December 4, 2025 • 30 mins
Hosted by Neil Scott and Dr. Tom Walsh
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Speaker 1 (00:00):
Welcome to Men's Health Matters with doctor Tom Walsh, director
of the University of Washington's Men's Health Center and Associate
Professor of Urology at UW, featuring important topics dealing with
men's health, including prostate cancer and erectiledys function. Now here's
your host, Neil Scott.
Speaker 2 (00:20):
Welcome to the November edition of Men's Health Matters. November
edition putting a spotlight on men's health and coming to
you from the iHeart Studios in Seattle. My co host
is doctor Tom Walsh, the director of the University of
Washington's Men's Health Center. Doctor Walsh, Happy Movember, Neil, Happy November. Yeah,
so glad to be here. November's mission is to save
(00:42):
lives and improve men's health by funding research and support programs.
Some of the health issues that November focuses on include
prostate cancer, testicular cancer, mental health, suicide prevention, and you
can find out more at Movember dot com. Tonight, doctor Walsh,
we take a new look at state cancer. We have
a world expert and an innovator for focal therapy. Can't wait.
Speaker 3 (01:06):
You know I'm entering that age at I'm beginning my
prostate cancer screening journey. As I think about my future,
I'm really excited to hear what George has to say.
Speaker 2 (01:16):
We have an interesting conversation with doctor George Shade in
just a few moments. But first, as we do on
every edition of Men's Health Matters, we answer questions from
the anonymous inbox. That's a chance to send your questions
about any health issue, no matter how embarrassing, with only
using your first name. All you have to do is
send us an anonymous email at Men's Healthmatters at iHeartMedia
(01:38):
dot com. We will not retain or share your email address.
We start this month, doctor Walsh with a question from
Michael from Seattle. I'm a man in my mid thirties
and recently a female friend of mine asked me if
I had been vaccinated for HPV. I had no idea
what she was talking about. She told me that it
was a leading cause of cancer. Frankly, I have never
(01:59):
heard of it.
Speaker 3 (02:00):
This is a tough one, Michael. HPV human papalomavirus is
ubiquitous and is now considered a sexually transmitted infection between
men and women. While it doesn't have huge repercussions for men,
it does have consequences as a risk factor for cervical cancer,
(02:21):
and therein is the challenge. The absolute best source of
understanding are you a candidate for an HPV vaccine? Are
you too old, too young, appropriate or not? Would be
the University of Washington STI Clinic, which is based out
of Harbor View Medical Center. And truly, this is a
clinic that is the source of information.
Speaker 2 (02:44):
Let's move on to AL from Lakewood. I recently met
a woman who I really like, and she is insisting
that I get checked out for possible sexually transmitted diseases.
I was stunned, and I was pissed off that she
didn't trust me. But it is a deal breaker, so
I guess I have to do it. Is there a
simple blood test that I have to take? Where do
(03:04):
I do it? And how do I get a certificate
that I can shore? AL?
Speaker 3 (03:08):
Don't be angry. This is responsible sexual behavior. As I
referred Michael, I would say the UW Sexually Transmitted Infection
Clinic based out of Harborview Medical Center.
Speaker 2 (03:21):
That's the place to go.
Speaker 3 (03:22):
If you have a good primary care provider, that would
be another great source.
Speaker 2 (03:27):
It is just a blood test.
Speaker 3 (03:28):
They're not going to give you a certificate. My friend,
They're going to give you a lab result, and in
this modern era of electronic medical records, you'll be able
to walk out the door with that result as soon
as it post.
Speaker 2 (03:39):
Remember you can send an anonymous email on any health
issue to Men's Health Matters at iHeartMedia dot com. We
will not retain or share your email address one hundred
percent anonymous. Our guest is month doctor George Shade. Are
youw Associate professor in urology. He's an adjunct Assistant professor
in the UDB Center for Industrial and Medical Ultrasound and
Applied Physics Lab. Doctor Shay is also a world expert
(04:02):
on prostate cancer and an innovator on focal therapy for
prostate cancer. Welcome to Men's Health Matter is doctor Shade.
Good to have you here. Thanks, Neale's great to be here. Tom,
good to see you. Prostate cancer is the second leading
cause of death in American men, behind only lung cancer.
About one in forty four men who die of prostate cancer.
(04:24):
That's the bad news. The good news is that prostate cancer,
when diagnosed and treated early, the five year relative survival
rate is greater than ninety nine percent. This includes stages one, two,
and three where the cancer is contained within the prostate gland.
The earlier prostate cancer is detected and treated, the more
likely the patient will remain disease free. Tonight, we're going
(04:46):
to focus on a relatively new procedure for treating prostate cancer.
You know, fortunately we live in Seattle with access to
one of the leading cancer research and treatment centers in
the nation, Fred hutch and they've reached and added what
is called IRE, which is high intensity focused ultrasound and
cryotherapy focal therapy. And let's begin, doctor Shade with a
(05:10):
definition of focal therapy, which I believe is less invasive
and as fewer side effects. And why is it a
game changer?
Speaker 4 (05:18):
Yeah, thanks Neil, it's a great question. The idea of
focal therapy is analogous a lumpectomy for breast cancer as
opposed to a mistectomy. So the idea is you're treating
just a portion of the gland that has the disease,
as opposed to treating the whole gland in the form
of surgery or radiation.
Speaker 2 (05:33):
And how long has this been around?
Speaker 4 (05:35):
Some of these technologies have been around for twenty five
or thirty years. And we're available in Europe and Asia
over that timeframe, but the first devices we're available here
in the US in twenty fifteen.
Speaker 2 (05:45):
Who's a candidate for this?
Speaker 4 (05:46):
I get that question all the time. The brief answer is,
it's a little bit of a Goldilock's phenomenon. So your
cancer has to be just right and your procetate has
to be just right. The perfect candidate would be somebody
with what's called a Gleasin score of seven, and for
proces cancer, that's considered an intermediate grade. The lowest grade
is a six and the highest grade is a ten.
And the idea there is you have to have a
cancer that's not too aggressive that if we don't get
(06:08):
at all, we could hurt you. And if the cancer
is a very low grade cancer, you may not need
any treatment at all. So we want to have a
cancer that you could benefit from treatment, but again not
so aggressive that we might hurt you by missing something.
And so that's the first criteria, has to be at
least in seven. And then the second is the goal
is we're just trying to treat a small part of
the prostate, and so ideally it's a small tumor that's
involving just one side of the prostate, so that way
(06:29):
we can stay far away from the critical structures on
the other side to avoid side effect.
Speaker 3 (06:33):
Actor Walsh, you know, as a practicing urologist who's been
in this profession for so many years, the idea behind
a focused therapy that treats cancer but leaves normal behind
is it's a game changer. When we talk about surviving
prostate cancer, we're talking about typically living with some of
the consequences, either they removal or the destruction of the
(06:56):
entire prostate gland, which becomes really kind of a useful
organ when we get older. You know, this is a
fertility organ, so destroying it or removing it is okay,
but there are consequences. So the idea that we can
cure cancer potentially and not destroy any of the peripheral
areas around the prostate is just absolutely huge.
Speaker 2 (07:15):
What is cryotherapy.
Speaker 4 (07:17):
Cryotherapy is one of the options available to us for
focal therapy. The ideas cryo means freezing, so it's basically
freezing in this case of the prostate. With cryotherapy, patients
asleep under anesthesia. We pass what are called cryoprobes into
the prostate under ultrasound guidance and then we place those
around the area of interest and then under image guidance
freeze the appropriate part of the prostate. So that's just
(07:39):
one of the many, many mechanisms through which we can
treat the prostate.
Speaker 3 (07:42):
Why freezing, why not heat?
Speaker 2 (07:44):
What's the difference?
Speaker 4 (07:46):
The truth is is that there's a lot of ways
that we can do focal therapy. Cryotherapy is one of
the earliest ways, and it's honestly falling out of favor
over the last several years. So we typically use it
most often not for men or their initial treatment, but
and men who've had radiation previously and then failed and
need a subsequent treatment.
Speaker 2 (08:04):
Of course, all this begins with the screening process. Men
should get a screening annually for prostate cancer. Now, it's
controversial and a lot of pros and cons of prostate
cancer screening. Who should be screened, how should they be screened,
and what will be the next step?
Speaker 4 (08:22):
Yeah, you're hitting all the hot button topics right now
in the world of prostate cancer screening. It's something that's
evolved a lot over the last several years, going from
we should screen almost everybody several years ago to what's
called the US Protective Task Force, which is the national
federal body that writes guidelines for cancer screening, recommending against
(08:43):
it for pretty much everybody. To now a more moderate
take on it. The current guidelines call for screening and
men of at least average risk with at least average
life expectancy beeen the ages of fifty five to seventy.
And then there's other guidelines bodies like the American Neurologic Association,
and it's in similar bodies that have kind of further
expanded upon that, especially if you're in a group of
(09:04):
men that have higher risks, such as men with a
family history, men of African descent for instance.
Speaker 5 (09:10):
There's some other risk factors as well.
Speaker 4 (09:12):
In those patient populations, we consider screening as early as
age forty five.
Speaker 2 (09:16):
If there's a high PSA number. My understanding is that
in a lot of men, and there's different categories of men,
obviously it's a zero to four, what would be considered alarming.
Speaker 4 (09:28):
Yeah, that's another good question. So the short answer is
that it really depends on your age. The standard cut
off of four. That's really a kind of a very
narrow patient population, and the idea there is just that
as US men get older, our pro states get bigger,
and the more prostate we have, the more PSA we make,
and so the upper limit of normal gets bigger as
(09:48):
our prostates get bigger. And so for a man in
his forties, your PSA really should be below one, and
so anything more than one and a half to two
is really pretty high. And then in your fifties it
should be still particularly less than one, less than one
and a half, So anything over two and a half
is considered above the cutoff. And then as we gin
to our six sies, that's typically where that score of
a four to four and a half come into play.
(10:09):
And then for men in the seventy sometimes will even
tolerate up till about five.
Speaker 5 (10:13):
And a half.
Speaker 2 (10:13):
Can the prostate be reduced?
Speaker 4 (10:16):
Yes, So there's a number of mechanisms through which we
can reduce the size of the prostate. One would be medications.
So there's a specific type of medication that shrinks the
prostate about thirty percent.
Speaker 5 (10:26):
While you take it.
Speaker 2 (10:27):
Finest Ride.
Speaker 4 (10:28):
Finastride is one, the other is detaster ride. Proscar and
Aviadart are the trade names. And then there's a number
of surgical procedures through which we can remove a portion
of the prostate or less a rotor router, if you will,
to help menpee better and reduce the size of the prostate.
Speaker 2 (10:42):
Doctor Walsh Neil.
Speaker 3 (10:43):
There's so many nuances here to how age associates with
the man's PSA, how PSA can change over time, and
about who are some specific at risk populations. But what
I want to drive home to every single person who's
who's listening, is that all of this discussion, which begins
(11:04):
by talking to your provider about it, it's about being
curious about your health. Knowing that prostate cancer is the
most common cancer diagnosis among men in the US and
is a leading cause of cancer related death that is preventable.
So this begins with that bold move of taking charge
of your health seeking out a test. Don't always just
(11:26):
expect that your primary provider is going to bring this
and present it to you. Be knowledgeable, ask about it,
ask if it's right for you, engage in a discussion,
and if a value isn't right, then we begin these discussions.
You know, so many people and myself included, it's fearful
to go and investigate one's health. It's kind of a
(11:47):
scary business. But what I want everyone to know, is
that going to a doctor, going to a nurse practitioner,
going to a physician assistant, all these different people is
really just about learning.
Speaker 2 (11:58):
As far as focal therapy is concerned. I mean, it
sounds amazing, however it's not for everyone. I was amazed
in doing my research to find out it was simply
an outpatient procedure.
Speaker 4 (12:09):
Vocal therapy isn't just one treatment because there's multiple different
treatments in that space. Generally speaking, they're all performed in
a pretty similar way. So, at least in the US,
patients are under anesthesia, so they're asleep and comfortable so
they don't feel anything during the treatment. And then we
use some type of energy source. So it could be
what's called high intensity focus ultrasound which heats the tissue.
(12:31):
It can be what's called IRA, which is irreversible electroporation.
That's a mouthful, but that uses electricity to create holes
or pores in the cells. There's cryo therapy, which you
touched on. There's lasers to heat tissue that way, and
then there's a number of other technologies in the pipeline.
In general, under anesthesia with some type of imaging to
tell us where to go in the prostate. We either
(12:54):
aim the ultrasound to heat the prostate in the case
of hifuet the area of interest, or we place probes
into the prostate to either electrocute, freeze, or laser the
disease part of the prostate, and only takes about anywhere
from two to three hours, depending on how big the
prostate is, how big the tumor is, things of that nature.
And then the patient wakes up. What about recovery time afterwards?
(13:16):
The prostate can well make it difficult to ferment to urinate,
so as a result, they go home with a catheter.
In my practice, typically about a week at some places
only a few days. We do it longer here just
because we cover the entire Pacific Northwest, and so I
have patients coming down from Alaska, coming from Montana, etc.
And so I just don't want somebody to be at
home in the middle of the night, not able to
pee and trying to find an er. And then beyond that,
(13:38):
once the catheter comes out, it's mostly just letting the
prostate cool off, so to speak. Afterwards, the prostrate's pretty angry,
so you tend to feel like they have to pee
you pretty bad. They can have some burning, occasionally some
blood in the urine. Most of those symptoms are typically
better within something like about three to four weeks, occasionally
a little bit longer.
Speaker 3 (13:54):
I want to play make believe for just a moment.
Let's imagine I'm somebody who is the Goldilocks. Know I've
I've done my screening, We've identified a focal area in
my prostate, which you can enlighten us in a bit
maybe how we do that, but that I'm somebody who
wants that focal experience. Where do I have to go?
(14:15):
Can I just go anywhere? Can I go see my
local urologist? Do I have to travel? What's the process?
And where do I need to be for this kind
of technology?
Speaker 4 (14:23):
Currently, you to a large extent, have to be at
a center of so called excellence, like a major cancer center.
That that's changing. So there's huge interests right now in
our field, among all of our colleagues and urology and
even in radiation ecology. In some areas, it's kind of
slowly percolating through into the community, but to a large extent,
it's at the larger center. So here in Seattle, for instance,
(14:44):
we have a program Swedish has been trialing machine over
the last several months, and then there's a dock at
Evergreen who's been trialing system as well.
Speaker 3 (14:53):
But at the bottom line is that in this moment,
I need to come to the Fred Hutch. I need
to talk to you or your colleagues to.
Speaker 5 (14:58):
A large extent y patient driven.
Speaker 2 (15:00):
You can't go in and say, well, I've got prostate cancer,
I'd like vocal therapy. You have to be a candidate correct.
Speaker 4 (15:07):
When people read about it and hear about it for
obvious reasons, they want it. And so I see a
lot of men who have maybe they read about it,
a friend's told them about it, what have you. So
they come to learn about it thinking they want it.
And in some cases they're a great candidate, and it's
sort of full steam ahead once we confirm that they're
a good candidate, and others we have to have a
(15:27):
more difficult conversation that I wish they were a candidate.
They're just not a good candidate, either because they're where
their cancer is or the grade of the cancer, et cetera.
Speaker 2 (15:34):
How does this procedure affect sexual performance following the procedure.
Speaker 4 (15:39):
One of the main reasons that the men are potentially
interested in focal therapy is that it tends to have
better outcomes in terms of sexual functions. Process cancer treatments
can impact sexual function in two ways. The first is
it can impact our erections, and the reason for that
is the nerves that control erections run more or less
intertwined with the blood supply going to the prostate, and
(16:02):
so during surgery we have to control the blood flow
of the organ, and so we try to spare those nerves,
but there's still trauma and that can impact sexual function.
And with radiation, that's in the field, and so those
nerves are radiated. And then the second way, the prositate
is a reproductive organ. It makes our semen or contributes
to it anyway, and so if we remove the prostate
during surgery, you don't ejaculate anymore. And the case of radiation,
(16:24):
you may still make some semen, but often there's a
lot of scarring and the ducks that drain the prostate,
so many men don't ejaculate after radiation either. So in
the case of focal therapy, we're not treating the whole prostate,
and so if we're only treating one side, we're not
doing anything at all to the one nerve. We might
be able to not go very close to the nerve
(16:44):
on the effected side, or maybe we have to treat
right up to it, but we're still not traumatizing it.
With surgery, we're not radiating it. Because of that, there
tends to be a much lower risk of ED afterwards. So,
for instance, after surgeony, anywhere from forty to eighty percent
of men we'll be able to have intercourse long term,
whereas with focal therapy it's about eighty percent of men
who are able to have intercourse before.
Speaker 3 (17:04):
This is why that as these technologies and their precision
seems to only be growing. I compare what doctor Shade's
talking about today relatives when I was a trainee. You know,
I would know in a heartbeat that this would be
the treatment that I would want if I were a
candidate for a surgeon like me, who is really in
(17:25):
that arena where we are treating the aftermath of prostate
canch treatment. You know, I just hope George doesn't put
me out of business.
Speaker 5 (17:32):
I'm just gonna say that's my goal.
Speaker 2 (17:35):
What about follow up? I mean six months, a year,
two years, three years down the.
Speaker 4 (17:39):
Road, so the way we follow patients afterwards is similar
to what's called active surveillance. In some cases we actually
refer to focal therapy as actor surveillance.
Speaker 5 (17:48):
Plus.
Speaker 4 (17:49):
So the plus is we're doing something. We're trying to
cure a man's cancer, but we're not treating the whole prostate,
and we have to one make sure that you don't
develop a new cancer on the other side in the future.
And then two, more importantly, we have to make sure
we get everything, because if we're not treating the whole prostate,
we have to ensure that we've treated the correct part
of the prostate and covered enough of the prostate to
(18:09):
get everything.
Speaker 5 (18:11):
That strikes me as just good branding, ex exactly. Yeah.
Speaker 2 (18:14):
Our guest this month on men's health matter is doctor
George Shade. Doctor Shade is a u TO renowned surgeon
and Associate Professor in urology, specializing in your logic oncology,
with a specific focus on bladder, prostate, kidney, and testicular cancers.
We're going to continue our discussion with doctor Shade right
after this quick timeout.
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Speaker 2 (19:28):
We're back on men's health matters. I'm Neil Scott. My
co host is the director of the UW Men's Health Center,
doctor Tom Walsh. As we continue our discussion with doctor
George Shade, a prominent surgeon and Associate Professor of Urology
at the UDUB and a pioneer in focal therapy in
the treatment of prostate cancer, A fascinating topic.
Speaker 3 (19:48):
Dr Walsh, You know, George, before the break, we we
began kind of elaborating on, you know, why focal therapy,
the idea that, as you said it, it's like a
lumpectomy versus a mastectomy, which resonates with a lot of folks,
And you talked about some of the benefits are that
there is not that sort of collateral damage that affects
men's sexual function, I know, and you know that the
(20:10):
prostate sits in this really pivotal anatomic location where it's
also involved in our urinary function. And you talked about
some of the symptoms during initial recovery after focal therapy
that men may experience. Maybe you could talk about, you know,
what should a man expect and is there a benefit
to urinary function in the setting of vocal therapy if
(20:30):
you're a candidate.
Speaker 4 (20:31):
That's actually I think one of the biggest drivers for
why men are interested in focal therapy and one of
the biggest advantages of it. As we discussed, the prostate
is a reproductive organ but it's also basically the first
part of our urethruck. So the ladders attached to our
prostate and when we pee, the urine travels through the
prostate and then it ends up at the base of
the penis and then makes its way to the outside world.
(20:53):
Anything that we do to the prostate can impact urinary function,
similar to sexual function, as we were talking about earlier.
The case of prostate cancer treatments. If we're doing surgery,
the main drawback is leakage, and right after surgery, almost exclusively,
everyone leaks. And the reason for that is the sphincter
muscle that squeezes to keep us dry, goes around the
(21:14):
urethra basically right at the junction with the prostate, and
so during surgery, although we try really hard to protect
that muscle, it does get traumatized a little bit. And
then after surgery you have a catheter, so the muscle weekends.
And the way I describe it is if you have
a knee surgery, you're operating on a joint in between
their's muscles above and below, and then you have an
ee brace afterwards, we're not using those muscles the way
(21:35):
you would. You have to rehab to learn how to walk.
After surgery, you have to learn how to control again
with rehab, and so long term most men will regain
their control after surgery, but something like about ten to
fifteen percent of men will end up wearing a pad
for life. Fortunately it's not a huge majority, but if
you're in that group, you can really impact your quality life.
And in fact, we were talking about this during the break.
(21:57):
Sometimes we see men where they're really prioritizing their sexual function,
and I always take a step back and just say, well,
urinary function is more important because that impacts everything you do,
and at the end of the day, if you're leaking
a lot, you're not going to have sex anyway. Compared
to surgery, for instance, because focal therapy isn't treating the
whole prostate. If your tumor is way far away from
(22:17):
the sphincter muscle, we're not going to be treating anywhere
close to it. With focal therapy, for instance, even if
it is we try to spare tissue, we're not going
on the other side. Because of that, the risk of
leakage is much less, both immediately afterwards but also long term.
Speaker 2 (22:31):
When you diagnose a person with prostate cancer and you
want to do a work up to find out if
he is a candidate for this, what is that process?
Speaker 4 (22:40):
Yeah, yeah, well I get asked that all the time.
The vast majority of my patients they already have a diagnosis,
so it's not so much that we're working them up. Initially,
their local doc is seeing them. They've had typically an
MRI after an elevated PSA test that that's become the norm,
I would say in most areas of the country, and
then they'll have a biopsy. Often use what's called MR fusion,
(23:01):
where we basically combine the MRI and then the ultrasound
we do to guide the bibe C in the same setting,
so we know that we're hitting the area of interest
and so that leads to a diagnosis. And then if
you end up in my office, we'll talk about focal therapy.
The workout that I do typically involves at the very
least doing an ultrasound or other prostate and the reason
for that is big factors that can determine if someone
(23:24):
is a candidate for HAIFU, which is the high intensity
focus ultrasound to heat or they may need another treatment
is if they have calcifications in their prostate that can
block the ability of ultrasound waves to get into the prostate,
and calcifications are really common. It's a benign thing, sort
of like kidney stones. The physiology is different, but they're
really common. Between the three of us, probably we have
(23:44):
at least one or two at least And so that's
the first thing. And the second is that I recommend
to repeat BIBEC and I don't require it because bib
cs aren't necessarily the funnest thing on earth, as you
can imagine, if a patient is very opposed to, I
don't require it. The reason why I recommend it is
that in the setting of only having one prior prossy biopsy,
(24:05):
if we look again, we find either additional cancer or
potentially worse cancer, and something like about thirty to forty
percent of patients. This is very much the Goldilocks phenomenon.
The cancer can't be too hot, too cold, it can't
be too big or too small, and so if we find,
say cancer on the other side we didn't know about, well,
in that case, you probably need your whole process treated,
(24:25):
and so probably something like surgery radiation might be better.
And so that's the reason it's much better to know
about that before the treatment, as opposed to you get
your treatment and then a year later, when we're doing
our follow up, we find that we miss something because
we didn't know about it.
Speaker 2 (24:39):
Back to the biopsy, it is uncomfortable. However, you can
do it under anesthesia. I could not undergo a clinic biopsy.
I had a biopsy under anesthesia. How common is that?
Is it available to everyone?
Speaker 4 (24:51):
I would like to think that any urologists you go
to would be an option to have a biopsy under anesthesia.
As far as how common I think append there's probably
a little bit on the practice itself. I know in
some practices they do a fair number of their bibecies
under anesthesia, especially if it's what's called transparent neal, which
is where it goes through the skin between the scrotum
(25:12):
and the rectum, that that can be a common practice
in some offices. In my own personal experience, with adequate
numbing and counseling about what to expect, probably something like
about ninety percent of patients can get through it in
the office, but definitely not everybody.
Speaker 3 (25:25):
I want to talk about a little bit of a
dirty subject, if you don't mind, which is insurance, health
insurance and the eyeword. Oftentimes, in the history of healthcare
and payment for healthcare in the United States of America,
we've seen new technologies sometimes lag we would call third
(25:49):
party pairs. Insurance medical insurance companies view these things. You
and I have the same employer. If I'm diagnosed with
prostate cancer, can I have vocal therapy?
Speaker 5 (26:02):
I think the short answers that you have. If you
have my insurance, then the answer is no. No.
Speaker 4 (26:05):
Interesting Medicare pays for it, So if you have Medicare
A and B, it would be covered. You might have
a copay depending on exactly what your program looks like.
But if you have private insurance, including a Medicare advantage plant,
because those are administered by private insurance, then it really
depends on the insurer and the policy you have. In general,
the pendulum is swinging towards focal therapy. So there are
(26:27):
some private insurance companies out that pay for it, but
there are some that do not.
Speaker 3 (26:32):
How can I get our listener the people who are
going to benefit from this, which is either a man
or somebody who has a man in their life, which
is everybody. How can we send the message that this
is something that has to be available to everybody.
Speaker 4 (26:48):
As you can imagine, if you're living through this process
and there's a treatment that you want and you can't
have it. It's very frustrating. So you know, I don't
know that I have a clear solution, but I think
probably the most important thing you can do is either
pick up the phone or send an email, and that
could be to your insurance company or HR. For some
of the bigger employers in the region, like Boeing and Microsoft,
(27:09):
for instance, they have enough sway because there's such a
big contract that in some cases they can kind of
hooke the beast, so to speak, to try to help
get their insurance partners to try to pay for various services.
And the other one is obviously talk to your represent representatives.
So whether that's more locally or at the state level,
it's a complicated world we live in. Obviously, there's a
lot of hot button topics today in healthcare, so I
(27:31):
don't know how inclined our representatives are going to want
to get involved in those types of discussions. I think
what's going to really take is there's going to be
some politician who wants vocal therapy and then he's going
to learn that his federal employee plan doesn't cover it.
Because I've encountered that for other federal employees and then
all of a sudden there's going to be a big shift.
Speaker 3 (27:50):
Bottom line is we all have to be our own
self advocate. If your plan is denying a treatment for you,
don't take that lying down.
Speaker 2 (28:00):
Fascinating discussion, a lot of options, more options as we
move along in this lifetime. Focal therapy is exceptional if
you are a good candidate. But you know, I want
to bring it all the way back, however, to the
fact that if you're a man between the ages of
fifty five and seventy, you need to get a PSA test.
(28:21):
You need to do it yearly. It's not a big deal.
Go in, get it checked out as part of her
annual physical. And if you're not having an annual physical,
why the hell not. If your father died of prostay
cancer or had prostay cancer, or your brother, or if
you're African descent, when your clock ticks forty five, think
(28:44):
about engaging and screening, then do it, damn it, do it.
Speaker 3 (28:48):
And let me add if your mother had breast cancer.
So if somebody wants to learn about information on focal
therapy in this region at the Hutch, what should they do?
Speaker 5 (28:56):
Go to the Fred Hutch website.
Speaker 2 (28:57):
Fred Hutch dot org.
Speaker 3 (28:59):
So for listeners if you want to learn more Fred
Hutch dot org. And what if I just want to
learn more about prostate cancer in general, screening, other treatments,
so on and so forth.
Speaker 4 (29:08):
The American Cancer Society dot org, ACS dot org and
then PCF dot org, which is Prosay Cancer Foundation.
Speaker 2 (29:14):
That wraps up this edition of Men's Health Matters special
thanks to our guest doctor George Shade, a DUB surgeon
and associate professor in urology. As we mentioned at the
start of the program, this is November and all men
can take part in November by going to Movember dot com.
By the way to reach the Men's Health Center at
the UDUB the phone numbers two six five nine eight
(29:35):
six three five eight. If you want to go online,
it's Udubmedicine dot org forward slash Men's Health Center. I'm
Neil scottabyhalf of my co host, doctor Tom Walsh. Thank
you for listening to Men's Health Matters and wishing you
good health and good sense and matters relating to men's health.
Stay healthy, live in gratitude and be kind to one another.
And thanks for listening.
Speaker 1 (29:57):
You bring listening to men's Health Matters, doctor Tom Walsh,
Associate Professor of Urology at the University of Washington and
director of UW's Men's Health Center, and your host Neil
Scott on Sports Radio ninety three point three KJR FM
Welcome to Men's Health Matters with doctor Tom Walsh, director
of the University of Washington's Men's Health Center and Associate
Professor of Urology at UW, featuring important topics dealing with
men's health, including prostate cancer and erectiledys function. Now here's
your host, Neil Scott.
Speaker 2 (00:20):
Welcome to the November edition of Men's Health Matters. November
edition putting a spotlight on men's health and coming to
you from the iHeart Studios in Seattle. My co host
is doctor Tom Walsh, the director of the University of
Washington's Men's Health Center. Doctor Walsh, Happy Movember, Neil, Happy November. Yeah,
so glad to be here. November's mission is to save
(00:42):
lives and improve men's health by funding research and support programs.
Some of the health issues that November focuses on include
prostate cancer, testicular cancer, mental health, suicide prevention, and you
can find out more at Movember dot com. Tonight, doctor Walsh,
we take a new look at state cancer. We have
a world expert and an innovator for focal therapy. Can't wait.
Speaker 3 (01:06):
You know I'm entering that age at I'm beginning my
prostate cancer screening journey. As I think about my future,
I'm really excited to hear what George has to say.
Speaker 2 (01:16):
We have an interesting conversation with doctor George Shade in
just a few moments. But first, as we do on
every edition of Men's Health Matters, we answer questions from
the anonymous inbox. That's a chance to send your questions
about any health issue, no matter how embarrassing, with only
using your first name. All you have to do is
send us an anonymous email at Men's Healthmatters at iHeartMedia
(01:38):
dot com. We will not retain or share your email address.
We start this month, doctor Walsh with a question from
Michael from Seattle. I'm a man in my mid thirties
and recently a female friend of mine asked me if
I had been vaccinated for HPV. I had no idea
what she was talking about. She told me that it
was a leading cause of cancer. Frankly, I have never
(01:59):
heard of it.
Speaker 3 (02:00):
This is a tough one, Michael. HPV human papalomavirus is
ubiquitous and is now considered a sexually transmitted infection between
men and women. While it doesn't have huge repercussions for men,
it does have consequences as a risk factor for cervical cancer,
(02:21):
and therein is the challenge. The absolute best source of
understanding are you a candidate for an HPV vaccine? Are
you too old, too young, appropriate or not? Would be
the University of Washington STI Clinic, which is based out
of Harbor View Medical Center. And truly, this is a
clinic that is the source of information.
Speaker 2 (02:44):
Let's move on to AL from Lakewood. I recently met
a woman who I really like, and she is insisting
that I get checked out for possible sexually transmitted diseases.
I was stunned, and I was pissed off that she
didn't trust me. But it is a deal breaker, so
I guess I have to do it. Is there a
simple blood test that I have to take? Where do
(03:04):
I do it? And how do I get a certificate
that I can shore? AL?
Speaker 3 (03:08):
Don't be angry. This is responsible sexual behavior. As I
referred Michael, I would say the UW Sexually Transmitted Infection
Clinic based out of Harborview Medical Center.
Speaker 2 (03:21):
That's the place to go.
Speaker 3 (03:22):
If you have a good primary care provider, that would
be another great source.
Speaker 2 (03:27):
It is just a blood test.
Speaker 3 (03:28):
They're not going to give you a certificate. My friend,
They're going to give you a lab result, and in
this modern era of electronic medical records, you'll be able
to walk out the door with that result as soon
as it post.
Speaker 2 (03:39):
Remember you can send an anonymous email on any health
issue to Men's Health Matters at iHeartMedia dot com. We
will not retain or share your email address one hundred
percent anonymous. Our guest is month doctor George Shade. Are
youw Associate professor in urology. He's an adjunct Assistant professor
in the UDB Center for Industrial and Medical Ultrasound and
Applied Physics Lab. Doctor Shay is also a world expert
(04:02):
on prostate cancer and an innovator on focal therapy for
prostate cancer. Welcome to Men's Health Matter is doctor Shade.
Good to have you here. Thanks, Neale's great to be here. Tom,
good to see you. Prostate cancer is the second leading
cause of death in American men, behind only lung cancer.
About one in forty four men who die of prostate cancer.
(04:24):
That's the bad news. The good news is that prostate cancer,
when diagnosed and treated early, the five year relative survival
rate is greater than ninety nine percent. This includes stages one, two,
and three where the cancer is contained within the prostate gland.
The earlier prostate cancer is detected and treated, the more
likely the patient will remain disease free. Tonight, we're going
(04:46):
to focus on a relatively new procedure for treating prostate cancer.
You know, fortunately we live in Seattle with access to
one of the leading cancer research and treatment centers in
the nation, Fred hutch and they've reached and added what
is called IRE, which is high intensity focused ultrasound and
cryotherapy focal therapy. And let's begin, doctor Shade with a
(05:10):
definition of focal therapy, which I believe is less invasive
and as fewer side effects. And why is it a
game changer?
Speaker 4 (05:18):
Yeah, thanks Neil, it's a great question. The idea of
focal therapy is analogous a lumpectomy for breast cancer as
opposed to a mistectomy. So the idea is you're treating
just a portion of the gland that has the disease,
as opposed to treating the whole gland in the form
of surgery or radiation.
Speaker 2 (05:33):
And how long has this been around?
Speaker 4 (05:35):
Some of these technologies have been around for twenty five
or thirty years. And we're available in Europe and Asia
over that timeframe, but the first devices we're available here
in the US in twenty fifteen.
Speaker 2 (05:45):
Who's a candidate for this?
Speaker 4 (05:46):
I get that question all the time. The brief answer is,
it's a little bit of a Goldilock's phenomenon. So your
cancer has to be just right and your procetate has
to be just right. The perfect candidate would be somebody
with what's called a Gleasin score of seven, and for
proces cancer, that's considered an intermediate grade. The lowest grade
is a six and the highest grade is a ten.
And the idea there is you have to have a
cancer that's not too aggressive that if we don't get
(06:08):
at all, we could hurt you. And if the cancer
is a very low grade cancer, you may not need
any treatment at all. So we want to have a
cancer that you could benefit from treatment, but again not
so aggressive that we might hurt you by missing something.
And so that's the first criteria, has to be at
least in seven. And then the second is the goal
is we're just trying to treat a small part of
the prostate, and so ideally it's a small tumor that's
involving just one side of the prostate, so that way
(06:29):
we can stay far away from the critical structures on
the other side to avoid side effect.
Speaker 3 (06:33):
Actor Walsh, you know, as a practicing urologist who's been
in this profession for so many years, the idea behind
a focused therapy that treats cancer but leaves normal behind
is it's a game changer. When we talk about surviving
prostate cancer, we're talking about typically living with some of
the consequences, either they removal or the destruction of the
(06:56):
entire prostate gland, which becomes really kind of a useful
organ when we get older. You know, this is a
fertility organ, so destroying it or removing it is okay,
but there are consequences. So the idea that we can
cure cancer potentially and not destroy any of the peripheral
areas around the prostate is just absolutely huge.
Speaker 2 (07:15):
What is cryotherapy.
Speaker 4 (07:17):
Cryotherapy is one of the options available to us for
focal therapy. The ideas cryo means freezing, so it's basically
freezing in this case of the prostate. With cryotherapy, patients
asleep under anesthesia. We pass what are called cryoprobes into
the prostate under ultrasound guidance and then we place those
around the area of interest and then under image guidance
freeze the appropriate part of the prostate. So that's just
(07:39):
one of the many, many mechanisms through which we can
treat the prostate.
Speaker 3 (07:42):
Why freezing, why not heat?
Speaker 2 (07:44):
What's the difference?
Speaker 4 (07:46):
The truth is is that there's a lot of ways
that we can do focal therapy. Cryotherapy is one of
the earliest ways, and it's honestly falling out of favor
over the last several years. So we typically use it
most often not for men or their initial treatment, but
and men who've had radiation previously and then failed and
need a subsequent treatment.
Speaker 2 (08:04):
Of course, all this begins with the screening process. Men
should get a screening annually for prostate cancer. Now, it's
controversial and a lot of pros and cons of prostate
cancer screening. Who should be screened, how should they be screened,
and what will be the next step?
Speaker 4 (08:22):
Yeah, you're hitting all the hot button topics right now
in the world of prostate cancer screening. It's something that's
evolved a lot over the last several years, going from
we should screen almost everybody several years ago to what's
called the US Protective Task Force, which is the national
federal body that writes guidelines for cancer screening, recommending against
(08:43):
it for pretty much everybody. To now a more moderate
take on it. The current guidelines call for screening and
men of at least average risk with at least average
life expectancy beeen the ages of fifty five to seventy.
And then there's other guidelines bodies like the American Neurologic Association,
and it's in similar bodies that have kind of further
expanded upon that, especially if you're in a group of
(09:04):
men that have higher risks, such as men with a
family history, men of African descent for instance.
Speaker 5 (09:10):
There's some other risk factors as well.
Speaker 4 (09:12):
In those patient populations, we consider screening as early as
age forty five.
Speaker 2 (09:16):
If there's a high PSA number. My understanding is that
in a lot of men, and there's different categories of men,
obviously it's a zero to four, what would be considered alarming.
Speaker 4 (09:28):
Yeah, that's another good question. So the short answer is
that it really depends on your age. The standard cut
off of four. That's really a kind of a very
narrow patient population, and the idea there is just that
as US men get older, our pro states get bigger,
and the more prostate we have, the more PSA we make,
and so the upper limit of normal gets bigger as
(09:48):
our prostates get bigger. And so for a man in
his forties, your PSA really should be below one, and
so anything more than one and a half to two
is really pretty high. And then in your fifties it
should be still particularly less than one, less than one
and a half, So anything over two and a half
is considered above the cutoff. And then as we gin
to our six sies, that's typically where that score of
a four to four and a half come into play.
(10:09):
And then for men in the seventy sometimes will even
tolerate up till about five.
Speaker 5 (10:13):
And a half.
Speaker 2 (10:13):
Can the prostate be reduced?
Speaker 4 (10:16):
Yes, So there's a number of mechanisms through which we
can reduce the size of the prostate. One would be medications.
So there's a specific type of medication that shrinks the
prostate about thirty percent.
Speaker 5 (10:26):
While you take it.
Speaker 2 (10:27):
Finest Ride.
Speaker 4 (10:28):
Finastride is one, the other is detaster ride. Proscar and
Aviadart are the trade names. And then there's a number
of surgical procedures through which we can remove a portion
of the prostate or less a rotor router, if you will,
to help menpee better and reduce the size of the prostate.
Speaker 2 (10:42):
Doctor Walsh Neil.
Speaker 3 (10:43):
There's so many nuances here to how age associates with
the man's PSA, how PSA can change over time, and
about who are some specific at risk populations. But what
I want to drive home to every single person who's
who's listening, is that all of this discussion, which begins
(11:04):
by talking to your provider about it, it's about being
curious about your health. Knowing that prostate cancer is the
most common cancer diagnosis among men in the US and
is a leading cause of cancer related death that is preventable.
So this begins with that bold move of taking charge
of your health seeking out a test. Don't always just
(11:26):
expect that your primary provider is going to bring this
and present it to you. Be knowledgeable, ask about it,
ask if it's right for you, engage in a discussion,
and if a value isn't right, then we begin these discussions.
You know, so many people and myself included, it's fearful
to go and investigate one's health. It's kind of a
(11:47):
scary business. But what I want everyone to know, is
that going to a doctor, going to a nurse practitioner,
going to a physician assistant, all these different people is
really just about learning.
Speaker 2 (11:58):
As far as focal therapy is concerned. I mean, it
sounds amazing, however it's not for everyone. I was amazed
in doing my research to find out it was simply
an outpatient procedure.
Speaker 4 (12:09):
Vocal therapy isn't just one treatment because there's multiple different
treatments in that space. Generally speaking, they're all performed in
a pretty similar way. So, at least in the US,
patients are under anesthesia, so they're asleep and comfortable so
they don't feel anything during the treatment. And then we
use some type of energy source. So it could be
what's called high intensity focus ultrasound which heats the tissue.
(12:31):
It can be what's called IRA, which is irreversible electroporation.
That's a mouthful, but that uses electricity to create holes
or pores in the cells. There's cryo therapy, which you
touched on. There's lasers to heat tissue that way, and
then there's a number of other technologies in the pipeline.
In general, under anesthesia with some type of imaging to
tell us where to go in the prostate. We either
(12:54):
aim the ultrasound to heat the prostate in the case
of hifuet the area of interest, or we place probes
into the prostate to either electrocute, freeze, or laser the
disease part of the prostate, and only takes about anywhere
from two to three hours, depending on how big the
prostate is, how big the tumor is, things of that nature.
And then the patient wakes up. What about recovery time afterwards?
(13:16):
The prostate can well make it difficult to ferment to urinate,
so as a result, they go home with a catheter.
In my practice, typically about a week at some places
only a few days. We do it longer here just
because we cover the entire Pacific Northwest, and so I
have patients coming down from Alaska, coming from Montana, etc.
And so I just don't want somebody to be at
home in the middle of the night, not able to
pee and trying to find an er. And then beyond that,
(13:38):
once the catheter comes out, it's mostly just letting the
prostate cool off, so to speak. Afterwards, the prostrate's pretty angry,
so you tend to feel like they have to pee
you pretty bad. They can have some burning, occasionally some
blood in the urine. Most of those symptoms are typically
better within something like about three to four weeks, occasionally
a little bit longer.
Speaker 3 (13:54):
I want to play make believe for just a moment.
Let's imagine I'm somebody who is the Goldilocks. Know I've
I've done my screening, We've identified a focal area in
my prostate, which you can enlighten us in a bit
maybe how we do that, but that I'm somebody who
wants that focal experience. Where do I have to go?
(14:15):
Can I just go anywhere? Can I go see my
local urologist? Do I have to travel? What's the process?
And where do I need to be for this kind
of technology?
Speaker 4 (14:23):
Currently, you to a large extent, have to be at
a center of so called excellence, like a major cancer center.
That that's changing. So there's huge interests right now in
our field, among all of our colleagues and urology and
even in radiation ecology. In some areas, it's kind of
slowly percolating through into the community, but to a large extent,
it's at the larger center. So here in Seattle, for instance,
(14:44):
we have a program Swedish has been trialing machine over
the last several months, and then there's a dock at
Evergreen who's been trialing system as well.
Speaker 3 (14:53):
But at the bottom line is that in this moment,
I need to come to the Fred Hutch. I need
to talk to you or your colleagues to.
Speaker 5 (14:58):
A large extent y patient driven.
Speaker 2 (15:00):
You can't go in and say, well, I've got prostate cancer,
I'd like vocal therapy. You have to be a candidate correct.
Speaker 4 (15:07):
When people read about it and hear about it for
obvious reasons, they want it. And so I see a
lot of men who have maybe they read about it,
a friend's told them about it, what have you. So
they come to learn about it thinking they want it.
And in some cases they're a great candidate, and it's
sort of full steam ahead once we confirm that they're
a good candidate, and others we have to have a
(15:27):
more difficult conversation that I wish they were a candidate.
They're just not a good candidate, either because they're where
their cancer is or the grade of the cancer, et cetera.
Speaker 2 (15:34):
How does this procedure affect sexual performance following the procedure.
Speaker 4 (15:39):
One of the main reasons that the men are potentially
interested in focal therapy is that it tends to have
better outcomes in terms of sexual functions. Process cancer treatments
can impact sexual function in two ways. The first is
it can impact our erections, and the reason for that
is the nerves that control erections run more or less
intertwined with the blood supply going to the prostate, and
(16:02):
so during surgery we have to control the blood flow
of the organ, and so we try to spare those nerves,
but there's still trauma and that can impact sexual function.
And with radiation, that's in the field, and so those
nerves are radiated. And then the second way, the prositate
is a reproductive organ. It makes our semen or contributes
to it anyway, and so if we remove the prostate
during surgery, you don't ejaculate anymore. And the case of radiation,
(16:24):
you may still make some semen, but often there's a
lot of scarring and the ducks that drain the prostate,
so many men don't ejaculate after radiation either. So in
the case of focal therapy, we're not treating the whole prostate,
and so if we're only treating one side, we're not
doing anything at all to the one nerve. We might
be able to not go very close to the nerve
(16:44):
on the effected side, or maybe we have to treat
right up to it, but we're still not traumatizing it.
With surgery, we're not radiating it. Because of that, there
tends to be a much lower risk of ED afterwards. So,
for instance, after surgeony, anywhere from forty to eighty percent
of men we'll be able to have intercourse long term,
whereas with focal therapy it's about eighty percent of men
who are able to have intercourse before.
Speaker 3 (17:04):
This is why that as these technologies and their precision
seems to only be growing. I compare what doctor Shade's
talking about today relatives when I was a trainee. You know,
I would know in a heartbeat that this would be
the treatment that I would want if I were a
candidate for a surgeon like me, who is really in
(17:25):
that arena where we are treating the aftermath of prostate
canch treatment. You know, I just hope George doesn't put
me out of business.
Speaker 5 (17:32):
I'm just gonna say that's my goal.
Speaker 2 (17:35):
What about follow up? I mean six months, a year,
two years, three years down the.
Speaker 4 (17:39):
Road, so the way we follow patients afterwards is similar
to what's called active surveillance. In some cases we actually
refer to focal therapy as actor surveillance.
Speaker 5 (17:48):
Plus.
Speaker 4 (17:49):
So the plus is we're doing something. We're trying to
cure a man's cancer, but we're not treating the whole prostate,
and we have to one make sure that you don't
develop a new cancer on the other side in the future.
And then two, more importantly, we have to make sure
we get everything, because if we're not treating the whole prostate,
we have to ensure that we've treated the correct part
of the prostate and covered enough of the prostate to
(18:09):
get everything.
Speaker 5 (18:11):
That strikes me as just good branding, ex exactly. Yeah.
Speaker 2 (18:14):
Our guest this month on men's health matter is doctor
George Shade. Doctor Shade is a u TO renowned surgeon
and Associate Professor in urology, specializing in your logic oncology,
with a specific focus on bladder, prostate, kidney, and testicular cancers.
We're going to continue our discussion with doctor Shade right
after this quick timeout.
Speaker 6 (18:34):
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(18:55):
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Speaker 2 (19:28):
We're back on men's health matters. I'm Neil Scott. My
co host is the director of the UW Men's Health Center,
doctor Tom Walsh. As we continue our discussion with doctor
George Shade, a prominent surgeon and Associate Professor of Urology
at the UDUB and a pioneer in focal therapy in
the treatment of prostate cancer, A fascinating topic.
Speaker 3 (19:48):
Dr Walsh, You know, George, before the break, we we
began kind of elaborating on, you know, why focal therapy,
the idea that, as you said it, it's like a
lumpectomy versus a mastectomy, which resonates with a lot of folks,
And you talked about some of the benefits are that
there is not that sort of collateral damage that affects
men's sexual function, I know, and you know that the
(20:10):
prostate sits in this really pivotal anatomic location where it's
also involved in our urinary function. And you talked about
some of the symptoms during initial recovery after focal therapy
that men may experience. Maybe you could talk about, you know,
what should a man expect and is there a benefit
to urinary function in the setting of vocal therapy if
(20:30):
you're a candidate.
Speaker 4 (20:31):
That's actually I think one of the biggest drivers for
why men are interested in focal therapy and one of
the biggest advantages of it. As we discussed, the prostate
is a reproductive organ but it's also basically the first
part of our urethruck. So the ladders attached to our
prostate and when we pee, the urine travels through the
prostate and then it ends up at the base of
the penis and then makes its way to the outside world.
(20:53):
Anything that we do to the prostate can impact urinary function,
similar to sexual function, as we were talking about earlier.
The case of prostate cancer treatments. If we're doing surgery,
the main drawback is leakage, and right after surgery, almost exclusively,
everyone leaks. And the reason for that is the sphincter
muscle that squeezes to keep us dry, goes around the
(21:14):
urethra basically right at the junction with the prostate, and
so during surgery, although we try really hard to protect
that muscle, it does get traumatized a little bit. And
then after surgery you have a catheter, so the muscle weekends.
And the way I describe it is if you have
a knee surgery, you're operating on a joint in between
their's muscles above and below, and then you have an
ee brace afterwards, we're not using those muscles the way
(21:35):
you would. You have to rehab to learn how to walk.
After surgery, you have to learn how to control again
with rehab, and so long term most men will regain
their control after surgery, but something like about ten to
fifteen percent of men will end up wearing a pad
for life. Fortunately it's not a huge majority, but if
you're in that group, you can really impact your quality life.
And in fact, we were talking about this during the break.
(21:57):
Sometimes we see men where they're really prioritizing their sexual function,
and I always take a step back and just say, well,
urinary function is more important because that impacts everything you do,
and at the end of the day, if you're leaking
a lot, you're not going to have sex anyway. Compared
to surgery, for instance, because focal therapy isn't treating the
whole prostate. If your tumor is way far away from
(22:17):
the sphincter muscle, we're not going to be treating anywhere
close to it. With focal therapy, for instance, even if
it is we try to spare tissue, we're not going
on the other side. Because of that, the risk of
leakage is much less, both immediately afterwards but also long term.
Speaker 2 (22:31):
When you diagnose a person with prostate cancer and you
want to do a work up to find out if
he is a candidate for this, what is that process?
Speaker 4 (22:40):
Yeah, yeah, well I get asked that all the time.
The vast majority of my patients they already have a diagnosis,
so it's not so much that we're working them up. Initially,
their local doc is seeing them. They've had typically an
MRI after an elevated PSA test that that's become the norm,
I would say in most areas of the country, and
then they'll have a biopsy. Often use what's called MR fusion,
(23:01):
where we basically combine the MRI and then the ultrasound
we do to guide the bibe C in the same setting,
so we know that we're hitting the area of interest
and so that leads to a diagnosis. And then if
you end up in my office, we'll talk about focal therapy.
The workout that I do typically involves at the very
least doing an ultrasound or other prostate and the reason
for that is big factors that can determine if someone
(23:24):
is a candidate for HAIFU, which is the high intensity
focus ultrasound to heat or they may need another treatment
is if they have calcifications in their prostate that can
block the ability of ultrasound waves to get into the prostate,
and calcifications are really common. It's a benign thing, sort
of like kidney stones. The physiology is different, but they're
really common. Between the three of us, probably we have
(23:44):
at least one or two at least And so that's
the first thing. And the second is that I recommend
to repeat BIBEC and I don't require it because bib
cs aren't necessarily the funnest thing on earth, as you
can imagine, if a patient is very opposed to, I
don't require it. The reason why I recommend it is
that in the setting of only having one prior prossy biopsy,
(24:05):
if we look again, we find either additional cancer or
potentially worse cancer, and something like about thirty to forty
percent of patients. This is very much the Goldilocks phenomenon.
The cancer can't be too hot, too cold, it can't
be too big or too small, and so if we find,
say cancer on the other side we didn't know about, well,
in that case, you probably need your whole process treated,
(24:25):
and so probably something like surgery radiation might be better.
And so that's the reason it's much better to know
about that before the treatment, as opposed to you get
your treatment and then a year later, when we're doing
our follow up, we find that we miss something because
we didn't know about it.
Speaker 2 (24:39):
Back to the biopsy, it is uncomfortable. However, you can
do it under anesthesia. I could not undergo a clinic biopsy.
I had a biopsy under anesthesia. How common is that?
Is it available to everyone?
Speaker 4 (24:51):
I would like to think that any urologists you go
to would be an option to have a biopsy under anesthesia.
As far as how common I think append there's probably
a little bit on the practice itself. I know in
some practices they do a fair number of their bibecies
under anesthesia, especially if it's what's called transparent neal, which
is where it goes through the skin between the scrotum
(25:12):
and the rectum, that that can be a common practice
in some offices. In my own personal experience, with adequate
numbing and counseling about what to expect, probably something like
about ninety percent of patients can get through it in
the office, but definitely not everybody.
Speaker 3 (25:25):
I want to talk about a little bit of a
dirty subject, if you don't mind, which is insurance, health
insurance and the eyeword. Oftentimes, in the history of healthcare
and payment for healthcare in the United States of America,
we've seen new technologies sometimes lag we would call third
(25:49):
party pairs. Insurance medical insurance companies view these things. You
and I have the same employer. If I'm diagnosed with
prostate cancer, can I have vocal therapy?
Speaker 5 (26:02):
I think the short answers that you have. If you
have my insurance, then the answer is no. No.
Speaker 4 (26:05):
Interesting Medicare pays for it, So if you have Medicare
A and B, it would be covered. You might have
a copay depending on exactly what your program looks like.
But if you have private insurance, including a Medicare advantage plant,
because those are administered by private insurance, then it really
depends on the insurer and the policy you have. In general,
the pendulum is swinging towards focal therapy. So there are
(26:27):
some private insurance companies out that pay for it, but
there are some that do not.
Speaker 3 (26:32):
How can I get our listener the people who are
going to benefit from this, which is either a man
or somebody who has a man in their life, which
is everybody. How can we send the message that this
is something that has to be available to everybody.
Speaker 4 (26:48):
As you can imagine, if you're living through this process
and there's a treatment that you want and you can't
have it. It's very frustrating. So you know, I don't
know that I have a clear solution, but I think
probably the most important thing you can do is either
pick up the phone or send an email, and that
could be to your insurance company or HR. For some
of the bigger employers in the region, like Boeing and Microsoft,
(27:09):
for instance, they have enough sway because there's such a
big contract that in some cases they can kind of
hooke the beast, so to speak, to try to help
get their insurance partners to try to pay for various services.
And the other one is obviously talk to your represent representatives.
So whether that's more locally or at the state level,
it's a complicated world we live in. Obviously, there's a
lot of hot button topics today in healthcare, so I
(27:31):
don't know how inclined our representatives are going to want
to get involved in those types of discussions. I think
what's going to really take is there's going to be
some politician who wants vocal therapy and then he's going
to learn that his federal employee plan doesn't cover it.
Because I've encountered that for other federal employees and then
all of a sudden there's going to be a big shift.
Speaker 3 (27:50):
Bottom line is we all have to be our own
self advocate. If your plan is denying a treatment for you,
don't take that lying down.
Speaker 2 (28:00):
Fascinating discussion, a lot of options, more options as we
move along in this lifetime. Focal therapy is exceptional if
you are a good candidate. But you know, I want
to bring it all the way back, however, to the
fact that if you're a man between the ages of
fifty five and seventy, you need to get a PSA test.
(28:21):
You need to do it yearly. It's not a big deal.
Go in, get it checked out as part of her
annual physical. And if you're not having an annual physical,
why the hell not. If your father died of prostay
cancer or had prostay cancer, or your brother, or if
you're African descent, when your clock ticks forty five, think
(28:44):
about engaging and screening, then do it, damn it, do it.
Speaker 3 (28:48):
And let me add if your mother had breast cancer.
So if somebody wants to learn about information on focal
therapy in this region at the Hutch, what should they do?
Speaker 5 (28:56):
Go to the Fred Hutch website.
Speaker 2 (28:57):
Fred Hutch dot org.
Speaker 3 (28:59):
So for listeners if you want to learn more Fred
Hutch dot org. And what if I just want to
learn more about prostate cancer in general, screening, other treatments,
so on and so forth.
Speaker 4 (29:08):
The American Cancer Society dot org, ACS dot org and
then PCF dot org, which is Prosay Cancer Foundation.
Speaker 2 (29:14):
That wraps up this edition of Men's Health Matters special
thanks to our guest doctor George Shade, a DUB surgeon
and associate professor in urology. As we mentioned at the
start of the program, this is November and all men
can take part in November by going to Movember dot com.
By the way to reach the Men's Health Center at
the UDUB the phone numbers two six five nine eight
(29:35):
six three five eight. If you want to go online,
it's Udubmedicine dot org forward slash Men's Health Center. I'm
Neil scottabyhalf of my co host, doctor Tom Walsh. Thank
you for listening to Men's Health Matters and wishing you
good health and good sense and matters relating to men's health.
Stay healthy, live in gratitude and be kind to one another.
And thanks for listening.
Speaker 1 (29:57):
You bring listening to men's Health Matters, doctor Tom Walsh,
Associate Professor of Urology at the University of Washington and
director of UW's Men's Health Center, and your host Neil
Scott on Sports Radio ninety three point three KJR FM
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