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Look, this is your Health First, the most beneficial health program on radio with doctor Joe Bellotti. During the next hour, you'll learn about health, wellness and the prevention of disease. Now here's your host, doctor Joe Bellotti.
Well, the good Sunday evening to everybody.
Doctor Joe Gillotti, thanks for tuning in this Sunday evening. And if you're new to this program, you're new to k tr H, or you're new to the iHeartRadio app. We are here every Sunday evening between seven and eight pm Central Time, broadcasting from our home headquarters in Houston, Texas and the Texas Medical Center, Broadcasting not only here in Texas, but across the globe on the iHeartRadio app.
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Set your calendar and schedule every Sunday at seven pm Central Time to tune into the program and become a better consumer of healthcare. Raise your Health IQ, And as we've been saying for all these twenty plus years that we've been on the radio every Sunday night, we are going to provide you with actionable information that you can hear it right now and act on it immediately. This is not some sort of theoretical, too difficult to digest
information that we was sharing with you. It is actionable on the spot to follow along with all of us our website doctor Joegalotti dot com, our j O E. G. A. L A t I dot com, Sona for all of our social media there, follow us along. We're on Instagram, We're on TikTok, we are on YouTube. It's all there, Doctor Jogilati dot com and especially Sona for our weekly newsletter that goes out on Saturday mornings across the country. All right, so on the program tonight, we are going
to be continuing our discussion on prostate cancer. We have on the phone a little later this evening, a true expert in prostate cancer, doctor Brian Miles, who is at Houston Methodist Hospital here in the Texas Medical Center, a pioneer and not only robotic surgery for prostate cancer, but
the approach to patients with prostate cancer. And certainly with the revelation of what was disclosed about President Biden a couple of weeks ago in his prostate we're going to get an opinion or suggestion of what may have actually happened with President Biden and learn about that. The one thing I want to chat about is and this really gets into prostate cancer or any cancer where you're getting
a second opinion. The New York Times had an article talking about logging on for a second or third opinion, so logging on meeting, going to Google or somewhere on the internet for a second opinion. And I have always been a big advocate of getting a second opinion. So many of the patients that I see, I am seeing them as a second, third, or even a fourth opinion. So it is important that you if you're confronted with a diagnosis, whether it's life threatening or not life threatening,
that you consider getting a second opinion. But in this day and age, so many people are going online and looking for a second opinion.
And the amount of Google.
Searches that have to do with health and wellness is really quite predominant. And this is what we are all doing now. It is a good thing. I'm not going to say don't do it, but I would believe that there is information that you can get that is inaccurate, and so you don't want to search thinking that you're going to find information that's going to be helpful to you, but then at the end of the day end up penalizing yourself.
So the.
Current strategy out there is that so many people that have a particular disease, whether it's prostate cancer, whether it's multiple sclerosis, whether it is breast cancer, people are posting information about their own case, their own treatment, their own sort of follow up after surgery. And by creating this community around a certain disease, there is a benefit to this.
There is the opportunity to see what other people went through, but you have to keep it in the context of your own case, your own particulars with regard to your health and wellness, and have a really healthy conversation with your physician. But when you look at the different websites that you could look at, there are basically five categories of websites that you want to look at. The first would be general interest websites, something like WebMD or even
the New York Times health site. It is of value and so this is where you're going to get information about a particular disease, news and lifestyle advice, and learn from medical institutions like Mayo clinics, so that's a general interest.
The second is a medical research site. So if you want to learn about what is being done or published within research, you're going to have to go to a website like PubMed, which is done which is really organized under the National Library of Medicine, but if you just type in PubMed you will find out. The other is a website called Clinicaltrials dot gov, which will track various research protocols, and you can actually type in a disease and where you live and it will narrow down something
that's in your particular neighborhood. Then there are a number of patient sites, and this is really what is booming. There's the Association of Cancer Online Resources. There is something called epatients dot net, as well as a site patients like me and Trusira t r U s e r a dot com which provides a bit of a Facebook
style like social connection for patients. Then you get into the disease specific sites, which would be American Heart Association, American Cancer Society, American Diabetes Association, which will sort of target a particular disease. And then lastly there are web tools that will help you learn about nutrition, disease risk, factors, certain medications that you will be on. So there's a lot there. I'm going to post this article on the Facebook page which is at doctor Joe Galotti.
But it's interesting. So again, we.
Don't want you to not search online. I believe you have to be a good consumer and open to all of this information and trying to sort of out. All right, we're going to take a quick break right now. You tuned into your health First. Every Sunday between seven and eight pm, visit doctor Joegalotti dot com for more information
about me, our team and our Livid Disease practice. Doctor Brian Miles talking about prostate cancer coming up in just a minute before all right, Well, as I've been saying this evening, we have a true expert and need I say a legend in the world of urology is a very modest gentleman, doctor Brian Miles, who his credentials are impeccable where he is the vice chair of Urology at Euston Methodist Hospital, He's a professor of urology, he's the
director of Robotic Surgery at Houston Methodist Hospital and truly an individual that in the field of medicine when you talk about prostate cancer. Doctor Brian Miles's name comes up, So Dodtor Miles. So great to have you on the program this evening.
Jill, thank you so much for including me, and this is a wonderful opportunity to talk about something that is foremost in many men's minds in this time.
Yes, for sure, and certainly with the revelation of President Biden and his diagnosis, it's raised questions but also some confusion as to what I should do, and we will certainly get to that. So you know, the basic issue is every man over fifty, let's say, know what their PSA is, prostate specific antigen. And even this has become a little controversial. So what is your explanation everybody tonight about PSA?
Who should get it?
And how much weight do we put on it if it is indeed elevated?
Well, PSA is an important screening tool. There's no other wonderful blood test like this for any other cancer, breast cancer or colon cancer. Could find a blood test like this, it would be a huge help. But PSA just gives us an idea that someone might be at increased risk right now. The guidelines say you should start at age fifty, and they tend to say stop at age seventy five.
If you have a family history of prostate cancer or you're African American, I believe you need to start getting tested at age forty because your risk is substantially higher. I would also add it, I my Joe, that PSA is a screening tool. If someone has an elevated PSA, I don't rush to biopsy. In the old days, we would.
What I do now is another specialized test. There are many varieties, but the one I use is called a four K test that looks at all aspects of PSA and one of the proteins of the Cali crime family. That PSA is a part of that family. That helps us predict whether someone has a true risk of cancer. Right if someone has a mildly elevated PSA, Joe, chance of having cancer is twenty eight to thirty percent, you know, I mean between four and nine. But I'm biasing one
hundred men to find those. If I do a four K test, I only have to do I only have to buy the sixty men to find the same number the same thirty. It's a very helpful test.
So I would say over the past ten years or so, or maybe fifteen years. Organizations like the American Cancer Society have come out somewhat to the chagrin of experts like you, that maybe we don't need to check PSA. Too many biopsies are being done. What do you say to that today, with the knowledge that you all.
Have, that's wrong. That's wrong. We found when the US Prevented the Task Force came out with their recommendations, like the American Cancer Society, five years later, we found that the increase in people presenting with metastatic disease like President Biden shot almost straight up as you would predict. Five years is about the time it takes from inception of a disease that's fairly aggressive to metastatic disease, so that they're wrong. And you know, it's hard for many of
us to admit, perhaps we were wrong, but this was wrong. Unfortunately, it is still in the mindset of some primary care doctors. But I think that with President Biden, we should all wake up.
Yeah, yeah, And I would say you're right that sometimes when these these new rules come down or suggestions, it becomes the word of the land, and it is more difficult and more problematic to unravel that thinking you almost have an entire generation of physicians trained that PSA really isn't that important and they're not getting it done.
I couldn't agree more. Couldn't agree more.
Yeah, Now, with regard to risk factors for prostate cancer, you mentioned African American and that certainly is significant. But what are some of the other risk factors, be it obesity or diabetes, smoking, alcohol, things like that.
Well, it's certainly family history is the next big one after AfOR race being African American, But obesity, for instance, there's really not an increase in prostate cancer disease so much as there is an increased risk of being more aggressive disease. Meaning if you're diabetic it doesn't or obese it doesn't mean you have a higher risk of getting it, but if you do get it, there's a higher risk
that it's a much more aggressive cancer. Diet Diet is always, as you know, everything in life eventually comes down to diet because diet is what can we as individuals do to modify our risk. And unfortunately there's no real good
data on this. I will tell you that in this country, people spend over one trillion dollars on nutraceuticals meaning vitamins and very substances to help modify their risk of cancer, prostate cancer being very high on that list, and yet none of them have really been studied well enough to show what the true benefit is. So there's nothing you can really do there. Keep your weight good, be active, keep your immune system good, so even if you get prostate cancer, it'll be easily managed.
Right, right, And that's so general for everything, cardiovascular disease, liver disease, lung diseases.
Got it.
You want to have a healthy diet, stay active, and keep your weight down. Now, symptoms of prostate cancer, because a lot of people will say, well, gee, my PSA may be elevated, but I feel fine. What are the symptoms that may be very mild and nonspecific, and what are the absolute red flags to say you need to get in see an expert like yourself with regard to their prostate health.
None.
Okay, that's that's very easy.
Because when we ask questions, we always ask questions like are you getting up too often at night? Is your stream week? Are you having urgency? These are signs of benign growth of the prostate, but any they are not signs of someone having increased risk of prostate cancer. Fact the matter is that, as in most cancers that you know of, Joe, if you get symptoms that are directly related to that cancer, it is most likely already.
Spread, right right, Yeah, exactly. So again it gets back to early intervention and really awareness. Would you would you say that when you look at prostate and if you just want to compare it to breast cancer, which certainly everybody is aware of, it's on everyone's mind, do you find that the general awareness of men and prostate cancer is lacking?
Oh? Absolutely, Men. Breast cancer, by the way, and prostate cancer a fairly similar. Breast cancer tends me a little more, a little more aggressive, but also found a little later. It doesn't have blood tests, it doesn't have that PSA test. But men are still historically fairly stoic and at some level whims I don't want to go to the doctor, They don't want to go to the doctor that I have, and they certainly don't want me examining their prostate rect right.
But women are much more proactive. I think this comes from motherhood and all of those things. Perhaps where you're taking care of the family, a caregiver, and the family's mom and breast cancer and women coordinate better they you know, the breast cancer walks are so important. You won't find much of that. And men it's it's but women tend to take care of their husbands. Nine times out of
the ten. A guy coming in to see me, if he doesn't have an elevated PSA already, is because his wife wants me to examine it.
Yeah, excited, you know, speaking of the examination.
And you know, we've gotten so much more technology and scanning and fancy blood works. Is the digital rectal exam a dead item or should we still be Should we still be doing these on our man and encouraging primary care physicians to do a rectal exam to say, on that digital exam, you may find a prostate cancer.
What do you think?
Well, you know, this becomes generational. I'm a bit older, So I was raised with a digital rectal exam. PSA came out just after I finished residency, and so we only found prostate cancer through the digital rectal exam, right, And so that's what would lead to a biopsy. But back then, fifty percent of the de men already had advanced disease beyond the prostate So thank god with PSA that's changed dramatically, and so I still recommended yours little
rectal exam. But is it critical. No, if you have an equivocal PSA, I think it's very important. But if you've got to do one test, do the PSA not directly right?
Exactly? All right, We're going to take a quick break.
We're talking with doctor Brian Miles, a world renowned urologist and prostate cancer expert, on your Health First this Sunday evening on.
Doctor Joe Galotti.
Don't forget doctor Jogalotti dot com is our website. Stay tuned more prostrate discussion in a moment. Welcome back everybody, doctor Joe Glotti, thanks for tuning in on this glorious Sunday evening to your Health First. We hear every Sunday between seven and eight pm bringing you.
The best in health and wellness.
We want to raise your health IQ, make you better consumers of healthcare, making sure that you have all of the facts you need to stay healthy, to stay on top of your health and all of the important topics such as prostate cancer, which sometimes is just in a black box that we just don't want to talk about things.
But tonight on the program, we have been chatting with doctor Brian Miles, a true expert in prostate cancer here in Houston, Texas at Houston Methodist Hospital where he is the Professor of Urology and the director of the Division of Robotic Surgery. And it's so great to have him on the program tonight explaining to us what we need
to know about prostate cancer. So take me through a sixty year old gentleman that has on routine screening PSA is elevated, and maybe over the last five years the PSA was sort of in the normal range and this year it jumped up a little bit and either the primary care or the guy's wife said, wait a second, we have to get this worked up. They come and see you or some other eurologic expert, and what is the plan of care. How do you approach a patient like this?
Well, as I said said earlier, besides doing a digital rec exam, I also do the four K tests and advanced test that is looking at total PSA, free PSA, complex PSA and HK two that protein within the calikrin family that PSA is a part of. That tells me whether this person really has an increased risk of prostate cancer, or whether it's just related to the genetics of his family and his age. As we get older, the PSA tends to go up within families. There are PSA patterns.
I can think of a family I once that with six brothers, and they all as each brother got to age sixty, their PSA got to ten of a big number. None of them ever had positive cancer. So there is a familial trend to some of these things, and you have to fit that into the pattern of what you're doing with the patient. But a sixty year old I'm going to get a four K test of it shows an intermediate elevated risk, I'll get an MRI of the prostrate. If it's elevated risk, they're going to get a biopsy.
Whether the MRI is positive or not. If the four K test says intermediate risk for aggressive disease or disease, it should be treated. The MRI is negative, I'll watch them for intermediate group. So you know, you don't want to be you don't want to be doing what the American Cancer Society said, we were always doing, over diagnosing,
over biopsing, this sort of thing. You want to do it with some thought process that has value for the patient without putting them in harm's way by scaring them because they have a really low grade disease, or by a scaring them the all negative bio scenes. But are still wonder to be harboring cancer.
There right right now, you have been one of the pioneers. Gosh, it's probably been twenty plus years with robotic surgery on the prostate. And what is the current state of affair with regard to prostate surgery? Because I would think that men are petrified of having that prostate cut out. They may have trouble with impotence and urinary incontinence, and they would almost well, I can't speak for them. They would almost say, forget about it, this is not for me.
I'll take chemo, I'll take radiation. Where are we at with state of the art prostate cancer technology?
Well, I would say that with appropriate informed consent, which form consent means you expose the patient to risk. What's the potential for risk, So risk knowledge and then risk acceptance and whether you get Chemotherapy has no role in prostate cancer till very late. So your choices are doing radiation, having me remove the prostrate or having me treat the prostrate with what are called a BLATI of therapies like
high intensity focused ultra scenography or cryosurgery. Right, those localized treatments all have risk impotence, incontinence, and problems with the rectum or bladder depending on the treatment options. And the fact of the matter is that they are generally minor minimal if you will accept for impotence. Impotence is the one thing where you know, at least the third of men will in general depending on age, but in general we'll have problems getting back to normal rectile capacity. We're
still studying that. I have. I've created what's called a survivorship clinic for my patients, trying to find ways to get their erections back if they were sexually potent and and interested remain interested in being intimate with their partner, Okay, And so there's a lot going on there because that is that is the key. I don't want to cure cancer and yet create another disease us, and so we have to focus on that.
Yeah, So with removal of the prostate, the rates of cure are very good, would you say that?
Yeah? I mean, you know, they're not one hundred percent whether you're radiated or remove it. But the thing I always catch it early and treat the primary disease. The chance of death from prostate cancer is very unusual.
So now that segues into the recent news a week or so ago with President Biden, this revelation out of nowhere that he has prostate cancer, let alone it is advanced to his bones apparently. So there's all kinds of speculation and we are not here to create some political chaos and be controversial. But what do you think went on there from a professional standpoint.
Well, it is really hard to explain that It's easy to judge, but you have to be careful having not been there and what you were allowed to do or not allowed to do. Possibly the person who's taking care of the president. The primary care doc was a firm believer that when you're older, you don't need to get a PSA. I am, as you know, different than that. I wrote a paper quite a few years ago, still have to get a published because people didn't want to
buy it. That age is an independent predictor of getting high risk disease. You're over the age of seventy five, your chance of having high risk cancer is fifty percent as opposed to twenty or twenty five percent. And so that was not well received because I do PSAs based on the patient's robustness and their willingness to do that. Again, getting older, I've noticed that the years pile up, but
I don't get old and you don't. And so anyhow, somebody missed the ball and didn't do a PSA on this man, because I can tell you he is his PSA is very high, over fifty, over fifty at least I would expect. And you know, it's unfortunate because he will die of this disease or his treatment, his treatment with hormone therapy and all will further impact his cognition.
Right, And so your.
Generalized theory is that going back ten years, his PSA may have been creeping up until it got to a critical point of the amount of disease in the pro state where it sort of broke loose.
Correct, correct, Yeah.
So is there is there, and you know it's you hate to hear that somebody like this, especially somebody as so much under the microscope as any president or dignitary or famous person that that right in a sense, right before us, this took place. But is there a lesson for everybody tuning in tonight to have them recalibrate how they are looking at prostate cancer for themselves or a parent or another loved one.
Yes, I think they should. That this would hopefully enlighten your average mail out there that you know it's this is something that can sneak up on you and suddenly you're eighty and you're feeling like you're sixty and some and you never got your PSA checked because you know, the government task force said I don't have to do that, and you suddenly have metastatic disease and your life as
you knew it it's not the same anymore. So it's it's something that men should take cautiously, should be aware of, but don't be afraid of getting a PSA and going to an expert, because elevated PSA doesn't mean someone's going to put needles in your prostate. It means they're going to look at it a little more closely and see what your risk are. What can we do do other studies like MRIs or PET scans and help reassure you that your life is still yours.
Right and certainly you want that expert care. And so here in Texas and certainly in Houston, you and your colleagues are definitely the go to people. But if somebody is living in Colorado or New England somewhere, is it in a sense adequate enough to go to a general urologist.
Should they look.
Up somebody that specializes in prostate cancer? How do you give direction?
Well, my sense of that is that a board certified urologist is well trained to deal with this and move forward with it. If a man has prostate cancer, always, of course seek a second opinion. If someone does that with me, it doesn't that's not an insult to me. That's a rational thing that people should do, and it's when But when you're dealing with an abnormal LAMB value, what you want to do is go to a urologist.
Have the mixam in you. You know, the community urologists who refer to me are terrific surgeons are terrific docs, right, And I would have no problem at all with anyone who has an elevated PSA going to the nourish urology and talking with them about this.
All right, Well, Brian Miles from Houston Method Hospital, you know years ago, Brian, when I first started getting on the radio, they had said, you know what you for me this show. We don't have guests on the program. We have experts, and you certainly and you certainly fit that bill, Doctor Brian Miles, Houston Methodist Hospital expert Urologists, thanks so much for it. It's always great and we do need to get together and cook up some pizza together.
And I am counting on that, Doctor Galotti.
All right, Brian, thank you so much. All right, final segment of this week's Your Hell First is coming up in just a moment, thanks to doctor Bryan Miles.
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Doctor Joeglotti dot com is our website, center for our newsletter, everything that we do, our team, it's all there on doctor Joe Galotti dot com. We'll be right back. Final segment of Your Health First on this Sunday evening, Doctor Joe Galotti. Don't forget go to doctor Joe Galotti dot com. Doctor Joe Galotti dot com. Now you may be sitting there saying, well, how does this guy spell his name? G A l A t I Doctor Joe Galotti. No spaces,
no periods, just doctor Joe Galotti dot com. Me I don't pay by mills.
What do I think got growth?
All? Right?
Final segment here, I hope you're having a good Sunday night and getting planned for the weekend. You know, for so many years, what I've been doing is we've always used Sunday night as the time to plan the week out. What are we eating, what are our activities? Looking at a calendar and planning it would be around not only what we were doing, but what about eating. It's always very, very important that you have that plan for you, your family,
your kids, and those that you care most about. In the final segment here, I found an article which was in the New York Times column in their health section in their fizz ed area, and I would say, if you are interested in health and wellness, this is a very nice column by Gretchen Reynolds, and it has to do with exercise and depression. Now, the slight twist here is this is a study that I don't think has
really ever been done to this level. Now, there have been studies in the past that show exercise, one form or another is good for your mood, makes you a little happier, and it doesn't make you as depressed. Maybe you sleep a little better. You tend to wake up a little bit more refreshed when you exercise. I think we all know this, but this particular study got into it way deeper, and it's pretty interesting. They get into
this Mendelian randomization. And what they did was they went into a database of I believe four one hundred thousand men and women, and we carry a little piece of genetic material that is encoded for whether or not you are at risk for depression, and also whether you were going to be active or more sedentary. And so what they did was they looked at the people that had the more active gene and the depression gene, and lo and behold, they found that the people that were less
depressed exercised more and vice versa. Now, there's still a lot of questions that one would have when you look at something to this grand scale. And what they found is that about fifteen minutes a day is enough to reduce the chance of developing depression. Now, if you had less taxing exercise, let's say say housework, walking fast, you needed about an hour to cut down and make a
dent in the depression. So for those that now, again you're not going to go to the laboratory tomorrow and say, hey, test me, test my genes for depression, or test my genes if I should be more active or not. The bottom line is, somehow we all need to carve out time a little every day for some vigorous exercise. And there's so many ways to do that. Ride a bike, get a stationary bike, go running, get on a treadmill, do some workouts, play basketball, play a little tennis, play
a little handball. There's so many things.
That we all could do.
And realize that it may have a definite impact on your depression. Now, the reason I brought this up and the reason that caught my eye, so many of my patients say or report that they are depressed. They just are not happy. They feel like they have the weight of the world on their shoulders, the glass is half empty,
and I do not understand why I do talk with them. Now, I am not a psychiatrist, but I believe I need to take a few minutes and talk with my patients and try to understand what's going on, because if they're depressed, it's going to interfere with what I have to do with them. If they're depressed, they're not going to eat well. If they're depressed, they're probably not going to exercise. If they're depressed, they're less likely.
To follow up.
And and so I do take tremendous interest in this. But so many people out there, many of you listening tonight, just feel that their life is just not right.
They wish they were happier.
And that's a that's a that's a tough nut to solve. But can we fix some of this with exercise and and getting down to the to the basics. I just don't know. So I think what you need to do is you have to be mindful with regard to not only what you're eating. And as I said at the very beginning of the program tonight, we have to get to a point where we are listening to our bodies.
Are you getting these signals? Are you appreciating that little bit of abdominal pain or that pain in your leg, that pain in your neck, that pain in your side, the shortness of breath, a wheezing that you may be getting. And again, you don't want to become a hypochondrias, but you need to listen to what's going on. All right, we're gonna close out for tonight I'm gonna pick a song that should make you a little happy as we as we go out of here tonight.
I'm doctor Joglotti.
Don't forget dot go to doctor joglotti dot com. We'll see you next Sunday night. Have a great week. Truly, I do mean that. Stay well now