KATZ'S CORNER - - 09 - 29 - 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
Gone Health. It's Katz'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 sevent ten WOOR
It's the Chairman of Urology at NYU Land Gone Hospital,

(00:31):
Long Island. Here is doctor Aaron Katz.

Speaker 3 (00:36):
Now, good morning everyone, Welcome to Katz's Corner here on
wr iHeartRadio. We are alive in this final Sunday of
September twenty twenty four, so glad you could join me
this morning. If you'd like to give me a call,
the show goes rather quickly, so please give me a
call as early as possible. In the show, the number

(00:57):
is eight hundred three to one zero. That number again
is eight hundred and three to two one zero, seven ten,
and we will take your phone calls. Last week on
the show, I was talking about a conference that I
went to in Washington, d C. On focal therapy for
prostate cancer as well, attended as tremendous enthusiasm now for

(01:20):
treating patients with prostate cancer in a focal manner rather
than treating the entire prostate clan, something that we had
thought of in the past to be the only way
to treat prostate cancer, and now we're finding that with
our MRI technology and imaging modalities that have significantly improved

(01:42):
over the last few years, and our biopsy strategies where
we're no longer just doing you know, kind of random
biopsies of the prostate, but actually targeting in on the
area of interest that is found on the MRI, that
we can now treat patients in a focal manner. And
this has been shown not only to get rid of

(02:05):
the cancer, and that's obviously the primary goal, but the
secondary goal for patients with an abnormality in the prostate
and that require treatment is to preserve normal and maintain
normal urinary function and sexual function. And these technologies whether

(02:26):
whether the energy is used with cold energy this is
called cryotherapy we have this here at NYU, or heat
energy high intensity focused ultrasound we have this at NYU.
Which are the two commercially available right now energy that

(02:46):
are employed. These both seem to do rather well in
both of those areas and the cancer the oncological aspects
as well as maintaining the quality of life. There are
some new energies that are coming down that are being
studied that may play a significant role. One is something

(03:08):
called IRE, which is using electrical energy irreversible electro poration
of the prostate where needles are put in electrical almost
like electrical shocks, or energy is applied rather than heat
or cold. People are looking at different forms of laser

(03:29):
energy to get rid of cancers. So lots of enthusiasm
not applicable to all patients who have prostate cancer. But
that's you know, that's why people need individualized care and
individualized you know, consultations with our team to make sure

(03:52):
that you may or may not. First of all, the
question is do you need treatment at all? And we
find that today many patients do not need treatment at
all of the prostate. You know, you hear about different
forms of treatment or robotic surgery, radiation therapy, cybernife, focal therapy.
That the bigger question that I always see when I'm
discussing a console with a patient is whether or not

(04:15):
this patient requires treatment at all. In that does require
a deeper dive, if you will, into the biology of
the cancer, looking at the genomic essays. We now have
tests to look at the DNA of the actual individual

(04:35):
cancer cells and can tell you with reasonable accuracy just
from that DNA in the area of the cancer what's
going on in the rest of the prostate. And so
maybe you don't need treatment and you can go on
something that we call active surveillance, which I will tell
you I have been doing for at least twenty years

(04:58):
now in my practice, has certainly gained lots of acceptance
these days. And you know, there's certainly people say to
me all the time. Patients say, well, you know, I
have this cancer, and maybe I should just get treated,
because sooner or later I'm gonna need treatment, you know.
And I get that, and you might. But if you

(05:20):
have a situation where you know, the area of the
cancer is not something that is aggressive, that may be
very slow growing, you may not need treatment. And in
my own particular studies and other studies around the country,
if we properly select and we do proper what we

(05:41):
call risk stratification where you know, we can actually look
at your risk and we have low, intermediate, and high
risk and if you are low risk by the biology,
by the histology, by the look under the microscope, and
low risk by the DNA, and also sometimes we can

(06:04):
look oftentimes we look at other parameters like the MRI characteristics,
making sure that there's nothing outside the prostate. We can
look at the PSA velocity over time, and we can
also look at things like your family genetics. It's no
doubt that genetics play a significant role in so many

(06:28):
diseases today, in fact, you know, beyond just risk cancer itself.
But you know, I've had many patients come in and say,
you know, my brothers have had it, my father had
prostate cancer, he died young. You know, these are things
that we need to take into account when discussing, you know,
you know, whether or not somebody really needs treatment or not.

(06:50):
And then the other thing that we're finding today is
not only about you know, a family history of prostate cancer.
But you know, now it's it's almost standard that we
in a consultation and I say, we as physicians, urologists, oncologists,
radiation oncologists discuss or find out about other cancers in

(07:13):
the family, such as if your mom or sisters have
had breast cancer, ovarian cancer, These genetic syndromes like Lynch
syndrome where people get multiple types of cancers of the
colon and could be breast, could be prostate. So you know,

(07:37):
it's not just oh, well, does anyone in your family
have prostate cancer now, but we need to see about
other other cancers which may indicate that perhaps you should
have what's called genetic testing. Now that's different than the
genomic testing of the biopsy, but genetic testing looking at
what we call a germline mutation. If you have something

(07:57):
that's a Baraka mutation or one of these other mutations
that can occur that we're finding that may indicate that
this is a bad actor of bad cancer and does
need treatment and should not go on to surveillance. So
these are some of the things that we all need
to keep in mind. Phone lines are open, by the way.

(08:21):
One eight hundred three two one zero seven ten one
eight hundred three two zero one eight hundred three to
two one zero is seven ten. On this final Sunday
here in September, things are moving quickly. They always seem
to do once the summer goes even the summer seems
to go fast these days, So I don't know, at

(08:41):
least that's my perception. I guess. I guess maybe the
busier you are, the time goes quicker. But so I'd
love to hear from you. The other thing I'd wanted
to let people know is that we do have an
email if you want to email me. Some people have
emailed me through the week, and that email us is
Men's Health at nyulandgone dot org, Men's Health at NYU

(09:07):
landgone dot org. I did receive a email from Michael
this week, who is seventy four years old, who has
emailed me about his situation. He has a PSA of
four point three a couple of years ago and now
it went up to six. He had another type of

(09:30):
test called a four K score. So a four K
score is like the PSA, but it can determine whether
or not if you have an elevated PSA. The four
K score can determine if the elevation in the PSA
may or may not be due to cancer or even

(09:52):
a concerning form of cancer. For his four K score
was elevated, no family hit no urinary issues, but does
have a significant heart issue. He's got some carnary arter disease,
he has a known history of high blood pressure. And
the question is, you know, what should he do? This

(10:14):
one is pretty simple for me. Somebody that's coming in
with a arising PSA and elevated four case score with
the family history at all whatsoever in his family, but
the PSA did jump. It was two point four, then
it was four point two point four, and then jumped

(10:36):
up to four point three. Somewhat concerned about an MRI
the contrast, and also very anxious about an MRI. I
doesn't want to go into the tube. I get it.
So some of the recent publications have come out that
even in patients with chronic kidney issues, he has chronic

(11:00):
kidney issues, can get the contrast safely. It's not going
to make your kidneys worse. In terms of going through
the MRI, we certainly can provide a medication for you,
like xanax or something like that if you are anxious,
and you can go through the MRI without significant anxiety.

(11:20):
It does take about twenty to thirty minutes, and you
have to prepare for that for the time. But for
this gentleman. Yes, Michael, I would recommend that you certainly
need to undergo an MRI and then and then we'll
see what the MRI shows, and if it's concerning, then
you may or you may not need a biopsy. We

(11:43):
will see. But that's certainly something that you know, I
don't have any answer for right now, but certainly something
that I think. The first thing that I decide is
whether or not somebody should have an MRI or not
somebody like that certainly should. I also had an email
from Bernard who is sixty five years old, who comes

(12:10):
in and says it has an email saying that he
had an MRI and it did show a concerning area.
It was a Pirad's four. So when you get an MRI,
you will get a score. Everything in medicine is a
number or a score or a risk. So you know,

(12:31):
and that's how we as physicians and can help guide
treatment decisions for people. I think it's important. It's an
incredible de session. It's not like, well it looks good,
it doesn't look good. No, you got a number. Now,
so you get an MRI, you get a number, and
the number is one to five. Okay, So he has
a Pirad's four and he had a biopsy, so the

(12:56):
biopsy did show that there were and this gentleman again
did not have any did not have any significant family
history of prostate cancer his you know, he just had
a family history of some colon cancer and heart disease,
but no prostate cancer, but did have colon cancer in

(13:20):
the family, elevated PSA and no significant urinary issues. And
the biopsy came back. And again, when you get a biopsy,
you're going to get another number. And with prostate cancer
these days, it can be a little confusing for people
because you can get two numbers. One is the classic
Gleason score, which is based out of ten, and the

(13:45):
Gleason grading system has been there since I think the
nineteen sixties, if I'm not mistaken. Galaeson was a pathologist
and this system has been used for you know, since
the nineteen sixties. It really hasn't been changed. The only
thing that's really changed is is that although it's a
score out of ten, we don't really see anyone less

(14:07):
than six. So you're at least a six when you
start if you have cancer, and the sixes are the
ones that are considered to be low risk. That we
may not need to treat. If you get into the sevens, eights,
and nine, those are ones that we get concerned about

(14:28):
and then there's So that's one type of a system
that you might or classification. The other is what we
call a grade group, which is one to five, which
is also based upon the Gleason score. So this gentleman
has a couple of spots here of a six, a

(14:49):
lease in six. Now, when you get a biopsy back,
it will show not only the Gleason score, but it'll
also tell you how much of the biopsy and each
of the areas is involved with cancer. And the higher

(15:09):
the number, the percentage of the tumor, the higher the
volume of the cancer, they're more likely that there could
be that there could be some disease outside the prostate.
So his numbers were somewhere higher. There were sixty five percent,

(15:30):
and so at this point he's sixty five years old.
He has a low grade. But you know, so we
discussed the different things and one of the things that
he needs to have done is the genomic testing. So
we're going to do that for him and then to
see if this is in fact really a low risk

(15:53):
prostate cancer or it's something higher and something higher that
we need. So here's a situation where we have a
patient who has considered to be low risk. The question
is is it in fact low risk. We're going to
get what's called a decipher score. There are two different
types of genomic testing available today, but this is the

(16:15):
one that we've been using and for a while, many
many doctors use this score and it can really be
very helpful. I'm going to stop there and again if
you'd like to give me a call, the number is
eight hundred three two one zero seven ten. One eight
hundred three two one zero seven ten. We are here

(16:35):
on Katz's Corner. I'm your host, doctor Aaron Katz, and
we are live. So please feel free to to give
me a call if you'd like to. So I don't
want to talk all morning about prostate cancer, but we
are still in the month of September, final weekend here,
and you know this is this is prostate cancer Awareness month,

(16:57):
and it's you know, the number one cancer in men,
and we are continuing to see it's estimated close to
three hundred thousand new cases of prostate cancer this year.
And you know, as I've talked about this show, time
and time again. It's the It still relies on the PSA.

(17:18):
And so certainly if you are I believe over the
age of forty five, you should probably get a PSA
once a year or fifty if you have no other
risk factors. But if you if you have risk factors,
I think you know. But we do see you know
today we see a lot of men in their forties

(17:41):
with no significant risk factors. And you know, your PSA
can be very informative even if you're in your forties.
So especially and the other thing is especially if you're
having some urinary issues. You know, if you notice that
you know, your urinary pattern has changed, you're getting up
at night, you have some maybe some burning, or if

(18:01):
you notice any blood at all, that that is you know,
that is certainly a warning sign for for many different things.
But that you know doesn't have to be prostate cancer.
Could be an infection, but it could be bladder cancer,
it could be prostate cancer, could be an enlarging prostate.
You need to see a urologist for that, okay, But
if you you know, you notice that you're going to

(18:22):
the bathroom more during the day, if you're having urinary frequency,
you've got to run to the bathroom. If you're starting
to have some leaking, you need to come in and
get tested. It's not a big deal to get tested.
You need a blood test, you need to get a
urine test, you need to have I'm a little old school,
but yeah, you know, my patients that are listening this morning,

(18:44):
we'll chuckle and we'll say, yeah, you know, doctor Cancy
he still does directal exams, you know, And yeah, I
do because I still have found many cancers that way.
So you know, and look, if you are having these
urinary issues that I'm not here to tell you state cancer.
That's that's not That's not what this is about. But

(19:05):
it is about It could be a warning sign. But
it could also be the other things that I mentioned.
It could be just a urinary infection. It could be
an enlarged prostrate, It could be benign. It doesn't have
to be. Okay, the number are cancer, The numbers eight
hundred three, two, one zero seven ten. People are starting
to wake up and the calls again. Hot, Okay, let's
go to Doris on the line. Good morning, Doris, how.

Speaker 4 (19:26):
Are you, doctor Katz?

Speaker 3 (19:28):
How are you very well?

Speaker 4 (19:31):
Un calling? I actually talked to you about probably three
months ago. My husband has BPH. You treated him over
the years for a long time. When COVID came, we
stopped coming into the city and he had an aquiblation
in New Jersey eleven weeks ago, successful, no side sects.

(19:51):
We were really pleased. I've talked to you about it
back then and you said go forward, and it was
a good choice for him. Anyway, My question is, we
saw the doctor several weeks ago postop and he was
suffering from nocturia and everything else. Absolutely no side effects
from the aquiblasion. So I highly recommend even for younger

(20:14):
men to consider that as a treatment. But my question
is now he seems to be urinating just that night
frequently and I think in large volume when I know
that he goes a lot. The doctor asked us for
two twenty four hour urine urine samples, know that he
should measure twenty four hours and to do it twice randomly.

(20:38):
But my concern is, and I just wanted to ask
you about it. Are there some other reasons that maybe
the bladder has been overstretched over the year, over all
those years of BPH, and could it be a bladder problem?
Could it be some kind of a chemical reaction where
he's making more urine in the middle of the night
for some reason. Do you have any.

Speaker 3 (20:59):
He could be that. It could be that now that
has and that he's had the A cooblation, which is
one of the newer technologies that we've been using, and
I'm glad to hear that he's had such a great
success with that that now that his prostrate has been
opened by the a cooblation, which is a water type
of a jet propulsion that goes into the prosthetic eth

(21:21):
and opens the prostate, that he's able to get more
of the urine out. Whereas before he was in retention.
There is a condition known as post obstructive diuresis, meaning
that once he was if he was blocked up, and
now he's not, that the kidneys may be producing more

(21:43):
urine and more dilute urine, less concentrated urine. It would
be rare to have that ten weeks out, but that,
I guess is a possibility. I like the idea of
during the twenty four hour urine collection, I used to
that he's not on any diuretic or anything like that. Correct,

(22:03):
he is not.

Speaker 4 (22:04):
He is not on any other he stopped.

Speaker 2 (22:06):
Uh.

Speaker 4 (22:06):
We were on for nesteride for a little while during
right before and for a month after. He stopped his
flomax six months after the procedure. Ye, no reason for
I feel like the obstruction has been handled and something
else is going on. He did have a eurodynamic test
prior to it. There was no we were not reported

(22:28):
that there was a problem with the bladder. I know
that it was what's the word tubiculated meanings scrapeculated. Yeah,
there was some of that. So I didn't know if
there's when we go back to the doctor if we
should address that, or there is a condition with some
kind of a hormonal thing that makes more urine in
the middle of the night. Are you aware of that

(22:49):
with nocturia?

Speaker 3 (22:50):
Yes, yes, atrial naturetic factor an S, which is produced
in the heart, which is something that can cause you know, diarysis,
So that that is something that could be occurring, I
would certainly. I'm sure they've checked his kidney function is

(23:11):
creating level.

Speaker 4 (23:12):
Yes, that's all normal. Everything else normal, No chronic illness,
is no high blood pressure, no heart and he.

Speaker 3 (23:19):
Tried to reduce liquids which only at night the problem. Huh.

Speaker 4 (23:22):
Yeah, he's fine during the day. He doesn't urinate that
frequently during the day, So we will be calling the
doctor back in the next week or so. He asked
us to get a little more time. Seventy seven years old,
we understand it's time to recover after having something for
so many years. Now suddenly he can pee with no trouble.

(23:44):
So okay, So that basically we should ask about the
post obstructive DIARYSIS.

Speaker 3 (23:50):
Yeah, I would do that. I would check his electrolytes
as well, making sure that his sodium level is okay,
his creating levels are good, and it may just be
may just take.

Speaker 4 (24:01):
Some time for things, maybe just takes some time that
we should still be patient. And yeah, it's just hard
when you can't when you have to get up so
much at night.

Speaker 3 (24:10):
Yeah, yeah, I don't know if there's anything else that
I would recommend at this time. One of the other
things that he could do is see a nephrologist, not
just a urologist, to do other additional testing of his urine.
But I think the twenty four hour urine collection is

(24:30):
probably a good start, and also measuring the volume of
urine that he's putting out throughout the day.

Speaker 4 (24:38):
Great, great, yea, and we will be doing that over
the next week for so great Okay, your information, Thank
you so much.

Speaker 3 (24:46):
Glad to help you. Joh yeah, thank you all right, yeah,
and I'm glad that that recommendation was a good one.
That is a procedure that is relatively new for men. Again,
a couaplation is not for as we were talking about
much of the show this morning, for cancer, but for
men with an enlarged prostate, usually a relatively very large

(25:08):
prostate where there can be a blockage around the around
the bladder, and as you've been hearing, once that bladder,
once the obstruction of the blockage is removed, you know,
people will certainly have an improvement in their urinary flow

(25:28):
and in their urgency. But nocturia getting up at night
is and producing a lot of urine at night is
something that is usually the last piece to recover, which
may take some time, especially if you've been a bit
blocked over a significant amount of time. We have just
a few minutes a here on Katsis Corner half hours

(25:50):
going rather quickly. If you'd like to get me a
quick call in the numbers eight hundred three two, one
zero seven ten. If not throughout the week, you can
send me an email at me NDS Health at NYULANDGNE
dot org. And you know, again, this is the end
of Prostate Cancer Awareness Month, and I believe next month

(26:12):
is Breast cancer Awareness. But we all need to be
aware of the different testings that we can do for
ourselves and to be proactive about things. And certainly for men,
it is getting in and you can get a PSA
from your interness, primary care family care doctor as well.
Certainly you don't have to go to a eurologist, but

(26:33):
if you are having any of these symptoms that you know,
like Doris's husband was having, certainly a urologist should be
called and get in for a quick evaluation. And you know,
sometimes the evaluations could be a quick ultrasound of the bladder.
You'urine testing, blood testing, it's not it's not going to
be it's enough to be invasive at all. And you know,

(26:57):
we do have as Doris mentioned, her husband had euro
dynamic testing that's a test of the bladder function to
check and make sure that you know your bladder is
functioning well, especially if you've had a blockage for a while.
God only gave us one bladder, and so you don't
want to get into a situation where the bladder can
get overly stretched. A bladder is just a muscle, and

(27:19):
if it does get stretched too thin, then some of
the muscle tissue may not be able to be repaired,
and you know that that can cause other significant problems.

Speaker 2 (27:31):
You've been listening to Katzer'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 (27:42):
The proceeding was a paid podcast. iHeartRadio's hosting of this
podcast constitutes neither an endorsement of the products offered or
the ideas expressed.