Podcasts about American Urological Association

At the American Urological Association's 2025 Annual Meeting in Las Vegas, Dr. Félix Guerrero-Ramos (ES) presented the first results from cohort 4 of the SunRISe-1 study, assessing TAR-200 monotherapy in patients with Bacillus Calmette-Guérin (BCG) - unresponsive papillary-only high-risk non-muscle-invasive bladder cancer.In this episode, UROONCO BCa chief editor Dr. Benjamin Pradere (FR) interviews Dr. Guerrero-Ramos about the study's design, a detailed discussion of the results, comparisons with other trials such as BOND-003, and the implications for clinical practice. For more updates on bladder cancer, please visit our educational platform UROONCO BCa.For more EAU podcasts, please go to your favourite podcast app and subscribe to our podcast channel for regular updates: Apple Podcasts, Spotify, EAU YouTube channel.

On this episode, Dr. Sadaf breaks down everything you need to know about the newly released American Urological Association guidelines on Genitournary Syndrome of Menopause (GSM). Learn all about this common condition that is caused by low estrogen after menopause, how doctors diagnose GSM, and what symptoms it comes with. This episode is a full breakdown of these new guidelines that are essential towards providing women and their providers with valuable insights and strategies for effectively treating GSM.You can read the new GSM guidelines here: https://www.auanet.org/guidelines-and-quality/guidelines/genitourinary-syndrome-of-menopauseDisclaimer: Anything discussed on the show should not be taken as official medical advice. If you have any concerns about your health, please speak to your medical provider. If you have any questions about your religion, please ask your friendly neighborhood religious leader. It's the Muslim Sex Podcast because I just happen to be a Muslim woman who talks about sex.To learn more about Dr. Sadaf's practice and to become a patient visit DrSadaf.comLike and subscribe to our YouTube channel where you can watch all episodes of the podcast!Feel free to leave a review on Apple Podcasts and share the show!Follow us on Social Media...Instagram: DrSadafobgynTikTok: DrSadafobgyn

Guest: Ihtisham Ahmad Preclinical findings in animal models have shown that activating cannibinoid receptors can shrink prostate tumors in animal models. To explore whether these effects translate to human populations, a recent study examined a potential link between cannabis use and the development of prostate cancer. Hear from Ihtisham Ahmad, a fourth-year medical student at the University of Toronto, as he explains the methodology and findings from his research, which he presented at the American Urological Association 2025 Annual Meeting.

In this episode, Dr. Geo shares a practical guide to choosing the right prostate cancer treatment. Broadcasting from the American Urological Association meeting in Las Vegas, he explains how to navigate overwhelming advice, ask better questions, and make confident, informed decisions based on your diagnosis, values, and personal goals.Key Learning Points:Why it's important to gather multiple opinions before deciding on a treatment.How to weigh treatment options based on potential cure rates and side effects.The role of your personal values and intuition in making the final decision.Why bringing a supportive partner to medical visits can make a big difference.How lifestyle medicine can help reduce the risk of recurrence after treatment.________________________ Introducing The Dr. Geo Prostate Podcast Exclusive MembershipWe'll continue bringing you powerful weekly episodes to support your prostate health journey. But if you're ready to dive deeper, the Exclusive Membership gives you more: curated transcripts, detailed show notes, expert resources, and member-only perks—all designed to help you live better with age. Join HERE [https://drgeo.com/membership]_________________________ Thank you to our partnersThe ProLon 5-Day Fasting Mimicking Diet is a plant-based meal program designed to provide fasting benefits while allowing food intake. Developed by Dr. Valter Longo, it supports cellular renewal, fat loss, and metabolic health through low-calorie, pre-packaged meals that keep the body in a fasting state.Special Offer: As a listener, you can get the ProLon kit for just $148 using this [https://bit.ly/3TVehAx ].We'd also like to thank our partner AG1 by Athletic Greens. AG1 includes 75 high-quality vitamins, minerals, whole-food sourced ingredients, probiotics, and adaptogens to help you start your day right. This blend supports your gut, immune system, energy, focus, and more—all in one daily scoop. https://bit.ly/3mA2tVV_________________________

Guest: Wayne Kuang, MD In an exciting time for diagnostics and therapeutics in urology, the discussions at the American Urological Association's 2025 Annual Meeting are redefining the landscape of men's health. Dr. Wayne Kuang, CEO of MD for Men in Albuquerque and Founder of the ManVsProstate campaign, highlights some of the most anticipated topics at this year's conference, including prioritizing early intervention, preserving vitality, and expanding the focus beyond the prostate to protect the bladder.

In today's episode of The Root Cause Medicine Podcast, Dr. Carrie Jones sits down with Dr. Rena Malik to tackle the often-taboo subject of sexual health and its crucial role in overall well-being. 1. Why sexual health is still a taboo in modern medicine 2. What society gets wrong about sex 3. How to talk about sexual health with your doctor 4. The link between erectile dysfunction and heart attacks 5. How everyday medications could be impacting your libido Dr. Malik is a board-certified urologist with specialized training in Female Pelvic Medicine, Reconstructive Surgery, and Sexual Medicine, along with certification as a Menopause Society Practitioner. Recognized as the American Urological Association's Young Urologist of the Year in 2023, Dr. Malik runs a popular YouTube channel, ranked in the Top 500 Educational Channels, where she is committed to making healthcare education accessible. She is also a sought-after speaker, digital opinion leader, and podcaster. Order tests through Rupa Health, the BEST place to order functional medicine lab tests from 30+ labs - https://www.rupahealth.com/reference-guide

Not necessarily a fun 'sode to do, but we wanted to revisit The IC Solution - written almost 10 years ago now - to see what we got wrong or would change if we wrote another edition.We talk about the book-writing process, how we wrote a good chunk of it in a oceanfront pool in Mexico, and what our goal was for patients.The book has been the best-seller in it's Amazon category and reached nearly 25,000 patients.  And it's something we're incredibly proud of.A lot of things in the book changed opinions or have aged really well.  The American Urological Association added our 'no kegels' rule for treating patients with IC to their 2022 Guidelines.  We showed in the book the evidence for Elmiron helping patients was very weak and almost certainly didn't outweigh the side effects. There was a major emphasis in the book on 'nervous system upregulation', which we would now call more 'central sensitization', even before much of that research came out.But three things we got wrong (or would do differently if we wrote it today):Using more 'trigger point' language than we would today.  As it's a patient-focused book we might have left the term in, but our explanation of it would have been very different and focused more on global overactivity.Vaginal estrogen.  If written today, with all the research that has been done, this likely would have it's own chapter or a long section.  We didn't have any mention of it in the book.How to find a great pelvic therapist.  Our goal for the book was to get people with IC to go to a pelvic therapist.  We didn't put in resources for helping them find one who was a great fit or give them the right questions to ask. Hope this has been helpful to see how opinions evolve and change.  Anything you put out into the world won't be perfect in 10 years - just put it out!PelviCon Recordings - 1 Day Flash SaleIf you missed the PelviCon recordings, we're doing a 1-day flash sale with a portion of the proceeds benefitting Hurricane Helene relief.  You have less than 24 hours - here's the link!  www.pelvicon.com/recordingAbout UsNicole and Jesse Cozean founded Pelvic PT Rising to provide clinical and business resources to physical therapists to change the way we treat pelvic health.   PelvicSanity Physical Therapy (www.pelvicsanity.com) together in 2016.  It grew quickly into one of the largest cash-based physical therapy practices in the country.Through Pelvic PT Rising, Nicole has created clinical courses (www.pelvicptrising.com/clinical) to help pelvic health providers gain confidence in their skills and provide frameworks to get better patient outcomes.  Together, Jesse and Nicole have helped 600+ pelvic practices start and grow through the Pelvic PT Rising Business Programs (www.pelvicptrising.com/business) to build a practice that works for them! Get in Touch!Learn more at www.pelvicptrising.com, follow Nicole @nicolecozeandpt (www.instagram.com/nicolecozeandpt) or reach out via email (nicole@pelvicsanity.com).Check out our Clinical Courses, Business Resources and learn more about us at Pelvic PT Rising...Let's Continue to Rise!

Robert E. Brannigan, MD, expands on the American Urological Association and American Society for Reproductive Medicine's 2024 amendment to the male infertility guideline. As chair of these guideline amendments, Dr. Brannigan delves into recommendation updates, as well as their effect on diagnostic processes and how male infertility is evaluated.

Jennifer U. Miles-Thomas, MD, a trailblazing urologist and advocate for gender diversity in the field, shares her personal journey, from her specialization in female reconstructive surgery to her recent appointments as vice chair – Regional Integration and Innovation and assistant professor of Urology at Northwestern Medicine, and as treasurer-elect of the American Urological Association. As an expert in the field, Dr. Miles-Thomas sheds light on her unique approaches to her practice and discusses obstacles that hinder gender diversity in urology. She discusses her vision for the future of gender diversity in urology and how it can positively impact patient care and outcomes.

Our guest is Dr. Daniel Lin, a urologist, professor and Chief of Urologic Oncology at the University of Washington and professor of the Division of Public Health Sciences at the Fred Hutchinson Cancer Center. The goal of this podcast is to help patients and caregivers learn how prostate imaging is used to detect prostate cancer. Dr. Lin talks about prostate imaging as it relates to the American Urological Association, or AUA, clinical guidelines. Our hope is that this podcast will help patients to better talk with their doctors so they can make informed decisions about their prostate health and care. This podcast was sponsored in part by Blue Earth Diagnostics. For more information, please visit www.UrologyHealth.org and don't forget to subscribe to our free digital magazine, UrologyHealth extra® at www.urologyhealth.org/uhe. **** September 12, 2024

In this 30-minute CME episode of Better Edge, Robert E. Brannigan, MD, professor of Urology at Northwestern Medicine and the guideline amendment chair at the American Urological Association, expands on the 2024 amendments to AUA's guideline for male infertility.He delves into the specific updates made to the recommendation on evaluating azoospermic patients and how these updates impact the diagnostic process. Additionally, Dr. Brannigan explains the changes in the recommendation on karyotype testing and how they contribute tothe evaluation of male infertility and explores the implications of the updates regarding the use of imaging modalities when evaluating patients.

In this episode, we discuss treatment of acute ischemic priapism, including some updates from the American Urological Association.    Show notes and references: FOAMcast.org

In Episode 6, Drs. Aly-Khan Lalani and Christopher Wallis are joined by The View on GU's first guest Dr. Diana Magee to discuss why location matters when it comes to medical conferences. They touch upon Dr. Magee's recent article in The Journal of Urology, and consider the ethical, economic and political implications of the upcoming American Urological Association conference in Texas following implementation of the state's abortion ban. The View on GU with Lalani & Wallis integrates key clinical data from major conferences and high impact publications, sharing meaningful take home messages for practicing clinicians in the field of genitourinary (GU) cancers. Learn more about The View on GU: https://theviewongu.com This podcast has been made possible through financial support by Bristol Myers Squibb, Merck, and TerSera. The views and opinions expressed in this podcast are those of the hosts and guests and do not necessarily reflect the position of hospital corporations and are not intended to be personal medical advice.

Lisa is joined by Karyn Eilber, MD who talks about five reasons why exercise is good for sexual health and much more!Karyn Eilber, MD: Board Certified in both Urology and Female Pelvic Medicine and Reconstructive SurgeryAssociate Professor of Urology and Obstetrics and Gynecology, Associate Director of the Urology Residency Training Program, and Co-director of the Female Pelvic Medicine and Reconstructive Surgery Fellowship Training Program at Cedars-Sinai Medical Center in Los AngelesInvited lecturer and presenter at local, national, and international conferences on the subjects of male and female voiding dysfunction, female sexual dysfunction, and pelvic reconstructive surgeryDr. Eilber is one of only 9% female urologists in the United States and is board certified in both Urology and Female Pelvic Medicine and Reconstructive Surgery. She is an Associate Professor of Urology and Obstetrics and Gynecology at Cedars-Sinai Medical Center in Los Angeles where she is also the Associate Director of the Urology Residency Training Program and Co-director of the Female Pelvic Medicine and Reconstructive Surgery Fellowship Training Program. Prior to joining Cedars-Sinai, Dr. Eilber practiced at Memorial Sloan-Kettering Cancer Center where she gained extensive experience in pelvic reconstruction following cancer treatment. Also at that time, she held a dual appointment as an Assistant Professor at Weill Medical College at Cornell University. Dr. Eilber's clinical and research focus has been in the areas of urogynecology and voiding dysfunction. She has published multiple peer reviewed manuscripts and is co-editor of The Use of Robotic Technology in Female Pelvic Floor Reconstruction . In addition to being a member and past-president of the Los Angeles Urologic Society, Dr. Eilber is a member of the American Urological Association, the Society of Urodynamics, Female Pelvic Medicine & Urogenital reconstruction, and the Society of Women in Urology. She is an invited lecturer and presenter at local, national, and international conferences on the subjects of male and female voiding dysfunction, female sexual dysfunction, and pelvic reconstructive surgery.

Interstitial cystitis (IC) is a scary and incredibly misunderstood diagnosis.  You may have also heard terms like ‘painful bladder syndrome' or ‘bladder pain syndrome' as well.  We want to shed some light on what IC is, how it's diagnosed and what you can do about it!Definition of IC:  Interstitial cystitis is defined by the presence of two symptoms in the absence of any other explanation (like a UTI or bladder cancer).  It's:Pain or pressure we perceive to be related to the bladder, and Urinary urgency or frequencySymptoms of IC:  In addition to the hallmark symptoms of bladder pain and urinary urgency/frequency, people often have other related issues.  These can include painful intercourse, low back pain, having to go to the bathroom at night (nocturia), pain with sitting or exercise, constipation and other pelvic health symptoms. Do I really have interstitial cystitis?  IC is a diagnosis of exclusion, which means it's only diagnosed by ruling out other things (like bladder cancer or a UTI).  There's no test that can confirm you have IC (including a cystoscopy).  If you have the symptoms above - pelvic pain perceived to be related to the bladder and urinary urgency/frequency - you can be diagnosed with IC just by the symptoms.Importantly, the IC diagnosis doesn't tell you anything about WHY you have the symptoms or WHAT the best treatment option will be for you!Physical Therapy for Interstitial Cystitis.  The muscles and nerves of the pelvic floor can be responsible for every symptom of IC.  They can cause the bladder pain and urinary symptoms.  They are also the cause of seemingly unrelated symptoms like painful intercourse, low back pain, hip pain or constipation.  It's the reason symptoms are often worse when sitting or after strenuous exercise, and why they can get better after gentle stretching or a warm bath.Physical therapy is the highest recommended treatment (Grade ‘A') by the American Urological Association.  It's literally the first recommendation you should get from a urologist when IC is suspected.  We hope this gives you a good overview of the condition, and we want to leave you with the first lines of The IC Solution (link): “Thousands of people with IC live healthy, happy and pain-free lives - and so can you!”About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcast Follow @pelvicsanity for great info! Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

Infectious Complications Following Prostate Biopsy: Strategies for Reducing Infections and Reducing Health Care Costs CME Available: https://auau.auanet.org/node/39485 Release Date: December, 2023 Expiration Date: December, 2024 LEARNING OBJECTIVES At the conclusion of this activity, participants will be able to: 1. Describe health care costs associated with prostate biopsy infections. 2. Identify the steps where modifications in technique can reduce the risk of complications. 3. Apply modified technique at various steps of the procedures to mitigate the risk of complications. ACKNOWLEDGEMENT Project Firstline is a national collaborative led by the U.S. Centers for Disease Control and Prevention (CDC) to provide infection control training and education to frontline health care workers and public health personnel. AMA has partnered with Project Firstline, as supported through Cooperative Agreement CDC-RFA-CK20-2003.  The American Urological Association is proud to collaborate with AMA and Project Firstline in this educational activity.  CDC is an agency within the Department of Health and Human Services (HHS). The contents of this event do not necessarily represent the policies of CDC or HHS and should not be considered an endorsement by the Federal Government.

Health Insurance continues to be a very complex, difficult to understand and in many instances less than transparent entity.    This episode explores health insurance from multiple perspectives (individuals, employers, health care providers and care delivery organizations.    The role of Pharmacy Benefit Managers (PBM's) is also explored   Guest:   Dr Jeffrey Frankel, MD,  Is a Past President of the Washington State Urology Society, a Past President of the Western Section of the American Urological Association, a Past President of the American Association of Clinical Urologists, and he currently chairs the Government Affairs Committee for the Washington State Urology Society He has practiced Urology in the King County area since1985. During This Episode We Discuss:   What is your responsibility regarding your insurance coverage prior to visiting a medical providers office, undergoing a procedure or study and or surgery.   How does your coverage differ from someone else who might be under the same plan   What happens when you are in Network or out of Network.. What does that mean?   What happens when you care provider becomes employed by a healthcare entity, clinic or insurance company   How does Medicare, Medicaid work? How is it different from private insurance?   What are Medicare advantage plans?   What are Pharmacy Benefit Managers?      Recommended Resources:   Episode 17 Understanding and Navigating the health Insurance System, The Original Guide to Men's Health  

Dr. David Penson, Chair of the Department of Urology at Vanderbilt University, discusses his comparative effectiveness research in prostate cancer. He talks about the evolution of Prostate Cancer awareness in the US, and historic screening and side effect issues that have made it a stigmatized topic for many men. Dr. Penson describes the nuances of PSA testing and how higher diagnosis rates of Prostate Cancer has led to overtreatment in the past, and the current shift to focus on active surveillance is helping to better balance the treatment paradigm for men with Prostate Cancer. Key Highlights: What is comparative effectiveness research and why does it matter to cancer patients? The evolution of the stigma associated with Prostate Cancer. How to think about the nuances of PSA screening tests. About our guest: David F. Penson, MD, MPH is the Hamilton and Howd Chair in Urologic Oncology, Director of the Center for Surgical Quality and Outcomes Research and Professor and Chair, Department of Urology at Vanderbilt University. He currently maintains a clinical practice in urologic oncology at the Vanderbilt-Ingram Cancer Center.  While his general research focus is clinical epidemiology and health services research across all urologic disease, his specific interests include the comparative effectiveness of treatment options in localized prostate cancer and the impact of the disease and its treatment on patients' quality of life. Key Moments: 6 minutes: What is CER and why does it matter? “Comparative effectiveness research has been around forever. People have different names for it, but it's comparing the effectiveness of various interventions for a condition. I've been focused in prostate cancer, so a lot of what I'm focused on is comparing the effectiveness of surgery and radiation and, for that matter, active surveillance in outcomes in prostate cancer.” 21 minutes: How cultural differences impact stigma. “In the US, prostate cancer is much more common in Black men. And the way they respond to the diagnosis may be different than other cultural groups. Hispanic men have another way of looking at it, white men, etc. So you do have this cultural element to it too, because sexuality and body image is often tied to cultural norms.” 31 minutes: The nuances of PSA screening. “The American Urological Association just came out with new recommendations around screening and does say, discuss screening, but doesn't say everyone should be screened. They've sort of started talking about getting a PSA test in your mid-40s, because there's pretty good literature that a baseline PSA test will establish your pretest probability of clinically significant prostate cancer in your lifetime. But the other thing that they mentioned is they basically say we should probably not be doing annual screening with PSA testing, probably every other year. Because less may be more here.” This episode was supported by the Patient Centered Outcomes Research Institute (PCORI) and features this PCORI study by Dr. Penson. Visit the Manta Cares website  Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions. --- Support this podcast: https://podcasters.spotify.com/pod/show/manta-cares/support

Chronic Pelvic Pain, Chronic Prostatic Pain Syndrome, Chronic Testicular and Penile Pain often have origins in abnormal pelvic floor muscle tension. Listen and find out how modern pelvic physical therapy can help. Guests:   Molly Riley, PT,DPT: Pelvic Health Physical Therapist, University of Washington,Northwest Outpatient Medical Center   Ken Berger, JD, MD: President of the Washington State Urology Society,  Practicing Urologist, Tri-State Health,Clarkso,WA, Chair of American Urological Association's Leadership and Business Education Committee. During This Episode We Discuss: The Evaluation and Management of Chronic Pelvic, Prostatic, Testicular, and Penile Pain.  Management of the abnormal voiding ( the non relaxing voider ), improving post operative stress urinary incontinence, and appropriate technique for strain free bowel evacuation.   Chronic Prostatitis is now referred to as Chronic Pelvic Pain Syndrome (CPPS): This is an effort to change thinking that all chronic prostatitis is infection oriented. Many times CPPS patients respond very nicely to pelvic floor PT   Quotes: Referring to the steps in evaluating testis pain….” If I do all of that and I don't find anything, that becomes a much more difficult problem for me as a Urologist to treat. That is where I start thinking about sending ( the patient ) to Physical Therapy.                                                                                                                                                                                  Dr. Ken Berger, JD, MD. Recommended Resources: Pelvicrehab.com:  Use this as a resource to find a Pelvic Health Physical Therapist  

Two cracking bladder cancer studies to discuss on GU Cast today (in our brand new GU Cast studio)! We are joined by Dr Sia Daneshmand, Urologist and Director of Urologic Oncology at the University of Southern California, who presented the headline-making Tar-200/SunRIse-1 study at the recent Annual Meeting of the American Urological Association. Not sure what a urological pretzel is and how it can help patients with high-grade non-muscle-invasive bladder cancer? Sia explains all! He was also an investigator on the SWOG 1011 trial presented at the ASCO Annual Meeting recently by Dr Seth Lerner. A practice-changing randomised trial of standard vs extended pelvic lymph node dissection for patents with invasive bladder cancer. These are very significant papers and we really enjoyed having Sia on GU Cast to discuss. Even better on YouTube when you can check out our new studio!

Join us for a conversation about men's health as it relates to men's health awareness, men's willingness (or lack thereof) to access health care, and creating a culture where men within the minority communities are more engaged with their health. Panelists Dr. Ulysses Burley III, Chief Executive Officer/Founder UBtheCURE, LLC. Dr. Ulysses W. Burley III is the founder of UBtheCURE LLC, a consulting company on the intersection of Faith, Health, and Human Rights. A native of Houston, Texas, Ulysses studied Biology and Spanish at Morehouse College and Medicine and Public Health at Northwestern University Feinberg School of Medicine, where he went on to train in Allergy, Asthma, and Immunology. Ulysses then served as Program Director for the Evangelical Lutheran Church in America (ELCA) Strategy on HIV/AIDS, as well as Director of HIV/AIDS Programs at Heights Pharmacy. Currently, Ulysses is the Project Director for the HIV Vaccine Trials Network (HVTN) Faith Initiative to connect with diverse faith communities to share evidence-based information regarding HIV and vaccines and antibodies being developed for its prevention. Although his primary training is in Immunology and Cancer Epidemiology, Ulysses is dedicated to a vocation of social justice advocacy through faith and community-based initiatives. His main work has been around HIV and AIDS awareness, advocacy, and capacity building, but also includes LGBTQIA+, gender and racial justice, and peace in the Holy Land. He has been a guest at both the White House and United Nations for consultations on the intersections of faith and HIV/AIDS, sexual and reproductive health rights, racial justice, and global drug reform. Dr. Glen McWilliams President, Manhattan Central Medical Society National Medical Association Dr. McWilliams is Chief of Robotic Surgery at the James J. Peters Veterans Affairs Medical Center and an Assistant Clinical Professor of Urology at Columbia University and Mount Sinai School of Medicine and was named the James J. Peters VAMC Physician of the Year for 2018. He is a graduate of the Columbia University College of Physicians and Surgeons and Urology Residency Training Program. He completed a fellowship in Urologic Oncology at the National Cancer Institute and is a Lt. CDMR(ret) in the United States Public Health Service. Dr. McWilliams is an active member of the American Urological Association, the R Frank Jones Urologic Society and the Society of Urologic Oncology. Dr. McWilliams in the President of the Manhattan Central Medical Society. Dr. McWilliams has an extensive experience in the minimally invasive and robotic surgery and developed the first Robotic Surgery Program within the Veterans Integrated Systems Network 2. Dr. McWilliams is an investigator on multiple research projects involving urologic oncology and health care disparities. Originally published June 9, 2023

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

Sponsored by TrackableMed Go behind the scenes of the American Urological Association Annual Meeting and discover why some physicians choose to embrace new technology and dive head first into learning despite their peers' reluctance to change. In this week's episode, sponsored by TrackableMed, we revisit some of the most exciting tech booths from AUA with Dr. Garrett Pohlman, Urologist and host of the Prostate Health Podcast. Dr. Pohlman joined us in Chicago as we explored the technology and asked innovators to talk about their solutions. In the interview, we also discuss the value of direct-to-patient marketing, why it's important to have multiple tools to help patients with, and tactics to ensure patients return for another visit regardless of previous results. What we discuss in the episode: AUA 2023 Highlights & Takeaways If flashy booths at conferences are worth the investment The impact of direct-to-consumer marketing Why Urologists need to have more than one tool in their toolset Effective strategies to keep patients active in seeking treatment Resources from this episode:  Get the free MedTech Talk Tracks for Action Listen to the Prostate Health Podcast Social Media:  Connect with Dr. Pohlman on LinkedIn Connect with Zed on LinkedIn Connect with Clark on LinkedIn

With every passing year, we see new technologies emerge to equip urologists with better tools for combating prostate cancer. This year's annual meeting of the American Urological Association in Chicago was no exception! We are excited to take you behind the scenes today for a closer look at some of the new and upcoming technologies for diagnosing and treating prostate cancer.   Prostate cancer is one of the most common cancers. But it is also one that has seen remarkable progress in technology. Dr. Pohlman has had first-hand experience of how innovative developments in diagnosis and treatment have revolutionized how this disease gets treated. For today's episode, he interviews Dr. Amit Vohra, the President and CEO of Promaxo, Michael Waidler, the Area Business Director for Palette Life Sciences, and Dr. Fernando Bianco, from the Urology Specialist Group, in Miami Lakes, Florida, at the AUA meeting this year, about the latest technologies in the prostate cancer arena. Sit back, relax, and get ready to be amazed by what's available right now for the diagnosis and treatment of 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: At Promaxo, they are commercializing a portable office-based MRI for doing interventions of prostate biopsies in addition to treatments. What makes Promaxo unique when compared with other available technologies? Dr. Pohlman will now offer the Promaxo technology to patients in his practice. He explains how it works. Dr. Pohlman talks to Michael Waidler from Palette Life Sciences about a new rectal spacer to help protect healthy tissue from radiation beam exposure and reduce the long-term side effects of radiation therapy for prostate cancer. What makes Barrigel unique from a urologist and patient perspective? What do rectal spacers do? The advantage Barrigel has over other rectal spacers. Dr. Fernando Bianco highlights the benefits of targeted therapy versus active surveillance. Innovation drives progress! The advancements in prostate cancer technology are a true testament to that. Today's glimpse into the AUA annual meeting has only scratched the surface of what is to come. So, subscribe to our podcast to stay up-to-date on the latest prostate cancer diagnosis and treatment developments, and don't forget to tune in to our next episode, which will be Part Two from the AUA annual meeting in Chicago, where we will explore the exciting new technology for men with an enlarged prostate or BPH. Thanks for joining us, and see you next time! 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. Promaxo Barrigel The Urology Specialist Group  

Join us as Dr. Lewis describes the UTI Risk Factors Model & discusses how the tool can be used for both neurogenic and non-neurogenic patients, primarily in the adult female patient population. Guest bio: Dr. Tamra Lewis holds board certification in Female Pelvic Medicine and Reconstructive Surgery and she currently practices at Comprehensive Urology in Chicago, IL.  Dr. Lewis received her B.A. in Biology from Luther College in 1994, and she obtained her Medical Doctorate in 1999 from the University of Iowa College of Medicine. In 2005, Dr. Lewis completed her Surgical and Urology residencies at the University of Nebraska and then went on to complete a fellowship in Female Urology and Voiding Dysfunction at Metro Urology in Minneapolis/St. Paul, MN. Dr. Lewis's professional interests include management of incontinence, voiding dysfunction, bladder prolapse, and urinary tract infections. She is a member of the American Urological Association, the Society for Urodynamics and Female Urology, the Society for Women in Urology, and The Chicago Urologic Society, where she currently serves as President. Dr. Lewis has been an invited speaker or presenter for numerous events on topics including incontinence, overactive bladder, hematuria, and urinary tract infections.  Visit  Coloplastprofessional for more offerings! 

Em geral, uma faixa total de testosterona de 300 a 1.000 ng/dl é considerada normal, de acordo com a Endocrine Society. A American Urological Association também utiliza 300 ng/dL como seu ponto de corte para o diagnóstico de baixos níveis de testosterona (hipogonadismo). Bobby Joe / @bobbyjoe1907 Tradição Restauradora https://t.me/TradicaoRestauradora LINKS DOS CANAIS NVP: NVP CULTURAL: https://www.youtube.com/channel/UCnbt43tbyeIh5V5z5NZINLQ/featured NVP ENTRETENIMENTO: https://www.youtube.com/channel/UCQx0mk39maqKNsx35VC-UNA/featured

In this episode we discuss focal therapy for the treatment of prostate cancer.  Historically, men diagnosed with localized prostate cancer have had to choose between two treatment options: surgery and radiation therapy.  Both options involve treating the entire prostate gland, regardless of the size, location, or number of cancerous tumors.  Recently, however, more localized treatment options have become available for prostate cancer that involve focally treating only the tumors, rather than the entire prostate gland.  So, what are these focal therapies?  How do they work?  What risks are involved? What advantages do they have over traditional therapies?  And, probably most importantly, how successful are they at actually curing prostate cancer?  To answer these questions and many more, we turned to a true expert. Dr. Arvin George is an Associate Professor of Urology at the University of Michigan.  After obtaining his medical degree from the Royal College of Surgeons in Ireland, he completed his Urology Residency at the Smith Institute for Urology at the Hofstra North Shore-LIJ School of Medicine.  He remained to complete his Endourology fellowship in New York gaining additional subspecialty expertise in robotic, laparoscopic, and percutaneous surgery.  Subsequently, he completed a Urologic Oncology fellowship at the National Cancer Institute, National Institutes of Health.  Dr. George's research interests include minimally invasive and image-guided treatments, functional prostate imaging and focal therapy for prostate cancer. He is an active member of the American Urological Association, Society of Urologic Oncology, the Endourological Society, and the American College of Surgeons.#prostate #prostatecancertreatment #prostatecancer #focaltherapy

According to Mayo Clinic, about 50% of women suffer from urinary incontinence, the inability to control urination voluntarily. However, only 25-61% of affected women discuss this problem with their healthcare providers. The resistance to sharing these urologic issues, both men and women, stem from shame and fear of judgment. This also stands true for other medical issues confined within the intimate parts of our bodies, including sexual dysfunction (whether it be low libido and premature ejaculation) and anatomical conditions (like uterine prolapse). Today, with empathy and compassion, we bring to light the pertinent issues "down there" that one may usually hide and fear.We are joined today by Dr. Fenwa Milhouse, a board-certified urologist, pelvic surgeon, and sexual health specialist. She received her BA in Biology from The University of Texas at Austin in 2003, MD from McGovern Medical School at UTHealth in 2008, Urology residency at the University of Chicago in 2014, and Female Pelvic Medicine and Reconstructive Surgery (Urogynecology) fellowship at Metro Urology in 2020. She currently stands as the attending physician and CEO of Down There Urology, PLLC, and has been appointed to the board of the Chicago Urological Society. Dr. Milhouse also utilizes social media to destigmatize sexual conditions and demonstrate the importance of representation in medicine, on which she has garnered over 100,000 followers. She has also been featured in articles by Insider, WebMD, and The American Urological Association.Livestream Air Date: March 21, 2022Olufenwa Famakinwa Milhouse, MD: IG @drmilhouse, TikTok @yourfavoriteurologist, & Web www.yourfavoriteurologist.comFriends of Franz: IG @friendsoffranzpod & FB @friendsoffranzpodChristian Franz (Host): IG @chrsfranz & YT Christian FranzThankful to the season's brand partners: Clove, BETR Remedies, Eko, Lumify, RescueMD, Medical School for Kids, Your Skincare Expert, Twrl Milk Tea

This series of the Elevate Podcast illuminates the path scientific communication takes from teaching to diagnosis to treating all the way to changing, prolonging, and saving patient lives. External Education of a growing variety of stakeholders in healthcare by the Medical Affairs Division of Pharma and Medical Device industry reflects the critical role Education in Medicine plays in our Age of Information. The podcast features critical discussions with leading educators across healthcare from the various perspectives of pharma / biotech sponsors, program organizers, attendees, and patients with a quest to explore some of the most novel, intriguing formats of Medical Education, following their approaches to learning in our digital age as well as their current gaps or success stories. The goal of the podcast is to make medical education simpler to access, more relevant to apply across healthcare organizations, and more continuous to inspire innovation and quality.This is a first of a series of episodes that examines the podcast as one of the most effective emerging channels and formats of education in medicine. Our host, Tim Mikhelashvili, PharmD, Co-Founder and CEO of Amedea Pharma and Chair of the Mentorship Program at the Medical Affairs Professional Society (MAPS) speaks with Shelby Englert, Vice President of Education at the American Urological Association to learn why podcasts are powerful from a Professional Medical Society's perspective. Shelby explains why its organization started its AUA University podcast, now with 165 episodes and the role it has played in building and growing its community of urologists in the association. She also describes how the AUA University podcast is structured, how it has evolved over time, and shares personal suggestions for elements of education most valuable and relevant to an audience in a podcast, providing specific examples that demonstrate the direct impact of the podcast on patient and physician behaviors as well as health outcomes. Listen to this episode because it not only centers on the ultimate impact of podcasts on the quality of medical education, but also discusses all the “supporting players” and “accessories” to the podcast required such as channels, technology, and timing of podcast communication to make a podcast successful and valuable in healthcare.

In this episode, guest host Dr. David Canes interviews Dr. Matthew Allaway about PrecisionPoint, his medical device for transperineal prostate biopsy, and his journey towards changing the paradigms of prostate cancer diagnosis. The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/0Lmsku --- SHOW NOTES Dr. Allaway starts by outlining his path to medicine. The choice to pursue urology was largely influenced by his personal cancer diagnosis. He cites cancer as the greatest lesson in his life, since it brings an enhanced level of empathy to his patient care and inspires him to contribute to the field of urology. Throughout his career, he has always examined his procedures for logical sense – if a process was inefficient, he tried to devise ways to make improvements for patient care. In 2013, Dr. Allaway decided to switch from the transrectal to transperineal approach for prostate biopsies. With the traditional transrectal approach, he found unacceptably high rates of infection and failure to detect cancers in the anterior prostate region. He started performing transperineal biopsies with a freehand technique, using ultrasound in one hand and a biopsy probe in the other. He built a database of his own patients, which showed an increased cancer detection rate. His technique eventually evolved into the PrecisionPoint transperineal access system. He originally started marketing the device at American Urological Association (AUA) meetings, through booths and video competitions. Although Dr. Allaway works in private practice and not academia, he was able to form connections with institutions and key opinion leaders to encourage adoption of the transperineal approach. PrecisionPoint has been accepted by early adopters, and his team is now working to capture a larger share of the biopsy market. Importantly, they are also marketing the device to patients, since patients can also recognize the safety and diagnostic benefits, and being the ultimate consumers of healthcare, can influence urologists to adopt the device. Dr. Allaway also gives advice for budding entrepreneurs. He highlights the need to link the device to a specific clinical need, research existing devices, check the your device's feasibility and pricing strategy, and find good mentors who will allow you to learn from their mistakes. In terms of product marketing, he encourages entrepreneurs to look beyond the United States and explore worldwide markets to increase the chances of product adoption. His confidence in PrecisionPoint grew when he received positive feedback from other urologists about the simple elegance of the device. Finally, Dr. Allaway discusses the importance of truly believing in your product. He says that if you are ashamed of your product's price, you have priced it wrongly. He encourages entrepreneurs to focus on their product's benefit to society, rather than profitability. --- RESOURCES Precision Point: https://perineologic.com/precisionpoint/ American Urological Association: https://www.auanet.org/ Zero to One by Peter Thiel: https://www.amazon.com/Zero-One-Notes-Startups-Future/dp/0804139296

In this episode of BackTable Urology, Dr. Jill Buckley, professor of urology at UC San Diego, interviews Dr. Jack McAninch, professor emeritus of urology at San Francisco General Hospital and an international leader in the field of genitourinary trauma and reconstructive surgery. --- CHECK OUT OUR SPONSOR Laurel Road for Doctors https://www.laurelroad.com/healthcare-banking/ --- SHOW NOTES First, Dr. McAninch delineates his path to becoming a doctor. He grew up in Merkel, a small Texan town, and worked on an oil rig after high school to save money for college tuition. He attended Texas Tech University and majored in animal husbandry. After college, he received a master's degree in animal science from the University of Idaho. However, during his time in graduate school, he was required to take various pre-medical classes and discovered a passion for medicine. He applied to and received an acceptance to the University of Texas Medical Branch in Galveston. During his time in medical school, he worked as a research assistant in the plastic surgery department and discovered his interest in surgery and reconstruction. However, he chose urology as his specialty as the hours and training were less demanding than plastic surgery. He decided to enlist in the army and was sent to Letterman Army Hospital in San Francisco to complete his urology residency. During his time there, he operated on many Vietnam war soldiers and gained valuable insight in acute care and reconstructive surgery. After being stationed in Germany for 3 years, he returned to San Francisco and was recruited to San Francisco General Hospital to start a reconstructive urology program. As the only reconstructive urologist, he worked closely with the general and trauma surgeons to manage a high-volume caseload. He then went on to start the first fellowship in reconstructive urology at UCSF. Next, Dr. McAninch explains his different leadership roles throughout his career, including being an original board member of the Society of Genitourinary Reconstructive Surgeons (GURS), the president of the American Board of Urology, the president of the American Urological Association, and an important leader representing the urologic field in the American College of Surgeons. Finally, Dr. Buckley and Dr. McAninch end the discussion by reflecting on the phenomenally rapid technological advancements that have been made in the field of urology. --- RESOURCES Society of Genitourinary Reconstructive Surgeons https://societygurs.org/

When the U.S. Food and Drug Administration released a letter to healthcare providers in April 2021 announcing its investigation into numerous medical device reports involving reprocessed urological endoscopes, Dr. Seth Bechis and his colleagues set out to learn more about reprocessing and its effectiveness. They focused on flexible ureteroscopes in their research and found that, while studies assessing the effectiveness of on these specific scopes is limited, their findings line up with recent news about other flexible endoscopes — that a surprising number still harbor protein and other debris even after reprocessing, raising patient safety concerns. Their findings were published in the journal Urology. We caught up with Dr. Bechis at the American Urological Association's annual convention in New Orleans to talk more about the study. Dr. Bechis is a board-certified urologist and member of the comprehensive Kidney Stone Center at UC San Diego Health. Hes' also an Ambu consultant. Show notes: Bio: Seth Bechis Urology: “Reprocessing Effectiveness for Flexible Ureteroscopes: A Critical Look at the Evidence” Single-Use Endoscopy: “FDA Investigating Reports of Infections Associated with Reprocessed Urological Endoscopes” The FDA's Letter to Healthcare Providers: Infections Associated with Reprocessed Urological Endoscopes Single-Use Endoscopy: “Why Problems with Reprocessing Ureteroscopes ‘Haven't Gone Away'” Endoscopy Insights: Breaking Down the FDA Letter to Healthcare Providers Endoscopy Insights Show Page

Matthew Katz was at Weill Cornell Medicine when a chance digital encounter ended up steering him into urology. “If you had asked me what a urologist did before medical school I probably wouldn't have been able to answer the question,” he told me self-deprecatingly when we chatted at the American Urological Association's annual conference in New Orleans. But a blast email to the entire medical school looking for people interested in robotics research caught Katz's eye. His background in bioengineering had sparked an interest in doing something medically that was hands on, working with new technology and focusing on minimally invasive procedures. A next-generation urologist was born. Today, Katz brings a unique perspective to starting a urology practice. He's less than a year out of an endourology fellowship, has an MBA and has co-authored research on telemedicine. He also has interesting insights on the emergence of single-use endoscopes and the role they can play in urology practice going forward. Katz is affiliated with NYU Langone Health and is a clinical assistant professor in the urology department at the NYU Grossman School of Medicine.  Show notes: Bio: Matthew Katz Diseases of the Colon & Rectum: “Assessment of Ileostomy Output Using Telemedicine: A Feasibility Trial” Single-Use Endoscopy: “5 Things Urologists Were Talking About at AUA 22” Single-Use Endoscopy: “How Robotics is Shaping the Future of Urology” Endoscopy Insights Show Page

*apologies for Dr. Spitz's sound not being as high of quality as what you are use to hearing when I interview other guest. The audio does improve towards the second half of the podcast. Today I interview the author of “The Penis Book,” Urologist Dr. Aaron Spitz! Dr. Spitz is not only a urologist and author but he is also a television personality who is frequently called upon to shed light on various men’s health topics. He has appeared on Dr. Phil, the Real Housewives, and he is a frequent guest and part-time co-host on the popular CBS talk show, The Doctors. In 2018, Dr. Spitz was featured in the documentary The Game Changers on Netflix, which shed light on the game-changing effects of a plant-based diet in elite athletes. Dr. Spitz has also authored several peer-reviewed journal articles regarding the treatment for male fertility. He serves as the lead delegate representing all of America’s urologists to the American Medical Association (AMA). In 2020, the American Urological Association, presented Dr. Spitz with The Distinguished Service Award. Dr. Spitz is a national leader in health policy for urologists across the nation. We discuss his five-step plan to maximize penis health that he writes about in “The Penis Book” - A Doctor’s Complete Guide to the Penis – From Size to Function and Everything in Between. 1. Food 2. Sexercises 3. Go Offline/Porn 4. Detox 5. Sleep We also discuss: Kegel exercises for men The average man’s penis size The relationship between shoe size and penis size What is a grower and a shower Should men pee after sex? What kind of underwear should a man wear? Covid’s impact on ED The impact porn has on the brain Plant based eating Why an audio doppler is not useful in diagnosing a venous leak/erectile dysfunction The Penis Book on Amazon: The Penis Book: A Doctor's Complete Guide to the Penis--From Size to Function and Everything in Between Paperback Recommended by Dr. Spitz: The China Study on Amazon: The China Study: Revised and Expanded Edition: The Most Comprehensive Study of Nutrition Ever Conducted and the Startling Implications for Diet, Weight Loss, and Long-Term Health Cookbook on Amazon: The New 2023 Engine 2 Diet Cookbook: Guide To Lowers Cholesterol, Burns Away the Pounds, Eat Plants, Lose Weight, Save Your Health The Game Changers on Netflix: https://www.netflix.com/title/81157840 About The Game Changers - Meeting visionary scientists and top athletes, a UFC fighter embarks on a quest to find the optimal diet for human performance and health. Starring: Arnold Schwarzenegger, Lewis Hamilton, James Wilks Click here to watch Dr. Spitz on the Dr.'s The Doctors TV Show Click here to visit Dr. Spitz's website Dr. Aaron Spitz Click here to learn more about Victory Men's Health For questions about today's podcast you can contact Amy Stuttle at podcast@amystuttle.com

Today's Episode Dr. Raj talks with Dr. Monish Aron about screening for prostate cancer and available treatment options.   Today's Guest Dr. Monish Aron is an expert in robotic and laparoscopic surgery for malignant and benign conditions of the prostate, kidney, bladder, adrenal gland, and the ureter. He trained in urology at premier institutions in India, Australia, and the United States. Dr. Aron completed his fellowship training in advanced robotics and laparoscopy at the Cleveland Clinic and was recruited to the University of Southern California in 2009. He has received numerous acclaimed awards including the GMOMG Medical award from the Royal College of Surgeons in Edinburgh as well as awards for his scientific presentations and surgical videos at the American Urological Association. Dr. Aron has published more than 200 publications and serves as a reviewer for 8 leading urologic journals including editorial board appointments for 3 journals. Dr. Aron has played a pioneering role in the refinement of robotic prostate and kidney surgery, single-incision laparoscopic surgery, and robotic surgery for bladder cancer. Dr. Aron has been invited to speak and demonstrate minimally invasive surgical techniques at numerous national and international institutions. About Dr. Raj Dr Raj is a quadruple board certified physician and associate professor at the University of Southern California. He was a co-host on the TNT series Chasing the Cure with Ann Curry, a regular on the TV Show The Doctors for the past 7 seasons and has a weekly medical segment on ABC news Los Angeles. Want more Dr. Raj? Check out the Beyond the Pearls lecture series! The Ultimate High Yield Bundle: The complete review of high-yield clinical medicine topics necessary for graduate medical education board exams including NBME, USMLE Steps 1/2/3, ITE and ABIM Boards. You can also listen to the Beyond the Pearls podcast. An InsideTheBoards Podcast. Check out our other shows: Crush Step 1 Step 2 Secrets Physiology by Physeo Step 1 Success Stories The InsideTheBoards Study Smarter Podcast The InsideTheBoards Podcast The Health Beat   Produced by Ars Longa Media To learn more about us and this podcast, visit arslonga.media. You can leave feedback or suggestions at arslonga.media/contact or by emailing info@arslonga.media. Produced by: Christopher Breitigan. Executive Producer: Patrick C. Beeman, MD The information presented in this podcast is intended for educational purposes only and should not be construed as professional or medical advice. Learn more about your ad choices. Visit megaphone.fm/adchoices

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

Testicular Cancer Society Founder - Mike Craycraft The Not Old Better Show, Science Interview Series Welcome to The Not Old Better Show on radio and podcast, today's episode is sponsored by MANSCAPED.  I'm Paul Vogelzang and June is National Men's Health Month! National Men's Health Month is all about encouraging the men in your life (including you, men out there!) to take care of their bodies by eating right, exercising, and working to prevent disease. Because June 2022 is Men's Health Month our conversation with Mike Craycraft.  Mike Craycraft is a testicular cancer survivor, a clinical pharmacist, with a substantial medical and healthcare background, and the founder of the Testicular Cancer Society. Join us today as we discuss Topics including trends in cancer research and treatment for testicular cancer, as well as disparities and challenges in educating young and old, including those in our Not Old Better Show audience here on radio and podcast about the disease.   Learn more about prevention, diagnosis, and treatment for testicular cancer by visiting the  American Urological Association's Testicular Cancer Diagnosis Guideline Update, Cancer.nets's explanation of the disease, including recent data, and some additional testicular cancer statistics from Johns Hopkins. Visit The Not Old Better Show's partner, Manscaped's testicular cancer awareness page, and join me in welcoming to The Not Old Better Show on radio and podcast, Mike Craycraft. My thanks to our sponsor today, MANSCAPED™ for sponsoring today's episode.  June is Men's Health Month, so let's raise awareness of all things health for men by raising awareness for the most common form of cancer in men aged 15-35, providing education about the disease, and giving support for fighters, survivors, and caregivers.  My thanks to you, my wonderful Not Old Better Show audience on radio and podcast.  Please be safe, be well, let's support each other and decry violence…and in so doing, Let's Talk About Better; The Not Old Better Show on radio and podcast.  Thanks, everybody and we'll see you next week.

Featuring perspectives from Drs Raoul Concepcion, Fred Saad and Matthew Smith, moderated by Dr Emmanuel Antonarakis, including the following topics: Introduction (0:00) Management Approaches for Nonmetastatic Prostate Cancer — Raoul S Concepcion, MD (3:00) Role of Treatment Intensification in Metastatic Hormone-Sensitive Prostate Cancer — Matthew R Smith, MD, PhD (31:55) Selection and Sequencing of Therapy for Metastatic Castration-Resistant Prostate Cancer — Emmanuel S Antonarakis, MD (1:00:03) Current and Future Integration of PARP Inhibitors in the Management of Prostate Cancer — Fred Saad, MD (1:30:29) CME information and select publications

In this week's episode I talk with Jill Osborne, founder of the Interstitial Cystitis Network. We discuss the new changes in the IC world from the American Urological Association, which has recently updated its guidelines on diagnosing and treating IC. Connect with Jill: Website: https://www.ic-network.com/ Instagram: @icnetwork Facebook: @interstitialcystitisnetwork YouTube: https://www.youtube.com/user/icnjill IC Network number: 1.800.928.7496 Link to register for webinar: https://go.callieknutrition.com/1-registration-page-non-diet-triggers Updated AUA Recommendations: https://www.auanet.org/guidelines/guidelines/diagnosis-and-treatment-interstitial-cystitis/bladder-pain-syndrome-(2022) AUA fact sheet: https://www.ic-network.com/new-ic-bps-guidelines-released-in-usa/?fbclid=IwAR3o1gOZEB0olmUoC82MtHKGDaDrLQhYj1RVoxmjiqe6ZpfZu0eI6_kFx68# Road To Remission Program: https://www.callieknutrition.com/road-to-remission IC friendly recipes: www.callieknutrition.com/blog Connect with me! Instagram : https://www.instagram.com/callieknutrition/ Facebook: https://www.facebook.com/callie.krajcir.9 Pinterest: https://www.pinterest.com/callieknutrition/_created/ Website: https://www.callieknutrition.com/ Email: support@callieknutrition.com Apple Podcast: https://podcasts.apple.com/us/podcast/ic-you/id1604016381 Spotify: https://open.spotify.com/show/6a4lQrKBcA31b5uAQpKNPf

Featuring perspectives from Drs Matthew Galsky, Ashish Kamat and Stephen Williams, moderated by Dr Sumanta Kumar Pal, including the following topics: Introduction (0:00) Available Data with and Ongoing Investigation of Novel Agents and Strategies for Non-Muscle-Invasive Bladder Cancer (NMIBC) — Ashish M Kamat, MD, MBBS (2:17) Novel Therapeutic Approaches for Muscle-Invasive Bladder Cancer (MIBC) — Stephen B Williams, MD, MS (33:41) Current and Future Front-Line Management of Metastatic Urothelial Bladder Carcinoma (mUBC) — Matthew D Galsky, MD (1:00:55) Selection and Sequencing of Therapy for Relapsed/Refractory mUBC — Sumanta Kumar Pal, MD (1:43:07) CME information and select publications

The American Urological Association just announced new Guidelines for the treatment of interstitial cystitis.  It's the first update in 7 years, and it's big for pelvic rehab professionals!We basically have an entire category of treatment ("behavioral and non-pharmacological") that we are unique qualified to administer.Among the highlights (and things we've been advocating for...The AUA specifically calls out that Kegel exercises should not be done for patients with ICAdditional studies showing Elmiron has limited efficacy (or, in several trials, no efficacy at all) in treating IC over a placebo, as well as the chance for long-term eye damageAcknowledging an elimination diet (and not the 'IC Diet') is the gold standard for nutritional careHere's the link to the new AUA Guidelines for IC - hope you enjoy the 'sode!IC: Holistic Evaluation & TreatmentIf you're looking for the resource to go through all the physical therapy treatments, demonstrations of techniques on patients, medical management and everything you need to quarterback your patient's care, check out the IC: Holistic Evaluation & Treatment course! (www.pelvicptrising.com/ic)Pelvic PT Rising Business Mentorship - New Cohort!For the first time in over a year we are offering new spots in our Business Mentorship to cash-based pelvic health providers!  Our mentees on average have doubled their case load and increased revenue by over $125,000 in the first year of working with us!  We have 25 new spots available - for more information or to apply, visit www.pelvicptrising.com/mentoring.Shout Out and Get in Touch!If you're enjoying the podcast, please take a few seconds to take a screenshot and put it up in your Instagram Stories and tag Nicole (@nicolecozeandpt).  Or send us an email at Nicole@PelvicSanity.com with your thoughts, questions or ideas.  We'd love to hear from you!About UsNicole and Jesse Cozean founded PelvicSanity Physical Therapy together in 2016.  It grew quickly into one of the largest cash-based physical therapy practices in the country.  They run Pelvic PT Rising, providing both clinical and business resources exclusively tailored to pelvic PTs.

Paul Maroni is a urologic oncologist at University of Colorado in Denver.  He also runs the American Urological Association course on “Winning the Battle Against Burnout.”  Paul is also an extremely thoughtful and mindful surgeon, physician, and educator.  In this episode of OWZ, we tackle a lot more than burnout.  We discuss extreme ownership of the good and bad that occurs in our surgical practices, we talk about putting successes and failures into perspective, and, in Paul's own words, we seek to find “joy serving others.”  We would be lying if we said everyday as a surgeon is amazingly positive.  But everyday can be amazing with the right perspective and approach. (Music Credit: Sunshine, Simon Jomphe Lepine.)

We talk with urologist Dr. Jay Shah, leader of urologic oncology at the Stanford Cancer Center, about seizing leadership opportunities in the world of academic medicine. --- CHECK OUT OUR SPONSOR DI4MDs Protect your most valuable asset, the skill and ability to practice your medical specialty. Be prepared by establishing a specialty specific disability insurance policy from the experts at DI4MDs. Contact them today at www.Di4MDS.com or call 888-934-4637. --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/voLZNT --- SHOW NOTES In this episode of BackTable Urology, Dr. Aditya Bagrodia interviews urologist Dr. Jay Shah, leader of urologic oncology at the Stanford Cancer Center, about seizing leadership opportunities in the world of academic medicine. First, the doctors discuss the importance of finding a niche for their medical practice and research. Dr. Shah encourages young faculty members to identify a specific interest within their field and start research related to that topic. Although it was hard for him to prioritize his niche at first, he realized that gaining knowledge in quality improvement, his chosen niche, was much easier when he merged both his clinical and academic work. Then, Dr. Shah and Dr. Bagrodia discuss the challenges of a mid-career change. Dr. Shah moved from MD Anderson to Stanford, while Dr. Bagrodia moved from UT Southwestern to UC San Diego. Both doctors agreed that changing institutional cultures and practices can be daunting; however, they noted that it was important to build credibility and to keep an open mind about listening to the ideas of their new colleagues. Dr. Shah believes that new faculty may take up to four years at their new institution before they start to feel comfortable in their new position. Dr. Bagrodia then warns against having unrealistic nostalgia for old institutions. Finally, the doctors suggest ways to build leadership skills and gain leadership experience within the field of urology. Both doctors found leadership courses and having an executive leadership coach helpful. They also encourage young urologists to get involved in committees of urological societies, including the American Urological Association.

In this episode we discuss robotic radical prostatectomy as a treatment option for prostate cancer. Over the last 20 years, robotic radical prostatectomy has become the gold standard for surgical management of prostate cancer.  While the concept of robotic surgery is exciting, it also leads to a lot of questions amongst men faced with a decision as to how to treat their prostate cancer.  How does the procedure actually work?  Is the surgery performed by a surgeon or by a robot?  What are the risks and side effects? Are all men good candidates for the procedure.  And, of course, how effectively does it cure prostate cancer?  To answer these questions we turned to Dr. Alexander Kutikov.  Dr. Kutikov is a Professor and Chief of Urology and Urologic Oncology at the Fox Chase Cancer Center. He is a board certified, academic urologic surgical oncologist who treats urologic tumors using minimally invasive (robotic / laparoscopic) and traditional surgical techniques. Dr. Kutikov received an MD from Harvard Medical School's Harvard-MIT Health Sciences and Technology Program in 2003. He then completed his Urologic residency training at the University of Pennsylvania in 2008 and finished a 2-year Society of Urologic Oncology fellowship at the Fox Chase Cancer Center in Philadelphia, USA. He has co-authored more than 170 original manuscripts in peer-reviewed journals and has published chapters in leading urologic textbooks as well as holding leadership positions both in the American College of Surgeons and the American Urological Association.

In this episode we discuss penile enlargement.  A recent study revealed that 45% of men wish that their penises were larger. That desire is further confirmed by the multitudes of creams, medications, and procedures promising to increase the length and/or the girth of the penis.  But is it actually possible to increase the size of the penis? Do any of these treatments actually work?  And, if so, to what extent?  What are the risks of these penile enhancement treatments?  And are there trade offs involved?  To answer these questions, we are fortunate to be joined by Dr. Matthew Ziegelmann.  Dr. Ziegelmann is an Assistant Professor specializing in male sexual dysfunction and infertility (Andrology) in the Department of Urology at the Mayo Clinic. He obtained his medical degree from the University of Minnesota and then completed a residency in urology at Mayo Clinic in Rochester, MN. He then continued his sub-specialty training in male sexual dysfunction and infertility (Andrology) at Rush University Medical Center in Chicago, IL. He is an active member of the American Urological Association, North Central Section, and Sexual Medicine Society of North America. He has published extensively in male sexual dysfunction and speaks nationally on topics related to male sexual dysfunction and other urologic conditions.

Lisa is joined by Dr. Karyn Eilber, a board-certified urologist with sub-specialty board certification in Female Pelvic Medicine and Reconstructive Surgery.  Lisa and Dr. Eilber talk about women's pelvic, vaginal, urethral, and sexual health. In addition, Dr. Eilber and Lisa discuss the 5 reasons exercise is good for sexual health.  Dr. Eilber also talk about the GLISSANT ​intimate lubricants which she and a colleague developed. Dr. Eilber has over 20 years of experience taking care of women's most intimate needs. She is an Associate Professor of Urology and Obstetrics & Gynecology at Cedars-Sinai Medical Center and is the Associate Program Director for the Cedars-Sinai Urology Residency Training Program. Prior to joining Cedars-Sinai, Dr. Eilber served at the Memorial Sloan-Kettering Cancer Center's Urology Department, where she gained extensive experience in pelvic reconstruction following cancer treatment.​Dr. Eilber's research focus has been in the field of urogynecology, and she has published multiple peer reviewed manuscripts and book chapters. In addition to being a member and past-president of the Los Angeles Urologic Society, Dr. Eilber is a member of the American Urological Association, the Society of Urodynamics, Female Pelvic Medicine & Urogenital reconstruction, the American Urogynecologic Society, and the Society of Women in Urology. She is also a Founding Medical Partner of Doctorpedia. Dr. Eilber earned her bachelor's degree in Biomedical Sciences from the University of California, Riverside, which was an accelerated 3-year premedical program that allowed her to matriculate into the University of California, Los Angeles School of Medicine (UCLA). She completed a general surgery internship, urology residency and female pelvic medicine fellowship at UCLA.  GLISSANT ​intimate lubricants were created and designed for the woman ​who knows what she wants.   As a physician at Cedars-Sinai specializing in female pelvic medicine, Dr. Eilber often heard her patients tell her that they avoided sexual activity because of pain due to vaginal dryness. They wanted a lubricant that was natural and without hormones or harsh chemicals, but there was nothing she could recommend.  She knew with the help of her friend Renée and her experience utilizing natural ingredients that they could develop a product that would actually help ALL women who deserve to enjoy intimacy without fear of pain.

In this episode we discuss the relationship between COVID and male sexual health.  As if COVID has not caused enough problems, we are now learning that it can creep into our bedrooms as well.  Anybody on social media can tell you that there are all sorts of claims about the impact of COVID on the sex lives of men. And, just in case you weren't confused and worried enough, those claims are often conflicting.  While some claim that COVID can cause problems ranging from erectile dysfunction to infertility, other claim that it's the COVID vaccines (rather than COVID itself) that are causing the problems. So who do we believe?  What do we know to be true versus what we think is true vs what may not be true vs what we know to be just pure nonsense? To help us sort the facts from the fiction, we are fortunate to be joined by Dr. Rena Malik. Dr. Malik is Assistant Professor of Surgery in the Division of Urology at the University of Maryland. She completed her training at the University of Chicago and the University of Texas at Southwestern Medical Center. She is currently a member of the American Urological Association and the Society of Women in Urology. She has published over 20 peer-review articles and book chapters. She also has a very popular YouTube channel dedicated to men's health that currently educates and entertains over 700,000 subscribers. And now, without further ado, I bring you our conversation with Dr. Renal Malik about the relationship between COVID and male sexual health.

Featuring slide presentations and related discussion from Drs Arjun Balar, Ashish Kamat, Guru Sonpavde and Robert Svatek, including the following topics: Current and Future Role of Novel Therapies in the Management of Metastatic Urothelial Cancer — Arjun Balar, MD (0:00) Immuno-oncology and Novel Agents in BCG-Unresponsive Non-Muscle-Invasive Bladder Cancer — Ashish M Kamat, MD, MBBS (28:11) Optimal Application of Immune Checkpoint Inhibitors in Metastatic Urothelial Bladder Cancer — Guru Sonpavde, MD (57:20) Current and Potential Future Role of Immune Checkpoint Inhibitors as Adjuvant and Neoadjuvant Therapy for Muscle-Invasive Bladder Cancer — Robert Svatek, MD (1:33:20) CME information and select publications

A special audio program developed from a satellite symposium held during the American Urological Association 2021 Annual Meeting. Featuring perspectives from Drs Arjun Balar, Ashish Kamat, Guru Sonpavde and Robert Svatek, moderated by Dr Neil Love.

Featuring perspectives from Drs Arjun Balar, Ashish Kamat, Guru Sonpavde and Robert Svatek, including the following topics: Personalized Continuing Medical Education Introduction (0:00) Understanding the Millennial Physician — Jason Hafron, MD (2:30) Non-Muscle-Invasive Urothelial Bladder Cancer (UBC) Case: A man in his late 70s with bacillus Calmette-Guérin (BCG)-refractory non-muscle-invasive bladder cancer — David S Morris, MD (9:27) Case: A man in his mid-60s with high-risk non-muscle-invasive UBC — Gordon A Brown, DO (14:45) Case: A man in his late 50s with high-risk, BCG-refractory non-muscle-invasive bladder cancer — Dr Hafron (23:03) Case: A man in his mid-80s with recurrent high-grade noninvasive papillary carcinoma — Dr Morris (32:16) Neoadjuvant and Adjuvant Treatment of Muscle-Invasive UBC Case: A man in his mid-80s with muscle-invasive bladder cancer who declines cystectomy — Sulfi Ibrahim, MD (37:22) Selection of Patients for Neoadjuvant Therapy — Dr Morris (44:08) Case: A man in his late 70s with Gleason 4 + 3 adenocarcinoma of the prostate and urothelial carcinoma — Dr Hafron (53:03) Treatment of Metastatic UBC Urologists' Questions about Second- and Later-Line Therapies and Management of Side Effects — Dr Morris (1:02:11) Case: A woman in her early 70s with metastatic UBC, PD-L1 30% — Dr Ibrahim (1:09:15) Case: A woman in her mid-50s with muscle-invasive bladder cancer — Dr Brown (1:25:20) CME information and select publications

One of the region's leading and most experienced urologists, Dr. Bruce Sloane is a specialist in Men's Health issues and Age Management Medicine. He helps his patients take control of their aging process, increase their health span and enjoy a higher quality, more vigorous life.Dr. Sloane earned his medical degree at Upstate Medical Center (Syracuse, NY). He fulfilled his residency in General Surgery at North Shore University Hospital (Manhasset, NY) followed by his residency in Urology at Tulane University School of Medicine (New Orleans, LA). In addition to his private practice, he holds an appointment as Clinical Assistant Professor in Surgery at Drexel School of Medicine (Philadelphia, PA).Dr. Sloane is certified by the National Board of Medical Examiners and the American Board of Urology. He is a Fellow of the American College of Surgeons and a Fellow of the Philadelphia College of Physicians. He has presented research papers and abstracts at professional meetings, and is widely published in peer-reviewed journals. He is a member of several medical societies and associations, including the American Urological Association and American Medical Association.https://philaurology.com/the-practice/bruce-b-sloane/GAINSWave: https://gainswave.com/fat/Get your own Phoenix pro for at home treatment: https://rockhardscience.com/dannyvega/ Low Carb Hustle podcast: www.lowcarbhustlepodcast.com Announcement Links:Protein pancakes: https://www.instagram.com/p/CKnRtPrgCGD/Protein: https://www.seacretdirect.com/300943591/en/us/item/3898/SHAKE-VANILLA-Shake-Vanilla/Recovery: https://www.seacretdirect.com/300943591/en/us/item/2020/Recovery-Buy-3-Get-1-FREE-Recovery-Promo-Pack-Qty-4/Molecular hydrogen studies: www.molecularhydrogenstudies.com Intro Song - https://soundcloud.com/freemusicforvlogs/kazura-back-to-you-free-music-for-vlogs This week's sponsor is keto brick, our favorite shelf-stable fat bomb. Keto bricks have great ingredients and there are both vegan and whey options. Use VEGA at checkout for a chance to win a month's supply of bricks!Http://www.ketobrick.com **Follow us!**http://www.instagram.com/fatfueledmomhttp://www.instagram.com/dannyvega.mshttp://www.instagram.com/fatfueledkidsYouTubehttp://www.youtube.com/fatfueledfamilyPlease make sure to SUBSCRIBE and leave us a 5-STAR RATING & REVIEW if you like our content!Please visit our blog:http://www.fatfueled.family Carnivore Keto Cut:https://carnivoreketocut.com/sales-page **PRODUCT CODES and LINKS**Amazon Store - http://www.amazon.com/shop/fatfueledmomKetoLogic 10% discount code: FATFUELEDFAMKetoLogic KETO 30: http://bit.ly/2EaqQRGKetoLogic BHB gummies: http://bit.ly/2DhgvkHFBOMB 20% discount code: FATFUELEDFAMFBOMB nut butters: http://bit.ly/2PySREs1Up Nutrition Supplements: Use code FFM20 for 20% off your order at https://1upnutrition.comCarnivore Crisps! - http://www.carnivorecrisps.com Code: FFF to save.Spiral Band Fitness: Use code MAURA to save 10% at https://www.spiralbandfitness.comPili Nuts: FATFUELEDMOM saves you  10% at http://www.eatpilinuts.comNeuroroast Coffee: KETOCC saves you 10% at http://www.neuroast.comSelect CBD: https://bit.ly/2AesxgyBeautycounter Safe Non-Toxic Beauty Products: http://www.beautycounter.com/mauravegaSanta Cruz Medicinals: Save $5 with code fatfueledmomFat Fueled Family bundle from eBar Cattle Company:https://ebarcattlecompany.com/collections/packages/products/fat-fueled-family-bundleMake sure to use FATFUELEDFAM to save 10% on your entire order!

Featuring perspectives from Drs Leonard Gomella, Maha Hussain, A Oliver Sartor and Neal Shore, including the following topics: Nonmetastatic (M0) Castration-Resistant Prostate Cancer (CRPC) Introduction: Personalized Continuing Medical Education (0:00) Case: A man in his early 70s with M0 CRPC — Gordon A Brown, DO (9:48) Case: A man in his late 70s with M0 CRPC — Sulfi Ibrahim, MD (17:13) Case: A man in his mid-70s with M0 CRPC — Jason Hafron, MD (22:11) Metastatic Hormone-Sensitive Prostate Cancer Case: A man in his late 60s with metastatic hormone-sensitive prostate cancer — Dr Brown (38:40) PARP Inhibitors in the Management of Metastatic CRPC (mCRPC) Case: A man in his mid-50s with mCRPC and a BRCA2 mutation — Dr Brown (48:53) Case: A man in his mid-70s with mCRPC and a somatic BRCA2 homozygous deletion — Dr Hafron (1:13:08) Case: A man in his mid-70s with mCRPC and a BRCA2 mutation — Dr Ibrahim (1:18:36) CME information and select publications

A special audio program developed from a series of webinars held during the American Urological Association's Annual Meeting (AUA2021). Featuring perspectives from Drs Leonard Gomella, Maha Hussain, A Oliver Sartor and Neal Shore.

In the second edition of this two-part Oncology, Etc. episode, hosts Dr. Patrick Loehrer (Indiana University) and Dr. David Johnson (University of Texas) continue their conversation with Dr. Otis Brawley, a distinguished professor of Oncology at Johns Hopkins and former Executive Vice President of the American Cancer Society. Subscribe: Apple Podcasts, Google Podcasts | Additional resources: elearning.asco.org | Contact Us Air Date: 10/5/2021   TRANSCRIPT [MUSIC PLAYING] SPEAKER: The purpose of this podcast is to educate and inform. This is not a substitute for 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. [MUSIC PLAYING] DAVID JOHNSON: Welcome back to Oncology, Etc, and our second segment of our conversation with Otis Brawley, professor of Medicine at Johns Hopkins Medical School and the Bloomberg School of Public Health. Pat, I don't know about you, but Otis is a very impressive man, and he had a lot of really interesting things to say about his career development, family, et cetera in the first segment. This second segment, we're going to get to hear more about his time at the ACS. What were your thoughts about segment one? PATRICK LOEHRER: Well, I loved talking to Otis, and you too, Dave. Parenthetically, Otis once told me in a dinner conversation we had that he felt like Forrest Gump, and I can identify with that. Where over the field, our field of oncology over the last several decades, we've met some incredibly wonderful people, and we've been lucky to be part of the history. The three of us, I think, do have a deep sense of the historical context of oncology. This is a young field, and there's just some extraordinary people, many of them real true heroes, and Otis has his figure on the pulse of that. DAVID JOHNSON: Yeah, that's why he's been in some of the right places at the right time, and we'll hear more about that in this segment coming up now. PATRICK LOEHRER: Now Otis has had a career in many different areas, including ODAC, the NCI, the ACS, now at Hopkins. So let's hear a little bit more about Dr. Brawley's experience at the American Cancer Society and particularly with his experience with the former CEO, John Seffrin. DAVID JOHNSON: Sounds great. [MUSIC PLAYING] OTIS BRAWLEY: John and I had a wonderful run at the American Cancer Society. Got to do a lot of things. Got to testify for the Affordable Care Act. Got to do some of the science to actually argue that the Affordable Care Act would help. And I was fortunate enough to be there long enough to do some of the science to show that the Affordable Care Act is helping. DAVID JOHNSON: Yeah, I mean actually all of the things you accomplished at the ACS are truly amazing. Let me ask you, just on a personal level, what did you like most about that job, and then what did you like least about that job? [LAUGHTER] OTIS BRAWLEY: I like the fact-- there were a lot of things I liked about that job. There were a couple hundred scientists and scientific support people that you got to work with. And I used to always say, I do politics so you can do science. And what I used to like the most, every Wednesday afternoon that I was in town, I would walk around just to watch those people think. I used to joke around and say, I'm just walking around to see who came to work today. But I really enjoyed watching them work and watching them think, and that was fun. Another fun aspect of the job was people used to call and ask a little bit about the disease that they are a family member would have. And sitting down with them on the phone in those days-- we didn't have Zoom-- and talking to them through their disease. Not necessarily giving them advice on what to do in terms of treatment, but helping them understand the biology of the disease or connecting them with someone who was good in their disease. And I happen to, by the way, have sent some patients to both of you guys. That was a lot of fun. Then the other thing, of course, was the fact that you could actually influence policy and fix things. I'll never forget sitting across from Terry Branstad, then the governor of Iowa, and convincing him that the right thing to do is to raise the excise tax on tobacco in Iowa. Being able to see that you're effective and to see that you're positively influencing things. The bad side, some of the politics. I didn't necessarily like how some of the money was being raised or where they were raising money from. I think that you have to have a certain standard in terms of where you accept money. And we always had that tension with the fundraisers. But it's also true-- and I will give them a nod-- you can't do the fun things unless you raise money. So I really truly enjoyed my time at the American Cancer Society. And by the way, a shout out to Karen Knudsen, who is the CEO running the American Cancer Society now. And I'm fully committed to helping the ACS and helping Karen be successful. DAVID JOHNSON: One of the things I read-- I think I read this that you had said that one of your proudest accomplishments was revising the ACS screening guidelines. Tell us just a little bit about that. OTIS BRAWLEY: Yeah, going all the way back to the early 1990s, I started realizing that a lot of these guidelines for screening, or back then, this is before the NCCN guidelines for treatment even, that were published by various organizations, including the American Cancer Society. We're almost the equivalent of-- get the impression that in the 1960s, it would have been a smoke-filled room. But you gather a bunch of people into a room, and they come up with, this is what we should be doing. Indeed, the American Cancer Society in 1991 endorsed annual PSA screening for prostate cancer based purely on getting a group of primarily urologists into a room, and that's what they came up with. There was very little review of the science. There really was no science at that time except the science to show that PSA screening found cancer. There were no studies to show that led to men benefiting in that they didn't die. Indeed, in 1991, there was no study to show that treatment of early prostate cancer saved lives. The study to show treatment of prostate cancer saves lives was first published in 2003, and the radiation saves lives in 1997, 1998. Surgery saves lives in 2003 and screening has a small effect published in 2009. But they started recommending it in 1991 in this almost smoke-filled room kind of atmosphere. When I got to the American Cancer Society, I started an effort, and we involved people from the National Academy of Medicine, we involved people from the NCCN, from the American Urological Association, the American Academy of Family Physicians, the American College of Physicians. And we got together in that almost smoke-filled room again, but the idea was, how do you make responsible guidelines? And we wrote that up into a paper guide widely accepted by all of the organizations, and it involves a review of the literature that is commissioned by someone. And they spend a long time reviewing the literature and writing a literature review. And then you have a group of experts from various fields to include epidemiology and screening, social work, someone who's had the disease. Not just the surgeons and medical oncologists who treat the disease but some population scientists as well. They sit down and they reveal all of the scientific data, and then they start coming up with, we recommend this. And then they rank how strong that recommendation is based on the data. We published this in 2013 in The Journal of the American Medical Association. I do think that was important, you're right. That's Otis trying to bring his policy and his belief in orthodox approach to science and bring it all together. PATRICK LOEHRER: So let me reflect a little bit more on something. There is a book that I also just recently read by Dax-Devlon Ross, and it's a book entitled, Letters to my White Male Friends, and it was a fascinating read to me. You have this public persona and professional persona of being an outstanding physician, clinician, public speaker. But what we the three of us have never really had the conversation today is we have much more interest now in DEI. One of our other speakers talked about the fact that there's a tax that is placed upon underrepresented minorities and academics. They are all expected to be on committees. They have to be doing different things. And so the things that they love to do, they can't do it because they have to represent their race or their gender or their ethnicity. OTIS BRAWLEY: I have been blessed and fortunate. There are problems, and there are huge burdens that Black doctors, and women doctors by the way, have to carry. I have been fortunate that I have skated through without a lot of that burden. Maybe it has to do with oncology, but I will tell you that I have been helped by so many doctors, men and women, predominantly white, but some Asian, Muslim, Jewish, Christian. I don't know if it's oncology is selective of people who want to give folks a fair shake and really believe in mentoring and finding a protege and promoting their career. I have been incredibly, incredibly fortunate. Now that I say that, there are doctors, minority doctors and women, who don't have the benefits and don't have the fortunes that I have had, and we all have to be careful for that. As I said early on, John Altman told me that I will thank him by getting more Blacks and women into the old boys club. And so that was his realizing that there is a-- or there was a problem. I think there still is a problem in terms of diversity. Now I have seen personally some of the problem more outside of oncology in some of the other specialties. More in internal medicine and surgery, for example. By the way, there are also some benefit. I did well in medical school in third and fourth year in medical school at the University of Chicago because there were a group of Black nurses who were held that I wasn't going to fail. The nurses took me under their wing and taught me how to draw blood, how to pass a swan. The first code I ever called, there was a nurse standing behind me with the check off list. And so there are some advantages to being Black as well. But there are some disadvantages. I've been very fortunate. My advice to Black physicians is to keep an open mind and seek out the folks in medicine who truly do want to help you and truly do want to mentor you. And for the folks who are not minority or not women in medicine, I say, try to keep an open mind and try to help everybody equally. PATRICK LOEHRER: Thank you. DAVID JOHNSON: I want to go back to your book for a moment. And again, for those who've not read it, I would encourage them to do. So it's a really honest book, I think, well-written. You made a comment in there-- I want to make sure I quote it near correctly. You said that improvement in our health care system must be a bottom up process. What do you mean by "bottom up?" OTIS BRAWLEY: Well, much of it is driven by demand from patients and other folks. The name of the book was, How We Do Harm. And the synopsis is there are bunch of people who are harmed because they don't get the care that they need. And there's a bunch of people who are harmed because they get too much medicine and too much care. And they rob those resources away from the folks who don't get care at the same time that they're harmed by being overtreated, getting treatments that they don't need. The other thing, if I can add, in American health care, we don't stress risk reduction enough. I used to call it "prevention." Some of the survivors convince me to stress "activities to reduce risk of disease." We don't do a lot in this country in terms of diet and exercise. We try to do some work somewhat successfully on tobacco avoidance. We need to teach people how to be healthy. And if I were czar of medicine in the United States, I would try to make sure that everybody had a health coach. Many of us go to the gym and we have a trainer. We need trainers to teach us how to be healthy and how to do the right things to stay healthy. That's part of the bottom up. And in terms of costs you know my last paper that I published from the American Cancer Society, I published purposefully, this is my last paper. Ahmedin Jemal who's a wonderful epidemiologist who I happen to have worked with when I was at the National Cancer Institute and again later in my career at the American Cancer Society, I pushed Ahmedin-- he publishes these papers, and we estimate x number of people are going to be diagnosed with breast cancer and y number are going to die. He and I had talked for a long time about how college education reduces risk of cancer death dramatically. If you give a college education to a Black man, his risk of death from cancer goes down to less than the average risk for a white American. There's something about giving people college education that prevents cancer death. I simply challenged Ahmedin, calculate for me how many people in the United States would die if everybody had the risk of death of college-educated Americans. And he came back with of the 600,000 people who die in any given year, 132,000 would not die if they had all the things from prevention through screening, diagnosis, and treatment that college-educated people. Just think about that-- 132,000. Then I started trying to figure out what drug prevents 132,000 deaths per year? And I couldn't think of one until recently, and it happens to be the coronavirus vaccine. Which ironically has shown itself to be the greatest drug ever created in all of medicine. But in cancer, there's no breakthrough drug that is more effective than just simply getting every human being the care from risk reduction and prevention all the way through treatment that every human being ought to be getting. The solution to some of that starts with fixing third grade and teaching kids about exercise, about proper diet. PATRICK LOEHRER: We're going to have to wind things up here. But real quickly, a book you would recommend? OTIS BRAWLEY: Skip Trump, who's someone that we all know, wonderful guy used to run Roswell Park Cancer Center, just published a book actually it's coming out in September called, Centers of the Cancer Universe, A Half Century of Progress Against Cancer. I got a preprint of that, and it is a great book. It talks about what we've learned in oncology over the last 50 years since Richard Nixon signed the National Cancer Act. Keep in mind, he declared war on cancer on December 23, 1971. So we have an anniversary coming up in December. PATRICK LOEHRER: I want to close. Another book, I read the autobiography of Frederick Douglass. It's a wonderful read. It really is good. There were some endorsements at the end of this book, and one of them was written by a Benjamin Brawley, who wrote this review in a book called, The Negro in Literature and Art in 1921. And Benjamin Brawley was writing this about Frederick Douglass, but I would like to have you just reflect a moment. I think he was writing it about you, and I'm just going to read this. He basically said, at the time of his death in 1895, Douglass had won for himself a place of unique distinction. Large of heart and of mind, he was interested in every forward movement for his people, but his charity embraced all men in all races. His mutation was international, and today, many of his speeches are found to be the standard works of oratory. I think if your great, great grandfather were here today, he would be so incredibly proud of his protege, Otis. And it's such a privilege and pleasure to have you join us today on Oncology, Etc. Thank you so much. OTIS BRAWLEY: Thank you. And thank both of you for all the help you've given me over the years DAVID JOHNSON: Great pleasure having you today, Otis. I want to also thank all of our listeners for tuning in to Oncology, Etc. This is an ASCO educational podcast. We really are here to talk about anything and everything. So we're looking for ideas. Please, if you have any suggestions, feel free to email us at education@ASCO.org. Thanks again, and remember, Pat has a face for podcasts. [MUSIC PLAYING] SPEAKER: Thank you for listening to this week's episode of the ASCO e-learning weekly podcasts. To make us part of your weekly routine, click Subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive e-learning center at elearning.asco.org.

Guest: Aaron M. Potretzke, M.D. (@potretzke) Host: Darryl S. Chutka, M.D. (@ChutkaMD) Microscopic hematuria, and less commonly gross hematuria, are conditions commonly seen by the primary care provider. Malignancy is the most ominous cause of hematuria. Fortunately, other causes are much more likely. Since this is a relatively common health condition, when should we investigate hematuria and what should the evaluation consist of? How do we evaluate a patient's risk for urinary tract malignancy? Dr. Aaron Potretzke, a urologist at Mayo Clinic joins us to discuss these questions. Specific topics: Definition of hematuria Benign causes of hematuria Risk of malignancy in low, medium, and high-risk patients Stratifying malignancy risk in patients for genitourinary malignancy Recommended evaluation for patients with hematuria How to manage patients with persistent hematuria despite a negative evaluation Role of urine cytology in the evaluation of hematuria Additional resources: American Urological Association hematuria guideline and algorithm: https://www.auanet.org/guidelines/guidelines/microhematuria Connect with the Mayo Clinic's School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Episode 63: Tumor Markers Basics. George and Harendra discuss with Dr Arreaza the role of tumor markers in the diagnosis and monitoring of different types of cancer.  Introduction: Recent News about COVID-19Written by Hector Arreaza, MD. Participation: George Karaghossian, MS3, and Harendra Ipalawatte, MS3.Before we talk about our topic today, there are three news worth sharing about COVID-19.First, we are all aware of the increased number of patients affected by COVID-19 and increased mortality. Most of the patients who are severely ill or those who require admission are unvaccinated. The cases of breakthrough infections (infections in patients who are fully vaccinated) continues to be rare.Second, CDC has officially recommended COVID-19 vaccination in pregnant women (August 11, 2021)[1].  All people 12 years of age and older is recommended to get vaccinated against COVID-19, including pregnant women. There were 2,500 women who received the mRNA vaccine against COVID-19, and there was not an increased risk for miscarriage. Vaccinated pregnant women (or persons) had a miscarriage rate of 13% (similar to the miscarriage average in general population, which is 11-16%).Third, FDA gave an emergency use authorization for a third dose of mRNA vaccines (Pfizer and Moderna) for certain immunocompromised patients (August 12, 2021)[2]. The third dose of the vaccine (it has to be the same vaccine you received) has to be given at least 28 days apart from your last dose. Patients who may receive a third dose include: Patients who are undergoing active treatment for solid tumor and hematologic malignancies, recipients of solid-organ transplant and taking immunosuppressive therapy, moderate or severe primary immunodeficiency (e.g. DiGeorge syndrome, Wiskott-Aldrich syndrome), patients with advanced or untreated HIV infection, patient who are taking high-dose corticosteroids (i.e. >20 mg prednisone or equivalent per day) and other immunosuppressive medications. If in doubt, consult our oncologists and rheumatologists.Let's switch gear and introduce the topic for today. Given the high mortality and morbidity of cancer, in general, early detection of cancer is one of the most important goals in primary care. Today George and I will discuss the usefulness, pitfalls and will mention some of the most common tumor makers.This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. Tumor Markers Basics. By George Karaghossian, MS3, Ross University School of Medicine; Harendra Ipalawatte, MS3, Ross University School of Medicine; and Hector Arreaza, MD.   Introduction:Do you remember how we came up with the idea for this topic? We had a patient with an intraabdominal malignancy which appeared to be from the GI tract vs an adnexal mass. We order tumor markers to assist in the diagnosis of the origin of this malignancy.  Definition: Tumor markers are usually proteins or other substances that are produced by cancer cells or non-cancerous cells. Circulating biomarkers and tissue biomarkers are the two types of tumor markers we utilize to track the course of the tumor's growth. Circulating tumor markers are found in bodily fluids such as blood, urine, and stool. Tissue markers are typically found on the actual cancer cells. These markers can help in the assessment of certain cancers. The downside of tumor markers is that they are not always reliable, and they may not be detected in the early stages of cancer[2].  Characteristics of a good screening test: A good screening test must be capable of detecting a high proportion of disease when patients are asymptomatic, tests should be safe, not excessively expensive, lead to improved health outcomes, be widely available, and interventions after a positive test should also be available. Can tumor markers be used for cancer screening?Tumor markers should not be used as a primary tool for cancer screening because they lack sensitivity and specificity. The most definitive tool for diagnosis of cancer therefore is biopsy, thus tumor markers cannot be used to diagnose cancer. Tumor markers can be done in blood, in urine, and in tissue (biopsy). An example of tumor markers in biopsies are estrogen receptor (ER) and progesterone receptor (PR). What are tumor markers good for?Tumor markers may be good indicators of response to cancer therapy. When cancer patients are undergoing therapy for treatment of their cancer, we usually track tumor markers to see if there is downward trend over the course of therapy indicating that the therapy is working.  Tumor markers are also a good tool to monitor early relapse of certain malignancies. After treatment, tumor markers may be measured to see if the cancer is returning after treatment. Some tumor markers also assist in deciding which treatment is best. For example, the example I mentioned before ER and PR are tumor markers that can be used to pick the best treatment for certain breast tumors. Pitfalls of tumor markers. A benign disease can raise some tumor marker levels. Some people without cancer can have high levels of a tumor marker. Tumor marker levels can change over time, and levels may be undetectable until cancer gets worse.  Common tumor markers:PSA (Prostate specific antigen): Elevated in prostate cancer, BPH, DRE (recently showed to be questionable for screening). PSA is one of the most controversial tumor markers when it comes to screening for prostate cancer. Although PSA has been shown to be elevated prostate cancers, it has also been shown to be increased in BPH, prostatitis, digital rectal exams as well as post ejaculation. This tumor marker remains controversial in screening because there is an uncertainty about the outcome of localizing such prostate cancers. According to the American Urological Association they suggest that patients should be given an abundant amount of education about PSA, and they should ultimately decide if they would like this marker to be used as a tool for screening for their prostate cancer. PSA was widely used in the past for prostate cancer screening. It was like the “savior” for men who wanted to avoid digital rectal exam. Well, several years later, PSA increased the number of biopsies and even mortality related to prostate cancer diagnostic tests. The IsoPSA may be a better tool, but it is not ready for prime time yet (listen to episode 60). If you find a PSA higher than 4, refer to urology.ALP (alkaline phosphatase): Elevated in metastasis to bone and liver and Paget's disease of the bone. In Paget's disease, you will not be able to use ALP to tell if the patient has bone cancer or just the progression of the disease, but an incidental elevated ALP can prompt you to investigate and come to a diagnosis of Paget's disease after an extensive work up. ALP is also elevated in many other conditions, for example, obstruction of the biliary tree. AFP (alpha feto-protein): Elevated in hepatocellular carcinoma, yolk sac tumor, neural tube defects, ataxia telangiectasia, mixed germ cell tumors. Beta-hCG (beta human chorionic gonadotropin): Elevated in hydatidiform mole, testicular cancer, mixed germ cell tumors.After treatment of a molar pregnancy, the patient has regular measurements of hCG until it is undetectable. A rise in hCG may prompt additional treatment or work up because there is an increased risk of choriocarcinoma. CA 19-9 - pancreatic adenocarcinoma.CA 19-9: When we think of this tumor marker our minds tend to think about the possibility of pancreatic adenocarcinoma. However, this tumor marker is also associated with other malignancies such as biliary tract cancers and esophageal cancer as well. CA 19-9 has less than 1% PPV, but in the case where pancreatic cancer is already diagnosed, screening with CA 19-9 has a positive predictive value of 97%. Also, there is an 80% and 90% sensitivity and specificity respectively for pancreatic cancer, when already diagnosed. CA 125: Elevated in ovarian carcinoma, and malignant ascites. This tumor marker is often associated with epithelial ovarian cancers, often increased when malignancy is present. CA 125 levels are elevated in 85% of women with malignant type ovarian cancer. However, this marker is insensitive to early stages of ovarian cancer and are not very useful. CA 125 has not shown an increase in survival for women with ovarian malignancies. CEA (Carcinoembryonic antigen): Commonly elevated in colon or pancreatic cancers. Less commonly elevated in gastric cancers, breast cancers, medullary thyroid carcinoma, irritable bowel disease, non-small cell lung carcinoma, increased in smokers.[4]CEA is a tumor marker that is overexpressed in adenocarcinomas especially when it comes to colorectal cancers. When we see elevated CEA values, we tend to think colorectal cancer is imminent however, this is one of the tumor markers that are ultimately one of the most nonspecific. CEA is also elevated in cigarette smoking, PUD, IBD, pancreatitis and medullary thyroid cancers. The American Society of clinical oncology recommends that we monitor CEA levels every two to three months for at least two years with patients for surgical candidates with stage II/III colorectal cancers.  Calcitonin: Elevated in medullary thyroid carcinoma, MEN2A/2B. Some doctors may be tempted to measure calcitonin before initiating a GLP-1 receptor agonist medication, these meds are very popular now for diabetes treatment and obesity. Calcitonin measurement is not recommended before starting treatment. Medullary thyroid carcinoma was demonstrated in mice who received GLP-1 RA, not in humans. MEN2 (multiple endocrine neoplasia type 2) and personal and family history of medullary thyroid cancer are contraindications to GLP-1 RA (exenatide, dulaglutide, semaglutide, those meds that end in -tide). As a reminder, all MEN2 presents with pheochromocytoma and medullary thyroid carcinoma. MEN2A, additionally presents with parathyroid hyperplasia, and MEN2B presents with mucocutaneous neuromas, GI symptoms and muscular hypotonia (marfanoid habitus).  Chromogranin A: Elevated in neuroendocrine tumors (insulinoma, glucagonoma, VIPoma) carcinoid tumor, small cell lung cancer. LDH (lactate dehydrogenase): Elevation indicates tumor invasiveness. This is widely used test for many non-malignant conditions as well, for example hemolytic anemias. CYFRA 21-2: Elevated in lung cancer (non-small cell type), squamous cell lung carcinoma (68% sensitivity, 94% specificity).[3] SMRP (serum soluble mesothelin related peptide): Elevated in mesothelioma. NSE (neuron specific enolase): Elevated in small cell lung cancer, carcinoid, neuroblastoma, also released 2/2 brain injuries. Monoclonal immunoglobulins: Elevated in multiple myeloma, Waldenstrom macroglobulinemia. S-100: Elevated in malignant melanoma. B2 microglobulin: Elevated in multiple myeloma, CLL. Final remarks.George: The biggest challenge we face with these biomarkers is the inconsistency of the results which may be influenced by our collection methods and sample storage[4].  The science community has come a long way over the years in assessing these markers and using them to the best of their abilities, however it remains a subject matter that must be further assessed to make sure our research and data does not result in false and misleading outcomes.Arreaza: For now, use tumor markers with responsibility. Discuss with patients the consequences of elevated tumor markers, as you may end up with more questions than answers. But, we have to be fair and also highlight the role of tumor markers in monitoring response to treatment and cancer recurrence. Also, they may be useful (especially the tissue specific markers in identification of cancers and in the decision on treatments). Conclusion: Now we conclude our episode number 63 “Tumor Markers.” Some of the most common markers were discussed. We hope this information will help you decide when to use tumor makers to evaluate your patients. Remembering which conditions cause elevation for each tumor marker is challenging, but with practice and time, you can master the most common ones. Even without trying, every night you go to bed being a little wiser. Comirnaty®: I want to make sure you know about this. The FDA finally gave official approval to the Pfizer BioNTech COVID-19 vaccine on August 23, 2021. This vaccine now has a brand name: Comirnaty®. It is approved for persons older than 16 years old, however, it continues to be available for children between 12-15 years old. Safety monitoring will continue but so far, this vaccine has a strong evidence of being effective and safe.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Harendra Ipalawatte, and George Karaghossian. Audio edition: Suraj Amrutia. See you next week! _____________________References:New CDC Data: COVID-19 Vaccination Safe for Pregnant People, CDC Online Newsroom, August 11, 2021. https://www.cdc.gov/media/releases/2021/s0811-vaccine-safe-pregnant.html. Talking with Patients Who Are Immunocompromised about an additional dose of an mRNA COVID-19 vaccine, Centers for Disease Control and Prevention, https://www.cdc.gov/vaccines/covid-19/clinical-considerations/immunocompromised-patients.html. Perkins GL, Slater ED, Sanders GK, Prichard JG. Serum tumor markers. Am Fam Physician. 2003 Sep 15;68(6):1075-82. PMID: 14524394. https://www.aafp.org/afp/2003/0915/p1075.html Nagpal M, Singh S, Singh P, Chauhan P, Zaidi MA. Tumor markers: A diagnostic tool. Natl J Maxillofac Surg. 2016;7(1):17-20. doi:10.4103/0975-5950.196135 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5242068/ Wieskopf Bram, et al, CYFRA 21-1 as a biological marker of non-small cell lung cancer. Chest Journal, Clinical Investigations, vol 108, issue 1, P163-169, July 01, 1995, DOI:https://doi.org/10.1378/chest.108.1.163. https://journal.chestnet.org/article/S0012-3692(16)38611-1/fulltext#relatedArticles. Schrohl, Anne-Sofie, et al. Tumor Markers, from laboratory to clinical utility. Molecular and Cellular Proteomics. Journal of Oncological Studies, vol 2, issue 6, P378-387. June 01, 2003. https://www.mcponline.org/article/S1535-9476(20)34451-0/fulltext. Tumor Markers in Common Use. National Cancer Institute. National Institutes of Health. https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/tumor-markers-list.

This episode features Dr. Joseph Sonstein, MD. He completed his medical school and residency training at UTMB in Galveston, Texas. He currently serves as the program director for urology and as an associate professor in urology at UTMB.In this episode, we get a program director's opinion on what it's like to apply to urology and things students should keep in mind. We discuss STEP1, personal statements, letters of recommendation, and more!RESOURCES:UroResidency (https://uroresidency.com/resources)Urology Match (https://www.urologymatch.com/) American Urological Association (https://www.auanet.org/)Society of Academic Urologists (https://sauweb.org/home.aspx)EMAIL:Dr. Sonstein: josonste@utmb.eduME: atmeffor@utmb.edu 

Jihad Kaouk, MD FACS, FRCS (Glasgow) is an American Board certified Urologist and the Director of the Center for Advanced Robotic and Image Guided Surgery at the Cleveland Clinic Glickman Urological and Kidney Institute. He also serves as a Professor of Surgery at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, the Vice Chair of Enterprise Surgical Operations and the chair holder for the Zegarac-Pollock Endowed Chair in laparoscopic and robotic surgery. Dr. Kaouk has performed several "first" surgical procedures, including the first Robotic single port surgery through the belly button in 2008, the first completely transvaginal kidney removal in 2009, and the first robotic perineal prostatectomy in 2014. Dr. Kaouk holds 2 USA patents for medical devices used mainly during partial nephrectomy and in robotic surgery. Currently Dr. Kaouk chairs the American Urological Association's “Laparoscopic, Robotic and New Technology” committee. In this episode, Dr. Kaouk shares advances in robotic surgeries and its current state of the art applications in the operating room. He presents his innovative views on how robotics is supporting surgeons perform surgeries which improve patient outcomes, address complex operative challenges and integrates data from other sources such as imaging. Moderated by Dr. Frank Papay, Chair of Dermatology and Plastic Surgery Institute at the Cleveland Clinic and Alok Kothari, Machine Learning Engineer, they discuss the future applications of robotics and applications of artificial intelligence to provide better guidance to the clinicians in the operating room.

The outcomes of prostate cancer can differ vastly. Some patients have slow-growing cancer that will never threaten their health, while others have aggressive cancer that progresses quickly. Urologists have a variety of new tools available to help them match the patient with the right course of treatment. Those tools range from cutting-edge tests to expose the molecular basis of the cancer to imaging techniques that can allow for the precise targeting of the cancer. A urologist who understands the use and limitations of those tools is critical for attaining the best outcomes.  We have a very special guest joining us today! We are happy to welcome Dr. Chris Barbieri, a urologist from Weill Cornell Medicine! The above opening statement was taken from his personal statement, and he remains committed to it. He also remains at the forefront of prostate cancer care in the 21st century.  Dr. Christopher Barbieri attended Vanderbilt University School of Medicine, where he obtained both his MD and Ph.D. degrees. He completed both his Urology Residency and Urologic Oncology Fellowship at Weill Cornell Medical College. Dr. Barbieri's research interests include using genomic data to define distinct molecular subclasses of urologic malignancy, with a specific focus on prostate cancer. His work has led to recognition as a Prostate Cancer Foundation Young Investigator and a Urology Care Foundation Research Scholar; he is also the recipient of a Career Development Award from the National Cancer Institute to fund his work on prostate cancer.  In addition, Dr. Barbieri has also been recognized as a Rising Star in Urology Research by the American Urological Association, and with a Clinical Investigator Award from the Damon Runyon Cancer Research Foundation. He is a prostate cancer surgeon and a highly active researcher in prostate cancer genomics in the Sandra and Edward Meyer Cancer Center at Weill Cornell. That has allowed him to stay at the forefront of prostate cancer in the 21st century and deliver the best possible care to his patients. Be sure to stay tuned for 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. Barbieri explains why there is no one-size-fits-all solution when it comes to prostate cancer treatment. Some of the initial factors can be looked at to distinguish between men with low-risk prostate cancer and those with higher-risk disease. Dr. Barbieri explains how patients can be better guided in determining which cancers might be more aggressive versus those that might be less aggressive. The difference between genomic testing and genetic testing for prostate cancer. Dr. Barbieri discusses various scenarios related to genomic testing. Dr. Barbieri explains how genomic testing helps him counsel men in the grey area of cancers that can safely be observed after a biopsy versus more serious forms of prostate cancer. Dr. Barbieri does not advocate for any specific genomic test or company. They are all reliable with good performance characteristics. Dr. Barbieri talks about the role that genomic testing for prostate cancer plays for men who have already undergone a radical prostatectomy. There are many new and exciting developments happening in the field of prostate cancer. Dr. Barbieri urges men to keep themselves informed of those. 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.

We are keeping the ball rolling with another amazing MS4 match episode! Alek sits down with Dr. Cesar Delgado, MD, and Dr. Hannah Slovacek, MD, two recent 2021 Loyola Stritch School of Medicine graduates that matched into Urology at University of California San Diego (UCSD) and University of Texas, Houston (UT Houston) respectively. Here, Cesar and Hannah reflect on their journey in pursuing a career in Urology, as well as provide tips and recommendations for all stages of the match process. If you are interested in learning more about Urology, you can reach out to Cesar via DM on Twitter @CesarDelgadoMD or Hannah at hannah.slov@gmail.com, or the official American Urological Association website at https://www.auanet.org/ Episode produced by: Alek Druck Episode recording date: 05/2021 www.medicuspodcast.com | medicuspodcast@gmail.com | Donate: http://bit.ly/MedicusDonate --- Send in a voice message: https://anchor.fm/medicus/message

How the American Urological Association and their Dr. members advocate for better health. Quardricos Bernard Driskell is a federal lobbyist, legislative and political affairs manager for the American Urological Association. Before the AUA, he worked for two patient voluntary health associations where he advanced the patient voice into policy and research deliberations through services to Congress, Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and National Institutes of Health (NIH). Based in Washington, DC, Quardricos represents his company before the federal government. During Quardricos’ typical workday, he engages Members of Congress, Capitol Hill staffers, and other stakeholders in the government to develop, progress, or halt legislation that affects health care. He is an adjunct professor of legislative politics at the George Washington University Graduate School of Political Management. He is an opinion contributor for the Washington D.C. top political news site, The Hill. His work and insights have been featured in several national and international news outlets, including the New York Times, Voice of America, NBC News, MSNBC, Religion News Service, the BBC, and Showtime’s Documentary, “The Fourth Estate.” Thank you to our sponsor: Rap Index, tell them Roger sent you. https://www.rapindex.com   This podcast is dedicated to the art of advocacy. Also listen for this episodes advocacy tip. Contact Voices In Advocacy at: www.VoicesinAdvocacy.com 480 488-9150 At Voices in Advocacy we work with organizations that want to inspire, educate, engage, and activate their supports to become even better influential advocates.

UTIs: sex differences / antibiotics / self-diagnosis / cranberry juice / probiotics / D-mannose / drinking water / peeing after sex / contraception / topical estrogen. iPhone 12's effect on pacemakers and implanted defibrillators. COVID-19 vaccines: Johnson & Johnson's / AstraZeneca's / variants / scams.   * Jingle by Joseph Hackl * Theme music: “Fall of the Ocean Queen“ by Joseph Hackl. * Assistant researcher: Nicholas Koziris   To contribute to The Body of Evidence, go to our Patreon page at: http://www.patreon.com/thebodyofevidence/.   Patrons get a bonus show on Patreon called “Digressions”! Check it out!     References:   1) Statistics from the American Urological Association: https://www.urologyhealth.org/healthy-living/urologyhealth-extra/magazine-archives/summer-2016/understanding-utis-across-the-lifespan   2) Urinary Tract Infection Syndromes: Occurrence, Recurrence, Bacteriology, Risk Factors, and Disease Burden: https://www.sciencedirect.com/science/article/pii/S0891552013000743?via%3Dihub   3) Patient-initiated treatment of uncomplicated recurrent urinary tract infections in young women: https://pubmed.ncbi.nlm.nih.gov/11434727/   4) Antibiotic sparing strategy: https://www.bmj.com/content/351/bmj.h6544   5) Cochrane review on Cranberries for preventing urinary tract infections: https://doi.org/10.1002/14651858.CD001321.pub5   6) Cranberry Extract for Symptoms of Acute, Uncomplicated Urinary Tract Infection: A Systematic Review: https://www.mdpi.com/2079-6382/10/1/12   7) Cochrane review on Probiotics for preventing urinary tract infections in adults and children: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008772.pub2/full   8) Systematic review of the literature on D-mannose for recurrent UTIs: https://pubmed.ncbi.nlm.nih.gov/32972899/   9) Fluid intake to prevent recurrent UTIs: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584323/   10) Prevention and treatment of uncomplicated lower urinary tract infections in the era of increasing antimicrobial resistance-non-antibiotic approaches: a systemic review: https://link.springer.com/article/10.1007/s00404-019-05256-z   11) The Role of Asymptomatic Bacteriuria in Young Women With Recurrent Urinary Tract Infections: To Treat or Not to Treat? https://doi.org/10.1093/cid/cis534   12) INESSS Antibiotic Guidelines: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Outils/GUO/Anglo/Guide_InfectionUrinaire_EN_WEB.pdf       Music Credits:   Joy And Optimism (loopable) by chilledmusic Link: https://filmmusic.io/song/7580-joy-and-optimism-loopable- License: https://filmmusic.io/standard-license   Long Road Ahead by Kevin MacLeod Link: https://filmmusic.io/song/3996-long-road-ahead License: https://filmmusic.io/standard-license  

View the show notes in Google Docs here: http://bit.ly/3bFS43j Gonorrhea Updates Gonorrhea Treatment and Care. Centers for Disease Control and Prevention Website. https://www.cdc.gov/std/gonorrhea/treatment.htm. Published December 14, 2020. Accessed January 11, 2021. CDC No Longer Recommends Oral Drug for Gonorrhea Treatment. Centers for Disease Control and Prevention. https://www.cdc.gov/nchhstp/newsroom/2012/gctx-guidelines-pressrelease.html. Published August 9, 2012. Accessed January 11, 2021. Recurrent UTI Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2019). American Urological Association. https://www.auanet.org/guidelines/recurrent-uti?fbclid=IwAR1TwSTQNHv8PDWLfW7WjsDan46D_9b6Qs1ptJxaXr6YFnDpBeptpW3BY. Published 2019. Accessed January 11, 2021. Combo Ibuprofen and Acetaminophen / Pain Advil® Dual Action. GSK Expert Portal. https://www.gskhealthpartner.com/en-us/pain-relief/brands/advil/products/dual-action/?utmsource=google&utmmedium=cpc&utmterm=ibuprofen+acetaminophen&utmcampaign=GS+-+Unbranded+Advil+DA+-+Alone+-+PH. Accessed January 11, 2021. FDA approves GSK's Advil Dual Action with Acetaminophen for over-the-counter use in the United States. GSK. https://www.gsk.com/en-gb/media/press-releases/fda-approves-gsk-s-advil-dual-action-with-acetaminophen-for-over-the-counter-use-in-the-united-states/. Published March 2, 2020. Accessed January 11, 2021. Tanner T, Aspley S, Munn A, Thomas T. The pharmacokinetic profile of a novel fixed-dose combination tablet of ibuprofen and paracetamol. BMC clinical pharmacology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2906415/. Published July 5, 2010. Accessed January 11, 2021. Searle S, Muse D, Paluch E, et al. Efficacy and Safety of Single and Multiple Doses of a Fixed-dose Combination of Ibuprofen and Acetaminophen in the Treatment of Postsurgical Dental Pain: Results From 2 Phase 3, Randomized, Parallel-group, Double-blind, Placebo-controlled Studies. The Clinical journal of pain. https://pubmed.ncbi.nlm.nih.gov/32271183/. Published July 2020. Accessed January 11, 2021. 1000 mg versus 600/650 mg Acetaminophen for Pain or Fever: A Review of the Clinical Efficacy. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK373467/. Published June 17, 2016. Accessed January 11, 2021. Motov S. Is There a Limit to the Analgesic Effect of Pain Medications? Medscape. https://www.medscape.com/viewarticle/574279. Published June 17, 2008. Accessed January 11, 2021. Motov, Sergey. Faculty Forum: A Practical Approach to Pain Management. YouTube. https://www.youtube.com/watch?v=lJSioPsGw3A. The Center for Medical Education. Published December 2, 2020. Accessed January 1, 2021. Wuhrman E, Cooney MF. Acute Pain: Assessment and Treatment. Medscape. https://www.medscape.com/viewarticle/735034_4. Published January 3, 2011. Accessed January 11, 2021. Social Pain Dewall CN, Macdonald G, Webster GD, et al. Acetaminophen reduces social pain: behavioral and neural evidence. Psychological science. https://pubmed.ncbi.nlm.nih.gov/20548058/. Published June 14, 2010. Accessed January 11, 2021. Mischkowski D, Crocker J, Way BM. From painkiller to empathy killer: acetaminophen (paracetamol) reduces empathy for pain. Social cognitive and affective neuroscience. https://pubmed.ncbi.nlm.nih.gov/27217114/. Published May 5, 2016. Accessed January 11, 2021. Other / Recurrent liner notes Center for Medical Education. https://courses.ccme.org/. Accessed January 11, 2021. Roberts M, Roberts JR. The Proceduralist. https://www.theproceduralist.org/. Accessed January 11, 2021. The Procedural Pause by James R. Roberts, MD, & Martha Roberts, ACNP, PNP. Emergency Medicine News. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx. Accessed January 11, 2021. The Skeptics' Guide to Emergency Medicine. sgem.ccme.org. https://sgem.ccme.org/. Accessed January 11, 2021. Trivia Question: Send answers to 2viewcast@gmail.com Please note that you must answer the 2 part question to win a copy of the EMRA Pain Guide. “What controversial drug was given a black box warning for prolonged QT and torsades in 2012 and now has been declared by WHICH organization to be an effective and safe treatment use for nausea, vomiting, headache and agitation?” Practical Pain Management in Acute Care Setting Handout Sergey Motov, MD @painfreeED • Pain is one of the most common reasons for patients to visit the emergency department and other acute care settings. Due to the extensive number of visits related to pain, clinicians and midlevel providers should be aware of the various options, both pharmacological and nonpharmacological, available to treat patients with acute pain. • As the death toll from the opioid epidemic continues to grow, the use of opioids in the acute care setting as a first-line treatment for analgesia is becoming increasingly controversial and challenging. • There is a growing body of literature that is advocating for more judicious use of opioids and well as their prescribing and for broader use of non-pharmacological and non-opioid pain management strategies. • The channels/enzymes/receptors targeted analgesia (CERTA) concept is based on our improved understanding of the neurobiological aspect of pain with a shift from a symptom-based approach to pain to a mechanistic approach. This targeted analgesic approach allows for a broader utilization of synergistic combinations of nonopioid analgesia and more refined and judicious (rescue) use of opioids. These synergistic combinations result in greater analgesia, fewer side effects, lesser sedation, and shorter LOS. (Motov et al 2016) General Principles: Management of acute pain in the acute care setting should be patient-centered and pain syndrome-specific by using multimodal approach that include non-pharmacological modalities and pharmacological ones that include non-opioid and opioid analgesics. Assessment of acute pain should be based on a need for analgesics to improve functionality, rather than patients-reported pain scores. Brief pain inventory short form BPI-SF is better than NRS/VAS as it assesses quantitative and qualitative impact of pain (Im et al 2020). ED clinicians should engage patients in shared decision-making about overall treatment goals and expectations, the natural trajectory of the specific painful condition, and analgesic options including short-term and long-term benefits and risks of adverse effects. If acute pain lasting beyond the expected duration, complications of acute pain should be ruled out and transition to non-opioid therapy and non-pharmacological therapy should be attempted. Non-Pharmacologic Therapies • Acute care providers should consider applications of heat or cold as well as specific recommendations regarding activity and exercise. • Music therapy is a useful non-pharmacologic therapy for pain reduction in acute care setting (music-assisted relaxation, therapeutic listening/musical requests, musical diversion, song writing, and therapeutic singing (Mandel 2019). • The use of alternative and complementary therapies, such as acupuncture, guided imagery, cognitive-behavioral therapy, and hypnosis have not been systemically evaluated for use in the Acute care setting including ED. (Dillan 2005, Hoffman 2007) • In general, their application may be limited for a single visit, but continued investigation in their safety and efficacy is strongly encouraged. • Practitioners may also consider utilization of osteopathic manipulation techniques, such as high velocity, low amplitude techniques, muscle energy techniques, and soft tissue techniques for patients presenting to the acute care setting with pain syndromes of skeletal, arthroidal, or myofascial origins. (Eisenhart 2003) Opioids • Acute Care providers are uniquely positioned to combat the opioid epidemic by thoughtful prescribing of parenteral and oral opioids in inpatient setting and upon discharge, and through their engagement with opioid addicted patients in acute care setting. • Acute Care providers should make every effort to utilize non-pharmacological modalities and non-opioid analgesics to alleviate pain, and to use opioid analgesics only when the benefits of opioids are felt to outweigh the risks. (not routinely) • When opioids are used for acute pain, clinicians should combine them with non-pharmacologic and non-opioid pharmacologic therapy: Yoga, exercise, cognitive behavioral therapy, complementary/alternative medical therapies (acupuncture); NSAID's, Acetaminophen, Topical Analgesics, Nerve blocks, etc. • When considering opioids for acute pain, Acute Care providers should involve patients in shared decision-making about analgesic options and opioid alternatives, risks and benefits of opioid therapies, and rational expectations about the pain trajectory and management approach. • When considering opioids for acute pain, acute care providers should counsel patients regarding serious adverse effects such as sedation and respiratory depression, pruritus and constipation, and rapid development of tolerance and hyperalgesia. • When considering administration of opioids for acute pain, acute care providers should make every effort to accesses respective state's Prescription Drug Monitoring Program (PDMP). The data obtained from PDMP's to be used to identify excessive dosages and dangerous combinations, identify and counsel patients with opioid use disorder, offer referral for addiction treatment. • PDMPs can provide clinicians with comprehensive prescribing information to improve clinical decisions around opioids. However, PDMPs vary tremendously in their accessibility and usability in the ED, which limits their effectiveness at the point of care. Problems are complicated by varying state-to-state requirements for data availability and accessibility. Several potential solutions to improving the utility of PDMPs in EDs include integrating PDMPs with electronic health records, implementing unsolicited reporting and prescription context, improving PDMP accessibility, data analytics, and expanding the scope of PDMPs. (Eldert et al, 2018) • Parenteral opioids when used in titratable fashion are effective, safe, and easily reversible analgesics that quickly relieve pain. • Acute care clinicians should consider administering these analgesics for patients in acute pain where the likelihood of analgesic benefit is judged to exceed the likelihood of harm. • Parenteral opioids must be titrated regardless of their initial dosing regimens (weight-based or fixed) until pain is optimized to acceptable level (functionality status) or side effects become intolerable. • When parenteral opioids are used, patients should be engaged in shared-decision making regarding the route of administration, as repetitive attempts of IV cannulation and intramuscular injections are associated with pain. In addition, intramuscular injections are associated with unpredictable absorption rates, and complications such as muscle necrosis, soft tissue infection and the need for dose escalation. (Von Kemp 1989, Yamanaka 1985, Johnson 1976) • Morphine sulfate provides better balance of analgesic efficacy and safety among all parenteral opioids. a. Dosing regimens and routes: b. IV: 0.05-0.1mg/kg to start, titrate q 10-20 min c. IV: 4-6 mg fixed, titrate q 10-20 min d. SQ: 4-6 mg fixed, titrate q 20 min e. Nebulized: 0.2 mg/kg or 10-20 mg fixed, repeat q 15-20 min f. PCA: prone to dosing errors g. IM: should be avoided (pain, muscle fibrosis, necrosis, increase in dosing requirements) • Hydromorphone should be avoided as a first-line opioid due to significant euphoria and severe respiratory depression requiring naloxone reversal. Due to higher lipophilicity, Hydromorphone use is associated with higher rates of euphoria and subsequent development of addiction. Should hydromorphone be administered in higher than equi-analgesic morphine milligram equivalents, close cardiopulmonary monitoring is strongly recommended. Dosing h. IV: 0.2-0.5 mg initial, titrate q10-15 min i. IM: to be avoided (pain, muscle fibrosis, necrosis, increase in dosing requirements) j. PCA: prone to dosing errors (severe CNS and respiratory depression) k. Significantly worse AE profile in comparison to Morphine l. Equianalgesic IV conversion (1 mg HM=8mg of MS) m. Overprescribed in >50% of patients n. Inappropriately large dosing in EM literature: 2 mg IVP o. Abuse potential (severely euphoric due to lipophilicity) • Fentanyl is the most potent opioid, short-acting, requires frequent titration. Dosing: p. IV: 0.25-0.5 μg/kg (WB), titrate q10 min q. IV: 25-50 μg (fixed), titrate q10 min r. Nebulization: 2-4 μg/kg, titrate q20-30 min s. IN: 1-2 μg/kg, titrate q5-10min t. Transbuccal: 100-200μg disolvable tablets u. Transmucosal: 15-20 mcg/kg Lollypops • Opioids in Renal Insufficiency/Renal Failure Patients-requires balance of ORAE with pain control by starting with lower-than-recommended doses and slowly titrate up the dose while extending the dosing interval. (Dean 2004, Wright 2011) • Opioid-induced pruritus is centrally mediated process via μ-opioid receptors as naloxone, nalbuphine reverse it, and can be caused by opioids w/o histamine release (Fentanyl). Use ultra-low-dose naloxone of 0.25 -1 mcg/kg/hr with NNT of 3.5. (Kjellberg 2001) • When intravascular access is unobtainable, acute care clinicians should consider utilization of intranasal (fentanyl), nebulized (fentanyl and morphine), or transmucosal (rapidly dissolvable fentanyl tablets) routes of analgesic administration for patients with acute painful conditions. • Breath actuated nebulizer (BAN): enclosed canister, dual mode: continuous and on-demand, less occupational exposures. a. Fentanyl: 2-4 mcg//kg for children, 4 mcg/kg for adults: titration q 10 min up to three doses via breath-actuated nebulizer (BAN): systemic bioavailability of 50-60% of IV route. (Miner 2007, Furyk 2009, Farahmand 2014) b. Morphine: 10-20 mg g10 min up to 3 doses via breath-actuated nebulizer (BAN)-Systemic bioavailability (concentration) of 30-35% of IV Route. (Fulda 2005, Bounes 2009, Grissa 2015) c. Intranasal Fentanyl: IN via MAD at 1-2 mcg/kg titration q 5 min (use highly concentrated solution of 100mcg/ml for adults and 50 mcg/ml for children)- systemic bioavailability of 90% of IV dosing. (Karisen 2013, Borland 2007, Saunders 2010, Holdgate 2010) d. IN route: shorter time to analgesia, titratable, comparable pain relief to IV route, minimal amount of side effects, similar rates of rescue analgesia, great patients and staff satisfaction. Disadvantages: requires highly concentrated solutions that not readily available in the ED, contraindicated in facial/nasal trauma. Oral Opioids • Oral opioid administration is effective for most patients in the acute care setting, however, there is no appreciable analgesic difference between commonly used opioids (oxycodone, hydrocodone and morphine sulfate immediate release (MSIR). • When oral opioids are used for acute pain, the lowest effective dose and fewest number of tablets needed should be prescribed. In most cases, less than 3 days' worth are necessary, and rarely more than 5 days' worth are needed. • If painful condition outlasts three-day supply, re-evaluation in health-care facility is beneficial. Consider expediting follow-up care if the patient's condition is expected to require more than a three-day supply of opioid analgesics. • Only Immediate release (short-acting) formulary are to be prescribed in the acute care setting and at discharge. • Clinicians should not administer or prescribe long-acting, extended-release, or sustained-release opioid formulations, which include both oral and transdermal (fentanyl) medications in the acute care setting. These formulations are not indicated for acute pain and carry a high risk of overdose, particularly in opioid-naïve patients. • Acute care providers should counsel patients about safe medication storage and disposal, as well as the consequences of failure to do this; potential for abuse and misuse by others (teens and young adults), and potential for overdose and death (children and teens). • Oxycodone is no more effective than other opioids (hydrocodone, MSIR). Oxycodone has highest potential for abuse, misuse and diversion as well as increased risks of overdose, addiction and death. Oxycodone should be avoided as a first-line oral opioid for acute pain. ( Strayer 2016) • If still prescribed, lowest dose (5mg) in combination with acetaminophen (lowest dose of 325 mg) should be considered as it associated with less abuse and diversion (in theory). Potential for acetaminophen overdose exist though with combination. • Hydrocodone is three times more prescribed than oxycodone, but three times less used for non-medical purpose. Combo with APAP (Vicodin)-Use lowest effective dose for hydrocodone and APAP (5/325). (Quinn 1997, Adams 2006) • Immediate release morphine sulfate (MSIR) administration is associated with lesser degree of euphoria and consequently, less abuse potential (Wightman 2012). ED providers should consider prescribing Morphine Sulfate Immediate Release Tablets (MSIR) (Wong 2012, Campos 2014) for acute pain due to: o Similar analgesic efficacy to Oxycodone and Hydrocodone o Less euphoria (less abuse potential) o Less street value (less diversion) o More dysphoria in large doses o Less abuse liability and likeability • Tramadol should not be used in acute care setting and at discharge due to severe risks of adverse effects, drug-drug interactions, and overdose. There is very limited data supporting better analgesic efficacy of tramadol in comparison to placebo, or better analgesia than APAP or Ibuprofen. Tramadol dose not match analgesic efficacy of traditional opioids. (Juurlink 2018, Jasinski 1993, Babalonis 2013) • Side effects are: o Seizures o Hypoglycemia o Hyponatremia o Serotonin syndrome o Abuse and addiction • Codeine and Codeine/APAP is a weak analgesic that provides no better pain relief than placebo. Codeine must not be administered to children due to: o dangers of the polymorphisms of the cytochrome P450 iso-enzyme: o ultra-rapid metabolizers: respiratory depression and death o poor metabolizers: absent or insufficient pain relief • Transmucosal fentanyl (15 and 20 mcg/kg lollypops) has an onset of analgesia in 5 to 15 minutes with a peak effect seen in 15 to 30 minutes (Arthur 2012). • Transbuccal route can be used right at the triage to provide rapid analgesia and as a bridge to intravenous analgesia in acute care setting. (Ashburn 2011). A rapidly dissolving trans-buccal fentanyl (100mcg dose) provides fast pain relief onset (median 10 min), great analgesics efficacy, minimal need for rescue medication and lack of side effects in comparison to oxycodone/acetaminophen tablet (Shear 2010) • Morphine Milligram Equivalent (MME) is a numerical standard against which most opioids can be compared, yielding a comparison of each medication's potency. MME does not give any information of medications efficacy or how well medication works, but it is used to assess comparative potency of other analgesics. • By converting the dose of an opioid to a morphine equivalent dose, a clinician can determine whether a cumulative daily dose of opioids approaches an amount associated with increased risk of overdose and to identify patients who may benefit from closer monitoring, reduction or tapering of opioids, prescribing of naloxone, and other measures to reduce risk of overdose. • Opioid-induced hyperalgesia: o opioid-induced hyperalgesia (OIH) is a rare syndrome of increasing pain, often accompanied by neuroexcitatory effects, in the setting of increasing opioid therapy. o Morphine is by far the most common opiate implicated in OIH. Hydromorphone and oxycodone, members of the same class of opiate as morphine (phenanthrenes), can also cause OIH. Fentanyl, a synthetic opioid in the class of phenylpiperidine, is less likely to precipitate OIH. Existing data suggests that OIH is caused by multiple opioid-induced changes to the central nervous system including: -Activation of N-methyl-D-aspartate (NMDA) receptors -Inhibition of the glutamate transporter system -Increased levels of the pro-nociceptive peptides within the dorsal root ganglia -Activation of descending pain facilitation from the rostral ventromedial medulla -Neuroexcitatory effects provoked by metabolites of morphine and hydromorphone • OIH can be confused with tolerance as in both cases patients report increased pain on opioids. The two conditions can be differentiated based on the patient's response to opioids. In tolerance, the patient's pain will improve with dose escalation. In OIH, pain will worsen with opioid administration. This paradoxical effect is one of the hallmarks of the syndrome. Non-opioid analgesics • Acetaminophen is indicated for management of mild to moderate pain and as a single analgesic and has modest efficacy at most. Addition of Acetaminophen to Ibuprofen does not provide better analgesia for patients with acute low back pain. The greatest limitation to the use of intravenous (IV) versus oral acetaminophen is the nearly 100-fold cost differential, which is likely not justified by any marginal improvement in pain relief. Furthermore, IV APAP provide faster onset of analgesia only after an initial dose. (Yeh 2012, Serinken 2012) • NSAIDs should be administered at their lowest effective analgesic doses both in the ED and upon discharge and should be given for the shortest appropriate treatment course. Caution is strongly advised when NSAIDs are used in patients at risk for renal insufficiency, heart failure, and gastrointestinal hemorrhage, as well as in the elderly. Strong consideration should be given to topical NSAID's in managing as variety of acute and chronic painful Musculo-skeletal syndromes. The analgesic ceiling refers to the dose of a drug beyond which any further dose increase will not result in additional analgesic efficacy. Thus, the analgesics ceiling for ibuprofen is 400 mg per dose (1200 mg/24 h) and for ketorolac is 10 mg per dose (10 mg/24 h). These doses are less than those often prescribed for control of inflammation and fever. When it comes to equipotent doses of different NSAIDs, there is no difference in analgesic efficacy. • Ketamine, at sub-dissociative doses (also known as low-dose ketamine or analgesic dose ketamine) of 0.1 to 0.4 mg/kg, provided effective analgesia as a single agent or as an adjunct to opioids (reducing the need for opioids) in the treatment of acute traumatic and nontraumatic pain in the ED. This effective analgesia, however, must be balanced against high rates of minor adverse side effects (14%–80%), though typically short-lived and not requiring intervention. In addition to IV rout, ketamine can be administered via IN,SQ, and Nebulized route. • Local anesthetics are widely used in the ED for topical, local, regional, intra-articular, and systemic anesthesia and analgesia. Local anesthetics (esters and amides) possess analgesic and anti-hyperalgesic properties by non-competitively blocking neuronal sodium channels. o Topical analgesics containing lidocaine come in patches, ointments, and creams have been used to treat pain from acute sprains, strains, and contusions as well as variety of acute inflammatory and chronic neuropathic conditions, including postherpetic neuralgia (PHN), complex regional pain syndromes (CRPS) and painful diabetic neuropathy (PDN). o UGRA used for patients with lower extremity fractures or dislocations (eg, femoral nerve block, fascia iliaca compartment block) demonstrated significant pain control, decreased need for rescue analgesia, and first-attempt procedural success. In addition, UGRA demonstrated few procedural complications, minimal need for rescue analgesia, and great patient satisfaction. o Analgesic efficacy and safety of IV lidocaine has been evaluated in patients with renal colic and acute lower back pain. Although promising, this therapy will need to be studied in larger populations with underlying cardiac disease before it can be broadly used. o knvlsd • Antidopaminergic and Neuroleptics are frequently used in acute care settings for treatment of migraine headache, chronic abdominal pain, cannabis-induced hyperemesis. • Anti-convulsant (gabapentin and pregabalin) are not recommended for management of acute pain unless pain is of neuropathic origin. Side effects, particularly when combined with opioids (potentiation of euphoria and respiratory depression), titration to effect, and poor patients' compliance are limiting factors to their use. (Peckham 2018) References: Chang HY, Daubresse M, Kruszewski SP, et al. 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Non-opioid pain medications to consider for emergency department patients. Available at: http://www.acepnow.com/article/non-opioid-painmedications- consider-emergency-department-patients/. 2015. Wightman R, Perrone J, Portelli I, et al. Likeability and Abuse Liability of Commonly Prescribed Opioids. J Med Toxicol. September 2012. doi: 10.1007/s12181-012-0263-x Zacny JP, Lichtor SA. Within-subject comparison of the psychopharmacological profiles of oral oxycodone and oral morphine in non-drug-abusing volunteers. Psychopharmacology (Berl) 2008 Jan;196(1):105–16. Hoppe JA, Nelson LS, Perrone J, Weiner SG, Prescribing Opioids Safely in the Emergency Department (POSED) Study Investigators. Opioid Prescribing in a Cross Section of US Emergency Departments. Ann Emerg Med. 2015;66(3):253–259. Baehren DF, Marco CA, Droz DE, et al. A statewide prescription monitoring program affects emergency department prescribing behaviors. Ann Emerg Med. 2010; 56(1):19–23 Weiner SG, Griggs CA, Mitchell PM, et al. Clinician impression versus prescription drug monitoring program criteria in the assessment of drug-seeking behavior in the emergency department. Ann Emerg Med 2013;62(4):281–9. Greenwood-Ericksen MB, Poon SJ, Nelson LS, Weiner SG, et al. Best Practices for Prescription Drug Monitoring Programs in the Emergency Department Setting: Results of an Expert Panel. Ann Emerg Med. 2016 Jun;67(6):755-764 Patanwala AE, Keim SM, Erstad BL. Intravenous opioids for severe acute pain in the emergency department. Ann Pharmacother 2010;44(11):1800–9. Bijur PE, Kenny MK, Gallagher EJ. Intravenous morphine at 0.1 mg/kg is not effective for controlling severe acute pain in the majority of patients. Ann Emerg Med 2005; 46:362–7. Birnbaum A, Esses D, Bijur PE, et al. Randomized double-blind placebo- controlled trial of two intravenous morphine dosages (0.10 mg/kg and 0.15 mg/kg) in emergency department patients with moderate to severe acute pain. Ann Emerg Med. 2007;49(4):445–53. Patanwala AE, Edwards CJ, Stolz L, et al. Should morphine dosing be weight based for analgesia in the emergency department? J Opioid Manag 2012; 8(1):51–5. Lvovschi V, Auburn F, Bonnet P, et al. Intravenous morphine titration to treat severe pain in the ED. Am J Emerg Med 2008;26:676–82. Chang AK, Bijur PE, Napolitano A, Lupow J, et al. Two milligrams i.v. hydromorphone is efficacious for treating pain but is associated with oxygen desaturation. J Opioid Manag. 2009 Mar-Apr;5(2):75-80. Sutter ME, Wintemute GJ, Clarke SO, et al. The changing use of intravenous opioids in an emergency department. West J Emerg Med 2015;16:1079-83. Miner JR, Kletti C, Herold M, et al. Randomized clinical trial of nebulized fentanyl citrate versus i.v. fentanyl citrate in children presenting to the emergency department with acute pain. Acad Emerg Med 2007;14:895–8. Furyk JS, Grabowski WJ, Black LH. Nebulized fentanyl versus intravenous morphine in children with suspected limb fractures in the emergency department: a randomized controlled trial. Emerg Med Australas 2009;21:203–9. Borland M, Jacobs I, King B, et al. A randomized controlled trial comparing intranasal fentanyl to intravenous morphine for managing acute pain in children in the emergency department. Ann Emerg Med 2007;49:335–40 Im DD, Jambaulikar GD, Kikut A, Gale J, Weiner SG. Brief Pain Inventory-Short Form: A New Method for Assessing Pain in the Emergency Department. Pain Med. 2020 Sep 11:ppnaa269. doi: 10.1093/pm/pnaa269. Epub ahead of print. PMID: 32918473. Mandel SE, Davis BA, Secic M. Patient Satisfaction and Benefits of Music Therapy Services to Manage Stress and Pain in the Hospital Emergency Department. J Music Ther. 2019 May 10;56(2):149-173. Piatka C, Beckett RD. Propofol for Treatment of Acute Migraine in the Emergency Department: A Systematic Review. Acad Emerg Med. 2020 Feb;27(2):148-160. Tzabazis A, Kori S, Mechanic J, Miller J, Pascual C, Manering N, Carson D, Klukinov M, Spierings E, Jacobs D, Cuellar J, Frey WH 2nd, Hanson L, Angst M, Yeomans DC. Oxytocin and Migraine Headache. Headache. 2017 May;57 Suppl 2:64-75. doi: 10.1111/head.13082. PMID: 28485846. Yeh YC, Reddy P. Clinical and economic evidence for intravenous acetaminophen. Pharmacotherapy 2012;32(6):559–79. Serinken M, Eken C, Turkcuer I, et al. Intravenous paracetamol versus morphine for renal colic in the emergency department: a randomised double-blinded controlled trial. Emerg Med J 2012;29(11):902–5. Wright JM, Price SD, Watson WA. NSAID use and efficacy in the emergency department: single doses of oral ibuprofen versus intramuscular ketorolac. Ann Pharmacother 1994;28(3):309–12. Turturro MA, Paris PM, Seaberg DC. Intramuscular ketorolac versus oral ibuprofen in acute musculoskeletal pain. Ann Emerg Med 1995;26(2):117–20. Catapano MS. The analgesic efficacy of ketorolac for acute pain [review]. J Emerg Med 1996;14(1):67–75 Dillard JN, Knapp S. Complementary and alternative pain therapy in the emergency department. Emerg Med Clin North Am 2005; 23:529–549. Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychol 2007;26:1–9. Eisenhart AW, Gaeta TJ, Yens DP. Osteopathic manipulative treatment in the emergency department for patients with acute ankle injuries. J Am Osteopath Assoc 2003;103:417–421.

Dr. Lewis discusses urinary tract infections (UTI) and how she evaluates and manages UTIs. This podcast also reviews the clinical research she has completed on UTIs and how this has impacted her approach to her evaluation and treatment process. Guest BioDr. Tamra Lewis is a private practice urologist at Comprehensive Urologic Care in the northwest suburbs of Chicago. Dr. Lewis received her BA in Biology from Luther College in 1994, and she obtained her Medical Doctorate in 1999 from the University of Iowa College of Medicine. In 2005, Dr. Lewis completed her surgical and urology residencies at the University of Nebraska and then went on to complete a fellowship in female urology and voiding dysfunction at Metro Urology in Minneapolis / St. Paul, Minnesota. She was among the first group of urologists to receive board certifications in female pelvic medicine and reconstructive surgery. She is a fellow of the American College of Surgeons, member of the American Urological Association, The Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), the Society of Women in Urology and the Large Urology Group Practice Association.Visit https://www.coloplast.us/professional/ for more educational offerings.

ONS member Barbara Zoltick, CRNP, nurse practitioner at the University of Pennsylvania in Philadelphia and member of the Bucks-Montgomery Counties ONS Chapter, joins Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, to discuss nursing considerations for the treatment of patients with advanced or metastatic urothelial cancer. Seagen Inc. provided support for this podcast episode through an educational grant. Music Credit: "Fireflies and Stardust" by Kevin MacLeod  Licensed under Creative Commons by Attribution 3.0  Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by December 11, 2022. The planners and faculty for this episode have no conflicts to disclose. This episode is supported by an educational grant from Seattle Genetics, Inc. ONS is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.  Episode Notes  Complete this evaluation for free NCPD.  ONS Voice article: A Primer on Urothelial Cancer  Oncology Nursing Podcast Episode 127: Reduce and Manage Extravasations When Administering Cancer Treatments  Clinical Journal of Oncology Nursing article: Percutaneous Nephrostomy Infusion: Nursing Considerations for Treatment of Upper Urinary Tract Urothelial Carcinoma  Oncology Nursing Forum article: Gender Differences in Bladder Cancer Treatment Decision Making  American Cancer Society bladder cancer resources  American Urological Association  Bladder Cancer Advocacy Network  National Comprehensive Cancer Center guidelines for bladder cancer 

Dr. Casperson was born on the shores of Lake Superior. Not literally, she was born in a hospital. In Duluth, MN.She went to college and medical school at the University of Minnesota, and then moved to Denver, CO to do a six year urology residency and meet the love of her life, Dave.She specializes in urogynecology, which addresses urological conditions specific to female patients, such as stress urinary incontinence, pelvic organ prolapse, vaginal atrophy related to menopause, sexual health and other pelvic health concerns. Dr. Casperson is also an expert in InterStim® therapy and Botox® injections for bladder leakage, urinary incontinence, and incomplete bladder emptying, as well as vaginal laser therapy treatment for genitourinary symptoms of menopause.She is a proud member of the American Urological Association, International Society for the Study of Women’s Sexual Health and Society of Women in Urology.Dr. Casperson also has her own podcast, You Are Not Broken. New episodes are released each week, and you can download and listen to them here: https://podcasts.apple.com/us/podcast/you-are-not-broken/id1495710329She coaches surgeons on living their best lives, as well as hosts group sex education and coaching classes over at her website: www.kellycaspersonmd.com. Her mission is to empower women to live their best love lives. Combining the power of mind-work, body-science and relationships, she joyously breaks down the societal barriers that are keeping us from awakening into our best intimate lives.Whether you are young or past menopause, single or in a long-term bond, it is never too late or too early to realize YOU ARE NOT BROKEN. With humor, candor and ease, she breaks down the stories that we have been told about being sexual beings, to help us play, explore, and normalize our lives.www.kellycaspersonmd.comIG: @kellycaspersonmdFacebook: @youarentbroken

Jay Simhan, MD, joins the Inside Tract Podcast today to discuss advice on "applying for the position." In 2015, the American Urological Association’s (AUA) Young Urologists Committee (YUC) developed the first Transitioning from Residency to Practice Manual to guide trainees and early-career urologists during the transition from training to independent practice. The 5th Edition of the manual was released in May 2020 and is now available at www.auanet.org/youngurologists.    

How do you approach a treatment plan for incontinence in the female population? If your initial plan of care does not alleviate symptoms, what other strategies do you consider? Listen to this podcast to hear Dr. Lewis answer these questions and more! Guest BioDr. Tamra Lewis is a private practice urologist at Comprehensive Urologic Care in the northwest suburbs of Chicago. Dr. Lewis received her BA in Biology from Luther College in 1994, and she obtained her Medical Doctorate in 1999 from the University of Iowa College of Medicine. In 2005, Dr. Lewis completed her surgical and urology residencies at the University of Nebraska and then went on to complete a fellowship in female urology and voiding dysfunction at Metro Urology in Minneapolis / St. Paul, Minnesota. She was among the first group of urologists to receive board certifications in female pelvic medicine and reconstructive surgery. She is a fellow of the American College of Surgeons, member of the American Urological Association, The Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), the Society of Women in Urology and the Large Urology Group Practice Association. Visit https://www.coloplast.us/professional/ for more educational offerings.

Course Director: Philip M. Hanno, MD Clinical Professor of Urology, Stanford School of Med Dept of Urology Quentin Clemens, MD Professor of Urology, University of Michigan Urology Dept Role: Course Faculty Sandor Lovasz, MD, PhD Rozsakert Medical Center Role: Course Faculty This course on IC/BPS is designed for the urologist, gynecologist, and advanced practice providers who see these patients and are responsible for their medical care. It is designed to focus on what we know, what we have learned from recent research efforts, how we can best use our knowledge in the care of these patients, and what may be coming in the future. We will discuss definition, nomenclature, epidemiology, possible etiology, and review the latest American Urological Association guideline which provides a working framework from which to practice. The issue of phenotyping, an important new focus on clinical trials, will be highlighted. We will review the major findings of the NIDDK Multidisciplinary Approach to the study of Pelvic Pain (MAPP) which is completing a decade of intensive research on this syndrome. How might this research inform and translate into the clinical arena and help our patients. Learning Objectives: Upon completion of the activity, participants will be able to: 1. Recall the AUA guidelines and describe how to apply them to care of their patients. 2. Describe the major findings for the 10-year NIDDK MAPP research effort and its current and potential future impact on patient care. 3. Determine how the syndrome is viewed in Europe and identify new treatments and innovations that may impact care. 4. Define the importance of phenotyping patients to improve outcomes. 5. Recognize the controversy regarding whether Hunner lesions comprise a distinct disease.

Dr. Tamra Lewis talks to us about the different types of incontinence, specifically to the female population. She also talks about the evaluation tools for diagnosing incontinence. Guest BioDr. Tamra Lewis is a private practice urologist at Comprehensive Urologic Care in the northwest suburbs of Chicago. Dr. Lewis received her BA in Biology from Luther College in 1994 and she obtained her Medical Doctorate in 1999 from the University of Iowa College of Medicine. In 2005 Dr. Lewis completed her surgical and urology residencies at the University of Nebraska and then went on to complete a fellowship in female urology and voiding dysfunction at Metro Urology in Minneapolis / St. Paul, Minnesota. She was among the first group of urologists to receive board certifications in female pelvic medicine and reconstructive surgery. She is a fellow of the American College of Surgeons, member of the American Urological Association, The Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU), the Society of Women in Urology and the Large Urology Group Practice Association.Visit https://www.coloplast.us/professional/ for more educational offerings.

Dr Hayes interviews Dr. Lawrence Einhorn and patient, John Cleland, on the cure for testicular cancer.     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. Welcome to JCO's "Cancer Stories, The Art of Oncology," brought to you by the ASCO Podcast Network, a collection of nine programs, covering a range of educational and scientific content and offering enriching insight into the role of cancer care. You can find all of the shows, including this one, at podcast.asco.org. Welcome to the "Cancer Stories." I'm Dr. Daniel Hayes. I'm a medical oncologist and a translational researcher at the University of Michigan Rogel Cancer Center. And I've also been privileged to be the past president of ASCO. I'll be your host for a series of podcast interviews with the founders of our field, have been, and will continue to be over the next several months. In this series of podcasts, I'm hoping to bring the appreciation of the courage and the vision and the really scientific background among the leaders who founded our field of clinical cancer care over the last 70 years. I hope that by understanding the background of how we got to what we now consider normal in oncology. We can all work together towards a better future for our patients and their families during and after cancer treatment. Today, my guests our Dr. Larry Einhorn, who first demonstrated the cure of testicular cancer with cisplatin. And we have a special guest, Mr. John Cleland, who as far as I know was the first man to be cured of this cancer with cisplatin in the world. Dr. Einhorn is currently the Distinguished Professor of Medicine on the faculty of the section of hematology oncology at Indiana University School of Medicine. Mr. Cleland is now retired after a distinguished career as a high school teacher in track and field coach in Indiana. This interview is really particularly poignant for me. I knew John Cleland socially before I had ever heard of Larry Einhorn because our respective wives worked together while I was in med school as I began my clinical training. I then had the enormous privilege of being assigned to the oncology ward at the University Hospital for one of my rotations in internal medicine during my third year of medical school in 1977. And Dr. Einhorn was the attending. And frankly, for me, the rest is history. I had no chance. I had to become an oncologist. Dr. Einhorn received his undergraduate degree at Indiana University, went to medical school at the University of Iowa. He then returned to Indiana for his residency and fellowship. But he spent an oncology fellowship year at MD Anderson, Houston. After that you then returned back to IU in 1973 and has remained there ever since. He has won nearly every award and honor available in clinical research. And I'm not going to try to name them all, but most importantly, like me, as many people in this podcast series, he has served as president of ASCO, in his case, in the year 2000 and 2001. Dr. Einhorn and John, welcome to our program. Thank you. Thank you. Thank you. Dr. Einhorn, I'll start with you. Obviously, your greatest contribution is the cure for testicular cancer, which is pretty good. Can you kind of walk us through the history? How did you get involved with cisplatin? How did you derive the three drug regimen? What were the early obstacles? Especially with your returning back to Indiana. Can you kind of just walk us through that history? Certainly. So as you mentioned, I did a one-year fellowship in oncology at M.D. Anderson before returning to the faculty in 1973 and Indiana University. And in that time period, which was 46 years ago, the thought was that you might be able to cure adult leukemia like was cured with childhood leukemia from the wonderful studies from St. Jude's and that the studies that were ongoing in lymphomas and other hematological malignancies were very promising. But it was felt that you really don't want to do too much toxicity in a solid tumor, where you're getting a one log kill before you get progressive disease. And there was a clear pervasive atmosphere of pessimism of what can be done with solid tumors in general. So when I joined the faculty in 1973, I was the only oncologist. We had two hematologists that were there in our small faculty, which went from 2 to 3. And I wanted to be involved with both liquid tumors as well as solid tumors. But I wanted to be involved with solid tumors that were chemo sensitive. And even back in the early 1970s, testicular cancer was responsive to older drugs like actin or myosin-D and later with a two-drug combination of vinblastine plus bleomycin. And there were a small number of not just remissions but cures, and that was one of the few solid tumors that actually had a modest cure rate back at that time. And then the platinum story came around. And this is a podcast of itself with the wonderful work of a biophysicist at Michigan State, Dr. Barnett Rosenberg, who first discovered that platinum could be the first heavy metal ever to be looked at as antineoplastic agent. And when platinum entered first in human clinical trials in 1972 and 1973, it was [? selfed ?] at an NCI-sponsored phase I working group that I attended that this drug was producing minimal benefit and tremendous toxicity, especially horrendous nausea and vomiting. And the drug was pretty close to being discarded as a interesting novel mechanism of action, but not a drug that really had much of a future. But what changed the history of platinum and changed the history of testis cancer was the fact that among the phase I patients were treated with platinum, which included melanoma, lung cancer, colon cancer, breast cancer, the usual type of patients that enter phase I studies back in those older days were 11 patients that had testicular cancer who had failed actin or myosin D, failed vinblastine, plus bleomycin, and so they received single agent platinum. And when we, even today-- Actually, where were those studies done? That was done at Roswell Park actually, phase I study. And Roswell Park-- and this was an era, by the way, that there were only four NCI cancer centers in the United States, Roswell Park, M.D. Anderson, Memorial Sloan Kettering, and, of course, the NCI. So Roswell Park did a broad-based phase I study. Jim Holland was there at that time. He has unfortunately subsequently passed away. He was one of the real pioneers and also a past ASCO president. So among the patients in that phase I study were 11 patients with testes cancer. And there were three complete remissions and two partial remissions. And even in 2019, if we saw that with the phase 1 novel agent, there would be a tremendous amount of enthusiasm generated. We also looked at some of the preclinical work with platinum. And it is a drug that can cause testicular atrophy. In my youthful ignorance, I didn't realize that there are many drugs that cause testicular atrophy. So with that as a background, in 1974-- and I was on the faculty for one year at that time-- we wrote a protocol to simply add platinum, a novel experimental drug, and added it to the established two-drug regimen that I learned about when I was at M.D. Anderson, namely vinblastine and bleomycin. And the principles of combination chemotherapy aren't complicated. We want each drug to have single agent activity, different mechanism of cytotoxicity, different toxicity, and platinum as a non-mild suppressive drug, which can be given in full dosage, with vinblastine as a mild suppressive drug, and evidence of synergy. And one of the unique characteristics of platinum is it is synergistic across a panoply of cytolytic agents. So we started to study in the late summer of 1974 as a phase II study. And so we treated 47 patients when we first presented this data at the American Urological Association, later at ASCO. And I would be the first to admit that I was as startled as anyone that we were able to literally have a one logarithmic increase in the cure rate, because most progress in oncology is going from a 5% to a 10% to a 15% long-term survival rate. But all of a sudden with this three-drug combination, 60% of these patients were not only complete remission, but durable complete remission and cures. There was a lot of toxicity with platinum. And over the years, we learned, as science tends to learn, when a drug is active to mitigate the side effects as far as nephrotoxicity and nausea and vomiting. And we made modifications to the treatment regimens as the years went by, as you know, with changing the dosages have vinblastine, lowering the duration of maintenance therapy, and eliminating maintenance therapy, reducing the number of courses of platinum, substituting etoposide for vinblastine to where it's now the standard, bleomycin, etoposide, platinum, or BET. And I will make a final comment, in my long career, that this was a very exciting time in 1974. There were several chemotherapy drugs that were experimental drugs, such as doxorubicin and even a nitrosourea the first drugs to have penetration into the blood brain barrier. But the era of chemotherapy is gone and appropriately so. And science and medicine has moved forward. And now, we look at molecular targeted agents and immune checkpoint inhibitors and immunooncology. And that's what is exciting, so much more exciting about the field in 2019 than it was in 1974. But nevertheless, platinum has had legs. In 2019, it is still first line therapy in 12 different types of malignancies. Of course, testis cancer being the poster child for curable cancer. And I often mention that just as platinum has cured thousands, tens of thousands, hundreds of thousands of young men with cancer, testicular cancer saved platinum, because if it weren't for those early studies showing activity of platinum, I think I can say without fear of contradiction that the drug wouldn't be around right now because of this tremendous toxicity in the early phase I studies. Yeah, Larry, let me ask about that, because in the early 1970s when-- I wasn't around, but you didn't have antiemetics. You didn't have drug fractures. You didn't really understand the renal toxicity. Just briefly, how did you get around those? How do you get people-- I'm going to ask John the same question in a minute. What were you thinking, John? John is the recipient of our ignorance in that era. So taking it one item at a time. Platinum is a heavy metal. And we were somewhat slow in realizing that other heavy metals, like mercury, can cause acute tubular necrosis. And so when patients were getting platinum, as is true in those days, they would often just get IV pushed platinum. And so we learned that in order to prevent acute tubular necrosis, we needed to make sure that patients were well hydrated with IV saline solution before they start chemotherapy. We then give the intravenous platinum and then follow that with intravenous saline hydration, so that the drug doesn't accumulate in the proximal tubules, and we force a diuresis. And we never needed mannitol. And some people back then, in fact, perhaps even now, are doing the silly thing of mannitol diuresis, which is totally unnecessary. And so back in the early days before we had antiemetics, everyone had to be treated as an inpatient because we had to give 24-hour continuous hydration because of the [INAUDIBLE] from severe nausea, vomiting, and dehydration that would happen. Of course, today, it's all done as an outpatient with three or four hours of hydration. As far as nausea and vomiting is concerned, one of our first studies we published in The New Journal of Medicine was a cannabinoid derivative from Eli Lilly, called nabilone. And so nabilone, didn't produce a marijuana-type of high. It didn't cause euphoria. It caused some dysphoria and had a variety of side effects. But it lowered the incidence of nausea and vomiting. But what revolutionized chemotherapy induced nausea and vomiting, and ASCO recognizes this as one of the five leading advances in the past 50 years, was the discovery of the first 5-HT3 receptor antagonists. And this was a rational, selective pharmaceutical development. And this truly changed the face of how we give chemotherapy with drugs like platinum. Instead of having an average of 10 to 12 emetic episodes on day 1 of platinum, today with appropriate anti-emetics, the median number of emetic episodes is zero. People still get nausea. People still get occasional vomiting. But everything is done as an outpatient now. And it's done as an outpatient because of the discovery by others of what is the mechanism with platinum, which is not a gastrointestinal mechanism, but affects the emetic center in the medulla oblongata and the chemo receptor trigger zone and finding that patients get drugs like platinum, they get high level of 5-HT3. And developing a selective 5-HT3 receptor antagonist change the field completely. And, of course, now we also [? weigh ?] a methasone and neurokinin-1 antagonist, aprepitant or fosaprepitant. And we also have olanzapine as far as the nausea issue. And olanzapine is probably the best drug for nausea. So patients today have no concept of what patients like John went through when we had no knowledge about any of this whatsoever. And we were looking at things kind of naively by 2019 standards. I don't think I'm making this up. I recall as a medical student walking down the inpatient at University Hospital and thinking this smells just like my fraternity house. Without the fun involved. Yeah. And I got a kick now out of the so-called medical marijuana. But didn't you talk the administration into looking the other way for a while so that these guys could do that? Sort of. What had happened with nabilone, it had to be under lock and key, as if it were gold at Fort Knox. When we had an audit by the FDA and we had-- I don't know how many, I think 60 or 70 patients on nabilone, you know, we had to make sure we had every consent form and every safety guarded and everything. You know, here, we're using these incredibly toxic chemotherapy drugs and there was no regulation at all. And here we're using a pill to lessen nausea and vomiting, and it was just the hoops you had jump through were tremendous. When did you start realizing you had something big. Was it, you know, after two, three patients, or later-- Well, again, when you're young and dumb, it's easy, because you treat someone like John and you get the first chest X-ray three weeks later and things are gone and with pulmonary metastases. And you naively think, not only this cool, but, gee, that's great, it's not going to come back again. But we know even 40 years later that most epithelial malignancies that we get nice remissions with, the disease does come back again. So we had initial enthusiasm that platinum vinblastine myosin was a very active, but very toxic regimen. And we had the hope that this might be durable remission. And, Dan, I actually first presented data with testes scores, not at ASCO, but with the Annual American Urological Association meeting, and that was 99% urologists there. And so we had 20 patients that we had treated. And then that following year, I submitted an abstract to ASCO. And back then, it wasn't done online. We would send a paper abstract with a self-addressed postcard that they would send back to us whether it was accepted or not. And so when I sent in the abstract, I get the postcard back saying it was accepted as a plenary session paper. And I had no idea what plenary session even meant. It's true. And we get this postcard back in January for this June meeting. And all of a sudden my naivete went away, and I thought what, if I make a fool of myself? And I had this initial abstract with these complete remissions, and by the time June rolls around every one of them would have relapsed, which I was starting to learn happens in other tumors like small cell lung cancer, that are chemo sensitive disease. But fortunately, the time of presentation everyone was still disease free. And, of course, everyone for the most part remain disease free. So we had the first glimpse of activity with the first few patients. But it really wasn't until patients were out at a year that we really had the realization that these were not temporary remissions, but these were durable. And as it turned out, permanent remissions and cures. I wasn't there, but I understand that after you recorded that it looked like you had change the ratio of [? puranoctur ?] from 10%, 90% to 90%, 10%, that people in the audience, you had a standing ovation at the end of your presentation. Yeah, it was very heartwarming. It's literally the walk on the moon type of things is the things that you do once in your career, you know, that you never forget about. I had the opportunity to do that and not one of those four NCI cancer centers, but little Indiana University with our faculty of three. And we had one oncology nurse at that time, Becky Furness. We had no data managers. We had no compliance office or anything else. And we were giving [INAUDIBLE] back in the 1970s. I'd like now to turn briefly to your relationship with John Cleland. John, can you give us a brief history of your cancer treatment before you and Dr. Einhorn decided to go with the cisplatin. I was a student Purdue University, the fall of 1973, when I discovered I had a lump on the my left testicle. And I went to a local urologist. And he examined me on a Tuesday afternoon, in the middle of November, and told me he wanted me at the hospital the following morning. And the following day after that, they performed surgery. And I was diagnosed with testicular cancer. That was November 15, 1973. On the 29th of November then, I had a retroperitoneal node dissection. That was at the UI Cancer Center by Dr. John Donohue. And then on December 3, 1973, on a Monday morning, Larry Einhorn walked into my hospital room. And that was my first introduction to Dr. Einhorn. He talked to me a little bit and said we were going to put me on a 5-day course of a drug called mithramycin. We took mithramycin for five days. And then a couple of days after that, I was released from the hospital. So that was in the 1st of December of 1973. The middle of February of '74, I returned to IU Med Center just for a routine checkup. And I was diagnosed there again with testicular cancer had returned. And Dr. Einhorn began putting me on a three-drug regimen-- adriamycin, bleomycin, and [INAUDIBLE]. And I was on that until about July of '74. Then I was on actin myosin-D for a couple of months. And then we ultimately started in on the cisplatin in early October of '74. You have to tell us the story that you actually had to tell Dr. Einhorn about cisplatin because of a radio show you listened to. Well, by the middle of the summer, I had been pretty beat up, after all the chemotherapy and the nausea and everything. And I didn't really have a job-- or I couldn't do a job or anything. So most of the time, I just lay on the couch in our apartment and listened to the radio or watch TV. And one day-- I really like Paul Harvey-- and he came on the radio every day at noon there in Lafayette, Indiana. And one day he begins talking about researchers at Michigan State University. have maybe come up with the cure for cancer. So I begin listening much closer. And they talked about this chemotherapy called cisplatin. So I just made a mental note to myself, well, the next time I go see Dr. Einhorn, I'm going to ask him about this. Well, a couple of weeks later, I'm down at IU. And he's palpating me and listening to my chest and all this type of thing, you know. And I began asking him about that. And he said, John, just don't get too excited about that. We've heard of these cancer cures before. Probably nothing important has happened here. Don't worry about it, you know. And then two or three months later, I'm taking it. So that was my introduction, Dan, to cisplatin. Well, I can't to you-- Some of those Purdue graduates are pretty smart every now and then. We get lucky, like a blind squirrel. I just say, I can't tell you how many-- probably 100, 200 patients will told me things like this. And I've said exactly what Dr. Einhorn said to them, yeah, yeah, yeah. I wonder how many cures I've missed. OK, and the second story I want you tell us, John, is about your readmission to the hospital after your first cycle of chemotherapy. Yeah, I started this platinum October 7, 1974. I had five doses in the hospital. And then I was released. That was on October 7. October 20 rolls around, which was a Sunday, and I was violently ill. I had a fever of over 104, almost 104 and 1/2. And I was just completely almost derelict. My wife and a couple of friends, we contact Becky first, us my oncology nurse. And I guess she called Dr. Einhorn. And he said, well, come on down and check in through the emergency room at IU. And so that's what we did. We got there late at night, 9:30, 10:00 at night, something like that. And they always-- if I went to the emergency room, they always took a chest X-ray, which they did. And then in the hospital overnight and middle of the next morning, I see Dr. Einhorn and Becky getting off the elevator. My room was kind of in a corner. I could see part of the lobby out there and the elevator and the nurses station. And I could see them kind of go past the nurses station. And I could just tell that something was up. Somebody had good, let's put it that way, just by their body language, and the way they looked at each other and talked and walked. And they kept coming closer and closer and closer to my room. And finally, they walked in. And Dr. Einhorn says, John, your chest X-rays are clear. That's really good news. And, you know, I kind of interpreted that as, hey, I'm cure, you know. And ultimately, I guess I was, because from that chest X-ray the night before, my chest film was-- the weak before, my chest film was just riddled like Swiss cheese. And then the film was totally clear. You probably don't know this, but I've seen your chest x-rays, which is probably illegal now. Probably did a lot of illegal things back then. And, you know, that's when the scales fell from my eyes and I said, I'm going to be an oncologist. This is unbelievable. But, you know, I think to emphasize, it wasn't clear you were going to survive that weekend. To survive, you would be cured. But that goes back to how toxic this drug was at the start. Right. Right. It was not a lot of fun. I know that. Yeah. Well, I want to get back, Larry, to you for a moment, because there were two people in your life who were really essential to this story. One, of course, was Dr. Donohue, with whom you have published the, I think, seminal and classic paper in the annals of internal medicine. You want to say a few words about John. And the other is I'd love you to talk a little bit about Steve Williams. Steve was a fellow when I was a med student that I used to tease-- I mean, he's the only guy I ever knew who went from being a fellow to cancer center director I think in one year. I'm making that but-- he kept saying, you know, I might as well put me on faculty because he doesn't have any other fellows. Sure. So when I joined the faculty in 1973, in July of 1973, as I mentioned, I was the first oncologists. There were two hematologists there. And John Donohue is a true gentleman, one of the world leaders in urological oncology and the urological transplant with kidney transplant and many other fields. His ability to surgically cure patients with extensive retroperitoneal disease was known worldwide. And because of who John was and the fact that there were very few oncologists in the state of Indiana treating solid tumors, when he would see patients who would relapse after a retroperitoneal lymph node dissection, he would give chemotherapy himself, usually with actin myosin-D, which, by the way, causes almost as much nausea and vomiting as platinum did. And when I first got there, I knew John by reputation, but not by his interpersonal relationships with others. And with some fear and trepidation, I walked into his office because I told him I wanted to start looking at clinical trials in testes cancer. And I thought we might have a turf battle because he was treating patients with chemotherapy himself. And he just welcomed me with open arms. And he was so enthusiastic about finally having a partner and someone to collaborate with. And we had a wonderful, 30-plus years of collaboration with many important discoveries that John made equally, as I did. And, unfortunately, after John retired, he subsequently died when he was in Florida. And it's a similar sad story with Steve Williams. So Steve Williams was in my third fellowship class, which means we had one fellow a year. He was great, very humble, from Bedford, Indiana. And father was a newspaper reporter from the small town newspaper. And Steve was the eternal optimist. And to show you what an eternal optimist he was, when the Indianapolis Colts would those 14 games in a row, he always knew they going to win the next game, you know. And that's Steve. And John Cleland talking about Paul Harvey, Steve would have believed that platinum was going to be the cure too, you know. He was just a very positive person. And Steve was very gifted. He has a great relationship with patients. And there's not a person, a doctor, nurse, or patient, who has ever said anything unkind about Steve. He's one of the kindest people that we ever had the privilege of knowing. And Steve was very much involved with our testicular cancer research studies and many other pivotal studies as well. We decided to be a NCI cancer center, which is an enormous amount of work. And by then, we had about 10 faculty members in hematology, oncology. And no one wanted to do it. And so we went up to poor Steve and said, boy, Steve, this would be a great career move for you-- without telling him how much work is involved. We are cancer center today because Steve Williams made us a cancer center and everything that goes along with that. And before leaving, and fortunately, we're talking about John being cured with fourth line therapy with platinum combination chemotherapy, whereas if John had had that disease diagnosed a year earlier, quite honestly, John, you wouldn't be alive right now. And it's sort of the opposite for Steve Williams. He eventually developed metastatic melanoma before any of the marvels with immunotherapy or even the BRAF inhibitors were around. And he eventually died from these diseases that he fought so hard to palliate and prolong survival and cure with metastatic melanoma. And now there's a 30% cure rate-- 30%, 5-year survival and continuous 5-year survival with single agent PD-L1 inhibitors. And I want to make a final comment about John. And if this were 2019, rather than 1974, and you're looking at a patient who has been through mitramycin, which is used by me as adjuvant therapy briefly for adenocarcinoma, which is what John had, and then going through actin myosin-D and all the toxicity with that drug and then gone through a adriamycin combination chemotherapy, and looking at fourth line therapy. So when we started platinum combination chemotherapy, and John his fourth line therapy, yes, his chest X-ray looked like Swiss cheese, as he mentioned, but he was pretty much asymptomatic. And the courage and fortitude that it takes to go through treatment like this, because we knew what the side effects were with platinum. It had been around for about eight months, and we knew about all the horrendous side effects of the drug. We had no idea whether this would produce as fourth line therapy any prolongation of survival or any meaningful quality of life. And to go through this therapy without any idea whether it's going to help you, but to do it with truly altruistic motives and knowing that maybe this will help other patients in the future is really noble and admirable. And this is why John over the decades has been such a role model for clinical trials and for the cancer patient population. And I want to follow up. John, briefly, tell us about your history since then-- your family, your athletics, your career. I think it's inspirational, frankly. Well, I worked for the animal science industry for five years following my cure. And I decided finally I needed to give something back a little more to society than what I was actually doing. So I knew I wasn't smart enough to be a medical doctor. Male nursing wasn't exactly in vogue at that time, which might have been honestly a pretty good job for me. So I thought, well, I could be a teacher. I can teach life sciences. So background is pretty much life sciences in agriculture. So I did. I turned to teaching and teaching biology for 31 years and did a lot of coaching of track and cross country. And my wife and I have three kids. I married my college sweetheart even before I had testicular cancer. And, you know, I owe her just about everything in life. She hung in there with me when times were really dark. And I say we got three kids. And I've had great job and great career and friends. I want to emphasize you've had three children since your treatment. I also want to emphasize I know you've run one or two marathons since your treatment. Actually, Dan, I ran four marathons. So you ran four marathons since your treatment. Four full marathons, yes, sir. And I believe that your baseline creatinine is something like twice normal. And, Larry, you probably know this better than I do. But, again you've been inspirational to all of us. Well, thank you. Thank you, Dan. I'll tell you this. Every day I live is a blessing. I should have probably died 44, 45 years ago. I could drop dead at the end of this telephone conversation and have no regrets in life whatsoever. Well, John, you keep thinking that maybe one day you'll live long enough to see Purdue win the NCAA, but I wouldn't count on it. I was going to make a point, it must pain him truly to thank two guys from Indiana and also be appreciative of Michigan State, you know, for a guy from Purdue that must really be painful. Well, yeah, you know, testicular cure is basically Big 10 centered with Michigan State coming up with this cisplatin and Dr. Einhorn being on the IU you faculty. But it took a Purdue Boilermaker to be tough enough to handle all that to begin with, you know. That's true. OK, we're running out of time. I need to bring this to an end. I want to thank both of you again, both of you're inspirational, John for all the things we've talked about and Dr. Einhorn for so many of us who've gone into the field that we've trained and even the ones we've never touched directly, you touched hundreds of thousands of oncologists around the world indirectly. So thanks for all your contributions and what you've done. And thank you both for being on this podcast. I hope it opens up more inspiration for other young investigators and other young oncologists who don't really realize how we got where we are. So with that, we'll end this. And thanks a lot. And hope you have a nice weekend. OK, thanks, everyone. Have a good rest of the week. Bye, bye. Until next time, thank you for listening to this JCO's "Cancer Stories, The Art of Oncology" podcast. If you enjoyed what you heard today, don't forget to give us a rating or review on Apple Podcasts or wherever you listen. While you're there, be sure to subscribe so you never miss an episode. JCO's "Cancer Stories, The Art of Oncology" podcast is just one of ASCO's many podcasts. You can find all the shows at podcast.asco.org

*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

Did you know that in 2018, 33 IMGs applied into Urology and 8 of them matched? This created a match rate of 24% for IMGs! You can find full stats on the American Urological Association website HERE. Before you run off saying “Nah Dr. Lum, that's too slim of a chance” … Dr. Milhouse thinks this is good news for IMGs because Urology is generally a very small sub-specialized and closed off field, so in her books the stats are fair for the competitive IMG! In this episode she share details on: The Urology match (which is different from the usual NRMP match) How to match urology (like she did) Her perspective of IMGs in urology (she also dishes out that her co-resident was an IMG). As you know, once you start residency a majority of your preceptors and attending physicians will be US graduates. Thus, it is fitting that we entertain non-IMGs on the podcast for several reasons: 1. During the match process the US graduate or US student is our major competition (not in a bad way but in a statistical manner). 2. During our interview process we are more likely going to encounter program directors, faculty etc who were previous US graduates. Let's just call this IMG Roadmap Series # 27 with Dr Fenwa Milhouse. If you enjoy this episode, please rate, comment and subscribe to this podcast. You can also find me (Dr. Lum) at drninalum.com --- Support this podcast: https://anchor.fm/ninalum/support

We've got Dr Ralph Esposito (or Dr Espo as we like to call him) back on the pod today. We're stoked to have this legend on the show with us again, especially as we're celebrating the bro's this month for Brovember. Today Dr Espo shares his insights on men's health, particularly in areas of prostate care, men's hormones and men's mental health. With his extensive experience as a naturopath, licensed acupuncturist and functional medicine practitioner, Dr Espo is an absolute weapon of knowledge in his field of expertise, so strap yourself in and enjoy the ride.  Mason and Dr Espo bro down on: The link between cortisol and prostate health. High insulin as a driving factor of dis-ease. The risk factors involved in prostrate cancer. Keeping up to date with your GP for regular prostrate exams.  The male hormonal cascades. Testosterone and oestrogen. How the liver supports hormonal balance. The diet and lifestyle interventions a man can embody to prevent testosterone aromatisation. The importance of men's mental health and the shame that often surrounds it. Male "man-o-pause, aka andropause.   Who is Dr Espo? Dr. Esposito is a naturopathic physician, licensed acupuncturist and functional medicine practitioner specializing in Hormones, Integrative Urology and Men's Health. His precise and personalized style embodies a progressive approach to medicine. He has been published and is a peer reviewer in well-respected medical journals. Furthermore, Dr. Esposito has authored several medical textbook chapters and has designed education modules for health professionals specifically on urological conditions, fertility, male and female hormone dysfunction, Low Testosterone, exercise, fitness, men’s health and sexual dysfunction. He has trained at NYU Integrative and Functional Urology Center. Dr. Esposito also holds a position as adjunct professor at New York University where he lectures on integrative medicine.   Resources: Dr Espo Instagram  SuperFeast Deer Antler  SuperFeast Ashwagandha   Q: How Can I Support The SuperFeast Podcast?   A: Tell all your friends and family and share online! We’d also love it if you could subscribe and review this podcast on iTunes. Or  check us out on Stitcher :)! Plus  we're on Spotify!   Check Out The Transcript Here:   Mason:   Dr. Espo, welcome back, man. Dr. Espo:    Wow, thanks so... I can't believe I'm back for almost, what is it, a third time? Mason:    Yeah.... I've never said this before, but you're a friend of the show. Dr. Espo:   Yes. [crosstalk 00:00:19]... I'm the best friend. Mason:   Was it three years ago when we first had our chat over on my old podcast? Yeah, a second time having you here, and we're recording a little bit before, but now we're in Brovember. We're celebrating men's health, I was going to talk to you anyway, but one of the reasons I really wanted to have you on again is because in the last year for Movember... I don't know if everyone knows Movember. I think it's pretty synonymous with November now, you shave off, you grow Mo, and it's all about raising awareness and money for prostate health essentially. Is that right? Dr. Espo:   Yeah, for cancers that impact men. So testicular cancer, prostate cancer, and also male mental health. Mason:   Yeah. Nice. But I'm really awesome, and I learned a lot from you, so if you're not on the Instagram we're doing a lot of sharing of Ralph's posts especially through that last year, November and all the way up until currently. So get over there and look at those because there's heaps of juicy stuff, but we're going to be going into it today as well. And with Brovember, of course, we are going to be focusing, yes, and including those particular cancers that are affecting men, especially going to be looking at prostate health, but we're blowing it out into men's health. Mason:   We're going to be of course talking about mental health as well, but blowing out into like all areas of health that are affecting men. So bro, let's start diving in. Now, of course, prostate health is something that is... I feel we just had a little conversation before about how you're still working in that clinic that you mentioned in the last podcast, which is awesome. And we were saying how, it's a little bit easier for you to get the patient's history, but often it's so incomplete and just how it's one of those things where when you're a bit younger you just don't value your medical history and how it's like, you don't value getting your taxes and finances in order until stuff starts hitting the fan. You go, "Oh shit, yeah, I really got to get on top of this." Mason:   I mean, it's like that with prostate health is one of those things. All we need to do is just get a little bit of insight now, especially if you're a bit older, but when you're young, ideally start really understanding your physiology in your anatomy. So let's dive into prostate health. Do you want to just go start with just jamming with us about what it is and its function? Dr. Espo:   Yeah. So the prostate is a gland that sits beneath the bladder. And if you're a man over the age of 40 or 45, sometimes 50, your doctor has probably stuck his finger in your rectum and did a prostate exam. And it's probably one of the most exciting things that men love to look forward to once they reach 50. But no, and in all honesty, it's an important test to get done because the prostate has... its primary function is for sexual function. It creates a fluid that allows your semen and your sperm to survive to inseminate or to impregnate an egg. Dr. Espo:   Now, it's there your whole life, but as you get older, your prostate can start to enlarge and it also is susceptible to cancer. Now, the great thing about prostate cancer is that most men will die with prostate cancer than from prostate cancer. And the great thing is that it's also typically a very slow growing type of cancer. So what I usually tell men is by the time you're 65, 70 years old, you probably will have some type of prostate cancer cells in your body. That doesn't necessarily mean that they're going to kill you and it doesn't necessarily mean that they're going to be a malignant. Dr. Espo:    But I want to make sure that I'm protecting my body and preventing any type of cancer cells, especially prostate cancer, but any cancer from growing, because it seems to be one of the most prominent cancers in men. So it's a really important cancer to get on top of. And also it's easily to, well I don't want to call it easy, but it's one of the cancers that can be treated rather well compared to other types of cancers like pancreatic. Mason:   And especially, just with lifestyle you mean? Dr. Espo:   Yeah. So for prostate cancer, prostate cancer is largely a cancer of lifestyle. So there are genetic causes that contribute to it. So there is the BRCA gene, which is often associated with breast cancer, but in fact there are individuals who do have a BRCA mutation that can increase their risk of prostate cancer. So whenever I asked a man, speaking of family history, I say, "Hey, what's your family history of prostate cancer?" He might say, "Oh, I had an uncle had prostate cancer. And then I say, "Well what was your family history of breast cancer or ovarian cancer?" Dr. Espo:   And they tell me, "Oh yeah, my mom had breast cancer or my sister had breast cancer." I'm like, okay, that tells me that it's a possibility, although it's not entirely likely not for certain that if your sister had breast cancer, she had a BRCA gene, but if she had a BRCA gene, it's possible that you too, you do as well. And that makes me super vigilant in making sure that your prostate cancer or your potential for prostate cancer is very low to minimum. Dr. Espo:   So we know there's a lot of lifestyle things that increase the risk of prostate cancer. And we know that a plant-based diet, which is really hard to define, but we know that those who eat more leafy greens, berries, fruits like pomegranates, tomatoes, those are the foods that you want to have to protect your prostate and staying away from charred meats. And then you come into the conversation of sleep and then exercise, right? So all of these things together will reduce your risk. And there's a bunch of men who may have the BRCA but don't necessarily get prostate cancer. And I think that's where the lifestyle come into play. Mason:   All right. So then with prostate cancer, you mentioned family. I just wanted to just throw in that, I remember there was a post too about brothers and if your brother has prostate cancer, the percentage going up. And so I obviously in the same family of that, but that was a pretty, that percentage was quite high. It's just worth knowing, I guess. Then let's stay in the preventative world, I guess like everything we've talked about, especially on that last podcast, we've talked a lot about herbs for men's health. Obviously you're not going to be able to focus on any area, whether it's testosterone optimization, sleep, the inclusion of certain herb's and adaptogens like Ashwagandha and Mucuna without largely affecting the prostate gland, I imagine. Is that just, obviously because you've created an environment where harmony can somewhat ensue or is prostate effected by high levels of stress as well or is there no real link there? Dr. Espo:   No. No, no. okay. So a really good follow up question to this is what do you mean by stress? Mason:   Yeah, well that's really great. Are we talking like what in terms of clinical markers, are we talking about hormonal markers with stress, are we talking about like a stealth stress that's in the mind? And that's really, really good distinction there. And I'd love for you to just take it in any way you feel is relevant. Dr. Espo:   Yeah. So when it comes to stressors and prostate cancer, it's almost an arguable to say stress in an umbrella form is not going to be harmful. So in other words, stress is harmful for prostate cancer. And the reason why and most of the time what we see is that individuals who are highly stressed, which is often measured by cortisol because it's one of the major stress hormones. The other ones are the catecholomines like epinephrine, norepinephrine, adrenaline, noradrenaline those are basically our stress hormones. And then you have stress markers like interleukin-1, interleukin-1V, interleukin-6, et cetera, TNF, right? So all of these are markers, they fall within the umbrella of stress. And then they cause inflammation, right? Dr. Espo:   So chronically elevated levels of cortisol can impair your immune system. And there's one immune cell that we know that is super helpful to protect against prostate cancer and those are NK cells, also known natural killer cells. And you're going to love this because mushrooms significantly improve the production of NK cells. It's one of the ingredients in there called AHC C, which is found mostly in mushrooms that increases the synthesis of and NK cells, which are targeted towards cancers and one of the cancers that has most effect on his prostate cancer. So- Mason:   So good. Dr. Espo:   Yeah, so if you wanted to develop an environment for prostate cancer to grow, to thrive, suppress the immune system, throw a bunch of inflammatory markers at it, and then feed it a diet full of sugar and you created a soup that prostate cancer will certainly love. I'm not sure exactly, it's actually hyperinsulinemia. Very, very high insulin levels for long periods of time, which will cause increase in IGF levels will cause prostate cancer cells to grow. It's not just the red meat, charred red meat, it's not just the stress. What I think is the catalyst is the insulin triggered by increased blood sugar, but also insulin can be triggered by increased cortisol levels. Mason:   Can we just jump down the IGF a little bit? I mean, that insulin growth factor is something I've looked into. Especially when I got ask questions because it's obviously in existence in deer antler. A little bit different for us because we're using a deer antler velvet that isn't isolated yet here are a lot of there are a lot of isolated supplements out there with IGF in there. And I saw that it was pretty non conclusive with deer antler at least. But I was like, I couldn't say in terms of whether it was going to be an aggravator in those instances where... Even if there's a susceptibility and women asking as well in terms of having that same gene that makes them prone to breast cancer. I don't know if you've got any take on it? Dr. Espo:   So is the question, does IGF, or exogenous IGF cause or is a major contributing factor to cancers? Mason:   Even if it's just like a suspect? Yeah. Something like... Whether you know that or whether it's something you suspect? Dr. Espo:   Yeah. So I think it's not just the IGF. Right... So a measure of IGF is growth hormone.... sorry. IGF is a measure of growth hormone. So you can measure growth hormone in the blood. It's highly inaccurate because it's pulsatile, which basically means growth hormone releasing hormone that tells your pituitary to release growth hormone. And that happens at various times throughout the day. So if you were to just take a random check of your growth hormone, that doesn't give you much information because it's just what was your growth hormone on November 2nd at 8:24 AM in the morning, right? Mason:   Yeah. Dr. Espo:   But IGF has a longer half-life and last longer. So by looking at IGF, you can look at growth hormone. And by understanding what growth hormone does to certain cancer cells, obviously causes them to grow, but there's a curve on it and it's we're at very low growth hormone levels the risk of Alzheimer's and cancers increase or high as you increase growth hormone, those things decrease. So the risk of cancers and Alzheimer's and chronic diseases decrease as you start giving more growth hormone. It's a super physiologic level. So very high levels of growth hormone, the risk goes up again. Mason:   Got ya. Dr. Espo:   It's like a U-shaped curve. Mason:   Okay. Dr. Espo:    And so when you tell me, does IGF cause cancer, number one, I'll never tell you that something causes cancer, but can it promote? Well, it depends on the environment that you are in. So there's a lot of bodybuilders who just take straight up insulin. I would say that is a higher risk for certain types of cancers. Actually, we know insulin can increase the risk of cancers. So I would say when you have to weigh the risk per verses benefit and really understand what is the relative risk, let's just put it into perspective of having a Snickers bar, it's probably more likely to increase your risk of developing a cancer promoting environment than deer antler or taking an exogenous type of supplement that might increase your own endogenous production. Mason:   Yeah, man. Then that's the getting a like a... I always like to play around in the buffer of having a herb or is this a much an extent even like supplementation and minerals and all that kind of stuff within the whole form, majority of the time it gives you that buffer. But I like that man. It's cool. Thanks for giving me that perspective on that. And so with prostate health and when we get into testing, can you just jam a little bit about the PSA testing and just any myths around that and how we can actually be grounded and levelled and responsible in terms of how we're testing and then managing enlarged prostates or prostate cancer. If we get to that point at which we hopefully obviously don't because we're on the prevention bandwagon. Dr. Espo:   Right. I was just having this conversation with a colleague the other day and a patient, and they're like, "Well, my doctor said I shouldn't test PSA." So okay, so you're 54 years old, your insulin levels at 18, which is high, your fasting insulin is that 18 typically it could be less than like 10 or nine. That's micro units per milliliter, and your doctor's telling me that there's really no point of testing PSA. So what else are you going to do to screen this guy to make sure he doesn't get prostate cancer? I'll just do a rectal exam. Those are highly insensitive. So basically the risk or the chance of you catching a prostate cancer on a rectal exam, if you are not a urologist is close to like 40% or 50% of the time. Mason:   What have you got?... Obviously you've just got specialized training with urology. What are you particularly looking for? Just the feel? Dr. Espo:   Just what you're feeling for. Mason:   Yes. Dr. Espo:   Right. So what's your feeling for is a nodule, you're feeling... So what I usually tell people is like if you make a fist, right, a normal- Mason:   Don't tell me that's how you test? (laughing) Then you're doing it wrong. Dr. Espo:   What kind of medical school did you go to? Okay. So if you are a urologist or a doctor and what's your feeling for is if you make a fist with your left hand, the palm, the left part of your hand, like at the bottom of your thumb, your femur eminence is a normal prostate. If you go on the opposite side of the culture to your pinky side, that's a boggy prostate. That's usually an enlarged prostate. And then you feel your knuckle. That's prostate cancer. So really hard is prostate cancer, normal buoyancy is.. Normal prostate and then really like just soft and mushy is more, more like an enlarged prostate. So that's when you do a DRE, what we call a DRE was a digital rectal exam. Dr. Espo:   You're trying to see, number one, what is the size? Is it large or small? Do I feel any nodules? Is the median sulcus there? Which is like a little indentation, like a Walnut is that there? If that's not there, then that means the process is getting bigger. And then you obviously check for tenderness. So if I press it, does it hurt? Prostate cancer typically doesn't hurt, but prostatitis will. So if you're telling me that your PSA is elevated at seven, but you're telling me a burns on your pee and when you ejaculate, you're having pain, probably a prostatitis probably an infection or a chronic non bacterial prostatitis I'm less inclined to think that that's a prostate cancer also depends on your age. Mason:   How would you, [crosstalk 00:17:56]. Dr. Espo:   So let's say you had. Mason:   Sorry. Dr. Espo:   Had- Mason:   No, no, no, I was just going to say with prostatitis, in terms of treatment do you go about that with just a different, you're just like case by case or do you have a protocol? Dr. Espo:   It depends on the type of bacteria that's found. So you can do a.. Basically you could do a urine test or you can do a prosthetic massage test. So you'll get a urine test, test that then you palpate the prostate. So you basically press the prostate, try to get a sample from that and then see if there's any type of bacteria that are growing there. Mason:   Right. Got you. Dr. Espo:   So then that'll determine what the therapy will be. Now, look, you don't always have to go with antibiotics, but it depends on the duration and how bad it is. Now sometimes you'll find the bacteria with a person who is asymptomatic. And I would say, I don't know if we really need to go ahead and aggressively go after this, but it depends on the individual. My concern with a non-treated prostatitis or a prostate infection, is it becoming a chronic non-bacterial infection. And I see that all the time because you have a lot of urologists are, a lot of men won't go to the doctor. So if you're listening to this podcast, please, if you take nothing else from this, just go to the doctor and get a checkup. Just have your doctor examine you. Dr. Espo:   So men won't go to the doctor, at the end when it's all resolved or they're feel like they're okay two months later, they're in chronic pain and there's no bacteria there because that bacteria has caused so much inflammation to the nerves and the prostate tissue that they can't recover. So as a naturopathic physician, my last option is an antibiotic, but it doesn't necessarily mean I'm completely opposed to it. Right. Because we then have to consider, like for example, if you're a 95-year-old woman who has a BMI of 17, and you have the pneumonia, I'm not giving you, oregano oil, go on antibiotics because your risk of dying is very high. So I take that approach with it. But certainly there are herbs that can be used that are natural antibacterial, antifungal, antiparasitic herbs that can help fight a prostate infection. The issue is that the prostate is such a hard area to reach. Mason:   Yeah. Have you looked at other ways besides orally like have you in terms of suppositories or enemas or anything like that? Dr. Espo:   Yeah. So those antibacterial herbs will not cross the colon or the rectum to get to the prostate. But there is research showing that the probiotics that colonize your colon will also colonize your prostate. Mason:   Like bifidus? Dr. Espo:   It depends on, I'm not sure which strain it was, but I know that when they gave individuals, whatever strains that they were giving them as a probiotic, it changed the flora in their prostate as well. Mason:   Okay. Wow. Dr. Espo:   So they do communicate and those nerves also communicate. So the nerves that impact your prostate also are impacting your rectum and your colon. So the first thing I ask men, well, who have our prostate chronic prostatitis. I asked them, "Well, are you eating dairy and are you constipated?" I look at those two things. I say, well, you're probably, if you're constipated, you're probably causing irritation to those nerves, which will also cause irritation to the prostate. Mason:   Yeah. Right. Okay. So you get that colon connection there. Big time with the prostate. Right. Okay. Well let's- Dr. Espo:   Speaking of the PSA, yes you can... I would check PSA. I checked PSA density, so I check how high is the PSA compared to the prostate? So just put it in comparison. A small prostate should make very little PSA and the large prostate will probably make a little bit more. But if you have a small prostate and your PSA is high, I'm more concerned than if you have a big prostate and your PSA is high. Mason:   Okay. What ages are you recommending going and getting checked? Dr. Espo:    It depends. So you know, you were discussing if you have a brother your risk of prostate cancer goes up. Typically, if a man has a first degree family member with prostate cancer, I'm screening them at about 40. Mason:   Okay. Dr. Espo:   Right. And that is only to get a baseline. Mason:   Yeah. Right. Dr. Espo:   Especially 40 if they're black or African American. All right. Mason:   Yeah. African Americans are really prone to prostate cancer, right? Dr. Espo:   They are more prone to prostate cancer than- Mason:   African, like those African genetics. Dr. Espo:   African or African American or black will typically have a higher risk of prostate cancer. They actually have a higher risk of aggressive prostate cancer. And that's the prostate cancer that you want to kill. Mason:   Is that because I know that folks.. African folks are a little bit more susceptible to kidney deficiencies as well. Dr. Espo:   Kidney again, so... Mason:   Kidney deficiency in general. I mean, and I don't know if that's obviously in proximity might be a little bit of a connection. I don't know? Dr. Espo:   Yeah. I haven't thought about it in that aspect. It's something that I think you should look into. I haven't thought about it that way. Mason:   I mean, I haven't really either. That's kind of like just a little bit of a hobby looking at the elemental deficiency, constitutional stuff that comes out of Taoism and classical Chinese medicine. But I'll look into it. I'll put it on the list Ralph. Mason:   And then when once you get past those inflammatory conditions and you start edging towards the realms of their being prostate cancer, how do you then gauge, when is it time to intervene using whether it's palpitation, PSA levels, age, so on and so forth. When is the surgeries rife? Right? People are getting rushed into prostate surgery. And there's like a lack of appropriateness. It's like none of you ever like practice much martial arts, but there's one thing you'd learn is an appropriate reaction to the stimulus, right? So if it's just a drunk friend, it's just like, cool, we'll just get him down. It's not an appropriate time to be breaking arms or choking out or anything like that. Mason:   And that seems like the word cancer is thrown in someone's face and it's like no matter what type it is, it's like that same reaction having a very intense reaction to just a drunk friend that just needs to be cuffed a little bit. And I know some prostate cancers could definitely be aggressive. I'm obviously curious, I'm not an expert in the area, but what's appropriate action? Is rushing into surgery necessary? Are the levels of surgeries going on necessary. Is everyone getting hysterical about it? Let's dive in. Dr. Espo:   I am so happy you asked that question because I don't if your viewers, obviously your viewers can't see the smile on face right now because I love that question. And you should actually just take a screenshot and just say, this is how Ralph is smiling. Mason:   Oh, don't worry. We've got the video recording as well. So guys, you can jump over on Instagram TV or YouTube and catch the video. Dr. Espo:   Let me make sure my hair's good. Mason:   Yeah. I should've told you that. Dr. Espo:   Okay. So I love this question because there are different types or grades or ratings of prostate cancer. So we usually rate prostate cancer based on something we call a Gleason, right? So a Gleason is a score that a pathologist will take a prostate tissue and say this patient has a Gleason. So the Gleason score is one to five, and you get two scores, so to a some of 10. So the pathologist can look at one set of cells and say this is a Gleason five, like that's really aggressive, poorly differentiated, this is a bad looking cancer. And then they can look at another one and say, well this one's also a Gleason five. This is also really poorly differentiated, really aggressive. You are a Gleason 10. Dr. Espo:   I've seen a dozen of those where it's just like there is no option here. You have to have your prostate removed because this is really, really bad. So now the AUA, the American Urological Association suggest that prostatectomy or prostate surgery should be considered when you have a Gleason six or above... I'm sorry, a Gleason seven or above is when you should start considering that. A Gleason six is borderline. So I'm a little bit of the thought that you should really take in the totality of the presentation. So number one is how quickly has the prostate level been increasing? So if you went from prostate level of one to two to three to four over four years, I'm concerned, that's increasing quite, quite rapidly. Or if you're going to one to two, to four to eight, that's a doubling time. That's extremely risky. So that's something you take into consideration. Dr. Espo:   Then you do something called The 4KScore and a 4KScore takes into consideration four different types of PSA. So when you get a regular PSA scores, you're giving you total PSA, you could also do free PSA and then The 4K add two more PSAs. And those, you have an algorithm, when you take into consideration and you include all of them, you get a score and if the score is above seven, your risk of having an aggressive prostate cancer is high. But if your score is less than seven, 7%, then your risk of having an aggressive prostate cancers is lower. So I used that as a consideration as well. Dr. Espo:   Then you look at family history and then you look at diet and lifestyle. Like if you smoked and if you drank and if you ate like crap and you have this family history and you had a Gleason six, I'm probably going to tell you, you know what, let's be very, very aggressive with this. Then I would say we should do MP-MRI, which is called a Multi-parametric MRI, which is a very, very specific and very advanced MRI that can look at your prostate and identify nodules very, very clearly and then also identify how risky they are for prostate cancer. Dr. Espo:   So your question was very simple, but it's a very complex scenario and algorithm. And essentially what it comes down to is urologists are a little bit more, they're really a bit more excited to do surgery because look, their thought is, well, if I see a sign of cancer, let me just get rid of it so there's very little to no risk. Rather than saying, Oh, let me just watch it. But a lot of men don't want to have prostatectomies, they don't want their prostate removed because it can lead to incontinence. It can lead to erectile dysfunction. It can lead to chronic pain and it's not a cure.... Dr. Espo:   If you miss a little bit of your prostate during the surgery, there's a risk of it coming back. Now, it depends on if it's spread or not, but I've seen men who get a prostate removed, their PSA is zero and then two years later their PSA is at like 0.8 and I'm like, huh. Point eight is low, but it's high if you don't have a problem with prostate. There are some breast cancers that can cause a PSA to increase, but that's like a canary in a coal mine. So you have to take all of these things into consideration. Dr. Espo:   What I usually tell men is see two urologists and then see a integrative naturopathic functional medicine doctor who understands urology, who understands prostate cancer so they can really just be your quarterback and show you, "This is the whole picture. I'm not here to remove your prostate and I'm also not here. I'm also here to make sure you live forever. I have your best interests in mind. I don't have your pros... You know, the surgery is not my best. It's not in my best interest. So let me give you my, you know, 40,000 foot view." Mason:   Are urologists often surgeons as well? Dr. Espo:   Yes. Most of the time they are, there are urologists who don't do surgery, but most of the time they do. Mason:    [inaudible 00:31:07] Yeah. So what do they call them? Scalp jockeys. Dr. Espo:   I can't remember that. Mason:   I get it. If you've got a particular skill and you've been trained in a particular way, you want to play the safe game, but is it the safe game longterm, they don't have to be there 20 years from now with you when you don't have a prostate, so. Dr. Espo:   Right. Mason:   So man, thanks for that. Such good information. Really good. It's bringing up a lot of reminders for me, I can make sure I'm staying onto it, but especially, just being able to have this information to share with like family members fathers and all that. So it's like, yeah. Awesome. Now testosterone levels in general we've talked about in the last pod how we don't necessarily, we're not necessarily aiming to just have like through the roof testosterone levels that, having it in levels we can't even prove that increased levels are going to relate to like super increased output and it's generally just making sure that it's not bottomed out or super excessive. Is there an association between testosterone levels and prostate issues? First of I'll ask you that quick snappy question Dr. Espo:   Prostate issues as a totality of prostate cancer? Mason:   Well, just as a totality. Dr. Espo:   So increased dihydrotestosterone and its metabolites can increase your risk of enlarged prostate and some type of prostate cancers, but it's not the testosterone that is the issue. So I answered your short question with a short answer, but if you really want me to go in, I can. Mason:   Yeah. Well let's go. What's the issue there? Because obviously beyond prostate health, this is going to have a huge effect on our overall health. Dr. Espo:   Yeah. So what we've found is that the dihydrotestosterone, there's a beta and an alpha metabolite we call 3 alpha diol and 3 beta diol. And those are metabolites of DHT, and DHT alone can bind to androgen receptors, it binds to androgen receptors with a significantly increased affinity compared to testosterone. That's why a lot of men who take testosterone and they get acne or they get alopecia. So they lose their hair. That's because of the androgen gen receptors. So it has all to do androgen receptor sensitivity. Mason:   Really? They get alopecia from testosterone therapy? Dr. Espo:   Yeah, they certainly can. Yep. But then you have to look at the DHT and its metabolites. And the literature shows that the metabolites, these alpha and beta dial metabolics of DAC combined two estrogen receptors, and if the estrogen receptors that can cause the prostate to become poorly differentiated. So there's SGO receptors that cause the prostate to grow largely, but not maliciously. And then there's estrogen receptors that cause the prostate to grow maliciously. And it's the metabolites of the HT that bind to those receptors that cause it to grow maliciously, malignantly cause it to grow, what we say poorly differentiated, which then will cause the prostate to be more prone to prostate cancer. Mason:   So is it estrogen mimicking? Dr. Espo:   It's not estrogen mimic? Well, that an interesting question. Is it estrogen mimicking? I guess if you had defined estrogen mimicking as the ability to bind to estrogen receptors, then yes, it would. Mason:   All right. Are those are the same... I don't know much about these pathways, but always what sticks in my head is 16 alpha hydroxy estrone being one that is turning on that I don't know if this is like a bit generalized, but the genes that can lead to prostate and breast cancer, is that kind of in that realm of those receptors that have been here? Dr. Espo:   Different, actually a little bit different. So it's the four hydroxy metabolite of estrogen, so the 4OH estrogone that is more detrimental. And what it does, it causes DNA adducts. So actually, it does bind to estrogen receptors, but it actually goes into the nucleus, bind to your DNA and breaks up these DNA bonds and causes DNA adducts. So it genuinely destroys your DNA directly, whereas the two hydroxy estrogone is less likely to do that, is a little bit more protective and is has a lower affinity to make DNA adducts. Dr. Espo:   And a great way to get rid of four hydroxy estrogone and two hydroxy estrogone is with methylation. And as you know with the Dutch test, which I just think it's an exceptional test, you can test those metabolites in your urine and you can also see how much of that is be converted to the methylated forms. And that'll tell you, are you capable of getting rid of these things if and when you are exposed to them. Mason:   Cool. Okay, great. I mean, yeah, like we love Carrie. And I think the ladies have had it. We've recommended Dutch tests a lot, but of course, guys, and I'm really feeling it. I don't know, I'd love to get in there myself and get some actual, there's some real live panels going, so worth going and doing. But so I mean, this is something that comes around to springtime at the moment here. It's liver season and we just naturally go in there and just increase those methylators and whether it's just the B12 and betaine''ss and broccoli's and MSM, methylsulfonylmethane and so on and so forth. Just I guess really good to just get in there and clean house as well. The cruciferous vegetables. Right? Dr. Espo:   Absolutely. And I think beyond that is why not just get it at the source and prevent your body from aromatizing all of this testosterone into estrogen, into E1. Mason:   So then we do go into the conversation of aromatase inhibitors. I mean, I know a favorite is nettle root? I guess like a passion flower kind of fits in there. Dr. Espo:   Passion flower has crisen in it. Yep. Mason:   Okay. And that's, and that's what's causing that action? Dr. Espo:   Yes, it is. Doses have to be very high, however. A high dose will be- Mason:   On which level? Dr. Espo:   Of crisen. Mason:   Of crisen, okay. Dr. Espo:   Of crisen. So the doses have to be higher because it's absorbed pretty poorly. So there is one company, I don't know the name of it but they do like liposomal and- Mason:   Livon it. Is it those guys, the little satchels? The little- Dr. Espo:   I don't remember. What was it called? Mason:   L-I-V-O-N. Livon. Dr. Espo:   I don't remember. That might be them. I don't use very much. What I do is I try to establish a lifestyle that prevents you from aromatizing because I think that has a larger impact. It's kind of like taking a piss in the ocean. If you.. If you try to take a piss in the ocean, it feels like you're doing something, but in the grand scheme of things, you're really not doing too much. So I think making sure you're having a low insulin type of diet or diet that is not conducive to hyperinsulinemia and I bet is void or limited and alcohol because alcohol will induce aromatase enzyme. You exercise and keep body fat down and weight train and keep your anaerobic activity high so that you can induce growth hormone and testosterone and keep cortisol levels down because those are the things that will push you to aromatase. Mason:   Speaking of training, man, you're looking good. Dr. Espo:   Oh yeah. I actually injured my shoulder recently. So my- Mason:   So you're like this is nothing? Dr. Espo:   You don't look so big anymore. I said, yeah, because all I could do is work out my legs. So I said, "Give me till the summer. I'll have a bottom just like J-Lo. Mason:   I notice how jacked curves we're looking. In terms of training, just briefly... your life revolves around the optimization often, and therefore you've been a men's health specialist. It's like a very, very relevant for us to take a peak into the routine. What type of training you're doing, and then off the back of that, just have you got any supplements and things that you've taking around your training routine would just be like really nice to just get an insight. And you say a lot on the Instagram, so I'll say it for you. You don't say that what you take, everyone should take. So this is just Dr.Espo's routine. Dr. Espo:   Yeah, this is my own personal routine. So my type of training revolved around weight training with very little rest. I don't do a lot of power lifting. I'm not trying to be the world's strongest man. And my goal of training is to induce an anaerobic response to increase lactic acid in a very short period of time in order to induce an optimal hormonal response. Because we do know that lactic acid in a very short burst will cause your body and your lighting cells to make more testosterone. That we know that is the mechanism by which we think weight training increases testosterone. So that's number one. Dr. Espo:   I don't do endurance exercise, so you won't catch me running a half marathon. The most, I'll probably run it as a five K because you know, beyond 45 minutes of endurance high intensity or high zone, zone four, zone five or zone, yeah, zone three, zone four type of wei.. Endurance training, you will start increasing cortisol levels at approximately the 45 to 60 minute Mark. So you won't catch me doing that. Instead, I do short bursts of exercise that allow me to increase my aerobic capacity. So that would be like the Airdyne or I'll do like the Tabata type of training as part of my cardio. And then my downtime is yoga and stretching. Dr. Espo:   So I am not a yoga expert. I would love to be because my mobility is crap. But beyond the mobility part, I find that we do need a little bit of... I mean, I live in New York, man. It's intense. It's stimulating. And I think yoga is a great way to just zone yourself out. Mason:   What style of yoga's are you doing? Dr. Espo:   Yeah.And then my supplements are, I do creatine monohydrate. I do beta alanine, I do some branch chain amino acids because I do time restricted feeding. So I typically only eat for about six to eight hours of the day. And if I work out fasting, I want to make sure that I'm optimizing my muscle synthesis. So branching amino acids helped me do that. And then all my other... my herbs, I do rhodiola, ashwagandha I actually do some deer antler as well. I actually, honestly, I love yours. I've noticed the best impact with that. I know a few other companies, I've used it I'm not saying that to brown nose, I actually find your product to be very good. Mason:   Thanks man. Yeah, it's a really good product. I'm really proud of that one. Dr. Espo:   Yeah. And surprisingly, I kind of liked the taste of it, so don't [inaudible 00:43:28]. A lot of people are like, "I hate the taste." I'm like, "Oh, it's actually not that bad." Mason:   Yeah, I agree. Dr. Espo:   And then yeah, that's pretty much it. And then B vitamins and et cetera and fish oil. Mason:   On the fish oil as well. You got to get those omega's in. Dr. Espo:   Yes, absolutely. I do a lot of flax and chia, but I like to get my EPA and DHA straight, so I do that. Mason:   Yeah, of course, man. So good. Hey before, you know, we've gone on for a little bit here, but we've got a while longer for possibly the most important conversation we'll be having in Brovember is around mental health. Suicide levels have been crazy high. Unacceptably high in men, in the Western world. I might just like open... Let's just open that book and dive down. Do you want to just like start us off in this conversation and your work around it? Dr. Espo:   Yeah, I think this is a really important conversation to have because a lot of men don't really realize that one of major killers in men under the age of 30 is suicide or accidents or homicide. And it's really important to discuss because approximately 20% of all accidents and injuries are due to suicide in men, depending on your age. So usually from like 20 to about 35 is when you're at the highest risk. And as you get older, that risk tends to decrease. But I really want to emphasize the fact that mental health is super important and it's important because you need to know when you're not well, and it's okay to say when you're unwell. I think there's a little bit of a stigma around saying you're mentally fatigued or anxious or depressed or moody, right? Dr. Espo:   It's like, no, only women can be moody around their period. Like, no, that's bullshit. Number one, not all women are moody around their period and men can be moody too. So it's okay to say that you're feeling that way. And certainly it's a life risk factor for young men. And I actually see it a lot more because I see more men, but you see young men who have the pressures of being like their dad or being like they're superheroes, right? And they want to do performance enhancing drugs and they want to take testosterone and they want to do all these things to improve their appearance or the way they appear to social media, right? But in the inside, all that shit is fake. Mason:   It's all fake. Dr. Espo:   It's all fake. My Instagram feed when you go into the search has bunch of guys like with six pack abs, eat this, not that have this to lose body fat. Like not everybody is like that. Mason:   Well, and that's the thing about training. I mean... Dan Sipple, who introduced us, he was on the podcast and we were talking around about the shame sometimes that we have around building testosterone at this point. And really coming into this place where we're really potentiating ourselves, especially if you are aware of just how stupidly superficial and boofy, the #Gains Instagram fitness world is that doesn't necessarily seem to have much intention. Mason:   And I think the other thing around these physical trainings is they're not embedded in a philosophy that has any ancient roots or any genuine intention that a human, a healthy human would have towards being just a beautiful person for themselves and community and have longevity in the way that they are, that they can continue just to, right up into the end, be able to have a chuckle and stay you know, contributing beautiful person. Mason:   And so I think it's always important to realize how detrimental all that stuff is to mental health. And then where I found myself in when having my identity crisis. I wasn't in the bodybuilding kind of world, but I was definitely in the excessive health world that leads you down towards more orthorexia in obsession with what I was eating. But then you start getting into this like exasperation of like, if it's not about that identity crisis, if it's not about that, what is it about? Mason:   And if there is that, well if they're, there's is, as I said, there's a that quagmire, which seems to not be, you can't on the mesh that desire to potentiate your physicality and be a robust human without associating with that part of yourself that historically had the identity wrapped so far up and in high up in those gains equaling you being a quality human or being someone that is worthy. And so I feel like that conversation is being had more and more. But not real question, I'll throw it back over to you now. I'm not necessarily the answer or anything, but yeah, you just brought that reflection up in me. Dr. Espo:   Yeah. I mean I don't think there is an answer. I think the answer is just make sure you take care of yourself. You do need self care. You can't be macho and tough all the time. I meditate every morning. If I'm feeling down, I tell my girlfriend or I tell my family, "I'm not feeling well right now. Like I'm not doing okay." "Well why?" "Because I'm not sleeping or I'm stressed out over this." It's okay to say those things because they're there to help you and you need help sometimes. We can't be expected... just piggybacking on what you said, humans, we are social animals, we are group animals, and we do well when we have support and that's just how we've evolved. And we've seen this for centuries of just human culture and it's typically when we become supporting each other as when we can achieve the most. Dr. Espo:   No one person has basically taken credit for the greatest inventions in the world, right? It's always been a collaborative process. And your health should be viewed the same way. If you want optimal health, it should be a collaborative process. So make sure you have the right social support, make sure you have the right access to foods, make sure you have the right access to doctors and physicians and therapists and acupuncturists and trainers and all of those, whatever you need. But build your clan so that it can support you. Don't expect to do this on your own. Dr. Espo:   And I think that's the most important part about mental health is like, we do see a lot of mental health issues in today's society and we do see a lot of gun shootings. And whether that's a result of media or whatever it is, it doesn't matter. It's still exists and we should aware that it's manageable before it gets to that point. Mason:   Couple of things just in terms of you talking to your family and just kind of say like, I'm not doing so well, not sleeping, not doing. I think the whole stigma around when men finally get to that point where they have to go down. It's like with the man flu, it's like tough and burly, hold on tough, tough, tough, tough. She'll be right, mate. And then if you do need to really go down, if you get the flu, the only way you can justify it as a lot of the time is to go into like victim and really sooky mode. Mason:   And what you're talking about and just like has been really significant in my life is when you are asked like how you're doing, people who are close to you, of course you have to go around to saying it to strangers. But not needing it to be like really super charged and not necessarily needing to so much significance and victim- hood into it. Mason:   Just being kind of like, how healthy it is just to release the pressure and just be like, "Yeah, not so great at the moment. I've just been like sad and I've been going down every now and then and not feeling like I have much motivation. I can't really see a point, whatever you know of. Although those are very significant feelings and you go and talk to someone. Even if it is like if it's not like a massive, big thing, just having like a real, it's almost a nonchalant sharing with your family. It doesn't have to come from like victimhood, but you don't have to do anything with them. You don't have to solve anything. It's just that gentle sharing consistently what you're feeling is really significant Dr. Espo:   And it can make you feel better. Mason:   Yeah. Dr. Espo:   And that's really what we want. We just want you to be well, and just by saying it, "I'm not feeling so great right now." It's like, Oh, okay. I've been able to come to terms with that. Well, that's what meditation is, right? But I meditate every day. I'm thinking about a million different things while I'm meditating. But I still come back to my thought. I'm like, okay, I am thinking about those things, therefore I can overcome them and overthink them. Same thing about expressing your feelings. Mason:   Yeah, that's significant in terms of many different styles of meditation, many different ways that you can practice and have reflection in the morning. But what you are speaking to is very simple, yet profound and almost can't be captured in one particular practice because it's synonymous with a healthy human who's giving yourself space to be like, ah, you know what? You would've just gone and distracted yourself all day. However, that obviously is very important to me and it's triggering a pattern and it's going to be playing out through my day. Maybe I can grab it and do something about it. That's so good, man. Hey, is there anything else you wanna say on that? Dr. Espo:   No, I think we've hit all the right points. I just want men to know, you know, it's, we all feel that. Mason:   Oh yeah, we do. I just went and had a recently at a good psychological little clean out to put it in a jovial sense. But I just went and had a week offline doing a bit of that work and feel all better for us and all the benefit of not having to do it on the sly and in the shadows. Dr. Espo:   Absolutely. Mason:   I'll let you go in a second. I just wanted to just quickly end on andropause. I know this is probably a huge conversation, but I know we probably have a somewhat of a handle on what it is, but can I just ask you from your perspective, what is andropause and what is it in very much if you want to get like energetic and spiritual about what it is for human, I'd kind of feel in that way. It's obviously a bridging, but physiologically I assume everything we've talked about is going to help us maintain an easy transition. But what can we prepare for and look out for in ourselves or when we're observing family members going through it? Dr. Espo:   Yeah. I think in essence andropause or mano-pause or whatever you want to call it, is the point at which men start experiencing a change in their hormones. Similar to female menopause except female menopause typically happens sometimes like this, just like your hormones drop. Whereas men, I think after the age of 30, they lose about 1.1 to like 1.6% of their testosterone per year. All right. So it seems very slow progress and essentially it's a point in which a man feels less like his 20 or 30-year-old self. And it's a psychological experience. It's a physiological experience. Sex drive is lower. They don't recover from poor sleep as well. They don't recover from poor diet as well. They have more aches and pains from weight training. They're really sore after and they have sexual dysfunction and things like that. Dr. Espo:   That is what... and then obviously they have low testosterone levels. They don't have low testosterone levels to be in menopause or andropause. So it's essentially a period in a man's life as to which they are experiencing these things, which can be contributed to low testosterone, but it doesn't have to happen when you're 50. So it can happen younger, but that we just call that hypogonadism or low testosterone or testosterone deficiency. But it can happen when you're like 70, and that's a normal response because over time your fertility does decrease and your brain does become fatigued if you're under the chronic stress of 70 years. Dr. Espo:   So it's something that occurs frequently, but it's not necessarily normal. Like menopause, female menopause is a normal physiologic response. But with men, that doesn't have to be that way. And I think it's largely a lifestyle issue that's comorbid with obesity and metabolic syndrome and high insulin levels and weight gain and et cetera. Mason:   Wow. So, yeah. Right. So it's like, it's just a little bit of a wake up call away then. Dr. Espo:   Yeah. It's like, Hey, something's wrong here. The first thing I usually come in, the first thing to go is your sexual dysfunction. And when you notice that your penis isn't working as well, that should be a sign to say, all right, let me get on top of this because something's wrong. Mason:   So I mean, it's almost like at that, when you kind of exit that lifespan and enter into that death span, right? Like I imagine it's that same like you've in a Taoist perspective, you've basically burned through your Jing and you therefore don't have the ability to maintain and manage, the function of the skeletal system, bone marrow and androgens. Right? Dr. Espo:   Right. Exactly. So, in Chinese medicine, it's a Jing deficiency. Mason:   All right. I love it. And it just the fact that andropause is a wake up call and you can start getting on top of your health now integrating all these things that we're talking about and not have to go through that process. You can give yourself a wake up calls in other ways that aren't as intense. Dr. Espo:   Right. Mason:   All right. Man, I love it. I really appreciate you coming on for Brovember and laying all this down. I know everyone else does. But let's tune in. Obviously you've got areas that you're deeply researching. Make sure you let me know when you start cracking into something like really new and juicy. Hit me up and we'll go for around four. Dr. Espo:   You got it, man. Mason:   I recommend everyone go and follow you on Insta. You really rocking it even just going back to your story highlights, you've got like a heaps of really deep information on there. Are you Dr. Ralph Espo, is that right? Dr. Espo:   It's dr.ralphesposito. Mason:   All right, Doc, I will put it in the show notes as well. And website? Dr. Espo:   Right now it's just Instagram. That is under development. Mason:   Okay. Sweet. Thanks so much, bro. Dr. Espo:   (Thanks man. Thanks for having me. 

What is Peyronie's Disease? Peyronie's' disease is a condition of scarring in the shaft of the penis, specifically a layer called the tunica albuginea. The scarring is a disorganized, excessive deposition of collagen that results in formation of a collagen plaque. Peyronie's disease most often manifests in a triad of symptoms: pain, bending of the penis with an erection, and a palpable lump on the penis. Peyronie's disease may also result in changes in shape such as narrowing on one or both sides of the penis, and erection trouble such as not being able to get an erection that is hard-enough for penetration or difficulty in maintaining an erection. Treatment for Peyronie's disease is usually initiated for a penis that is unusable, either because it's too soft or to crooked. The American Urological Association has published guidelines for the treatment of Peyronie's disease that can be accessed online. I will put a link in the show notes. https://www.auanet.org/guidelines/peyronies-disease-guideline

Erectile dysfunction (ED) can arise from several different causes, making diagnosis a bit of a complex algorithm. The good news is that treatments are many and effective for these causes. All treatments (including Viagra), should be used with some medical supervision, due to interactions/side effects/contraindications with other aspects of an individual's/couple's health and life. Guest: Hunter Wessells, M.D. Professor and Chair of the Department of Urology, University of Washington School of Medicine, member of Advisory Committee for Urology on the American College of Surgeons Legislative Task Force, and member of the Uro-Trauma Legislative Taskforce of the American Urological Association.

Every person in the US needs the information in this episode. First, to learn how to make informed and efficient health care decisions for themselves in our current insurance system. And second, to gain an understanding of how the current system works and doesn't work, so they can evaluate the different positions on fixing the system taken by various political and organizational platforms. Guests: Dr. Jeffrey Frankel M.D. Urologist with Frankel, Reed and Evans; President of the Western section of the American Urological Association.   Mark Painter, B.A. Vice President of Coding and Reimbursement Information for Physician Reimbursement Systems, Inc. (PRS). Managing Partner of PRS Consulting, LLC; CEO of PRS, LLC.

For both weekend warriors and serious athletes, sports injury prevention involves managing injury risk—with knowledge, proper technique, and personal safety equipment. A second key to injury prevention is not ignoring problems or ‘pushing through the pain.' Lastly, the fitter and more active a person is, the faster they recover from injury and disease. Guests: Stanley A. Herring, M.D.,  Senior Medical Advisor and Co-Founder of the UW Medicine Sports Health & Safety Institute, Medical Director of Sports, Spine and Orthopedic Health for UW Medicine, and Co-Director of the Sports Concussion Program, a partnership between UW Medicine and Seattle Children's. Clinical Professor, Departments of Rehabilitation Medicine, Orthopaedics and Sports Medicine, and Neurological Surgery at the University of Washington Team physician for the Seattle Seahawks and the Seattle Mariners and a consultant to the UW Sports Medicine Program. Hunter Wessells, MD Professor and Chair of the Department of Urology, University of Washington, a member of the Advisory Committee for Urology on the American College of Surgeons Legislative Task Force, and a  member of the Euro-Trauma Legislative Taskforce of the American Urological Association.

The focus of infertility treatment traditionally has primarily been on the female. However, in almost 50% of couples, the male is in fact responsible for infertility. Recent research has shown that males now produce less than half as many sperm than males in the early 1970s. In addition to having lower quantities, sperm are now are also of lower quality.So, how can men improve their fertility?In this episode, Jamin Brahmbhatt, M.D., a board-certified urologist specializing in chronic testicular pain and infertility, joins host Mark P. Trolice, M.D., to discuss the male role in infertility and what men can do to protect and preserve their fertility. Listen in as he shares insights on everything from low sperm count treatment, sperm freezing, and hormone treatment to diet, marijuana use, and alcohol consumption.Tune in to discover:What lifestyle changes men can do to protect their fertility and stay healthyHow mental health can affect a man’s fertilityThe impact of age on male infertilityWhat to expect when visiting a urologist for an infertility consultationThe types of interventions available for men to improve their fertilityAbout Jamin Brahmbhatt, M.D.Dr. Jamin Brahmbhatt is a board-certified urologist specializing in chronic testicular pain and infertility. He completed his urology residency at the University of Tennessee followed by a fellowship in robotic microsurgery at the University of Florida. He is now co-director of PUR Clinic (Personalized Urology & Robotics) at South Lake Hospital & Orlando Health.He is an active member of several professional organizations including the American Urological Association, SMSNA, CAPI, and the Florida Urological Society where serves on the executive committee. He is a TEDx speaker and winner of numerous awards including 40 under 40 and Top Doctor.He is frequently seen offering expert medical opinions on national media platforms and his own social media channels. He is the co-founder of the Drive 4 Men’s Health, an annual non-profit public engagement campaign that continues to encourage millions of men to eat better, get active, and engage in preventative medical screenings.About Mark P. Trolice, M.D.Mark P. Trolice, M.D., FACOG, FACS, FACE is Director of Fertility CARE: The IVF Center in Winter Park, Florida and Associate Professor of Obstetrics & Gynecology (OB/GYN) at the University of Central Florida College of Medicine in Orlando responsible for the medical education of OB/GYN residents and medical students as well as Medical Endocrinology fellows. He is past President of the Florida Society of Reproductive Endocrinology & Infertility (REI) and past Division Director of REI at Winnie Palmer Hospital, part of Orlando Health.He is double Board-certified in REI and OB/GYN, maintains annual recertification, and has been awarded the American Medical Association’s “Physicians’ Recognition Award” annually. He holds the unique distinction of being a Fellow in all three American Colleges of OB/GYN, of Surgeons, and of Endocrinology. His colleagues select him as Top Doctor in America® annually, one among the top 5% of doctors in the U.S. In 2018, he was awarded the “Social Responsibility Award” by the National Polycystic Ovary Syndrome Association. For ten years his foundation, Fertile Dreams, organized seminars to increase fertility awareness and granted national scholarships for those unable to afford in vitro fertilization (IVF) treatment.Dr. Trolice serves on committees for the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology as well as the editorial advisory board of Ob.Gyn.News. He has conducted

The American Urological Association in conjunction with the National Medical Student Education Curriculum Committee is proud to sponsor a free podcast that will provide exposure to the core concepts and terminology underlying the care urologists provide within Transgender Medicine. This webinar will provide an overview of this complex discipline, and is designed to give medical students the ability to engage in thoughtful discourse with colleagues when caring for this patient population. It will also provide specific insight into the ways Urology is emerging as a leading specialty in this discipline, paving the way for optimization of lifelong care, including before and after surgical reconstruction.

Welcome to Prostate Cancer & You, a series of podcasts sponsored by the Massachusetts Prostate Cancer Coalition. Today’s podcast features an interview with Aria Olumi, MD, chief of Urologic Surgery at Beth Israel Deaconess Medical Center, the endowed Janet & William DeWolf Professor of Surgery at Harvard Medical School, and he serves as the Chair of Research for the American Urological Association. He will be discussing the Changing Landscape of Prostate Cancer Screening.  If you are interested in hearing more about this topic from Dr. Olumi, he will be presenting at the 2019 Massachusetts Prostate Cancer Symposium on Friday, May 10 at the Newton Marriott. Go here for more information and to register.  

I opened my email Friday Jan 18, 2019 and found an email from the American Urological Association announcing that date was “match day” for medical students applying for urology residency positions starting July 2019.  Most of you listening to this podcast may not know what the matching system is for medical training. The Urology match day is a day when all of the medical students applying to become urology residents around the country will find out where they will be spending the next five to six years of their lives as residents. The “match” is a process whereby all of the students applying for training and all of the programs that have open positions to fill are put together or “matched” on a best fit analysis by a computer algorithm. Does this all sound a little arbitrary to you? Just come up with a rank list and then on a certain day get a letter telling you that is where you are going and you just have to go? Doctors have been trusting or not trusting in the process now for 60 plus years. And it's not arbitrary. In fact, the scientific work done proving this process works has won a Nobel Prize.

In this podcast, we will cover the combined committee opinion from the ACOG and AUGS regarding asymptomatic microscopic hematuria in women. The ACOG deviates from the American Urological Association recommendation for evaluation of asymptomatic microscopic hematuria in women over age 35, as the risk of any urological malignancy is very low. Data taken from the ACOG committee opinion 703, June 2017.

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.

We review the American Urological Association guidelines on penile fracture and priapism. We supplement this with core content from Tintinalli and Rosen's Emergency Medicine.

“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