Thanks for tuning in to the Armor Men’s Health Hour Podcast today, where we bring you the latest and greatest in urology care and the best urology humor out there.
In this segment, Dr. Mistry and Donna Lee answer a listener's question about having an unexplained, chronically high PSA number beginning when he was only 45 years old. Despite several biopsies and an MRI, this listener writes that his urologists have been stumped over the years by his elevated PSA. While it is possible that this listener has a transition-zone cancer (in the middle of the prostate), Dr. Mistry explains it's unlikely that a large or aggressive cancer could be missed under such scrutiny. More likely is that this listener's prostate is over-producing PSA, which actually serves the biological purpose of liquifying semen. If so, he can rest assured that having ruled out any nefarious cause, there is no need to continue such frequent prostate screening. Importantly, Dr. Mistry reminds us that trust in your provider is crucial--if you aren't satisfied with the testing and/or diagnoses you've received by your urologist, you can and should seek a second opinion!
If you enjoyed today’s episode, don’t forget to like, subscribe, and share us with a friend! As always, be well!
Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.
We enjoy hearing from you! Email us at armormenshealth@gmail.com and we’ll answer your question in an upcoming episode!
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Speaker 1:
Welcome to the Armor Men's Health Hour with Dr. Mistry and Donna Lee.
Dr. Mistry:
Hello and welcome to the Armor Men' Health Hour. I'm Dr. Mistry, your host, here as always with my cohost Donna Lee.
Donna Lee:
And sound engineer to you.
Dr. Mistry:
Sound engineer.
Donna Lee:
Co-host, sound engineer extraordinaare.
Dr. Mistry:
Co-host, scheduling maestro, everything that we need around here. I'm a board certified urologist. This men's health show. This show is brought to you by the practice that I started to in 2007, NAU Urology Specialists.
Donna Lee:
What does NAU stand for, Dr. Mistry?
Dr. Mistry:
It's North Austin Urology. That was what our old days were. You know, it made me think of sometimes how you try to keep a little bit of the old flavor even, even though you're changing and growing as a group. But...
Donna Lee:
Let it go, Dr. Mistry.
Dr. Mistry:
We're not going to, we're not going to let it go. We're going to remember, remember our past.
Donna Lee:
Going to hold on tight, like an ex-boyfriend. We just gotta let it go.
Dr. Mistry:
And sometimes I think if I keep the more complicated name, it'll like stick in somebody's craw a little bit, like,"Man, what's the name of that practice again?"
Donna Lee:
"NA-something?"
Dr. Mistry:
I think it's just urology specialists.
Donna Lee:
That's what we're going for.
Dr. Mistry:
That's what we're going for. We are located all over Austin. We are still seeing patients in as safe of a way as possible. And I know we reach so many people here on the radio, but we're really proud to offer all of our episodes on podcast. We in fact send a lot of these podcast episodes to our patients.
Donna Lee:
We do. If you miss the podcast or the answer to your question on the radio show, I respond to the email and I'll send you the podcast, so there you go.
Dr. Mistry:
Well, that's great. I think that we've given so many people so much hope and so many answers. I've had, you know, daily, we, I get myself at least two or three patients that were brought straight from the radio show. And you know, sometimes they're surprised they get to actually see me.
Donna Lee:
I think that we have spawned and I'm marketing bonanza in Austin, because now I see all these urology commercials on TV and I hadn't, I didn't before. I think we started something interesting. Or is that just my big ego?
Dr. Mistry:
Probably. You know, they say imitation is the sincerest form of flattery.
Donna Lee:
Well, that's true. Well we're being flattered and imitated all over the place.
Dr. Mistry:
Donna, why don't you tell people how to get ahold of us and where our offices are?
Donna Lee:
Of course! You can call us at(512) 238-0762. Our offices are in Round Rock, North Austin, South Austin, and the lovely Dripping Springs. I always say that--you know, the other locations are lovely, too. So I don't want anybody to not feel any love there. Our website's armormenshealth.com. Our email address for your incredible insightful and engaging questions is armormenshealth@gmail.com. And you can listen to our podcasts all over the world for real.
Dr. Mistry:
All over the world. Although we like to talk about a specific topic, you know, every segment here on the show, people are always like,"Well, how come you guys don't talk about Peyronie's disease or shock wave or this or that?" We are a general urology practice. We take care of everything and you just missed the episode is all that it means. We talk about kidney stones, we talk about nutrition, we talk about so many things, and you are going to get an amazing experience in our practice. We are just for example, our, our workup and evaluation of male fertility is so far head-and-shoulders beyond what you're going to get anywhere else. We are here to make you have babies.
Donna Lee:
Older, young, either way. We want you to have a baby.
Dr. Mistry:
That's right. That's right.
Donna Lee:
It doesn't matter. And if you don't want to have babies, we're going to give you a vasectomy.
Dr. Mistry:
That's right. That we might be able to reverse later in life. Yes. And now that the other guy in town has retired...
Donna Lee:
The interesting-name one?
Dr. Mistry:
That's correct, the interesting-named doctor who also does vasectomies has retired. There's only one interesting-name doctor now.
Donna Lee:
Yeah. You don't want to get your vasectomy from Dr. Smith. You want your vasectomy done by Dr. Mistry!
Dr. Mistry:
I hope there's no Dr. Smith in town.
Donna Lee:
I was going to say Dr. Johnson, but that was appropriate.
Dr. Mistry:
Dr. Johnson! So your q uestions really helped drive this show. That's enough banter lady.
Donna Lee:
Oh, sorry.
Dr. Mistry:
Get to the, get to the meat of it.
Donna Lee:
Get to the question. You ready?"Hi, Dr. Mistry. I've listened to your weekend show for several months and appreciate the information you've covered. This one was a bit difficult for me to address over the radio, so I'm writing to get your thoughts. In 2013 at age 45 in annual physical showed that I had a high PSA. I think it was around eight at the time I consulted with a well-respected urologist and conducted a prostate biopsy. All of the core samples were benign. I continued to meet with him or her every six months and still do. In 2014, as my PSA went higher, I had another biopsy. Again, no cancer. My PSA continued to gradually go higher over the years. July 2017, I had an MRI presented with some uncertainty. My doctor again, did a biopsy in August and again, no cancer. My PSA notched up higher and higher into the high teens moving forward in September, 2020 after a physician physician suggested a second opinion. He referred me to a different urologist. That person ordered an MRI. The MRI looked pretty good and noted that cancer was not likely. My original doctor, who I went to see every six months doesn't ever feel anything from a DRE either. And I don't really have any odd urinary symptoms. He just mentioned that my prostate was somewhat enlarged. My PSA is now 26 during my last visit." His question is,"After three biopsies, my odds of having cancer are very low since it's been checked so thoroughly." He's now 53. What are your thoughts?
Dr. Mistry:
That's a great question. And I think this issue of what to do with a persistently high PSA after you've had a biopsy is a question that I think a lot of men end up with. And the majority of men, in fact. Because if you have a PSA that's high and you get a biopsy, the chances are you don't have cancer.
Donna Lee:
Why is it so high if you don't have cancer? I mean, thank God he doesn't have cancer.
Dr. Mistry:
So that's just the normal person. Now, him--what do you do with a guy with 26? Now that number should be under 4, and for a guy that young, it should be under 3. So what it means is that his prostate is just hyper productive, producing PSA. It is making too much of it. I think that in some people just having a very high or a super productive PSA doesn't necessarily mean anything. What PSA is, it's an actual, the PSA we measure it in the blood, but it actually has a purpose. It actually helps liquefy semen. That's why our prostate makes PSA. It actually has a job.
Donna Lee:
It helps liquefy semen?
Dr. Mistry:
That's right.
Donna Lee:
Okay.
Dr. Mistry:
Maybe you just got really slippery semen.
Donna Lee:
Just a lucky high number.
Dr. Mistry:
Maybe just a lucky high number. But if you've had three biopsies, first of all, you have to don't check it more than once a year. Okay? You don't need that kind of anxiety. Then you can look for things that will reduce the PSA. And there are drugs that will reduce the PSA. There are surgeries, that'll reduce the PSA. But reducing the PSA is just like kind of putting a piece of tape over your check engine light. You know, if you've checked the engine, then it just means the light is broken and you don't need to hide it. You don't need it, you don't need to like cover it up. What you need to do is you need to protect yourselves from overly aggressive urologist who doesn't want to biopsy all the time. And you need to understand that you're just on the, on the outer edge of a bi-modal distribution when it comes to PSA levels.
Donna Lee:
Is that a hereditary thing?
Dr. Mistry:
It can be.
Donna Lee:
Do you think his dad had high PSA?
Dr. Mistry:
It can be. I think that there's several zones, but there's two big zones of the prostate: the peripheral zone, which goes around the side and the central zone, which is right in the middle around the urethra. And I'll give you an example. Just this week, I did a high intensity focused ultrasound-HIFU-on a patient who was only 50 years old. His PSA was 40, which is very high. But it's because he had what's called a transition zone prostate cancer. So it was only in the middle of the prostate. And so that's something that I was going to suggest to this listener that perhaps he could have a transition zone cancer, but I'll be honest if you've been biopsied three times and you've had two MRIs and everybody's looked and looked and looked--you probably don't have, you probably don't have cancer. And so, and you probably don't have a really big cancer that everybody missed because prostate cancer comes in sizes: little ones, big ones, fast growing ones, slow growing ones. It's just unlikely that you have a fast growing large cancer that's been biopsied three times and missed by two different, you know, urologists and a well-known highly respected one.
Donna Lee:
It wasn't you?
Dr. Mistry:
I guess not.
Donna Lee:
Who's that?
Dr. Mistry:
I was thinking maybe it was a backhanded compliment. I was supposedly well-known.
Donna Lee:
This is your patient. Let me check his chart.
Dr. Mistry:
So, I think that being overly worried is probably going to be the, the biggest threat to your life. I think, I think getting, getting too many procedures and too much work done.
Donna Lee:
That's a lot of stress on a human being.
Dr. Mistry:
It is a lot of stress and it is not, it's not nice to have a really out of whack number that causes every urologist that you see to gasp. So sticking with a urologist does help because when you switch them, they tend to want to, you know, have my own look at things, you know.
Donna Lee:
Right. Do things all over again."They did that biopsy wrong. I'm going to do it again!"
Dr. Mistry:
Trust me, I do this, I do the same thing. And that's our nature. Right? I'm a surgeon. I inherently feel that I do it better than others. Because you don't want to go to a surgeon that's like,"Yeah, that guy probably does a better job, but I'll try it." You know, that's not, that's not, that's not something you want in your surgeon. You want your surgeon to have a lot of confidence that he's going to be handle that problem pretty well. And so, so if somebody comes to see me and they're like,"Well, I'm really by this problem." I mean, I get my big point boy pants on. I'm like,"Let's go see what we can do better for this man." And sometimes that works in your disfavor because that means you're going to have procedures repeated and things of that nature. But I think in this case, you've been very well biopsied. If you're out there with an elevated PSA, you should insist on having it done right the first time. If you're out there and you haven't had an MRI of your prostate, if you haven't had the proper exams, if they're not doing it in the right location--I mean, these are things that you should, you should, you should wonder about. And it, it is the case that not all urologists are going to treat them the same. I see urologists that do fewer than 12 biopsies even though the studies are very clear that at least 12 need to be performed. I see patients who are Medicare patients that don't get MRIs, even though MRI, the MRI is paid for by insurance. And there are reasons not to do it. Maybe there's a contraindication, or maybe you're just not that at risk or something, but, but I'm such a big believer of getting all the information I can borrow to proceeding with a biopsy. And I think that is becoming kind of the natural standard of care, especially inside the big city. But so many of our listeners are on the outskirts, you know the outside of main Austin. And they may not know that all of these pieces of technology are available. Or maybe your urologist works for a large institution, you know, they're trying to save money. I mean, you don't need them to save money on your prostate.
Speaker 3:
Right. Good point. Thank you for that answer. You can reach out to us with questions at armormenshealth@gmail.com and you can visit our website armormenshealth.com. Listen to our podcast, the Armor Men's Health Hour. We'll be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com Men's health, edgy, gmail.com.