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May 16, 2020

Add Quality to Your Years: Dr. Mistry and Donna Lee Answer a Listener Question About Testosterone After Cancer Treatment

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Hello and welcome back to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, here with my cohost, Donna Lee.

Donna Lee: 

Hi. Welcome back everybody.

Dr. Mistry: 

Do you know somewhere along the way in an actual release of our show, there’s like a whole paragraph on you.

Donna Lee: 

There is?

Dr. Mistry: 

That’s right. It has like she was voted like this and this that.

Donna Lee: 

On the transcriptions?

Dr. Mistry: 

I’m wondering if you wrote it.

Donna Lee: 

Maybe. I do have access to our account to upload that information.

Dr. Mistry: 

Well, I love…welcome to the Donna Lee Show.

Donna Lee: 

Welcome everybody!

Dr. Mistry: 

She is going to be the most regular fixture of this show.

Donna Lee: 

That’s right.

Dr. Mistry: 

Thank God for your humorous disposition, your dirty, dirty jokes, which keep this place going.

Donna Lee: 

Well, we have to be a little dirty in urology.

Dr. Mistry: 

That’s right. You know, I became a urologist?

Donna Lee: 

Because of the jokes.

Dr. Mistry: 

Because of the jokes.

Donna Lee: 

I had a t-shirt on yesterday that had a penis on it and I had to go somewhere after work and kind of forgot because it’s just second nature for us. And the looks I got…Oh boy, I forgot. And then our other t-shirt says “We’re nuts for urology at Urology Specialists.”

Dr. Mistry: 

They don’t like that. That, my funniest shirt that we ever had here was when you didn’t know urology very well and you put the term “you’re in good hands,” and instead of U-R-I-N-E you put Y-O-U-‘-R-E. And I was like “I think, I don’t think she gets the joke. I think she misspelled the T shirt.”

Donna Lee: 

I remember that. I still have that t-shirt.

Dr. Mistry: 

That’s right. And then we blamed the t-shirt guy and then he had to make them again. That was pretty good. Good job Donna Lee. Thanks for being a great office manager around here.

Donna Lee: 

You’re welcome. Saved you lots of money.

Dr. Mistry: 

That’s right. Welcome to the Armor Men’s Health Hour. I’m Dr. Mistry, your host, and I am a board certified urologist. Our urology practice is called NAU Urology Practice–Urology Specialists, sorry. NAU Urology Specialists. And I’m Dr. Mistry. That is my real name.

Donna Lee: 

M. I. S. T. R. Y.

Dr. Mistry: 

That’s right. And we have Dr. Yang as part of our practice.

Donna Lee: 

Y.A.N.G.

Dr. Mistry: 

Dr. Jacomides, don’t even try.

Donna Lee: 

J.A.C.O.M.I.D.E.S.

Dr. Mistry: 

And then Dr. Ong.

Donna Lee: 

O.N.G!

Dr. Mistry: 

That’s right. That’s easy.

Donna Lee: 

Her name’s easy because it’s like “O-N-G.”

Dr. Mistry: 

No, that’s right. Oh there you go. Everybody’s extremely well trained here. Very much focused on making your life better and try and do so in a safe and effective manner. I think that we really pride ourselves in trying to take a new and unique view to your men’s health issues.

Donna Lee: 

Holistic.

Dr. Mistry: 

Much much to our chagrin of our staff here, you know there is no such thing as a simple problem or a simple question. You know, I like to make maybe things a little overly complicated because I want people to know that their own individual problems are something that we take with an individual approach, not a cookie cutter approach. If you have an enlarged prostate, not just one treatment is going to work for everybody. If you have prostate cancer, not just one treatment is going to work for you.

Donna Lee: 

That’s so old school thinking.

Dr. Mistry: 

It is. If you have overactive bladder or if you have any number of conditions, even kidney stones, you know, we want to make sure you know what’s the buffet or plethora of options that are available for you. And then how are we going to take care of you after the initial problem? How do we take care of you for not getting more stones or having more urinary complaints or having a worsening cancer even after we do the initial treatment. That’s why so many of our patients become really a part of our family. We’re so appreciative for all of their support for our practice, the show, and of course all of you that participate by sending us questions.

Donna Lee: 

Right. And we have a question right along those lines.

Dr. Mistry: 

Let me hear it.

Donna Lee: 

Oh, this patient sent in the subject is “Testosterone after prostate removal.” “Dr. Mistry, I had robotic prostatectomy one year ago. My libido is poor. Would it be a danger to get testosterone now? I’m 62, had a fairly aggressive cancer located in the anterior section of my prostate.” The original biopsy, he said, missed it. “First PSA after surgery was zero.”

Dr. Mistry: 

Excellent. So, this is, if you’ve listened to the show before, I’ll try to, you know, break this down into several different components. So the first thing is what is the likelihood that you’re going to miss a cancer when you do a prostate biopsy? Now most of the time you’re doing a prostate biopsy if you had an elevated PSA level that’s a blood test looking for your, to stratify [inaudible] for prostate cancer. And if the tumor is located kind of far away from the rectum because that’s how we access the prostate is trans rectally, then it is possible to miss an anterior or a central tumor. And so that’s why in our clinic we almost always will obtain an MRI. Even if you’ve had a biopsy, we get an MRI about six months after your biopsy just to make sure we didn’t miss a tumor that may have been somewhat inaccessible from our traditional template. A lot of insurances won’t pay for the MRI before the biopsy, which we prefer because, if you can get an MRI beforehand, we can do something called an MRI guided biopsy, much higher degree of accuracy, and we’re not going to miss something big that’s usually not in the right place. And so that’s something that we make kind of commonplace in our practice. The second question is what do we do about men with either low testosterone or low libido after the radical prostatectomy? And this is where we get a little bit into nomenclature. A lot of times men confuse the term “libido” with erectile function. Just like I have very low golf libido because my golf function is poor. You understand? Like, I don’t want to play golf because I’m terrible at golf, right? So if you’re not getting an erection, then your desire for having sex is low. That’s understandable. But if your libido is low and that you’re just, your sex drive is low and you think it might be due to testosterone, then it could be improved with testosterone. But if you have severe erectile dysfunction after a radical prostatectomy after they removed the prostate gland, that may not be something that’s going to get fixed with testosterone. Usually in a case like that, the nerves that helps you know transmit the signal to your penis to get erect, they’ve been damaged. They may have been irreversibly damaged. And other things may be necessary and that’s a different topic, different show. Absolutely, we’ve talked about it many times and if you have severe ED or a stress urinary incontinence after your prostate has been removed, it’s something that we consider ourselves to have a special expertise in here, a special fellowship training, and we’d love to see you about it. But if your libido is low or you’re symptomatic from low testosterone in other ways like low muscle mass, poor cognition, and you’re worried about taking testosterone after prostate cancer, I can tell you that the data does not support that there’s any risk to you. The data is supportive, in fact, that normalizing your testosterone and taking testosterone replacement may in fact decrease your chance of getting a later recurrent disease. That’s research that’s been published just in the last year. But this has also kind of proven or been very consistent with data that we as urologists have known for a long time, which is that low testosterone levels are often associated with more aggressive cancers. And so if you have low testosterone, you actually have a higher chance of getting cancer, and taking testosterone should not pose any additional risk to you after you’ve been treated and certainly if you’ve been surgically cured, as this listener has suggested. Taking testosterone we consider safe. We have hundreds of patients that are on testosterone after prostate cancer treatment. We even have hundreds of patients on active surveillance for prostate cancer that are getting testosterone. And that data also shows that it is safe to be able to prescribe that. We don’t hyper dose you, we get you to a normal level, get you to feeling good, and that’s kind of what the goal of any doctor that’s taking care of you should do, is to get you to normal levels in a safe, in a safe way.

Donna Lee: 

So you don’t want levels at like 1000, 2000?

Dr. Mistry: 

Maybe you don’t want 2000, you know, we don’t need bodybuilder kind of…

Donna Lee: 

We’re not judging, though. It’s OK if that’s your jam.

Dr. Mistry: 

That’s fine, if that’s what you’re doing, that’s what you’re doing. But in terms of kind of what we’re going to be able to do in kind of a safe manner, that’s kind of what we’re going for. And when it comes to issues like the safe administration of testosterone or regaining functioning after prostate cancer, this really gets to that heart of that point, which is that, you know, just being diagnosed with cancers tough enough. But not getting guidance on how to adjust your diet, your lifestyle, how to maximize your function, having the right physical therapist, having the right sexual advice, you know, warning you about how you’re a jacket volume and an orgasm might change after such a surgery. Coming to grips and helping you overcome that, that’s what we do. And that’s something special that we do, I think. And absolutely something that we’ll spend just as much time on just trying to convince you to do a radical prostatectomy or any kind of procedure for your prostate. I think that’s something that if you haven’t gotten enough of and you’ve been suffering from any of these medical conditions, it is absolutely an appropriate reason to seek a second opinion.

Donna Lee: 

Second opinion! Doctor second opinion over here.

Dr. Mistry: 

We’ve been together so long and finishing my sandwiches.

Donna Lee: 

I will finish your sandwich. I’m hungry. Oh my goodness. So you said rectum earlier and I just had to throw out there every time, my husband has some joke that he knows and every time somebody says rectum, which is unfortunately a lot around our house with three teenage boys, somebody will say rectum, and he says, “Rectum him? Damn near killed him!” I don’t know what the joke is but that’s the punchline. And that’s all I hear at home. So we’ll have to, we’ll find the joke for you.

Dr. Mistry: 

Yes, she is a board certified comedienne in fact, but she doesn’t know that joke.

Donna Lee: 

That joke. Is it a common joke? You don’t know. I’m going to find the joke and we’ll have it for you next week on this show.

Dr. Mistry: 

They didn’t teach that in our urology residency, that particular joke.

Donna Lee: 

Oh, well, I can’t steal other people’s jokes, but I can certainly repeat that joke when I find it. I’m telling Carlos Mencia.

Donna Lee: 

Good story. I met him, and we had a long talk about people stealing jokes.

Dr. Mistry: 

That’s right. He was unhappy with you. Well, Donna Lee, why don’t you tell people how to reach out to us for questions and for that second opinion or for appointments with us or anything else we can do for them.

Donna Lee: 

Or for the rectum joke. You can call us at (512) 238-0762. Our website is armormenshealth.com. You can send questions to that website. There’s a little spot there to send your questions or you can email us at armormenshealth@gmail.com. We’re located in Round Rock, North Austin, South Austin, and Dripping Springs, and we so very much appreciate your questions because that’s what keeps us going. Right, Dr. Mistry?

Dr. Mistry: 

That’s right.

Donna Lee: 

Well, have a great day. Bye!

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The Armor Men’s Health Hour is brought to you by Urology Specialists of Austin. For questions or to schedule an appointment, please call (512) 238-0762 or online at armormenshealth.com.

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