EP 661: Dr. Mistry Answers Listener Questions About Life After Prostate Cancer Treatment

In this segment, Dr. Mistry and Donna Lee respond to listener questions about life after prostate cancer treatment. Despite being one of the most common cancers affecting men, prostate cancer has a low mortality rate because it is highly treatable. Dr. Mistry explains the benefits and drawbacks of each main treatment option he recommends for his patients: radical prostatectomy (removing the entire prostate), HIFU, and Cyberknife. If you or someone you love has been diagnosed with prostate cancer or an elevated PSA, contact NAU Urology Specialists today to learn more about cancer treatment 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.

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Phone: (512) 238-0762

Email: Armormenshealth@gmail.com

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Transcript

Speaker 1: 0:00

<silence>

Speaker 2: 0:07

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

Speaker 3: 0:15

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

Speaker 4: 0:23

Hello. Welcome everybody. Welcome to the shoe .

Speaker 3: 0:26

I was at the hospital the other day , uh, and , uh, one of the ultrasound techs said that she loves our show and she says that we make a great team. And I couldn't agree more. Oh , that's

Speaker 4: 0:35

So sweet. Did she say that we were super cute? That's

Speaker 3: 0:37

As well . No, she did not use

Speaker 4: 0:39

Them . Oh , okay . That's the important part. Those

Speaker 3: 0:40

Exact words.

Speaker 4: 0:41

<laugh> . Alright .

Speaker 3: 0:43

I'm a , uh, board certified urologist is a men's health show. We love to talk about all the issues that ale you between the nipples and the knees. Uh, and , uh, Donna, we are taking new patients. Uh, we have , uh, six wonderful urologists and interventional radiologists. We have six , uh, excellent advanced practice providers. That's , uh, PAs and nurse practitioners, two pelvic floor physical therapists, a health coach and a sex therapist, and a strong desire to treat all of you as a whole person when it comes to your ur urologic needs.

Speaker 4: 1:12

Why is it such a tongue twister? Your urologic? I get it. How do

Speaker 3: 1:17

People get ahold of us

Speaker 4: 1:18

Appointments ? Well, there was a really appointments , yeah . There was a really long wait in the past until these new doctors showed up, so you don't have a long wait anymore.

Speaker 3: 1:23

And we're answering our phones

Speaker 4: 1:25

<laugh> . Oh , yeah , that's right. Which is nice. We have a 93 second hold time, apparently, so that's awesome. But you can reach out to us at 5 1 2 2 3 8 0 7 6 2. Our website is armor men's health.com and we're available Monday through Friday. You can even ask for me, we're in Round Rock, north Austin, south Austin and Dripping Springs, Texas.

Speaker 3: 1:43

We have a question from one of our listeners.

Speaker 4: 1:45

We do. I had a very sweet talk with a patient yesterday. Of course, he will remain anonymous, but I thought you might find this interesting for other listeners who might be going through the same thing. Let me just start with saying he's terrified. He said he's probably got prostate cancer as he's been diagnosed , um, by his PCP, but not yet seeing the urologist. He will be. He's a patient. But moving forward, what he said to me, which really struck me, is that he's completely nervous and anxious and terrified. He asked , um, though, after hearing some of our podcasts, how PAE Prostate artery embolization plays a part in having a really big prostate and possible diagnosis of pretty serious prostate cancer. And his words to me, basically worst case scenario is there life after a full prostate removal.

Speaker 3: 2:28

That's a , uh, a great set of questions. And, you know, being concerned and afraid of a cancer diagnosis is completely normal. And finding the right partner to guide you through that process to give you proper information to expediently get your workup done. Mm-Hmm. <affirmative> , these kinds of things are very important in keeping you informed. My , uh, stepmother just this last week was diagnosed with breast cancer. Oh . And , uh, I could see how the, she's not in medical and so every step in the process is like one huge mountain you've gotta climb. Mm . Not knowing anything about the process. Right. And it's, you know, a tendency of mine to kind of calm her down and try to give her reassurance, but sometimes that's not, that's not it. You just have to be there to listen and that's Mm-Hmm . <affirmative> something that we have learned about our own patients as well. Uh , being your doctor is really important, but being your advocate through this cancer process is just as important. Mm-Hmm. <affirmative> , because we need your trust as we go through this decision making process. So , uh, first and foremost, I would just tell this particular patient that he probably had an elevated PSA given to him by his primary care doctor. Mm-Hmm. <affirmative> . And he's really concerned that that is going to mean cancer. But for those of you out there that have been given a diagnosis of a high PSA, and generally we consider that over four in anyone. Mm-Hmm. <affirmative> . But really there are age-based numbers as well. So , uh, for me in my practice, if you're under the age of 50, that number should be under two. If you're under the age of 60, the number should be really under three mm-Hmm . <affirmative> up to 70. I'll give you a four, and maybe if you're older, we'll give you a little bit of a higher number. And the size of the prostate definitely correlates with the PSA. So you understand cancer can give you a high PSA, a big prostate can give you a high PSA Mm-Hmm . <affirmative> an infection can give you a high PSA or they could exist together. And so that can become confusing.

Speaker 4: 4:24

Where's the infection? Possibly just any infection,

Speaker 3: 4:27

A prostate infection. Oh. So this will be like ,

Speaker 4: 4:29

But you're like a finger infection?

Speaker 3: 4:30

No, a finger infection's. Unlikely. Okay. <laugh> . Um, but also, and you get , uh, interesting to that point is that we consider PSA to be an inflammatory biomarker. So we do have patients that have high PSAs, and we think that it's due to some sort of bodily inflammation. And so that's where our health coach steps in Mm-Hmm . <affirmative> to try to give dietary and lifestyle advice to help reduce inflammation, which we think makes cancer's not as bad. And other conditions. So sometimes you do have a high PSA, but you don't have a very bad cancer. So the , so the two aren't correlated. Right . So that's where I think inflammation is playing a role in making a high PSA.

Speaker 4: 5:09

So has that always been the case? Because I was telling this patient that 10, 20 years ago, a high PSA might've been scarier because the diagnosis was so serious and the procedures were more limited.

Speaker 3: 5:19

Those are perhaps the case. But in the past, because PSA was not used as much Mm-Hmm. <affirmative> , you didn't find somebody until they were very advanced.

Speaker 4: 5:28

Oh,

Speaker 3: 5:29

I see. And so in those cases, those patients ended up being a lot sicker. But prostate cancer is the most commonly diagnosed cancer in men. That's non-kin. So it's the most common solid organ cancer. Mm-Hmm. <affirmative> . Uh, and it really causes the death of very few people because it is such a slow growing disease. And that death rate is even decreasing even more because of great and more advanced and even focal therapies that, that we offer and other people offer. So getting to his very last question, is there life after prostate removal? Well, certainly there's life after it. We remove thousands of prostates , uh, you know , uh, within our own , uh, practice or treat prostate cancer many, many, many times. Mm-Hmm. <affirmative> , uh, over the many years I've been removing prostates robotically for 20 years. Mm-Hmm. <affirmative> . I'm one of the few people remaining nowadays that could still remove it with a knife if I had to. What open? I know. <laugh> . What is that? These kids today? <laugh> <laugh> . Um, and, and understanding how to do that case properly and to make sure that we keep you whole as a man Hmm . As much as possible is something that we take a lot of pride , uh, and work in. Mm-Hmm. <affirmative> , the two things that you're likely to have suffer from prostate removal is your erections as well as your ability to hold your urine or your continence. Mm-Hmm. <affirmative> . So sometimes men are, what they're really saying is there's really no life if I can't get my own erection. Mm . And I, I understand that sentiment. Yeah. But people lose their erections as part of age-related issues all the time. And we are not having, you know, a bunch of men just jumping off bridges. Right. Because we have great treatments for Ed. If you're motivated, if there's a will, we'll find a way that's right to get you an erection. And

Speaker 4: 7:10

We don't have very tall bridges around here,

Speaker 3: 7:12

<laugh>. Thank God, <laugh> . And so we want to , um, we want to make sure that , uh, you are intact and we really focus on your continents, because although not getting an erection may seem like the bigger issue, really, what affects your lifestyle in terms of going out and playing golf and all the things that you want to do? Mm-Hmm. <affirmative> , uh, in your , uh, uh, later years , uh, we wanna make sure to remain intact. There's other things that many people don't think about. If you're diagnosed in your forties , uh, and you're need to get remarried, then your sexual functioning plays a very, very big role. Mm-Hmm. <affirmative> in kind of how you're gonna find a partner and things of that nature. Maybe you still want to have kids. You want to know if being able to have kids is still a possibility after prostate removal. So , uh, keeping your life intact is a very important goal of ours. That's why we have a sex therapist, pelvic floor, physical therapist, health coaches, things like that on our staff to try to maximize not just your cancer care, because quite frankly, many, many, many urologists out there can just take your prostate out. Right. That's a skillset . Mm-Hmm. <affirmative> , the real art of medicine is helping make sure that you remain intact as a human being. Good point . As you go through this process,

Speaker 4: 8:20

And we've had this podcast separately with one of our pelvic floor physical therapists, Dr. Rodin , who talked about prehab and rehab after a prostatectomy,

Speaker 3: 8:28

And how important it's to get in touch with, you know, men don't really know about this concept of getting in touch with your body except, except physically, except for three or four times

Speaker 4: 8:37

A week, <laugh> .

Speaker 3: 8:38

Uh , and so it understanding how we actually have a lot more control over our bodily functions, especially when they've been disrupted with surgery. Mm-Hmm. <affirmative> , I think is , uh, is really important. Interesting. The next part this patient is asking is, what role does prostate artery embolization, which is where we cut off the, the blood flow to the prostate, have in prostate cancer? Mm-Hmm. <affirmative> . And I'll tell you, it would be, it would be erroneous for our listeners to believe that prostate artery embolization is a treatment for cancer. Correct . 'cause although it sounds great. Mm-Hmm. <affirmative> taking the blood flow away, it is not sufficient to kill cancer. Mm-Hmm. <affirmative> , we, however, do use PAE in two different situations, and both of them have to do with downsizing the prostate prior to other therapies. So you have a very big prostate. They give you the same amount of radiation if you're gonna pick radiation for your cancer, whether you have a really big prostate or really small prostate. Mm-Hmm. <affirmative> . Similarly, if you get high intensity focused ultrasound, high food therapy, that's the focal therapy where we use ultrasound just to kill the part of the prostate that has cancer, oftentimes that procedure works better in a smaller prostate. So by doing prostate artery embolization, we are able to shrink the prostate, get it to be smaller, and then we believe have better rates of treatment efficacy with radiation and hy food therapy . So , mm-Hmm .

Speaker 4: 10:00

That it's a combo.

Speaker 3: 10:01

The summary here is this, first of all, don't assume that a high PSA or an abnormal test means that you have cancer. Number two, not all cancers are the same. In fact, most cancer of the prostate isn't that dangerous? Mm-Hmm. <affirmative> number three, you have to find a partner in your urologist that's going to help take care of your cancer, as well as take care of you as a person. And then prostate artery embolization can be used in conjunction with other therapies to help maximize prostate cancer therapy. And so this is the messages that we'd like this listener to know, to know, Donna, how do people get ahold of us?

Speaker 4: 10:33

Well , they gimme all the warm and fuzzies. Thank you for answering that. Uh , you can call us at (512) 238-0762 and check out our website, armor men's health.com, and listen to our podcasts wherever you listen to free podcasts.

Speaker 3: 10:45

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

Speaker 4: 10:52

Hello everybody. Welcome back to the shoe .

Speaker 3: 10:55

You said that I'm a board

Speaker 4: 10:55

Certified back

Speaker 3: 10:55

In the day, back in the shoe .

Speaker 4: 10:57

Is it like Jack Par ? I don't know . I don't

Speaker 3: 11:00

Know . You're gonna , it's old . You're gonna embarrass yourself.

Speaker 4: 11:01

I know. Okay. I'm not that old. Okay . You ahead , Jack Benny?

Speaker 3: 11:05

No. If you , if you say so. Okay . I don't know . Uh, I'm a board certified urologist as a men's health show. We love talking to you about your questions. When it comes to men's health. Uh, we also sprinkle in a little bit of women's health in there. Do we? We know that many of our listeners are women, in fact. Mm-Hmm. <affirmative> . We already have Dr. Wang back and talk and do a little , uh, that's what she said. Segment.

Speaker 4: 11:24

We do, we have a couple of female , um, OBGYNs who wanted to join the show and talk about Oh,

Speaker 3: 11:29

We should definitely do

Speaker 4: 11:30

That. Yeah. Talk about men's and women's wellness. But those will also be called, that's where she said segments.

Speaker 3: 11:34

I love it. I love it. We are open for business as a urology practice. This show is brought to you by NAU Urology specialist. The practice that , uh, was begun in 2007, we are now much bigger than we were before. Our very first office Christmas party was just a , a three of us around a , a table. No , I , I think , uh, in our first office,

Speaker 4: 11:55

Really? Three of you sitting around at

Speaker 3: 11:57

Lunch. Yeah . And now I think we're gonna have 200 people at our next office Christmas party.

Speaker 4: 12:00

That's pretty good . We're gonna have a lot of people at

Speaker 3: 12:02

Christmas party . That's not, that's not bad in 16 years . Right. Uh , we think this community for all their support and we love giving back with this show, Donna, how do people get ahold of us and become a patient of ours? If

Speaker 4: 12:11

You can become a patient of ours and a sponsor of our upcoming Christmas party at 5 1 2 2 3 8 0 7 6 2 , our website, as always is armor men's health.com. And you can find us in central Texas, round Rock, north Austin. South Austin and Dripping Springs. I have a quick shout out though. Let's do it. Mr. Hoover Alexander, who owns Hoover's cooking in Maynard , Texas, adorable human being. He sponsored our previous Thanksgiving lunches at work, and he's just an adorable man. Anyway, he started this new , um, effort called Love Rocks Texas, and he's donating 33% of the proceeds to charity. And I thought that was really amazing. And some of the proceeds go to his amazing Hoover's cooking family. But guess what he did? So he paints these rocks and he has people paint rocks and he has them write love or do a love painting on the rock, and then he shares them with people, or he keeps 'em in his house, or his restaurant, or his truck. So he came the other day and he brought me a love rock, Dr. Mystery . And guess what? It's shaped like. It's

Speaker 3: 13:09

Shaped like a , a rocket ship.

Speaker 4: 13:11

Um, if, if that's what penises look like, <laugh> , that is correct. But I thought I have been given by one of our biggest fans, a penis shaped rock that says love on it. And I thought it was adorable.

Speaker 3: 13:21

Well , uh, he's an excellent , uh, human being. He's adorable . Uh , super nice. Yes . Uh , has been , uh, a friend of ours for, for a number of years. Mm-Hmm. <affirmative> always cooking our , um, holiday meals for us. Did , do you have a website or something so people can reach out to him?

Speaker 4: 13:35

That's right. You can reach out to Hoover's cooking and call them at (512) 479-5006. Or you can visit the restaurant. It's in Maynard , Texas, 2002 Maynard Road. And , uh, the address is Austin though, 7 8 7 2 2. But drop by he opens at 11 almost every day. And the cooking is outstanding. Um, I think you've had it right. It's amazing. Yes, of

Speaker 3: 13:56

Course. Every holiday. It's

Speaker 4: 13:57

Delicious. Every time. So anyway, shout out to Hoover's Cooking and all the wonderful people there listening to the show, and be sure to visit the restaurant.

Speaker 3: 14:04

All right . Well, thank you so much, Donna, for doing that. Um, let's talk about questions. We love your questions. We want your questions sent into us. Uh, and that's really what kind of guides us and , uh, gives us a fodder for this show.

Speaker 4: 14:16

Um , perfectly sending ourselves into the next question and segment because of the last one. You can also send your questions to arm men's health.com. There's a little button at the top right that says, submit your question. We'll answer them anonymously. This one is , uh, for you Dr. Misre , obviously. Hello, Dr . Misre . Are prostate biopsy still needed for active surveillance following haifu treatment, high intensity focused ultrasound for low grade pc? And if so, how often?

Speaker 3: 14:41

That's a great question. You know, on this show, we've often talked about different forms of treatment for prostate cancer. It appears that this particular listener has had a high intensity focus . Ultrasound FU therapy FU therapy uses very high intensity ultrasound energy. The same ultrasound that we use to look at your prostate or to image your inside of your bodies , just like rays of light, we can focus them like a magnifying glass Mm-Hmm. <affirmative> to make the intensity of the ultrasound very strong. And that heat can actually kill tissue and kill prostate cancer. And that's where we use high intensity focused ultrasound to kill prostate cancer.

Speaker 4: 15:20

Every time you say that and describe that, I think of little kids sitting on the sidewalk with their magnifying glass or with a glass, and they're taking the sun ray and they're like killing little bugs. That

Speaker 3: 15:28

Sounds like a Lockhart thing. <laugh> in Sugarland, Texas, we were , uh, uh, helping the , the ants build bridges.

Speaker 4: 15:34

You were at the mall. I know. We were at the mall. We didn't have a mall in a Lockhart

Speaker 3: 15:38

<laugh> . So , uh, oh boy. Hate mail from Lockhart <laugh>. Uh , so , um, haifu therapy allows us to both image the prostate and treat the cancer at the same time, which allows us to do the treatment in a very focal way. So , mm-Hmm. <affirmative> , if only the top right needs to be treated, or only the bottom left needs to be treated, we can do that. Mm-Hmm . <affirmative> based upon where our biopsy was positive. And if you have a low risk prostate cancer, haifu is wonderful. It can maintain your continence, it can maintain your potency, so you can keep your erections. It takes all of about an hour and a half to do in the operating room. Mm . Uh , and it has minimal , uh, side effects.

Speaker 4: 16:17

But when you said, wait back up, you said for minimal, a minimal prostate cancer, meaning how, what's the size or number

Speaker 3: 16:23

You'd like , you'd like a Gleason six cancer. And, and it , and it is different. This is certainly something that has to be kind of evaluated. Yeah . Conversation with your, with your doctor, your health, your age, your cancer. There are many different considerations, but the , the , the important takeaway is it is possible to just treat the part of the prostate that has cancer. Mm . Without removing it or radiating the whole thing.

Speaker 4: 16:45

That's amazing.

Speaker 3: 16:46

And not every urologist offers this. In fact , uh, a very small percentage of urologists in the country offer it. Um , here in Austin, I think there's probably only four people that offer it. Mm-Hmm. <affirmative> , uh, all throughout Texas, there's only maybe four machines that are able to do the procedure.

Speaker 4: 17:03

You've done the most,

Speaker 3: 17:04

Even, even in such a big state. And we have done many, many, many procedures because , uh, uh, we were one of the first ones to get into it. And then we, when it was cash based , we charged a third of what everybody charged. Mm-Hmm . <affirmative> . So we had a lot of patients that traveled for it, and then now insurance covers it. And since it's a part of our practice and we have so much experience with it, we're able to provide that procedure with excellent , uh, professionalism. And

Speaker 4: 17:27

Shout out to you, you've trained other urologists on the HIFU procedure.

Speaker 3: 17:30

That's right. I'm a proctor for the HIFU procedure, and we of course, trained our own new partners here on it as well. So what do you do afterwards though? And that's a great question because I , I think , uh, when you're facing the mountain of a cancer diagnosis, again, all you're worried about is getting over Mm-Hmm . <affirmative> this first treatment decision. But you have a life to live after that . How do you monitor your cancer afterwards? If you've had your prostate removed, your PSA should go down to zero. And then we just look for PSA elevations. Mm-Hmm . <affirmative> to tell us that the cancer may have come back. This

Speaker 4: 18:03

Is a dumb question. Is , um, there ever a prostate number if the prostate's completely removed? Is it , is it always zero because it's gone ? It

Speaker 3: 18:10

Should be zero . It should be, it should be zero or makes sense or near zero. And so if your PSA is rising or coming back after your prostate removed was removed, that means that some cells have escaped either right. Where the prostate used to be called the prostate bed. Mm-Hmm . <affirmative> or to other places like lymph nodes or other organs. And then we have to look for them and we'll do some scans to look for

Speaker 4: 18:31

It pesky .

Speaker 3: 18:32

If you've had radiation, we will also monitor your PSA Initially, it may go down low, but it may take a couple years to go all the way down because the, you think of radiation kind of like a Star Wars ray gun that kind of blasts and kills the prostate. Mm-Hmm . <affirmative> . But in fact, the death of the prostate occurs over time, months and even years. Oh . And so that , that , that reduction in PSA may take a , you know , kind of a prolonged time. And then we'll just see how the PSA goes up after that. I see . And if it appears to be doubling or the PSA number seems to be going too high, then we might have to look for the cancer having returned. Then we have patients who have high FU or high intensity focused ultrasound. And why this is important is because as I mentioned before, we didn't treat the whole prostate. We just treated the area where the cancer was. So if your prostate develops another cancer in another part of the prostate, then we're gonna have to look for it. Every center of FU does it a little differently. And so, to answer this listener's specific question, some centers will always do a biopsy like at six months or a year. And we don't, we will wait until the PSA starts coming back or rising to a level that seems dangerous to us, and then we'll do another biopsy. Okay. And that's to minimize the number of unnecessary biopsies. Not to put you through so many things because

Speaker 4: 19:53

They're so fun,

Speaker 3: 19:54

Because they're not fun <laugh> . And , uh, and usually you're not gonna have a slow growing cancer year one. And then year three have a really, really bad fast growing cancer that, that, that transition doesn't usually occur. But we will keep a close eye on your PSAs and try to make sure that we are not missing something, because that's what we're here for. We're here to be your , uh, you know, early warning system on your prostate cancer coming back. So there's a pro and a con of focal therapy. The pro is you get to maintain your continence and your function and has minimal side effects. Mm-Hmm. <affirmative> the con is there's an increased chance that the cancer may come back. Mm-Hmm . And so being vigilant is the only way that we can help reduce the likelihood of risk with that strategy. Wow.

Speaker 4: 20:38

That's a lot.

Speaker 3: 20:38

That is Donna. How do people get ahold of us and people learn about fu

Speaker 4: 20:42

You can reach out to us and , uh, visit our website, armor men's health.com. That'll take you to our main website, which is NAU Urology Specialists or north austin urology.com. Our phone number's (512) 238-0762 . And you can see us in Round Rock , north Austin, south Austin, and Dripping Springs, Texas. Don't forget to listen to our podcasts wherever you listen to available podcasts. And we'd like to say to Hoover, we love

Speaker 2: 21:06

You. The Armor Men's Health Show is brought to you by NAU 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.