EP 617: When Prostates Attack: Dr. Mistry Tames Prostate Problems From Aggressive Cancer to Angry Bladders

In this episode, Dr. Mistry and Donna Lee answer listener questions about different prostate issues. For a anxious listener with advanced prostate cancer, Dr. Mistry warns against overly-aggressive treatments with major side-effects. And a listener with a bad urolift experience gets advice on dealing with his new bladder leakage. To learn more about your prostate symptoms and the treatments available at NAU Urology Specialists, give us a call today!

Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

We enjoy hearing from you! Email us at armormenshealth@gmail.com and we’ll answer your question in an upcoming episode.

Phone: (512) 238-0762

Email: Armormenshealth@gmail.com

Website: Armormenshealth.com

Our Locations:

Round Rock Office
970 Hester’s Crossing Road
 Suite 101
 Round Rock, TX 78681

South Austin Office
6501 South Congress
 Suite 1-103
 Austin, TX 78745

Lakeline Office
12505 Hymeadow Drive
 Suite 2C
 Austin, TX 78750

Dripping Springs Office
170 Benney Lane
 Suite 202
 Dripping Springs, TX 78620

Transcript

Speaker 1: 0:07

Welcome to the Armor Men's Health Show with Dr. Mystery and Donna Lee.

Speaker 2: 0:13

Hello and welcome to the Arm Men's Health Show. This is Dr. Mystery, your host joined always with my excellent co-host, Donna Lee.

Speaker 3: 0:20

Hello. Welcome everybody. So we have a little bit of new equipment and I get very excited cuz it's all super fancy from what

Speaker 2: 0:25

I'm looking at. We'll see. Everything was pretty good before, so it was

Speaker 3: 0:28

Not

Speaker 2: 0:29

<laugh>. I'm a board certified urologist. This is a men's health show. We have been giving you this show for almost two and a half years now. Almost three. Almost three years now. Yeah. We've gotten great feedback from our listeners. I love hearing from our nurses and doctors in the operating room telling us how much they enjoy, uh, listening to the show. Oh, uh, I'm, I'm a working urologist, so this is Yep. Just a side gig.<laugh> and, uh,<laugh>, this

Speaker 3: 0:51

Isn't

Speaker 2: 0:52

Your main gig every week some patient will come in and tell me some other myth that they thought was going on with the show and this week I heard that. Does Donna really work for you or do you just hire her out?

Speaker 3: 1:01

Oh,<laugh> to do dirty things.

Speaker 2: 1:02

I don't know.<laugh>, you're for what? I'm banger I'm not getting much<laugh>. No,

Speaker 3: 1:10

Nor is Michael.

Speaker 2: 1:10

That's right. So Donna has been with the practice for, what, seven years?

Speaker 3: 1:14

Almost six

Speaker 2: 1:15

Years. Six years. Uh, she's got six little sperm pins. We give you a per sperm pin for every year that you're with us here at our clinic. Makes

Speaker 3: 1:21

For good small talk at the gas station

Speaker 2: 1:23

<laugh>. Which is funny because every time I stop at the gas station with our truck, with our logo on it, somebody talks to me about their testicular pain. Mm,

Speaker 3: 1:30

I bet. Cuz it's got a big old set of balls

Speaker 2: 1:31

Hanging off the back. It does have a big set of balls. Our practice and this show is brought to you by N A U Urology specialists. We have four offices, we have four physicians, we have five mid-level providers, two pelvic, four physical therapist, sex therapy, health coach, and a really, uh, holistic view of how we're gonna take care of you as our patient. Mm-hmm.<affirmative>, uh, we love your questions, Donna. How do people get ahold of us?

Speaker 3: 1:52

You can reach out to us to armor mens health.com. You can submit your questions there and find out if I really am an employee, if I'm a real boy and<laugh>, you can call us during the week at 5 1 2 2 3 8 0 7 6 2. You can even ask for me, which happens now. Every week people will call and ask for me. So that's nice. I can help answer your questions cuz I'm a doctor.

Speaker 2: 2:09

That's right. No, you're not<laugh>. The the questions that you send us, uh, really mean a lot to us. Uh, it's, uh, especially engaging that people will remember our email address, armor men's health gmail.com and then ar o r and then, uh, send us emails, uh, when they get out of their car. So, uh, Donna, what's the question? We

Speaker 3: 2:26

Got? Uh, we have a pretty recent question. We have a little backlog, so I apologize on the wait for some of these folks, but I will, we will get to you, I promise. This person sent in Gleason score five plus four, PSA 4.6, biopsy positive in 14 out of 18 cores. PET scans showed no metastatic spread genomic score 0.99 surgery two weeks ago. Pathology showed all lymph nodes clear, margins clear and no spread. Two surrounding tissues, one nerve bundle spared age 74, very little incom incontinence. If my PSA in four weeks is zero, would you you recommend any follow up radiation or a D T chemotherapy? My surgeon is reluctant to damage healthy tissues or tissue unnecessarily. I agree, but I also don't want any stray cancer cells to escape. Almost done. My decipher score indicates 34% positive response to a D t and 94% positive response to chemo. Well, that's all. I didn't understand any of that.

Speaker 2: 3:17

That's fine. So I'll just kind of break it down. Okay. So this 74 year old man mm-hmm.<affirmative> had a PSA that was just barely high. Right. And what he was gifted with for a barely high PSA was a terrible disease. He has a very aggressive prostate cancer that was probably taking over most of his prostate. 14 of 18 cores is a pretty significant disease. Oh. If he was in good shape, meaning he was active and able to, you know, pretty healthy, you know, even though he was over the age of 70, uh, I would've offered him a radical prostatectomy as well. And that's what this patient got. More than likely he had a robotic radical prostatectomy. That's the way that most of us do these surgeries nowadays. Okay. Takes about two hours. It's done in a hospital. My patient stay overnight, but many doctors now are sending patients home the same day. I think that it's just nicer to stay in the hospital overnight and get some extra care, but that doesn't really change anything. You keep a catheter for between 10 days and two weeks depending on your surgeon. Mm-hmm.<affirmative> and the catheter comes out. So this, this patient just had his catheter out and luckily he's dry because impotence and incontinence are the two side effects that most people associate with a radical prostatectomy. And that's kind of what makes people not want to do it because of, because of that. Right. But there's really no solution for prostate cancer that's better than surgical removal. So although it's a pretty, uh, radical as we say, uh, approach to, uh, the surgery, uh, or to to, to your prostate cancer, it is the, the solution that leads to cure at the highest rate. It's an amazing thing that this patient had negative margins and negative lymph nodes and a negative PET scan because such an extensive Gleason's nine cancer oftentimes have spread. And this, uh, listener is very astute in thinking that maybe there's something microscopic that may have already spread and that maybe doing something more aggressively to kind of kill anything that could have got gotten out is in his best interest. Mm-hmm.<affirmative>. So he's very smart to think that. So when we do this surgery, uh, we have lots of little tests that we can do. So, um, this patient had what's called a decipher test that's on the actual prostate specimen that was removed surgically. We can look at the genes. It's really cool. We can, we do these tests where we look at the genes and see whether this is a more aggressive gleasons nine or a less aggressive Gleasons nine. And it gives us some insight into whether or not we should do radiation early or late to kill anything that might have been left behind. So, um,

Speaker 3: 5:41

Is that new that gene test?

Speaker 2: 5:43

That's it. The gene test and the introduction of this kind of way of thinking about when to do treatment is certainly in the last 10 years, which may not seem brand new, but it's pretty brand new. Hmm. It, it may seem like all, all doctors read the same books,<laugh>, but it's not really the case.<laugh>, uh, you know, if you've graduated or you've been in practice for 10 or 15 or 20 years, um, the way that you practice medicine is more similar to the way you, you learned it. Mm. And that's true of, of a lot of people. It's not just true of urologists, but the data and the information and the change in practice pattern starts with the academic doctors who are in big universities. It, it flows to their people that they're teaching that just come out mm-hmm.<affirmative>. So, although the people that just come out of training may know the latest and greatest<laugh>, that doesn't mean they can do the latest and greatest because they're just babies. You know,<laugh>, they gotta, they gotta learn where they're That's true. You how to tie their scrub still in practice,<laugh>. So, um, so although they may have a lot of book knowledge, some of the, uh, really important knowledge of kind of how to take that book knowledge and, and really put it upon patients, uh, is important. And this is a great example of how sometimes book knowledge mm-hmm.<affirmative> and patient care knowledge can change. So what have we derived from this listener? He is very, very, very much wanting to live. Yeah. Right.

Speaker 3: 7:06

Been very knowledgeable about

Speaker 2: 7:07

His health and he wants to live. Yeah. And he wants to take the most aggressive course of action to try to kill any cancer that might be left behind. Mm-hmm.<affirmative>. And what I would say to this listener is that going early with androgen deprivation therapy, which is to take away all your testosterone mm-hmm.<affirmative> is probably not the greatest idea because number one, he seems like he's pretty young, healthy, and like virile. Mm-hmm.<affirmative> and taking away all your testosterone's gonna make you feel tired, pretty tired, you know? Yeah. Hot flashes, you know, your breasts are gonna grow. Oh, you're gonna feel fatigued. Uh, I mean, you're gonna be Donna essentially<laugh> Wow.<laugh> except with not as great hair. Oh, that's right. Or big boobs. And so, and so, um, uh, going with androgen deprivation therapy in the, when there's no cancer that you can see is probably, in my opinion, gonna make you feel worse than it's gonna make things better. Hmm. Same with the chemotherapy. Another thing, and although I don't know your specific case, the fact that you had such a bad disease and such a low psa mm-hmm.<affirmative> just barely over four. Right. Me. Makes me believe that maybe your cancer does not make PSA quite like you would expect. Because sometimes the worst cancers, the worst prostate cancers, they forget that they're prostate, they don't even know they're prostate. They might think they're some, some other organ, so they forget to make psa. So the number just doesn't, so in some people the PSA is not a very good judge of how aggressive your cancer is. And this particular listener, I would put him in that category because wow, you would expect such a, such an extensive disease to have a PSA of 15 or 20 or at least eight or or 10. Right. Certainly not four. And so, um, with that in mind, um, sometimes when we have a patient where the PSA is not a very good marker of prostate, uh, mass, uh, those patients, uh, don't respond to androgen deprivation therapy as well either. Hmm. So, um, if I were the doctor for this, uh, particular listener, I would recommend waiting a little longer, you know, maybe three, six months. And then he gave us some, some conclusions of his decipher test. But the one part that he didn't tell us is what is the likelihood that he would respond well to early radiation therapy? And that piece of paper that he's gonna get is gonna tell him that. So if it says that there's more than a 30% chance that he would benefit from early radiation therapy, then I would do it. Okay. Because number one, he had a bad cancer. Mm-hmm.<affirmative>, number two, the genomics will support it. And number three, he, uh, you know, in his email dust seems very aggressively wanting to kind of be proactive about getting rid of anything that might be left behind. Mm-hmm.<affirmative>. And if he's not leaking, which is the biggest reason not to do radiation early, I would say go for it. Wow. What a great question. That was good. Donna, before we take a break, how do people get ahold of us?

Speaker 3: 10:06

Reach out to us at 5 1 2 2 3 8 0 7 6 2. Our website again is armor men's health.com where you could submit your questions that will answer anonymously just like these. And you can listen to our podcasts wherever you listen to free podcasts. Please follow us, download us. We've had over 160 something thousand downloads, so be part of the party. Thanks so

Speaker 2: 10:26

Much. Hello and welcome back to the Armor Men's Health Show once again, this is Dr. Mystery board certified urologist and your gracious host joined always with our business development manager for our practice. Uh, Donna Lee.

Speaker 3: 10:37

Hello everybody. Welcome back to the Armor Men's Health Show. I said the hour the other day, arm Men's Health Hour. We used to be an hour,

Speaker 2: 10:43

We used to be an hour. We really were four 15 minute segments<laugh>. It was very confusing to the people that are helping

Speaker 3: 10:48

Us today. We had a guy overseas that listened to an 11 minute podcast and he said, I'm confused as to why your show is called The Armor Men's Health Hour, because I'm listening to 10, 11 minute segments

Speaker 2: 10:58

Because this is America and things go so fast.<laugh>, we do an hour and 11 minutes.<laugh>, I'm a board certified urologist. This show is brought to you by N a U Urology specialist, the practice that I started in 2007 here in the Austin Metropolitan area. Donna, how do people become our patient? Because we do see patients lots of,

Speaker 3: 11:15

Well first you need to be patient because we're a little busy, but you can call us to become a patient at 5 1 2 2 3 8 0 7 6 2. Please have your insurance card ready. I think patients forget that we have to take all of the information and when I talk to vasectomy patients, that's just a foreign thing. They'll text me, Hey, I wanna vasectomy on this day. Thank you. And that's all I get. So we'll need more information when you call us and you can reach out to us through our website. It's armor men's health.com. Uh, that will link you to our parent company, which is n a u Urology Specialist. So you can see all of our services and providers and stuff.

Speaker 2: 11:45

That's funny that they do that because we try to make the vasectomy experience so easy. Mm-hmm.<affirmative> and Seamless. It's a single visit so you don't have to make two visits. Mm-hmm. Like most people, people have to, you get IV sedation here, so you don't have to worry about picking up any medicines before you get here. We even have jock straps for sale here. Try to make it so easy. Right. And they still just want it. So there's a hole in the wall and you just have to stick it in there and just get it done and drive away. Is that

Speaker 3: 12:06

Like a, what is that? That's dirty. Right?

Speaker 2: 12:09

I don't know what that is. It's when

Speaker 3: 12:11

You, anyway, okay. I'm

Speaker 2: 12:13

Serious. You're older than I am. You know, you know, you know some things that I

Speaker 3: 12:15

Don't know by like a month and a few years. Few years. Okay. Well, we have more

Speaker 2: 12:18

Questions. Let's go with another question.

Speaker 3: 12:20

All right. Well, we just talked about the previous person's PSA and prostate cancer issues. This patient sent in a question, says hi, on March of this year, I was told that I had an enlarged prostate and a result. And as a result had a lift done. I was told that I would be good to go in about three days. I ended up going to the emergency room uhoh for being unable to urinate and consequently put on a catheter. Ever since then, I'm having bladder leakage issues. I was given medication and recently had Botox done of the bladder. Probably not his face. None of these are working. And I'm asking for your guidance. Please respond to this email and thank you for

Speaker 2: 12:53

Your help. Well, that's great. And you were wrong. It has nothing to do with PSA or prostate cancer.

Speaker 3: 12:57

No, you, well you said in large prostate,

Speaker 2: 12:59

You, you, you really paired two questions that don't matter match.

Speaker 3: 13:02

No, he said enlarge

Speaker 2: 13:02

Prostate. It's gonna make it very hard to put a title podcast. It's gonna

Speaker 3: 13:05

Be called Podcast episode Podcast. It's gonna be called all of the above Regarding your Prostate

Speaker 2: 13:09

<laugh>. Okay, very good. Let's first start with, and, and remember for those listeners out there, I'm just getting like whatever you email us mm-hmm.<affirmative>, and I'm not even reading the email, I'm just listening to whatever Don is telling me.<laugh>. So half the time she can't even pronounce the words right. I

Speaker 3: 13:21

Can't

Speaker 2: 13:21

<laugh>. So, so in this case, we have somebody who says they were diagnosed with an enlarged prostate. Mm-hmm.<affirmative> who got a eurolift. And a euro lift is a way of taking care of quote unquote BPH h using these special, um, sutures with two clips on it that kind of move the lobes of the prostate away out of the way of the urethra to allow you to have a, a clear flow. First I'm gonna start with the fact that when you're diagnosed with an enlarged prostate, really how big your prostate is has nothing to do with how, what your symptoms are. So you can have a very tiny prostate and still have urinary symptoms or a big prostate and not have any symptoms. When you are diagnosed with enlarged prostate, what we're saying really is either somebody put their finger in your rectum and but booty to booty home and found that your prostate was larger than they felt your finger, their finger test would say is normal, but really what they're feeling and how big your are really have no correlation with one another. The only way to really know how big your prostate is with a was with an ultrasound, uh, or an mri. This patient had symptoms either a slow flow urgency and frequency or incomplete emptying. And their urologist felt that a uro lift was the best option. You're supposed to be able to pee immediately afterwards because the UroLift doesn't actually block anything. And this particular patient three days later wasn't able to pee. What could have happened is swelling from the Euro lift because of the procedure caused the, some blockage of the urinary system. And then they had to have a catheter placed. And then the patient says, subsequently they developed urinary incontinence. Now all of that doesn't sound right. None, none of that sounds right. No. Number one thing is, if you put something in and it makes everything worse, you should take that thing out.

Speaker 3: 15:00

<laugh>. That's what she said.<laugh>,

Speaker 2: 15:04

If it's not working for you, you gotta get that sucker out. Yeah. And although again, because I don't know this particular case, I will say that one of the most common complications of a eurolift can be that one of the clips accidentally was placed in the bladder.

Speaker 3: 15:21

Oh

Speaker 2: 15:21

No. And if it's in the bladder, it can cause you to have irritation and cause you to leak. Oh, no. And the Botox is certainly not the right way to go about

Speaker 3: 15:30

It. Oh

Speaker 2: 15:30

Really? Now, I don't think that most urologists would've made that mistake. So I'm guessing that the leakage was already there to start with. That's what I'm

Speaker 3: 15:39

Guessing.

Speaker 2: 15:40

<laugh>, I'm I'm guessing the, the leakage was pre-existent.

Speaker 3: 15:43

Oh,

Speaker 2: 15:43

Okay. Because any patient that gets it, if, if you, if you have a and you do B, and now your symptoms are C, you cannot discount the fact that your intervention could have caused it. Hmm. And the nice thing about the euro lift is that it's reversible. I mean, you can, you can cut those clips out, especially if you did the Euro lift and you know where the clips are. Oh. But oftentimes I get patients who had a Euro lift done elsewhere and I don't know where they are, so I gotta like go hunt them all down. Oh. So we'll read the operative note, get an idea of where they might be, how many clips we're supposed to find. And although you cannot remove all the components of the Euro lift mm-hmm.<affirmative>, you can remove a good portion of them. I've had a few patients that had severe, severe reactions to the Euro lift. The, um, the clip is made of a, a substance called nickel. Mm-hmm.<affirmative>. And initially, way in the beginning when we did Euro lifts, people are allergic. You had, you had to have a nickel allergy test. Oh. But then the, but then the number of people that were allergic were so low they stopped requiring it. But there's, there's some people out there that are allergic to nickel. Right.<laugh>. And so both of those patients that I've had over the years that you put the, the euro lift in and almost immediately they're miserable. Oh. And so we go back and take'em out and they have, and they're fine. They're perfectly fine.

Speaker 3: 16:58

What's the backup then to euro lift with nickel?

Speaker 2: 17:01

Uh, ironically in the process of removing it, you actually remove a lot of prostate tissue and they pee. Great<laugh>.

Speaker 3: 17:07

Oh, stop.

Speaker 2: 17:08

So,

Speaker 3: 17:08

Oh, that's funny.

Speaker 2: 17:09

<laugh>. So, um, so if, if for this listener, uh, and for those of you still paying attention,<laugh>, if you had a procedure done and you had a Euro lift put in and you were only since the Euro lift, did you have problems then, then, you know, let your urologist or let me take it out.

Speaker 3: 17:27

Oh,

Speaker 2: 17:27

And let me cut'em out. If the, if the leakage was preexisting mm-hmm.<affirmative>, then you might need both. You might need a more extensive surgery on your prostate. Mm-hmm.<affirmative> and the Botox both together might, might help. Mm. Um, and so the and

Speaker 3: 17:43

The Botox is of the bladder. That's correct. Or the folks who don't know why we keep talking about Botox.

Speaker 2: 17:47

Botox. So we wanna get, get those wrinkles out of the bladder. Mm-hmm.<affirmative>, uh,

Speaker 3: 17:51

It's

Speaker 2: 17:51

A pretty bladder. Botox is a medication that works on smooth muscle tissue to stop it from contracting. That's what causes wrinkles. Mm-hmm.<affirmative> in our forehead. It can cause that contraction can lead to, uh, discomfort in the, um, uh, in the neck causing migraines. So we use Botox in the neck for migraines

Speaker 3: 18:11

And the are

Speaker 2: 18:11

Pits for sweat. And then, and then the, the, the smooth muscle that goes around sweat glands, you can put Botox around those to cause them to not contract either. And that causes, that helps you with not sweating mm-hmm.<affirmative> and in the bladder. And, and we use it in, uh, people with neurologic issues where contraction of smooth muscle and even, uh, in that case, uh, even some, uh, nons smooth muscle can cause contraction of the limbs. Mm-hmm.<affirmative> so that they don't completely extend. And in the bladder we use it to, uh, help us. Um, uh, the bladder not overly contract or feel like there's a lot of urgency and that helps with urgent continence. Hmm. Now I assumed that this patient was having urgent incontinence. If he was having stress incontinence, which means that he's leaking when he coughs and sneezes and gets out of a chair. Mm-hmm.<affirmative>, then that means that the U lift damaged his sphincter. And although again, I think it's highly unlikely the way we put these in makes it less likely to endure this sphincter. And it's just very unlikely that his sphincter was injured. But if his sphincter was injured, then that's a whole nother, you know, ball of yarn.

Speaker 3: 19:19

Why is sphincter a funny word?

Speaker 2: 19:21

<laugh>. Because you think of your blood hole every time.

Speaker 3: 19:23

<laugh> booty hole<laugh>.

Speaker 2: 19:27

Uh, that's

Speaker 3: 19:27

True in

Speaker 2: 19:28

The tanks. Sorry, kids. Uh, we are adults. Uh,

Speaker 3: 19:30

Don't forget the taint. We are Oh, we got a complaint about that. I forgot to tell you. We are adults. We had a lady calling. I said, our, our show was ridiculous. The commercials are embarrassing and we've lost all of the respect of the community.<laugh>. I said don't listen to the show, lady<laugh>.

Speaker 2: 19:44

Yeah. Please don't listen to the show.

Speaker 3: 19:45

Just turn it

Speaker 2: 19:45

Off. We lost the respect of the community.<laugh> tell our six month wait list. Exactly.

Speaker 3: 19:51

<laugh>, whoa word

Speaker 2: 19:52

<laugh>. How do people get ahold of us to join that wait list?

Speaker 3: 19:54

You can call<laugh> five two two three eight zero seven<laugh>. Sorry. 5 12 2 3 8 0 7 6 2 oh. That was a perfect response. Thank you. I needed that cuz I was angry at that lady. Our website is armand's health.com and then, um, our podcast, listen to our podcast wherever you listen to free podcasts. They are amazing. And you can download them and share them with your friends, the friends you don't like or the friends you like.

Speaker 2: 20:20

The best part about that lady mm-hmm.<affirmative> is she had to have listened to part of the show. Mm-hmm.<affirmative> gotten offended,<laugh>, and then waited to the end to get our phone number.<laugh>. That is great. I think she doth for test too much.

Speaker 3: 20:31

Bless her. I did call her, but she didn't call me back.<laugh>. So call me back lady. Um, again, armor men's health.com give us your questions like these and we'll answer them anonymously. And thank you so much Dr.

Speaker 1: 20:42

Misre. The Armor Men's Health Hour is brought to you by Urology Specialist. For questions or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at armor men's health.com.