Phone: 512-238-0762

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August 8, 2020

Facing Your Prostate (Exam): Dr. Mistry Explains the Importance of Physical Prostate Exams and the Need for Prostate MRI’s

Speaker 1: 

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

Dr. Mistry: 

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

Donna Lee: 

Hello everybody.

Dr. Mistry: 

Donna Lee was the seventh funniest mom in America.

Donna Lee: 

Per Nick at Night.

Dr. Mistry: 

Per Nick at Night.

Donna Lee: 

That’s some street cred.

Dr. Mistry: 

That’s right.

Donna Lee: 

I’m hanging onto that five minutes of fame from 14 years ago.

Dr. Mistry: 

That’s right. It’s her high school football championship moment.

Donna Lee: 

Well, you didn’t have a high school football championship moment, so you’re jealous.

Dr. Mistry: 

I might be.

Donna Lee: 

That’s why you keep bringing it up.

Dr. Mistry: 

That’s right. Baylor College of Medicine graduation was my highlight of my life.

Donna Lee: 

That, well there’s that. I think if you listened last week, we kind of had a weird blip cause we talked about Sch*t’s Creek, but we said it so fast that Daniel had to bleep out the whole thing, so it just sounded strange. But anyway, if you listened last week and you’re confused, I was comparing myself to the lady on the show because she had five minutes of fame and she’s still convinced that the whole world knows who she is, much like myself.

Dr. Mistry: 

She goes into restaurants and like ducks her head wondering where the paparazzi are. You know.

Donna Lee: 

We’re in the big sunglasses and nobody’s around. That’s me at Luby’s yesterday. With my face mask, of course.

Dr. Mistry: 

I’m a board certified urologist. This is a men’s health show. This show is brought to you by our urology practice established in 2007. It is the NAU Urology Specialists. We have four locations. We have four physicians, four PA and nurse practitioner providers. We have a pelvic floor physical therapist. We have an amazing functional nutrition program. We offer testing for sleep apnea because there’s a big overlap between urologic issues and sleep apnea. And we even do sex therapy. So if you have sexual issues that you don’t know what your etiology is, if you think there could be a psychological component or a component related to performance anxiety, having that sex therapy resource in our office is a wonderful resource for you as our patient.

Donna Lee: 

And don’t, don’t be surprised if we suggest it. A lot of the patients don’t expect it.

Dr. Mistry: 

That’s right. I mean, you know, if we actually see a number of patients that have impotence issues only when it comes to fertility. It’s a fascinating scenario. We have patients who can, who cannot orgasm, in fact, when their wife is obviating because of performance anxiety issues. And so we have to find ways to combat that or to get around it. It’s certainly something that we have a lot of experience with and having all these great resources really helps us kind of get a handle on it. So if you have issues that you think other people have either not treated to your satisfaction, or you’ve been too embarrassed to address them in the past, those types of sexual issues are exactly the things that we take care of every day.

Donna Lee: 

I never even thought about that. It’s anxiety issues with fertility.

Dr. Mistry: 

That’s right.

Donna Lee: 

That makes sense.

Dr. Mistry: 

Yeah.

Donna Lee: 

You guys are under so much pressure for everything.

Dr. Mistry: 

It’s hard being a boy.

Donna Lee: 

It is hard being a boy. I had a listener reach out to us. He became a patient and I thought, you’d get a kick out of this. He said he went to the South location, said he saw one of our incredible PAs, Jason, we love Jason. “Had a good visit, listened to me, very thorough prostate exam–I’m just glad he didn’t have huge hands.”

Dr. Mistry: 

It reminds me of a story not too long ago, you know, 20 years ago now, I went to do a community health prostate screenings with my fellow resident. Her name was Kim Takahashi and she was maybe 4′ 10″, she had, she wears a size five glove, and I wear a size nine glove.

Donna Lee: 

You don’t want a prostate check from Dr. Mistry.

Dr. Mistry: 

So when we walk into this crowded arena with men in individual little curtained-off cubicles, she yells out, she goes, “Would you guys please get the extra small gloves? You never have gloves small enough for my hands.” And I said, “Yeah, that reminds me. You never have the extra large gloves either!” And a guy pulls the curtain back and says, “I want her!” And the whole, you know, it was in the Astrodome and the whole floor of the Astrodome was built that the joke like went from one end all the way to the other end. It was very funny. But yes…

Donna Lee: 

You were not popular that day.

Dr. Mistry: 

That’s right. If you’re looking for small hands, Leonora Brown would be happy to do your prostate exam.

Donna Lee: 

We have Dr. Stacy Ong who’s pretty small, too.

Dr. Mistry: 

That’s right. That’s right.

Donna Lee: 

The end of this particular email string, we were going back and forth. He’s like, “I think I deserve a tee shirt for that.” So of course I’m sending him a t-shirt. But he said, “Thank you. Keep the mysterious one in check.” Meaning you. Dr. Mistry is his real name. M-I-S-T-R-Y. Please Google that.

Dr. Mistry: 

So that really gets to an interesting point, which is what is the value of the digital rectal exam? What are we trying to accomplish when we stick our finger there to check your prostate?

Donna Lee: 

Good question.

Dr. Mistry: 

Here are some things that are more myths. Although I’m checking your prostate with that exam, we don’t really know whether your prostate is really big or really small in a definitive way from that exam.

Donna Lee: 

Right? Because you’re not in there like for a while. You’re just kind of in and out.

Dr. Mistry: 

And more importantly is that your finger is only touching the back part of the prostate. So it’s like, it’s like feeling one part of an apple to tell me how big the whole apple is. People can have different shaped apples. They can have protrusions or the way that the prostate is grown can be different. The reliability between a physical exam and a real ultrasound sizing of the prostate: you’re wrong 70% of the time. Not, you’re not even, not even in the ballpark.

Donna Lee: 

The three things: the prostate check, the ultrasound, and the blood test.

Speaker 1: 

The PSA helps. That’s right. When you’re looking for prostate cancer. Now, if you have a bad prostate cancer, then we can feel it with our finger, and that’s really what we’re feeling for. All, what we’re feeling for are nodules and abnormalities of the prostate. The sizing of the prostate, so I see all the time guys will come in, they’ll say, “Yeah, I got my prostate examined. And my doctor said it was kind of big.” And they, and they think that somehow also correlates with their urinary symptoms. And the truth is all those things are completely separate. The physical exam, we’re looking for nodules, we’re trying to get some assessment of size, but really whether the prostate is big or small, it doesn’t necessarily mean that you’re going to have symptoms or not have symptoms. Sometimes people with very small prostates can have very, very bad urinary complaints because of an enlarged, of an obstructing prostate. So really what we’re looking for is whether the prostate is blocking the urine stream, whether it’s causing a slow stream, whether it’s causing you to have incomplete emptying, and those things can be completely unrelated to whether or not you have an enlarged or big prostate.

Donna Lee: 

Now, if you have an enlarged prostate, do you 100% of the time have urinary issues?

Dr. Mistry: 

No, not at all. We see prostates, a normal prostate’s about 30 grams. We can routinely see prostates in the 90, 120, with people that have no urinary symptoms whatsoever. Now where that large prostate can complicate your urologic health is that large prostates tend to make more PSA–prostate specific antigen. A lot of times we’ll get guys with high PSA’s, there’ll be sent to us for a prostate cancer evaluation, and we won’t find cancer, thank God, in a good, in a majority of them. Then what we look for is why is their PSA high? And a large prostate or something with lot of volume is oftentimes the culprit. And so we will do a calculation in some patients that have persistently high PSA is constantly worried about prostate cancer risk, we’ll do something called a PSA density, where we take the PSA and divide it by the volume. Now, the volume of the prostate, we determine with an ultrasound. So you can’t just use your finger idea of what it is. You actually have to physically do an ultrasound. Now we have another tool in the armamentarium for prostate cancer detection, and that is the prostate MRI. It is a three tier, three Tesla MRI. It cannot just use a regular one that has to be a very detailed MRI. It’s available in multiple places in Austin. And if you’re a patient of ours and you come to us with a high PSA, you’re going to get a PSA, a prostate MRI ordered. Now, not all insurances will pay for it. And that’s a little frustrating to us. If you’ve had a negative biopsy in the past, that insurances will pay for a prostate MRI. If you’re a Medicare patient, more than often, your prostate MRI will be covered. And if you’re just somebody out there, because I see it all the time, you have a high PSA, but you just don’t want to get a biopsy. You’re scared of it. You don’t want something put into you. You don’t, you don’t like the randomness of a standard prostate biopsy, and if you’ve just ignored this issue, or if you’ve been diagnosed with prostate cancer in the past and were put on watchful waiting, but never went back to see your doctor and just disappeared because you thought that…

Donna Lee: 

Watchful denial.

Dr. Mistry: 

That’s right, watchful denial…come on in, let us order you a prostate MRI. We can at least tell if something really big, bad, and dangerous is going or brewing in you, and we would encourage you to face that. The number of patients that I’ve seen along my career, that just totally ghost us once they get a cancer diagnosis is alarming.

Donna Lee: 

Wow. Right?

Dr. Mistry: 

You know, it is head in the sand kind of thinking. And if you don’t want to treat your prostate cancer, because you’re afraid of impotence and incontinence or whatever, whatever is motivating you to be in denial about these things, come to us and talk to us about it. Don’t, you don’t even have to experiment. If you want to do it with a functional nutritional medicine type approach, we have those providers that we can give you that advice. At the very least, you’ll still be under our watchful eye, and we can put you on a program where you won’t be harmed because you’ve disappeared.

Donna Lee: 

That’s right. We’re happy to help.

Dr. Mistry: 

I think facing those issues is something that we really take a lot of pride in being able to give you those resources so that you can do whatever you think is best for your health, but we can be there to augment and keep you safe. So, Donna Lee, how do people get ahold of us and send us messages is if they want a second opinion?

Donna Lee: 

You can reach out to us so that we can talk you out of watchful denial at armormenshealth@gmail.com. That’s our email address. We can also go to our website and leave an inquiry after reviewing the website, armormenshealth.com. Our phone number during the week is (512) 238-0762. Don’t forget, these are also podcasts and they are free and they are magical. Thank you so much.

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The Armor Men’s Health Hour, will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.

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