Episode Transcript
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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 Katts.
Speaker 3 (00:37):
Well, good morning everyone, and welcome to Katz's Corner here
on wri iHeartRadio. So glad you could join me this morning.
We are live this morning, and if you do have
a question or a concern that you'd like to give
me a call, I would welcome to hear from you.
The number is eight hundred three two one zero seven ten.
(00:59):
That number again is eight hundred three two one zero
seven ten. My good friend Ed Randall hopefully will be
joining us this morning. Ed has a Prostate Cancer Foundation
which is dedicated to the screening for men for prostate cancer.
He has an association with Major League Baseball and goes
(01:22):
around the country to different Major League players and ballparks
and promotes the screening of prostate cancer. We had an
event last week in New York City which was well attended,
and we are going to have our annual free seminar
that's coming up in September. It's September fifteenth. September fifteenth.
(01:47):
If you'd like to register for this prostate Cancer Awareness seminar,
I will be there at Randall will be there and
some of my colleagues from NYU, doctor Anthony Corporate doctor
Jonathan Hass will be talking about the latest and greatest
for the treatments of prostate cancer, what you need to
know about screening, will discuss robotic surgery, will discuss radiation therapy,
(02:11):
will discuss surveillance. It is on September fifteenth. It will
be held in downtown Minniola at the Research and Academic
Center which is one oh one Miniola Boulevard. And if
you'd like to attend, you can register at Men's Health
(02:32):
at NYU Landgone dot org dot email again and I'll
announce it again at the end of the show. Is
Men's Health at nyulandgone dot org. Or if you'd like
to be old school like myself sometimes and you'd like
to give us a phone call, you can do that
as well at five one six six six three two
(02:54):
two seven seven. That number again is five one six
six six three two two and you can register. It
is a free seminar. It'll be on Sunday, September seventeenth
at eight o'clock in the morning till around noon. We
will provide you with breakfast as well. There will be
(03:15):
some vendors there that deal with prostate cancer, some of
the pharmaceutical companies, some of the therapeutic companies will be there,
and of course I will be there in my colleagues.
So I hope that you can join us. So many
of you have asked me when are we having the
seminar again. This will be a little bit different. It
(03:38):
is not a complete men's health seminars we have done
in the past. If you listen to the show where
you've attended, which we do need to bring back, and
I think that we need to do that, perhaps we
can do that later this year, because that really, that
really was great. So many of the patients that I
continue to see when we talk about that Men's Health
(04:02):
seminar bring back a lot of joy and smiles to
my face because it really was terrific. We had speakers
from NYU with all for all different varieties for men's health,
bone health, cardiac health, wellness, sleeping. So we're going to
do that again, but on September fifteenth, we're going to
(04:23):
focus on prostate cancer awareness with my good friend Ed Randall,
who I believe will be joining us here this morning
and again that number if you want to register is
five one six six sixty three two two seven seven,
or you can certainly send us an email at Men's
(04:47):
Health at nyulandgoing dot org. The number again this morning
if you'd like to give me a call is eight
hundred three two one zero seven ten. Eight hundred three
two one one zero seven ten. I believe the phone
lines are open, and so give me a call. Love
to hear from you. And as we were talking this
(05:11):
week at our seminar, which really was more of a
dinner than a seminar we had in New York, there
are a number of new tests that people should be
aware of when being concerned about screening for prostate cancer.
Who should be screened when should you be screened? And
(05:33):
my typical response for that is usually men over the
age of fifty. Now there are a few exceptions to that,
men that are starting to have urinary issues. Certainly we
have you know, we see many men that are in
their forties that are starting to have a change in
(05:53):
their urinary pattern, which may not be prostate cancer. It
may be just a urinary fact infection. In fact, so
we do see that will really urine test on you.
But if you are having some change in urinary pattern,
you know, like if your stream is a little bit slower,
if you're having any burning, any certainly any blood in
(06:15):
the urine, that is a warning sign. It may may
be something else going on it. Again, that could be
an infection as well, but you know, it could be
a warning sign for other cancers like bladder or even
kidney cancer, or it could be a kidney stone. You
could have a stone if you have pain. But if
you don't have any pain and you're having blood in
(06:36):
the urine, that is clearly a sign that you should
seek urgent medical attention. But if you you know, also
if you're getting up at night, if you're you know
more than you know, the usual you know, one time
may be normal for you, but if you're getting up
to three four times a night, that could indicate prostate enlargement.
(06:59):
It could be but not enlargement could be prostate cancer.
So you know, if you're having any of those symptoms
before the age of fifty, I think that you need
to get evaluated and should have a PSA test at
that time. And you know, we are seeing lots of
men that get diagnosed before the age of fifty, There's
(07:20):
no doubt. And the other people that I think populations
of people that should get tested or before the age
of fifty, I think are people that were at a
higher risk. And you know, I've talked about this quite
a bit, but certainly there's no doubt that family history
is key. African American men, men of Caribbean descent, absolutely
(07:45):
are at higher risk. The reasons that we still have
not discovered why. Whether it's diet, whether it's just genetics,
We're not sure, but it does seem to be still
insistent over the years that I've been in urology that
we are aware that an African American men of Caribbean
(08:08):
descent certainly are at higher risk of developing prostate cancer
and earlier in life. And then we certainly have people
here in New York that were exposed to nine to
eleven that were down at the World Trade Center, So
those men are also at higher risk. Men that were
(08:29):
also in Vietnam exposed to agent orange certainly at higher risk.
So those those men should be screened. How often should
you be screened? I believe you should be screened once
a year, And I also believe that the PSA test
should be done in conjunction with a digital rectal exam.
I'm kind of old school that way. I know a
(08:50):
lot of doctors aren't doing that anymore. I still feel
that the initial evaluation, the initial screening should include a
digital rectal examination, and so I think that that's important.
And you know that that can be done. And so
we're waiting for a Randall and he may be coming
(09:12):
on the show and ed if you are listening to
the show this morning, you can call into the studio
the numbers two one two three seven two fifty six
oh two. If you are listening and you would like
to give me a call this morning if you have
a question, the number is eight hundred three two one
zero seven ten. That number again is three two one
(09:36):
zero seven ten, and I would love to hear from
you the other way that we are consistently screening for
prostate cancer. If you do have an elevated PSA, you
certainly can repeat the test. I just had a patient
this week that had was in his sixties that had
(09:58):
a PSA that was significantly elevated, and we repeated it
and it came back normal. How can that be, Well,
you know, there could be lab errors that that's possible.
It also could be that, you know, there's patients that
(10:22):
do have sexual relations within the last forty eight hours
of getting a blood test. That can be you know,
cause of PSA elevation. As I mentioned, it could be
a urinary tract infection. I see a lot of guys
that are avid bicycle riders that have had an elevated
PSA and so we repeat that and so it should
(10:45):
never be based upon one PSA. Make sure that you
get it repeated if it is elevated. You know, there
are some other tests that you can do. There's a
urine test that you can do now called the urinary
exosome test. There's a new well not really new, but
there's a test that's been round. Actually for a while,
(11:06):
I shouldn't say new called the four K score. I
personally don't use it a lot. To be frank, I
don't use the four K a lot. I think if
there are certain situations where I'm unsure whether or not
we should be getting an MRI, or if a patient
can't get an MRI, if someone is really let's say,
(11:26):
claustrophobic or has a pacemaker or a defibrillator, and we're
not sure if the PSA is elevated from prostate cancer
or not, then I think that's reasonable to get a
four K score in that situation. The four K score, again,
like the PSA is a blood test and it can
(11:50):
be It looks at four different subunits of the PSA
and it'll give you a new evaluation of your total PSA.
So tell us, based upon these four subunits, whether or
not you should or you have a higher likelihood of
having aggressive prostate cancer and may need a biopsy. So
(12:13):
that is certainly a test that's available. It is covered
by commercial carriers, all of them, and so that's something
that we can we can obtain for you. If there's
a question about your PSA being elevated, I will go
(12:37):
to the phones. There's the number again is eight hundred
three two one zero seven ten. I believe there's a
call on it. Is it Frank? Are you on the call?
Good morning?
Speaker 4 (12:49):
Yeah, it's Frank.
Speaker 3 (12:52):
Frank. Okay, Frank, yes.
Speaker 4 (12:53):
Sir, Okay, doctor. I want to ask you if if
you get injured, Okay, let's say this happened to me
a few years ago. I fell on my knee and
I was having issues with UH of prostate inflammation. Is
is it a good idea to believe or try to
(13:15):
like avoid cortizones that might affect any type of prostate
treatment of whatsoever. If you have prostate issues like I
had years ago.
Speaker 3 (13:24):
No, if you need a courtizon, I mean, if you
need a cortisone injection in your knee.
Speaker 4 (13:31):
Cortisone cream, a cortisone injection.
Speaker 3 (13:35):
No for your knee. That that that that is fine
to get. That's not a problem. Uh, go ahead and
do that, Okay. I don't see the reason if you
if you need a shot in your knee for for
for knee pain or a cortisone cream, that that's not
going to affect any any prostrate issues in the future
(13:55):
for you. Okay, Okay, yeah, thanks for your phone call. No,
no problem. We have another phone call that's interesting from Ron.
Good morning Ron.
Speaker 5 (14:08):
How are you look morning, Doctor Tats. I recally became
a patient of yours and I've had a large prostict
for a number of years and I'm on the typical
medications such as plooromax and finesse. Are there any natural
supplements that you could recommend for patients to help with
reducing you know, symptoms, et cetera.
Speaker 3 (14:31):
There are a number of natural supplements out there. There's
no doubt how much they work is certainly up for debate.
There have been a lot of different studies. The larger
studies didn't seem to show that they were more effective
than let's say, a placebo pill. Okay. In my own practice,
(14:54):
I have seen patients that have had benefit, whether it's
placebo or not, and still stay on the supplements and
swear by them. These supplements include things that contain salt, palmetto,
stinging nettles, pumpkin seeds, African and pigm There's a compound
that I've used quite a bit to reduce inflammation in
(15:17):
the prostate called zeiflament prostate. I have no connection or
ties to any of these products or companies. However, someone
like yourself that's already on medication, that's having significant urinary issues,
can it help there? I'm not really sure it can. Ron.
(15:40):
I think the situation where it might be helpful again,
might is in someone that has early warning signs, early
symptoms and says, I don't want to go on medication,
I want to try a supplement or two. But if
you're having a lot of symptoms, and it sounds like Ron,
you're already on two medications, I mean it could you know,
(16:03):
it's cheap, it's not you know, it's certainly not gonna.
I've never seen any toxicity from any of these things.
So could you add one of these prostate herbal supplements
to your regimen? You could? Could it help? I'm not
really sure. I don't have tremendous confidence that it would.
(16:24):
The question is, and I don't remember your exact case,
but you know, so you're on these two medications. How
are you currently doing? Are you doing okay with these medications?
Speaker 5 (16:33):
Well, interestingly enough, I had been taking finesteroid for years
and then I asked you that switched me over to
avadart and what I'm noticing is like in the middle
of the night sometimes when I have to urinate, I'm
having trouble with the flow of urine, whereas with a
finesteroid and flomax I didn't really have that problem. So
(16:55):
is it just like changing over to a new medication
that's causing that.
Speaker 3 (17:00):
It could be, or it could be that you're responding
better to the finasteride, or it could be that your
condition is getting a bit worse and you know you're
still having the growing issue despite being on the avidart
and finastride. They're in the same class of medications to
try and reduce prostate size. The avid art has the
(17:24):
theoretical advantage in that it is blocking two receptors in
the prostate, and phinasterrite is doing one receptor again blocking
the conversion of testosterone to dihydrate testosterone, which is the
active molecule for prostate growth. So it should shrink your prostata,
should also reduce your PSA. But if you're finding that
(17:46):
it's not working, then it depends upon how long you've
been on it, and I would give it at least
a couple of weeks. I don't remember how long you're
on it. But I would say a couple of weeks.
But if you're noticing that there's a change, I would
maybe switch back. And if you switch back and you're
still not happy, then it might be time to consider
an intervention, a procedure, you know that we can do
(18:10):
you know, in the office or in a procedure room
with anesthesia, depending upon Typically really depends upon the size
of your prostate. You know, you probably either have an ultrasound.
Speaker 5 (18:24):
State day, there's not an issue with that.
Speaker 3 (18:26):
Flowing during the data is not an issue.
Speaker 5 (18:29):
No, during the day, I have a good flow, but
it's in the middle of the night sometimes I was noticing.
Speaker 3 (18:35):
Yeah, no, that that is. I can't tell you how
common that is. That is so common that guys do
have this inflammation that the prospetly during the evening and
it really bothers people and it makes them get up
and then when you get up, you're kind of standing
over the toilet or sitting and it's it's the other
thing you maybe want to do is with the flowmax
(18:58):
is when are you taking in the morning.
Speaker 5 (19:00):
Or a take it right after dinner?
Speaker 3 (19:04):
Yeah, well that's a pretty good time to take it,
right Yeah, Yeah, you know it does. You know, it's
a tricky situation with this prosty because it does come
down to sometimes quality of life. You know, as long
as we don't have any objective measure to intervene, like
if you're not retaining urine on a scan or if
(19:27):
your kidneys are making sure that your kidney function is okay,
then as long as you're not retaining urine, you're not
retention and you're you know, you're not getting infections and
you're not bleeding and you're not getting stones from it
comes down the quality of life. And you know, if
you're getting up one or two times a night, but
you go, look, you know what I can deal with that.
I'm not it doesn't really bother me. I'm fine during
(19:47):
the day, then stay on it, you know. But if
it comes down to the point where you really are
bothered by it, and you know, you get tired because
you're up all night. Of course, a lot of people
have problems during the day and night and they've been
on medication. At that point, we do we do recommend
a procedure, or we recommend a procedure for somebody that
doesn't want medication, you know, as the medications as you know,
(20:12):
you know, it's not going to be like, oh, I'm
going to take it for a week and then I'm
going to be fine. It's not like an antibiotic. This
is a medication for life, you know, and medications obviously
have different side effects, so you know, it does you know,
it does come down to a thorough discussion. So I
guess I guess to your question about the natural supplements,
(20:32):
in a roundabout way, I would say, yeah, you could
give it a shot. I'm not fully confident with it.
But if you wanted to try something herbal, anti inflammatory,
that desire flamented something, if you haven't tried that, you
could maybe a couple of pills of that. Actually you do, okay, yes, well.
Speaker 5 (20:53):
Well then my friend, and hope it works.
Speaker 3 (20:57):
Then you keep your fingers crossed, work and you see
how things go, and you know, we'll check you when
you come back. But if you're not happy, then we
need to either switch back to to you know, to
the finastride or or consider a proceiver.
Speaker 5 (21:15):
All right, okay, all right, thank you very much, doctor.
Speaker 3 (21:19):
Yes, you're very welcome. Have a good day. Hopefully the
weather we'll get a little bit better. It's a bit
rainy out there now feels like day in London anyway.
If you'd like to give me a call, the number
is one eight hundred three two one zero seven ten,
one eight hundred three to two one zero seven ten.
I was talking earlier in the show in case you
(21:40):
missed it because you were still sleeping, but you shouldn't
be on a Sunday. You should be up listening to
the show every Sunday starting at seven. But if you
missed it, we're having a mends. We're having I'm sorry,
We're having a prostate cancer awareness seminar. Prostate cancer awareness seminar.
It's going to be September the fifteenth, and that's on
(22:03):
a Sunday, okay, And if you would like to attend
that seminar, you do need to give us a call
on September fifteenth. The seminar will be at the in
downtown Miniola at one oh one Miniola Boulevard. It'll start
at eight o'clock. It'll be on all about brons date cancer.
(22:26):
You can also ed Randall will be there and you
can also get all your questions answered, all the latest
and greatest information. The email is Men's Health at Nyulandgun
dot org to register, or you can pick up the
phone old fashioned way five one six six six three
(22:49):
twenty two seventy seven five one six six six three
two two seven seven. And we will provide a breakfast,
and we will all be there and look forward to
you just meeting you, greeting you and educating you, and
I will also feed you. We're also going to give
you a light breakfast as well. So it'll start at
eight am. That again will be on Sunday, September fifteenth,
(23:14):
Prostate Cancer Awareness Seminar. Bring your loved ones. It's free,
bring your friends at downtown Mineola at the Research and
Academic Center part of NYU lango On Health System on
Long Island, one oh one Miniola Boulevard. To see you there.
Just a few minutes left here on kats. It's going
(23:35):
in the morning on a rainy Sunday here in August.
If you'd like to give me a call, got a
few minutes left, eight hundred and three to two one
zero seven ten, eight hundred three two one zero seven ten.
And certainly, as I was talking about before, with the screening,
we'll be talking about when you should get an MRI
and what an MRI means if you get an MRI
(23:57):
and it's abnormal, and should you have a biopsy? If
you have a biopsy, what are the different types of biopsies.
Everything is changing in urology, and over the last few
years it's amazing the dramatic shifts that we have seen
and our ability to not only to biopsy accurately, I
(24:18):
would say, but to determine if you need a biopsy
or don't. And a lot of men we you know,
are not able to do it or need it. I
should say. Actually, we have a phone call right now.
William's on the line about an MRI. Good morning, William,
how are you.
Speaker 6 (24:36):
Good morning, doctor. It's an honor to speak with you.
I have a question about the DP parametric MRIs, which
I'm hearing a lot about. You don't need contrast, but
they're very accurate, are they yes? Are they to become
available soon?
Speaker 3 (24:50):
Well, they are available now. Frankly, you can get an
MRI with without contrast now, my friend, and thank you
for your phone call. But you know, I have to
tell you that in my experience I have not seen
any problems with the contrast agent at all. There are
(25:10):
the incidents of having some issues with the contrast agent.
The gadolinium is very very small these days, you know,
probably one in less than one in a thousand. I
believe I have not seen any and I order a
lot of MRIs. And if you get it without contrast,
yes you can. You can determine if there's cancer there,
but it's not going to be as accurate. It's not
(25:31):
going to be as specific as using the multi parametric
MRI with a gadolinium. So I would say right now,
as I sit here in August of twenty twenty four,
if we are ordering the MRI and if there's no
contra indication to get it with a contrast, like if
(25:53):
you've had a kidney issue or if you have a
known allergy, let's say, then we're getting it with the
world with the contrast, my friend. But that's a really
really good question. And you know, as I say, I
see here now. But you know, things are changing all
the time here in the field, and especially the way
(26:13):
that we're doing biopsy. We used to do everybody with
a trans rectal biopsy. Now we're doing transparent neal Biopsi's
not for everybody, but certainly something that we can talk about,
you know, with our radiation techniques. We'll talk about that.
We were doing five days of CyberKnife. Now here at
NYU we have a protocol that's opened. It's a clinical trial,
but it's now two days of radiation. I mean wow,
(26:36):
I mean it used to be forty five days for everybody.
Then it was five, and now it's possibly two. We're
doing a study there, so we'll talk about that, and
then of course we'll talk about the latest information for
men on surveillance that don't need any treatment at all,
who should get that And we have a lot of
patients that are on surveillance. So just because you have
(26:56):
a biopsy, just because you have cancer does not mean
does not mean that you need to be treated, and
we will talk about that in detail. And if you
do need treatment. We also have here at NYU a
very large, one of the one of the most large,
the largest, if not on Long Island robotic surgery program,
and we'll talk about that with our colleague, doctor Anthony Kukan.
(27:18):
But unfortunately that's the end of the show. So again,
the Prostate Cancer Awareness Seminar will be on September fifteenth.
Give us a call to register five one, six sixty
sixty three, twenty two, seventy seven five one six sixty six,
three two two, seven seven four if you can email
us at Men's Health at NYU Lando dot org.
Speaker 2 (27:38):
You've been listening to Catcer'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 (27:49):
The proceeding was a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.
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 Katts.
Speaker 3 (00:37):
Well, good morning everyone, and welcome to Katz's Corner here
on wri iHeartRadio. So glad you could join me this morning.
We are live this morning, and if you do have
a question or a concern that you'd like to give
me a call, I would welcome to hear from you.
The number is eight hundred three two one zero seven ten.
(00:59):
That number again is eight hundred three two one zero
seven ten. My good friend Ed Randall hopefully will be
joining us this morning. Ed has a Prostate Cancer Foundation
which is dedicated to the screening for men for prostate cancer.
He has an association with Major League Baseball and goes
(01:22):
around the country to different Major League players and ballparks
and promotes the screening of prostate cancer. We had an
event last week in New York City which was well attended,
and we are going to have our annual free seminar
that's coming up in September. It's September fifteenth. September fifteenth.
(01:47):
If you'd like to register for this prostate Cancer Awareness seminar,
I will be there at Randall will be there and
some of my colleagues from NYU, doctor Anthony Corporate doctor
Jonathan Hass will be talking about the latest and greatest
for the treatments of prostate cancer, what you need to
know about screening, will discuss robotic surgery, will discuss radiation therapy,
(02:11):
will discuss surveillance. It is on September fifteenth. It will
be held in downtown Minniola at the Research and Academic
Center which is one oh one Miniola Boulevard. And if
you'd like to attend, you can register at Men's Health
(02:32):
at NYU Landgone dot org dot email again and I'll
announce it again at the end of the show. Is
Men's Health at nyulandgone dot org. Or if you'd like
to be old school like myself sometimes and you'd like
to give us a phone call, you can do that
as well at five one six six six three two
(02:54):
two seven seven. That number again is five one six
six six three two two and you can register. It
is a free seminar. It'll be on Sunday, September seventeenth
at eight o'clock in the morning till around noon. We
will provide you with breakfast as well. There will be
(03:15):
some vendors there that deal with prostate cancer, some of
the pharmaceutical companies, some of the therapeutic companies will be there,
and of course I will be there in my colleagues.
So I hope that you can join us. So many
of you have asked me when are we having the
seminar again. This will be a little bit different. It
(03:38):
is not a complete men's health seminars we have done
in the past. If you listen to the show where
you've attended, which we do need to bring back, and
I think that we need to do that, perhaps we
can do that later this year, because that really, that
really was great. So many of the patients that I
continue to see when we talk about that Men's Health
(04:02):
seminar bring back a lot of joy and smiles to
my face because it really was terrific. We had speakers
from NYU with all for all different varieties for men's health,
bone health, cardiac health, wellness, sleeping. So we're going to
do that again, but on September fifteenth, we're going to
(04:23):
focus on prostate cancer awareness with my good friend Ed Randall,
who I believe will be joining us here this morning
and again that number if you want to register is
five one six six sixty three two two seven seven,
or you can certainly send us an email at Men's
(04:47):
Health at nyulandgoing dot org. The number again this morning
if you'd like to give me a call is eight
hundred three two one zero seven ten. Eight hundred three
two one one zero seven ten. I believe the phone
lines are open, and so give me a call. Love
to hear from you. And as we were talking this
(05:11):
week at our seminar, which really was more of a
dinner than a seminar we had in New York, there
are a number of new tests that people should be
aware of when being concerned about screening for prostate cancer.
Who should be screened when should you be screened? And
(05:33):
my typical response for that is usually men over the
age of fifty. Now there are a few exceptions to that,
men that are starting to have urinary issues. Certainly we
have you know, we see many men that are in
their forties that are starting to have a change in
(05:53):
their urinary pattern, which may not be prostate cancer. It
may be just a urinary fact infection. In fact, so
we do see that will really urine test on you.
But if you are having some change in urinary pattern,
you know, like if your stream is a little bit slower,
if you're having any burning, any certainly any blood in
(06:15):
the urine, that is a warning sign. It may may
be something else going on it. Again, that could be
an infection as well, but you know, it could be
a warning sign for other cancers like bladder or even
kidney cancer, or it could be a kidney stone. You
could have a stone if you have pain. But if
you don't have any pain and you're having blood in
(06:36):
the urine, that is clearly a sign that you should
seek urgent medical attention. But if you you know, also
if you're getting up at night, if you're you know
more than you know, the usual you know, one time
may be normal for you, but if you're getting up
to three four times a night, that could indicate prostate enlargement.
(06:59):
It could be but not enlargement could be prostate cancer.
So you know, if you're having any of those symptoms
before the age of fifty, I think that you need
to get evaluated and should have a PSA test at
that time. And you know, we are seeing lots of
men that get diagnosed before the age of fifty, There's
(07:20):
no doubt. And the other people that I think populations
of people that should get tested or before the age
of fifty, I think are people that were at a
higher risk. And you know, I've talked about this quite
a bit, but certainly there's no doubt that family history
is key. African American men, men of Caribbean descent, absolutely
(07:45):
are at higher risk. The reasons that we still have
not discovered why. Whether it's diet, whether it's just genetics,
We're not sure, but it does seem to be still
insistent over the years that I've been in urology that
we are aware that an African American men of Caribbean
(08:08):
descent certainly are at higher risk of developing prostate cancer
and earlier in life. And then we certainly have people
here in New York that were exposed to nine to
eleven that were down at the World Trade Center, So
those men are also at higher risk. Men that were
(08:29):
also in Vietnam exposed to agent orange certainly at higher risk.
So those those men should be screened. How often should
you be screened? I believe you should be screened once
a year, And I also believe that the PSA test
should be done in conjunction with a digital rectal exam.
I'm kind of old school that way. I know a
(08:50):
lot of doctors aren't doing that anymore. I still feel
that the initial evaluation, the initial screening should include a
digital rectal examination, and so I think that that's important.
And you know that that can be done. And so
we're waiting for a Randall and he may be coming
(09:12):
on the show and ed if you are listening to
the show this morning, you can call into the studio
the numbers two one two three seven two fifty six
oh two. If you are listening and you would like
to give me a call this morning if you have
a question, the number is eight hundred three two one
zero seven ten. That number again is three two one
(09:36):
zero seven ten, and I would love to hear from
you the other way that we are consistently screening for
prostate cancer. If you do have an elevated PSA, you
certainly can repeat the test. I just had a patient
this week that had was in his sixties that had
(09:58):
a PSA that was significantly elevated, and we repeated it
and it came back normal. How can that be, Well,
you know, there could be lab errors that that's possible.
It also could be that, you know, there's patients that
(10:22):
do have sexual relations within the last forty eight hours
of getting a blood test. That can be you know,
cause of PSA elevation. As I mentioned, it could be
a urinary tract infection. I see a lot of guys
that are avid bicycle riders that have had an elevated
PSA and so we repeat that and so it should
(10:45):
never be based upon one PSA. Make sure that you
get it repeated if it is elevated. You know, there
are some other tests that you can do. There's a
urine test that you can do now called the urinary
exosome test. There's a new well not really new, but
there's a test that's been round. Actually for a while,
(11:06):
I shouldn't say new called the four K score. I
personally don't use it a lot. To be frank, I
don't use the four K a lot. I think if
there are certain situations where I'm unsure whether or not
we should be getting an MRI, or if a patient
can't get an MRI, if someone is really let's say,
(11:26):
claustrophobic or has a pacemaker or a defibrillator, and we're
not sure if the PSA is elevated from prostate cancer
or not, then I think that's reasonable to get a
four K score in that situation. The four K score, again,
like the PSA is a blood test and it can
(11:50):
be It looks at four different subunits of the PSA
and it'll give you a new evaluation of your total PSA.
So tell us, based upon these four subunits, whether or
not you should or you have a higher likelihood of
having aggressive prostate cancer and may need a biopsy. So
(12:13):
that is certainly a test that's available. It is covered
by commercial carriers, all of them, and so that's something
that we can we can obtain for you. If there's
a question about your PSA being elevated, I will go
(12:37):
to the phones. There's the number again is eight hundred
three two one zero seven ten. I believe there's a
call on it. Is it Frank? Are you on the call?
Good morning?
Speaker 4 (12:49):
Yeah, it's Frank.
Speaker 3 (12:52):
Frank. Okay, Frank, yes.
Speaker 4 (12:53):
Sir, Okay, doctor. I want to ask you if if
you get injured, Okay, let's say this happened to me
a few years ago. I fell on my knee and
I was having issues with UH of prostate inflammation. Is
is it a good idea to believe or try to
(13:15):
like avoid cortizones that might affect any type of prostate
treatment of whatsoever. If you have prostate issues like I
had years ago.
Speaker 3 (13:24):
No, if you need a courtizon, I mean, if you
need a cortisone injection in your knee.
Speaker 4 (13:31):
Cortisone cream, a cortisone injection.
Speaker 3 (13:35):
No for your knee. That that that that is fine
to get. That's not a problem. Uh, go ahead and
do that, Okay. I don't see the reason if you
if you need a shot in your knee for for
for knee pain or a cortisone cream, that that's not
going to affect any any prostrate issues in the future
(13:55):
for you. Okay, Okay, yeah, thanks for your phone call. No,
no problem. We have another phone call that's interesting from Ron.
Good morning Ron.
Speaker 5 (14:08):
How are you look morning, Doctor Tats. I recally became
a patient of yours and I've had a large prostict
for a number of years and I'm on the typical
medications such as plooromax and finesse. Are there any natural
supplements that you could recommend for patients to help with
reducing you know, symptoms, et cetera.
Speaker 3 (14:31):
There are a number of natural supplements out there. There's
no doubt how much they work is certainly up for debate.
There have been a lot of different studies. The larger
studies didn't seem to show that they were more effective
than let's say, a placebo pill. Okay. In my own practice,
(14:54):
I have seen patients that have had benefit, whether it's
placebo or not, and still stay on the supplements and
swear by them. These supplements include things that contain salt, palmetto,
stinging nettles, pumpkin seeds, African and pigm There's a compound
that I've used quite a bit to reduce inflammation in
(15:17):
the prostate called zeiflament prostate. I have no connection or
ties to any of these products or companies. However, someone
like yourself that's already on medication, that's having significant urinary issues,
can it help there? I'm not really sure it can. Ron.
(15:40):
I think the situation where it might be helpful again,
might is in someone that has early warning signs, early
symptoms and says, I don't want to go on medication,
I want to try a supplement or two. But if
you're having a lot of symptoms, and it sounds like Ron,
you're already on two medications, I mean it could you know,
(16:03):
it's cheap, it's not you know, it's certainly not gonna.
I've never seen any toxicity from any of these things.
So could you add one of these prostate herbal supplements
to your regimen? You could? Could it help? I'm not
really sure. I don't have tremendous confidence that it would.
(16:24):
The question is, and I don't remember your exact case,
but you know, so you're on these two medications. How
are you currently doing? Are you doing okay with these medications?
Speaker 5 (16:33):
Well, interestingly enough, I had been taking finesteroid for years
and then I asked you that switched me over to
avadart and what I'm noticing is like in the middle
of the night sometimes when I have to urinate, I'm
having trouble with the flow of urine, whereas with a
finesteroid and flomax I didn't really have that problem. So
(16:55):
is it just like changing over to a new medication
that's causing that.
Speaker 3 (17:00):
It could be, or it could be that you're responding
better to the finasteride, or it could be that your
condition is getting a bit worse and you know you're
still having the growing issue despite being on the avidart
and finastride. They're in the same class of medications to
try and reduce prostate size. The avid art has the
(17:24):
theoretical advantage in that it is blocking two receptors in
the prostate, and phinasterrite is doing one receptor again blocking
the conversion of testosterone to dihydrate testosterone, which is the
active molecule for prostate growth. So it should shrink your prostata,
should also reduce your PSA. But if you're finding that
(17:46):
it's not working, then it depends upon how long you've
been on it, and I would give it at least
a couple of weeks. I don't remember how long you're
on it. But I would say a couple of weeks.
But if you're noticing that there's a change, I would
maybe switch back. And if you switch back and you're
still not happy, then it might be time to consider
an intervention, a procedure, you know that we can do
(18:10):
you know, in the office or in a procedure room
with anesthesia, depending upon Typically really depends upon the size
of your prostate. You know, you probably either have an ultrasound.
Speaker 5 (18:24):
State day, there's not an issue with that.
Speaker 3 (18:26):
Flowing during the data is not an issue.
Speaker 5 (18:29):
No, during the day, I have a good flow, but
it's in the middle of the night sometimes I was noticing.
Speaker 3 (18:35):
Yeah, no, that that is. I can't tell you how
common that is. That is so common that guys do
have this inflammation that the prospetly during the evening and
it really bothers people and it makes them get up
and then when you get up, you're kind of standing
over the toilet or sitting and it's it's the other
thing you maybe want to do is with the flowmax
(18:58):
is when are you taking in the morning.
Speaker 5 (19:00):
Or a take it right after dinner?
Speaker 3 (19:04):
Yeah, well that's a pretty good time to take it,
right Yeah, Yeah, you know it does. You know, it's
a tricky situation with this prosty because it does come
down to sometimes quality of life. You know, as long
as we don't have any objective measure to intervene, like
if you're not retaining urine on a scan or if
(19:27):
your kidneys are making sure that your kidney function is okay,
then as long as you're not retaining urine, you're not
retention and you're you know, you're not getting infections and
you're not bleeding and you're not getting stones from it
comes down the quality of life. And you know, if
you're getting up one or two times a night, but
you go, look, you know what I can deal with that.
I'm not it doesn't really bother me. I'm fine during
(19:47):
the day, then stay on it, you know. But if
it comes down to the point where you really are
bothered by it, and you know, you get tired because
you're up all night. Of course, a lot of people
have problems during the day and night and they've been
on medication. At that point, we do we do recommend
a procedure, or we recommend a procedure for somebody that
doesn't want medication, you know, as the medications as you know,
(20:12):
you know, it's not going to be like, oh, I'm
going to take it for a week and then I'm
going to be fine. It's not like an antibiotic. This
is a medication for life, you know, and medications obviously
have different side effects, so you know, it does you know,
it does come down to a thorough discussion. So I
guess I guess to your question about the natural supplements,
(20:32):
in a roundabout way, I would say, yeah, you could
give it a shot. I'm not fully confident with it.
But if you wanted to try something herbal, anti inflammatory,
that desire flamented something, if you haven't tried that, you
could maybe a couple of pills of that. Actually you do, okay, yes, well.
Speaker 5 (20:53):
Well then my friend, and hope it works.
Speaker 3 (20:57):
Then you keep your fingers crossed, work and you see
how things go, and you know, we'll check you when
you come back. But if you're not happy, then we
need to either switch back to to you know, to
the finastride or or consider a proceiver.
Speaker 5 (21:15):
All right, okay, all right, thank you very much, doctor.
Speaker 3 (21:19):
Yes, you're very welcome. Have a good day. Hopefully the
weather we'll get a little bit better. It's a bit
rainy out there now feels like day in London anyway.
If you'd like to give me a call, the number
is one eight hundred three two one zero seven ten,
one eight hundred three to two one zero seven ten.
I was talking earlier in the show in case you
(21:40):
missed it because you were still sleeping, but you shouldn't
be on a Sunday. You should be up listening to
the show every Sunday starting at seven. But if you
missed it, we're having a mends. We're having I'm sorry,
We're having a prostate cancer awareness seminar. Prostate cancer awareness seminar.
It's going to be September the fifteenth, and that's on
(22:03):
a Sunday, okay, And if you would like to attend
that seminar, you do need to give us a call
on September fifteenth. The seminar will be at the in
downtown Miniola at one oh one Miniola Boulevard. It'll start
at eight o'clock. It'll be on all about brons date cancer.
(22:26):
You can also ed Randall will be there and you
can also get all your questions answered, all the latest
and greatest information. The email is Men's Health at Nyulandgun
dot org to register, or you can pick up the
phone old fashioned way five one six six six three
(22:49):
twenty two seventy seven five one six six six three
two two seven seven. And we will provide a breakfast,
and we will all be there and look forward to
you just meeting you, greeting you and educating you, and
I will also feed you. We're also going to give
you a light breakfast as well. So it'll start at
eight am. That again will be on Sunday, September fifteenth,
(23:14):
Prostate Cancer Awareness Seminar. Bring your loved ones. It's free,
bring your friends at downtown Mineola at the Research and
Academic Center part of NYU lango On Health System on
Long Island, one oh one Miniola Boulevard. To see you there.
Just a few minutes left here on kats. It's going
(23:35):
in the morning on a rainy Sunday here in August.
If you'd like to give me a call, got a
few minutes left, eight hundred and three to two one
zero seven ten, eight hundred three two one zero seven ten.
And certainly, as I was talking about before, with the screening,
we'll be talking about when you should get an MRI
and what an MRI means if you get an MRI
(23:57):
and it's abnormal, and should you have a biopsy? If
you have a biopsy, what are the different types of biopsies.
Everything is changing in urology, and over the last few
years it's amazing the dramatic shifts that we have seen
and our ability to not only to biopsy accurately, I
(24:18):
would say, but to determine if you need a biopsy
or don't. And a lot of men we you know,
are not able to do it or need it. I
should say. Actually, we have a phone call right now.
William's on the line about an MRI. Good morning, William,
how are you.
Speaker 6 (24:36):
Good morning, doctor. It's an honor to speak with you.
I have a question about the DP parametric MRIs, which
I'm hearing a lot about. You don't need contrast, but
they're very accurate, are they yes? Are they to become
available soon?
Speaker 3 (24:50):
Well, they are available now. Frankly, you can get an
MRI with without contrast now, my friend, and thank you
for your phone call. But you know, I have to
tell you that in my experience I have not seen
any problems with the contrast agent at all. There are
(25:10):
the incidents of having some issues with the contrast agent.
The gadolinium is very very small these days, you know,
probably one in less than one in a thousand. I
believe I have not seen any and I order a
lot of MRIs. And if you get it without contrast,
yes you can. You can determine if there's cancer there,
but it's not going to be as accurate. It's not
(25:31):
going to be as specific as using the multi parametric
MRI with a gadolinium. So I would say right now,
as I sit here in August of twenty twenty four,
if we are ordering the MRI and if there's no
contra indication to get it with a contrast, like if
(25:53):
you've had a kidney issue or if you have a
known allergy, let's say, then we're getting it with the
world with the contrast, my friend. But that's a really
really good question. And you know, as I say, I
see here now. But you know, things are changing all
the time here in the field, and especially the way
(26:13):
that we're doing biopsy. We used to do everybody with
a trans rectal biopsy. Now we're doing transparent neal Biopsi's
not for everybody, but certainly something that we can talk about,
you know, with our radiation techniques. We'll talk about that.
We were doing five days of CyberKnife. Now here at
NYU we have a protocol that's opened. It's a clinical trial,
but it's now two days of radiation. I mean wow,
(26:36):
I mean it used to be forty five days for everybody.
Then it was five, and now it's possibly two. We're
doing a study there, so we'll talk about that, and
then of course we'll talk about the latest information for
men on surveillance that don't need any treatment at all,
who should get that And we have a lot of
patients that are on surveillance. So just because you have
(26:56):
a biopsy, just because you have cancer does not mean
does not mean that you need to be treated, and
we will talk about that in detail. And if you
do need treatment. We also have here at NYU a
very large, one of the one of the most large,
the largest, if not on Long Island robotic surgery program,
and we'll talk about that with our colleague, doctor Anthony Kukan.
(27:18):
But unfortunately that's the end of the show. So again,
the Prostate Cancer Awareness Seminar will be on September fifteenth.
Give us a call to register five one, six sixty
sixty three, twenty two, seventy seven five one six sixty six,
three two two, seven seven four if you can email
us at Men's Health at NYU Lando dot org.
Speaker 2 (27:38):
You've been listening to Catcer'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 (27:49):
The proceeding was a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.
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