Phone: 512-238-0762

Fax: 512-341-7370

October 10, 2020

So You’ve Had a Radical Prostatectomy…Now What? Dr. Mistry Explains Treatment Options

Speaker 1: 

Welcome 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 as always with my cohost, Donna Lee.

Donna Lee: 

Hello, everybody. Happy day!

Dr. Mistry: 

Happy day, Donna Lee . Thank you guys so much for joining us here on our radio show on news radio KLBJ 590 AM 99 .7 FM.

Donna Lee: 

That’s right. The only AM and FM station available in Central Texas.

Dr. Mistry: 

Well, there you go. It’s the most popular talk radio show, talk radio station. And I’d like to say, you know, maybe the best talk radio show.

Donna Lee: 

I think so. And they’re the smartest for sure for having us on board.

Dr. Mistry: 

Well, there you go. I’m a board certified urologist. This is a men’s health show. The kinds of topics that we talk about range from urologic type issues, such as erectile dysfunction and low testosterone. But we also talk about issues that affect both men and women, such as kidney stones, kidney cancer. We talk a lot about kind of advanced medical treatments for cancer, and then specifically highlight the approach that our practice takes to urology, which is a more holistic whole body approach, where we try to maximize your health while treating your medical problems .

Speaker 1: 

That’s right. We also have speaking of women’s health, we’ve had a couple of women email us requesting more information about women’s wellness. So that’s when I referred to the dr. Donner show. That’s funny,

Speaker 2: 

You know, how I started in urology was a real focus on hormone health and wellness. And we did a lot of treatment of women for women’s sexual dysfunction. When we first started practice right over the years that women’s sexual dysfunction practice has been kind of taken over by a lot of the great OB-GYNs in town. And so now we just see like the really, really tough ones, the super hard, the severe pain, since, you know, since the very first time they had intercourse or the anorgasmia, or the very difficult to treat patients after breast cancer. And we’re happy to take care of these patients and really try to provide them amazing high level service when it comes to their sexual functioning. Uh , but we do treat a lot of men. Uh, fortunately for us, we think we do an excellent job and a lot of men who are out there trying to explore their health may go to physicians or practices that don’t really take care of men. They just kind of offer a service like, you know, if your car’s making a funny noise and you only go to a place that changes your oil, you’re probably gonna get your oil change, what they’re caused the noise or not. And so that’s where I think a lot of men, you know , ultimately find us as a practitioner and as a urologist , uh , I started a practice here in Austin in 2007 called NAU urology specialists . And that is who brings you this show? We have four physicians, five physician assistant and nurse practitioners. We have two physical therapists, a sex therapist. We do, we have a strong program here when it comes to the association between obstructive sleep apnea and your logic condition . So we also do an order home sleep test out of our office. And I really try to go to that extra mile to take care of you, including doing an integrative nutrition approach.

Speaker 3: 

Yup . We have lots of people on staff and a little funny story about our billing supervisor, Yolanda, her boyfriend forced her to go through our sleep program because apparently she said ,

Speaker 2: 

That’s funny. You know, when you’re single for a long time, they’ll be complaining, you know ? And then all of a sudden, all of a sudden, maybe , uh, maybe stick a C-PAP

Speaker 3: 

That’s right. He’s like no more sleepovers. Didn’t get slaked debts . And so she came right back to work the next day , looking for her sleep then,

Speaker 2: 

Well, there you go. So your questions really drive this show and seeing us patients in our clinic really keep us going, obviously from a business standpoint, that also helps. And so we’d love you to come see us as a patient. We are seeing patients in as safe as up manner as we can possibly do here in the COVID environment, by telemedicine in person in a socially distanced way, in an well cleaned office with fully max staff. And then you ask us questions by contacting us here . So Donna, if people want an appointment , uh , where our offices and how do people get on ,

Speaker 3: 

You can call us at (512) 238-0762 at during the week. Of course. And we’re in round rock, North Austin, South Austin in dripping Springs. But back to your point about a clean office, this is probably the safest place to be is probably a medical office because I was at the store the other day. And I went to put in my credit card and then I went to touch the little, the little buttons to do my security code. You just saw the mucusy fingerprint , right? And there was like that little piece of plastic. And I thought, how many people have touched this? And it hasn’t been cleaned. So yuck indeed. So you will come to a safe

Speaker 2: 

Wash your hands clear mass state .

Speaker 3: 

That’s right. Do you want a question? We got a bunch. Well , I’d love to hear a question. All right . This patient sent in after RP two and a half years ago for aggressive Gleason score of eight, having zero PSA labs until this week, PSA has shown up again. Not sure if I read that right, but physician believes it’s cancer all the way. Rechecking again, in a couple of months choices, given one, do nothing to radiation, three chemo pill, or four chemo castration. I’ve chosen to wait for the next lab test. Curious as to what other questions I might ask. Thanks .

Speaker 2: 

That’s a great question. So this is a question from a patient who had a radical prostatectomy. That means their prostate was removed after being diagnosed with a very aggressive prostate cancer. A Gleason’s eight now as a confusing thing for many patients, is that when they’re diagnosed with prostate cancer and undergo something as radical as removing the prostate, they kind of feel like they’re never going to have to worry about cancer. Again. When in fact a really aggressive cancer can have little bitty kind of tentacles of microscopic cancer. That’s extending out of the prostate into the surrounding tissue and even more frightening, a little microscopic satellites can actually break off the cancer and go travel to other parts of the body, the bones, the bones, the lungs, lymph nodes. And so those are things that you don’t see before surgery because they’re too small to show up on imaging. So the only way we track it later is by measuring your PSA. And in our practice, we do something called an ultra sensitive PSA measurement. So there are two things that are really important after a radical prostatectomy or after your prostate’s removed. When it comes to PSA is coming back to consider if the PSA never went down all the way, if it never went down to zero, then there was probably cancer there from the very first day, the prostate was removed. It’s probably somewhere else. And considering therapy really needs to be geared towards treating the whole body. But in this case, this listener had a PSA that was undetectable or PSA of zero for several months, or I don’t know how long, but then more recently started coming back. So it is why is this too look and see how many, how long in between PSA increases you can go. So we do something we calculate what’s called a PSA doubling time to see how fast it’s doubling. And that gives us an idea of how much cancer’s lying around the options given to this listener were to do radiation and that’s called Agilent salvage radiation. And it works really well up to 70% of people can get cured with a little bit of radiation where the process that used to be not a lot of side effects. So , and in the adjuvant setting, really people tolerate it very well with minimal side effects. Okay . And so what’s the difference though? I think psychologically is people are wondering what are they radiating? The prostate is gone, right? And so what we have tried to convince her, explain to people is that we’re really radiating where the prostate used to be, because that’s where we think the recurrence of those small cancers were. Now again, if the recurrence is very quick, like just a few months after the radical prostatectomy or the PSE never goes down, then we start thinking about castration therapy or which is therapy designed to take away people’s testosterone. And the pill probably should never be given or habit the pill for chemically castrating. Somebody should rarely be given by itself. Usually chemical castration has given by an injection and , uh , the pill and the injection, or sometimes use in combination, huh ? The one imaging test that we almost always try to get, if somebody’s PSA is coming back is a bone scan and a cat scan, but there’s another scam . And that’s a specific scan. That’s only indicated in this environment and that’s called an Ottoman pet scan. A pet scan is a special kind of CT scan that looks for metabolically active cancer. And the Axeman dye that we use is specific for prostate cancer. So depending on what your urologist things is appropriate, it is a paid for by insurance. It is paid for by Medicare. It’s a fairly quick and easy test to do, and it can find if there’s cancer outside of where the prostate used to be over the prostate bed and how that affects your treatment is that if it’s not just in the prostate bed, if it’s say it’s in your bones or your lymph nodes, then doing radiation to your prostate bed is not going to help you. You know, it’s not going to fix anything. So you don’t want to go through treatment that has no hope of working. So in our practice, we’ll wait for two consecutive PSA rises each separated by three months and then do an Axeman pet scan along with a bone scan and a cat scan. And if we don’t find any evidence of it anywhere else, because sometimes that pet scan can be negative, then we will do radiation to the prosthetic bed. Um, and , uh, and like I said, we have almost a 70% cure rate. So we’re very happy with that.

Speaker 3: 

Well, that’s awesome. Low side effect, issue and hive , um , cure

Speaker 2: 

That’s right. So I think that , uh, for this listener , uh, there’s certainly no reason to think that all hope is done or just because the cancer has come back potentially. Um, that, that means that that was a failure of decision making beforehand. I mean, this is why cancer scary because it does things that are unpredictable. Right? So thank you so much for that. Caller has done a , how do people get ahold of us ?

Speaker 3: 

You can call us during the week at (512) 238-0762. And this is a perfect example. I’m going to respond to this person’s question, let them know that we’ll send them the podcast as a link if they don’t catch the show. So if you send in your question at all, please let me know. If you don’t catch the show and you get a free pocket , then you know, they can listen to our podcasts everywhere. That’s right . You can sit at home and just tell Alexa, the Armour men’s health hour and we will magically appear in your home. Um, our website is [inaudible] dot com and again, send those questions to our mental at Gmail,

Speaker 1: 

The armor men’s health hour. We’ll be right back. If you have questions for dr. Mystery, email him at Armour men’s health, ed gmail.com.

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