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, your
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 Landgone Hospital, Long Island.
(00:32):
Here is doctor Aaron Katz.
Speaker 3 (00:36):
Good morning everyone, Welcome to Katz's Corner here on woar iHeartRadio.
We are live this morning. If you'd like to give
me a call, I'd love to hear from you. The
number I'll announce it a few times is eight hundred
three two one zero seven ten. That number again is
eight hundred three two one zero seven ten. So glad
(00:58):
you could join me here this morning. We are in
the middle of the month here in December, rather chilly
out this morning.
Speaker 4 (01:05):
I was up earlier this morning.
Speaker 3 (01:06):
I recently bought a new puppy, which I thought initially
was a good idea. But you know, it's a lot
of work. It's like having a new baby. And I'm
up earlier and earlier, get a little cranky, you know,
walking around in the park at four thirty in the morning. Also,
I don't know, I'm thinking maybe it's a little dangerous,
you know.
Speaker 4 (01:25):
I got a little puppy there, but.
Speaker 3 (01:28):
You know, you know, hopefully not. I look around, try
to go into two bright lit areas and walk around.
So that's what I was doing at four thirty this morning,
and I had my tea and then I'm over here
and hopefully we'll talk to some wonderful people. And I've
received great emails by the way from friends and colleagues
(01:50):
and listeners over the years. I've made this announcement that
unfortunately Kansas Corner will continue on another venue, but will
not be here on wo R.
Speaker 4 (02:02):
But if you.
Speaker 3 (02:02):
Would like to email me, you certainly can. It's Men's
Health at nyulandgone dot org. That's Men's Health at NYU
landgone dot org. To to let you know where I
will be and will continue my mission, my calling in
(02:23):
life of bringing you the latest and greatest in not
only in men's health, but that is my focus but
in all areas of health, and I continue to do that.
I know, I've been on the radio here at this
station and at other stations before that, and I've been
on the air for probably close to twenty years now,
(02:44):
and it's been part of my routine, part of my life,
and I.
Speaker 4 (02:47):
Do enjoy it.
Speaker 3 (02:49):
It keeps me as well updated with information because it
enforces me to continue to read and push myself, as
I do with my residence as well. We have interesting
journal club articles that we review, and on rounds we
discuss latest information about health of course, and in patient
(03:11):
care here at NYU, which is our utmost priority. But
you know, I will continue to do it and I
feel it's extraordinarily important. I don't know too many other
shows may be wrong, but I'm not aware of any
other show that's really dedicated to men's health by.
Speaker 4 (03:33):
A person.
Speaker 3 (03:35):
I'd like to think that I'm a credible guy. You know,
I've been in the field as I'd graduated my residency
program in nineteen ninety two and did a fellowship at
Columbia University and Eurologic Oncology. Was faculty at Columbia for
twenty years, and our chairman of the Urology Department here
at NYU on Long Island, and we do follow guidelines.
(03:57):
We have evidence based medicine. Not all patients fit into
the guidelines. Sometimes you need to go outside of the guidelines,
but you need to let patients know about that. But
there are certain guidelines, especially when dealing with specific cancers
that we deal with in the urinary tract, which is
particularly prostate kidney bladder. We don't see too much testicular
(04:21):
cancer out here, very little. We don't see a lot
of penile cancer. There is some cases. We actually had
a case this past month that we presented in our
monthly Tumor Board with the increase in HPV infection, which
is a precursor of PNL cancer. Not necessarily a precursor.
(04:43):
It's a risk factor, that's what I should say.
Speaker 4 (04:46):
It's a risk factor.
Speaker 3 (04:47):
For PNL cancer as well as being uncircumcised is a
risk factor for penl cancer and smoking and of course
the other things that we see with cancer like all
other cancers, obesity and things like that. This unfortunate person
did have a cancer of the penis that did require
(05:07):
removal partial removal of the penis and also it can
spread into the lymph nodes, and so we're going to
have to take out some of the lymph nodes in
the in the inguinal area and the groin. But again,
you know, we are following evidence based practices here and
NCCN guidelines, and so, you know, I think that obviously
(05:28):
that is extremely important when you're dealing with cancer. And
then you know, in our department, and I've talked about
this many times, and a lot of people are you know,
will like to call me and speak to me and
see me about the urinary issues that they're having, you know,
getting up at night, frequent urination, urgency, leaking of urine,
(05:49):
we see some urinary tract infections, and all of that
can occur in both men and women. Of course, there
are different causes in men and men. Most commonly, although
not always, is related to prostrate growth. By the way,
if you're just waking up here on Kats's Corner, you
want to give me a call. We are live here
in the middle of December. It's chilly out there. It's
(06:11):
about twenty I think it's about twenty six twenty seven
degrees when I was up at four thirty this morning.
The number if you want to give me a call,
love to hear from you. Eight hundred three two one
zero seven ten. Eight hundred three two one zero seven
ten phone lines are open, uh, and we have the
ability to interact with you. Okay, we've got someone on
(06:34):
the line here this morning. Someone is up, Henry, good morning,
How are you?
Speaker 5 (06:40):
Good morning? Thank you doctor Katts for your great program
and for taking my call. Right now. I'm taking Flomax
and prosh car for my overactup ladder, but I understand
the other medications a number as a matter of fact,
(07:01):
that can be used in the treatment of o actablada
detrol and vers a care. Yes, a number of different
medication actually about ten. I guess when you think about it,
in your opinion, if Flomax and proscar are not really
helping me, especially getting up maybe four or five times
(07:24):
in the night, can you think of something that would
be better for me? My age is seventy nine and
that's my situation.
Speaker 4 (07:35):
Yeah, well, thank you, Henry.
Speaker 3 (07:36):
You know, we certainly see this quite a bit with
patients that are on medication, the dual medication proscar and
Flomax proscard to shrink the prostate. If your prostate size
is large and flomax. It's just been used since I
was a resident, probably around thirty five years or so ago.
Still used to kind of relax the prostatic muscle and
(07:59):
open up the prostate and give you a better flow,
hence the name flow max, and it is used typically
for men with large prostates that are dealing because the
prostate can push on the bladder and as you mentioned,
give you.
Speaker 4 (08:12):
An overactive bladder.
Speaker 3 (08:13):
There are other medications out there, but you know, medications
have side effects, and a lot of these newer findings
of the medications are that they can interfere not only
with your bowel movements, causing constipation and giving you a
dry mouth, but they also can some of the medications
can be associated with cognitive function and your ability to
(08:38):
think properly, and even there are some studies hinting that
it may be linked to early dementia. There are some
new medications out there that seem to be a little
bit more specific to the bladder muscle. Those can be
associated though we give you a side effect of high
(08:58):
blood pressure. One of the things that I would think about, Henry,
if you've been on the medication and rather than switching
it around, and if you are kind of still having
bothersome symptoms is to a determine the size of the prostate,
either with an ultrasound or an MRI, and then you know,
maybe get off the medications and consider a procedure if
(09:19):
you're seventy nine, but you know, if you're otherwise healthy,
We here at NYU have had great success with a
procedure called aqua lublation. I don't know if you're familiar
with that. It's a powerful water jets. It's robotic driven.
It does require a hospital admission overnight, but that has
been quite good in getting patients off the medications, especially
(09:42):
for those men with rather large prostates. If the prostate
size is between forty and eighty. We do have, you know,
in the office types of procedures that have been shown
to be very effective. They're probably the most common one
that we're using here at NYU and Long Island is
called the euro lift. Again, it would depend upon the size,
(10:05):
and you know, have the urologists do a a what's
called a look inside the bladder or a systoscopy. But
I would think that that would be reasonable rather than
switching the medications around. You know, seventy nine, You know,
these medications. As I said that, you know, there's there's
no free lunch. They can certainly cause lots of side effects,
and if they're not working, you could switch it. You
(10:28):
could switch over to a different medication. But that was
something that I would consider for you, Henry.
Speaker 5 (10:35):
Thank you.
Speaker 6 (10:36):
There is a relationship, I think between the function of
the bladder and how the brain sensors creates a sense
of urgency for the bladder to initiate its its function.
Speaker 7 (10:54):
Can you did you ever have a patient who had
good urinary function, a good urinary system, but yet had
a problem with the pontine mictorition center in the brain
in the ponds. Have you ever studied that?
Speaker 3 (11:11):
Perhaps No, I mean I haven't particularly studied that, but
you know, the pontin micturation center, as you say, is
certainly something that does control the urinary blodder in the brain.
Certainly patients that have had a stroke or MS or Parkinson's,
(11:32):
all of these things neurologically can affect the blodder. So
I hope that helps you, Henry. But one of the
things that I would think about is, look, if you
are considering you've had a neurological issue, then you may
need something called a Eurodynamics test to check the functioning
of the blotder. That could be very helpful to you
(11:53):
to determine if you do, in fact still have a
blockage of the blodder or if there's something neurologically going
on there. You know, obviously I don't know your full
medical history, but that would be something to consider. Thanks
you for your phone call, Henry. I hope you have
a great day and appreciate you tuning in. We're live
here on Katz's Corner. Unfortunately, as I mentioned earlier, the
(12:16):
show here on this station will be ending. I will
be continuing though on a different venue, and if you'd
like to send me an email, you can at Men's
Health at Nyulandgone dot org. Men's Health at nyulandgone dot org.
The number is eight hundred three two one zero seven ten.
This morning, love to hear from you. Joe has a
(12:36):
question about testosterrom. Good morning, Joe, how are you?
Speaker 8 (12:41):
Yes, good morning doctor. Thank you for taking my call
and from great work you've done.
Speaker 4 (12:47):
Thank you.
Speaker 8 (12:48):
My question to you as an eighty ar oll guy
who's on a little bit of metaprol twenty five miligrams
ten milligrams at lepertoire and a baby asked for at
night heart tack back in twenty twenty two. That's really
my maintenance medication. My PSA is one point three and
(13:11):
my total testosterone is over seven hundred. My free testosterone
is only four point five, which is quite low. My
testosterone is being bound up by a high d DHT
and high sb HG hormones. So my question is is
(13:38):
there a natural way of lowering those binding hormones and
freeing up more testosterone which would give me a little
more energy, a little more ooph and doosterone would be
(14:01):
I do know all about metal root for the SBHG
bind that binds low the s PhD.
Speaker 3 (14:08):
I understand, okay, but but Joe, you're telling me that
your testosterone level is seven hundred.
Speaker 4 (14:13):
Is that right?
Speaker 8 (14:15):
I'm sorry, I beg your pond.
Speaker 3 (14:16):
Your total testosterone is seven hundred. Yeah, I mean that
that's kind of normal. That's it's very normal. It's it's
it's super normal for somebody of your age. So I'm
not so sure that anybody is going to give you
additional testosterone.
Speaker 4 (14:33):
Or know of ways.
Speaker 3 (14:34):
I'm not aware of any natural ways that you could
alter your free testosterone level. But you know, everything that
I've read seems to indicate that in men that have
very high testosterone levels that you know, you're not going
to be able to alter that for you uh and
uh and not supplement your testosterone. But interestingly, I will
(14:59):
tell you that there's you know, the whole controversy of
testosterone is really changing quite a bit, Joe. And you know,
the urology community has always felt that testosterone replacement therapy
would be a contraindicated in patients with prostate cancer. And
(15:21):
that theory goes back to years and years ago when
people Huggins and Hodges discovered that if you removed testosterone
with a castration, that that could be a treatment for
prostate cancer. So it was thought for many years that, oh, no,
we could never give somebody testosterone back if you've undergoing
(15:41):
prostate cancer, if you had prostate cancer. Well, that myth
has really been is going away quite rapidly. In fact,
this month in our Bible of Urology, the Journal of Urology,
there's an excellent article by the folks at one of
the hospitals here in New York Memorial Sloan Kettering that
basically looked at men that had radical prostate surgery, their
(16:04):
prostates removed, and then gave them back a testosterone and
a subgroup of men and looked to see if in
the future the men had a higher recurrence rate of
prostate cancer than the men that did not have testosterone
replacement therapy. And in fact, what they showed in a
ten year follow up study was that there was no
(16:27):
difference in recurrence rates for men that had a radical
prostate surgery who were given testosterone. Now, these men that
had the radical surgery and were given testosterone were at
the time did not have a recurrence. So you had
to have no recurrence. A PSA has to be under
(16:48):
zero point one and a low testosterone of around three hundred.
But they followed these men and you know, lo and behold,
you don't see any recurrence. So and I personally have
agree read with this paper. I have used this in
my practice for years.
Speaker 4 (17:04):
I should have.
Speaker 3 (17:05):
Probably maybe I still will publish a paper looking at
men here at NYU that have had radiation therapy and
that are out at least about a year with a
stable PSA. Now, the PSA doesn't go to zero after radiation,
but with a stable PSA, and you know, low Testosterolona.
(17:25):
You know, it's it's remarkable men. You know. Unfortunately in
your particular case, you know, Joe that you're calling me about,
it's not you know, I'm not going to be able
to improve on that seven hundred level, Joe, There's just
no way. But in men that have really low T
levels of you know, one hundred or two hundred, that
(17:45):
are sluggish, that have poor performance and that want a
better performance you know sexually let's say, or more energy
or more muscle mass, and the tustogeal levels are low.
I personally have found this to be really effective for
that subset of men, no doubt. Now, look, you know,
(18:05):
if you're listening to go wow, you know I have
low energy, can't get out of bed, and you know
all these things that do the kats is saying it's
probably my testosterone that may not be. So you want
to get a testosterone level, and get the testosterone level
in the morning, that's when it's most reliable. Your internists
can do it, urologists can do it, endocrinologists can do it.
Speaker 4 (18:27):
Anyone.
Speaker 3 (18:27):
You can order the testosterone. It's a pretty easy test
to do and see what your number is and if
it's below three hundred, which is typically the cutoff, then
you may be a candidate for replacement. The question is
how do you replace testosterone, which is a whole other controversy.
There's gels, there's injections, there's new nasal spray actually, and
(18:51):
it's unclear which.
Speaker 4 (18:52):
One is really best.
Speaker 3 (18:54):
But you do need to be under the supervision of
a doctor because in rare cases, you know, the PSA
may go up. In rare cases, you know, the prostague
can swell, and maybe your urinary issues will get worse
again rarely, And then in rare cases, your blood count
needs to be monitored because one of the things that
(19:17):
testosterone does is it affects the blood in the bone marrow,
makes your blood counts, and sometimes they can go really high.
It's called you know, your hemoglobin can't go over like
fifteen or sixteen. I actually had a patient this week
that I had to discontinue for a bit because it's
just his hemoglobin went up to I think it was eighteen,
which is which is too high.
Speaker 4 (19:38):
And that's definitely concerning.
Speaker 3 (19:40):
So yeah, you know, I mean, people like they listen
to these shows at night and you know you're going
to take testosterone, and he has a pill for it,
which is really never been at least not until recently
shown to be effective, and it's given without the supervision
of a doctor.
Speaker 4 (19:58):
I think it's dangerous.
Speaker 3 (20:00):
And I think for young guys that are doing these
things too, I mean young, I mean you know, thirties, forties,
twenties even that are taking testosterone, it may it probably
will shut off your own ability to make a testosterone
and could interfere with your sperm production. Now, look, if
you're in your seventies or eighties, you don't care about
your sperm production anymore, right, of course not. But you know,
(20:22):
young guys that are taken these taking these shots in
the gym, I don't think they realize everything that they're
doing to their bodies.
Speaker 4 (20:31):
And I know, I get I get it.
Speaker 3 (20:32):
You want to get big, you want to get juiced up,
you want to have nice you know, biceps and triceps,
you know, But I think you can do that all
or you know, organically and without supplementation. The number is
eight hundred and three two one zero seven ten one
eight hundred three two one zero seven ten. As I mentioned,
my time here on this particular venue is ending at
(20:54):
the end of the month, but I will be going
to another venue and I would If you want to
get the information from me, you can send me an
email at Men's Health at Nyulandgone dot org, Men's Health
at NYU Landgoon dot org. The number here this morning,
we are live. If you want to give me a
(21:14):
phone call. We have just just a few minutes left.
Speaker 4 (21:18):
So I know. People start waking up this time of.
Speaker 3 (21:20):
Year, this time of morning, especially this time of year
when it's so cold out.
Speaker 4 (21:24):
People are like, I don't know how you get up
so early in the morning.
Speaker 3 (21:27):
You know, Well, one reason is I got this new puppy,
so that's that's pushing me out at four point thirty
in the morning. But I don't know. I like to
start the day early. I always have done that. And
you know, I do the show. I'm a kind of
a routine guy. I do the show and then I
go do my exercise, and you know, by nine o'clock,
I'm up. I did the show, I did the exercise.
(21:49):
I'm good, you know, and then take care of some
patient issues and try to relax. Maybe watch you a
little football today. I don't really know who's playing, but
Dad's a big Navy guy. He was in the Navy,
and he was really happy about the Navy game yesterday,
he text me, which apparently turned out to be a
good game for Navy and a good game overall. So
(22:11):
good for Navy this year for winning. My son, actually,
if you've listened to me over the years, my oldest
son was in the Army for a while after going
to college, and he decided he wasn't sure what he
was going to do after college and entered the army
on his own, and it absolutely changed his life. I
(22:33):
wonder if it's something that I don't know. It's hard
to make it mandatory, as they do in the State
of Israel, but the military can be such a wonderful
opportunity for so many people. And he spent a few
years in the army. He got a degree as a
respiratory therapist. He was working in the height of COVID,
(22:53):
you know, as a respiratory therapist, and then said, you
know that I think I want to go to medical school.
Speaker 4 (22:58):
And this past May.
Speaker 3 (23:00):
He he graduated from Dartmouth Medical School and now he's
out in Utah doing emergency medicine in residency. And you know,
the military completely changed his life. I I, you know,
don't really have any one of my family. Well, my
father was in the Navy for a couple of years,
(23:20):
but I think it was only because he didn't really
have too many options at the time. My son here,
he was a college graduate, but he felt like he
needed to to to change his life a bit. You know,
he kind of majored in fraternity life during during college,
so uh, and it completely refocused him. And I don't
(23:43):
know if you know somebody in your lives that you
feel is unsure young person of where the direction is
and where they're going.
Speaker 4 (23:50):
Uh.
Speaker 3 (23:50):
Think about the military, the different branches of the military.
It's a it was for me personally. My son completely
changed his life and he spent several years there. So again,
if you'd like to continue to listen to me and
hear what I have to say and my thoughts and
opinions about men's health will be moving to a different
venue at the end of the month. You can send
(24:13):
me an email at Men's Health at NYU Langoon dot
org to find out what that particular venue will be.
And I will continue to go on my life's mission,
my life's calling. I think we all have a calling
and that seems this seems to be my calling is
to help to educate men and their spouses, their loved
(24:37):
ones about their health. And these are the things that
I incorporate in my own life. You know, I think
that there's three basic things in life that you need
for long term sustainability, which is a good diet, balance,
the exercise and sleep, and of course reduction that goes
(25:01):
without saying structure if we can, but I think the
basic tenets, the basic three pillars that people need to
do is to be very mindful about their nutrition, and
try to get in as much exercise as you can.
And if you're a little older and you can't move
around so much, even walking or walking faster, or moving
(25:22):
your arms or your legs, just moving your body is key.
And then getting enough sleep. And you know, I can't
tell you how much that is so important. And I
hear time and time again from my patients that they're
not sleeping. Okay, Mark is up. You have a question
(25:43):
about Good Morning.
Speaker 4 (25:45):
How are you?
Speaker 7 (25:46):
Yes, you said last year that there was gonna be
a like for EED, but I've never heard you talk
about it since.
Speaker 3 (25:54):
Yeah, that's a good point, Mark, I have to do
more research on that ointment. I believe that there was
an ointment that was recently in the last few months
FDA approved, and I you know, we are still using
the basic treatments here for ED, which is the viagraph,
the cialis the injection therapy. We have the shockwave therapy
(26:18):
which has come out, which some of the guys in
the practice here in the way you were using. And
then of course you know, penile injection therapy. And then
we have the of course this long standing penile implant
for those men that are refractory to all of those
and want to have erections.
Speaker 4 (26:37):
But that does.
Speaker 3 (26:38):
Require obviously a surgical procedure. But the yeah, I think
maybe what I'll do is next week, Mark, I'll do
more information and ask my colleagues about that. I do
think that there was something that was recently FDA approved,
but it hasn't really caught on. I haven't really heard
too many people talking about it. But boy, wouldn't that
(26:58):
be great? You know, no more needles, no more pills,
just put a cream on. It seems easy enough to
do in terms of developing a biomaterial that would go
right through the skin, that would give increased blood supply
to the linings. With the cylinders within the penis, the
(27:19):
the corpora cavernosa. But okay, Mark, well I've got my
homework to do for next week, so I will do that.
Speaker 4 (27:25):
Thank you very much for bringing that to my attention.
Speaker 3 (27:29):
Well, we only have thirty seconds left and that's going
to be the end of the show. Again, if you
want to keep in touch with me, you certainly can
at Men's Health at nyulandgom dot org. And unfortunately out
of my control, but I really have enjoyed my time
here at WOR. I will be on for the next
(27:50):
few Sundays until the end of December.
Speaker 2 (27:53):
You've been listening to Katcher's Corner, come back every week
to hear more straight talk on a wide range of
Lend's health topics and advice on how to live your
healthiest life.
Speaker 1 (28:04):
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, your
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 Landgone Hospital, Long Island.
(00:32):
Here is doctor Aaron Katz.
Speaker 3 (00:36):
Good morning everyone, Welcome to Katz's Corner here on woar iHeartRadio.
We are live this morning. If you'd like to give
me a call, I'd love to hear from you. The
number I'll announce it a few times is eight hundred
three two one zero seven ten. That number again is
eight hundred three two one zero seven ten. So glad
(00:58):
you could join me here this morning. We are in
the middle of the month here in December, rather chilly
out this morning.
Speaker 4 (01:05):
I was up earlier this morning.
Speaker 3 (01:06):
I recently bought a new puppy, which I thought initially
was a good idea. But you know, it's a lot
of work. It's like having a new baby. And I'm
up earlier and earlier, get a little cranky, you know,
walking around in the park at four thirty in the morning. Also,
I don't know, I'm thinking maybe it's a little dangerous,
you know.
Speaker 4 (01:25):
I got a little puppy there, but.
Speaker 3 (01:28):
You know, you know, hopefully not. I look around, try
to go into two bright lit areas and walk around.
So that's what I was doing at four thirty this morning,
and I had my tea and then I'm over here
and hopefully we'll talk to some wonderful people. And I've
received great emails by the way from friends and colleagues
(01:50):
and listeners over the years. I've made this announcement that
unfortunately Kansas Corner will continue on another venue, but will
not be here on wo R.
Speaker 4 (02:02):
But if you.
Speaker 3 (02:02):
Would like to email me, you certainly can. It's Men's
Health at nyulandgone dot org. That's Men's Health at NYU
landgone dot org. To to let you know where I
will be and will continue my mission, my calling in
(02:23):
life of bringing you the latest and greatest in not
only in men's health, but that is my focus but
in all areas of health, and I continue to do that.
I know, I've been on the radio here at this
station and at other stations before that, and I've been
on the air for probably close to twenty years now,
(02:44):
and it's been part of my routine, part of my life,
and I.
Speaker 4 (02:47):
Do enjoy it.
Speaker 3 (02:49):
It keeps me as well updated with information because it
enforces me to continue to read and push myself, as
I do with my residence as well. We have interesting
journal club articles that we review, and on rounds we
discuss latest information about health of course, and in patient
(03:11):
care here at NYU, which is our utmost priority. But
you know, I will continue to do it and I
feel it's extraordinarily important. I don't know too many other
shows may be wrong, but I'm not aware of any
other show that's really dedicated to men's health by.
Speaker 4 (03:33):
A person.
Speaker 3 (03:35):
I'd like to think that I'm a credible guy. You know,
I've been in the field as I'd graduated my residency
program in nineteen ninety two and did a fellowship at
Columbia University and Eurologic Oncology. Was faculty at Columbia for
twenty years, and our chairman of the Urology Department here
at NYU on Long Island, and we do follow guidelines.
(03:57):
We have evidence based medicine. Not all patients fit into
the guidelines. Sometimes you need to go outside of the guidelines,
but you need to let patients know about that. But
there are certain guidelines, especially when dealing with specific cancers
that we deal with in the urinary tract, which is
particularly prostate kidney bladder. We don't see too much testicular
(04:21):
cancer out here, very little. We don't see a lot
of penile cancer. There is some cases. We actually had
a case this past month that we presented in our
monthly Tumor Board with the increase in HPV infection, which
is a precursor of PNL cancer. Not necessarily a precursor.
(04:43):
It's a risk factor, that's what I should say.
Speaker 4 (04:46):
It's a risk factor.
Speaker 3 (04:47):
For PNL cancer as well as being uncircumcised is a
risk factor for penl cancer and smoking and of course
the other things that we see with cancer like all
other cancers, obesity and things like that. This unfortunate person
did have a cancer of the penis that did require
(05:07):
removal partial removal of the penis and also it can
spread into the lymph nodes, and so we're going to
have to take out some of the lymph nodes in
the in the inguinal area and the groin. But again,
you know, we are following evidence based practices here and
NCCN guidelines, and so, you know, I think that obviously
(05:28):
that is extremely important when you're dealing with cancer. And
then you know, in our department, and I've talked about
this many times, and a lot of people are you know,
will like to call me and speak to me and
see me about the urinary issues that they're having, you know,
getting up at night, frequent urination, urgency, leaking of urine,
(05:49):
we see some urinary tract infections, and all of that
can occur in both men and women. Of course, there
are different causes in men and men. Most commonly, although
not always, is related to prostrate growth. By the way,
if you're just waking up here on Kats's Corner, you
want to give me a call. We are live here
in the middle of December. It's chilly out there. It's
(06:11):
about twenty I think it's about twenty six twenty seven
degrees when I was up at four thirty this morning.
The number if you want to give me a call,
love to hear from you. Eight hundred three two one
zero seven ten. Eight hundred three two one zero seven
ten phone lines are open, uh, and we have the
ability to interact with you. Okay, we've got someone on
(06:34):
the line here this morning. Someone is up, Henry, good morning,
How are you?
Speaker 5 (06:40):
Good morning? Thank you doctor Katts for your great program
and for taking my call. Right now. I'm taking Flomax
and prosh car for my overactup ladder, but I understand
the other medications a number as a matter of fact,
(07:01):
that can be used in the treatment of o actablada
detrol and vers a care. Yes, a number of different
medication actually about ten. I guess when you think about it,
in your opinion, if Flomax and proscar are not really
helping me, especially getting up maybe four or five times
(07:24):
in the night, can you think of something that would
be better for me? My age is seventy nine and
that's my situation.
Speaker 4 (07:35):
Yeah, well, thank you, Henry.
Speaker 3 (07:36):
You know, we certainly see this quite a bit with
patients that are on medication, the dual medication proscar and
Flomax proscard to shrink the prostate. If your prostate size
is large and flomax. It's just been used since I
was a resident, probably around thirty five years or so ago.
Still used to kind of relax the prostatic muscle and
(07:59):
open up the prostate and give you a better flow,
hence the name flow max, and it is used typically
for men with large prostates that are dealing because the
prostate can push on the bladder and as you mentioned,
give you.
Speaker 4 (08:12):
An overactive bladder.
Speaker 3 (08:13):
There are other medications out there, but you know, medications
have side effects, and a lot of these newer findings
of the medications are that they can interfere not only
with your bowel movements, causing constipation and giving you a
dry mouth, but they also can some of the medications
can be associated with cognitive function and your ability to
(08:38):
think properly, and even there are some studies hinting that
it may be linked to early dementia. There are some
new medications out there that seem to be a little
bit more specific to the bladder muscle. Those can be
associated though we give you a side effect of high
(08:58):
blood pressure. One of the things that I would think about, Henry,
if you've been on the medication and rather than switching
it around, and if you are kind of still having
bothersome symptoms is to a determine the size of the prostate,
either with an ultrasound or an MRI, and then you know,
maybe get off the medications and consider a procedure if
(09:19):
you're seventy nine, but you know, if you're otherwise healthy,
We here at NYU have had great success with a
procedure called aqua lublation. I don't know if you're familiar
with that. It's a powerful water jets. It's robotic driven.
It does require a hospital admission overnight, but that has
been quite good in getting patients off the medications, especially
(09:42):
for those men with rather large prostates. If the prostate
size is between forty and eighty. We do have, you know,
in the office types of procedures that have been shown
to be very effective. They're probably the most common one
that we're using here at NYU and Long Island is
called the euro lift. Again, it would depend upon the size,
(10:05):
and you know, have the urologists do a a what's
called a look inside the bladder or a systoscopy. But
I would think that that would be reasonable rather than
switching the medications around. You know, seventy nine, You know,
these medications. As I said that, you know, there's there's
no free lunch. They can certainly cause lots of side effects,
and if they're not working, you could switch it. You
(10:28):
could switch over to a different medication. But that was
something that I would consider for you, Henry.
Speaker 5 (10:35):
Thank you.
Speaker 6 (10:36):
There is a relationship, I think between the function of
the bladder and how the brain sensors creates a sense
of urgency for the bladder to initiate its its function.
Speaker 7 (10:54):
Can you did you ever have a patient who had
good urinary function, a good urinary system, but yet had
a problem with the pontine mictorition center in the brain
in the ponds. Have you ever studied that?
Speaker 3 (11:11):
Perhaps No, I mean I haven't particularly studied that, but
you know, the pontin micturation center, as you say, is
certainly something that does control the urinary blodder in the brain.
Certainly patients that have had a stroke or MS or Parkinson's,
(11:32):
all of these things neurologically can affect the blodder. So
I hope that helps you, Henry. But one of the
things that I would think about is, look, if you
are considering you've had a neurological issue, then you may
need something called a Eurodynamics test to check the functioning
of the blotder. That could be very helpful to you
(11:53):
to determine if you do, in fact still have a
blockage of the blodder or if there's something neurologically going
on there. You know, obviously I don't know your full
medical history, but that would be something to consider. Thanks
you for your phone call, Henry. I hope you have
a great day and appreciate you tuning in. We're live
here on Katz's Corner. Unfortunately, as I mentioned earlier, the
(12:16):
show here on this station will be ending. I will
be continuing though on a different venue, and if you'd
like to send me an email, you can at Men's
Health at Nyulandgone dot org. Men's Health at nyulandgone dot org.
The number is eight hundred three two one zero seven ten.
This morning, love to hear from you. Joe has a
(12:36):
question about testosterrom. Good morning, Joe, how are you?
Speaker 8 (12:41):
Yes, good morning doctor. Thank you for taking my call
and from great work you've done.
Speaker 4 (12:47):
Thank you.
Speaker 8 (12:48):
My question to you as an eighty ar oll guy
who's on a little bit of metaprol twenty five miligrams
ten milligrams at lepertoire and a baby asked for at
night heart tack back in twenty twenty two. That's really
my maintenance medication. My PSA is one point three and
(13:11):
my total testosterone is over seven hundred. My free testosterone
is only four point five, which is quite low. My
testosterone is being bound up by a high d DHT
and high sb HG hormones. So my question is is
(13:38):
there a natural way of lowering those binding hormones and
freeing up more testosterone which would give me a little
more energy, a little more ooph and doosterone would be
(14:01):
I do know all about metal root for the SBHG
bind that binds low the s PhD.
Speaker 3 (14:08):
I understand, okay, but but Joe, you're telling me that
your testosterone level is seven hundred.
Speaker 4 (14:13):
Is that right?
Speaker 8 (14:15):
I'm sorry, I beg your pond.
Speaker 3 (14:16):
Your total testosterone is seven hundred. Yeah, I mean that
that's kind of normal. That's it's very normal. It's it's
it's super normal for somebody of your age. So I'm
not so sure that anybody is going to give you
additional testosterone.
Speaker 4 (14:33):
Or know of ways.
Speaker 3 (14:34):
I'm not aware of any natural ways that you could
alter your free testosterone level. But you know, everything that
I've read seems to indicate that in men that have
very high testosterone levels that you know, you're not going
to be able to alter that for you uh and
uh and not supplement your testosterone. But interestingly, I will
(14:59):
tell you that there's you know, the whole controversy of
testosterone is really changing quite a bit, Joe. And you know,
the urology community has always felt that testosterone replacement therapy
would be a contraindicated in patients with prostate cancer. And
(15:21):
that theory goes back to years and years ago when
people Huggins and Hodges discovered that if you removed testosterone
with a castration, that that could be a treatment for
prostate cancer. So it was thought for many years that, oh, no,
we could never give somebody testosterone back if you've undergoing
(15:41):
prostate cancer, if you had prostate cancer. Well, that myth
has really been is going away quite rapidly. In fact,
this month in our Bible of Urology, the Journal of Urology,
there's an excellent article by the folks at one of
the hospitals here in New York Memorial Sloan Kettering that
basically looked at men that had radical prostate surgery, their
(16:04):
prostates removed, and then gave them back a testosterone and
a subgroup of men and looked to see if in
the future the men had a higher recurrence rate of
prostate cancer than the men that did not have testosterone
replacement therapy. And in fact, what they showed in a
ten year follow up study was that there was no
(16:27):
difference in recurrence rates for men that had a radical
prostate surgery who were given testosterone. Now, these men that
had the radical surgery and were given testosterone were at
the time did not have a recurrence. So you had
to have no recurrence. A PSA has to be under
(16:48):
zero point one and a low testosterone of around three hundred.
But they followed these men and you know, lo and behold,
you don't see any recurrence. So and I personally have
agree read with this paper. I have used this in
my practice for years.
Speaker 4 (17:04):
I should have.
Speaker 3 (17:05):
Probably maybe I still will publish a paper looking at
men here at NYU that have had radiation therapy and
that are out at least about a year with a
stable PSA. Now, the PSA doesn't go to zero after radiation,
but with a stable PSA, and you know, low Testosterolona.
(17:25):
You know, it's it's remarkable men. You know. Unfortunately in
your particular case, you know, Joe that you're calling me about,
it's not you know, I'm not going to be able
to improve on that seven hundred level, Joe, There's just
no way. But in men that have really low T
levels of you know, one hundred or two hundred, that
(17:45):
are sluggish, that have poor performance and that want a
better performance you know sexually let's say, or more energy
or more muscle mass, and the tustogeal levels are low.
I personally have found this to be really effective for
that subset of men, no doubt. Now, look, you know,
(18:05):
if you're listening to go wow, you know I have
low energy, can't get out of bed, and you know
all these things that do the kats is saying it's
probably my testosterone that may not be. So you want
to get a testosterone level, and get the testosterone level
in the morning, that's when it's most reliable. Your internists
can do it, urologists can do it, endocrinologists can do it.
Speaker 4 (18:27):
Anyone.
Speaker 3 (18:27):
You can order the testosterone. It's a pretty easy test
to do and see what your number is and if
it's below three hundred, which is typically the cutoff, then
you may be a candidate for replacement. The question is
how do you replace testosterone, which is a whole other controversy.
There's gels, there's injections, there's new nasal spray actually, and
(18:51):
it's unclear which.
Speaker 4 (18:52):
One is really best.
Speaker 3 (18:54):
But you do need to be under the supervision of
a doctor because in rare cases, you know, the PSA
may go up. In rare cases, you know, the prostague
can swell, and maybe your urinary issues will get worse
again rarely, And then in rare cases, your blood count
needs to be monitored because one of the things that
(19:17):
testosterone does is it affects the blood in the bone marrow,
makes your blood counts, and sometimes they can go really high.
It's called you know, your hemoglobin can't go over like
fifteen or sixteen. I actually had a patient this week
that I had to discontinue for a bit because it's
just his hemoglobin went up to I think it was eighteen,
which is which is too high.
Speaker 4 (19:38):
And that's definitely concerning.
Speaker 3 (19:40):
So yeah, you know, I mean, people like they listen
to these shows at night and you know you're going
to take testosterone, and he has a pill for it,
which is really never been at least not until recently
shown to be effective, and it's given without the supervision
of a doctor.
Speaker 4 (19:58):
I think it's dangerous.
Speaker 3 (20:00):
And I think for young guys that are doing these
things too, I mean young, I mean you know, thirties, forties,
twenties even that are taking testosterone, it may it probably
will shut off your own ability to make a testosterone
and could interfere with your sperm production. Now, look, if
you're in your seventies or eighties, you don't care about
your sperm production anymore, right, of course not. But you know,
(20:22):
young guys that are taken these taking these shots in
the gym, I don't think they realize everything that they're
doing to their bodies.
Speaker 4 (20:31):
And I know, I get I get it.
Speaker 3 (20:32):
You want to get big, you want to get juiced up,
you want to have nice you know, biceps and triceps,
you know, But I think you can do that all
or you know, organically and without supplementation. The number is
eight hundred and three two one zero seven ten one
eight hundred three two one zero seven ten. As I mentioned,
my time here on this particular venue is ending at
(20:54):
the end of the month, but I will be going
to another venue and I would If you want to
get the information from me, you can send me an
email at Men's Health at Nyulandgone dot org, Men's Health
at NYU Landgoon dot org. The number here this morning,
we are live. If you want to give me a
(21:14):
phone call. We have just just a few minutes left.
Speaker 4 (21:18):
So I know. People start waking up this time of.
Speaker 3 (21:20):
Year, this time of morning, especially this time of year
when it's so cold out.
Speaker 4 (21:24):
People are like, I don't know how you get up
so early in the morning.
Speaker 3 (21:27):
You know, Well, one reason is I got this new puppy,
so that's that's pushing me out at four point thirty
in the morning. But I don't know. I like to
start the day early. I always have done that. And
you know, I do the show. I'm a kind of
a routine guy. I do the show and then I
go do my exercise, and you know, by nine o'clock,
I'm up. I did the show, I did the exercise.
(21:49):
I'm good, you know, and then take care of some
patient issues and try to relax. Maybe watch you a
little football today. I don't really know who's playing, but
Dad's a big Navy guy. He was in the Navy,
and he was really happy about the Navy game yesterday,
he text me, which apparently turned out to be a
good game for Navy and a good game overall. So
(22:11):
good for Navy this year for winning. My son, actually,
if you've listened to me over the years, my oldest
son was in the Army for a while after going
to college, and he decided he wasn't sure what he
was going to do after college and entered the army
on his own, and it absolutely changed his life. I
(22:33):
wonder if it's something that I don't know. It's hard
to make it mandatory, as they do in the State
of Israel, but the military can be such a wonderful
opportunity for so many people. And he spent a few
years in the army. He got a degree as a
respiratory therapist. He was working in the height of COVID,
(22:53):
you know, as a respiratory therapist, and then said, you
know that I think I want to go to medical school.
Speaker 4 (22:58):
And this past May.
Speaker 3 (23:00):
He he graduated from Dartmouth Medical School and now he's
out in Utah doing emergency medicine in residency. And you know,
the military completely changed his life. I I, you know,
don't really have any one of my family. Well, my
father was in the Navy for a couple of years,
(23:20):
but I think it was only because he didn't really
have too many options at the time. My son here,
he was a college graduate, but he felt like he
needed to to to change his life a bit. You know,
he kind of majored in fraternity life during during college,
so uh, and it completely refocused him. And I don't
(23:43):
know if you know somebody in your lives that you
feel is unsure young person of where the direction is
and where they're going.
Speaker 4 (23:50):
Uh.
Speaker 3 (23:50):
Think about the military, the different branches of the military.
It's a it was for me personally. My son completely
changed his life and he spent several years there. So again,
if you'd like to continue to listen to me and
hear what I have to say and my thoughts and
opinions about men's health will be moving to a different
venue at the end of the month. You can send
(24:13):
me an email at Men's Health at NYU Langoon dot
org to find out what that particular venue will be.
And I will continue to go on my life's mission,
my life's calling. I think we all have a calling
and that seems this seems to be my calling is
to help to educate men and their spouses, their loved
(24:37):
ones about their health. And these are the things that
I incorporate in my own life. You know, I think
that there's three basic things in life that you need
for long term sustainability, which is a good diet, balance,
the exercise and sleep, and of course reduction that goes
(25:01):
without saying structure if we can, but I think the
basic tenets, the basic three pillars that people need to
do is to be very mindful about their nutrition, and
try to get in as much exercise as you can.
And if you're a little older and you can't move
around so much, even walking or walking faster, or moving
(25:22):
your arms or your legs, just moving your body is key.
And then getting enough sleep. And you know, I can't
tell you how much that is so important. And I
hear time and time again from my patients that they're
not sleeping. Okay, Mark is up. You have a question
(25:43):
about Good Morning.
Speaker 4 (25:45):
How are you?
Speaker 7 (25:46):
Yes, you said last year that there was gonna be
a like for EED, but I've never heard you talk
about it since.
Speaker 3 (25:54):
Yeah, that's a good point, Mark, I have to do
more research on that ointment. I believe that there was
an ointment that was recently in the last few months
FDA approved, and I you know, we are still using
the basic treatments here for ED, which is the viagraph,
the cialis the injection therapy. We have the shockwave therapy
(26:18):
which has come out, which some of the guys in
the practice here in the way you were using. And
then of course you know, penile injection therapy. And then
we have the of course this long standing penile implant
for those men that are refractory to all of those
and want to have erections.
Speaker 4 (26:37):
But that does.
Speaker 3 (26:38):
Require obviously a surgical procedure. But the yeah, I think
maybe what I'll do is next week, Mark, I'll do
more information and ask my colleagues about that. I do
think that there was something that was recently FDA approved,
but it hasn't really caught on. I haven't really heard
too many people talking about it. But boy, wouldn't that
(26:58):
be great? You know, no more needles, no more pills,
just put a cream on. It seems easy enough to
do in terms of developing a biomaterial that would go
right through the skin, that would give increased blood supply
to the linings. With the cylinders within the penis, the
(27:19):
the corpora cavernosa. But okay, Mark, well I've got my
homework to do for next week, so I will do that.
Speaker 4 (27:25):
Thank you very much for bringing that to my attention.
Speaker 3 (27:29):
Well, we only have thirty seconds left and that's going
to be the end of the show. Again, if you
want to keep in touch with me, you certainly can
at Men's Health at nyulandgom dot org. And unfortunately out
of my control, but I really have enjoyed my time
here at WOR. I will be on for the next
(27:50):
few Sundays until the end of December.
Speaker 2 (27:53):
You've been listening to Katcher's Corner, come back every week
to hear more straight talk on a wide range of
Lend's health topics and advice on how to live your
healthiest life.
Speaker 1 (28:04):
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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