Armor Men's Health Show

"Suspicious" Prostate?: Dr. Mistry Explains What Your Prostate Biopsy Results Mean

• Dr. Sandeep Mistry and Donna Lee

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Thanks for tuning in to the Armor Men’s Health Hour Podcast today, where we bring you the latest and greatest in urology care and the best urology humor out there.

In this segment, Dr. Mistry and Donna Lee answer a listener's question about blood in the ejaculate after a prostate biopsy and what the biopsy results really mean. Seeing blood and even small tissue remnants in the semen or urine after a prostate biopsy is completely normal, although amounts should decrees over time rather than increase. Regarding the results of the biopsy, it is important to remember that most prostate cancers are slow growing and can be observed for changes over a period of time rather than requiring immediate treatment. Your treatment plan should reflect not only the nature of the cancer, but also other factors like age and other health problems. While living with cancer may seem intolerable to some, and "suspicious" biopsy results have a high chance of coming back positive when retested over time, "watchful waiting" is a common treatment recommendation for prostate cancer due to its slow-growing nature. If immediate treatment is necessary, HIFU (high intensity focused ultrasound) is an excellent option for killing the cancer while preserving continence and sexual function. If you or a loved one have a high risk for prostate cancer or have had a "suspicious" or positive biopsy result and would like a second opinion, please give us a call. 

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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

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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, your host, your exuberant host.

Donna Lee:

You're so happy.

Dr. Mistry:

Maybe a little too loud in the microphone. Here as always joined by my cohost, my practice manager, and partner in crime here, Donna Lee.

Donna Lee:

And one of your best friends.

Dr. Mistry:

There you go.

Donna Lee:

That's right. Hello! Happy day, everybody.

Dr. Mistry:

Happy day, everybody. This is a men's health show. I'm a board certified urologist and very proud to be providing this show and all this information to the listeners of KLBJ news radio.

Donna Lee:

And the world.

Dr. Mistry:

And the world.

Donna Lee:

Mr. Worldwide. We're in a few different continents, countries. There are listeners overseas learning about their junk from Austin, Texas.

Dr. Mistry:

Their Yum Yum's and Ding-a-lings. This last week in the clinic, we had a wonderful patient who came to us from another doctor after hearing the show. And he said that,"You know, one of your shows...it was real."

Donna Lee:

It was real?

Dr. Mistry:

It was real.

Donna Lee:

Wow. Touched a nerve, did it?

Dr. Mistry:

He said that we taught him how to use his Viagara better, we gave him more confidence on what to expect about his prostate issues. And then he said,"And I told my financial planner that I need$6,500 put aside for penile enlargement." I think giving people the price was the best, because now they have like a goal in their mind.

Donna Lee:

That's funny.

Dr. Mistry:

"Well, if I don't have any McDonald's for the next three weeks..."

Donna Lee:

No Starbucks, carry the two.

Dr. Mistry:

Carry the two....I can have a bigger, I can have a bigger phallus by Christmas.

Donna Lee:

Wow! That's awesome. That was Dr. Dellinger who was talking about girth and, yeah...fillers.

Dr. Mistry:

That's right. And the fillers that we offer as a partnership between our practice and his, for men with who are looking for some genital enhancement.

Donna Lee:

Yeah. We had an, I also took a patient call during the week of the same thing. It must've been a really popular segment that day because he was called and he said,"Yeah, I was listening to the radio and I want to know how to make my penis bigger!"

Dr. Mistry:

Right thing, right time, you know? Our urology practice was founded in 2007, right here in Austin, Texas--the heart of central Texas. And we have offices now all throughout the area and are open to seeing patients and open for business right now.

Donna Lee:

That's right. Coronavirus what?!

Dr. Mistry:

No, Coronavirus is a very serious disease, Donna.

Donna Lee:

Oh, yeah. Whatever. I'm just, just a little tired of it.

Dr. Mistry:

Social distancing. Masks. Wash your hands. All that's the same.

Donna Lee:

We're wearing our masks, that's true. But I am ready for, to not be wearing my mask. It's getting old. But we are in Round Rock, North Austin, South Austin, and Dripping Springs...wearing our masks.

Dr. Mistry:

That's right. We are available by televisits. We're available in-person visits. We see patients of all urologic type issues, both men and women, whether they be kidney stones, infertility, low testosterone, prostate issues, prostate cancer. And I feel one of the most holistic and cutting edge practices that you're going to find.

Donna Lee:

Yup. We also added on a new provider, so she's joining us soon. And I think that she was super impressed with that holistic discussion we had with her.

Dr. Mistry:

I think making sure that we can provide you care to the best of our ability and scientifically available. We had a patient this week who came to see us for fertility issues. And although we gave them the medicines to improve their sperm count, what really changed his life was the fact that we found a gluten sensitivity. It made his energy better, he lost 20 pounds, and his sperm counts are through the roof.

Donna Lee:

Really? That's a great story.

Dr. Mistry:

That's right. And then we had another case of a patient who's had a worsening hemoglobin, A1C level, which means that they're, pre-diabetic. It's been going on and on for quite some time--they were being threatened with medication. And then after meeting with our nutritionist, they were put on a diet plan program. And along with testosterone and along with the diet nutrition plan and along with treating of the high blood pressure, they lost weight. And they're no longer pre-diabetic.

Donna Lee:

No, it feels great, I bet. That's awesome. What a great holistic approach.

Dr. Mistry:

It's a wonderful thing that we do. Your questions really feed this show and keep us going just like your presence in our office makes me happy to get up in the morning and makes Donna proud to be part of such a great practice. So we'd love to see you as a patient. And I'd love to hear your questions.

Donna Lee:

Yeah, we have a bunch.

Dr. Mistry:

Yeah. Donna, give us a question.

Donna Lee:

That's right. This particular person was driving around on a Saturday and he caught our show. He said it was very good timing, in his case. He had a recent prostate biopsy done: one area low grade cancer, then two were considered suspicious and for additional evaluation. I saw a blood and now what looks like tissue over the two weeks, but nothing significant. I had one ejaculation and also saw the redness or dark brown in the semen. My question is, is it healthy for the prostate to get as much residual blood out as soon as possible?

Dr. Mistry:

Well, first of all, very importantly, ejaculation is healthy. So keep it up. Yeah, there was, there was a study that once showed that the more, that the number of ejaculates correlated with a lower risk of prostate cancer.

Donna Lee:

Right. My husband keeps reminding me of that study. Thanks.

Dr. Mistry:

That's right. I mean, all you're doing is damaging his chances of living without prostate cancer by, you know what I'm saying? I mean, you only have...anyway. So, the point is that ejaculations after a prostate biopsy will lead to some blood in the ejaculate and certainly getting it out is probably in your best interest. I guess how I would advise you is that if the color of the blood is bright red, so it looks like it's actively bleeding, then I might give the prostate a little bit of a rest. But if it's darker red or brownish, then certainly, you know, cleaning the tube is going to be in your best interest. There's no damage to your partner or risk to your partner from having that little bit of a bloodstain, staining of the, of the semen after a biopsy. Having some blood in the urine and even maybe what may seem like tissue passage is not necessarily abnormal, but if you can't pee or if you're a couple of weeks out and the bleeding seems to be getting worse, or you're having urgency and frequency or any other problems, then you need to get in to get a urine culture to make sure that you don't have a urinary tract infection that's causing worsening. So things should be getting better every day, not getting worse. And so if things are getting worse--and I'd say that for almost any surgery. If things, if you're in pain, you're in more pain, more pain day after day, that's probably a sign of something bad. If it's less and less, you should be improving after, you know, most procedures that we would do for example, on a daily basis. Now getting to the other part of that question, and we don't have any information about this, this man, we don't know how old he is or what his symptoms are, what his PSA was, but it sounds like he had a multi-core biopsy of his prostate with one positively identified as cancer and two suspicious for cancer. This is a real dilemma for many patients to decide what to do. What do you do if you're given a diagnosis and told that this is a very slow growing disease, that is not dangerous? And this is where psychology sometimes overcomes biology. That is the, what is the psychology of living with cancer? And if this is the kind of thing that's keeping you up at night and you're having lots of trouble dealing with it--even if they tell you it's not life threatening your doctor--you may want to hear an opinion for treatment. One of the best treatments that we offer that exact scenario is high intensity focused ultrasound. It's a focal therapy. We just treat where the cancer is, we leave the rest of the prostate alone.

Donna Lee:

Very little side effects, if any.

Dr. Mistry:

Well, I mean, there's, we've had exceptional success. Our program here in Austin is one of the busiest in the entire country of patients that come from all over the country to get the HIFU procedure in our practice. It is one that we can do in a way that preserves your, your potency and your continence so that longterm side effects can be minimized. And it doesn't take any other future kinds of treatment off the table. First, you got to decide if it's worth treating. If you're older, if you're not in great health, then they may be reasons to not treat. We also worry sometimes that large prostates or certain types of prostate cancer may be under sampled in a disease like that. So we almost always try to get an MRI of the prostate to make sure there's no big lesion that was under sampled during the course of that biopsy. And if you've already had a biopsy and your insurance wouldn't pay for an MRI beforehand, it will pay for one now, once you have a diagnosis of cancer. We usually wait about three months, let the prostate cool-down after the biopsy, and then go ahead and do an MRI of the prostate gland. And so that will tell us if maybe you were under sampled. You have two additional areas that are abnormal or suspicious, but not diagnostic of cancer. And I tell what I, how I explain that to patients is that, we diagnose prostate cancer based upon what the cells look like under the microscope architecturally. And so if there's not enough abnormality to get to the threshold of cancer, then it's called suspicious. But if you rebiopsy a guy who's suspicious, more than half the time you find cancer, you'd find more that architecture. So in my mind, when I see"suspicious, but not diagnostic" for, you know, I, you know, I kind of assume that, you know, 50% of the time I'm going to find cancer if I biopsy them in that same area. So that gives me an idea of what, what they're in for. If you're young, if you're 45 years old and you have prostate cancer, you know, you may want to consider treatment, because even a slow growing disease is going to have many, many, many years. One of the tools that we use is the Memorial Sloan Kettering prostate nomogram. If you are interested, we'll put it on our Facebook site, the link to the, this nomogram. You put in the information about your cancer, about your age, about your PSA, and what gets spit out is,"What is your risk that this disease is likely to progress with or without treatment?" And that's very valuable.

Donna Lee:

Huh? Interesting. Well, what a great question.

Dr. Mistry:

That was a great question. Donna, how people send us questions and how do they get ahold of us if they want to make an appointment?

Donna Lee:

That's right. You can call us during the week at(512) 238-0762. You can send us your amazing questions that we'll answer anonymously, and I will respond to every one of them to let you know when we're going to discuss your question so you can listen in or receive a free podcast link. It's armormenshealth@gmail.com. Again, that's armormenshealth@gmail.com. Our website is armormenshealth.com, where you can see, like I always say, Dr. Mistry's smiley, handsome face so you can get a, I dunno, meet and greet by website. And then you'll want to make an appointment, and then you can call us.(512) 238-0762. And we really appreciate y'all listening.

Speaker 2:

The Armor Men's Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.