Podcasts about american urologic association

Topics covered in this episode: What is the pelvic floor? Why toilet posture is at the root of pelvic floor dysfunction. The guarding reflex, bladder and bowel dysfunction. Why real or perceived stress impacts your bowel and bladder dysfunction. How big a problem is pelvic floor dysfunction? And more ...   Dr. Fleischmann is board certified in urology and Female Pelvic Medicine and Reconstructive Surgery. She received her medical degree from the State University of New York Downstate Health Sciences University in Brooklyn, NY, where she graduated summa cum laude. Dr. Fleischmann completed her surgery and urology residency at Albert Einstein College of Medicine in Bronx, NY and continued her training in a fellowship at NYU School of Medicine. She is passionate about practicing an integrative approach to urogynecology, correcting the pervasive, unconscious and paradoxical behaviors which can turn into the structural problems and bothersome symptoms that prompt women to seek care. She is the author of the new book “The Second Mouth”, which addresses the powerful mind-body connection in functional urology. Dr. Fleischmann serves as Director of FPMRS at White Plains Hospital Center where she has been in clinical practice for the last 25 years. She holds an active appointment as Assistant Clinical Professor in Obstetrics and Assistant Clinical Professor of Gynecology and Urology at Albert Einstein College of Medicine. Additionally, she is a member of the American Urologic Association and Society for Urodynamics and Female Urology (SUFU). Dr. Fleischmann is the author of several research publications and presentations. She lives and practices in New York. @drnicolefleischmann Thesecondmouthbook.com

If you think that your only hope for treating overactive bladder is to focus on your pelvic floor muscles, you may be overlooking a different type of approach that's been proven successful for hundreds of thousands of patients: Nerve stimulation. It turns out that certain nerves play a critical role in bladder function, and there are devices that can stimulate those nerves to substantially reduce leaks. Many patients find that their symptoms improve by 50% or more with a simple, in-office procedure called sacral neuromodulation. Today's guest is Dr. Vikas Desai, a urologist, a board-certified member of the American Urologic Association and a member of the Society of Prosthetic Urologic Surgeons, to tell us more about it. To learn more from Dr. Desai about bladder health, visit his YouTube channel at https://www.youtube.com/@DesaiUro.For more information about the National Association for Continence, click here, and be sure to follow us on Facebook, Instagram, Twitter and Pinterest.Music:Rainbows Kevin MacLeod (incompetech.com)Licensed under Creative Commons: By Attribution 3.0 Licensehttp://creativecommons.org/licenses/by/3.0/For over 35 years, Tranquility Products has provided real-life protection for people with incontinence. Choose from disposable briefs, pull-on underwear, booster pads and more, in a wide range of sizes from youth to 5XL. Go to TranquilityProducts.com and click “Free Samples” or call us at 1-866-865-6101... We're here to help!

One thing that a lot of men who are facing prostate surgery often don't realize is that once the procedure is done, you're almost certain to experience bladder leaks. For most men, those leaks resolve after a few weeks or months, but for some, they can persist for years. The good news is that there are things you can do to improve your chances for rapid improvement, and today's guest, Dr. Vikas Desai, is here to explain how. Dr. Desai is a urologist, a board-certified member of the American Urologic Association and a member of the Society of Prosthetic Urologic Surgeons with more than 16 years of clinical experience. To learn more from Dr. Desai about prostate care, men's and women's bladder health, treatments for sexual dysfunction and other topics, visit his YouTube channel at https://www.youtube.com/@DesaiUro.For more information about the National Association for Continence, click here, and be sure to follow us on Facebook, Instagram, Twitter and Pinterest.Music:Rainbows Kevin MacLeod (incompetech.com)Licensed under Creative Commons: By Attribution 3.0 Licensehttp://creativecommons.org/licenses/by/3.0/For over 35 years, Tranquility Products has provided real-life protection for people with incontinence. Choose from disposable briefs, pull-on underwear, booster pads and more, in a wide range of sizes from youth to 5XL. Go to TranquilityProducts.com and click “Free Samples” or call us at 1-866-865-6101... We're here to help!

In this Healthy, Wealthy, and Smart Podcast episode, host Dr. Karen Litzy welcomes Dr. Nicole Fleischman, a board-certified urogynecologist based in New York. Dr. Fleischman specializes in treating women with pelvic floor conditions, including urinary incontinence and organ prolapse, utilizing both medical and surgical approaches. During the conversation, they explore a paradigm shift in understanding pelvic health—moving away from the traditional view of pelvic weakness and the need for strengthening to a more nuanced perspective. Dr. Fleischman also discusses her book, "The Second Mouth," which delves into these concepts. Tune in to gain insights into women's urinary health and the importance of specialized care in this field. Time Stamps:  [00:01:26] Urogynecology and pelvic health. [00:04:32] Pelvic floor muscle understanding. [00:08:12] Pelvic floor awareness through breathing. [00:12:19] Stomach sucking and breathing issues. [00:14:14] Breathing and pelvic floor health. [00:18:45] Pelvic floor awareness and coordination. [00:21:51] Surgery necessity in urogynecology. [00:26:21] Empowering women through education. [00:29:10] Biopsychosocial lens in medicine. [00:32:19] Importance of proper toilet training. [00:34:55] Incontinence awareness and prevention. [00:38:26] Breathing techniques for health. [00:42:07] Knowledge sharing in healthcare.  More About Dr. Nicole Fleischman: Dr. Fleischmann is board certified in urology and Female Pelvic Medicine and Reconstructive Surgery.  She received her medical degree from the State University of New York Downstate Health Sciences University in Brooklyn, NY, where she graduated summa cum laude. Dr. Fleischmann completed her surgery and urology residency at Albert Einstein College of Medicine in Bronx, NY and continued her training in a fellowship at NYU School of Medicine.  She is passionate about practicing an integrative approach to urogynecology, correcting the pervasive, unconscious and paradoxical behaviors which can turn into the structural problems and bothersome symptoms that prompt women to seek care. She is the author of the new book “The Second Mouth”, which addresses the powerful mind-body connection in functional urology.  Dr. Fleischmann serves as Director of FPMRS at White Plains Hospital Center where she has been in clinical practice for the last 25 years. She holds an active appointment as Assistant Clinical Professor in Obstetrics and Assistant Clinical Professor of Gynecology and Urology at Albert Einstein College of Medicine. Additionally, she is a member of the American Urologic Association and Society for Urodynamics and Female Urology (SUFU). Dr. Fleischmann is the author of several research publications and presentations. She lives and practices in New York.Resources from this Episode: The Second Mouth Book Dr. Fleischman on TikTok Dr. Fleischmann on Instagram   Jane Sponsorship Information: Book a one-on-one demo here Front Desk @ Jane Mention the code LITZY1MO for a free month Follow Dr. Karen Litzy on Social Media: Karen's Twitter Karen's Instagram Karen's LinkedIn Subscribe to Healthy, Wealthy & Smart: YouTube Website Apple Podcast Spotify SoundCloud Stitcher iHeart Radio

Dr. Wiegand joins us today with a closer look into the female urethra and lower urinary tract when there is a clinical need for intermittent catheterization. Incomplete bladder emptying associated with urinary retention in females presents a unique set of challenges, teaching opportunities, and potential complications. Dr. Wiegand addresses each of these from an expert urologist's perspective, providing explanations and solutions. He focuses on teaching the female population how to catheterize, providing tips for anyone working with females and needing to teach intermittent catheterization. Listen in as Dr. Wiegand addresses the importance of compliance for females and why the female urethra is not just a shorter version of the male urethra.Guest bio: Dr. Luke Wiegand is a board-certified urologist with Orlando Health Medical Group Urology specializing in reconstructive urology. Sought after for second opinions and complex case referrals, he strives to communicate honestly and directly with his patients to help put them at ease and achieve their goal of returning to their normal lives.  Dr. Wiegand earned his medical degree and completed his urology residency at the University of South Florida Morsani College of Medicine in Tampa. He was chief resident in his final year. Dr. Wiegand performed his fellowship in reconstructive urology at Washington University in St. Louis, where he supervised residents in general urology and reconstructive urologic procedures. He serves as assistant editor of the Video Journal of Prosthetic Urology. He is the author of several medical textbook chapters and is a frequent contributor to peer-reviewed journals.  Dr. Wiegand is board-certified by the American Board of Urology. His professional memberships include the American Urologic Association, Florida Urological Society, and the Society of Genitourinary Reconstructive Surgeons. Visit https://www.coloplastprofessional.us/ for more offerings!   

On this special edition episode, Shikha Jain, MD, with Physicianary's Hansa Bhargava, MD, and Mend the Gap's Dagny Zhu, MD, discuss the evolution of empowering yourself and others and advocacy with a panel of guests.  •    Intro 1:01 •    What does it mean to empower women in medicine, and what are the ways that we can really empower others to achieve the things that they may not see for themselves?  2:39 •    What are some ways in which you have empowered or hope to empower women in medicine? Are there tips or skills that have worked well?  5:43 •    How have you been empowered by others, or have helped others find their voices?  8:38 •    Do you agree that the conversation is changing toward a cultural shift in empowerment for women in health care? 13:53 •    What are some challenges facing advocacy and empowerment? What do you do when your advocacy work is not being received or it is a struggle to speak up for someone?  18:40 •    Emphasizing the importance of communication in advocacy work. 24:00 •    Intro to Physicianary's part 3 on physician burnout and work-life balance. 24:16 •    Thanks for listening 25:00 Vineet Arora, MD, MAPP (NAM), is a Herbert T. Abelson professor of medicine, vice dean of education in the biological sciences division and dean for medical education at the University of Chicago Pritzker School of Medicine. She is also an elected member of the National Academy of Medicine. She is a founding member of the 501c3 Women of Impact and advisor to the Women in Medicine Summit. Jennifer Bepple, MD, MMCi, is a double board-certified physician in urology and informatics. She is a member of the American Telemedicine Association, American Urologic Association and American Medical Informatics Association and holds a certification from the American Board of Telehealth and the American Board of AI in Medicine. Hansa Bhargava, MD, is Healio's chief clinical strategy and innovation officer. Listen to her Healio podcast, Physicianary. Shikha Jain, MD, FACP, is a board-certified hematology and oncology physician. She is a tenured associate professor of medicine in the division of hematology and oncology, the director of communication strategies in medicine and the associate director of oncology communication & digital innovation at the University of Illinois Cancer Center in Chicago.  Mara Schenker, MD, FACS, FAOA, is an orthopedic trauma surgeon at Grady Memorial Hospital. She is double board certified in orthopedic surgery and clinical informatics. She serves as the chief of orthopedics and associate chief medical information officer.  She is an associate professor of orthopedics at Emory University School of Medicine. She serves on multiple boards for medical and digital technology advisory and sits on major national committees for the American Academy of Orthopaedic Surgeons, AAMC, American College of Surgeons and the Orthopaedic Trauma Association. Dagny Zhu, MD, is a cornea, cataract and refractive surgeon and medical director and partner at NVISION Eye Centers in Rowland Heights, CA. She can be reached on X @DZEyeMD. We'd love to hear from you! Send your comments/questions to Dr. Jain at oncologyoverdrive@healio.com. Follow Healio on X and LinkedIn: @HemOncToday and https://www.linkedin.com/company/hemonctoday/. Follow Dr. Jain on X: @ShikhaJainMD.  Disclosures: The hosts and guest report no relevant financial disclosures.

On this special edition episode, Dagny Zhu, MD, with Oncology Overdrive's Shikha Jain, MD, and Physicianary's Hansa Bhargava, MD, discuss leadership in medicine and the importance of mentorship with a panel of guests. Intro 0:28 Meet the panel 2:00 Vineet Arora, MD 2:12 Jennifer Bepple, MD 2:29 Mara Schenker, MD, FACS 2:55 In this episode 3:21 How did you become the leader that you are today? And what is your advice for young physicians who want to find themselves in your position one day? 3:27 Were you always “leadership material” or was it something you developed over time? 10:26 How has mentorship improved your outlook on your career? And what is your advice on finding a good mentor? 12:33 What are some quick, easy tips to finding a mentor? 23:07 Thanks 25:38 Join us for part two on Oncology Overdrive 25:41 Vineet Arora, MD, MAPP (NAM), is a Herbert T. Abelson professor of medicine, vice dean of education in the biological sciences division and dean for medical education at the University of Chicago Pritzker School of Medicine. She is also an elected member of the National Academy of Medicine. She is a founding member of the 501c3 Women of Impact and advisor to the Women in Medicine Summit. Jennifer Bepple, MD, MMCi, is a double board-certified physician in urology and informatics. She is a member of the American Telemedicine Association, American Urologic Association and American Medical Informatics Association and holds a certification from the American Board of Telehealth and the American Board of AI in Medicine. Hansa Bhargava, MD, is Healio's chief clinical strategy and innovation officer. Listen to her Healio podcast, Physicianary. Shikha Jain, MD, FACP, is a board-certified hematology and oncology physician. She is a tenured associate professor of medicine in the division of hematology and oncology, the director of communication strategies in medicine and the associate director of oncology communication & digital innovation at the University of Illinois Cancer Center in Chicago. Listen to her Healio podcast, Oncology Overdrive. Mara Schenker, MD, FACS, FAOA, is an orthopedic trauma surgeon at Grady Memorial Hospital. She is double board certified in orthopedic surgery and clinical informatics. She serves as the chief of orthopedics and associate chief medical information officer.  She is an associate professor of orthopedics at Emory University School of Medicine. She serves on multiple boards for medical and digital technology advisory and sits on major national committees for the American Academy of Orthopaedic Surgeons, AAMC, American College of Surgeons and the Orthopaedic Trauma Association. Dagny Zhu, MD, is a cornea, cataract and refractive surgeon and medical director and partner at NVISION Eye Centers in Rowland Heights, CA. She can be reached on X (formerly Twitter) @DZEyeMD. We'd love to hear from you! Send your comments/questions to podcast@healio.com. Follow us on Twitter @Healio_OSN. Disclosures: The hosts and guest report no relevant financial disclosures.

 In this episode, Dr. Wiegand focuses on the urethra for males and females and provides an understanding of intermittent catheterization of the bladder, associated with incomplete bladder emptying. He highlights the importance of patients remaining compliant with bladder emptying protocol. Dr. Wiegand discusses different treatment options for urinary retention including intermittent catheterization and surgical reconstruction of the urethra.  Guest bio: Dr. Luke Wiegand is a board-certified urologist with Orlando Health Medical Group Urology specializing in reconstructive urology. Sought after for second opinions and complex case referrals, he strives to communicate honestly and directly with his patients to help put them at ease and achieve their goal of returning to their normal lives.  Dr. Wiegand earned his medical degree and completed his urology residency at the University of South Florida Morsani College of Medicine in Tampa. He was chief resident in his final year. Dr. Wiegand performed his fellowship in reconstructive urology at Washington University in St. Louis, where he supervised residents in general urology and reconstructive urologic procedures. He serves as assistant editor of the Video Journal of Prosthetic Urology. He is the author of several medical textbook chapters and is a frequent contributor to peer-reviewed journals.  Dr. Wiegand is board-certified by the American Board of Urology. His professional memberships include the American Urologic Association, Florida Urological Society, and the Society of Genitourinary Reconstructive Surgeons.  Tags: ##bladder, #urology. #whydoineedtodrainmybladder, #whathappensifIskipcatheterization, #utiprevention, #compliancewithbladdercatheterizaion, #teachingcatheterization, #urinaryretention, #bladderemptying, #whyintermittentcatheterization,  

We are delighted to partner with Olympus America for this episode of the Prostate Health Podcast. Minimally invasive surgical therapies (MIST) have revolutionized treatment options for men suffering from symptoms of an enlarged prostate. So, we are excited to have urologist Dr. Rahul Mehan joining us today to bring our listeners up to speed on the iTind™ procedure. Dr. Mehan is a nationally recognized expert in minimally invasive urology treatments and the Founder of East Valley Urology Center in Mesa, Arizona. In his practice, he provides state-of-the-art urologic care, using the latest technology to improve the quality of life of his patients. He led several workshops at the national meeting of the American Urologic Association in San Antonio earlier this year and frequently gets invited to teach surgery across the US. He is also a social media influencer, providing enjoyable educational content. Stay tuned as Dr. Mehan shares the low-down on the iTind™ procedure, highlighting its safety and explaining how it provides rapid symptomatic relief while preserving the sexual function of men with enlarged prostates. Disclaimer: The Prostate Health Podcast is for informational purposes only. Nothing in this podcast should be construed as medical advice. By listening to the podcast, no physician-patient relationship has been formed. For more information and counseling, you must contact your personal physician or urologist with questions about your unique situation. Pertinent disclosure for today's episode – Dr. Mehan is a paid consultant for Olympus. The following are the opinions of Dr. Mehan based upon his education and personal experiences and are not those of Olympus.   Show Highlights: Explanation of what the iTind™ device is  Dr. Mehan was one of the first urologists to utilize the iTind™ technology in his region. How men have recently been taking a stance against medications with sexual side effects Which men are ideal iTind™ candidates? What are the risks associated with theiTind™ procedure? How the iTind™differs from other currently available MIST interventions  Expectations from the iTind™procedure  What recovery looks like after the iTind™ procedure, in terms of device removal, potential limitations, and symptomatic improvement Dr. Mehan shares some of the clinical pearls he gained from his iTind™ experience. Links:  Follow Dr. Pohlman on Twitter and Instagram - @gpohlmanmd  Get your free What To Expect Guide (or find the link on our podcast website)   Join our Facebook group  Follow Dr. Pohlman on Twitter and Instagram  Go to the Prostate Health Academy to sign up.  You can access Dr. Pohlman's free mini webinar, where he discusses his top three tips to promote men's prostate health, longevity, and quality of life here. Olympus America iTind™ East Valley Urology Center, Mesa, Arizona  

Episode summary: Dr. Wiegand joins us today with a closer look into the male urethra and lower urinary tract when there is a clinical need for intermittent catheterization. Incomplete bladder emptying associated with urinary retention in males presents a unique set of challenges, teaching opportunities, and potential complications. Dr. Wiegand shares his expertise on these topics and addresses the importance of compliance with an intermittent catheterization routine. Guest bio: Dr. Lucas Wiegand is a board-certified urologist with Orlando Health Medical Group Urology specializing in reconstructive urology. Sought after for second opinions and complex case referrals, he strives to communicate honestly and directly with his patients to help put them at ease and achieve their goal of returning to their normal lives. Dr. Wiegand earned his medical degree and completed his urology residency at the University of South Florida Morsani College of Medicine in Tampa. He was chief resident in his final year. Dr. Wiegand performed his fellowship in reconstructive urology at Washington University in St. Louis, where he supervised residents in general urology and reconstructive urologic procedures. He serves as assistant editor of the Video Journal of Prosthetic Urology. He is the author of several medical textbook chapters and is a frequent contributor to peer-reviewed journals. Dr. Wiegand is board-certified by the American Board of Urology. His professional memberships include the American Urologic Association, Florida Urological Society, and the Society of Genitourinary Reconstructive Surgeons. Visit  Coloplastprofessional for more offerings!  

  Dr. Wiegand joins us today to share one of his goals as a urologist; restoring and/or creating natural urinary habits for his patients, while keeping the urinary tract healthy. In this episode, Dr. Wiegand spends time discussing urinary retention, incomplete bladder emptying, mechanical as well as surgical options, and the importance of patient compliance. Dr. Wiegand also provides tools for instructing patients on intermittent catheterization for complete bladder emptying.Guest bio: Dr. Lucas Wiegand is a board-certified urologist with Orlando Health Medical Group Urology specializing in reconstructive urology. Sought after for second opinions and complex case referrals, he strives to communicate honestly and directly with his patients to help put them at ease and achieve their goal of returning to their normal lives.  Dr. Wiegand earned his medical degree and completed his urology residency at the University of South Florida Morsani College of Medicine in Tampa. He was chief resident his final year. Dr. Wiegand performed his fellowship in reconstructive urology at Washington University in St. Louis, where he supervised residents in general urology and reconstructive urologic procedures. He serves as assistant editor of the Video Journal of Prosthetic Urology. He is the author of several medical textbook chapters and is a frequent contributor to peer-reviewed journals.  Dr. Wiegand is board-certified by the American Board of Urology. His professional memberships include the American Urologic Association, Florida Urological Society, and the Society of Genitourinary Reconstructive Surgeons. Visit  Coloplastprofessional for more offerings!  

Dr. Michelle Weeks is the founder of Weeks Wellness. She initially began her career in orthopedics focused on treating musculoskeletal and chronic pain conditions, but developed a strong interest in pelvic health, postpartum, and pregnancy physical therapy. She believes in a whole-body treatment approach and is passionate about helping people reach their optimal level of function. Her treatment philosophy balances proven manual therapy techniques with therapeutic exercise prescriptions individually designed for each patient to achieve their goals.   Dr. Weeks has gone through the CAPP-Pelvic program through the APTA and became a Board-Certified Women's Health Clinical Specialist, one of about 500 in the country. Dr. Weeks has also received certification in dry needling through Master Dry Needling. and has obtained advanced training in the areas of visceral and neural manipulation through the Barral Institute, myofascial release, taping, pregnancy, and postpartum through the Institute for Birth Healing, Male Pelvic Pain with Gerard Greene, McKenzie assessment and management of spine and joint conditions and gynecological visceral mobilization. Through continuing education, she continuously advances her skills. She enjoys spending time with her family traveling, hiking, biking, running, and enjoying the great outdoors.   Dr. Michelle Weeks earned her Doctorate of Physical Therapy from Creighton University and her Bachelor of Science in Nutrition from Pennsylvania State University. Show Notes: 4:33 - how nutrition fits into physical therapy and pain perception 8:11 - visceral manipulation for organ restrictions 13:55 - body's ability to heal through homeostasis 14:53 - everything is connected 15:57 - the American Urologic Association, physical therapy to treat interstitial cystitis 17:25 - calming the nervous system with vagal nerve stimulation 19:11 - food sensitivity testing, the MRT for highly sensitive people (HSPs) 22:34 - C-section and hernia repair physical  therapy 25:59 - scar tissue in the abdomen, mobility 27:00 - dry needling and the autonomic nervous system 30:58 - foreign body reactions - triggers for autoimmune cascade 33:06 - need for more collaboration between surgeons and therapists 35:09 - trauma stored in tissue 36:30 - organ shifts with postural changes and protective stances Contact Information https://www.weekswellness.com/ IG @WeeksWellness FB @WeeksWellness Linktr.ee - Pelvic Floor Physical Therapy | Instagram, Facebook | Linktree --- Send in a voice message: https://podcasters.spotify.com/pod/show/functionallyenlightened/message

We are excited to share the highly anticipated second part of our riveting technology highlights podcast series, broadcasting straight from the heart of the annual American Urologic Association meeting in Chicago, Illinois! The world of BPH treatment options is booming with innovation! Get ready for an exclusive sneak peek into several upcoming technologies Dr. Pohlman discovered while scouring the exhibition hall at the American Urologic Association annual meeting.  This week, we focus on the incredible advancements in BPH technology and share insightful interviews with representatives from pioneering companies and urologists utilizing these cutting-edge tools. While we will only scratch the surface of the fan favorites at this year's conference, you can rest assured we will keep you up to speed on other ground-breaking technologies throughout the year! Get ready to stay ahead of the curve on our podcast journey! In this episode, we dive into the intriguing world of cutting-edge solutions for an enlarged prostate, known as benign prostatic hyperplasia or BPH. Prepare yourself for an exclusive glimpse behind the scenes as we uncover the latest advancements that will revolutionize prostate management. Whether you are concerned about your own health or that of a loved one, this is an episode you cannot afford to miss! Join us as we unlock the mysteries of prostate health and equip you with the knowledge to navigate this crucial aspect of well-being! Disclaimer: The Prostate Health Podcast is for informational purposes only. Nothing in this podcast should be construed as medical advice. By listening to the podcast, no physician-patient relationship has been formed. For more information and counseling, you must contact your personal physician or urologist with questions about your unique situation. Show highlights: Dr. Pohlman is already utilizing Optilume BPH for managing urethral strictures in his practice. He explains how it works. Dr. Pohlman talks with Ian Schorn, Vice President of Clinical Affairs at Urotronic, about using Optilume for managing BPH. Ian Schorn explains something unique about Optilume BPH. The clinical data on the Optilume device has shown very good outcomes in terms of flow rate improvement after treatment. Urotronic hopes to get official FDA approval within the next few months for its Optilume technology. Dr. Pohlman shares the secret to the successful results of Optilume. Dr. Pohlman describes the new stent devices now emerging for BPH and explains which ones will most likely rise to the top, in terms of outcomes and urologist preference. Dr. Pohlman talks to the CEO of Butterfly Medical, Idan Geva, about their new technology for BPH. How does Butterfly Medical's new nitinol implant compare with other available technologies? What is Aquablation therapy?  Dr. Lewis Kriteman, from Georgia Urology, discusses the benefits of Aquablation therapy and explains how it compares with the procedures he used before. Dr. Pohlman was the first urologist in the Seven State Region, including Nebraska, Kansas, Iowa, Missouri, Montana, Wyoming, and Colorado, to offer Aquablation. It is encouraging and exciting to see the continuous advancements in technology and techniques for managing BPH! Today's tantalizing glimpse into emerging technologies at the AUA annual meeting is just the beginning. We will delve even deeper into these breakthroughs in future episodes.  Stay connected by subscribing to our podcast to ensure you are always in the loop, and get ready for a journey of knowledge and discovery as we explore the forefront of BPH management! Links:  Follow Dr. Pohlman on Twitter and Instagram - @gpohlmanmd  Get your free What To Expect Guide (or find the link on our podcast website)   Join our Facebook group  Follow Dr. Pohlman on Twitter and Instagram  Go to the Prostate Health Academy to sign up.  You can access Dr. Pohlman's free mini webinar, where he discusses his top three tips to promote men's prostate health, longevity, and quality of life here. Urotronic  Butterfly Medical Georgia Urology

I went to the 2023 American Urologic Association's National Conference. Here are some top takeaways and thoughts.

One challenge in developing treatments for rare diseases is finding enough people with the condition to mount valid clinical trials.  Databases that contain diagnostic codes for specific conditions can help, but those miss people who may have the condition but have yet to be conclusively diagnosed.  That's where Verana Health comes in, a digital health company that uses AI to mine its data network of more than 20,000 healthcare providers and the clinic notes they make about patient encounters. “If you wanted to find somebody with a specific genetic defect, or a specific condition for which a diagnostic code doesn't even exist, clinic notes represent really the only place you could discover that information,” explains Dr. Michael Mbagwu, an ophthalmologist and Verana's Senior Medical Director. Verana partners with the American Academy of Ophthalmology, the American Academy of Neurology and the American Urologic Association to manage their clinical registries which were built to improve quality of care, answer research questions and help physicians report quality metrics. Join host Michael Carrese for an exploration of the ways medicine is being changed by the ever-growing amount of data available and the new technologies which allow clinicians and others to analyze and use all of that information. “Some of the things that we just assumed were never possible or were kind of hopeless endeavors are now possible for the first time thanks to AI.” Mentioned in this episode: https://www.veranahealth.com/

We first learned of Dr. Aaron Spitz from The Game Changers film. In his book, aptly named The Penis Book, Dr. Spitz states that the most common reason for erectile dysfunction is a problem with blood flow to the penis due to narrowing of the arteries. In my conversation with Dr. Spitz, we discuss the causes and what you can do to prevent and even reverse erectile dysfunction by improving penis health. Aaron Spitz, MD: Dr. Spitz earned his medical degree from Cornell Medical College, completed his Urology residency at the University of Southern California, and then obtained fellowship training in infertility at the Baylor College of Medicine. Dr. Spitz has expertise in treating male infertility and sexual dysfunction and is actively engaged in clinical trials and research in andrology, male sexual dysfunction, and male infertility. Dr. Aaron Spitz served as an assistant clinical professor in the U.C. Irvine department of Urology, specializing in male reproductive medicine and surgery.    Dr. Spitz directs the Male Reproductive Medicine and Surgery Center at Orange County Urology in Laguna Hills and Mission Viejo, California.  Dr. Spitz is the co-Chair of the AUA Telemedicine task force.  He also serves on the AUA Workforce Work Group, the AUA Advanced Practice Practitioner Work Group, and the AUA opioid position statement workgroup. He served as the lead delegate to the American Medical Association House of Delegates, representing the American Urologic Association. He has served as the President of the California Urologic Association. He is the Orange County District representative to the Western Section of the American Urologic Association. Dr. Spitz served on the Board of Directors as Vice President of Finance for the Pacific Coast Reproductive Society. Dr. Spitz also served as treasurer for the Society for the Study of Male Reproduction.   Dr. Spitz has been awarded several prestigious honors, including Alpha Omega Alpha at the University of Southern California and the Distinguishes Service Award from the American Urological Association.  Dr. Spitz is the author of The Penis Book: A Doctor's Complete Guide to the Penis, published by Rodale Books, from size to function. He appears regularly on CBS The Doctors to discuss urology topics. He was also featured in the documentary The Game Changers. He has authored book chapters and articles in peer-reviewed publications on the topic of male infertility and sexual dysfunction as well as on Telemedicine. Dr. Spitz is a member of the AUA, AMA, SSMR, SMRU, ASRM. He serves as a reviewer for the Journal of Endourology, The Journal of Urology, and the Journal of Andrology and Urology Practice.  (https://www.aaronspitz.com/) Music Credit: Woho, I Thought It Be Me & You (ft. Lily Hain) by Leonell Cassio https://soundcloud.com/leonellcassio Creative Commons — Attribution-ShareAlike 3.0 Unported — CC BY-SA 3.0

Have you or your spouse been diagnosed with male factor infertility? In this episode with Dr. Barrett Cowan and Dr. Natan Bar-Chama you will gain a better understanding of male infertility, causes, and what options are available to diagnose and treat it. Dr. Cowan, is co-founder of Posterity Health. A comprehensive digital male fertility management platform designed to help assess, evaluate, and treat male fertility. The company seeks to educate, engage, and treat men, shifting the burden of conceiving from solely the woman and creating a unifying experience for the couple.On Monday, March 14th, Posterity Health launched a new nationwide initiative called Project AIM (Access to care - Inclusion of the Male partner). Project AIM provides men with at-home testing and access to male fertility specialists through leading OB/GYN's across the country, beginning with RMA of New York, widely acknowledged as a national and international leader in state-of-the-art reproductive medicine.Project AIM's benefits include:Supporting the couple through their journey to parenthood by promoting the coordinated evaluation of both partiesExploring the root cause of male infertility and possibly detecting underlying men's health conditions Embracing the LGBTQIA+ community with inclusive family building servicesNew Yorkers looking to conceive will have the opportunity better navigate a fertility journey together through a new initiative called Project AIMDr. Cowan is the Co-founder and Chief Medical Officer of Posterity Health. He has specialized in treating men with infertility for over 20 years. He received his medical degree with honors and completed his urology residency and fellowship at Stanford University School of Medicine. He remains committed to helping couples who struggle with infertility issues. He has published multiple scientific articles and authored a chapter on a commonly read fertility book. He is a member of the American Urologic Association, American Society for Reproductive Medicine, the Society for the Study of Male Reproduction, and the Society for Male Reproduction and UrologyDr. Bar-Chama is the Director of the Center of Male Reproductive Health at RMA of New York, is a board-certified Urologist and Male Infertility Specialist. Following his urology residency at the Albert Einstein College of Medicine, he was awarded the New York Academy of Medicine F.C. Valentine Fellowship and sub-specialized in Male Reproductive Medicine and Surgery at The Baylor College of Medicine in Houston, Texas. For the last 20 years, Dr. Bar-Chama has been the Director of Male Reproductive Medicine and Surgery and is on faculty in both the Departments of Urology and Obstetrics/Gynecology and Reproductive Science at The Icahn School of Medicine at Mount Sinai. Dr. Bar-Chama's practice is exclusively dedicated to the fields of male infertility and sexual medicine, and he has published extensively and lectured throughout the world in these areas. He is currently on the Board of Directors and slated to be President of the Society for Male Reproduction and Urology (SMRU), is past president of the Society for the Study of Male Reproduction (SSMR) and serves on the board of directors of the patient advocacy organization.Grab your (in)fertility Awareness & Advocacy products-Use Code: IAM15 for a discount on your next purchase. https://www.infertiletees.comSupport the show and join on Patreon to get private community and early AD-free episodes.Support this podcast at — https://redcircle.com/infertility-and-me/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

The Doctor Dads sit down with Dr. Judson Brandeis to talk about Men's health. The 21st Century Man is a man's guide to address our health issues as we move through life's journey. Learn from 50 board-certified physicians who are experts in cardiology, oncology and cancer genetics, vascular health, urology, orthopedics, chiropractic, pain medicine, infectious disease, podiatry, hand surgery, and sleep, as well as experts in the emerging fields of sexual health and rejuvenation medicine. Judson Brandeis, MD, is a board-certified urologist who currently practices men's health and sexual medicine in Northern California. Dr. Brandeis attended Brown University, Vanderbilt Medical School, and received a Howard Hughes Medical Institute Research Award for his year of transplantation immunology research at Harvard Medical School. He completed two years of general surgical training and four years of urology residency at UCLA Medical Center and served as Chief of Urology at John Muir Hospital and at Hill Physicians from 2012 to 2018. Dr. Brandeis has been a pioneer in surgical robotics, Greenlight Laser, and MRI prostate biopsy. At BrandeisMD, he performs clinical research using shockwave therapy, platelet-rich plasma, high-intensity focused electromagnetic waves, microvascular ultrasound, and nutritional supplements for conditions such as sexual dysfunction and Peyronie's disease. Dr. Brandeis is on the Board of Advisors for BioTE, GAINSWave, and BTL. He is the CEO of AFFIRM Science, which creates nutritional supplements based on current scientific data, formulating products that include AFFIRM, PreLONG, SupporT, and SPUNK. Dr. Brandeis is a member in good standing of the American Urologic Association, the Sexual Medicine Society of North America, and the International Society of Sexual Medicine. He has been voted Top Urologist in the Bay Area by San Francisco Magazine for eight consecutive years, 2014 to 2021, and has appeared on The Doctors TV show and numerous pod- casts, including Ben Greenfield Fitness and Dr. Drew. BrandeisMD.com, www.AFFIRMScience.com FIND THE BOOK AT thetwentyfirstcenturyman.com

Dr. Jennifer Bepple is a board-certified general urologist. She is passionate about improving access to high quality care and develops patient-centered digital health solutions to bridge the gap between technology and healthcare. Jennifer's expertise in digital health includes the development of a national telehealth program and virtual specialty clinics. Her combined clinical and technical background make her ideal for scaling digital health solutions. Jennifer completed medical school and residency training at the Eastern Virginia Medical School and was in private practice until 2021. She is now pursuing a Master of Management in Clinical Informatics from Duke University and is in the inaugural class of telehealth fellows with Doximity. Jennifer is also consulting in real world evidence and other digital health efforts. She is a member of the American Telemedicine Association, American Urologic Association, and American Medical Informatics Association. She has presented nationally on her digital health efforts and holds a certification from the American Board of Telehealth. She is an advocate for improving special education and enjoys taking family adventures with her three children and husband. You can reach Dr Bepple at https://www.linkedin.com/in/jennifer-bepple-md/ An offer from Doximity "Thank you for listening to my feature on the podcast this week! As mentioned during our talk, all listeners can get a 1-year free trial of Doximity Dialer Pro. Simply fill out this form, and the Doximity team will send an access code. Feel free to reach out to me with any questions. Doximity Dialer Pro Benefits: Custom CallerID HIPAA Compliant Unlimited call minutes One-click video call For additional information on Dialer Pro, click here!" --------------------------------------------------- About FPE If you are a women physician, join us at Female Physician Entrepreneurs Group We learn and grow together https://www.facebook.com/groups/FemalePhysicianEntrepreneurs Our website-sign up for free resources https://FPEStrong.com

Dr. Jennifer Bepple is a board-certified general urologist. She is passionate about improving access to high quality care and develops patient-centered digital health solutions to bridge the gap between technology and healthcare. Jennifer's expertise in digital health includes the development of a national telehealth program and virtual specialty clinics. Her combined clinical and technical background make her ideal for scaling digital health solutions. Jennifer completed medical school and residency training at the Eastern Virginia Medical School and was in private practice until 2021. She is now pursuing a Master of Management in Clinical Informatics from Duke University and is in the inaugural class of telehealth fellows with Doximity. Jennifer is also consulting in real world evidence and other digital health efforts. She is a member of the American Telemedicine Association, American Urologic Association, and American Medical Informatics Association. She has presented nationally on her digital health efforts and holds a certification from the American Board of Telehealth. She is an advocate for improving special education and enjoys taking family adventures with her three children and husband. You can reach Dr Bepple at https://www.linkedin.com/in/jennifer-bepple-md/ An offer from Doximity "Thank you for listening to my feature on the podcast this week! As mentioned during our talk, all listeners can get a 1-year free trial of Doximity Dialer Pro. Simply fill out this form, and the Doximity team will send an access code. Feel free to reach out to me with any questions. Doximity Dialer Pro Benefits: Custom CallerID HIPAA Compliant Unlimited call minutes One-click video call For additional information on Dialer Pro, click here!" --------------------------------------------------- About FPE If you are a women physician, join us at Female Physician Entrepreneurs Group We learn and grow together https://www.facebook.com/groups/FemalePhysicianEntrepreneurs Our website-sign up for free resources https://FPEStrong.com

Healthcare is one of those areas where more data is almost always better. And I talk a lot on the show about how data is helping doctors and patients make smarter decisions. But a lot of the data we'd still like to have is stuck in those arcane Electronic Health Record systems or EHRs that medical practices or hospital systems use to track their patients. These systems tend to be closed, proprietary, user-unfriendly, and incompatible with one another. And we've repeatedly made the case here on the show that EHR technology is holding back innovation across the healthcare market.That's why we like to meet companies that are working to make EHR data more useful. And in this episode we welcome a pair of guests from a company called Verana Health that's trying to do just that. The company recently brought in $150 million in new venture capital funding to help scale up its data services, which currently focus on the subspecialties of ophthalmology, neurology, and urology. Verana takes data on patients in these fields, cleans it up, analyzes it, and pulls out insights that could be useful—both for clinicians who want to increase the quality of the care they're providing, and for pharmaceutical companies who need new ways to measure the effectiveness of their drugs and better ways  to find patients for clinical trials. Here to explain more about all of that are Verana's CEO, Sujay Jadhav, as well as its senior vice president of clinical and scientific solutions, Shrujal Baxi. (If you're a longtime listener you might remember that we had Shrujal on the show once before, back in 2018, when she talked about her previous company Flatiron Health.) Please rate and review The Harry Glorikian Show on Apple Podcasts! Here's how to do that from an iPhone, iPad, or iPod touch:1. Open the Podcasts app on your iPhone, iPad, or Mac. 2. Navigate to The Harry Glorikian Show podcast. You can find it by searching for it or selecting it from your library. Just note that you'll have to go to the series page which shows all the episodes, not just the page for a single episode.3. Scroll down to find the subhead titled "Ratings & Reviews."4. Under one of the highlighted reviews, select "Write a Review."5. Next, select a star rating at the top — you have the option of choosing between one and five stars. 6. Using the text box at the top, write a title for your review. Then, in the lower text box, write your review. Your review can be up to 300 words long.7. Once you've finished, select "Send" or "Save" in the top-right corner. 8. If you've never left a podcast review before, enter a nickname. Your nickname will be displayed next to any reviews you leave from here on out. 9. After selecting a nickname, tap OK. Your review may not be immediately visible.That's it! Thanks so much.TranscriptHarry Glorikian: Hello. I'm Harry Glorikian. Welcome to The Harry Glorikian Show, the interview podcast that explores how technology is changing everything we know about healthcare.Artificial intelligence. Big data. Predictive analytics. In fields like these, breakthroughs are happening way faster than most people realize. If you want to be proactive about your own health and the health of your loved ones, you'll need to learn everything you can about how medicine is changing and how you can take advantage of all the new options.Explaining this approaching world is the mission of my new book, The Future You. And it's also our theme here on the show, where we bring you conversations with the innovators, caregivers, and patient advocates who are transforming the healthcare system and working to push it in positive directions.Healthcare is one of those areas where more data is almost always better. And I talk a lot on the show about how data is helping doctors and patients make smarter decisions.But a lot of the data we'd still like to have is stuck in those arcane Electronic Health Record systems or EHRs that medical practices or hospital systems use to track their patients.These systems tend to be closed, proprietary, user-unfriendly, and incompatible with one another.And I haven't been shy here on the show about my opinion that the chaotic state of EHR technology is holding back innovation across the healthcare market.That's why I'm always interested in talking  with companies that are working to make EHR data more useful.And today I have a pair of guests from a company called Verana Health that's trying to do just that.The company recently brought in $150 million in new venture capital funding to help scale up its data services, which currently focus on the subspecialties of ophthalmology, neurology, and urology. Verana takes data on patients in these fields, cleans it up, analyzes it, and pulls out insights that could be useful—both for clinicians who want to increase the quality of the care they're providing, and for pharmaceutical companies who need new ways to measure the effectiveness of their drugs and better ways  to find patients for clinical trials.Here to explain more about all of that are Verana's CEO, Sujay Jadhav, as well as its senior vice president of clinical and scientific solutions, Shrujal Baxi.If you're a longtime listener you might remember that we had Shrujal on the show once before, back in 2018, when she talked about her previous company Flatiron Health. We're glad to welcome her back.Now, on to the show.Harry Glorikian: Sujay, welcome to the show, and Shrujal, welcome back to the show, now that you're at a different place. It's great to have you both here.Sujay Jadhav: Thanks, Harry.Shrujal Baxi: Happy to be here.Sujay Jadhav: Happy to be here as well. Thanks.Harry Glorikian: So. I want, you know, I want to ask you guys like if one or both of you can describe Verana's reason for existing, at least at a high level, and what is the unmet need in in the world of patient care or drug development that you are meeting?Sujay Jadhav: Yeah, yeah. Happy to jump in and Shrujal, you can sort of add in sort of the health care sort of goals that we have as well, but you know, in essence, what Verana is all about, we have an exclusive real-world data network focused on three therapeutic areas: ophthalmology and neurology and urology. And in essence, what we are doing is we're helping provide insights to providers in helping improve quality of care, helping improve their participation in clinical trials and also provide insights to life sciences companies across the drug lifecycle all the way from study design helping out in trial recruitment to helping them out in launching drugs, commercializing drugs so they can overall improve the quality of care in a more holistic fashion. You know, the crux of how we're going about doing it, in essence, is accessing HER data and eventually identifying it to provide these particular insights and high level there's data which is very, very structured and there's data which is unstructured and there's a sort of an increased focus on the unstructured data because I would say that's probably where there is the largest opportunity out there to provide insights across that overall value chain.Harry Glorikian: Yeah, I know I know the area well, but I want to sort of spend a moment on the origin story of of Verana Health, and I'm assuming it has something to do with the relationship between Verana and the American Academy of Ophthalmology, since I think the Academy's CEO David Parke is also a co-founder and executive chairman on Verana. You also have partnerships with the American Academy of Neurology and the American Urological Society. So it seems like these. And it's funny because I think of these associations as publishing journals or, you know, organizing conferences or maybe, you know, having representation in Washington. But it seems like you guys were a spinoff or a piece that came out of at least the American Academy of Ophthalmology. Is that correct?Sujay Jadhav: Yeah, you're absolutely correct. I mean, really, Verana was founded on, you know, sort of the ophthalmology registry, in essence. And, you know, the ophthalmology registry, is probably one of the leading registries in terms of the way that well, first of all, participation, you know, from the specialists, I think it's close to 70 percent of ophthalmologists are part of the registry, but they're one of the leaders in terms of taking the actual data from the ophthalmologists. And they were actually processing that particular data via third party out there to help provide insights, you know, to predominantly the ophthalmologists out there, but eventually to provide insights to help further research. And so Verana was really founded on sort of the ophthalmology registry. They decided to spin out that capability as an independent company, then bring in some external investors, sort of investors, which are very committed to digital health. Brooke Byers from Kleiner Perkins. Google Ventures. And they funded the separate entity. And then ultimately, the goal was to take that data capability that they have and then help normalize it and provide more insights around it to further the overall drug lifecycle. And then, you know, along the way, you know, other societies saw the progress that were making and decided to also partner with Verana, starting with the neurology society and then urology as well.Harry Glorikian: Now, you know, just so like for the listeners, if and you guys can correct me if I'm wrong, but I think like and because I like to give credit where credit is due, right is a lot of these, you know, medical associations began to gather a lot more data and build some giant databases. But I think that was driven by the, you know, CMS or, you know, Centers for Medicare and Medicaid Services sort of setting up this merit based incentive payment system and sort of driving this. So it's sort of like I always like to give government credit when they actually do something right, but they actually put some money behind this to encourage this sort of activity, which has resulted in this sort of dataset that's now available for us to really glean some insights for patients.Shrujal Baxi: I mean, I think I think when we when we look back sort of the development of the electronic health record is what set this off. And that was also a government initiative right to really move us all from paper charts and to electronic health records. And then sort of the potential that comes from that. If we think about the brilliance of these registries, they were smart enough to start collecting the data early on and sort of answering your first two questions from a medical perspective, like what is Verana here to do? We're here to help transform that data that's available in the electronic health record, sort of generated as part of regular care, and get all of the insights we can in health care, the way that data is generating insights and every other industry out there. But there is a particular sensitivity in health care to de-identification, making sure we're taking care and responsibility of that process, which makes sort of what Verana is doing a little bit different than what might be happening out there. But when you when you think about why there's so much excitement around what we're doing, it's that we're actually going to do it from a technological standpoint. So the scale at which we're hoping to do it should drive insights like we haven't been able to do with sort of the first pass at getting value from the EHR, if that makes sense.Harry Glorikian: Oh yeah. I mean, if you've listened to many of my shows, I have a big pet peeve with the normal EHR system. I mean, I've gone so far to say, you know, if anything breaks health care because of its inability to change, it's this arcane accounting system that got morphed into, you know, quote, we're going to manage patients. But you know, you mentioned from a physician's perspective, what kind of data do these databases that you have access to contain that's important or valuable for, you know, assessing quality of care, let's say?Shrujal Baxi: It really, it spans the gamut, right? Because data is just that. It's what we do is we provide, we transform it into a structured format that can be analyzed. But what you use it for is really it's limitless, right? Do we want to look at how to optimize how patients are seen? Who sees those patients? How do we get them into a clinical trial? How do we get a trial set up at a practicing site that happens to be seeing a lot of patients of a particular disease subtype? Are we starting to pick up patterns in how new medications are released into routine care that have been tried in clinical trials? Can we pick up safety signals in the real world that you can never capture when you only have a small clinical trial of 200 patients? But when you launch that drug at a larger cohort, what is actually happening in the real world? All of that is possible once you figure out how to transform all the information that's entered into the EHR into analyzing all formats. And so, you know, it's interesting, because Sujay gave all the real use cases, but in my mind, what we're doing is the technology, which is how are we going to do this in a sort of scalable way? So as the data is coming in, we can take it and output structured data that can then be used for analysis. And the better we get at that transformation step, the faster and the more reliable that is that really sort of unlocks what we can do with the data.Harry Glorikian: Yeah, it's funny. Yeah, it's funny. You're covering, like, I don't know, half a dozen podcasts I think I've done with various companies that are doing different parts of this. But I mean, I've looked at the company's literature and you put a lot of emphasis on what's called real-world data. And this is a topic, you know, I've covered on the show many times. You know, last year, late last year, I did an interview with Jeff Elton from Concert AI, where they collect post-approval data and help improve decision-making inside drug companies. So I want to ask you first, what do the folks at Verana have in mind when they talk about real world data? Does it basically mean any data collected outside of the context of a clinical trial?Sujay Jadhav: I know the real world data terminology has different types of descriptions, but fundamentally we look at it, generally any observational data, you know, is sort of what we categorize as real world data, and what we are focused on from a high level perspective. And you know what we see within the EHR, you know, there's a lot of that data available there. And in essence what we are doing is accessing it, extracting it, normalizing it, and then providing different levels of insights depending on the different types of use cases, which are important to improve the quality of care at the provider level there, and also help further research and within the life sciences arena as well. So, you know, that's high level the way we look at it. You know, one of the things, you know, in order to finish up sort of or complete the overall patient journey and have a holistic perspective, we need to also match that up with other types of data there. And so, you know, claims data, for example, at times there are longitudinal elements to it as well. So we spent a lot of effort and work doing matching there, you know, as well. You know, we're bringing in other types of data forms of imaging data and as well.Sujay Jadhav: So while we are very focused on the data there, we are actively complementing it with other types of data sources to get a more holistic picture there. But you know, I would say that a lot of companies out there have been doing a really good job of accessing this data from a more structured format perspective, right? And one of the things that I've seen, and this is more of a high level comment, is when you look at some of the structured data that can be an element of sort of extra latency in terms of getting that information to make certain decisions or decisions such as hey, for a particular clinical trial, what are the right patients that you should target, et cetera. And so what we are really focused on is the unstructured data, you know, the physician notes, and then leveraging sort of AI techniques there to provide those signals. So that allows us to, on a close to real-time basis, target particularly particular patients, which could be a better fit for a particular trial versus historical means, which have been a little bit more sort of delayed in terms of getting those data inputs.Harry Glorikian: So, you know, this begs the question before we jump into the product itself is. Do you guys have an opinion on why the medical establishment has not been so great at tracking or analyzing real world data up till now? I doubt it's lack of interest. It's probably more like technical limitations is my guess or maybe lack of interoperability, or all of the above.Shrujal Baxi: Harry, since the last time I was here, a lot has happened in the real-world data space. To start with, and I think we talked about this last time, which is real-world data has been here forever, right? Clinicians have been doing chart reviews and publishing case series. That's all real-world data. It's taking a look at what happens in the routine care of patients, pulling it out and analyzing it in order to deliver insights. I think what the electronic health record did or what we believed it would do is allow us to do that type of work at a scale that we couldn't do it before. The second thing, I think, that real-world data is now considered potentially useful for that it wasn't previously, is causation and the analytic ability to actually make linkage between input and output in a way that isn't just hypothesis generating. And the regulators are really sort of driving the space with the guidances that are coming out and really framing for companies like ours, how we should be thinking about data and the data quality and sort of where this data could be used.Shrujal Baxi: So there's sort of two parts, right? One is how do we generate it in real time at scale so that we can understand important questions? And then the other is the part that I think really sort of leaned in on, which is the entirety of a patient's journey. And this is a very patient-centric problem. It isn't captured in a single EHR. So how do we bring together all the different components of a patient's journey such that we get the complete picture, the genetics, the imaging, the multiple different providers, the claims for what was paid for, right? And so it's kind of an exciting time in the sense that we've sort of gotten to second base. Maybe we figured out how to get all the data. Now we're figuring out how to transform the data. Now we're going to figure out how to link the data. In the meantime, in parallel, we're figuring out how to analyze observational data. And a company like Verana is really well poised to do those things because of all the different components and the partners that we have to do that, I think.Sujay Jadhav: Yeah. And I'll just add to what Shrujal said there. And I think it's sort of inherent in your question around the technology was, has the technology been there before, et cetera? I think to some extent it has, but it has been evolving and obviously in the last decade with sort of AI techniques, natural language processing techniques, they've started to mature and kind of scale. But one of the key things around our industry is patient privacy, right? And so we have the technology and it's been leveraging a lot of other different industries. But the stakes are very, very high here because of protecting patient data overall. And so, you know, working through how can you access this data at scale and ensure and make sure that you're adhering to the patient's privacy? There has taken a little bit longer to do, but now we have it. Currently, right now, we have a lot of techniques on the de-identified data identified realm where we can now leverage that to address that particular point. And I think, you know, it's an exciting time right now. You know, which is we now have the tools to do this at scale, but ensure that we're keeping patient privacy intact as well.Shrujal Baxi: But we also have a responsibility on the end of that spectrum, which is we have to have high quality data. So we need to protect the patient's privacy. We need to be very responsible with the data, but we also have to be very responsible for how the data is generated, such that we don't end up with conclusions that are harmful. The integrity of the data throughout that process needs to be maintained because people are going to act on the output of our analysis using the data that we're generating. And so that's an incredible responsibility that I think we take on and sort of critical to how we think about what we do. It's not just data, it's data that's generated to make decisions in health care that impacts patients very directly.Harry Glorikian: Yeah, absolutely. So, you know, I think this is a maybe a good segue or opportunity. What have you guys actually built? Because we've been talking around it. What is, I think it's called the VeraQ health data engine, if I got it right? Tell me a little bit about the product. And you mentioned natural language processing and machine learning, and so how does that fit, at what point and where does it fit? And I'm sure there's a few people who are going to like listen closely at this part because they're interested in this stuff. Some others may not listen as closely. But if you could tell me a little bit about the product, that would be great for everybody listening.Sujay Jadhav: Sure. Sure, absolutely. So, you know, in essence, what we have is we do have a real-world data network where we access 20,000 providers. We have 90 million de-identified patients currently, and it's growing at a good clip right now. And what we do is we take that data, we ingest the data, we normalize it and curate it to provide insights to providers to improve quality and participate in trials and then also to the life sciences community as well to help further research. Broadly speaking, there, you know, sort of our technology platform is called VeraQ. We released it last year, in essence, it's sort of the secret sauce around ingesting it and normalizing and curating the data. And then once we do that, then what we do is we deliver it in what we call de-identified data modules called Qdata modules, which are aligned according to the therapeutic areas in certain disease states. And so what we do is within each of the three therapeutic areas we release on a quarterly basis different disease modules, Qdata modules there. And then that helps serve out, you know, a lot of insights that life sciences companies can use across different areas. So anything from a helping out in trial design work with a lot of large pharma companies around helping improve sort of how they target particular patients out there by leveraging these de-identified data modules to helping out on recruitment as well. In terms of working through what are the right providers that you're targeting to have that patient population trial to eventually see when you actually launch the drug, you know how the use is occurring out there in the marketplace, how they can better target it to improve the value of the particular drug they have there as well. And, you know, we eventually set that up instead of application modules across that overall drug lifecycle. So, you know, to summarize, our platform is VeraQ. We then serve it up in these Qdata modules and then we deliver it in these solution sets, which are provider facing and also life sciences space.Shrujal Baxi: I was going to say something that's really unique about Verana and shouldn't be glossed over is the fact that so many different EHRs are out there and they're they're created differently and they are so specialized to the provider with bells and whistles that each different practice pays for. And to take all of that disparate information and ingest it and harmonize it such that the output or variables that can be generated at a scalable fashion across millions of charts and then use that for analysis. I mean, GE made it sound really good and clean, but that's actually a that's a lot of work for anyone who's ever touched an EHR and try to get value out of the data that's entered. It's a feat. And I think that that that engine now that it's built, is sort of poised to take in and give out, right? That was the infrastructure build that was 2021. And 2022 is the data that's going to come out as he was describing. But I just want to, I'm particularly passionate about this because I've worked now at different companies that think about this and that particular part of harmonization from the starting point that are so many different places is really, I think, a technological advancement.[musical interlude]Harry Glorikian: Let's pause the conversation for a minute to talk about one small but important thing you can do, to help keep the podcast going. And that's leave a rating and a review for the show on Apple Podcasts.All you have to do is open the Apple Podcasts app on your smartphone, search for The Harry Glorikian Show, and scroll down to the Ratings & Reviews section. Tap the stars to rate the show, and then tap the link that says Write a Review to leave your comments. It'll only take a minute, but you'll be doing a lot to help other listeners discover the show.And one more thing. If you like the interviews we do here on the show I know you'll like my new book, The Future You: How Artificial Intelligence Can Help You Get Healthier, Stress Less, and Live Longer.It's a friendly and accessible tour of all the ways today's information technologies are helping us diagnose diseases faster, treat them more precisely, and create personalized diet and exercise programs to prevent them in the first place.The book is now available in print and ebook formats. Just go to Amazon or Barnes & Noble and search for The Future You by Harry Glorikian.And now, back to the show.[musical interlude]Harry Glorikian: We talk about major EHR systems sold to hospitals and, you know, on this show a lot and the interoperability and it's just, oh my God, it's a mess, right? And I hear it from patients too, right? I had someone call me the other day and they were like, I don't want to say they were chewing my ear off, but they were unhappy and they were like, and it was a friend of mine who had gone into a hospital. And he goes, I'm sure you know all this. I'm like, Yes, I know all this. But hearing it from somebody is interesting. It sounds like, I mean, you guys are harmonizing, or correct me if I'm wrong, at least from what I've heard, ophthalmology and neurology and and urology. If you were able to give that back to the physician, I think that would be hugely of value as a physician, assuming that it's simple for them to interact with and, you know, they don't need a degree in computer science, if you know what I mean.Sujay Jadhav: Yeah, yeah, that's exactly what we are also focused on. I mean, you know, sort of part of sort of the way we are approaching this opportunity is sort of twofold. Number one, working with the providers, helping improve that, they can provide care. And we're very committed to that in a way we're committed to. That is. You brought up sort of MIPS quality reporting, which is important for CMS submissions. And, you know, we actually have a particular solution that is provider facing, which allows them to work through sort of their quality scores, understand how they're doing overall in terms of overall quality of care from from a high-level perspective. You know, in addition to that, we're also allowing them to access sort of our patients, you know, data to help improve how they can participate in clinical trials. And, you know, we understand that their bandwidth is very, very constrained. They need to focus on care. And, you know, folks like myself and sure, you know, we've been doing this for a couple of decades as well and spent a lot of time, you know, working with physicians out there. And so we understand that, you know, making this user friendly, allowing them to come in and out as quickly as possible to get the insight they do is extremely important.Sujay Jadhav: And that's sort of a key part of what we are focused on as a company. And we're committed to helping improve quality of care by taking on sort of this MIPS reporting obligation as part of sort of our overall business model as well. But, you know, through that particular process, you know, we obviously have access to the data. We then de-identify it and then we can provide the next generation of insights to the life sciences industry, which is a very, very compelling across the board. And it's a really, really interesting that I've been doing this for, you know, 20 years plus, and I still feel we're just barely scratching the surface in how we leverage this particular data. And so, you know, there's definitely a lot of work that we are doing, leveraging natural language processing techniques to allow us to do this at a particular scale. And that's sort of core for us helping to deliver on this sort of next level of opportunity that we see to help improve care across the overall value chain.Harry Glorikian: Do one of you or both of you have your favorite case study that highlights the different strengths of the system that you can sort of, you know, put it into context for someone.Shrujal Baxi: Sujay, do you want to go first?Sujay Jadhav: Sure, yeah, absolutely, absolutely. So, you know, you know, from my perspective, where we're providing a lot of insights, as I mentioned, across sort of the overall drug life cycle, the area which got me the most excited around Verana is really on the trial side of the house, in essence. And so, you know, we do a lot of work around helping out in trial design, right? But you know, the areas that we're starting to see sort of the biggest next level of value that we're providing is really on the recruitment side of the house. And you know, as you know, recruitment is being a big pain point in the industry at large. I think a lot of companies are out there which are helping work through and target the right sites, help target the right PCs, providers, which you know, have the actual patients there. But that final mile of helping out do the actual recruitment is something which is very difficult to do. You know, the biggest influence in recruitment is a physician and, you know, via sort of the solutions that we're providing around our quality of reporting side as well, how safe we feel. At least we have some bandwidth there with the physician and we want to leverage that to improve recruitment. So, you know, we've done a number of projects in the recruitment side, particularly in the rare disease area, is an area that we've done a lot of work there because historically the way it is, the process has been, which is, hey, you know, these are the particular, you know, you know, physicians out there which have participated in historical trials, et cetera. Let's just target them as well. And it's more around historically which providers participate in trials. But what we're doing is we're doing it from a data level up there. And so what we did with a large pharma company out there in a particular rare disease area there is we actually identified a number of patients with actual providers which have never participated in trials before. And so we yielded a set of patients, which probably they never would have gotten via the normal mechanisms out there. You know, and I would say the types of improvements we're seeing starting to see in the trial side is north of 30 percent sort of efficiency improvements in the trial process overall. And if you extrapolate that to how much they spend in clinical trials, that's tens of millions of dollars of cost savings that you can take out of change. So, you know, that's probably the area where I've seen a lot of value that we're provided with this particular data. Shrujal, do you have any other examples?Shrujal Baxi: Mine is not nearly as grandiose, but it's really sort of brings home why data is important. So recently we ran an analysis with the American Urologic Association just as a sort of look at how the data can show us what's happening, and it's going to come out in their spring newsletter that they send to all their members. And we partnered with one of their academic collaborators, and we just asked a question about uptake of routine bone density scans for patients with prostate cancer who are going to go on to hormonal therapy for about six months to a year. And that has been a, that's been a quality measure that they've been tracking as an organization because it's a place for improvement for urology overall. And we were just curious sort of in our data, what does that look like, right? And so perfect use, create data, analyze data. What we found is that the uptake of this particular recommendation over time has steadily increased. But lo and behold, COVID hit people didn't stop getting prostate cancer, but they did stop doing screening for bone density. And we know that if you don't look for bone density, you're not going to treat low bone  density. And therefore these patients are going to be at risk for fractures, which are, you know, in a certain population, just devastating. And so the I sort of am stealing the thunder of the snapshot. So please forgive me, AUA, but the takeaway here is that there is something we can now do. Let's go back to those patients that we diagnosed in 2020, and let's make sure that all those patients get bone density scans. And if we can prevent even one fracture, then this data has served its purpose directly to the patient, right? And so that's just a glimpse of what we can do with the data. And there are so many opportunities like that to directly impact patient outcomes if we can just figure out what questions to ask and then how to disseminate that information. So not quite as big and grandiose, but really tactical and tangible, I think.Harry Glorikian: Yeah, no, no, I mean, I, you know, once you have the data, my brain goes in, you know, eight, 10 different directions of what can I do with it? Which is why I like investing in the space because it's, you know, if you've really got access to the right quality data and you can actually interrogate it, you're not just a one trick pony. And one of the things that I was thinking of is with all the data you've got, you know, couldn't you create like really optimized digital twins that might be able to also be used in a trial? I mean, that's one of the first things that popped into my head. But Shrujal, last time we talked, you were head of clinical science at Flatiron. And I think if I got it correctly, your title now is senior vice president of clinical and scientific solutions. So what does that mean?Shrujal Baxi: Good question. I think the fact that clinical and science are in both the titles sort of tells you that in many ways my role at a company like Flatiron or my role at a company like Verana is not all that different, right? It's to make sure that we are bringing through the perspective of the clinician who is fundamentally at the heart of the documentation that's happening and that we're translating that when we partner with our technology colleagues, to translate how that data is going to be transformed so that we don't lose the meaning of the information. As a scientist or an outcomes researcher, I was a consumer. I would interrogate databases that were generated like this and so I can put my outcomes or my health services research hat on, my clinician hat on. What questions do I need answered and what is the data need to look like? So I sort of sit in many ways at the start and at the finish and help partner along the way with our cross-functional colleagues who do really the bulk of the work. Like I think it's such a, the strength of these companies is how collaborative they are. The challenge of these companies is how many people have to work together and communicate and say the right words and the same words to mean the same things. And so the title sounds a little different, but in many ways I feel like my role is to preserve the voice of the provider and therefore indirectly the patient in everything that we're doing. Shrujal Baxi: The other piece that I think I've the title seems bigger at Verana, but what it's actually, I think, expanded my my scope into is to understand where engineering and data science and that AI/ML component of the transformation can really take us. I think technology enabled abstraction is one thing, but I think actually applying technology to extract the data is a whole 'nother level of complexity and scale. But once built, it's sort of a receptor just waiting for new data sources to come through because you can take 10 hours, 12 hours, 100 hours. If you built the pipeline and you've built that ML/AI to put on top of it, the output should come sort of instantaneously, so I say that with a wink almost too, because I know it's a lot harder than that, I've learned. But ultimately, that's what Verana is building towards. And so the scope of my work and how I think has changed just slightly.Harry Glorikian: Well, it sounds like a critical piece of the puzzle to make sure that, you know, everything is translated correctly and everything is understood correctly, et cetera. So it's I think it's a valuable position. They might need to clone you, though, because I feel like there's a lot going on there.Shrujal Baxi: I feel like there's a lot going on.Sujay Jadhav: There definitely is. I mean, you know, and we have we have sort of a network of medical professionals that we leverage, you know, across all three therapeutic areas, you know, and that's really, you know, part of sort of our overall process, right? But you know, I think you describe it very, very clearly. But ultimately, you know what, we're trying to get out of Shrujal and the group is sort of how to medically inform the overall process that we're doing right now, and make it relevant and practical to truly provide insights to the clinician right at the end of the day there. And so, you know, there's a pragmatic element to sort of her involvement in the overall process because technology can only take you so far. But to get that sort of final, pragmatic element to that particular therapeutic area, you know, requires a medical professional.Harry Glorikian: Yeah. And I think, you know, one of the most challenging things is how to present it. And like you said, I mean, real time is a that's a whole other, you know, dynamic to tackle that people don't understand. But. You guys just had some fantastic news. I, you know, a I believe recently a series of venture round brought in, I think it was $150 million, if I remember the number correctly, from J&J Innovation, as well as existing investors like Google Ventures. I mean, first of all, congratulations, that's a pretty good sized round. Can you fill us in on like, okay, somebody just handed you a $150 million check. What are you going to do?Sujay Jadhav: Yeah, no, it's a good question. Firstly, the $150 million raise is a significant raise, and we're very fortunate that it's come from comes from a diversified set of, you know, digital health investors, broadly speaking in combination of growth investors, innovation funds from life sciences companies as well as academia as well. And so I think it's a good cross-section mix that we have fundamentally a number of investors which are very committed to digital health overall and will allow us to sort of accelerate the business as we take it to sort of the next level. You know, in a lot of ways I think it's sort of recognition of where Verana is, you know, and you know, we've done a really good job of building out our digital technology platform. We are now commercializing the business very, very well, you know, in terms of what we're going to do with a capital, in essence, it's fuel for growth. We've anchored on a really good business model right now. And what we are going to leverage the money for is to help execute on our existing sustainable product strategy, which is coupled by premium services on a solid data foundation and the sort of sort of three areas that we are going to focus on. The first one is on the provider side of the house that we already have an existing set of solutions in the, you know, the quality area and the clinical trial area. And we're going to further those particular solutions taken to the next level to make it easier for physicians and providers to do that job. The second area that we're going to be investing in even more is on the life sciences solutions side there as well.Sujay Jadhav: And so, you know, both we have a set of trial solutions there. We have what we call data-as-a-service solution set, which allows these life sciences companies to access the curated data in a very easy fashion, so allows them to provide different levels of insights that they feel are important as well. And then, you know, the third area is just furthering sort of expanding sort of the data that we have currently right now. I think we've got a really good critical mass right now with 90 million de-identified patients, you know, 20,000 plus providers there. We're going to continue to increase that across our three therapeutic areas. But, you know, moving to other types of data sources, I think imaging is one we're going to invest in a big way. I think that can really, truly help complete the picture. Genetic information also is something that we're inserting in into the mix as well. And, you know, bringing in each data, bringing in claims data, bringing in imaging and genetic data, you know, is a complex equation, so to speak there, just to say the least. Yeah, it is. And you thought of doing that in a thoughtful way, doing it in a way which is scalable. It takes a lot of effort. And that's where we're going to be investing a lot of these funds to make that happen. And you know, we're well on the way to actually doing this. And so, you know, a lot of the money is in essence, just executing on the strategy.Harry Glorikian: Well, you know, it's been great having you both here. I love talking about this stuff, as you can tell. And you know, I wish you guys incredible luck because, you know, I keep getting older and I think I'm going to be, you know, at some point you become more of a patient. So the more that this advances, the better my health and wellness will become. And I look forward to, you know, maybe having you guys in the future and seeing the evolution of where this goes.Sujay Jadhav: Absolutely. Thanks a lot, Harry. Enjoyed talking.Harry Glorikian: Thank you.Harry Glorikian: That's it for this week's episode. You can find a full transcript of this episode as well as the full archive of episodes of The Harry Glorikian Show and MoneyBall Medicine at our website. Just go to glorikian.com and click on the tab Podcasts.I'd like to thank our listeners for boosting The Harry Glorikian Show into the top three percent of global podcasts.If you want to be sure to get every new episode of the show automatically, be sure to open Apple Podcasts or your favorite podcast player and hit follow or subscribe. Don't forget to leave us a rating and review on Apple Podcasts. And we always love to hear from listeners on Twitter, where you can find me at hglorikian.Thanks for listening, stay healthy, and be sure to tune in two weeks from now for our next interview.

So, what is a prostate anyway? Where is it located?  Today, we circle back and bring our very first podcast, Episode 1, out of the vault. It was an informative interview with the urologist, Dr. Brantley Thrasher, who explains everything you need to know about the prostate. This episode forms the foundation for your understanding of the prostate gland and what could go wrong with it. The information in this episode is vital to grasp, no matter which stage you are at in your prostate journey. Dr. Thrasher will bring you fully up to speed with all you need to know about the prostate gland, its function, and what could go wrong with it. Stay tuned for more! Dr. Thrasher is the immediate past president of the American Urologic Association, the former chair of the department of urology at the University of Kansas Medical Center, and the current executive director of the American Board of Urology. In addition to giving over 400 presentations at local, national, and international meetings, he has written more than 190 manuscripts, book chapters, and monographs in the field of urology.  We have taken a break from recording any new interviews until the start of Season 3 of the Prostate Health Podcast. We have had a lot of excitement recently with the launch of the Prostate Health Academy, and we ask you to keep our family in our thoughts as we will soon be welcoming our third child to our family! Disclaimer: The Prostate Health Podcast is for informational purposes only. Nothing in this podcast should be construed as medical advice. By listening to the podcast, no physician-patient relationship has been formed. For more information and counseling, you must contact your personal physician or urologist with questions about your unique situation.  Show highlights: Dr. Thrasher explains what a prostate is. The primary purpose of the prostate. Where the prostate is located and some of the structures that surround it. The average size of the prostate. The function of the prostate gland and what it does for a man. The different zones of the prostate. What stimulates the growth of the prostate. The things that men would need to worry about regarding the prostate. The consequences of removing a prostate. In cases where men are having symptoms, they should see a urologist. Links:  Follow Dr. Pohlman on Twitter and Instagram - @gpohlmanmd  Get your free What To Expect Guide (or find the link here, on our podcast website)   Join our Facebook group  Follow Dr. Pohlman on Twitter and Instagram  Go to the Prostate Health Academy to sign up for the wait-list for our bonus video content.  You can access Dr. Pohlman's free mini webinar, where he discusses his top three tips to promote men's prostate health, longevity, and quality of life here.  

Dr. Judson Brandeis trained in Urology at UCLA and currently practices sexual and rejuvenative medicine for men in San Ramon, California.  He was a pioneer in Surgical Robotics, Greenlight Laser and MRI prostate biopsy.  Dr. Brandeis was the Chief of Urology at John Muir Hospital and Hill Physicians from 2012-2018, and he was voted Top Urologist in the SF Bay Area (SF Magazine) 2014-2020.   Dr. Brandeis has appeared on The Doctors Show and dozens of Podcasts and Webcasts.  He created the SWEET (Shock Wave Erectile Enhancement Trial) Study which is the largest study of Shock Wave therapy for ED ever done.  His other clinical research studies include the SWAP Study (Shock Wave and Peyronie’s) utilizing his special Peyronie’s disease SWT protocol, the P-LONG study for minimally invasive penile elongation, the MenSella Study using HIFEM technology for improving the intensity and duration of orgasm and the SURGE study using a transdermal technology to deliver Nitric Oxide to the penis.   BrandeisMD in Northern California is at the leading edge of male rejuvenation and sexual medicine. Among the many cutting edge technologies, we use BioTE testosterone supplementation, Emsculpt and Emsella for muscular rejuvenation, and GAINSWave therapy and PRP for sexual rejuvenation.   Dr. Brandeis also founded AFFIRM Science which creates supplements based on the most recent scientific data (AFFIRMScience.com).   AFFIRM is a Nitric Oxide boosting supplement PreLONG is for the management of Premature Ejaculation SupporT is a natural Testosterone booster SPUNK is to improve prostate health Dr Brandeis attended Brown University as an undergraduate and Vanderbilt for Medical School.  He received a Howard Hughes Medical Institute Research Award for his year of transplantation immunology research at Harvard Medical School. Dr. Brandeis is a member in good standing of the American Urologic Association, Sexual Medicine Society of North America, and The International Society of Sexual Medicine. 4:31 Dr. Brandeis's unique path towards specializing in the niche of men's sexual health. 6:40 How Dr. Brandeis helps patients maximize sexual health into old age. 8:45 Dr. Brandeis explains ED, libido, and male sexual decline. 12:42 Dr. Brandeis's methodologies for treating ED. 22:20 Dr. Brandeis on the necessity to individualize treatment plans for patients. 25:11 How GAINSWave works and how Dr. Brandeis utilizes this treatment. 29:00 Understanding PRP. 32:49 Demystifying Stem Cell Therapy. 39:26 The do's and don't's for those seeking penis enlargement. 41:10 An integrative and holistic approach to male sexual health. Plus: what erectile dysfunction might indicate about a patient's cardiovascular health. Links mentioned in this episode: https://www.youtube.com/watch?v=b3_YoSv0Xp8&ab_channel=BrandeisMD (Night Time Erections) informational video. Website: https://brandeismd.com/ (BrandeisMD.com) https://www.affirmscience.com/ (AFFIRM Science: performance enhancing supplements) This episode is sponsored by http://www.getchews.com/ (TotumVos Collagen Chews). You can find TotumVos at www.getchews.com. *Use code DRDIVA for an additional 10% off your first order.

The treatment landscape for men with advanced prostate cancer keeps on shifting and expanding. As new therapy options continue to emerge, it is important to understand which treatment options are currently available and how they work in fighting the disease. To highlight a few of the new options, we have Dr. Natasha Kyprianou, an award-winning prostate cancer investigator, joining us on the podcast today to help you get up to speed. Stay tuned for more! Dr. Natasha Kyprianou completed her fellowship in molecular oncology at Johns Hopkins University and in molecular biology at the Imperial Cancer Research Fund in London, UK. She is a professor in the Department of Urology in Oncological Sciences at Mount Sinai Medical Center in New York City and a member of the National Cancer Institute-designated Tisch Cancer Institute. She has also been active nationally and internationally in several leadership positions, including being a board member of the International Prostate Health Council, member of the American Urologic Association Education Council, and honorary board member of the EAU Council, and has served as President of the Society for Basic Urologic Research. It is also worth noting that she was also the Chair of the Department of Defence Congressional Directed Program for Prostate Cancer Research, and was the first female to be elected to this position. Her research focuses on the molecular mechanisms underlying prostate cancer progression to metastasis and apoptosis-driven molecular therapeutics that are targeting urologic tumors. During her career, she has received numerous awards, including being the first female to be awarded by the American Urologic Association for her contribution to urology research. Be sure to listen in to find out what Dr. Kyprianou has to say about the new treatment options that are currently available for advanced prostate cancer. Disclaimer: The Prostate Health Podcast is for informational purposes only. Nothing in this podcast should be construed as medical advice. By listening to the podcast, no physician-patient relationship has been formed. For more information and counseling, you must contact your personal physician or urologist with questions about your unique situation. Show highlights: Dr. Kyprianou explains what motivated her to follow the path she has taken to get to where she is today. More than thirty-thousand men will die of prostate cancer in 2021. The survival rates for prostate cancer drop dramatically once cancer has metastasized to distant sites. Dr. Kyprianou explains what it means for a man to undergo Androgen Deprivation Therapy (ADT). Dr. Kyprianou discusses the novel agents developed in recent years for the treatment of advanced prostate cancer. Dr. Kyprianou talks about the role of the androgen receptor in driving advanced prostate cancer. Dr. Kyprianou explains how the new novel medication, Enzalutamide, also known as Xtandi, works in helping men with advanced prostate cancer. Dr. Kyprianou explains from a research perspective how a treatment like Enzalutamide gets discovered and then ultimately brought to the point where it becomes available to the consumer. Dr. Kyprianou talks about some of the more commonly reported side-effects of Enzalutamide. How the novel agent, Abiraterone, or Azteca, works in helping men with advanced prostate cancer. Dr. Kyprianou explains why men need to keep getting their ADT injections with the new therapy once their prostate cancer has become resistant to the standard hormonal therapy. Dr. Kyprianou discusses what the next ten years hold for the advancement of treatment options for men with advanced prostate cancer. Links and resources: Follow Dr. Pohlman on Twitter and Instagram - @gpohlmanmd  Get your free What To Expect Guide (or find the link here, on our podcast website)   Join our Facebook group  Follow Dr. Pohlman on Twitter and Instagram  Go to the Prostate Health Academy to sign up for the wait-list for our bonus video content.  You can access Dr. Pohlman's free mini webinar, where he discusses his top three tips to promote men's prostate health, longevity, and quality of life here.

One of the top concerns that men and their loved ones have around prostate cancer treatment is associated with urinary control. The more common questions that men ask include wanting to know if they will leak urine after undergoing prostate cancer treatment, and if so, how they can regain urinary control. Today, we are excited to bring you an interview with Dr. Daniel Kirages, an expert in pelvic floor exercises for regaining urinary control after surgery for prostate cancer. Stay tuned to hear more! Dr. Kirages is an associate professor of clinical physical therapy at the University of Southern California. In his clinical practice, he attends to a diversified patient load, including various pelvic health disorders. You can also find him lecturing at various academic institutions and health care facilities, both nationally and internationally. He is a member of the Clinical Practice Guidelines Development Panel for incontinence after prostate treatment for the American Urologic Association. Be sure to listen in today to learn about regaining urinary control after prostate removal. Disclaimer: The Prostate Health Podcast is for informational purposes only. Nothing in this podcast should be construed as medical advice. By listening to the podcast, no physician-patient relationship has been formed. For more information and counseling, you must contact your personal physician or urologist with questions about your unique situation. Show highlights: Why men have urine leakage initially after prostatectomy for prostate cancer. Dr. Kirages expounds on the sphincter deficiency reason for urine leakage. What men can do to regain their urinary control after prostate removal. Dr. Kirages explains what an anticipatory contraction is. Dr. Kirages explains how pelvic floor exercises help men in regaining their urinary continence. The best time for men to start doing pelvic floor exercises. The time that it typically takes for men to regain their urinary control after a prostatectomy. Dr. Kirages explains to men how they can find their pelvic floor muscles to know that they are doing their Kegels correctly. Dr. Kirages discusses the trouble he has seen with men going above and beyond and doing more repetitions than what was recommended by their physical therapists. Dr. Kirages talks about whether men should do their pelvic floor exercises while they still have a catheter in place. Links and resources: Follow Dr. Pohlman on Twitter and Instagram - @gpohlmanmd  Get your free What To Expect Guide (or find the link here, on our podcast website)   Join our Facebook group  Follow Dr. Pohlman on Twitter and Instagram  Go to the Prostate Health Academy to sign up for the wait-list for our bonus video content.  You can access Dr. Pohlman's free mini webinar, where he discusses his top three tips to promote men's prostate health, longevity, and quality of life here.

*Parental discretion is advised. Adult themes discussed. In this episode of Veggie Doctor Radio, I talk with Dr. Aaron Spitz, a urologist that specializes in male infertility and sexual health, about the influence of diet and lifestyle habits on a man’s penis.   About featured guest: Dr. Spitz completed a Bachelors of Arts in Government at Cornell University. He earned his medial degree from Weil/Cornell Medical College and he completed his Urology residency at the University of Southern California, and then obtained fellowship training in infertility at the Baylor College of Medicine. Dr. Spitz has expertise in the treatment of male infertility and sexual dysfunction, and he has participated in clinical trials and research in the area of andrology, male sexual dysfunction, and male infertility. Dr. Aaron Spitz serves as a voluntary assistant clinical professor in the U.C. Irvine department of Urology. Dr. Spitz currently directs the Center for Male Reproductive Medicine and Surgery at Orange County Urology in Laguna Hills and Mission Viejo, California.       Dr Spitz is the immediate past president of the California Urologic Association. He is the Orange County District representative to the Western Section of the American Urologic Association. He served as  the lead delegate to the American Medial Association House of Delegates representing the American Urologic Association.  He sits on the Health Policy Council of the American Urologic Association. He is co-chair of the Telehealth Task Force  of the American Urologic Association and he serves on the AUA Workforce Work Group and the AUA Advanced Practice Practitioner Work Group as well as the AUA opioid position statement workgroup. Dr. Spitz has served as faculty for the American Urological Association's national microsurgical course. Dr. Spitz has been awarded several prestigious honors including Alpha Omega Alpha at the University of Southern California. Dr. Spitz is the author of The Penis Book: A Doctor’s Complete Guide to the Penis, from size to function and everything in between published by Rodale/Crown/Penguin which has been translated in 4 languages including Italian, Dutch, and soon to be released in Chinese with rights secured in Check, Romanian, and Turkish.  He appears regularly on CBS The Doctors to discuss urology topics. He is a regular guest on Sirius XM radio medical talk shows.  He has authored  and co-authored book chapters and articles in peer reviewed publications on the topic of telemedicine, male infertility and sexual dysfunction, including the AUA white papers on Telemedicine and on Advanced Practice Providers. Dr Spitz is a member of the American Urological Association, American Medical Association, Society for the Study of Male Reproduction, American Society or Reproductive Medicine, Western Urologic Forurm, California  Urology Association, California Medical Association and the American Telemedical Association. He serves as a reviewer for the Journal of Endourology and the Journal of Andrology and Urology Practice.     DR. AARON SPITZ https://aaronspitz.com https://instagram.com/draaronspitz     Disclaimer: The information on this blog, website and podcast is for informational purposes only. It is not meant to replace careful evaluation and treatment. If you have concerns about your or your child’s eating, nutrition or growth, consult a doctor.   Mentions: Watch The Game Changers https://gamechangersmovie.com   Dr. Spitz’s book: https://www.amazon.com/Penis-Book-Complete-Penis-Everything/dp/1635650291/ref=as_li_ss_tl?crid=3QHV4K2D8E2A3&keywords=the+penis+book&qid=1580261071&sprefix=him,aps,229&sr=8-1&linkCode=sl1&tag=littlethingsl-20&linkId=42ab7238b5774b613c6eca90f61af0b6&language=en_US   A Parent’s Guide to Intuitive Eating: How to Raise Kids Who Love to Eat Healthy by Dr. Yami   Leave an 'Amazon Review'   MORE LISTENING OPTIONS Apple Podcasts: http://bit.ly/vdritunes Spotify: http://bit.ly/vdrspotify   NEWSLETTER SIGN UP https://doctoryami.com/signup OR Text 'FIBER' to 668-66     FIND ME AT Doctoryami.com Instagram.com/thedoctoryami Facebook.com/thedoctoryami Veggiefitkids.com         * * * * MORE FROM ME Read - http://veggiefitkids.com/blog Listen: http://bit.ly/vdrpodcast Watch - http://bit.ly/vfkvideos TEDx Talk - http://bit.ly/DOCTORYAMITEDX   * * * * Questions? Email me: Yami@doctoryami.com

Receiving a diagnosis of prostate cancer can be a frightening experience, and it could cause a lot of anguish for men and their loved ones. Fortunately, we have urologic oncologist, Dr. Simon Kim, as our guest for today's show, to walk you through the process. In today's episode, Dr. Kim talks about what it all means, what your options are, and he discusses where to go from there. Stay tuned to find out more.    Dr. Kim is a board-certified urologic oncologist at the University of Colorado's Anschutz Medical Campus. He has worn many hats including Director of Robotic Surgery. Dr. Kim's clinical practice focuses on the surgical management of prostate, bladder, kidney, testes, adrenal, and penile cancer. He has received independent funding from the NIH to develop decision aids for men diagnosed with localized prostate cancer. He has published more than 180 manuscripts and he is currently serving as assistant editor for the Journal of Urology. Be sure to listen in today, to get Dr. Kim's expert advice.   Disclaimer: The Prostate Health Podcast is for informational purposes only. Nothing in this podcast should be construed as medical advice. By listening to the podcast, no physician-patient relationship has been formed. For more information and counseling, you must contact your personal physician or urologist with questions about your unique situation.   Show Highlights:   What it means to be a urologic oncologist and what it takes to become one. Dr. Kim explains how he typically delivers the biopsy results. Dr. Kim shares his recommendations for men, to prepare for a prostate cancer consultation. Dr. Kim recommends some reliable online resources for prostate cancer patients. The kind of information you can expect to receive from a pathology report. The information that is obtained from the Gleason Score. The guidelines that Dr. Kim relies on when making his decisions. The criteria that Dr. Kim uses in determining who does and doesn't need additional imaging at the time of the diagnosis. A brief rundown of the typical discussion that Dr. Kim has with his patients, regarding their treatment options concerning the various risk groups. Dr. Kim is busy initiating a multi-disciplinary clinic for cancers. Looking at some different therapies, like cryotherapy, for prostate cancer. Dr. Kim talks about the Conquer Cancer Foundation, which recently honored him with an award.  The outcome for localized prostate cancer is usually very good.  Remaining fully informed is key for prostate cancer patients. Links and resources: Follow Dr. Pohlman on Twitter and Instagram - @gpohlmanmd   To get your free What To Expect Guide, go to www.prostatehealthpodcast/clinic Or find the link on our podcast website - www.prostatehealthpodcast.com    Journal of Urology - https://www.auajournals.org/ American Cancer Society - https://www.cancer.org/ American Urologic Association - https://www.auanet.org/ Know Your Options - https://www.cancercenter.com/community/blog/2016/07/know-your-prostate-cancer-options Conquer Cancer Foundation - https://www.conquer.org/

Welcome to the introductory episode of The Prostate Health Podcast, with your host, Dr. Garret Pohlman. For this podcast, we will be interviewing experts, innovators, and leaders in the field of urology. In today's episode, we're excited to have Dr. Brantley Thrasher joining us, to explain what the prostate is, its function, and where it's located. His was one of the very first names that came to mind when we were developing the podcast and thinking about possible guests. Dr. Thrasher is the immediate past president of the American Urologic Association, the former chair of the department of urology at the University of Kansas Medical Center, and the current executive director of the American Board of Urology. In addition to giving over 400 presentations at local, national, and international meetings, he has written more than 190 manuscripts, book chapters, and monographs in the field of urology. Tune in today, to find out more!  Disclaimer: The Prostate Health Podcast is for informational purposes only. Nothing in this podcast should be construed as medical advice. By listening to the podcast, no physician-patient relationship has been formed. For more information and counseling, you must contact your personal physician or urologist with questions about your unique situation. Show Highlights: Dr.Thrasher explains what a prostate is.  The primary purpose of the prostate. Where the prostate is located, and some of the structures that surround it. The average size of the prostate. Dr. Thrasher explains what the function of a prostate gland is and what it does for a man. The different zones of the prostate. What stimulates the growth of the prostate. The things that men would need to worry about, with a prostate. The consequences of removing a prostate. In cases where men are having symptoms, they should see a urologist. Links and resources: Prostate Health Podcast - www.prostatehealthpodcast.com To receive your free guide, go to www.prostatehealthpodcast.com/clinic or find the link on our podcast website

Session 80 Dr. Mary McHugh is a urologist who's been out in practice for a year and a half. She talks about her journey to urology, especially as a female, in a very male-dominated specialty. Also, be sure to check out all our other podcasts on MedEd Media Network to help you along this journey towards finally becoming a full-fledged physician! [01:21] Interest in Urology Mary was exposed early on to urology when she was a second-year student during a six-week general urinary block that covered OB/Gyn and Urology. She saw how urologists were fairly entertaining who showed videos of the robot. From that moment on, she got introduced to the concept of the specialty that she had never even considered or known much about. But this sparked her interest in learning more about surgical fields. "I just never thought about urology - period... I had always thought women didn't become surgeons." She always thought she'd do something that wasn't procedure-based or medicine-based. That said, she didn't really experience any gender bias when she took the course. In fact, there wasn't any single female lecture in the course. Every single person that came and talked to them was a man. So it was interesting she ended up down this path. What she really liked boiled down to medical management, procedures, and surgery. She likes the organ system, the anatomy, and that some of the problems had to deal with the quality of life. What she likes about it is that 100% of the issues people deal with is quality of life. And being able to make that impact and make it fairly quick, it leads to a lot of satisfaction to both patients and physicians. [04:20] What is Quality of Life? One of the biggest quality of life issues is overactive bladder urinary frequency. This would not be considered to be a life-threatening illness. However, it's something that affects how they carry out their daily activities. And some people get so bothered by this. Fortunately, there are things they can do for that to be fixed but they never even realized until they stepped into a urologist's office. Another example is stress urinary incontinence. This is leakage, or anytime there is an increase in intraabdominal pressure. So when a woman or man coughs, laughs, or sneezes, they may leak urine. Again, not a life-threatening condition, but can be ostracizing and can interfere with things they like to do like running, dancing, horse-back riding, hiking. They have things urologists can do to help improve that. [05:45] Traits that Lead to Becoming a Good Urologist You have to be a good listener and a good communicator, especially that patients that come to you have very sensitive issues that deal with sensitive areas of the body. And they want to feel like they've been heard and understood. As a woman, you get a lot of male patients that are very shy when they come in. But you have to make them feel at ease and like they can open up to you and talk to you, so you can get to the root of the problem. "Anybody who is going to be counseling patients on procedures, you really have to be a good communicator." That being said, you have to be able to set expectations and be very clear about what's happening, what the potential risks, complications, side effects, etc. So patients really know what they're getting into when they're signing up for surgery. Mary had other interests prior to urology such as dermatology to GI and then to peds, until eventually, she found urology after she took the course and went on her clerkships. She chose a clerkship path where surgery was second to rotation so she was able to make that decision right away. [08:18] Types of Patients Among her patients are those with overactive bladder, stress urinary incontinence, voiding symptoms in men due to enlarged prostate, erectile dysfunction, and recurrent infection (a big one she sees). She also sees a lot of chronic bladder pain syndrome or interstitial cystitis, stones, and hematuria workups. Mary is in private practice in northern New Jersey and she says 70% of her patients where an OB/GYN will identify a problem and send the patients to her. Then she goes from there and does everything on her own. The other 30% are looking for another opinion or have things done or they've seen another urologist. So about 70% are common and the other 30% come with some things done. [11:11] Choosing Private Practice over Community Setting Mary's husband came out of his training first and finished his fellowship. He wanted a specific job in a specific location so he moved while she was finishing her last year of residency. She has always envisioned herself going into private practice. She thinks it's hard to provide training and mentorship to residents when you haven't been out in practice or out in the world. She also likes the independence of private practice as she has always liked doing things herself and at her own pace. "It was the job market and my own style and personality that really influenced me to go into private practice." During Mondays, Mary is in the office seeing patients. Wednesdays are full days in the office seeing patients. Fridays are procedures they do in the office such as cystoscopy, vasectomy, urodynamics, and other procedures. She also does prostate biopsies and ultrasound and injection of Botox to the bladder. Tuesdays and Thursdays are a bit more variable. As a new attending in their area where they're saturated with physicians, it can be hard to get block time. So when she puts cases on her schedule, they get added to the hospitals she's on staff at. The way you get block time is either to acquire somebody else's block or to be employed by the hospital system. A lot of the consultations she gets sent are a lot of non-operative patients. About 20-25% of all the patients she sees end up having a procedure whether it be in the office or having surgery. This can be a little disappointing for her considering she wants to do surgery. "You do the cases that you can and you have the best outcomes that you can and that's how you build your reputation." She explains that one of the biggest things you have to realize coming out of training is that it takes time to build and it takes time to establish yourself and establish your reputation. Don't believe everything you see on Instagram where everyone has 10,000 cases on their first day. [17:55] Urology as a Male-Dominated Specialty It's just the perception of a lot of patients that only males will treat that part of the body or look at that part of the body. It has to do with traditionally, who was in the specialty looking back 20-40 years where even every specialty was even male-dominated. That said, women are still a rarity in the field but a lot more women are being trained now which is great for both male and female patients. [19:20] Taking Calls and Emergency Cases Mary is in a large urology group and in her care center, there's only two of them. Their call is going to be split by whoever is in your care center. So it's every other night for her. ER calls are determined by hospitals. One of the hospitals assigns ER calls a month at a time. She doesn't describe it as too bad. But based on politics, some hospitals keep a stronghold on the call and don't want outsiders taking it which she considers as a blessing in disguise. Some of the emergencies they see are necrotizing fasciitis of the genitals, testicular torsion, abscesses, the common ones they get consults for their scrotal abscesses, and septic stones. And retention -  a common one they get consulted for all the time. Oftentimes, they call you and patients are super uncomfortable so you have to go take care of it. [22:13] Work-Life Balance Mary considers having enough family-work life balance. Her husband's hours are pretty long as well. So they have that time when they go home at night where there's a couple of hours and then the weekends. Whatever weekends he's not working. It's a lot better than training she calls it. And there are things you can do to minimize your calls your make sure everybody's questions are answered and everyone is tucked in. If you're doing a procedure on a Friday, everything is taken cared of and you don't have any worries about that when you go on call over the weekend. It's a matter of letting people know that you're available but also explaining to them what kinds of things they should be calling you for. When they're not on call for the practice, it's not as bad. [23:35] Residency Path to Urology Urology is its own training program. Most of the programs are five years, some are six years. Although a lot of them have gone down to five years. The first year is a general surgical internship and then usually for four or five years of urology. A lot of the programs that are six years have built-in research year. "If you're applying, know how long the program is going to be. But it's all one program you match into the whole thing." The urology match precedes all the other matches, after the military. But urology matches in December. It's not through the NRMP, but through the American Urologic Association. They give you a number and you do it through its own unique match. The reason for this could be that it's a self-regulation issue. When you're in a specialty, you don't want to have so many people. This is just Mary's guess though. Urology matching is pretty competitive. Check out urologymatch.com and find a more specific breakdown. There are not a lot of applicants but it's a 60% match rate for those applicants and they break it down in general. You have to be really high performing as a student and have good Step scores. The process could be different now as well. Mary is a DO and a lot of the programs that were DO are now in the urology match accredited by the ACGME as a single graduate medical education system. And so it's gotten a lot harder than when she matched since it was a separate match. She applied into the urology match and applied to as many programs as possible. But they've done away with programs that are just AOA accredited. Mostly, all are ACGME-accredited at this point. [26:38] Negative Bias Against DO and Other Subspecialties Having been on both sides of the interview trail and as an interviewer, she thinks there are biases. The Specialty Stories breaks down per specialty, MD vs DO, and Mary thinks the data speaks for itself. It can be done as a DO but that's more of the exception than the rule. There are a lot of subspecialties you can do after urology such as oncology (2-year and 1-year fellowships), female pelvic medicine and reconstruction (2-year and 1-year fellowships), pediatrics (2 years), reconstruction and trauma (1 year), andrology and male sexual health (1 year), and fertility. Those are the general subspecialties. Urology is its own subspecialty. [29:30] Working with Primary Care and Other Specialties Mary says there are a lot more technology and a lot more procedures to help patients. She commends those primary care doctors for starting people on medication and working up a lot of the urinary complaints. For instance, Botox is for patients with frequency and urgency, indicated if you've failed to two or more medications. Sometimes, patients think that there's no solution or they're stuck with the medications. And people are always so surprised when they learn about their options. So just getting them into the urologist sooner and not being afraid to send in a patient to see if there's anything else they have to offer. "Sometimes, patients think there's no solution or they're stuck with the medications. And people are always so surprised when they learn about their options." Other specialties they work the closest with are general surgeons, OB/GYNs, family practice and other mid-level providers like PAs, NPs, etc. Opportunities outside of clinical medicine for urologists include speaking engagements, expert witness, write books, consults, etc. [32:15] What She Wished She Knew that She Knows Now Mary believes that one of the hardest parts of being a surgeon is that you become extremely disappointed when something doesn't go according to plan or someone has a complication. Dealing with that the most is one of the hardest parts of her job as it's emotionally taxing. So you have to learn how to deal and cope with that. When you go out, everyone is just so bright-eyed and bushy-tailed and ready to soar, but it takes time. It takes time to develop a rhythm. It takes time to develop finesse. So there should be patience and you should respect the process. "What you've done 10,000 times as a chief resident that you can do with your eyes closed suddenly becomes the hardest thing when you're an attending." What Mary likes the most about being a urologist is her patients which she considers to be very awesome and this adds to her job satisfaction 100%. She comes from an urban area in her training and so now it's different there. Now, she's out in the community and the suburbs. Patients listen to her and they take their medication. They make her job very enjoyable. The thing she likes the least is that sometimes you feel helpless in your ability to help people because you're constrained by what insurances will cover. This is an issue because people are on a fixed income and they can't afford these things. If she had to do it all over again, Mary would still probably do it. Again, on social media,  you see these people so happy after some procedures. But what it all comes down to is to think about what complaints or complications you're going to deal with. [37:30] Final Words of Wisdom Stay interested. Read as much as you can, when you can. Getting exposure early is key. If you're a medical student, it's doing all the things you should do to match into a competitive specialty. Learn the people who are on the faculty at your institution. Get involved with research. Meet the residents and get that chairman's letter if you have a department. Do as well as you can and you'll succeed! Links: MedEd Media Network urologymatch.com

Dr. Peter Steinberg is a board-certified urologist and the director of endourology and kidney stone management at Beth Israel Deaconess Medical Center, one of the chief teaching hospitals of Harvard Medical School, where he is an Assistant Professor. He graduated from the University of Pennsylvania School of Medicine. He completed a urology residency at Dartmouth Hitchcock Medical Center and an Endourology Fellowship at Montefiore Medical Center. His interests include: medical malpractice/expert witness, patient safety, communication in the operating room, medical writing, consulting related to medications and devices, health care venture capital, angel investing and public speaking. He has extensive experience as a urologic expert witness. He has been a guest on several other podcasts, most notably "The White Coat Investor" and "Radical Personal Finance". Based on our conversation, I'd say this work seems like a really good way to augment your clinical practice income. It's the ultimate moonlighting, in which you can make MORE than moonlighting clinically.  We did not talk about this, but work as an independent contractor, rather than an employee, allows you to create some beneficial tax-favored retirement accounts. These include options such as a SEP-IRA or a Solo 401(k). I’m not an accountant, so don’t rely on my advice on a retirement account. But definitely check it out if you work as an independent contractor, such as an expert witness, in addition to any employment arrangement you may have. Here are just some of topics we talked about during our conversation: The resources provided by the American Urologic Association to help you enter this field. The three big reasons Peter enjoys his work as an expert witness. The expected salary range. The three major duties of an expert witness. Other resources for those wishing to pursue this career. You can connect with Peter on LinkedIn – just search for Peter Steinberg MD. Show notes and a transcript for download can be found at vitalpe.net/episode053.

Health organizations’ guidelines about PSA screening for prostate cancer can be confusing. Dr. Ross Krasnow discusses how he advises men about the test.   TRANSCRIPT Introduction: MedStar Washington Hospital Center presents Medical Intel, where our healthcare team shares health and wellness insights, and gives you the inside story on advances in medicine. Host: Welcome, everybody, and thanks for joining us today. We’re talking to Dr. Ross Krasnow. He is a urologic oncologist at MedStar Washington Hospital Center. Welcome, Dr. Krasnow. Dr. Krasnow: Thank you for having me. Host: So, we’re going to talk about PSA testing for prostate cancer. In 2016, Ben Stiller, the actor, made waves with a blog post titled, “The Prostate Cancer Test That Saved My Life,” in which he encouraged men to learn more about PSA testing, and it was something that he had gone through personally. And, the article also renewed a debate between medical professionals and organizations about the effectiveness of this test. Please explain to us a little bit more about what PSA testing is. Why is there so much debate surrounding this test? Dr. Krasnow: PSA stands for prostate specific antigen. It is a substance that the prostate actually secretes into the ejaculate. The prostate is a sexual organ. It’s not really supposed to be in the bloodstream, but it does leak into the bloodstream in small amounts. When a patient has prostate cancer, PSA will be secreted into the bloodstream at a higher level. Because of how PSA can be elevated in the bloodstream, it can be used as a screening test for prostate cancer, and it has been used successfully as a screening test for prostate cancer. Unfortunately, some of the data that demonstrates the efficacy, or lack thereof, of PSA testing for prostate cancer, is controversial. Specifically, in 2012 the US Preventative Task Force gave PSA testing a grade D recommendation. What that means is that they thought that the benefits of testing did not outweigh the harm, and they did not recommend PSA testing in men. In May of 2017, the US PTF, the US Preventative Task Force, revised their recommendation, and upgraded the recommendation to a grade C recommendation in men between the ages of 55 and 69. What this grade C recommendation means is that the test should be offered based on the professional judgment of the clinician and patient preference. Prostate cancer screening works when used properly, but there are harms. That’s why the Preventative Task Force came out with their recommendation in 2012. And those harms are a false positive rate of 15 percent. That means that 15 percent of men with an elevated PSA may not have prostate cancer at all and undergo unnecessary testing. When I say unnecessary testing, that primarily means a prostate biopsy, and a prostate biopsy can have complications. Also, there is a real risk of overtreatment. Most of the prostate cancer that’s diagnosed with the prostate biopsy ends up being low-grade prostate cancer, also what we call indolent prostate cancer. Yes, under the microscope, the cells are abnormal, and it’s technically called prostate cancer, but it’s unlikely to negatively impact that man’s life in any way. Also, there’s a risk of over-detection of prostate cancer in men who are older with a lower life expectancy. Prostate cancer is a very slow-growing cancer, and it takes 10 to 15 years for it to progress, and maybe even longer for it to cause death. So there’s not a lot of utility in screening and treating older gentlemen. Host:  So, what do current screening guidelines say about PSA tests then? So, for example, like the US Preventative Services Task Force or American Cancer Society? Dr. Krasnow: As I mentioned, the updated recommendations from the US Preventative Task Force give it a grade C recommendation for men between the ages of 55 and 69. This means that a conversation needs to take place between the physician or advanced practice provider ordering the PSA test and the patient to understand the risks and benefits associated with PSA screening. And really, the American Cancer Society and American Urological Association guidelines have a similar emphasis on shared decision-making. The American Cancer Society updated their recommendations in 2016. They recommended that screening should start at the age of 50 after a conversation using shared decision-making takes place. They also recommend screening, specifically African-American men, starting at the age of 45, and they recommend screening patients with a family history of prostate cancer at the age of 40. The American Urologic Association has similar recommendations. They recommend starting screening a little bit later at the age of 55, but again they emphasize the importance of the patient understanding the benefits and harms of screening before undergoing PSA testing. The American Association of Family Physicians hasn’t revised their recommendations in some time, but they do not recommend screening at this time. Host: As a younger male, how is a man supposed to know which guidelines to follow? Dr. Krasnow: There really is no right or wrong guideline to follow. The key is that the patient themselves has to engage in the decision-making process with their provider to decide whether they should undergo PSA testing or not. They need to understand the benefits of PSA testing, that PSA testing can lead to a decrease in the risk of a prostate cancer mortality, but they also need to understand that you have to screen a lot of patients before you save even one person, and the treatment for prostate cancer has its own risks associated with it. One person may feel that they don’t want to undergo that type of test for what they find to be minimal benefit. Another person may say, “You know what? I want to know if I have cancer, and if I have it, I want to treat it, because I don’t want to face the long-term consequences of having a cancer down the line.” The other thing to mention is that the detection of prostate cancer with PSA testing may not impact survival as much as we would expect, but there is a lot of benefit to preventing patients from having progressive prostate cancer that either invades into local structures or becomes metastatic. I’ve certainly seen patients in my practice who have advanced prostate cancer that spreads to other organs and they feel that, had they had testing at an earlier stage, an intervention could have been offered sooner. Host: That makes me wonder, you know, have you seen patients like Ben Stiller, who is a younger male than I guess what is presented in those guidelines to follow, in which this test found the cancer really at the really early stage of their lives, or have you seen patients who went through a biopsy and it turned out that the test was false positive? Dr. Krasnow: I’ve definitely seen both of these types of scenarios. I have a specific patient in mind that I treated. He was a very young gentleman. He was less than 50 years old, who ended up getting a PSA test because he had some urinary symptoms. In reality, based on the strict screening guidelines, he may not have needed a PSA test at all because he was less than 50, but it was warranted because he had some urinary symptoms. His PSA was very, very high. At that point, we did a prostate biopsy on him and it showed only a very small focus of low-risk cancer, but something didn’t make sense. His PSA should not have been that high for having such a low, small focus of cancer on the biopsy. So we had a long discussion about what the next step should be. Should we continue PSA testing? Should we treat? Should we do an MRI? We ended up doing an MRI, which showed an area that was of concern for a higher-risk cancer. We then discussed the potential treatment options, and he elected to undergo a radical prostatectomy using the robotic platform. And at the end of the day, his final pathology was a very high-grade cancer that left unchecked would likely have led to a lethal prostate cancer, so I was very relieved that he had had that PSA test and that we had intervened. On the other side of the spectrum, I’m often referred patients in their 70s, mid-70s or patients who have a lot of medical, what we call comorbidities. That means they have a lot of other medical problems—heart problems, lung problems, vascular problems, and they end up being referred to me for elevated PSA and for a biopsy. And when I meet with them, I say, “You know what? We should not biopsy you because we’re likely to find prostate cancer or likely to find an indolent prostate cancer, but it’s unlikely to ever affect you in your lifetime. So, I feel that I have avoided overtreatment in many patients as well. I think the key is to be smarter about testing, being more selective. Host: How do you advise men regarding prostate cancer screening and do you find the test valuable, or do you think more men are harmed than helped because of false positives? Dr. Krasnow: Let’s not forget that prostate cancer is by far the most common cancer in men. Over 160,000 men are diagnosed with prostate cancer each year, and it’s the number 2 cause of cancer death in men with 26,000 men dying of prostate cancer each year. This number is really comparable to breast cancer in women. Since the inception of PSA testing, there has been a sharp decrease in prostate cancer mortality. Approximately 1 out of 7 men in the US will be diagnosed with prostate cancer during their lifetime, and nearly 2.8 percent of men will die from the disease. We’ve discussed how PSA testing can decrease prostate cancer mortality and that treatment is associated with better survival over just watching it, so yes, I think that we definitely can help patients through PSA testing, but we can cause harm if we test the wrong patients. So, we really need to engage in smarter PSA screening. I think an important key is the shared decision-making so that patients really understand the benefits and risks associated with testing. I think we need to be smarter about screening patients who are at an increased risk of prostate cancer, such as African-American and those who have had a close family member with prostate cancer. I think that it’s reasonable to start screening even at an earlier age, such as 50 or below, and I think that there is now data that suggests that a low PSA at the age of 50 may suggest that you don’t need any further testing, and so I think that is something that’s coming down the line. It’s important that we don’t test patients who have a life expectancy of less than 10 years because they’re really unlikely to derive any benefit from the testing and any further workup or treatment could definitely result in harm. I really advocate for stopping screening at the age of 70, except in only rare situations where someone is extremely healthy for their age, has a long life expectancy and, for whatever reason, is extremely burdened about the health of their prostate. I think it’s important that we check PSA in men with urinary symptoms, especially before procedures or treatment of benign prostatic hyperplasia, like the young gentleman I told you about earlier. Host: Dr. Krasnow, are there certain men who are at risk for prostate cancer and should be screened earlier or more frequently? Dr. Krasnow: Absolutely. There are populations of men who are at increased risk of prostate cancer. Race is strongly correlated with prostate cancer mortality. African-Americans have at least double the incidence of prostate cancer compared to white men. And it’s not only that the incidence is higher. They have an increased risk of high-risk prostate cancer and they have a 2 to 3 times increased risk of dying from prostate cancer, so not only is this a population that’s underrepresented in the medical literature, but they’re at increased risk of having an adverse outcome from prostate cancer, so it’s more important that we screen in that population. Another important population that I talked about earlier is men with a family history of prostate cancer, and when I say family history I specifically mean those who have a father or a brother with prostate cancer. They have a much higher risk of developing prostate cancer, and again, more importantly, a higher risk of dying from prostate cancer. And studies suggest that screening in those patients with a family history may decrease prostate cancer death by 50 percent. We are also developing a better understanding of those who may have an increased genetic predisposition to prostate cancer. For example, one of the most common causes of breast cancer is a gene mutation called the BRCA gene, associated with breast and ovarian cancer in women. And what we’re learning now is that men who have this mutation also have an increased risk of prostate cancer and an increase in lethal prostate cancer. Now we know that men who have a family history of breast cancer in the women in their family should also be more aggressively screened for prostate cancer. Host: So, to me it sounds like the PSA test and the screening, it’s effective. What’s the future for prostate cancer screening? Are there better methods coming down the pipe? Dr. Krasnow: I definitely think that PSA testing is effective when used in a smart fashion in patients who are younger and in patients who are more likely to die from prostate cancer. But the test could definitely be improved. Also, we’re understanding that just because a man has a diagnosis of prostate cancer doesn’t mean that we have to treat them for prostate cancer. We can effectively prevent prostate cancer death by watching the cancer closely. But, there are better methods coming down the pipeline. There’s a lot of interest in earlier screening for prostate cancer, but not yearly screening. There was recently a publication by my colleague, Mark Preston, in the Journal of Clinical Oncology that showed that by essentially screening with a single PSA test at a younger age, if your PSA value is below a certain cutoff, you may never need PSA screening again for the rest of your life, and I think that’s a very exciting proposition to say, OK, at the age of 45 we are going to do one PSA test. If it looks OK, we never have to do it again. That would certainly prevent screening in a large amount of patients, but we’re not there yet. Also, we’re better integrating advanced imaging into the diagnosis of prostate cancer. Specifically, I mean MRI for prostate cancer—magnetic resonance imaging. This type of imaging has increasingly been used in men who had an elevated PSA and have had a negative biopsy, but a scary high-level PSA, and it can be used to see prostate cancer that you can’t see on the ultrasound and detect by routine biopsy. Now there is data that suggests that we may be able to push the MRI into an earlier phase and use it in the screening process, so instead of the process being an elevated PSA leading to a negative biopsy, leading to an MRI, leading to another biopsy, maybe a smarter way to do it is an elevated PSA, leads to an MRI, and then if there is something suspicious on the MRI, then we do the biopsy. This is new because up until recently the MRIs haven’t had a high enough resolution to really see prostate cancer. There’s also better biomarkers for prostate cancer. One is called the 4K score. It uses not just PSA, but PSA that’s found in the blood and PSA that’s further broken down by the body, and it may also be useful in screening patients who have an elevated PSA prior to biopsy to better detect those who may just have a lethal prostate cancer. And, in fact, MRI and these new biomarkers, like the 4K score, have recently been integrated into the NCCN guidelines. So, we’ve made a lot of progress in how to intelligently use PSA testing for the screening of prostate cancer. I think that we have more work to do, but it’s looking even more promising, and I’m hopeful that we can further reduce the burden of screening and the harms of screening through these new technologies. Host:  That is really great news. I especially liked the part where you were telling us about how we can do it just one time at the age of 45 or so, and then never have to do it again. Hopefully, that time will come soon. Dr. Krasnow: I hope so. It’s early data now, but it’s looking like that may be promising. Host: Thank you very much for joining us today. Dr. Krasnow: It was my pleasure. Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Hello and welcome to the ASCO Guidelines Podcast Series. My name is Shannon McKernin, and today I'm interviewing Dr. Justin Bekelman from University of Pennsylvania Perelman School of Medicine, lead author on "Clinically Localized Prostate Cancer: ASCO Clinical Practice Guideline Endorsement of an AUA/ASTRO/SUO Guideline.” Thank you for being here today, Dr. Bekelman. Thanks for having me. First, can you give us a general overview of what this guideline covers? Sure. So this guideline addresses the key question about what is the current best practice available for the management of localized prostate cancer. It's an endorsement guideline, which means it reinforces the recommendations offered by the American Urologic Association, ASTRO, SUO, which is the Society of Urologic Oncology. In April of 2017, these three groups got together to release a joint evidence-based practice guideline on clinically localized prostate cancer. And then, now more recently, in 2018 ASCO assembled a panel to review those policies, update them, and endorse them as appropriate. So this guideline has over 60 recommendations. So I'm not going to ask you to read through all of them. But can you talk about some of the key topics and discussion points that was added by the ASCO expert panel? Yeah, absolutely. I'd like to highlight four areas. The first area-- panel endorsed guideline recommendations on active surveillance for men with low risk Gleason 6 prostate cancer, what's called grade 1 prostate cancer now. The panel also felt it reasonable to add that ASCO has also produced a guideline on active surveillance which provides more context and counsel for clinicians and patients. It also includes a discussion of how surveillance might be considered for men with low volume Gleason 3+4, or what's called grade 2 cancers. And so I would reference that ASCO guideline on active surveillance for folks who are interested in that. Second, panel updated the recommendation regarding the length of androgen deprivation therapy or hormone therapy for men with higher risk clinically localized prostate cancer. Prior recommendations considered 24 to 36 months to be appropriate. And that's what's captured in the 2017 guidelines from the AUA, ASTRO, and SUO. But new evidence released after those guidelines were published from two trials-- one called RADAR and one called PCS IV trial-- shows that 18 months may be equivalent and permissible, and thus these trials should be followed really closely. But that's really interesting, provocative information for patients as they consider adjuvant hormone therapy for high risk cancers when they're receiving radiation. Third, the panel describes two really high impact quality of life studies comparing surgery, external beam radiation, and brachytherapy that were published in JAMA in 2017, again, after the AUA guideline was published. These two studies are actually summarized in the discussion of the panel findings. And they are an excellent reference for both clinicians and patients as they consider the potential benefits and harms of the various treatments for prostate cancer. The last one I'd want to highlight to the audience is the panel's recommendations regarding cryosurgery. And even though the original guidelines stated that selected patients are candidates for cryosurgery, the panel found that there was insufficient evidence to support the use of cryosurgery for clinically localized prostate cancer. So those are four highlights from the evidence based review. And why is this guideline so important? And how will it change practice? This guideline represents the most up to date consensus recommendations from the major professional societies that represent clinicians-- the surgeons, the radiation oncologists, the medical oncologists-- who counsel and treat men with prostate cancer. So it's a really important initial original guideline and then a really important endorsement. I think it will change practice by highlighting what the current best practice standards of care are for clinically localized prostate cancer. And finally, how will these guideline recommendations affect patients? I think this guideline will have an immediate impact on important questions that patients and their clinicians want answered. I think that's how the panel actually took its role, is thinking, how can we both endorse and provide further evidence that would be patient centered as we considered these guidelines. So this endorsement and the guidelines, they ask questions like, how should we conduct shared decision making with our patients to offer the highest chance that treatment decisions will be concordant with our patient goals of care? That's number one and so crucial. Who is appropriate for active surveillance? A top topic for men facing clinically localized prostate cancer. What are the differences and side effects among the major treatments for clinically localized prostate cancer, mostly focused on surgery and radiation? The endorsement updates the latest data through 2017 and even in 2018 with really patient-centric information about what patients might expect with each of these treatments. Even what are the aspects of prostate cancer care that represent the highest quality? And how might patients assess that? What are the most important aspects of survivorship? So the endorsement and recommendations from the original guidelines themselves hit on each of these. And I think that patients will find them very interesting and insightful. Great. Thank you so much for your time today. And thank you for your work on this important guideline, Dr. Bekelman. Oh, my pleasure. And thank you to all of our listeners for tuning in to the ASCO Guidelines Podcast Series. If you've enjoyed what you've heard today, please rate and review the podcast and refer this show to a colleague.

“Discovery requires serendipity but serendipity is not a chance event alone. It is a process in which a chance of event is seized upon by a creative person who chooses to pay attention to the event, unravel its mystery and find a proper application for it.” In this episode of Made You Think, Neil and Nat discuss Happy Accidents by Morton A Meyers. In this book we look at the serendipity of so many scientific discoveries and the author suggests how we can foster these chance happenings to make giant leaps in research and discovery. “Penetrating intelligence, keen perception, and sound judgment — is essential to serendipity. The men and women who seized on lucky accidents that happened to them were anything but mindless. In fact, their minds typically had special qualities that enabled them to break out of established paradigms.” We cover a wide range of topics, including: Penicillin, Petri Dishes and Moldy Mary The impact of freedom on research Tangents on Private Schools, Social Media & Conspiracy Theories Modern Diets, Drugs and Toxins turned into cures Self experimentation, Ostracism and changing Medical opinions A possible special kayaking retreat for supporters And much more. Please enjoy, and be sure to grab a copy of Happy Accidents by Morton A Meyers! You can also listen on Google Play Music, SoundCloud, YouTube, or in any other podcasting app by searching “Made You Think.” If you enjoyed this episode, be sure to check out our episodes on Skin in the Game by Nassim Taleb where he shares other stories of scientists trying treatments firsthand, and Merchants of Doubt by Naomi Oreskes and Erik Cornway for more on controversial science, academia and Pharma companies. Be sure to join our mailing list to find out about what books are coming up, giveaways we're running, special events, and more. Links from the Episode Mentioned in the show Bottom Up Methodology [01:31] Scientific Method [1:48] Penicillin [05:27] LSD Discovery [05:48] Contact High [06:01] Dogmatic [06:19] Petri dishes [08:01] Lifehacker [08:47] The Structure of Scientific Revolutions by Thomas S. Kuhn [9:31] Narrative Fallacy [16:17] Fleming Nobel Prize Speech [17:38] Peoria, Illinois [26:03] Corn Steep Liquor [26:09] Merck [26:48] Squibb [26:48] Pfizer [26:48] World War I [27:42] Aquatic Apes [29:04] Sippy Diet [30:27] Tetracycline Antibiotic [31:47] Acid Inhibitors [34:14] Statins [34:36] Carbohydrates [36:16] LDL [36:20] LDL receptors [36:33] Viagra [38:26] Asbestos [39:46] Facebook Groups [42:14] Discord Groups [42:15] Carnivore Diet [42:49] Shake Shack [44:04] M&M’s [44:07] Purina Dog Food [46:08] Stats of College Debt – Tweet [46:32] CMU [52:40] Choate School [53:45] Sidwell Friends [54:23] Boarding Schools [54:34] Alkylating Agents [57:15] Geneva Convention [58:08] Patreon [01:02:08] Google Trends on episode 35 [1:02:00] Epidemics [01:02:27] SARS [01:02:54] Influenza [01:02:56] Syphilis [01:03:22] Fish Aquarium Antibiotics [01:04:53] FDA [01:07:51] Nazi Testing [01:08:04] Japanese testing on Chinese prisoners [01:08:08] Tuskegee Study of Untreated Syphilis in the Negro Male [01:08:19] Eugenics [01:10:18] Darwinism [01:10:31] (related podcast) Russian Gulag [01:11:38] Thalidomide [01:11:52] Diethyl Glycol [01:12:59] Food, Drug and Cosmetic Act [01:13:10] Accutane [01:15:06] Doxycycline [01:16:26] Microbiome [01:16:52] Eczema [01:17:43] Steroids [01:17:36] Spartan Race [01:20:09] Nat’s Instagram [01:20:15] Blockchain [01:21:06] X-Rays [01:22:29] Morphine [01:23:51] American Urological Association [01:24:48] CVS patient statistics for Viagra [01:29:42] Netflix [01:31:18] Spleen [01:32:47] Confirmation bias [01:34:43] Ego death [01:39:38] Dissociative experience [01:39:40] Magic mushrooms [01:40:02] LSD Therapeutic Research Study [01:41:03] NASA [01:46:22] Direct to Consumer Drug Advertising [01:46:29] ADD [01:47:41] Premenstrual Dysphoric Disorder [01:47:58] Prozac / Seraphim [01:48:09] Paxil [01:48:18] Female Sexual Dysfunction [01:48:24] Lipitor [01:48:57] Zoloft [01:49:16] UBI [01:53:07] Ethereum [01:59:48] Books mentioned Happy Accidents by Morton A Meyers Beginning of Infinity by David Deutsch [00:42] (book episode) The War on Normal People by Andrew Yang [00:51] (book episode) Antifragile by Nassim Taleb [07:02] (Nat’s notes) (book episode) The Structure of Scientific Revolutions by Thomas S. Kuhn [9:31] Boron Letters by Gary C. Halbert [14:44] Skin in the Game by Nassim Taleb [30:00] (Nat’s notes) (book episode) Merchants of Doubt by Naomi Oreskes and Erik M. Conway [01:02:02]] (Nat’s notes) (book episode) Merchants of Doubt by Naomi Oreskes and Erik M. Conway [01:02:02] (Nat’s notes) (book episode) Homo Deus by Yuval Harari [01:02:36] (Nat’s notes) (book episode) Words that Work by Frank Luntz [01:28:24] LSD My Problem Child by Albert Hofmann [01:40:51] Brave New World by Aldous Huxley [01:48:46] People mentioned Morton A Meyers David Deutsch [00:42] (Beginning of Infinity episode) Andrew Yang [00:51] (The War on Normal People episode) Winston Churchill [05:04] Alexander Fleming [05:29] Nassim Taleb [07:02] (Antifragile episode) (Skin in the Game episode) Thomas Kuhn [09:21] Peter Thiel [10:12] Gary C. Halbert [14:44] Charles Darwin [18:39] (Daniel Dennett’s book) Ernst B Chain [22:31] Moldy Mary [25:56] Barry Marshall [31:07] Robert Koch [32:10] Bill Clinton [01:00:32] George W Bush [01:01:18] Erik M. Conway [01:02:02] Yuval Harari [01:02:45] (Homo Deus episode) (Sapiens part I and part II) FDR [01:13:08] Claude Bernard [01:22:24] Frank Luntz [01:28:24] John William Gofman [1:31:35] President Eisenhower [01:34:48] Timothy Leary [01:40:28] Albert Hofmann [01:40:51] Steve Jobs [01:41:00] Louis Pasteur [01:45:32] Aldous Huxley [01:48:46] Show Topics 00:26 – The book is fun to read, light, enjoyable, easy going. An exploration of scientific discovery and progress and how consistently it is influenced and driven by the role of Serendipity. A case opposite or complementary to the Scientific Method. Serendipity defined as a combination of accidents and sagacity. 05:05 – Not all discoveries are immediately realized or understood. Winston Churchill – “Men occasionally stumble over the truth, but most of them pick themselves up and hurry off as if nothing had happened”. Penicillin and LSD examples. The dangers of being dogmatic without leaving room for the unexpected. 06:53 – Central theme of the book–How do you foster that serendipitous mindset? Nassim Taleb says that serendipity comes from chance encounters, like a cocktail party. The potential gain from a chance encounter is worth the effort of stepping outside your comfort zone. 07:42 – Trying to harness serendipity for your own benefit. Serendipity through disorder and randomness. Investigating how scientists can foster serendipity in their lab work and how academia and education and research grants, peer review could change because of that. 09:41 – Normal vs revolutionary science, Meyers is dismissive of puzzle solving. Normal science is making incremental improvements on existing knowledge, whereas serendipity fosters revolutionary discoveries as they come from a change in the ordinary methods. 10:51 – Two stages to serendipity. You need something unusual to happen and you have to recognize it to take advantage of it too. 11:21 – Innovation departments rarely come up with paradigm-shifting ideas and products. Need a certain mindset to make the most of these opportunities. Reason, intuition and imagination. Too much experience in a field can cloud your judgement on new ideas. 13:51 – The book is primarily about serendipity in medicine and science but it can be applied to most fields. Breaking out of the norm and finding inspiration for innovation in other industries. Looking at magazines to apply to blog copywriting. 15:33 – "Analogical thinking has certainly been a cornerstone of science." Another theme in the book is looking for one thing but ending up on a totally different path. All of the people making discoveries seemed to have a level of independence in their research to follow a new path when it interests them. The narrative fallacy involved in serendipitous scientific discovery or startups growth. 17:40 – Alexander Fleming and discovery of Penicillin as anti-bacterial.  Fleming said that if he was working on a research team at the time it would have been ignored as it wasn’t what he was working on. Being free allows you to pursue these anomalies. 19:04 – Darwin and the finches in the Galapagos. Being told to go and study something brings different results than if you’re free to follow your own curiosity. The constraints of research impose harmful limits on discoveries. 19:54 – Structure of the book is Introduction of the premise, 30+ chapters of examples and the conclusion. Myers suggests at the end of the book that the structure for scientific research and funding is counter to the ability for these serendipitous events to happen. 20:50 – More on Fleming and Penicillin. Odds of it happening were astronomically low. He was away for two weeks and on returning and viewing his petri dishes on his desk discovered an anti-bacterial zone around the mold. It wasn’t until 7 years later that another researcher realized what he had found. 23:09 – For Fleming it took a number of environmental factors that allowed Penicillin to be discovered at all: heat, location, time. Penicillin wasn’t originally pitched as a drug, originally suggested as a way to isolate bacterial colonies. Then there was the huge scale up and production process of the drug. Peoria (IL), the role of corn syrup, and the mold discovered by chance. 29:00 – Bonus Material Discussion, Aquatic Apes, Patreon, future episode ideas. 29:52 – Causes of ulcers, used to be thought of as stress and spicy food. Discovery that it is caused by bacteria in 1981. Marshall ran an experiment on himself to take the bacteria, give himself ulcers and cure himself with antibiotics. Pharmaceutical industry had a strong incentive to not prove this as the cause, current drugs of acid inhibitors were reaching sales of $6 Billion dollars in 1992. 35:04 – Pharma companies lobbying to decrease acceptable cholesterol ranges to induce more people into treatments. Changing opinions of statins within last 10 years. Effects of low cholesterol on longevity, links to all-cause mortality. Reducing cholesterol and precursors to creating testosterone in diet has lead to a reduction in testosterone and erectile dysfunction requiring a need for Viagra. 39:59 – What are we currently doing in society now that we will look back on and question in the future? Possible future problems associated with over consumption of social media. Mental and physical health complaints are unknown. 41:53 – Pull away in society from open sharing, moving towards private communities. Effectiveness of diets, feeling good vs having long term health benefits. Benefits of adopting a new diet may be equal to reducing other harmful choices – like stopping drinking for a month. The changing conventions of meal-times, quality of dog food, college debt. 47:12 – Tangent. Education and the need to change the K through 12 program instead of starting with College reform. The benefits of private vs public school. Mixing with different socioeconomic backgrounds, expense of private school. Both build very different sets of social and academic skills. Bay Area dystopia, where citizens pay lots in taxes that go into public schools, but parents end choosing private ones. 55:53 – Chemical weapons, World Wars and the changing use of toxins into cures. Bombing a ship leading to the first chemo treatments for cancer. North Korea and the development of nuclear tech (more info in the Bonus material). Google health trends being able to predict health outbreaks based on search volume. Sex hormones and noticing the change of tumors in animals after castration. 01:07:55 – Consequences of controversial testing on wartime prisoners that have given us useful data. Study of African-American men with syphilis, they were told they were having free medical treatment but they were mislead and were being studied for the untreated effects of syphilis over 40 years. Possibilities of current testing on prisoners or other conspiracies. 01:11:52 – History of Thalidomide being marketed as a sedative and pain management. Widely distributed before it was realized it had the side effect of severely inhibiting fetal development. U.S avoided this because the FDA already setup due to a drug being administered alongside Diethyl Glycol which was toxic, killing over 100 children. Testing required before products could be marketed. Thalidomide now used as an anti-cancer drug as it inhibits new blood vessel growth. 01:15:05 – Acne treatments and the imbalanced side-effects on fertility. Use of cleanser on the face strips natural oils. Use of antibiotics for acne which causes destruction of the microbiome. Latex gloves that may transmit more bacteria than your hands. Effects of steroids and keto on curing eczema. Nat not using shampoo even after a Spartan race. Body naturally cleansing. 01:21:06 – Tangents, aquatic apes, blockchain, negative reviews. 01:21:59 – Heart chapter and testing of catheterization. Self-experimentation and the need to prove theories. Ostracism and dangerous procedures. 01:24:44 – Viagra, originally for treating angina, it was found that this medication increased blood flow and became a cure for impotence – renamed to erectile dysfunction. Self-experimentation on erectile dysfunction. "The annual scientific meeting of the American Urologic Association is usually a pretty staid Affair but one meeting has entered the annals of folklore in the early 1980s. During the course of his lecture on the effectiveness of injecting substances directly into the penis to increase blood flow one urologist announced that he had performed such injections on himself only an hour earlier. Stepping from behind the lectern and he dropped his trousers and proudly demonstrated to the audience his own erect manhood. Urologists who attended this meeting still shake their heads at the memory." 01:28:00 – The power of names and the words used, like pro-life and pro-choice. How you phrase something changes the impact. Pharmaceuticals changing the names of conditions to promote sales of new drugs. Sales of Viagra were $780 Million in the first 9 months of 1998. 01:30:02 – 1% of women take Viagra to increase arousal and sensation and orgasm strength. Netflix’s biggest competitor is sleep, Viagra’s biggest competitor is death. 01:31:48 – Cholesterol testing on rabbits. Cholesterol data seems outdated with the book being 11 years old. Comparison of Chinese soldiers and lifestyle and diet. Lack of nutrition education in Doctors, mostly educated by pharmaceutical companies. People seem to want to take a pill rather than change their lifestyle or diet and doctors have lack of trust in the patient that they will try to improve their own situation. 01:38:07 – Psychiatric stuff. Hoffman discovering LSD by accidentally pouring it over his skin. LSD microdosing experiences. 01:42:40 – Tangents on kayaking, LSD microdosing and the Made You Think – Patreon $1000 Tier. 01:43:06 – Conclusion. Modern sciences are antithetical to the process of serendipity and how our institutions penalize our ability to take advantage of it. Government contracts and grants impose constraints. If you're getting money to research a specific topic you will be disincentivized from exploring things that deviates. If you're a free agent, then you can run down those rabbit holes. 01:44:31 – Peer reviews. Most businesses are judged by their customers but academia is judged solely by their peers. Ostracism as a consequence of investigating fringe theories. Direct to consumer advertising for drugs. Diseases and disorders that seems to be created and renamed just to increase drug sales. Long terms effects of drugs. 01:52:19 – On Patreon you get all kinds of goodies. Bonus materials, detailed notes for each episode and book highlights. You get a space to discuss the show with both of us. You can also join for our monthly live Hangouts. If you join the $1000 a month tier you can join us for a major excursion – Made You Trip! 01:54:57 – Patreon is a great way to support the show and let us keep doing this ad free. So we don't have to break up the episode with ads and we keep rolling with the tangents. 01:55:48 – Leave a review on iTunes that is super helpful for us because we show up as a recommended podcast and also is a great way for us to book guests. Other ways to support the show, you can go MadeYouThinkPodcast.com/support and tell your friends. 01:57:58 – If you want to talk to us, you can talk to us on Twitter anytime. I'm @TheRealNeilS and I am @NatEliason. If you're shopping on Amazon click through on our link. We super appreciate that.  All right, we will see everyone next week. See you guys next time. If you enjoyed this episode, don’t forget to subscribe at https://madeyouthinkpodcast.com

November is National Bladder Health Awareness Month.  According to the Urology Care Foundation the cost of treating bladder problems in the United States is 70 billion dollars annually. For National Bladder Health Awareness Month, we are talking about bladder cancer. Bladder cancer is the 5th most common non-skin cancer in the United States. It is the 4th most common cancer diagnosed in men and by the Veterans Affairs Health System. Nearly 600,000 Americans live with bladder cancer today and 75-80,000 people will be diagnosed in the United States with bladder cancer this year. An estimated 16-17,00 people will die from bladder cancer this year. In the last episode, we talked about bladder cancer growing as a papillary tumor. It begins on the surface of the bladder, in the lining cells of the bladder called transitional cells. Most bladder cancers then grow into the inside of the bladder on a stalk. As tumors grow, however, they can grow roots and invade into the deeper layers of the bladder. As tumors invade the chance that the cancer metastasizes and spreads to organs beyond the bladder increases. Superficial tumors can be resected from the surface of the bladder as their only treatment. Higher stage and recurrent tumors will need to be treated with other treatments such as instillation of BCG, chemotherapy, or even removal of the bladder. This year the American Urologic Association, in collaboration with other oncologic societies, published guidelines for the treatment of muscle invasive bladder cancer. The guidelines were presented at the 2017 Annual Meeting. You can find the guidelines as well as other AUA guidelines at http://www.auanet.org/guidelines/muscle-invasive-bladder-cancer-new-(2017). Muscle invasive bladder cancer is a challenging problem in urology. The introductory paragraphs of the AUA guidelines gives the scope of the problem that muscle invasive bladder cancer is for patients and physicians: “Although representing approximately 25% of patients diagnosed with bladder cancer, muscle-invasive bladder cancer (MIBC) carries a significant risk of death that has not significantly changed in decades…In patients who undergo cystectomy, systemic recurrence rates vary by stage…Most recurrences will occur within the first two to three years…and…most patients with recurrence after cystectomy are not curable. …There is also a significant impact of treatment choices on outcome with the type and timing of therapy playing an important role.”  I am going to repeat that statement. “There is also a significant impact of treatment choices on outcome with the type and timing of therapy playing an important role.” Losing one's bladder, even if it is lifesaving, causes significant impact in a person's quality of life, and many patients and physicians choose to delay or defer surgery when it could be curative. Urologists, as we will discover, have always sought ways to restore or retain the quality of life for patients whose bladder must be removed because of cancer. If we choose the right treatment at the right time we can make progress in treating muscle invasive bladder cancer. I am going to go through the AUA guidelines.  There are 35 of them. Don't worry, I will not be going through each guideline individually but rather group them together into brief discussion points that patients who have muscle invasive bladder cancer and their physicians must think about before, during, and after the removal of the bladder. Guidelines 1-5 concern the initial evaluation and counseling. Full history and physical examination should be performed, the patient should have a staging evaluation with imaging and laboratory evaluation, and the patient should have a full discussion of curative treatment options. A complete discussion with regard to implications for quality-of-life should be discussed with the patient, including the type of urinary diversion. A multidisciplinary approach including surgical, chemotherapy and/or radiotherapy options should be discussed with patient. Guidelines 6-9 discuss either preoperative or postoperative chemotherapy. Chemotherapy should be offered to eligible patients prior to radical cystectomy although the best regimen for neo-adjuvant chemotherapy remains undefined. Guidelines 10-12 concern the radical cystectomy operation. Radical cystectomy should be offered to patients along with bilateral lymphadenectomy for surgically eligible patients. Standard radical cystectomy in the males includes removal of the bladder, prostate, and seminal vesicles. In females, the operation includes removal of the bladder, uterus, fallopian tubes, ovaries and anterior vaginal wall. The potential impact of sexual function and other quality of life issues after surgery for both men and women should be discussed prior to the operation. Guidelines 13 and 14 relate to urinary diversion. When the bladder is removed, an alternative to store and drain the urine must be created. Options for urinary diversion after removal of the bladder including ileal conduit, continent cutaneous diversions and ortho-topic neo-bladders. The choice of urinary diversion has a significant impact on long-term quality of life for patients who undergo radical cystectomy. Each type of diversion is associated with its own unique potential complications. Your surgeon will help you decide what type of urine diversion is right for you. I am not trying to be cute here but speaking of diversion, I want to take a step away from the guideline statements at this time and look at one of the articles from the 100th anniversary of the Journal of Urology published this year, a collection of reprints that highlight different eras and advances in Urology over the last 100 years. You can find the articles at JU100.org. I've highlighted some of these reprinted articles over my last few episodes. We have also been highlighting how “otherwise cautious urologists are also adventurous surgeons,” a phrase that struck me from the editor's introduction to the anniversary edition. One of the articles that was reprinted was a 25-year retrospective for one type of procedure for urinary diversion no longer used today called the Camey procedure. The original article was published in the Journal in 1984. Camey began doing his procedure in the late 1950s.  The Camey procedure is a type of urinary diversion isolating a 40-cm segment of ileal small bowel, attaching the ureters to either end and sewing the mid-segment of the isolated ileum to the remaining urethra after the bladder is removed. 84 patients were reviewed by Camey in his 25 year-experience. Dr. Camey's review paper is fascinating to read. In his paper Dr. Camey gives details about his experience, both his success as well as his failures. Let's hear him tell us about his first five patients. “The historical evolution of the current technique of bladder replacement can be divided into intervals of error, analysis, and correction. The first patient bladder replacement was attempted achieved continence. The second patient, operated upon a few days after the first, died within 15 days postoperatively…. The first functional enterocystoplasty in which total continence was a seen was performed in 1959 (patient #3). Pelvic lymphadenectomy revealed positive nodes and the patient died of carcinoma in 18 months… In an attempt to minimize infection, foreign body reaction and so forth, ureteral were not used in patient number four. This procedure proved disastrous when the patient became anuric secondary to edematous obstruction of the bilateral implants. As a consequence, bilateral ureteral stents delivered through the urethra and held in place by attachment to an indwelling urethrovesical 22 French straight catheter sutured to the penis have been used in all subsequent procedures. As a consequence of patient 5 the final U-shaped enterocystoplasty emerged. The error in this case was a graph design in which both ureters where anastomosed to the isoperistaltic end of the ileal loop with the distal end anastomosed to the urethra. This procedure resulted in peristaltic waves abutting against the urogenital diaphragm causing urinary frequency and leakage. Despite this deficiency the patient was the first long-term survival (15 years) with preservation of excellent renal function and electrolyte balance.” I will stop reading from Camey's article. It just gives us some idea of how this otherwise cautious urologist needed to be an adeventurous surgeon to make his breakthrough. As I said, the Camey procedure is no longer performed. This has been replaced by other types of urinary diversion and neo-bladder with other names such as Indiana, Hauttman, Studer, and Koch. The newer diversions use de-tubularized segments of bowel. The bowel is designed to contract in a coordinated peristalsis and move contents through it. Because of the coordinated peristalsis the pressures within a tubular segment of bowel will push urine through it rather than store the urine.  By de-tubularizing the bowel, we disrupt the peristaltic waves of the bowel and it begins to store the urine under low pressure. The different types of diversion deserve a whole podcast to themselves. Let's return to this podcast and the guidelines. Guidelines 15-18 relate the perioperative management of patients. Optimization of patient performance status and health prior to cystectomy and optimized recovery pathway protocols will enhance recovery. Guidelines 19 and 20 discuss the role of extended lymphadenectomy during the procedure. Guidelines 21through 29 discuss bladder sparing protocols for those patients not eligible for radical cystectomy or who choose to keep their bladder. For these patients, maximal trans-urethral resection of the bladder tumor should be performed. This is typically combined with a combination of radiation along with chemotherapy and close follow-up. Recurrences after bladder sparing techniques should be treated aggressively. Guidelines 30-34 relate to patient surveillance and long-term quality of life issues. Frequent imaging and laboratory assessment are appropriate for those who have undergone treatment to check for recurrence. For those patients struggling with their diagnosis there are number of bladder cancer support groups that would love to speak with you. The last guideline number 35 relates to unique, less common cancer types that may require variance from any of the above guidelines. Your surgeon will help you understand if you fall into one of these categories. The radical cystectomy, lymphadenectomy and the urinary diversion is one of the longest and most complicated procedures that a urologist does. In his conclusion, Dr. Camey wrote, “As a cautionary note the successful performance of this operation depends on an unusual degree of commitment to meticulous technique. The procedure is tedious and stressfully long, and requires a team approach that is logistically complex and not universally feasible.” Dr. Camey's operations routinely took 9 hours. He employed two sets of surgeons for the operation, one to remove the bladder and the other to do the urinary diversion. As urologists have gained surgical experience, operative times have improved.  For my partners and I it takes 2-4 hours to remove the bladder, perform the lymphadenectomy, and create the simplest urinary diversion, the ileal conduit. The current standard in my practice is to perform the removal of the bladder robotically using the daVinci system. But the urologic oncologist's long-term success and survival for patients with muscle invasive bladder cancer have not changed in the last 30 years. In his conclusion Dr. Camey writes, “The ancillary modalities, such as chemotherapy, immunotherapy, radiotherapy, antibiotic prophylaxis and nutritional supplementation, which may improve survival further must be perfected….” By creating the guidelines listed above the AUA and other various societies have for the first time come to an agreement about the best approach for these patients to give the highest chance of long-term success. I will end with some of the websites where you can find more information or support if you find yourself with this disease. Helpful websites include the Bladder Cancer Advocacy Network (http://www.bcan.org), Cancer Support Community (https://www.cancersupportcommunity.org), Cancer Care (https://www.cancercare.org), the American Bladder Cancer Society (https://bladdercancersupport.org), the American Cancer Society (https://www.cancer.org), and the Urology Care Foundation (http://urologyhealth.org). Support groups help reduce the three most significant stressors associated with cancer: unwanted aloneness, loss of control, and loss of hope. For those patients who are not interested in a support group, individual counseling may be available through an oncology social worker, psychologist, or local religious organizations. Lastly, if you have any questions, need my support, or have any feedback you can contact me at drbrandt@whyurologypodcast.com.

Dr. Brandt reviews prostate cancer screening using PSA testing. Links https://www.auanet.org/education/guidelines/prostate-cancer-detection.cfm  http://www.cancer.org/cancer/prostatecancer/moreinformation/prostatecancerearlydetection/prostate  http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/prostate-cancer-screening   What Does the American Urologic Association recommend?   The AUA has a guideline statement on PSA screening. The guidelines are as follows.  Guideline Statement 1: The Panel recommends against PSA screening in men under age 40 years. (Recommendation; Evidence Strength Grade C)   In this age group there is a low prevalence of clinically detectable prostate cancer, no evidence demonstrating benefit of screening and likely the same harms of screening as in other age groups. Guideline Statement 2: The Panel does not recommend routine screening in men between ages 40 to 54 years at average risk. (Recommendation; Evidence Strength Grade C)   For men younger than age 55 years at higher risk (e.g. positive family history or African American race), decisions regarding prostate cancer screening should be individualized. Guideline Statement 3: For men ages 55 to 69 years the Panel recognizes that the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, the Panel strongly recommends shared decision-making for men age 55 to 69 years that are considering PSA screening, and proceeding based on a man's values and preferences. (Standard; Evidence Strength Grade B)   The greatest benefit of screening appears to be in men ages 55 to 69 years.   Guideline Statement 4: To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce overdiagnosis and false positives. (Option; Evidence Strength Grade C) Additionally, intervals for rescreening can be individualized by a baseline PSA level.   Guideline Statement 5: The Panel does not recommend routine PSA screening in men age 70+ years or any man with less than a 10 to 15 year life expectancy. (Recommendation; Evidence Strength Grade C) Some men age 70+ years who are in excellent health may benefit from prostate cancer screening.

Dr. Marc Richman is a board certified urologist and expert on men's sexual health.  He is a member of the American Urologic Association and has over 10 years of experience.   He is the co-founder of Obsidian Men's Health and more information may be found at www.obsidianmenshealth.com    In this episode he defines erectile dysfunction (ED), talks about risk factors, and shares information about current treatment.   Disclaimer:  The information provided is for educational and entertainment puproses and is not intended for diagnosis or treatment.  Please seek the advise of your health care provider before making any changes to your health