature ejaculation, treatments for erectile dysfunction. We have weight loss programs, and really trying to get you to the next level of your urologic care. So if you’re trying to feel better, you’re trying to pee better, you’re trying to have better sexual relations, this is the place to come. And we also treat cancer: prostate cancer, bladder cancer, kidney cancer. In fact, the bulk of what I do surgically has to do with robotics and advanced endoscopic treatments of kidney stones and enlarged prostate, infertility, and cancer. And if you didn’t know what a urologist does, that’s a little quick little peek into it.
Donna Lee:
That’s right. They focus on the yum yums and the ding-a-lings.
Dr. Mistry:
And the ding-a-ling. I mean, that’s a very important part of what we do. We don’t just focus on the men, although you have given us a yum yums and ding-a-lings award.
Donna Lee:
For 2020.
Dr. Mistry:
That’s right.
Donna Lee:
Radio, “excellence in radio,” the award says
Dr. Mistry:
It would be embarrassing if we had to give an award to another urologist doing a radio show next year. You know what, they’re doing a much better show. We gotta give it to them.
Donna Lee:
They probably have a better label maker than I do, but I found these awards and they’re legitimate awards. They were given to me in life.
Dr. Mistry:
OK. We’re putting them on our Facebook page.
Donna Lee:
We shoud.
Dr. Mistry:
You can also listen to this as a podcast. It’s a free podcast available wherever you get your podcasts including Apple store, Google play, as well as Spotify and it’s even on your Alexa. So just say, “Play the Armor Men’s Health Hour.”
Donna Lee:
That’s right. If you’re at home, that’s kind of creepy, but cool. Say, “Play Dr. Mistry and Donna Lee.” Oh my.
Dr. Mistry:
It be right [inaudible].
Donna Lee:
One of the awards I have is actually , I was a local host for the local version of The Voice because of my comedy career that I was allowed to be the special guest. So there’s three of us. There’s like a singer, and then this other person…anyway , it was such a low budget thing that, you know in The Voice, when the chairs turned around with the electric chairs that turned around, we had stools and we had to like pitter patter our feet to turn around really quick when we wanted to see who was singing. But anyway, I got that award. Now it’s the ding-a-ling and yum yums award of 2020.
Dr. Mistry:
I love it. Well from that piece of levity to what is probably a little bit more serious, your questions to our show are really important to us. A lot of the questions that get asked to us are really sensitive, and we do get, try to get to them as quickly as possible. And this was a great question. So Donna, why don’t you share it?
Donna Lee:
That’s right. We have a weekly listener, so thank you for that. He said, “Dr. Mistry, based on slightly elevated PSA of 4.27, I just received the results from a biopsy of my prostate and received positive results on 4 of the 12 biopsy samples taken. What kind of questions should I ask when I meet with the doctor for the followup? What do I have to worry about? And should I get second opinions on what they found? I’m not experiencing any symptoms so far. Based on the four positive biopsies do I start some kind of treatments or continue to monitor with blood work? Thanks. I listen every week.”
Dr. Mistry:
What a great question. And this is a dilemma that so many are going to face , virtually 300,000 men are going to face in the United States every year. And so what to do when you are found to have prostate cancer. So what I tell patients is, you want to know how much cancer do you have, and that’s the 4 out of 12 biopsy, of course. How aggressive does it look? And that’s where the Gleason score comes into play. So that’s going to be a number like 3 plus 3 or 3 plus 4, 4 plus 3, or 4 plus 4.
Donna Lee:
What do you want?
Dr. Mistry:
You want the lower, the number the better. So you want a Gleason 6 because that’s going to be a little less aggressive for the most part. Then your urologist is going to play a little game and not a bad game, but a good game. So what I do in my office is I input all of your information into a special thing called the prostate cancer nomogram. It’s online at the Memorial Sloan Kettering Cancer Center. It’s called prostate cancer nomogram. And he put in all the information and it tells you what’s the likelihood that with your biopsy, when compared to thousands of other men, that your cancer is likely to have already spread, or is likely to spread in the next 10 years. And 10 years is our marker for when we think we should make a decision about whether to treat a man. So if there’s a high likelihood that the cancer is going to progress or spread in the next 10 years, and the guy in front of us looks like he’s going to live 10 years, then we decided to treat. If the guy in front of us does not look like he’s going to live 10 years, then we might choose not to. Now where there are a lot of error comes into play, is that people live longer sicker than ever before. And so dying of prostate cancer is a bad way to die. So we would prefer you die with it, not of it. So if treating you, you know, in a way that kind of lessens the likelihood of having to die from prostate cancer is an option, that may be something we choose even if you have a few medical conditions. A lot of questions that you should ask, have to do with what do you do, what options do you offer when it comes to treatment of prostate cancer? So, although this may sound insulting to some other urologists, if you don’t do radical prostatectomies doing, using the robot, then perhaps you will be less apt to recommend it. You know , if you don’t have a hammer in your tool belt, you may be less apt to suggest it. If your urologist has a financial interest in a radiation center, then don’t be surprised if they are going to recommend radiation. So what national data has shown is as urologists own more and more radiation centers across the country, that they recommend radiation for patients that they normally would have said, “Watchfully wait.”
Donna Lee:
That sounds so wrong.
Dr. Mistry:
Well, I mean, it is, it’s a natural inclination. So in our life we do HIFU or high intensity focused ultrasound. I speak about it. I don’t have an ownership interest in HIFU , but you know, I do get paid for doing it. And so, in our practice, HIFU may be something that gets offered to you. That’s the treatment. Now where we try to focus where you’re going to find not everywhere is what else can you do? Almost everyone asks me, what should I eat? And I can’t even imagine what they say in the other urologist practice. Do they give them a book or what they do? But we have Shefaly Ravula–she’s a integrative health specialist and a nutritionist. She’s a PA, and she’s going to meet with you and through our whole program of what we do nutritionally. Some people may ask, well, what’s going to happen to my erections, to my quality of life, with different forms of treatment. And we’re here to minimize the side effects and maximize the oncologic outcomes. You don’t get enough information just by knowing that it’s 4 of 12 [ inaudible]–you have to know how aggressive the disease is and a lot about you. How long would we expect you with your medical history to reasonably live a good life, and can we offer you a treatment that’s going to help you live a longer life better? Because in prostate cancer, even more than other cancers, you have the issue of lifestyle and quality of life that you have to take into consideration. But no matter how much we try to help guide patients through this decision, something else plays a role. And that’s what I call with my patients, sometimes the decision is more psychology than biology. I meet guys all the time, “I have cancer in me–cut it out, cut it out, cut it out.” I meet guys all the time, “I have cancer. I don’t care. Nothing’s going to kill me. I never want any treatment of any sort.” They’ll say, “I hate radiation.” Some people will say, “I hate surgery.” They’ll come in with a bias. A lot of times, the wives, if the husband says he doesn’t want treatment, t hat wife w ill look side items say, “You’re getting treatment. Y ou k now, you’re definitely getting treatment.” A 45 year old guy with 2 young kids at home, that’s a different consideration. I mean, that f amily i s g oing t o want that guy around. So even if I have to do whatever it takes, you know, I used to make the analogy that you go to MD Anderson, they put a mark across the word cancer, so they’re g oing t o cut you in half to get you cancer-free if they need to, especially if you’re young and they feel that you justify an aggressive treatment. But that may not be your decision. And so we c alled this “shared decision making” when it comes to prostate cancer treatment. So the questions you should ask or make sure you know, what your doctor does themselves, because that may bias their answers, perhaps what their financial incentives could be when it comes to treatment options that they offer. And you should always get a second opinion. If your guy doesn’t do robotic prostatectomy, you should go to a guy that does robotic prostatectomy. If you go to a guy that doesn’t own a radiation machine like us, we don’t own one, and if you come to us and you want to go to a radiation machine or radiation second opinion, you should do that. If you weren’t offered HIFU for your cancer, then you should go to s omebody that offers that. And if you haven’t been offered a nutritional or a more natural approach, you should, you should perhaps try to seek out one of those. And so getting the most out of your care is what we try to do. And if you’ve been diagnosed with prostate cancer, Donna, how do people get a second opinion from u s?
Donna Lee:
You can call us at (512) 238-0762 and send us an email to armormenshealth@gmail.com.
:
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