PROstate CONs: Dr. Mistry on the Dreaded Rectal Exam and Treating ED Symptoms After Prostate Cancer

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 listener questions about which prostate exams are right for high risk patients as well as intimacy after prostate cancer treatment. The bad news is that there is no substitute for traditional rectal exams when it comes to screening for prostate issues. The good news is that there are other, less invasive ways of determining your prostate cancer risk and/or detecting existing cancers. These include tests on PSA, urine, and blood as well as MRIs of the prostate. If you or a loved one are concerned about prostate cancer risk or have been diagnosed with any urologic cancer, we're here to help. Dr. Mistry is a big fan of the second opinion, so don't hesitate to bring your inquiries to us at NAU Urology Specialists. 

To address intimacy concerns that have arisen after prostate cancer diagnosis and treatment, the key is to determine whether ED symptoms are being caused by a physical element related to the treatment administered or to a psychological element related to the emotional impact of the illness/recovery. Regardless of which cause you're dealing with, there are many excellent options for restoring both sexual function and libido, including medication, vacuum erection devices (particularly effective when used with penile rings), sex therapy, hormone replacement, and Sparkwave treatment, among others. The most important thing is to know that a cancer diagnosis should not keep you from a healthy, fulfilling sex life with your partner, no matter your age. If you or a loved one is experiencing ED symptoms after a cancer diagnosis/treatment, please give us a call today!

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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.

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Transcript

Speaker 1 0:07

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

Dr. Mistry 0:17

Hello, and welcome to the Armor Men's Health Hour. I'm Dr. Mistry, your host, here as always with my well-rested cohost, Donna Lee.

Donna Lee 0:24

Can you tell I'm well-rested? I feel really good. Thank you for asking.

Dr. Mistry 0:28

Skin looks great.

Donna Lee 0:28

Trying. My auto-immune problem's going down. Thank you. Thank you for noticing.

Dr. Mistry 0:34

Too much information. This is a men's health show. I am a board certified urologist. This show is brought to you by the urology practice I started in 2007, NAU Urology Specialist.

Donna Lee 0:43

That was like 25, 30 years ago.

Dr. Mistry 0:44

It was...is that, I guess I am aging.

Donna Lee 0:47

Or 13 years ago.

Dr. Mistry 0:49

It was started in Round Rock, Texas. But now we have offices everywhere. Right?

Donna Lee 0:53

Mhmm. We have one in Round Rock, of course, South Austin, North Austin, and Dripping Springs, where they love dripping.

Dr. Mistry 0:58

They do love dripping. We're trying to get them to stop dripping.

Donna Lee 1:01

We gotta stop all that nasty dripping.

Dr. Mistry 1:03

Dripping Springs. The houses are selling like crazy. People are moving down there like crazy.

Donna Lee 1:07

It's still the number one fastest or biggest County in the country.

Dr. Mistry 1:11

Is it?

Donna Lee 1:11

I'm sorry, fastest growing County in the country. That was in the news.

Dr. Mistry 1:14

Just make up whatever you want. We're also the number one podcast...

Donna Lee 1:17

We're the number two podcast.

Dr. Mistry 1:17

....for those of you that, we're just going to make up stuff.

Donna Lee 1:22

We are the number one most listened to podcast ever in the history of the world. And I heard Joe Rogan's going to buy the old One World theater place out on Bee Caves road. So we need to make a ploy to be like a regular fixture. There. We could be like a comedy duo talking about men's wellness.

Dr. Mistry 1:37

Well, only one of us is very funny.

Donna Lee 1:40

And we know that's me.

Dr. Mistry 1:42

I was told recently...

Donna Lee 1:42

...that you were kind of funny?

Dr. Mistry 1:44

...that I was so funny and I should think about giving up urology.

Donna Lee 1:47

They didn't add the word"looking" at the end?

Dr. Mistry 1:50

I feel like that was a little bit of an insult.

Donna Lee 1:52

"You should give up urology."

Dr. Mistry 1:54

"Maybe, maybe you're going to be a better comedian." It's like when you tell the guy who's cutting your hair,"Maybe you should really look into something in some other field of practice." So we are a full service urology practice, and we treat kidney stones, prostate cancer, erectile dysfunction, whatever you think between the nipples and the knees, we say.

Donna Lee 2:11

We do say that? But it's confusing because some people think we treat nipples.

Dr. Mistry 2:14

That's right.

Donna Lee 2:15

We can get your nipple rings.

Dr. Mistry 2:16

Another there's another medical professional that has a podcast in town and it is a gynecologist and a podiatrist.

Donna Lee 2:24

Shut up.

Dr. Mistry 2:25

...and they called their podcast"From Tits to Toes."

Donna Lee 2:28

Stop it.

Dr. Mistry 2:28

....I am not kidding. Dr. Rush. She is, she is my she's going to deliver my grandbaby very soon. And...

Donna Lee 2:36

Wait, say it again."Tits to Toes."

Dr. Mistry 2:38

"Tits to Toes." We thought about doing a"Nipples to Knees"/"Tits to Toes" crossover episode.

Donna Lee 2:43

We should.

Dr. Mistry 2:44

We should definitely do that.

Donna Lee 2:47

Oh my gosh. Wait, we can't neglect that you just said grandfather or grandbaby, meaning you're going to be a grandpapa.

Dr. Mistry 2:53

That's right. Which makes my own attention to my own health so much more important, because I need to be one of those really active grandfathers that like, I dunno somehow goes and watch them play soccer for an hour. Wow.

Donna Lee 3:04

That's you! You're still doing that with your six year old.

Dr. Mistry 3:07

I know, we're still dealing with a six year old. The other aspects of our practice that we, that we provide include advanced testing, your metabolic system, cardiovascular testing. We have a nutritionist on staff who's a physician assistant, specifically trained in functional medicine. We have pelvic floor physical therapy, a sleep medicine here and deal with all of your hormonal needs, whether you're a man or a woman.

Donna Lee 3:29

Is that true?

Dr. Mistry 3:30

Yes.

Donna Lee 3:30

We do all that?

Dr. Mistry 3:31

We do all that.

Donna Lee 3:31

We're so impressive.

Dr. Mistry 3:32

We're pretty busy.

Donna Lee 3:32

That's why we're the number one most listened to podcast.

Dr. Mistry 3:35

We're pretty busy. And so when people are like,"You know, you should do one more thing." I'm like,"Okay, I'll try to find it, I'll try to find the time. I'm not sure where I'm going to find it." Your questions and your participation with our show is what drives us. So Donna, give us a question.

Donna Lee 3:47

We have a question that it was a little alarming, so I'm glad this person sent it in."I am 64 years old. I've had digital rectal exams for many years, as part of my annual physical. My new doctor doesn't do them and says that if my PSA is too high, he will send me to a urologist. So after 20 years or so of digital exams, he said now it isn't done. My dad was diagnosed with prostate cancer at 68 and died at 72. Is the PSA test all that I need, or should I be getting an exam? I can't always catch your show. So please email me." Which I totally will.

Dr. Mistry 4:17

Super. So this reminds me of a very interesting joke the other day, which is that a patient came to me one day and said,"Hey doctor, you know, this finger-up-the-butt thing, haven't you guys come up with anything different? And I said,"NAU Urology Specialist offering state-of-the-art digital rectal exams!" Because now it sounds like it's computerized."

Donna Lee 4:36

Aw. But it's still your finger.

Dr. Mistry 4:37

...but, because it's called a digit. That's how you get"digital."

Donna Lee 4:44

Can I tell you that you have to explain the joke, it's probably not a good idea.

Dr. Mistry 4:47

What are you a professional comedian? Oh, wait. You are. So any case, in any case. So if you're looking to get advanced prostate cancer diagnosis, come to our practice. We are a state-of-the-art offering digital rectal examinations. It's a great question on whether or not the finger exam is completely necessary. And that the truth of the matter is that as a percentage of cancers diagnosed, those found on your physical exam make up a minority. Most are found through an elevated PSA. But more importantly, if even if I find a nodule on the prostate, most of the time it's not cancer. So I consider the digital rectal exam the urologist handshake, because it's almost like if you come to my office and you're not going to get that exam, you kind of feel like, you know, I kinda got let down.

Donna Lee 5:39

Really. I got gypped because I didn't get a finger up my booty?

Dr. Mistry 5:40

I came all the way there and he didn't examine me. It's like, that's the only way that you know that I care. But we have so many other ways of like diagnosing your prostate cancer or finding out if you're at risk. PSA is by far and away the most commonly used one. If you're at very high risk and you have a questionable PSA, then we can do an MRI of the prostate, which can find a lot kind of diseases that you can't feel. And then we have some advanced testing. We have different kinds of PSA, blood tests. We have different kinds of urine tests, other things to assess your prostate cancer risk. The other aspect of the digital rectal exam that can be of real value is to find occult blood in the, in the, in the stool, which can be a sign of underlying colon cancer, as well as finding masses in the rectum, which ultimately can be anal cancer. So there's a lot of reasons...

Donna Lee 6:32

What is the digital exam. Like what, what kind of machine or process is it?

Dr. Mistry 6:35

Are you joking now?

Donna Lee 6:36

No, no, not the digits. The digital.

Dr. Mistry 6:37

There is no digital. I was joking.

Donna Lee 6:41

You sounded so convincing.

Dr. Mistry 6:42

Now, now this joke really sucks. When you have to, when you have to explain the joke...

Donna Lee 6:49

I thought maybe there was a machine I haven't seen in the office...

Dr. Mistry 6:49

When you have to explain that, I mean...Did you invest in something without me knowing?

Donna Lee 6:54

I did. I bought you a digital prostate checker.

Dr. Mistry 6:58

A digital prostate checker. No.

Donna Lee 6:58

It was$21,000.

Dr. Mistry 7:01

No, it's the finger digit. That's a great question. What's your next question there, Donna?

Donna Lee 7:04

This radio listener called, she sent a question for her husband. She says,"My husband is 76. He completed nine weeks of low dose, high frequency radiation. He did not receive hormonal therapy for surgery. His PSA is at a three and the prognosis is good. She's only 51. Are there any options to rekindle our bedroom activities?"

Dr. Mistry 7:27

That's a great question. So...

Donna Lee 7:28

That's is a good question. Besides having a boyfriend.

Dr. Mistry 7:30

It sounds...You know, boyfriend boyfriend is rarely the answer, Donna.

Donna Lee 7:35

I think it's oftentimes the answer.

Dr. Mistry 7:37

I mean only as often as girlfriend's the answer.

Donna Lee 7:39

Well, that's true.

Dr. Mistry 7:40

Okay. So, so there's the question of what has occurred to his erections as a result of the radiation. And so if I, if, if I could infer some, some things that were not stated, it would be that his erections were fine and they were having great sex and then he had radiation and then he's no longer.

Donna Lee 7:58

Right, we would assume that, yeah.

Dr. Mistry 8:00

And so now when it comes to rekindling, sometimes libido can go down, and that can be due to the psych psychological impact of a cancer diagnosis, more than just the physical impact of the radiation. Most people who are going to develop ED after radiation develop it slowly over time, not immediately at the time of radiation. So, whereas when you have a surgical removal, you get, you become impotent right away potentially, the impotence from radiation therapy evolves over 12 to 18 months. And so if the erectile dysfunction started like right at the beginning of radiation, then we have to be concerned about a psychological component, which we have all the resources in our practice to help deal with. If it's sex drive then it could be a testosterone issue. And, some doctors will be reticent to treat patients with prostate cancer with testosterone, but our practice, we have hundreds of patients with whom we treat testosterone because we've monitored or treated their prostate cancer. Then there's what are options for just improving blood flow? So shockwave is a wonderful option. The use of the vacuum erection device along with a penile ring is another great option.

Donna Lee 9:15

Right. And our shockwave is called Sparkwave.

Dr. Mistry 9:17

And then we have just plain old meds. So will it be Sildenafil, which is generic Viagra, or Tadalafil, which is generic Cialis. These are exceptionally good options to consider for improving blood flow and works most of the time. So, for sure, having a patient convinced that trying to get their erections back is worth their time and effort is probably the biggest thing. Just because you were diagnosed with cancer, doesn't mean you're broken by any means. We have ways to put you back together.

Donna Lee 9:54

Maybe some sex therapy, too.

Dr. Mistry 9:55

That's what I, that's exactly right. And so, finding a practitioner that's going to help rebuild erections and intimacy, I think there's a lot of opportunities and by no means should this 51 year old listener feel like her sex life is, you know...

Donna Lee 10:12

Over?

Dr. Mistry 10:12

...non salvageable. Well, that's a great question. Donna, how do people get ahold of us for more questions?

10:17

You can send us your email at armormenshealth@gmail.com. You can visit our website and send an email there as well to armormenshealth.com. And you can listen to our podcast because we're just awesome. And we are number one. Thank you. The armor men's health hour. We'll be right back. If you have questions for Dr. Mystery, email him at armor men's health, ed gmail.com.