The Armor Men's Health Show

Bonus Episode: What Every Man Should Know About Prostate Cancer Treatment: Cyberknife, HIFU, and More!

• Dr. Sandeep Mistry and Donna Lee

Share episode

In this segment, Dr. Mistry and Donna Lee respond to a listener who wants to know more about the Cyberknife treatment for prostate cancer. This listener’s PSA (prostate-specific antigen) levels are increasing and he wonders what treatments Dr. Mistry recommends for his cancer patients. 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 three main options he recommends for his patients: radical prostatectomy (removing the entire prostate), HIFU, and Cyberknife. While each has its merits, Dr. Mistry prefers to steer patients away from the Cyberknife, which uses fewer, more intense treatments than traditional radiation therapies but also has more side effects. If you or someone you love have questions regarding prostate cancer treatments or are seeking a second opinion, we would love to hear from you!

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


Speaker 1:

<silence>

Speaker 2:

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

Speaker 3:

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

Speaker 4:

Coho

Speaker 3:

Co-host, host , host <laugh> called you , a co-host.

Speaker 4:

You were German for a moment. Ha . Hey everybody, welcome to the show.

Speaker 3:

Uh , this show is brought to you by the urology practice that I started in 2007. We are all over central Texas. Really? Just all over Austin. <laugh> . I wouldn't say all over Texas . <laugh> . We're all over Austin . Well,

Speaker 4:

It's perspective.

Speaker 3:

It's a perspective. That's right. Austin is the center of Texas, though .

Speaker 4:

That's right. If you're in South Austin, you need to go to our Round Rock location. That's Central Texas.

Speaker 3:

That's central Texas. So , uh, Donna, how do people get a hold of us and how do they make visits all

Speaker 4:

Over central Texas? You can call us at (512) 238-0762 our website, armor mens health.com. Submit your questions. We love these questions and we are, like we said, round Rock North Austin, south Austin and Drooping Springs, Texas

Speaker 3:

When you come and see us as a patient. And we had a patient , uh, that came just yesterday from Wyoming for a vasectomy Really? During our vasectomy , uh, piece. Um , did,

Speaker 4:

Did we tell him that he didn't have to travel that far or we said, Hey, you get a free T-shirt

Speaker 3:

<laugh>. Yeah , we did give him a free T-shirt. Luckily <laugh> , uh, for making the trip. Wow . But he wanted IV sedation. He wanted the mystery vasectomy. Oh , he wanted a single incision. No metal clipped vasectomy. Nice. So for those of you out there contemplating a vasectomy , uh, we would encourage you to come in. Uh , people are coming from all over the country. Really? That isn't even the farthest. We had a guy that came from Oregon , uh, two years ago. We had this guy from Wyoming, and then about 10 years ago, we had a guy come all the way from Saudi Arabia.

Speaker 4:

Wow. That's right. Yeah.

Speaker 3:

That's a pretty impressive travel .

Speaker 4:

It's funny you say that 'cause I just talked to somebody. I do have a question for you, but if you answer this first one quickly, then maybe we can get into the second question Totally. Regarding vasectomies. Um, let's say a friend of mine who wants her husband to have a vasectomy and he's ready to have a vasectomy, but he won't, he keeps putting it off because he is worried about his quote unquote , manhood disappearing. Why did you guys think that they think their sex is gonna be different? They think the is gonna be different. Well,

Speaker 3:

Just the idea of having a man handle you that way

Speaker 4:

And your handles you , you're big hands .

Speaker 3:

I mean, I'm, I'm an expert and I'm very gentle.

Speaker 4:

Well , that's true. You know what I'm saying? I have seen vasectomy is very nice,

Speaker 3:

Very gentle. Um, and so , uh, I I think that there's so many

Speaker 4:

Things' when you cut the testicles for no reason that I appreciate it . You're like, oh, look at these little guys. Any flutter your fingers. See

Speaker 3:

What I'm saying is that kind of statement that make men think that somehow they're less of a man because they let somebody touch them. They might like it. But really there is the baseline kind of anthropological issue here, which is that we were put on earth as animals to procreate. Mm-Hmm. <affirmative> . And we are somehow not going to procreate anymore. And so does having a vasectomy take away a little bit of your manhood in the same way women often feel that way after a hysterectomy. Mm-Hmm . <affirmative> . So it's, it's in no way is it like unique and in , in no ways is it kind of really abnormal to feel that. However, children are expensive and women oftentimes are expensive, don't do well <laugh> on, on contraceptives. So either you have to wear a condom, which people don't wanna do either. Right? Like, so then it's about choosing the least of all evils,

Speaker 4:

Which is a vasectomy.

Speaker 3:

More kids, crazy wife, auto oral contraceptives or a condom. Mm-Hmm . And so when you have to weigh all these different options, sometimes a vasectomy seems like a really good option for you. And it's so easy. We are seeing so many young men today , uh, that have no kids that are interested in having a vasectomy. And , uh, we are open to that. If you're over the age of 18 and you can medically consent for yourself, we will do a single visit, no scalpel, IV sedation, vasectomy. We encourage you to come on board . What's the question, Donna? Uh ,

Speaker 4:

My PSA is slowly climbing based on quarterly measurements. At some point, is it possible that I will need treatment to that end? I notice lots of TV advertisings in the past about CyberKnife technology and wondering more about that for prostate cancer. I do not know anything about this mechanism. And is it premature to assume that its efficacy is high? He is interested in CyberKnife. He continues, but wants to know , um, your thoughts. Um, and he wants to ask for the listeners and he appreciates your show.

Speaker 3:

Well, that's excellent. So the first question is, what do we do about PSAs that are rising? Mm-Hmm. <affirmative> . And the second question is specifically about treatment for prostate cancer with a treatment called CyberKnife. The first thing I'll say is that PSA is a blood test that measures a protein that's made by the prostate. This protein actually has a purpose, right? The pro PSA actually is the protein that helps semen break down from solid to liquid. So if you've ever really examined your, you may notice that sometimes it comes out very , um, gooey and then it has to liquefy. And the PSA is what helps liquefy the semen after it comes outta you. Is

Speaker 4:

It normal to be gooey or liquified?

Speaker 3:

Which it doesn't matter. But in order for it to function, it has to be liquified. I see. It can come out liquified or it can come out gooey, but it better get liquified pretty quick. Mm . Or else it'll slip out of the vagina and won't be able to fulfill its purpose. I see. So that is the purpose of the PS. A years ago, they noticed that A PSA over four was a sign that you may have prostate cancer. And in general, the studies show that A PSA over four affords about a 40% chance of having prostate cancer. Hmm .

Speaker 4:

Four over four or 40% chance?

Speaker 3:

That's correct. Okay . So when you're in that , uh, in that grouping , uh, then a prostate biopsy or some type of sampling of the prostate , uh, could be in order. The younger you are, the lower the PSA should be. So if you're in your forties, the PSA should be around two. And if you're in your seventies, sometimes we allow your PSA to drift up to six. Oh. Now in our practice, of course, we're trying to find prostate cancer. So I'll usually, if you're young, have a lower threshold. But anything over four, usually I will biopsy it if I think you're healthy enough to undergo it. Okay. We'll do an MRI. We can even do some more advanced PSA tests . But if your PSA is rising and a rising PSA of anything more than 0.75 in any given year would be considered highly abnormal and worthy of an evaluation. And that's kind of what we would expect as a abnormal rise. Mm-Hmm. <affirmative> . But if your PSA is rising and approaching four , then I think a urologic evaluation is fully warranted. The next question is, what are your treatment options after being diagnosed with prostate cancer? And first we do test to make sure that it's localized to the prostate. We wanna make sure that it hasn't gone outside of the prostate. Mm-Hmm. <affirmative> . Next, if it has not gone outside of the prostate in our practice, we offer three treatments. We offer radical prostatectomy, which is to remove the prostate. Mm-Hmm. <affirmative> . Then we offer FU or high intensity focused ultrasound that burns the prostate while it's in your body and is best for treatment of cancer. That's only in one area. Hmm . So we call that focal treatment. Mm-Hmm. <affirmative> . And the third treatment is radiation therapy for prostate cancer. And if you've been listening to the show, we've had two great radiation onco , three great radiation oncologists, in fact. Mm-Hmm . <affirmative> . You can search them up. Uh, Courtney Schine with text oncology. Mm-Hmm. <affirmative> . And then we've had Dr. Piman Fui and Dr. Uh, Doug Rivera. Mm-Hmm . <affirmative> . So three radiation oncologists with previous podcasts that have discussed the ins and outs of radiation therapy. Dr. Doug Rivera is the one that currently in Austin does CyberKnife Mm-Hmm. <affirmative> CyberKnife sounds amazing. It's this fancy way of doing things, but in fact, almost all machines can do what CyberKnife does. So almost all radiation oncologists can offer something called SBRT therapy. Oh . And that is where you do the therapy. It's high volume. Mm-Hmm. <affirmative> short course treatment. So they can usually do it within two weeks or five treatments. You can get the whole thing done where traditional radiation therapy will take 45 treatments in nine weeks. Okay. Now I have them on, they're friends of mine and I trust 'em to make the best decisions for their patients. Right. Okay. And so we send them all the time. My own personal opinion is that there's probably some difference between five treatments and 45 treatments. Oh , <laugh> , you think probably something. Right? And I , I think , yeah . It's called 40 treatments and , and listening to the Beatles is great. I'm not sure it's better to listen to the Beatle Beatles. Louder. Oh . So by turning the intensity and the energy delivery up for these technologies, I personally think that you're getting, you might not be getting something for nothing. Meaning that there might be increased urgency and frequency and increased risk of, you know, other things that might get affected by the radiation. So my own personal advice to my patients as well as to my own family members is just to, if you don't have anywhere to be, then just do the 45 days. They're nice to you. Mm . It's quick in and out. You get to ring a bell at the end. I mean, <laugh> , you know , so if you have cancer and you need to do radiation, you'll, you , you know, you'll become friends. Yeah. Over there. And 45 treatments , uh, I think has really low , um, uh, complication rates. And if you're sitting at home and you're 70-year-old and you're, and you're retired, I mean,

Speaker 4:

What else do you ,

Speaker 3:

Aren't you looking for something to do? Oh , <laugh> , let's , let's go for nine weeks. You know ,

Speaker 4:

Five two pop in your Netflix on your phone.

Speaker 3:

That's not to say people don't do well with CyberKnife. And obviously, you know, they're there. And if I trust Dr. Rivera to take care of you, that means I trust him to give you advice. And if he and you think that CyberKnife is best for you, then I'll be fully supportive of it all right ? But as I give advice to, to patients and to family, I tend to push more towards the standard IMRT, which takes 45 treatments traditionally. And there's little, little nuances here and there. Mm-Hmm. <affirmative> . But if you've been diagnosed with prostate cancer, you should come to us for a second opinion. We don't own a radiation machine uhhuh , which means that I'm not financially motivated one way or the other. Yeah. So if , you know, if you're going to a urologist and they get financially motivated to send you to a particular radiation machine, you gotta think about that. Maybe , maybe there's something that , uh, could be , uh, you know, filtering their advice to you. Mm-Hmm. <affirmative> , we would love to see you as a second opinion. I think everybody with prostate cancer should get a second opinion. Donna, how do people get that second opinion? You

Speaker 4:

Can get your second opinion or first opinion by calling us at 5 1 2 2 3 8 0 7 6 2 during the week. And you can check out our website, armor men's health.com. Check out our podcast wherever you listen to free podcasts. And thank you again, Dr . Misery .

Speaker 3:

Thank you, Donna.

Speaker 2:

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.