Apr 14, 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!
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Welcome -- who's helped the way when I'm your host doctor Steven C nine. I'm joining us every week and at this time for the most advanced and all that -- discussion of topics most important immense help. Join us every week as we discussed topics like prostate cancer and prostate disease. Sexual health. Lifestyle and diet. Weight management. Heart health and hormone -- health. Every week will interview national experts in men's health. Empower you with up to date scientific progress of information that you can use to improve your overall health. Achieve weight loss lower your risk for heart disease. Maximize your sexual performance and deal with prostate problems. Now -- today show my special guest will be mr. John Ebert. He is the director of marketing and communications for -- care. Which is a company that specializes. In cry -- there be equipment and as you know you've listened to the show. That's one of the minimally invasive technologies allows the treat prostate cancer and an outpatient basis. With minimal side effects so -- interest in the top -- John. In here about the history crowd there -- in how it's being used in the United States and Mr. Big news -- off their today because. I'm pronouncing now officially for the first time that the Sierra. It's mowing this Sarasota Florida. So folks who have a website presence CI a deep prostate -- dot com. Or DR CRT dot com can find me that way. But the prostate center in which we specialize in advanced diagnostics in minimally invasive treatments is relocating. Opening on June 1 in Sarasota Florida so follow us on the web. And I'll see patients from all over the world and Pope sees a need for -- -- Tennessee is down in Sarasota. Says they killed. Will be right back with mr. Johnny which are gonna talk about prostate crown -- -- today we right back. Welcome back this is doctor Stephen C -- and the founder and director of the CI AP prostate senator formally of Boston and so to be up Sarasota. Florida. Now today and men's health the -- and I've got a special guest today mr. John Ebert it's John is the -- director of -- marketing and communications. For Indo care so John welcome to men's health knowing -- John what did you tell our our our listening audience a little bit out what you do it and don't care. Well right now I'm involved. As the title implies marketing communications so with regard to our cries of they're being. This system that day is used primarily for prostate cancer but mostly used for other forms of cancer well. Right okay. And so -- -- area you know and goes back for a lot of years but I also a bit about the history of and don't care what they how the company started and really what it does. -- into a pair started way back in 1996. And actually. Was the first company to get involved with what we consider they -- current generation. Price of their equipment. Prior to that it was so using liquid nitrogen which was. Little bit hard to control in terms of the freezing properties and so we -- is we moved to a new gaps are gone. And it allowed us to you actually control the reasoning much better. But still get us the advantages. -- that is killing cancer cells. Right now so I've lived through some of that I've been familiar with the technology now from the late ninety's and on and I've watched. The growth of this technology. And so. If you know a lot of folks don't know much about. -- crown therapeutic uses specifically in treating prostate cancer do you find that. Yes we do it's a somewhat unfortunate but a lot of just various. Activities that happened in the pastor serious deviations one of the ones I mentioned list. The fact that liquid nitrogen was hard to control so. Many of the positions that it heard about use of liquid nitrogen which is obviously still use for dermatology. But when it's used inside the body it's a little bit to market control and so. Doctors they heard about that may be concerned about side effects and they may not be completely. Understanding of the latest technology. And as a result it it has been challenged and -- get the word out. Well I think you're right. You know in in the in the 1990s. The -- characterized by liquid nitrogen. You know. Isn't any new technology I think we're still learning really how to use it and this goes back now you know twenty years. And you know I think some of the side effect profiles we saw. Really were really different than what we seats today. You know -- -- current affair being in my practice now for about fourteen years. And you know can honestly say that micro therapy patients some of the happy is guys that that I take care of today. Because they you know they were able to be treated with a minimally invasive outpatient procedure. Being caught -- leakage rates of an incredibly low. We'll talk more about you know how we select patients but SE is a physician who use the technology. And an incredibly incredibly. Impressed with just how well our patients do. In sometimes I think is difficult to get that word out and saw -- -- I know that that's something that you try and focus on John. Yes definitely and where were working to get the word out -- patients we actually just released. You video recently earlier this year. That attack has other testimonials from patients are released some information for patients in terms of what they experiences. As well as other positions. And you say that the ones that are using at the patients that have added testing to be very satisfied. Well not I think that's exactly right to so don't -- or is that wears a nuclear based these days. You know care currently is based in Austin, Texas it was actually bounded out in Southern California. Move to Austin, Texas. Just about to five years ago. And we view all our manufacturing here in Austin. And and we also hamper our corporate offices here in the appears actually part of health products incorporated. Which is a company that provides other urology services -- Right and so. There's access to use this technology. In virtually every state in the United States so I think isn't there. Yes there is not a good point electronics actually their primary business is to. Move equipment around to various hospitals on just a case by case basis. So in the case of cry at their -- they can actually take the in the air equipment into a hospital just for one case. And they can do that throughout that country and then there's -- Investment required from a hospital. Off course and his days these days in which you know costs are really a factor. You know many hospitals don't have the resource the buy expensive technology. So for example a coming up by this week. I think a Monday this coming week. I've got to two prostate. Ground surgery procedures and I'm doing over at the Beth Israel deaconess medical center Milton campus and Milton. And I know that one of our health products. Affiliates is is bringing in the equipment and technical team in their helmet with that procedure. Right and if we it will bring in a technician as well like you say to run the equipment. So it really becomes very easy process worthy -- positions as well as the hospital. Right right now it says very much it very much is very very convenient. And I think what that does that allows our patients to get access to it you know state of the art. I technology. It is well is -- you know technical support we need to make sure everything goes actually fine. Right and we're we're anxious to help in any way we. So that's that's been a great relationship over the years but -- let's talk a little bit of about -- you know. What time the medical side a little bit in a minute but but do you think you know prostate crown affair befits. You know there's certain patients that we think about that. Really are. Toward the ideal candidate so from the from indicators. Stamper you think that that the war -- you think it benefits the most what kind of patients who think that. Most of drastic -- therapy. Right the typically we consider you know non surgical patients. Those that can't have a radical props detective makes it's that relate. Still the gold standard. But for those patients that may be older. You know not able to tolerate that major search. If you mention right of surgery is is minimally invasive. And so it's. It's an alternative for those patients and it's also an important for patience that one too. Be able to just go in for an outpatient procedure and it. And leave that day and then be able to get back to their normal lifestyles. The other alternative for nonsurgical patience is radiation. Or external beam radiation country discussed this a long process in terms of several weeks you know one each day. Going into the radiation center so it takes a lot of time. Out of the patients' lives. And with -- of surgery it's just outpatient procedure that can be done quickly and get the patient back on the way. Want to know -- I would agree you know it's interesting numb the prime candidates obvious -- older men. Whom we really don't wanna put through and invasive. The procedures such as prostate removal surgery -- robotic. Bottom across attacked -- radical prost technique. But I'll be honest with -- a lot of my younger men who are who are fish who certainly could undergo the rigors of of a standard surgery choose not to. Because and they are attracted to the minimally invasive. Nature. And the rapid recovery of socialist crowd therapy so I don't think there's any. How is any patient that are clear patience clearly that. We can't treat. But I think the sweet spot certainly as you said the idea guys are a little older guys. And of course. If a man's head radiation therapy. And the cancer has returned. -- therapy is one of the few options that they truly have. For an in an attempt there really cure the disease. If that's a good point out there's -- Those patients that have recurrent disease after radiation as long as that disease is still localized to the prostate. Are also up prime candidates -- -- out there being. There's been some interest in publications talking about. Radical prospect me after radiation and apparently it's not a very easy procedure to you carry out reap most experienced -- And so in the case of -- of therapy again it's minimally invasive and make -- actually get to the prostate and this freeze any remaining cancer. Well on that that that's exactly right. He in fact you know this debate is going on me and in amongst urologist for many years. But even in the most experienced centers across the United States. Very few urologists are keen on the idea a really excited about the idea of taking -- prostate out after radiation therapies being used. It's not that he can't be done. But the side effect profiles are incredibly high especially. And in some published series. Is many is half of the man. Who have what's called -- salvage prost attacked me that is removal of the prostate surgically after radiation has been used. As many as half of those men will have urinary leakage problems. That requires some sort of you know protective padding in a -- under shorts. In my experience with -- therapy. Is that. -- their risk of that urinary incontinence is far far less. And in fact I believe in our -- serious and crowd therapy it's under 10% risk. And that is certainly Ben my experience is that to much safer procedure. Then than the removal procedure. -- important part of that I think is the fact that the procedure the -- of therapy procedure involves me you know warming cap that are for the so it actually protects that your read through -- -- with the -- -- detectives are obviously cutting the -- road and sewing it back together so. That theory is that that's part of what needs to be continents where with crap they're -- as were protecting that you -- for a it you know. Beats to bet -- street. Well I think that's very definitely part of it does the other part is there's just no way for a stream for prostate surgically. In not in do you fear what sort of nerve supply to what's called the pelvic floor muscles. The pelvic floor muscles are the muscles that that a -- can squeeze off and cut off the urinary stream. And so those public -- muscles. Will be really affected to some degree in virtually every man that we do we salvaged prost attacked me on. In certainly we don't interfere with those nerves to that degree with the prostate craft therapy. And he said the warming -- protects the restructure. But it also protects that muscular that what's called the pelvic floor or external -- there muscle. So there's a lot of technical reasons why I think we see that. But there's no question in my mind. As a surgeon. And Doctor Who specializes. Only in prostate cancer. That of a man has recurrence. After radiation therapy. In the cancer still confined to the prostate. Colonel therapy really I think is the best option and for an attempt to give that man now I cure his disease. Yeah and I would agree I mean -- speaking as a man who you know has the potential for prostate cancer. If if it was something that came back victory I think that right up there being with these. My therapy of choice. The other option of course is hormones that you probably discussed beat port those don't really treat the cancer they just that treat the symptoms. While that that's really -- I mean if we're talking about trying to eliminate the cancer. As long as it's confined the prostate. Ice you know -- temperatures -- colder than minus forty degrees centigrade. The cancers not gonna survive that. And that's where we can do it very precise control manner so I think the real message in order we're gonna talk a lot about some of the other applications we when we come back here a minute. But here's the message I wanna leave before break only with our audience with our guys out there. Men if you had radiation there be in your PSA is starting to rise. And particularly ones that PSE gets over around to the value to. Please you need to be further evaluated because if you've got. Prostate cancer in the prostate gland that survived the radiation therapy. It survived the radiation therapy. Your candidate is still be cured of your disease. In the key is to -- that early. So your PSA is starting to rise after radiation therapy. You need to consider the route to has experience with this type of evaluation you'll need a prostate biopsy. I generally use and memorized part of this a valuation but if we can determine that cancers -- murder come back or survive. The prostate. After radiation and it's nowhere else. And directing energy particularly freezing her -- energy to their prostate. Have a chance again to cure this cancer. And if we simply on hormone -- we were simply suppressing the cancer but. That -- Generally come back another day another with the cancer will will outsmart the hormone therapy. The double the call hormone resistance. And that will be a problem down the road so guys here's the message before break. If you're PSA is rising. After radiation therapy. You need further evaluation. To see whether that cancer. Has -- in the prost and if it has you're going to be a candidate for prostate crap every. So John Morton a break here will be right back here is that men and hopefully when this doctor Stephen CIA year post of men's health -- And director and founder of this beyond the prostate center. So and to be of Sarasota Florida will be right back we'll talk more about prostate cry -- therapy. Welcome back this is doctor Steven CR appear host men's health Millen and inept founder and director of the CI a deep prostate Centre of Boston. And soon to be. Sarasota Florida. As you know almost specialist in prostate cancer diagnostics and the advanced. Minimally invasive treatment for prostate cancer. What are my prime. Treatments that I utilize -- prostate crowd there be some very honored today to have mr. John. Who's the director of marketing and communications for -- appears my guest here on men's helpfully when. And John has been involved with growth Lieberman many years now as he told in the first segment. We talk about the use of crowd there refer. Salvage and that is radiation failure but John that's really the line share patients that we treat today. Our men who have never been treated before then it's primary patient's right. So let's talk a little bit about that primary patient -- why would you describe you know some of the features of the technology. That help -- to did to treat a primary patient with prostate cancer using current therapy. Sure. As we talked about before it's an outpatient procedure and involves. Piece of equipment. It's maybe the size of a small refrigerator. But we bring that into the operating room and then there are. Large needles that are used to introduced. The gas into the system although. -- never goes into the body it just circulates through these needles. And at the needles are placed in the prostate and the gases circulated through -- to reset. As part of the process. We have some planning software that's included in our equipment. That allows. The position to be utilized all percent to I'd get up by the prostate. -- your read for and the external thing after you mention and anything that they don't want a freeze. And then be software. Helps them in terms of placement of the yeah -- needles. To make sure that they freeze the prostate and and not the areas that they don't want trees. What you on the software -- has been a great advance because that allows us to really. Create and the way I think about the screen -- model. On the computer system of a man's prostate based on some you know very specific. Ultrasound image we take in you know outlining the prostate outline in the urinary channel. You know I'm in what I down you know how about that doppler function you know in this generally you know -- -- helpful to me. And it's a feature many ultrasound machines isn't it. Yes it is and what many people what many positions find it useful fours and it might -- -- buying Ares. High blood flow. Doppler. Ultrasound is is used to use utilizes the doppler effect that we heard about with the -- squared. It's you know that that sound of the frequency of the sound of the train changes as it goes by that same thing happens when blood flows and ultrasound. And so positions and can see that let's slow it. In determining areas that they they really want to you treat in areas that they want to protect. And I funny yeah and I find it particularly helpful when I do this procedure to identify what are called the neuro vascular bundles. And those are the that's a structure that's very close to the prostate. But the function of those nerve bundles is to provide the nerve signal. For. You know for erection for sexual performance. And there are some situations where you know I'm able to. You limit the extent of the freeze near those near bundles. And in many cases. Have an ability to preserve erectile function for a man so very helpful feature. Yes it's it's something that again this is part of the advancement come along over the years. That doppler. Ultrasound and the ability to -- -- of prostate everything around it without being inside the body. No I I agree and so you know the abuse -- this technology to create on the computer screen a model the prostate is designed precisely designed. How we wanna build back treatment how we want to design that treatment. Allows me to really. We call -- in in in inner America and the guys who do this we call this. Sort of molding their sculpting the ice ball. Right and because we have a lot of control over the world we apply the freezing energy. Right in quantity advanced missed just in the last five years is we have developed the goal that. Allows that nice size to be buried by the position right at the time of treatment. So they can I use the software to determine exactly how big the base needs to be. And been just dial it in on are very able probe which we call it. To make sure that they they get the ice coverage that they want. Well no that's been extremely helpful because you know prostate come in all sizes and shapes. And in a situation where we've got a smaller and shorter prostate. And we wanna confine the energy to -- unity just -- that prostate and not to the surrounding structures that's an incredibly helpful feature. That allows me to sculpt the the amount of ice and what are release of -- then. Is creating very cold temperatures -- the tissue that we want to kill. In minimizing any collateral damage to the surrounding -- and that's where. I'm proud of him you know we're able to do a beautiful job of -- balance. Between treatment and side effects. Yeah and it's interesting to look at some of the biological data end. When we use -- the kind of the outer edge of the ice it is. Is not legally does do damage to -- structures are you gonna go right up into. That stand inside a little ways. Price that's being formed this where they're really cold temperatures exist. And those get down to minus forty degrees Celsius. And it has been found that temperature. Kills the prostate cancer cells. Well you know you're exactly right I think most of the folks -- live you know they probably don't see this down in Texas but we we should disappear in New England. The you know in terms of our weather so think about this from it. You know if the edge of the ice ball which comes near the -- the rectum for example or comes near the the nerve bundles you know. Win the edge of the ice ball right at the freezing point so it's 32 degrees Fahrenheit. Or zero degrees centigrade right. So it's possible to remember as a little kid win in at least have a milkman that would come to our house we -- grown up. You know as little kids we run around in the morning get the milk out of the mailbox even in the winner. And of course the milk boxes on your you know he's in your back porch somewhere. And yet we we've run out there are bare feet with -- -- -- -- And you stuck in the snow for a minute and -- cold. But that that it eat your feet didn't guy -- your feet didn't turn black and fall off so a brief period of contact with. With the edge of an ice ball that's 32 degrees Fahrenheit or -- degree centigrade. Isn't lethal and that and that we learned that as kids you can hope. And so that we apply that today because you're right at the edges of the baseball. -- for brief periods of time although it's cold it's not going to kill tissue. It's the center. Of the ice will we achieve those very cold temperatures. Right to also love that we temperature monitoring. Well that's another good point is that we actually been in this part of our system. Include temperature probes. And those probes can be inserted. Into the you're the prostate or in the prostate. In the case of inserting the temperature probes into the prostate and insurers that the temperatures getting all the there. Where you wanna kill the cancer cells. And then the temperature probes can also be used year the prostate particularly between the prostate and the rectum to make sure that day it's not getting too old. -- old enough to caused damage. Well I think that's right so these are mini thermometers for guys that think of these as miniature them commoners and they're a connected to computer screen. And we can use those to verify that where they can answer is is getting cold enough to kill cancer. And then it kind virtually. -- we wanna keep the tissues say before we don't want we wanna preserve the collateral to issues the surrounding tissues that can make sure those areas are not getting to call. So it's a very elegant. Very precise technology. That's been that's been developed and it's it's about almost certainly available on our listening market and certainly available around the United States. Correct and we'll talk later or about you know how they patience might find those positions that offer -- of surgery. That it is something that says available throughout the state. Okay it's a -- if we're gonna come against a break here. But I think that the message for our guys out there is you know we do have a very high tech system a way of developing. You know and about developing -- system and delivering neck cancer treatment through some very small needles placed through the skin in the prostate. Using high tech ultrasound guidance temperature monitoring computerized planning. In the end that -- -- important our patience is that we can kill cancer minimize side effects without any major incision using quick recovery so that's kind of the that's a summary. But we're gonna talk more about this in just a minute this is doctor Steven -- out here host of mens health New England. And the director of the CI a -- prostate Centre of Boston and soon to be -- Sarasota Florida. Go to DR CIT DR SCI ON TI dot com got the senator -- for more information will be right back with the John Hebert so stay tuned. Welcome back this is doctor Stephen C appear out of men's health the wind would. I'm the founder and director of this young -- prostate Centre of Boston. And as I told you we are relocating. This program CN deep prostate center is moving in Sarasota Florida an opening in the locale. On June 1 so some exciting news that's gonna allow us to deliver to our patients. Personalized pathways for prostate cancer care. Personal attention. Advanced diagnostics and what we've been talking about on the show. So now we're gonna have a center that focuses and you the patient advanced diagnostics personalized care. And state of the art technology and of course some of that technology we're gonna have available is prostate -- therapy. So we've been talked with their own mr. John Ebert and John as the director of marketing communications for in no care. One of the major manufacturers. Of -- therapy equipment in the United States today so John welcome back. So we've had great discussions so far today about you know what crown -- B is. We've talked about some of the technology advancements in how it's not our grandfathers -- therapy right. In Iraq really different technology today. In that we talked about it you know. How we -- select patients in some ways man who never been diagnosed before. Oh men who have had radiation failure. But let's talk about -- patients learn about this because I'll be honest with you have been doing this now for a lot of years. In still it's refreshing to music prostate cancer specialist. That a lot of my colleagues. When there in talking to a patient whose newly diagnosed. Talk about two options only. They talk about surgery to remove the prostate you'll talk about radiation therapy but the conversation generally very quickly ends. It and I think that there's more to the story this does that you know in so as they say no here's the rest of the story. So tell us the rest of the story -- how to patients learn about these other options practically crowd therapy. Well there's several resources. One of that advancement again in the last five years where is that the Americans neurological association. Actually developed a best practice statement work right surgery or positions. And it really does address those issues that changes that it happened over the last decade and a half the terms of improvements to -- multi. And so the American neurological association does have some information on right up there -- Four patients as well in terms of can be used and in some of those issues of patience election. And things like. There's also some information there was an article published in the cancer journal and 2002 and that actually hired the the results. Cry you probably action here to use radiation there. And found that the results were -- quite a bit in terms of quite comparable. Between the -- so the actual. You know efficacy of these that there is there's now been demonstrated in in a randomized study. And we have some information on our web site as well that's designed four patients. The easiest way to get to it is just www. Stop cancer -- dot com. And there's information there actually for prostate as well as kidney and in other things that. Frozen in terms of that cancer. But they prostate. Cancer web site to -- -- -- -- -- as a lot of information in terms just out of procedure works some testimonials from patience. As well as a the videos that shows patients and physicians talking about right up there be of their experience. With the receipt. So that is stop. Prostate. Cancer called the stop cancer -- what's that would stop stop cancer. Stop cancer called so guys. Www. Stop cancer hold dot com. Stop cancer cold dot com that's a great resource now. If someone was on that website can they learn about physicians who've been trained in the crowd therapy procedure. I guess they can in fact again if they click on prostate and when they get to stop cancer cold dot com. On the prostate site there is a positions finder so they can just put in there's a code and that will show the experience by insurgents in that area. They'll have their contact information on the map to show where they are so it it really helps in terms of the access to the position. OK so great yeah I think part of this is empowering patients with the information. Exactly and you know prostate cancer is I know you discussed in the past news is one of those cancers where the patient is very involved. In the decision for how they're going to be treated because there's so many different options. And so the more the patient knows and the better quipped they art it's gonna talk with their position. And we hope that you know they'll include crypt -- being part of that discussion. Well I think that's important so you know the there's nothing more important. For a patient to do. What are diagnosed there and to get more information. Right and so. I think the days are gone win. The doctor does a biopsy says OKMR Jones you've got prostate cancer in your option is surgery. Let's do that next week. So. Surgery may well be the -- the proper you know the proper in the best treatment for patient but I think it's not a simple as that and more job. It's it's a much more complex decision tree. And in many cases in output file in this category. We've got studies showing equivalents of survival. Another words. You can't coherently making argument today than a man's gonna live longer the prostate removed then if we freeze the process I don't think we can make that argument scientifically. So the way I would look at this as a prostate cancer specialty position is that. It's a matter of a patient's choice. If the outcomes in the survival as a similar. Then it's a matter what side effects is a patient willing to under undergo or and in many cases tried to avoid. The preference because we still man still have a choice. And the we get a choice that really learn what the options are so what -- -- our guys out there. Is if you're suffering with prostate cancer if you -- diagnosed. If you've got a friend and colleague a family member that's -- diagnosed. Take the time to do their research and learn what all the options are. In the as a resource is out there to learn about crowd there. Www. Stop cancer called dot com stopped cancer called dot com learn about this option now it may not be the best option for any individual patient. But it's a truly it's a great option. So John we're gonna take a break here and come back it's a wrap this whole thing up on Aaron our topic of crusty -- therapy today. So I want him to -- to his doctors Stephen C hunting. I'm the founder -- -- this -- prostate senator relocating to Sarasota Florida. In June of this year so go to DR CIA DD RSC IO NTI doctors CIT dot com. And learn more about what's going on in our world here so stay to be right back in -- more than mr. John Ebert the director of marketing communications. Or -- care crowd there -- manufacturer. We'll be right back. Welcome back this doctor Steven -- the founder direct to -- not be prostate center. Of Boston is similar relocating to Sarasota Florida go to DRC not DD RSC IO NTI dot com. Learn more about this exciting development. Though today we got mr. John -- John is talked into its is the director of marketing communications from Indio care. We talk about prostate crowd therapy. But John -- therapy kills lots of different tumors in particularly for men with your logic cancers. There's some other applications so tell us where else -- therapy is principally used in in you know urinary tract that disease. Yet the interest thing area that it is expanded into really is kidney. People have probably heard now you know partial rectum -- circus taking out part of it. With the goal of being as they've missed much -- options possible. And so it's actually possible to freeze just a -- and it -- rather than taking it out. It's in an outpatient procedure less invasive than surgery and something that's also been found to be very effective. So an option firm and that has a small tumor in the kidney -- just cutting part of the kidney away. Would be freezing their tumors that right. -- And and that's generally done. You know sometimes even NM in a radiology suite through with a cat scan guidance. Yes and and in those cases sometimes -- without general anesthesia it's with oh conscious sedation she basically what they use for. Colonoscopy as well. And then sometimes -- tumors -- -- larger and year old who actually put a telescope and -- sort of belly button surgery. With a lap for scope and introduce the crown needles through what's called laparoscopic Porter a very small entryway into the body. So that's that's an exciting option another application in day in star -- You know that's really dependent upon location and size of the tumor in the kidney so I think. That's the sort of thing that I think give -- -- diagnosed with a kidney to really. You know talk to your doctor about whether -- therapy might be an option that situation. It so we shipped back to Protestant -- we've talked about a lot today. Here but let's talk about some of the take home messages then in terms of our discussion today about prostate -- therapy. Yeah as we talked to initially. One at the areas where. It probably has the most use is in those patients that. Had radiation therapy for. Prostate cancer but then there is a rise in the PSA. And it's important for those patients to be evaluated early on. And make sure determine if in fact -- managers still blind to the prospect because script they're. Is so one at that the best option sport treaty that. It's Alexei in the message demand is if your PSAs are rising and you had radiation therapy. You need further evaluation to see if they can't just come back in the prostate and whether crowd therapy might be an option for cure. OPEC to let that's one message and how about how what what else you want guys to take away from our our conversation this morning. I think on the primary. Treatment that is for patience that it just and diagnosed with prostate cancer. Important message is to consider all the alternatives. And you know we talked about price of their the here today and it's important to consider that -- quality things to. Considering in that process is to really look for position that offers because not every position does as we. Talked about there's been various reasons why. Someone mean not or particular position may not offer that procedure. But there are definitely positions throughout the country that offer it in and it's something that a patient. It would have the opportunity disgust with that position if -- if there is appropriate for them. Why I think that's right day in so one of the things we haven't really stressed I -- make sure when understands this is the crown -- Pete is in fact. FDA approved. It's a standard approach it's covered by Medicare. As well as virtually all. Primary insurers. In fact I can't remember a time in the last ten years. Where this procedure wasn't covered by patients insurance. Yeah we've found that very good reimbursement. Where the procedure. It is really not not been an issue is and actually approved by Medicare since 1999. -- right now that that is it's been a very long history that. So this is this is not something that you know is going to be you know impatient expense or cash procedure to covered covered procedure. So I always want to reiterate that that for a man who's faced with a diagnosis. It's important to learn what all the options are. In -- and I've said -- on the -- and at risk of getting you know we have -- -- -- -- -- -- say -- again. If you're diagnosed in your doctor has a conversation with few in says. All your only option is surgery in May be radiation and talks like nothing else. I'm gonna -- to find another doctor because you're only getting part of the story you see. Today this landscape was complex has -- a ways to treat prostate cancer. India need to know what your options are and what's gonna think -- the best the Internet your best friend in many ways because it will educate you about. What the options are. But then there's no substitute John I think for a patient. Meeting with an experienced physician experienced and all the modalities. Who could really have a really good up the -- discussion. Knowledge while the reached current literature at the current research and current scientific evidence and say okay. Here's the pros in terms of all the different approaches now let's figure out what's gonna fit you best. And I think that's an important conversation -- with patients. I definitely agree that the patient needs to understand the options and then. You know make the decision for themselves based on their discussions with probably more than one urologist. You know somebody offered some treatments and some others but to -- work to be able to. Consider all the options. Why agree and that's then and that's been our Montrae at this yuppie prostate center. I believe for many years that you know that spending the time dealing in get an accurate diagnosis. Another words get an accurate characterization. Of the extent. The size. The aggressiveness. The true nature of the prostate cancer. And then understanding the prostate anatomy this size the shape of the prostate now with someone's baseline urinary and sexual functioning as. These factors all I think going into a constructing any nearly personalized. -- pathway for care for patient. And we get down that pathway at the end of the day I think. We can get a much better match between a treatment. And that particular man who's having to deal with this this choice having to make this decision. And that's been very important again it. It's a life changing experience literally and patients need to understand their options and and be able to make an informed decision. When John thank you so much for joining us here on men's health the latest thing great -- knew that. Growth they're -- its current applications so again thanks -- taking his time audio data sharing her audience. Well thank you doctor it's -- I enjoyed it. All this is doctor Stephen center we're right back to close out the show and wool or something's -- in just a -- so stay tuned we'll be right back. Welcome back this is doctor Stephen -- out here host of men's -- the way were weathered just about out of time for today. We had a great discussion with mr. John Hebert -- by -- care talking about prostate. Craft their peak and -- the Shia people prostate center the approach you really is that we want to -- in it and personalized approach to our patients. We want to use advanced diagnostic techniques. And really defined what the full range of options for treatment are and I think that's an important concept. Now as intelligent a move in the center down to Sarasota Florida in June. But you know where enrolled in every insurance and Medicare provider. I'm happy to see patients from all around the country specially. My friends from appear knowing when. We're listing on the year or two with with -- so the only one radio shows so continue to listen to us as we talked about day issues that are important your health. So again today show I think and we get to take home messages -- to remember number one prostate cancer treatment is all about options. It's all about options and so prostate craft their. If you've had radiation there being here's the take a message today. If you've had radiation therapy in if the PSA is rising. You need to be further evaluated. To see whether or not they have PSAs coming from recurrent or residual cancer within the prostate in -- that's the case. You still an opportunity for cure by freezing their prostate so. Prostate crown -- be can be incredibly helpful -- one of the best options when there's radiation failure. Always called salvage treatment so guys be educated. It on the web learn about your disease drop me an email I can help it senate to -- health New England. WRKO slash men's health. And -- answer -- questions by email or personally on their shows so join us again for next week for men's help the -- is doctor -- sent to the founder of the -- a deep prostate center of Sarasota Florida. Or sign an offer this week we'll talk to again next week.