Demystifying Men's Urological Health with Dr. Jay Shakuri-Rad (Part 1)
It's time to break the silence on men's urological health. In part one of this frank discussion, Dr. Kerry Winge and expert guest Dr. Jay Shakuri-Rad dive deep into the world of prostate, penis, and beyond. They address common fears, debunk myths, and highlight the latest advancements in diagnosis and treatment. Learn why facing these issues head-on is crucial for quality of life.
Transcript
Dr. Kerry Winge: Welcome to the Bottoms Up Podcast, where we explore the science and practice of pelvic health and sexual wellness. I'm Dr. Kerry Winge, and I've dedicated 30 years to helping patients overcome pelvic health challenges through evidence-based physical therapy and rehabilitation.
This is the first episode in a two-part series with urological surgeon Dr. Jay Shakuri-Rad. We'll explore the intricate relationships between hormone regulation, cardiovascular health, and neurological function, discussing how factors like sleep patterns, stress response, and metabolic health influence male sexual and urinary wellness. The research reveals fascinating connections between lifestyle factors and urological outcomes that have significant implications for clinical practice and preventative care.
Before we begin, it's important to note that this podcast is for educational purposes only and does not constitute medical advice. The information shared should not be used as a substitute for professional medical treatment. Every person's situation is unique, and proper diagnosis and treatment require individual medical evaluation. If you have specific health concerns, please consult with a qualified healthcare provider.
In today's episode, we're going to examine:
The physiological mechanics underlying benign prostate hyperplasia (BPH)
Current evidence on screening methods for prostate and testicular health
How systemic inflammation affects urological outcomes
The latest developments in minimally invasive surgical techniques
The complex interplay between cardiovascular health and erectile function
The role of sleep and circadian rhythm in hormonal regulation
We'll also address the critical importance of early intervention and prevention care in maintaining optimal urological health. So let's begin our discussion of these essential but often overlooked aspects of men's health.
Let's get started!
Nathaniel DeSantis: We are in the month of November, and for those of you who do not know, November is also referred to as Movember. It is the month-long campaign where men grow mustaches. It has grown to a global movement raising awareness and funds for men's health issues like prostate cancer, testicular cancer, and mental health. It was started by a small group of friends in Australia in 2003, and the initiative has now raised hundreds of millions of dollars worldwide and sparked a real conversation about men's physical and mental well-being.
Dr. Kerry Winge: Yes, today we actually want to openly discuss men's sexual and emotional health. We are here to raise awareness, provide tools and solid advice on how you can communicate with your team. And by team, I'm actually talking about the people that you have chosen in your life who are there to support you. Your partners, your families and your doctors. And we are very honored today to have Dr. Rad with us today.
Dr. Jay Shakuri-Rad: Well, thanks for having me.
Nathaniel DeSantis: Formerly, Dr. Jay Shakuri-Rad, or Dr. Rad as we'll call him, was born in Iran and migrated to Germany as a child where he attended elementary school. He subsequently moved to the U.S. and graduated from Parkersburg High School in Parkersburg, West Virginia. Dr. Rad completed his undergraduate studies in the Honors College at West Virginia University with degrees in chemistry and German. He completed his medical studies at the West Virginia School of Osteopathic Medicine in Lewisburg, West Virginia. He graduated number one in his class with honors and moved to Grand Rapids, Michigan for training in advanced robotic urological surgery at University of Michigan West Health System. He has conducted multiple clinical studies and published in several peer-reviewed journals. Dr. Rad is an expert in minimally invasive and robotic surgery and has been named a master surgeon in robotic surgery by the Surgical Review Corporation. He currently serves as the Director of Robotic Surgery and Medical Director of Medical Specialties at Mon Health Medical Center in Morgantown, West Virginia. He is happily married to his wife, Dr. Whitney Shakuri-Rad, and has two sons, Cyrus and Darius.
Dr. Kerry Winge: Welcome, Dr. Rad.
Dr. Jay Shakuri-Rad: Oh, thank you.
Dr. Kerry Winge: You're welcome. Awesome. Prior to today's podcast, I had interviewed a lot of male family members and parents and patients and friends, and I actually asked them what their knowledge was in regards to men's health. And one of the common answers that I received was that it just was not discussed in their household growing up. So I'm wondering, what was your experience, Dr. Rad, and what was your experience, Nathaniel?
Dr. Jay Shakuri-Rad: All right. So, you know, it's interesting because when you talk about these discussions, we always look at generational changes. And so during my generation and certainly my parents' generation, this was not a topic of discussion in most households. People talked about general health sometimes, and often we talk about cardiovascular disease, you know, strokes and heart attacks. Those are the common things maybe people refer to, high blood pressure and diabetes, but we don't really segment it into men's health. And even women's health maybe sometimes was forgotten. And so this idea of men's health, I think it's a more novel and newer generational topic that has really come to surface. And it's very important. And I'm glad you're raising awareness.
Nathaniel DeSantis: Yeah. And I'll just say that I think my experience with men's health, I mean, outside of what we were taught in middle school sex ed. Not a whole lot. I mean, that's nothing against my parents who are probably watching or listening to this, but I think it was more, it was focused on health overall, but nothing specific to men's health. Definitely, I grew up with a sister who's really bad endometriosis. So a lot of women's health knowledge that I got from that, because that is like a whole different topic, but that's, that can be really like not fun to deal with. So, but men's health was never really like discussed a whole lot in terms of what we see in the Movember movement.
Dr. Kerry Winge: I completely agree with you. So my husband is one of six, so he has three sisters and even in my family women the reason why they're talking about their health more often is because girls have monthly cycles so you're forced to talk about it and you're forced to see the products. And even my son growing up, we can call him and he knew what drugstore to go to and what type of tampon we needed and when. And it was completely normal. And he made him a great husband now because he had so much training. But when I think back, we didn't really educate him a lot about his body or what to look out for in the future, kind of what was normal versus abnormal because the conversation was usually around the girls. So I guess the question is, how do we change the culture for the next generation going forward? I mean, you have two boys, Dr. Rad. So how are the conversations changing in your house now versus how you grew up?
Dr. Jay Shakuri-Rad: Yeah, so that's a great question because there's a stigma, right? So we have the stigma around discussing emotions and sexual health, especially with our boys because, you know, boys have to be tough, right? They have to grow up and do the heavy lifting and that's kind of the idea that came out of our grandparents' generations. And emotions and sexual health certainly was not a big topic. And that's unfortunate because as men grow up, as these boys grow up and become men, they sometimes are faced with these challenges that they just don't know where to go for answers. Something is changing in their bodies. They're understanding some new emotions and they don't want to talk about it because, well, you got to be the tough boy and then you just got to, you know, keep it inside and not really go to anyone and display that you're an emotional person, perhaps. And so with my boys, I kind of teach them early on, and I think my wife certainly does a great job with that as well, that, hey, you can have emotions, you can be sad, angry, you can love, you can hate, you got to understand those things. Because once you understand them, then you can truly appreciate your counterparts, your friends, your other family members. It creates stronger bonds between people. And that's kind of where we are with our emotional kind of teachings to our kids is we tell them that it's okay to feel a certain way, that they don't have to be ashamed of it. You know, they can display affection. And that's an okay thing. That's a natural thing. And that's really, I think, is different between what we're doing with our kids and how I was raised or how, you know, my wife was raised.
Dr. Kerry Winge: And to really understand really what they're feeling. So the emotion that they are feeling, having that awareness of what that emotion is, so it just doesn't come out as anger. Like, are you sad? Are you frustrated? Are you confused? Can you actually name that emotion? And that emotional intelligence, like you said, it helps with all of their relationships, not only personally and as they're growing up, but then as they are going forward in business and making decisions, really getting a hold of that, being able to separate it and have a cognitive choice when they're acting upon that emotion because they're able to identify what it is first.
Dr. Jay Shakuri-Rad: Yeah, and I think you hit it on the nail with, you know, changing the terminology even a little bit, because we talk about emotion as if it's a weakness. Well, change it into a change of discussion, change the definition. It's emotional intelligence, as you mentioned. So now people are going to be drawn towards intelligence. That's a good thing. That's a positive thing. So, well, what is emotional intelligence now? Let's become intelligent, right? More intelligent. And so I think just changing those stigmas and the definitions is going to be very important for the next generations to grow up a little bit healthier, perhaps, than what we did.
Nathaniel DeSantis: One thing that's really cool that this generation gets is limitless knowledge in their pocket. I mean, think of how lucky they are to have that. I was listening to a podcast on Nike, the shoe company. Jogging not that long ago, when my dad was a teenager, jogging was weird. People threw eggs and ridiculed people who jogged. They were like, what type of weirdo goes on a jog? And now we know that's a really healthy thing. That's interesting how societies change throughout time and how people view these things differently and how we have access to knowledge that we didn't have before. To be able to say, well, actually, you're going to be a better, more well-adjusted man if you can be more emotionally intelligent. Or if you do go to therapy if you need it or see a counselor, whatever it might be, or just know what's going on with your body, which we'll get into later. But really interesting how just technologically people can access all this information they couldn't before and probably become better men as a result of that.
Dr. Kerry Winge: Yeah. And understanding, you know, yourself gives you power and it gives you intelligence and it gives you confidence. Yeah. And that confidence helps you.
Dr. Jay Shakuri-Rad: Absolutely. And I think I love that technological aspect of it because, you know, we do have social media, right? We see all the negativity in social media sometimes about bullying and about, you know, kids getting in trouble. But there's also that other side of it where kids and influencers on these social media platforms are really showing that societal expectations of masculinity is maybe different than what, you know, most people are used to. And if you change that and say, hey, you know what, for a guy to be really masculine, they have to have some emotions. Well, now all of a sudden, you know, we're looking for those types of guys, right? And guys are willing to open themselves up to maybe become a little bit more vulnerable emotionally. And I think that's going to be very healthy for them. And it's part of that men's health topic.
Dr. Kerry Winge: It definitely is. And the other thing that I think is important is to accurately describe your anatomy, you know, being able to say, you know, the word penis, just like it's an elbow. With you and urology and me and pelvic floor, I mean, we see people's quote unquote private areas all the time, but for us, it is no different than an elbow or an ear or a knee. And you have to take care of your whole body and you can't just ignore anything below the belt. It's a very important part of ourselves. We are sexual beings. It is completely natural. It's normal. And it's important to take care of your pelvis and all of your sex organs, just like it is when you go to the dentist. I mean, it's funny. My husband said to me, he goes, yeah, it's normal for you now to go to the dentist. You're laid back in a chair. You got your mouth wide open. You got this bright light in your face, but people don't want to go and get their prostate checked. So that, you know, just doesn't even, just doesn't even make sense at all. So a lot of men too, they'll say, well, you know, I know I have a prostate, but I don't really know how the prostate is related to the bladder. And everything down there is just kind of an enigma. It's just down there. I don't really know what's going on. Something is just wrong. So can you expand a little bit, you know, on anatomy, you know, for people to make them understand the fact that, you know, we're looking at a plumbing system here.
Dr. Jay Shakuri-Rad: That's right. And that's exactly what I tell patients. I say it's a plumbing system. So you have a bladder, which is a pump, and that pump is responsible for pumping fluid that the kidneys make out of your body. Fluid has to travel through a tubing system, and that's the urethra. Now, us guys happen to have this structure called the prostate that surrounds that tubing. And that prostate's job is to provide the majority of the ejaculate fluid in the man. And so it's a sexual organ. It's part of our sexual health. And the prostate, unfortunately, because of its location, can cause some problems. It can grow and cause a quote-unquote kink in the urethra so that your bladder now has a harder time getting that fluid out. And that in turn can cause some bladder dysfunction. You can develop symptoms like urgency, frequency, a weak stream. And that's really something guys experience starting in their late 40s and 50s and beyond, and certainly does apply even to younger men. And then we talk about the penis, the testicles, and what do they do? Because when guys say, well, I'm going to have a vasectomy, does that mean that I'm not going to have any more fluid during orgasm, doc? Well, that's important to know the anatomy again, because the testicles do produce the sperm, and the sperm makes up only a very small fraction of the ejaculate fluid, which the prostate produces. And so when guys have a vasectomy, they don't really notice much change in the volume or composition of the ejaculate fluid. And that's important to know because, you know, we get concerned. A lot of guys may not want to seek a vasectomy as birth control and instead put their significant others, their wives or girlfriends perhaps, through a big invasive procedure to get a tubal ligation, to get a hysterectomy done. You know, those are big operations. But a vasectomy can be done in the office in 10 minutes under local anesthesia where we just numb up some of the structures we work on. So I think just understanding that is a big, big deal because it does make a difference in terms of how you decide to seek healthcare.
Dr. Kerry Winge: And that brings it back to some of the emotional intelligence that we were talking about. Figuring out what's going to be the least invasive and less risk for your partner, being able to have those open communication conversations and make the best decision for you as a couple.
Dr. Jay Shakuri-Rad: Correct. Absolutely. And, you know, with the recent changes in political climates, a lot of more guys were coming to our clinics asking about vasectomies. They said, well, you know, I don't want to have something happen, but, you know, you can just snip it off and then put it back together when I need it, right? And so, you know, that's, again, that understanding of your body. Hey, how does this work? If I want to have kids later, do I need this tube in there or does it not do anything? What is going on with the prostate business? And so that's part of the education that I provide to all patients that come in because like you said, they do talk about under the belt area like it's a mystery. And, you know, I did spend some time in Europe, and I still frequently travel there. And, you know, our European counterparts don't have that taboo kind of stigma associated with their health, with their sexual health. And they do live a little bit happier life because of it, I think, because it is, you know, just like your elbow, like you mentioned, you know, you talk about it. And if it hurts or there's something wrong with it, you go say, hey, you know, I want to have my penis examined. I want to have my testicles examined. There's something wrong there. And, you know, they understand that a little bit better.
Dr. Kerry Winge: And they're so clear and they're looking at you in your eyes and they're asking for what they need because the conversation is open, because the culture is different. We're here, you know, I'm sure, I don't know, I can't speak for your experience, but, you know, in my clinic, I kind of have the look down and you've probably never heard this, but I said, okay, look at me. Let's talk about what your needs are and how I can help you. That's why you're here. It's in a private office. You know, it's quiet. It's just you and I. Let's open up the conversation. And sometimes that's part of healing within itself letting them know that they're in a safe space and then we can talk about this.
Nathaniel DeSantis: So then I guess my question is as a guy who maybe isn't as in tune with everything below the belt and what to ask doctors, what's the most common thing men come in to see you for like below the belt as we've been saying? What does that look like?
Dr. Jay Shakuri-Rad: So a lot of guys end up coming in because their significant other made them, honestly, which is interesting because women are a lot more in tune with their bodies, as Kerry mentioned, because maybe they talk about it a little bit more because of that cycle, because of how they grow up having to deal with it on a monthly basis. And so they tell their guys, hey, you know what, you haven't been performing well in the bedroom, you need to go see a urologist, or you've been in the bathroom longer than what I'm used to you doing in the past. So you need to go see a urologist. So they come in and they say, well, my wife told me I need to come and see you. And so then I open up the conversation. I say, so very basic things. Are you urinating okay? Are you feeling like there is a change? I have them fill out questionnaires about both urinary function and sexual function. There are validated questionnaires in medicine. For the sexual health, it's called the sexual health men's inventory questionnaire. And for the urinary function, it's called the international prostate symptom score. These are validated questionnaires that any urologist will know exactly what's going on if they see the score out of that questionnaire. And so it's a universal language for us. And so when we have patients fill these things out, all of a sudden, they start thinking, hey, you know what, that question about my sexual health, well, what about my testicle? Because when I have intercourse, my right testicle always hurts. What's that all about? And so we open up the conversation about the anatomy. We talk about the bladder, the prostate, the penis, the testicles, and anything associated with the function of those things.
Dr. Jay Shakuri-Rad: And then we talk about screening. During Men's Health Month especially, we talk about one of the common cancers in young men, which is testicular cancer. Around ages 20 to 30, that's a very common cancer for men. So we want to make sure men screen themselves by just understanding, "I need to touch my testicles in the shower and see if the left side feels the same as the right side. And if it doesn't, I need to make sure a healthcare professional tells me that it's normal. And if it is, I'll look for changes in the future." You can be your own doctor essentially and examine your own parts. If there's a change, then you go and see someone that can either say whether something is wrong or whether it's a normal change for you. And then we do the same thing with the penis. If you have any rashes, any lesions, if you're sexually active with partners that may be at higher risk for infections, do you understand that? And if there's something growing there, make sure you don't hide it and say, "Oh, it'll probably go away." Go get a check because it could be something that turns into penile cancer, for example.
Those are important discussions that we have. And then for the older men, we talk about prostate cancer, which is the second most common cancer in U.S. men. It's the equivalent to breast cancer in women in terms of incidence. Breast cancer is the second most common in women, and lung cancer is kind of the umbrella number one cancer.
These are things that if we screen for and find them early, they're often curable. And so you go all of a sudden from having a deadly disease to curing it by just getting it screened, getting it examined early enough and often enough. So the education is really important. My colleagues here joke with me because I always run late in clinic. It's because I spend that extra time teaching. And so it just takes more time to do that. But it's very important. For you, as you go through each decade of your life as a man, you're going to look for different things. And those things will change. Certainly, there are some expectations that you need to develop in terms of invasiveness of testing or how much you are responsible for. How much is your doctor responsible for? Is there a blood test or is it just a physical exam? Those things I think need to really be highlighted during this month.
Dr. Kerry Winge: Absolutely. And when you were talking about the screening and just realizing what would be different on a man's body, it is very individualized. But one of the things is when any type of cancer abnormality is going to be present, it has to be accompanied with inflammation because there's not one disease that does not have an inflammatory base that I can think of personally. So sometimes with the testicles, you might feel a change in temperature or size, or one might be hanging lower than the other, or you might feel a lump. But it's important to realize what is normal versus what is not normal. Also, go to your doctor right away and don't be afraid that if you're going to the doctor, you're not going because you might get diagnosed with something because of the progression of whatever the disease may or may not be. I think one of the reasons why men don't go is because they're scared. Do you find that?
Dr. Jay Shakuri-Rad: Oh, absolutely, and that fear is often rooted in the stigmas that we have in society. Now as a man, if I have something, I'm going to be a weak man. I'm no longer that strong masculine character that I thought I was. So we need to kind of get rid of that and break that stigma in order to really improve the health of our population.
Dr. Kerry Winge: And I think for generations too, and I've heard from some men, "Well, of course, my urine stream isn't going to be as strong as when I was 20. Or of course, I'm going to have to go to the bathroom more often." Or, "My dad had that whatever they call like, quote-unquote, TURP procedure, roto-rooter." They have these slang names for different things. But just because they have them doesn't mean that they're normal. It's not a normal part of aging. Everyone does not have to end up with prostate cancer. Men do not have to end up with prostate problems just because they're getting older. There are things that you can do with lifestyle, with diet, with moving, with exercise. And I'm hoping that you can bring some of this to light, but it seems that the statistics are a lot worse in the United States than they are in other areas of the world. Is that accurate information?
Dr. Jay Shakuri-Rad: It is. And I think one way to get through to men, and I think this is part of, I blame this on the medical doctors, especially in the past, because we didn't speak the same language. As medical professionals, we see these things, we use these terminologies, it's normal to us. But for our patients, we need to realize, "Hey, if I present the information in a way that's digestible for them, that isn't as threatening to them, maybe they'll open up." So the American Urologic Association has actually recently changed the way they present this kind of information. For example, I have a big billboard in my waiting area. If you walk in, you'll see that there's a big picture of a car. And on that car, I don't know if you've seen it, it talks about a tune-up. And it says, "Guys, get your tune-up done." You need your oil changed on your car to keep it running, right? You need to get the brakes changed. So same thing you got to do with your body, get your PSA checked, get your urine checked, get your sexual health inventory exams done. And that's a tune-up for us. So now all of a sudden guys think, "Hey, that's a car thing. I can relate to that maybe." And it's a less threatening way of presenting their information. And I see this now being used in different ways where we start understanding our patients better by just presenting the information a little bit differently, less threatening.
Dr. Kerry Winge: I agree. I agree. So if there is an unfortunate case where a man comes in and you are suspecting prostate cancer, what are the different diagnostic tests that can be performed? And then I think it's important from that diagnosis, and obviously it's going to be on an individual basis. What do we have in the latest and the greatest treatment? Because I know you're an expert in it.
Dr. Jay Shakuri-Rad: Let me step back a little bit and say, how do we get to it? And why are men scared to come to the urologist? This has actually been a very hot topic in urology recently. When you talk about the prostate, the first thing people will think of is this guy right here, finger exam, their digital rectal exam. And they say, "I don't want anyone touching me in that area." And so the urology community and us physicians have really found that to be a negative connotation for patients. So we've looked at the data, we developed tools where we don't actually do the rectal exam as frequently as we used to. The prostate-specific antigen exam, which is a blood test, is the primary way we screen for prostate cancer. Just like you go get your cholesterol checked and your kidney function checked with a blood test, you get the PSA test. And it's recommended to get that done starting at age 50 if you do not have a family history of prostate or breast cancer. But if you have a family history of prostate, breast, or ovarian cancer, there are some genetic correlations there. We recommend getting yourself checked at around age 40 to 45.
African-American men are at higher risk for prostate cancer. So we also recommend they get checked starting at age 40 to 45 with a PSA test. Now, the PSA test is like a red flag. If that test is abnormal or we see abnormal trends year over year in that test, now we have a red flag that goes up. And that red flag does not mean you have cancer. It's just something that we need to further look into. It's like the check engine light. I always tell my guys, "You come to my office with an elevated PSA, that's your check engine light. It went on." Now, what do you do when you see a check engine light? Well, you got to pop the hood, take a look under the hood and see what's going on. Is the engine misbehaving? Is there something going on with the electric supply? And so the same thing we do when you come to the office, we look at that check engine light, we determine what your risks are, and based on that, we may order some testing.
So one of the first tests that you may hear your doctor talk about is going to be an MRI of the prostate. MRIs were not as common back in the day, and we weren't doing those for prostate cancer screening at all. And what has happened is we've developed metrics that allow us to determine with a certain degree of certainty whether or not someone has a suspicious nodule in their prostate on an MRI that could be correlated to prostate cancer. And then our radiologists actually give it a scoring system. It's called the PI-RADS score. And based on the PI-RADS score, we may say, "You know what, there's a suspicious nodule in there. It carries a 40%, 50% chance of being positive for cancer. Maybe we should biopsy it." And now the discussion changes from, "You're going to do a rectal exam on me" to, "Hey, I'm going to get a picture of your prostate." And then from that picture, we're going to decide what the next steps are.
And the way we do biopsies has also changed. If you talk to any man that had a prostate biopsy in the past maybe 15 years or so, 15 years or greater, they're going to say it was a terrible experience. They would come to the office, they are awake, they're laying in a fetal position with their ultrasound probe through the rectum, and they're getting poked with needles through the rectum, anywhere between 10 to 12 times. And so it's a very, very uncomfortable thing. And so now we're doing it differently. We do transperineal biopsies. Patients have a little bit of sedation. They get poked with two needles on the skin and we can take biopsies in a much better way with better results. And so now it's all of a sudden a much easier diagnostic test for them.
Dr. Kerry Winge: Is that a twilight sleep or is that a local anesthetic when they're getting the biopsy?
Dr. Jay Shakuri-Rad: So we give them a twilight sleep.
Dr. Kerry Winge: So that's good.
Dr. Jay Shakuri-Rad: That's a very good thing. They just get a little mask on their face. They go to sleep for about five, 10 minutes, and then they wake up refreshed and go home.
Dr. Kerry Winge: Do they have an IV during that time?
Dr. Jay Shakuri-Rad: They do. We do give them an IV just because we have the anesthesiologist there for safety, make sure that everything is going well. And afterwards, they go home and they can really carry on with the rest of their day.
Dr. Kerry Winge: So it's like the Michael Jackson drug.
Dr. Jay Shakuri-Rad: It is, but a little bit safer.
Dr. Kerry Winge: And they have a good sleep and they don't feel anything and they might be maybe a little bit sore afterwards, maybe some ice or something, but overall it's not a scary procedure and it provides the ability to have a correct diagnosis at that point in time.
Dr. Jay Shakuri-Rad: Yes.
Nathaniel DeSantis: And quick question. What is twilight sleep to us? So obviously it sounds like twilight sleep is this short, I think you said like five, 10 minutes. Anesthesia? What is it exactly? For those who don't know.
Dr. Jay Shakuri-Rad: Our anesthesiologist puts a little bit of medication through an IV into the bloodstream, and that medicine kind of creates a sleep state for the patient. And that can be controlled and reversed at any time. And it's different than general anesthesia, which often requires a tube to go down the mouth and we control the lungs. For these patients that we do twilight sleep for, they're actually breathing. We are not controlling their breathing. They're just naturally breathing. They're just in a state of sleep.
Dr. Kerry Winge: And when you come out, you got to make sure that someone you love is next to you because it's also a truth serum. So if somebody asks you a question after it's said, you can get some good information on that.
Dr. Jay Shakuri-Rad: I think we all have seen those TikTok videos, right?
Dr. Kerry Winge: Yeah, exactly. But they use the same type of anesthesia with a colonoscopy. It's very simple. But this is another reason to take the fear out of it for men. Procedure used to be painful. It is not anymore. And it's important to get the right information.
Nathaniel DeSantis: Now, so I have a quick question. I've always wanted to ask a doctor this. I have read online, and correct me, I just need to know if this is true or not, that if a man pees on a pregnancy test and it's positive, it means he might have prostate cancer. Is that true?
Dr. Jay Shakuri-Rad: No, so that's more of a myth.
Nathaniel DeSantis: That's a myth. Okay. Because I didn't know if that could, like, could men use that as an early screening method, but clearly that's a myth.
Dr. Kerry Winge: I think it's good to debunk it because if you've heard it, other people have.
Nathaniel DeSantis: Yeah. I've heard it online. I've read a lot of things online about people doing that. And so I've always wanted to know, I was like, surely this isn't like that simple, like this pee on.
Dr. Jay Shakuri-Rad: Speaking of pee, there are actually urine markers that we use now for prostate cancer screening, but they are different. They're not pregnancy tests by any means. So we can't actually, for patients, some patients actually have a fear of needles. They don't want to get poked even for blood work. And so for those patients, we actually do have a urine test that gives us a chance to evaluate their risk of prostate cancer. And those tools are actually to a point now where we can send it home with a patient. Some patients say, "At the doctor's office, I have a shy bladder, I can't even pee." I mean, we have patients like that. And we say, "Why don't you take it home, do it in the comfort of your home, give us the sample cup when it's ready, and we'll run the test at that point."
Dr. Kerry Winge: That's great kind of like a Cologuard where you can poo in a box and you know exactly going for the colonoscopy.
Nathaniel DeSantis: Exactly. My dad gets Cologuard. It's always funny when they get delivered because they don't try to hide that it's a Cologuard like they make it very obvious what it is. The box says you are pooing in the box. When you go to ship it back everyone's like, "Oh, I hope you had a good poo." So it's funny. I didn't know you could do that. That's crazy. So what happens after the screening?
Dr. Jay Shakuri-Rad: Let's say someone has prostate cancer. And when we talk about cancer, it's a scary word. So I always tell my patients, I say, "Don't, that C word can be daunting." I mean, when you hear about cancer, you associate it right away with death and your mortality comes to the surface. And prostate cancer is one of the slower growing cancers. And if it's caught early, in some cases, depending on how aggressive of a cancer we find, it may actually require no treatment at all. Prostate cancer is graded on a scale between one and five. We called it group grades. Some patients hear the term Gleason score, which is another way to grade prostate cancers. And if you have a low-grade prostate cancer, we offer patients what's called active surveillance. We say, "You know what? There's some changes in the cellular structure of your prostate that we think is cancer related, but it may not require treatment. It may be so slow growing that you may actually not suffer from this disease during your lifetime." And one of the things that we sometimes joke about with patients just so they feel, get that anxiety out of them is that, "Hey, maybe something else is going to get you before the prostate cancer."
And so I think understanding the disease is important at that point. So we do have active surveillance for patients with low-risk prostate cancer where we monitor them with blood tests and imaging every so often. And some of these men will never require treatment. And then other men who may have a little bit more aggressive version of the cancer, they have many options. Prostate cancer comes with a lot of options these days. We have focal therapies where we can focally try to treat the cancer in the prostate and reduce the harm to the surrounding tissues, like the nerves of the prostate, which control our sexual function, like the sphincter muscle around our bladder, which controls our urinary function.
And so these are minimally invasive outpatient treatments that we sometimes offer to men. We also have more scary treatments like radiation. We have surgery where we can take out the prostate. And so a lot of men that have had their prostates removed in the past or know of their grandfather that had their prostate taken out, they always associated with, "Oh, my grandpa had their prostate out and he was incontinent all the time, had to wear diapers all day and it was miserable." Well, that has changed dramatically. We now offer minimally invasive robotic surgeries that allow us to really do a great job for patients and maintain most of their function. And with the help of Kerry, we can actually provide them with pelvic floor physical therapy and introduce them to this whole world of pelvic health, where they can then work on physical therapy and regain these functions to a certain degree or completely. And so I think that those options have to be discussed with patients and they just have to hear it from people that do it on a daily basis. That way we can demystify it. We can take some of the anxiety out of it and also make a plan that's appropriate for each patient because it is an individualized treatment. It's not one drug for all prostate cancers or one surgery for all prostate cancers. It's really individualized.
Nathaniel DeSantis: What about testicular cancer? How's it changed for that?
Dr. Jay Shakuri-Rad: So testicular cancer, if you rewind, go back 40, 50 years, testicular cancer when it was caught was often a deadly disease, especially if it had metastasized. And overnight, once a certain chemotherapeutic agent was developed, it changed it completely. Testicular cancer became a curable cancer, even metastatic testicular cancer. And so the treatments for testicular cancer are really advanced now and there are great treatments available. However, the most important thing with any of these diseases we'll talk about today is screening and early discovery. You catch it early, get rid of it early, there won't be long-term sequelae most likely. You catch it late because you ignored it, now you're going to be in a lot more trouble.
Nathaniel DeSantis: So it's the difference between maybe keeping a testicle or losing a testicle? Maybe even worse, like losing your life, hopefully not that bad.
Dr. Jay Shakuri-Rad: Exactly. So I always kind of bring that mortality to the discussion. I say, what's the most important thing? It's your life. There are some things that we offer that may change the way you live your daily life, but what's important to you? And so that's how the discussion always goes, and that's how we identify the right treatment for the right patient at the right time. I always tell my patients about two very important things. I say that my job is to increase quantity of life while maintaining the quality. If I increase your quantity and make your quality miserable, I haven't done you any favors. But if I can maintain both of those aspects to a certain degree, then I think we've done a good job. And you as the patient, as the person undergoing treatment, you're going to have much better outcome and your goals are defined ahead of time.
So I think that's the important message is that when we look at these things, we always have to look at, yeah, sure, we have to treat the disease, but also, am I really doing a good job maintaining quality after that? Because you have to live your daily life. A lot of my guys come say, "Hey, doc, I'm so and so many years old. I have grandkids. I just want to watch them play sports. How many years can you give me?" And then I change the discussion sometimes. I say, "Well, I can give you X amount of years perhaps, but do you want to spend those X amount of years miserable watching them play basketball or football, or do you want to be cheering and have fun and not have to wear diapers all day?" And so the quality aspect comes back to the discussion. And I think part of that is that stigma again that we talked about before. Us men, we have to be tough, right? So just do whatever you have to, cut me into pieces, and I have to be a strong man, and I'll figure out how to live after that. Well, that's not going to cut it. I think we are understanding that we have to really apply a humanistic aspect to this where we treat the disease and the person and their quality of life.
Dr. Kerry Winge: Yeah. Suffering is not living for sure.
Dr. Jay Shakuri-Rad: Yeah.
Dr. Kerry Winge: But we, like you said, there are so many different options out there and giving them at least time and quality of life. You never know what other treatments may be available.
Dr. Jay Shakuri-Rad: So, about this testicular cancer I mentioned to you about this chemotherapy agent that changed everything, one of our very good urological experts, a professor in Michigan, used to tell the story that he used to give patients a few months. I can extend your life by maybe a couple months. And you know, is that really worth it? And then he said, "Well, you know what? It might be worth it because if you go back to when we discovered this chemotherapy for testicular cancer, if I had a guy that was diagnosed two months before we discovered that drug and I made him live two months longer, all of a sudden his cancer became curable after that second month." But if he had given up on it, he wouldn't have seen that cure come to the surface. So I think that is absolutely correct, Kerry. I think there are so many developments now in medicine. I always hope that I can get the patients to the next magic treatment.
Dr. Kerry Winge: I strongly believe that our bodies can take a lot. And our bodies can take a lot of toxicity, whether it's in the environment or our food. But it gets to the point where, just like your car, if you don't put the oil in it, everything seizes up. But what that point is where it seizes up and the inflammation and the disease takes over the system. So if you can give them time and do a combined approach, a multidisciplinary approach, look at their diet. Look at their movement. Look at their relationships. Look at their stress. Look at their hydration, look at their sleep.
You know, people are sitting on their butts 24-7. Well, if you're sitting down, you're not moving. Your lymph system itself doesn't have a pump. Your lymph system is moved by your muscles. So a lot of it is our environment. A lot of it is the culture. And so I believe that we can give these people more quality of life with all the advances that we've made in medicine, but also combine it with the basics that we're not doing every single day that we need to do to allow our bodies the chance and our immune system to work with that and get back to what we need.
Sometimes a health challenge can be a wake-up call, and that can increase your quality of life that you didn't even know that you wanted or that you were going to get.
Dr. Jay Shakuri-Rad: Yeah, and so, we talk about osteopathic medicine sometimes as a holistic kind of approach to medicine. And in osteopathic medicine, we talk about mind, body, and spirit. Those three things have to really be all addressed for you to be healthy. And in the allopathic world, we talk about biopsychosocial model, which is essentially the same thing. We have to focus on all those pillars of the person in order to improve their health. If you do take care of the body, but leave the mind to suffer or the spirit suffering, your body's actually going to break down. And vice versa, any of those can affect the others. And so we do have to take this concept of health and apply it to the whole person. And that whole person, I mean, it's their family, it's their loved ones, it's their social determinants of health that we talk about these days. It's their support system that's going to be playing a role. And then certainly, depression, anxiety, those things play a big role in how we can treat diseases effectively. Some people just through sheer will get through chemotherapy that's really toxic, and then they come out on top on the other side. So a great point there, Kerry.
Dr. Kerry Winge: Absolutely. And it's exciting. I think it is exciting. I think it's so important to educate people about what is available these days. And then going back to changing the culture of that emotional intelligence. You don't really know what you need until you really know what your needs are and able to communicate, understand them yourselves and then able to communicate them to others.
And that concludes Part 1 of our deep dive into men's urological health with Dr. Jay Shakuri-Rad. Tune in to part two as we discuss the practical concerns that bring men into the urologist's office, from erectile dysfunction to fertility. Dr. Rad will share more strategies for optimizing whole-body health and normalizing these vital conversations, so don't miss it!