WRKO>Audio & Video on Demand>>Men's Health New England- February 2nd

Men's Health New England- February 2nd

Feb 3, 2014|

Men’s Health New England is a weekly radio show dedicated to giving you the straight talk on Men’s Health. Hosted by Dr. Stephen Scionti, the Director of the Scionti Prostate Center of Boston, Dr. Scionti is globally recognized for his work in advanced prostate cancer diagnostics and minimally invasive prostate cancer therapy. From cardiac care to prostate issues, from sexual health to prevention and wellness, host Dr. Stephen Scionti will be discussing the topics on everyone’s mind, but what everyone’s afraid to talk about – their health!

Transcript - Not for consumer use. Robot overlords only. Will not be accurate.

Welcomed a men's health knowing when I'm your host doctor Stephen CO RD director this -- prostate Centre of Boston had Greater Boston urology. Join us every week and at this time for the most advanced and out the -- discussion topics most important immense help. Join us every week as we discussed topics like prostate cancer or prostate disease. Sexual health lifestyle and diet. Weight management. Heart health and hormone will help. Every week -- interview national experts in men's health and empower you with up to date scientific progress of information you can use to improve your overall health. Achieve weight loss. Lower your risk for heart disease maximize your sexual performance and deal of course with prostate problems. Down today show and be talking about one of the most common problems in men's health. And that is prostate cancer. Our review -- him the most common treatment but first we'll talk about PSA. We'll talk about the PSA controversy. We'll talk about some of the advanced techniques that we used to diagnose prostate cancer such as using MRI guided diagnostics and targeted biopsy. And our review -- some of the very common treatment as well some of the revolutionary. Cutting edge treatments for minimally invasive treatment of prostate cancer. Now -- remind you that you can learn more about prostate disease. And prostate cancer by going to my website at. DR CRT dot com that's DR SEI ON TI dot com. And my prostate center is located now at Greater Boston urology. With office locations in Framingham. And satellite locations in both Milton and Norway and now the office numbers 508. 3707703. That's 5083707703. Just called a satirist for Danielle and -- be sure to help you. Again the web site is D. -- CRT SEI ON TI dot com. And again the phone number in Framingham is 5083707703. -- -- right back with today's exciting shows so stay tuned. Welcome back whose doctor Stephen CIT a host of mens health New England. And the director and founder of the CO NT prostate Centre of Boston it. Greater Boston urology. We're located in Framingham with satellite offices in Milton and Norway. Our office numbers 50 way. 3707703. Remember you can always learn more about prostate disease and prostate cancer at my website which is. DR CR -- DD RNC. IO NTI dot com. That's -- I wanna touchy about. Prostate cancer. We really have to start with the discussion about. Something called PSA. That stands for prostate specific antigen. That's a blood test that most guys are familiar with it's been around since the late 1980s. Bad blood test has to be looked at as a screening test that is a way to detect minute may possibly have an early prostate cancer. There's been a lot of publicity about it lately because there's a lot of false positives that is just because your PSA as elevated. It by no means proves that you have prostate cancer. I think the best way to look at PSA. Is considerate but a warning -- going off the dash boarding your car. It's not even a red lights -- yellow -- -- blinking at you saying caution caution. When the PSAs elevated it simply means it's time to get a further look as to why their blood test as abnormal. Now there's many reasons why PSA can go up. They. We often call that brought the titans yeah they can also be elevated in situations where. There is prostate enlargement that is the larger the prostate gland is. And his guys get all of the prostate gland gets bigger. The larger the prostate gland is the more PSA the prostate. We'll make and -- elevated death PSA may simply mean nothing more than an enlarged prostate. But of course what we're concerned about -- prostate cancer. In anywhere for. From about 20%. To left 30% of men with an elevated PSA will be found to have prostate cancer so it's not a totally accurate test. But. When it's elevated it does indicate the need for. A closer look. This is really become more controversial lately because. In many cases when PSAs -- done an older guys particularly men in there you know mid seventies or even their eighties. If there was an early prostate cancer that was diagnosed. These cancers many times -- small slow growing. In -- and will likely die of something else before prostate cancer is even a problem in his life. In so. Many people feel that the PSA blood test has led to an over diagnosis. Of prostate cancer. Well the reality is is that if the testing used correctly. That is a man for whom the diagnosis of prostate cancer. Knowing if this prostate cancer would likely make a difference. In and their overall survival and certainly we want to use that test that can tell you. Today that I had many men still in their forties. -- come in with that elevated PSA and we diagnose prostate cancer and a man in his forties early fifties. I think we really. Have to make that diagnosis because that disease if untreated. Would certainly impact -- normal longevity. So the controversy really is going on today in the US because of issues regarding cost. An expensive. Attest to do and every single man. -- more to the point that at the PS sales elevated. It really triggers. A ranger further tests including prostate biopsy. And it's a cancers found even if it's a little small cancer. Many times -- man is offered aggressive total therapy including either surgery or radiation therapy. When it's hard to know whether or not. That procedure really added any longevity of the guys like. So there's a lot of concern about the over diagnosis in hints perhaps the over treatment of prostate cancer. In our senator. Are really think there's a balance here. And there's very little reason to be doing PSA blood tests and elderly men Silverman is certainly in his eighties. There's very little reason to be doing PSA screening. Even men in their seventies who may in fact have a multiple medical illnesses they've got significant heart disease significant diabetes kidney disease and so forth. Those men will certainly. -- die of some other form of you know disease before prostate cancer can really make a difference in their lives but for men -- have a ten year longevity tenure lifespan. Certainly I think PSA testing makes cents. Now appear young man and you've got a positive family history. My personal opinion he ought to be getting a PSA started about age forty. Now our guidelines from the American neurological association. Suggest an older age suggest fifty. I've diagnosed Sony men and clinical practice now in their forties for whom find his disease early. A lot of use less aggressive -- therapy I did that really makes a difference. So the bottom line guys I don't think it's wise to abandon PSA testing that's my opinion. I think that you needed as part of your normal. Surveillance part of a physical examination of the yearly basis if you've got a ten year lifespan in front you at least. PSA testing makes cents. If the PSA is extremely low then you may postpone to every two or three years. Well once we get through the issue of PSA screening what. Do we do have the PSA is elevated. Let me tell you the standard approach. The standard approach. Is to do an ultrasound guided prostate biopsy so what does that. An ultrasound guided prostate biopsy is a procedure where the -- places and Oprah Show probe into the correct the canal. And takes Oprah Show pictures of the prostate. And then basically biopsies the prostate in a random manner. Another words the boxes are particularly in any one thing a particular except that we trying. Put the needle into the prostate. Five to six times on the right side of the prostate and five to six times on the left side of the prostate. So that is what's called a systematic. Or random biopsy. That's been the mainstay of how prostate cancer has been diagnosed. For the past thirty years. Well that's got some problems because obviously. If there's a small tumor in the prostate. And the needle goes right along side with -- cancer actually is. The biopsy may read negative. When in fact there is a cancer present. Or how about the situation where there's a significant cancer present but the by casino goes right along the extreme edge of the cancer. Because remember this biopsies done blindly. And that biopsy result. Underestimates. The amount of cancer that's present in the prostate and lulls us into a very false sense of security. So I think they're smarter way to do this and if you listen to the show over the past year you've heard we talked about this. Today's technology is out there today to do what I call a Smart biopsy. In non blind by C -- targeted by Pepsi. So MRI as the key to this whole thing. There been a number of publications -- on the United States in the past two to three years most notably from the National Cancer Institute in Bethesda Maryland. It was a major study published. That looked at me and who have had. A previously. Negative prostate biopsy and others they have the standard biopsy done the -- read negative. But they're PSA blood test was still abnormal. In that group of men. If they had an MRI. And one could see an abnormality. They were very likely to have a prostate cancer in fact of an entire 200 achievement in this -- series. 39% of these men were found to have prostate cancer now the MRI was abnormal. In showed an area that was highly suspicious. As many as eighty or those 80% of those men had prostate cancer. When the biopsy can be targeted to the abnormal area on the MRI. To his new technology out there today. There's new technology it allows me to take an MRI picture. On a CD. Loaded onto a computer. Create a virtual model or virtual image of the prostate on a computer screen with a abnormal regions drawn right in there. We go back to the 0% owned. We do an ultrasound of the prostate. In now this computer technology. Is able to superimpose. The MRI images directly on top of the ultrasound images. This is called a -- registered are infused. Image. And now we can simply puts a bull's eyes on the abnormal areas. And the that technology we use allows us to direct a needle biopsy directly into the abnormal area. This is no longer a blind biopsy this is an MRI guided targeted by -- Now we often sample multiple areas within the prostate is -- to get a read of what the prostitution looks like. But this technology that I'm talking about. The trade name for the technology is called anonymous. Eight RT EM I guess eight RT EMI yes of Google that Google armaments. And there's a very nice video. That's put out by the that the Israel deaconess medical center at Milton Milton hospital. It shows the use of the armaments and shows how the procedures done. So in the Boston prostate center that we use are CIT prostate center. Headquartered now in Framingham Massachusetts. That's regardless lives. MRIs -- done its facilities around the United States are in fact right here Boston several excellent MRI facilities. Memorize then is brought to me we can read the MRI. And then it's a very nice way to work essentially -- used that to target debt target the biopsy. So while. Bottom line is is that that you know this is the state of the -- today. This is the most accurate way to diagnose prostate cancer. And in fact -- the most accurate way to really. Characterize. Exactly how much cancer in the prostate. And where exactly the cancer live news. So today it's no longer a question of do you have prostate cancer or not. The question is then where exactly does it live in the prostate and how large is. So once we've establish the diagnosis. -- several other sophisticated test that we mania news and -- talked about this before there's a -- comic test. That allows us. To actually look at the genetic programming of the prostate cancer cells. If she whether they're really program for slow growth are fast growth his sometimes that test is very very helpful. Help understand whether that cancer is one that really pose a risk to our patients or whether this cancer something that safely. Can be watched. So. What I'm trying to tell you today is that the diagnosis of prostate cancer. Is no longer just a simple. Thing were we do a blind biopsy. -- can just present yes or no. What we really want and now is we want to know if they can't just present where exactly it is. We want to know how large it is. We want to know whether it's got a slow growing. A characteristic or a fast growing characteristic. And other words is this cancer gonna behave like a lamb. Or is gonna behave like a tiger. That's an important distinction. Then finally the tools that we have. Beyond -- armaments we have economic assays are special testing be done to look at the genetic programming. Finally. What are we understand that. Then we can sit down and have a rational discussion. With a man about. Okay here's who we understand about -- disease. Here's its risk assessment is that low risk many medium risk medium risk scores and high risk. And we can think about designing a personalized. Treatment pathway. You see prostate cancer is not in fact it should not be. One size fits all should not be one size fits all this personalized care pathway. And it's based on getting a proper diagnostic information the most advanced information available in -- creating a plan. That take care of that cancer that takes into account. All the characteristics about the cancer -- and very importantly. What a man's wishes are because you know one of the things will get into and our next segment. There's no one way to treat prostate cancer in fact we have very few. Studies clinical studies that would ever compare one trip into another. So many times -- got to be given by patient preference but also I think with the consideration for. The type of cancer retreating and in fact the anatomical location. Where that cancer lives. If it wasn't that way -- be very simple process. Do you think the days are gone where. We look at prostate cancer is a yes no -- a black white. A question in other words it's not just to whether or not your prostate cancer or not it's a thorough understanding about. What type it is where it is how it's programmed in -- an intersection of we personal preferences own terms of what kind of -- effectively -- is important. For example -- a young man tells me the preservation of potency of erectile function is a very important factor I think a very different way about. How we might approaches problem then for an older man for whom that might not be a very important issue. Want to talk more about this we come back and take a break we're gonna talk about some of the specific treatments and a little more detail. This is doctor Stephen -- your host of men's health the -- of damage reckon this -- prostate Centre of Boston at. Greater Boston urology were on Wooster road in Framingham Massachusetts. You can call our office at 5083707703. That's 50 weight. 3707703. Just asked for Danielle. Already right back we'll talk more about. Treatments for prostate cancer so stay tuned. Welcome back this is doctor Steven C bureau of men's health knowing when the founder director. Of this CRP prostate Centre of Boston had Greater Boston urology. -- -- -- wrote in Framingham Massachusetts with satellite offices in both Norwood and Milton Massachusetts. Our numbers 50 white. 3707703. Com and spurred Danielle and she'll help you out. Go to our website to learn more about prostate disease and prostate cancer at. D. -- CIT DR SCI. ON TI dot com. So today we're talking about. The advanced diagnostic techniques we use for prostate cancer. We talked about the fact that it's not simply a yes or no or black or white decision about when a man has prostate cancer. We used advanced techniques such as MRI guided biopsy. It's called Armas biopsy are RD. In the party boxy allows that specifically in a biopsy based on where the MRI abnormality -- We think this is a much more accurate appreciation of exactly where the cancer is in how much cancers present in the prostate and what it's. Greater degree of aggressive mrs. But we've made the diagnosis. And assuming that there's you've got the -- of a patient significant long -- longevity your lifespan have you. And prostate cancer treatment is justified. That's the first decision we have to make. You see there's a very big trend to -- I'm a strong executives of something called active surveillance. So what does that mean. That does not mean that we ignore your prostate cancer. What that does mean is that if by doing these advanced techniques. We can determine that you got a very small volume. Slow growing type of prostate cancer. And usually advanced techniques such as MRI guided diagnostics. And -- comic valuation that is an analysis of the -- genetic and program and the prostate cells but of this everything adds up to a very slow growing low risk cancer. An active surveillance may will be a great strategy because. It's hard to have less side effects than if you do nothing so. Reality is is that if you got that kind of cancer. It doesn't mean we're gonna ignore we means that we're gonna watch it carefully we're gonna do markers that is blood tests. Every every three to six months. It one year after the first diagnosed are gonna repeat this whole process again. Where to go back with an MRI and use that to reach target the prostate Williams RD beginner for anonymous. We'll make sure that we -- study that prostate now we find that there's been no increase. In the -- the extent. Or the grade of the prostate cancer. And -- stand active surveillance. Now as the years go -- how we tend to space out those biopsy intervals. But you know there's been major studies that have shown that for low grade prostate cancer. We don't think there's any survival advantage to aggressive they're pretty. And therefore active surveillance makes an awful lot of cents. But now assuming this cancer is one that has characteristics. That would mandated treatment. What do we do. Well there's four main categories. Of prostate cancer treatment. We've talked about all of them on the -- over the past year. As most of you know. One of the most common treatment is surgery. So that's called radical across the tech to me. Now that means that the entire prostate -- will be taken on the body with an operation. Now the way that's been done for almost a hundred years is by making an incision in the abdomen. And this open procedure is called an open retro pubic crossed the tech to me. This was really pioneered at Johns Hopkins in the 1980s. And modernized at that time. And really became the standard of how we treated prostate cancer. For about twenty years. Until. The robotic technique was introduced by intuitive surgical. And you've heard that people have a robot take the prostate out. Who doesn't mean that the doctor's home in bed or playing golf or out fishing. In the robots just doing the job. What had really means is that. There's a series of mechanical arms that are attached to telescopes. In special tools. Inserted through little keyhole incisions in the body. Now the surgeon is sitting in the back in the operating room and a console. With his hands on the controls. Much like. The the Wii game you know the if you ever played their kids play the game with week. Where the put your hand and glove and the movement in the hand is translated by -- robotics that's exactly what happens here. So the surgeon's hand movements are translated to the instruments which have more ability to rotate. To turn more naturally smaller space than human hand. And surgeries done in that manner that's called -- robotic crossed the tech to me. Has been very controversial. It's very cool very high tech. It sounds really really really -- But it's really hard to show in any well published comparative clinical trials. That there's any real difference in terms of survival. War in fact side effects. It's safe to say that the incisions are smaller different reason I think they used their might will be a reason to think about robotic therapy robotic surgery. Now in men who have. Have had exposure to different drugs that thin the blood there seems to be a major advantage to robotics in terms of less blood loss. But. Once we leave the they debate of whether open -- robotic surgery is better that is that debate's gonna go on I think still for more years. Really she was a question -- side effects. From surgery. You know there's no way to remove the prostate gland on the body without at least some degree. Collateral damage. That's going to occur. The most common side effects than a man is gonna hand after surgical removal of the prostate. Relate to urinary control. And sexual function. So. Initially. Urinary control is not good days there's a significant money urinary leakage in the early days or weeks after the surgeries done. -- typically does improve. But as many as 10% of men are still left with some. Incomplete ability to control their -- That is they have to Wear some sort of protective pad especially if they're physically active working playing sports hitting the golf ball about what ever. The other issue courses sexual functioning. Initially virtually all man. Have no erections in the early days after surgery there is a recovery of erectile function is the is the first and second year go by. What it's safe to say is as many as half of all men who have surgically remove the prostate. Are still never -- achieved in normal natural usable correction. So that's really a lifestyle issue. Now if the cancer severe dangerous life threatening you might make the decision that that's a reasonable on trade off but. Here's the problem. But it can't just that we diagnosed and they are small slow growing and in fact may take fifteen to twenty years never cause a problem. If the price for a man is giving up his quality of life. Maybe that's not such a good deal and that's for the debate today years. So radiation is another approach that's been used -- -- all sorts of alphabet soup types irradiation machines. There's I -- RT IG RT. There's proton therapy cyber and -- there be seed implant therapy. They all involve placing radiation energy into the prostate. Most commonly by an external source such as a beam so whether it's a photon beam and that's called I AMR TR IG RT. Or whether it's actually proton therapy it's still radiation therapy. When the new repair region here about a cyber knife. Cyber -- his computer generated very precise. Cause they're attacked a three dimensional delivery of radiation therapy sounds pretty cool. Guess what guys are still radiation therapy. In the problem is that. There's no way to have no collateral damage because the radiation energy to get. Into the prostate from outside the body it's got to go through normal tissues and that affects the quality of the normal tissues for radiation changes. A major study was published in the New England Journal medicine in the past year. Look at men 51015. Years after surgery or radiation therapy in -- -- that as the years tick by. The urinary control issues and the sexual issues just got worse than you might expect that because guys are getting older but. The claim that radiation therapy preserves you wrecked house sexual function I don't think that's right. There's just no way to -- radiation into the pelvis and think that those small little fragile nerves that are supplied by small blood vessels. Are -- received some negative effects from the radiation there because that's what we seek clinically. That's who we -- -- so the point is radiation therapy work through this discussion is not about how to -- cure the cancer better. The early part of the show I told to the -- way to do this lots of choices no studies that show one treatments better than the other. So wanna come back in talk more about treatment options for prostate cancer in just a moment. State to this is doctor Stephens are here host of men's health the -- I'll be right back with more treatment options the disgust for prostate cancer. Welcome back this is doctor Steven C ninety a host of men's help the -- and and the founder and director of the CIP prostate Centre of Boston act. Greater Boston urology were located on 161. Of worst road route nine and Framingham Massachusetts with satellite offices. In Milton and Norway to our office numbers by -- 08. 3707703. You -- passport Danielle. Or go to our website at DR. CIA DMC IO NTI dot com. Learn more about prostate disease and prostate cancer. Today we're talking about prostate cancer in the last segment we talked about traditional therapies. For prostate cancer including surgery and radiation therapy and I told -- that it's not about which treatment is better. We in kill prostate cancer and lots of ways in that we have no study showing that one way is clearly superior but other methodologies. Wanna tell you about. A therapy that's been around for about twenty years. It's something that's called a violation therapy and specifically cry oh publication or freezing. We know from work done. Over really 304050. Years now from animal studies and from different -- systems we know that. Prostate. Tumor cells in -- tumor cells anywhere in the body are killed by extremely low temperatures. Prostate -- therapy is not new was introduced in 1963. Now in those days it was pretty primitive. But really somewhere around 1998. -- so. That is. Almost twenty years now the new generation crowd therapy quibble was introduced. In which. Ultrasound guided imagery was introduced software was used to help plan the treatment. And predict where -- temperatures are going to be. The needles that we place through the skin into the prostate became much smaller. In the the agent used to. Freeze the needles used to be liquid nitrogen. Very different difficult to control the -- nitrogen today is argon gas which allows for a very precise very controlled and very accurate freeze. So prostate -- therapy is a minimally invasive. Outpatient. One day treatment for prostate cancer. I've often thought that why would a guy go through radiation therapy. And radiation machine every day for two months. When. In the course of about four hours. We'd go to the hospital or surgery center and an outpatient basis. It's about an hour and ten minutes into the prostate -- therapy procedure. There's no major incisions. There's some puncture sites through the skin in the parent AM where the -- go. This can happen in the penis for a few days. But that guy. Three to four hours after the procedures on his way back home. In the next -- out walking around and doing most activities. Technology is a great solution here because prostate -- therapies now been shown through well done studies or 400 published clinical trial studies now. But it'd outcomes looking at how men do. In if we asked the question. Can we show that men live one day. Longer. Or shorter with growth therapy compared any other procedure we can't show that. We can't show that at all in fact the major study published about two years. In a journal called an apology. Look at a pro Specter of randomized comparative trial. That is the most accurate way to do a scientific trial in which a 125 men were chosen at random. They have radiation. And a 125 men randomly selected to have prostate -- therapy. These men had fairly aggressive prostate cancers. They are follow for over eight years. And you couldn't -- Men lived any longer or shorter time depending on which treatment they had another words. They -- an equal amount of time that they had surgery Gretchen if they had the crowd therapy an equal -- they had radiation. We could actually give it to the PSA control -- What we did show that study this is published by doctor Brian Donnelly out of Canada. What that the -- showed. Was that the man who had radiation. Had a three times. Higher rate but -- a positive. Via C three years after the prostate procedure was done. So another words you are more likely to have residual cancer on biopsy three years after radiation that you were. They have residual cancer after -- therapy. There hasn't translated into a survival difference. But it comes down to issues of convenience. And I think it was gonna side effects. We use radiation therapy very often there is a burned to the Blatter into the rectum. Urinary symptoms generally get worse there could be an increase in the frequency of -- movements and occasionally their bleeding problems can occur. Even years down the road. From the bladder or from the rectum. We don't see any of that with -- therapy. Now crowd therapy if we treat the entire prostate just like every other procedure has a very negative effect. On the ability to have an erection. But oftentimes we can control the freezing around the nerve bundles. In minimizing erectile dysfunction that's one of the advanced techniques we utilizing our center. What are the biggest advantage however. Is that the risk of urinary leakage. The risk of urinary incontinence. Is extremely low. It's in the order of about 2% risk. For men that have prostate -- therapy. So sorry this is say. An alternative for man as an alternative to surgery. An alternative radiation therapy it's a minimally invasive procedure. That's done on an outpatient basis. In which there's no major incisions. No blood loss a very low low risk of urinary leakage problems. But like other procedures does have significant correct tile dysfunction. That's one of the main procedures we offer and our center. I do most of my procedures today at the Beth Israel Deaconess Medical Center Milton campus that is Milton hospital is where the -- center is located is part of -- our crowd therapy treatment program and encourage guys out there you know when you get the diagnosis of prostate cancer. You know you have time. You make a logical decision. You don't feel. You don't need to feel like there's a you know the sword of damocles is hanging over your head. You have time to make a decision. You have time to decide which treatment is gonna -- you -- -- lifestyle. And very importantly. That you cancer. So if you've been diagnosed. And if your doctor says oh the only thing we can do is surgery or radiation. Say you know aren't there other ways to trade. He says don't know I don't know anything about that. Well maybe he's not giving all the information. It's always worth while to get a second opinion this doctor -- -- -- your host of men's health the when when. The director and founder of the CIT prostate Centre of Boston located at Greater Boston urology. Or I'm 161. Wished irrelevant to route nine in Framingham Massachusetts where it's not like novices in no way to end in Milton. You can call our offices at 508. 37077035083707703. In desperate Daniel would you be happy to help you. Go to my website net. DR Xeon DD RSC IO NTI dot com. I'll be right back. Back we're gonna talk about. The latest revolution of prostate cancer therapy high intensity focused ultrasound I'll be right back. Welcome back. This is doctor Stephen C don't be your host of men's -- the England and the founder and director of the CO OP prostate Centre of Boston had. Greater Boston urology were located on 161. -- -- that route nine in Framingham Massachusetts -- numbers 508. 3707703. Club there and asked for Daniel QB happening LP. They were talking about prostate cancer prostate cancer treatments that reviewed the diagnosis of the disease we've talked about. Proper understanding of how much can't just present. Whether it's aggressive or not. We've talked about traditional therapies like surgery radiation. No accident that we really talked about. Prostate -- therapy that's called completion therapy and is -- in the prostate inside the body. But really the the revolution in front of us is -- we call high intensity focused ultrasound. Abbreviated HI EF view or -- So what is that that's focused ultrasound energy. This placed into the prostate. To kill the prostate tissue in the prostate cancer. This is noninvasive. There's no cutting there's no puncture the body. There's an ultrasound probe an ultrasound transducer. That's in the -- the canal. No man is typically asleep while we do this this sound energy comes off the transducer. It goes through a little water balloon it's in the rectum and travels up into the prostate. We're just as the light rays going through a magnifying glass will be published to a pinpoint. This sound waves are focused. And at their -- zone with a sound waves come together it produces a very high. Density of energy. Which is converted into heat which basically -- the tissue in kills the prostate tissue in that area. Now using very advanced computer technology. We can outlined the entire prost in three dimensions. And we can directly machine to deliver energy across the entire part of the prostate or in fact we can treat as much. Or as little of the prostate gland as is necessary to treat. Now the advantage to this is that it's so precise the focus of the energy is so tight -- so precise. There's really tremendous mineralization of collateral damage. So it's possible to treat the -- but not the areas outside the prostate. How well does it work. Well high intensity focused ultrasound is relatively new it's been done in Europe since 1995. But still not approve the United States by the US FDA despite the fact that she used in every develop. Country in the world except in the United States. The product is under FDA clinical investigation right now these two manufacturers. One manufacturer called sonic care medical has a device called the sign a -- Another manufacturer called. Both devices are currently undergoing evaluation in clinical trial by the US FDA. And in fact. I believe we will see approval of these devices over the next year herself. Why this revolutionary. This is revolutionary because we now have a way to treat prostate cancer in Chile and non invasive fashion. And what do we mean by that well there's no cutting there's no blood loss but really when it comes down -- side effects that's the story. The chance of urinary incontinence is 1% the last in over 90% of men and maintain the ability. You have an erection that maintains sexual function that's a revolutionary. There's nothing else we do. To treat prostate cancer it's anywhere near that. This is a game changer guys. We've had guys on the showed that patients on the show but talked about their experiences. As you know is one of my areas of expertise. -- -- performance procedure outside the United States now in countries where licensed such as Bermuda. And Nassau Bahamas. In which guys around the United States who want to have this procedure. We -- we work with a company called sonic care medical based in Charlotte, North Carolina. They have a complete support staff nursing staff engineering staff logistical staff travel staff we whatever treatment down in Bahamas or Bermuda. If this is the right procedure to do we simply connected to our nursing team in Charlotte. And we instead of having to go you know drive fifteen or twenty minutes the surgery sooner we get -- the loading get an airplane and we get down to. Got to premiere internationally get this taken care. This is this the game changer guys. Because the -- had a procedure don't you heard similar Michelle. If you haven't heard go back to the some of the podcasts. -- wrko.com. Slash men's health. But -- so listen to some of our previous shows. And listen to what the guys are saying. Because. When facial decision how to treat prostate cancer it's. No longer necessary. To make that deal with the devil and that you're gonna get rid of your trade off your quality of life. Kill the cancer maintain your quality of life that's the future and I think that's -- -- is capable that's we can accomplish. That's one of the main -- there is who offered to right center but it really requires proper diagnostics. Proper selection guys' -- as a candidate but if you've got the right characteristics. You've got a fairly small contained. To win it needs treatment your proceeds of the right size. Is a fantastic way to treat this disease maintain quality of life. Read about this on our website. That a DR CIT DR CI knowing TI dot com now. I had a fascinating gentleman on the show. About a month and month and a half ago. But the Todd -- Todd as always psychologist who tracks that Newton. And he had me as a special guest on his TV show in December. And that that should always now available on their website of their TV station. If you go to new TV dot org that's NE WTV. Dot org. In Newton Massachusetts. And look at -- -- it's called on the sunny side of the street on the sunny side of the street. You'll see right on that show the -- the recording the show we recorded it which he talks about his experiences. Having a -- for procedure. Done down in Nassau Bahamas so again guys get more formation of this going to go to our website at DR COT dot com. Go to new TV NE WTV dot org. Look at doctor -- grosses. Show in learn about how we made that decision to proceed in this direction. What today we. Covered a lot of ground today and we've talked about advanced diagnostics. We talked about MRI diagnostics targeted by -- The of the what I want you to remember is that all prostate cancers are the same. A cookie cutter approach does not work don't accept that guys don't accept the cookie cutter approach. You're an individual you can't just individual. Every guy comes with a different topic cancer different anatomy. Different concerns. Different concerns about side effects. You need a personalized approach. Nancy approach we take. The whole range of options to be discussed. Maybe you do truly need surgery and then you want the best guy can do robotic procedure these confined. But if you can avoid the perils of a bit invasive therapy. Crown affair behind -- I think in the future. So. But our website DR CIT dot com car offers a Greater Boston urology 5083707703. Will be right back that close out the show so stay tuned. Well we're just about out of time today this is doctor Steven C out -- host them. Men's health the -- and and the founder and director of the CLP prostate Centre of Boston had greater. Boston urology. Or at 161 at Wooster road that's route nine in Framingham Massachusetts would satellite offices in Norwood. And in Milton Massachusetts. Our numbers 50 weight. 3707703. Call and -- for Danielle to be happening -- memory can always go to our website at DR CIT DR. SC IO in TI. Dot com so today we really reviewed the problem of prostate cancer we talked about the need. For PSA screening -- got a ten year life expectancy. We talked about advanced diagnostic techniques using MRI guided diagnostics and all right targeted Smart biopsy instead of just random blind biopsy. Most importantly. We talked about as a personalized pathway to care a personalized approach that is understanding you. Understanding your -- understanding the cancer weary days how big it is it is slow growing is it fast growing. We really need to treat the entire prostate we treat heart of the prostate. How important is it to you to maintain erect malfunction. What you call which your lifestyle you physically active. These things are all important terms of coming to attribute recommendation. And finally there's a whole range of treatment options ranging from judicial approaches like surgery like radiation. But minimally invasive revolutionary approaches such as crown affair -- and the future. High intensity. Focused ultrasound. Or -- So guys not -- you have the discussion. You know and when his deal with this sort of my website DR CIT DR FC IO NTI dot com. Thanks for listening we'll talk -- again next week.