KATZ'S CORNER - - 08 - 04 - 24

Episode Transcript

Speaker 1 (00:00):
The following is a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.

Speaker 2 (00:09):
The following program is brought to you by NYU Land
Going Health. It's Kats's Corner with doctor Aaron Katz. You're
trusted expert in men's health, providing straight talk on a
wide range of men's health topics and advice on how
to live your healthiest life. Now on seven ten woor
It's the Chairman of Urology at NYU Land Gone Hospital,

(00:32):
Long Island. Here is doctor Aaron Katz.

Speaker 3 (00:37):
Now, good morning everyone and welcome again to Katz's Corner.
I hope you are all having a wonderful Sunday for
Sunday here in August. Amazing how quickly the summer is
going here. Hope you're all doing well. We are live
this morning, coming to you live from Fire Island, actually
staying in a an old friend of mine who has
a beautiful place out here and is letting me stay

(00:57):
with him for the weekend. Really appreciate that. And if
you'd like to give me a call, the number is
eight hundred three two one zero seven ten. That number
again is eight hundred three two one zero seven ten.
Thank you so much everyone, and wonderful to be with
you today. We did have some exciting news at NYU,

(01:19):
not only for the hospital but for the urology department
the hospital. The rankings came out by US News and
World Report, and I'm very proud to say that the
NYU healthcare system is ranked number two. The hospital is
number two the system in the country, and for urology.

(01:41):
Last year we were number three and this year we
are number two in the country. So I'm very proud
of that. And you know, I also many people ask me,
so how do they go about these rankings, and you know,
how does the US News and World Report come up
with this? And it's based upon a number of things.
The first is obviously the overall quality of the hospital

(02:03):
and the overall patient outcomes, and has to also deal
with the types of patients that we're treating the complexity
of the patients. And then they look at how often
the patients that are coming into the hospital, let's say,
for surgery, need to be readmitted into the hospital after
they leave the hospital, how many cases you're doing, the

(02:26):
types of surgeries that you're doing, and certainly at our
hospital here on Long Island and in the city, we're
certainly doing a large majority of our cancer cases now robotically.
I've talked about this quite a bit on Katz's corner,
but for the most part, I would say ninety eight
percent of all of our cancer cases, our kidney cases,

(02:49):
our prostate cases are all done robotically, and even the
majority of our bladder cancer cases now are doing robotically.
It's rather extraordinary to me to recreate, to remove a
let's say, an organ of bladder, and then recreate a
new bladder for someone, all with a robot and with

(03:10):
very small incisions, and the patients obviously can leave the
hospital much quicker, there's much less blood loss, there's much
return to normal activity and work so forth. So really
really proud of all of that, I must say, And
it certainly takes a lot of effort. It's not obviously
just one person. It's a huge team of people, not

(03:33):
only the physicians, the nurses, the pas, the medical assistance,
everyone that really joins in and makes this extraordinary effort
happen each year. And I know the Dean Dean Grossman,
is very proud of us and he certainly expects a
lot and wonderful to have an incredible leader like doctor

(03:56):
Bob Grossman and Ken Langollen who's the chairman of our
book or who strives for perfection and strives for excellence,
and really I'm very proud of that we are alive
this morning. If you'd like to give me a call,
the number is eight hundred three to two one zero
seven ten. One eight hundred three to two one zero

(04:16):
seven ten. A lot of patients continue to come into
the office with complaints of getting up at night urinary issues.
What to do about that, They're feeling like they're not
emptying their bladder. We see occasionally some people that coming
in too late, unfortunately, and at that point that the
bladder is full of urine, you can put pressure on

(04:39):
your kidneys. We have some patients that have recently come
in unfortunately, we get a blood test and their kidneys
are showing failure. So if you are having early warning
signs and you've mentioned this to your primary care doctor
or you want to come and see us, definitely get
in to see the urology a urologist for a quick evaluation.

(05:01):
It doesn't have to be an extended evaluation. You know,
you want to come in and make sure that you're
not having a urinary tract infection. You want to do
a quick ultrasound in the bladder, make sure your bladder
is empty. You know, if you're feeling like you're you know,
you're getting up a little bit too many times at night,
you're run to the bathroom during the day, and maybe
you're not emptying your bladder. You know, God has only
given us one bladder. And if you know your bladder

(05:22):
starts to distend and becomes too full of urine, it
is a muscle, the bladder, and you're putting pressure on
that muscle. So you know, and you want to, of course,
get the blood test for prostate cancer. The PSA certainly
have talked about that a lot on the show, and
an excellent It remains the best still today after thirty

(05:45):
years in clinical practice, the best best test for detecting
prostate cancer. So we'll we'll go to the we'll go
to the phones. If again, if you'd like to give
me a call eight hundred three two one zero seven
ten here on Kats's corner. I think we have a
call from Joan. Good morning, Joan, how are you okay?

Speaker 4 (06:08):
I'll make this quick and short. My son pointy years
fifty one years old, his father saw you at prostate
cancer and did decide the night with doctor Hot Okay.
David had his first a prostate in twenty one. It

(06:28):
was one point five. The second was in July twenty
three it was two point five, the third in October
twenty three it was two point three. The fourth was
in twenty four January three point one. The last one
was this July at two point four. He had an

(06:52):
MRI with contrast on twenty twenty four and it showed
something suspicious, not conclusive. The Gleason school was free. Now
he went to My question is that he saw the
doctor Friday. He wants him to have this XX test.

(07:17):
Do you know what it measures? The urine and the doctor? Yes, yes,
it's a zero tests A very good test.

Speaker 3 (07:26):
Yeah, a good tests. And this is your son you're
talking about, and your son is fifty one unusual. You
know that you're calling for your son. It's very nice
of you. You're an extraordinary mom. I can tell that
that you know all of this data about your son

(07:48):
and all of his PSA numbers and his he hasn't
you mentioned a Gleason. He really hasn't had a gleasing
because he hasn't had a biopsy. So the score that
you're talking about is called a Pirad score, right, It's
called a Pyrad score. So it's a level three. Uh,
and the level three is equivocal. But somebody with fluctuating

(08:11):
PSAs like your son, with a family history, because he's
mentioned his father had prostate cancer, is that right?

Speaker 4 (08:18):
So?

Speaker 3 (08:19):
Which was right? Okay? So you know, family history is
certainly something that we look at very very strongly as
a predictor of somebody that may is at an increased
risk of prostate cancer. So, you know, with this, it's
good that he got the MRI. He's got a little
target there. I don't know how big it is, obviously

(08:40):
I don't have all the information here, but I think that,
you know, he probably should have a biopsy, a targeted
biopsy of that area. You know, obviously I don't know
what all of his medical issues, if he but assuming
that he's otherwise healthy. You know, these days, the targeted biopsies,
which the way that we're doing them now without going

(09:02):
through the rectum, it's called a trends perineal biopsy, is
very very safe, I will say, and the experience of
the patients are excellent because it's done with a little
sedation like a colonoscopy can take us literally fifteen minutes,
and you know, kind of give you a peace of
mind is to know what's going on there. So my

(09:23):
gut here would be to say that he probably you know,
he could get the urine test, but you know, there's
nothing like the biopsy to really tell us with greater
you know, nothing's one hundred percent of medicine, okay, but
with greater ability to know what's going on there. I
think it sounds like, you know, he's in his early fifties,

(09:43):
he's having these PSA fluctuations. Now he's got something early
on MRI. I probably would would probably suggest to him
a transparential targeted biopsy of that area.

Speaker 4 (09:54):
Okay, yes, but not through the rectum. The other is safe.

Speaker 3 (10:02):
That is correct. Yes, the transperenial is safer. And there
has been no need for a pre and post antibiotics,
which is extraordinary too, because some people have so many
people have allergies now to antibiotics. They come and say, oh,
I'm allergic to this, allergic to that, or or you
can get you know, some upstead of stomach. You can
get some diarrhea from antibiotics. So if we can exclude

(10:26):
and not use the antibiotics and not go through the rectum,
it is safer, ma'am. Yes, that is correct. So that's
the way that we've been doing it now for the
majority of patients, not everybody, but for the majority of patients.
The transparenteal biopsy and the targeted with the fusion and
the MRI where you take the MRI you fuse it
with the ultrasound so that you can be very precise

(10:48):
even with these you know, four or five millimeter You know,
sometimes patients come in. I don't know the size of
your son's prostat obviously, but you know, you can imagine
sometimes you have a prostate the size of a let's
say a peach, okay, or a small orange, let's say
an nectarine, all right, and then you got little dot there.
You know, you got to hit that with a needle.

(11:10):
In the old days, with just random biopsies, you'd miss
a lot of it. But we're definitely picking up a
lot more now. You don't always have to act on
prostate cancer. You know, I mentioned earlier on the show
I'm out here on Fire Island. And we went to
the in town last night and a patient of mine
came up to me, doctor Katz, is that you Oh
my god, you know? And he was with his wife

(11:31):
and he said, you know, I just want to say,
you know that you've been treating me for so long,
you know, for I think he said twelve fifteen years.
And he's had prostate cans, but he's never been treated.
He never had any treatment. He's been an active surveillance
And you know, I'm a firm believer, and I have
always been a firm believer one of the early adopters
of active surveillance for men with lower risk prostate cancer

(11:54):
that not everyone needs a cyber knife or a robotic
prostate and so I think that this is certainly the
way to go. So it was really nice to see
him and his wife. Anyway, I hope that that answers
your question.

Speaker 4 (12:07):
Wow, one more question. Should he do the urine test
or forget that.

Speaker 3 (12:14):
And just do the bud you know, what is the urine?
You know? I always say, if I'm going to get
a test, how is it going to help me? You know?
And from the information that you've given me, already. I
think he's tending towards a biopsy. So if it's negative,
maybe you can wait a little bit longer. But you know,
it's you're still You're still left with this station here

(12:35):
where you have a strong family history, you've got an
MRI lesion, and you've got a rising or fluctuating up
and down PSA. I think at the end of the day,
it probably is not going to be that helpful if
he's looking for a reason for absolutely to not do
the biopsy, and if the test comes back extremely low.
It's a relatively new test, by the way, it's kind

(12:56):
of a new kid on the block. I don't I
have a lot of experience with it. I'll be honest
with you. So I know some guys in the practice
and in the community out on Long Island are been
using it with great success and feel confident about the test,
which is good, and they can give that information to
the patient and to continue to watch them very closely. Okay,

(13:17):
So my gut, my answer to you is that I
would probably go go for the sampling.

Speaker 4 (13:23):
Okay, Okay, good. Thank you so much.

Speaker 3 (13:26):
For jo You're amazing, You are an amazing individual. You're
a great mom. And certainly I've seen many wives out
there that that are so, you know, knowledgeable about their spouse,
even more than the husbands. You know. But here's a
mom very unusual. But God bless you really, and thank

(13:49):
you for tuning into the show. And the educated patient
is our best customers. SI Sims used to say, okay,
dating myself there. Probably don't even know who Si Sims
is anyway, but most people don't, but a men's clothing
store anyway. Have a great day, Joan, appreciate your call
and thank you for tuning in. Thank you, You're wonderful

(14:09):
that our phone lines are open. Eight hundred three two
one zero seven ten. That number again is eight hundred
and three two one zero seven ten. If you're just
waken up here in the morning on Kansas Corner, Good morning.
We are live here on this first Sunday in August
of the summer, and so feel free to give me
a call. Earlier in the show, I was mentioning about

(14:30):
men that are having some issues with urinating. We have
a new system, a new approach that we've are using
here at NYU over the last few years called aqua oblation,
which is a robotic water jet approach to removing prostate tissue.

(14:50):
It's done as a impatient, so you'd spend one night
in the hospital after the procedure. It's done with anesthesia,
and it is approved by insurance care and Medicare for
a man that you know. I think it's great for
men with much larger prostates that are having urinary issues.
It's a device that goes into the urethra. It's robotic driven,

(15:12):
so that the doctor kind of measures the prostate during
the procedure, determining the size and the amount of water
propulsion that is needed. But it doesn't use electric CORTERI.
It doesn't use any heat or any electrical energy, so
there's much less scarring. The other nice thing about this
is that if you are still sexually active and interested

(15:37):
in maintaining your ejaculation and directions, but the main thing
is the preservation of the ejaculate, this procedure can do
that for the smaller prostates. The other procedure we've been
using for benign tissue that's growing that's causing a problem

(15:57):
is called the euro lift. Now that can be done
in the office, whereas the acablation has to be done
in the hospital under anesthesia. But those are two really
great improvements over the last few years. Of course, we
still have the old standard medications for people like flomax
and pro scar and uroc satrol and wrap a flow

(16:21):
and even daily cialis now which can be used for
both sexual function and urinary function. Sometimes insurance carriers kind
of don't want to pay for it, maybe a little
bit more expensive. The lower dose, the five milligrams a day,
has been approved for a few years now, and you know,
the majority of my patients that I put on that

(16:41):
seem to find that to be helpful and continue to
use that. So certainly something that you want to keep
in mind if that's you know, the issues that you're
having with you know, as I said, a lower stream,
getting up at night, not emptying your bladder, feeling like

(17:03):
you have to push the urine to get out. You know,
these things can be quite bothersome and as I mentioned earlier,
can have an effect on other organs in the body,
specifically the kidneys. So if you are having these issues,
you may also want to get a kidney test, as
you probably should at least once a year, and especially

(17:24):
if you have underlying other medical issues like high blood
pressure or you've had any cardiac issues, always remember the
kidneys and we can get a quick easy kidney test,
a blood test to call the baseline creating. That's another
number that all patients should know. You're creating. You also

(17:46):
obviously want to know your PSA, your hemoglobin A one c.
Obviously diabetes. If you turn on the TV every fifteen
minutes is another commercial about another medication for diabetes, so
hemoglobin A one c, which is a measurement of the
amount of sugar in your blood over time. And we've
had some great doctors talk about diabetes here can be

(18:07):
really predictive of whether or not you're diabetic, you're pre diabetic,
or whether or not you need to see an endocrinologist
or you or to have a further discussion with your
primary care physician, because that's obviously very very important. We
were talking about a prostate cancer earlier with a caller,

(18:29):
and as I mentioned, not all patients with prostate cancer
any treatment. I have probably several hundred patients in my
practice now that we are just following and that are
on what we call active surveillance. And I'm a very
firm believer in an actor surveillance, a term that I
coined I believe called active holistic surveillance, where we not

(18:49):
only just watch you, but we also make sure that
you're on the proper diet, make sure that you're eating right,
taking in the proper nutrition to lower your PSAs. Say,
is that true? I mean, can you really lower your
PSA with diet? The answer, in my experience in doing
this probably around thirty years now, is a definite yes.
If you lose weight, if you reduce the amount of

(19:12):
things in your diet that are inflammatory, and if you
reduce those things in your diet going to more of
a Mediterranean diet, more fresh vegetables, more fruits, raspberries, blueberries, strawberries,
more fish in your diet, less red meat, less fried foods,
less dairy, which can be pro inflammatory. These things can

(19:37):
cause inflammation in many parts of your body, including the prostate,
which often can raise PSA. And there's no doubt that
you can keep your PSA stabilized over years and not
have treatment. And again it's not for everyone. And the
patients that we put on active surveillance that have had
a biopsy are usually those that are lower grade, usually

(19:59):
a GLEA and six that would be called now a
grade group one in lower volume with a PSA typically
under ten. We do like to do a confirmatory biopsy,
usually in a year year and a half. There's some
guidelines that say that you should do another biopsy just
to make sure there's nothing else going on in the prostate.

(20:20):
We also do now this genomic testing where we can
do a DNA test of your biopsy, which can be
very helpful and gives us an idea of what's going
on in the rest of the prostate. That's called a
genomic testing, not a genetic testing. Genetic testing is more
if you're looking at specific what we call germline mutations

(20:42):
like a BRACA one Braka two. You've heard about these
things for breast cancer, Well, they actually can be found
in prostate cancer and can be predictive of whether or
not you're going to have a very aggressive form of
prostate cancer. So that's germline testing. We also can do
genomic testing if you've had a biopsy and looking at

(21:04):
your biopsy and rather fascinating to see that what's going
on in the biopsy can be representative of what's going
on in the entire prostate and can give you further
information as to whether or not you should have treatment
or not. And actually the radiation doctors and was mentioned earlier,
doctor has who runs the cyber knife team and the

(21:26):
chairman of the radiation oncology department, is now using these
genomic tests to stratify whether or not patients should get
higher or lower doses of radiation. And I have to say,
and I know they're doing a terrific job in radiation oncology.
They you know, they're now running a clinical trial where

(21:47):
cyber knife is five days, they're now running a clinical
trial that you can be treated in two days. Two days,
and doctor Jonathan Lishach, who's part of that team, is
running that trial well and really some terrific results. Seems
to be great, working great with just two days. And

(22:07):
they're also running trials for patients that have more intermediate
risk prostate cancer where patients typically are thought to need
hormone therapy and maybe you don't need hormones. So now
they're running a trial with randomizing patients half get hormones
and half don't get hormones. So these are the ways
that we kind of figure out things in medicine through

(22:27):
clinical trials and so, and of course I've been running,
and I've mentioned this on Kansas Corner, a national clinical
trial called the Intrepid Trial, where we're using a new
type of hormone pill which has spares men lots of
side effects and really has been terrific and doesn't allow
men to have that low testosterone level and no hot flashes,

(22:51):
and the PSA numbers have been terrific. In fact, a
few weeks ago we had a patient on the show
Gary who talked about his experien variance with the Intrepid Trial,
and he's done extraordinarily well. He's finished the trial I
think about almost a year now, and his PSA numbers
are terrific. We've got a few minutes left here in
the show shows going along rather quickly this morning here

(23:14):
on this first Sunday in August, we are live. If
you'd like to give me a call with just I
guess we've got to have five minutes left or so.
The number is eight hundred three two one zero seven ten.
That number again is eight hundred three two one zero
seven ten. And then you know, the other aspect that

(23:34):
we've been looking at is our robotic surgery program that really,
as I mentioned earlier in the show, US News and
World Report is now ranked the hospital number two in
the country for its quality care and its outcomes, and
it's also been ranked very highly with the what's called VISIANT,

(23:55):
which is the national quality the Ambulatory Quality and Accountability program,
and the urology department both at NYU and the city
and on Long Island has been ranked number two in
the country. Last year we've been number three. So we're
moving up the ladder and a lot of it has
to do with our outcomes, and we certainly are a

(24:17):
robust robotics program. We have the majority of our patients
that require surgery are being done robotically. We are now
initiating a program where some of these patients are going
home the same day, the same day that you've had
your prostate removed. I mean, this is extraordinary to me

(24:39):
to think that this could be done. But you know,
years ago before robots, where patients would stay in the
hospital a week, and now patients are actually the patients
that we do typically the first in the case of
the day the seven o'clock start, and even the second
patient of the day could go home if they're feeling
well enough. But this is certainly something that we're starting

(25:01):
to see in our field across the country. So really
exciting advances in the area of robotic surgery and so
exciting things. And we also mentioned earlier about some of
the hormonal treatments that's going on for prostate cancer patients.

(25:25):
And the new advance is there. The medication that I've
been studying called dear ludamide in combination with radiation has
shown to be extraordinary in our clinical trial, allowing men
to have normal testosterone level, reducing their PSA dramatically and

(25:46):
having excellent quality of life. And if you spare the
testosterone and men, men can have a normal sexual function,
and that is something that we did not see in
the past. This is a real advance. I must say.
You know, tiply, if men got hormone therapy, the testosterone
level would sink into the tank. You know, normal testosterone

(26:07):
level is you know, around for men, let's say above
three hundred. You like it to be four or five
hundred if you're on if you're on hormonal the classic
hormone therapy, testosterone is like less than ten. And you
know you have a testosteronal less than ten, you have
no energy, you have no sex drive, ability to have
sexual relations with the newer medication, this medication that we've

(26:30):
been using, dere ludamite, the testosterial level stay normal. The
testosterone level stay normal, and the cancer the PSA drops
dramatically because it's targeted to the prostate cancer cell itself
on the outside of the cell, so it keeps testosterone normal,
which is really something that we did never so I've

(26:53):
never seen this before in my career. So I know
we only have a few seconds left. I think waybe
less than a minute now, So I want to thank
you all for listening. I hope you enjoyed it as
much as I did, and tune in every week. I
know we have some great guests from NYU each week
that I have come on the show for all aspects
of men's health. Well that's the end of the show. Everyone,

(27:16):
hope you enjoyed it, Have a great day. Tune in
every Sunday here on Kats's Corner. We'll be back next
week with a great show. Have a great day everyone.
This is Dtor Aaron Katz.

Speaker 2 (27:39):
You've been listening to Katsu's Corner. Come back every week
to hear more straight talk on a wide range of
men's health topics and advice. On how to live your
healthiest life.

Speaker 1 (27:50):
The proceeding was a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed