The Dr. Geo Prostate Podcast

Before prostate surgery, there are 3 questions you should ask your surgeon—and “How many surgeries have you done?” isn’t enough.In this episode of The Dr. Geo Prostate Podcast, Dr. Geo sits down with renowned prostate cancer surgeon Dr. Jim Hu, Ronald P. Lynch Professor of Urologic Oncology at Weill Cornell Medicine, Vice Chair of Clinical Research, and Director of the LeFrak Center for Robotic Surgery.The conversation starts where many prostate cancer journeys begin: an elevated PSA.Do you really need a biopsy? Should you get an MRI first? What about PSA density, the 4Kscore, or newer urine tests? And if a biopsy is necessary, should you choose transperineal instead of transrectal biopsy?Dr. Hu explains why he now favors the transperineal approach and discusses findings from the PREVENT and UK TRANSLATE trials, including infection risk, antibiotic use, cancer detection, pain, and the learning curve physicians face when adopting the procedure.Then the conversation turns to one of the biggest decisions a man with prostate cancer may ever make:Surgery or radiation?And if you choose surgery, how do you know whether your surgeon is actually good?Dr. Hu explains why simply asking how many prostatectomies a surgeon has performed may not tell you what you really need to know. Instead, patients should be asking whether their surgeon actually tracks urinary continence and erectile-function outcomes.Because two surgeons can perform the same “robotic prostatectomy” very differently—and those differences may matter to your quality of life.In this episode, you’ll learn:• What an elevated PSA really means—and what may come before biopsy• How MRI, PSA density, 4Kscore, and urine biomarkers can help guide decisions• Why Dr. Hu favors transperineal prostate biopsy• What the PREVENT and TRANSLATE trials tell us about prostate biopsy• Why avoiding antibiotics may be another advantage of transperineal biopsy• The learning curve patients should consider when choosing who performs their biopsy• How to think about prostate surgery vs. radiation• Why robotic technology doesn’t automatically mean better surgical outcomes• Why surgical volume alone may not predict continence or erectile-function recovery• The questions to ask before choosing a prostate cancer surgeon• Why surgeons should track their own patient-reported outcomes• How surgical technique, nerve handling, and cautery may affect recovery• Where active surveillance and focal therapy may—or may not—fit• Why treatment choice matters if prostate cancer eventually returns• What patients should understand about salvage prostatectomy after radiation or focal therapyIf you’ve recently been diagnosed with prostate cancer—or you’re trying to decide whether to have a biopsy, surgery, radiation, focal therapy, or active surveillance—watch this conversation before making a decision you can’t easily take back.Chapters⏱️ KEY TIMESTAMPS00:00 – The prostate cancer decisions you can’t easily take back08:00 – Elevated PSA: Do you really need a biopsy?12:00 – How MRI can help some men avoid biopsy16:00 – PSA density, MRI & deciding whether to biopsy17:00 – Transperineal vs. transrectal prostate biopsy19:00 – PREVENT & TRANSLATE studies: infection and cancer detection22:00 – The learning curve for transperineal biopsy26:00 – Why transperineal biopsy may avoid antibiotics36:00 – Prostate surgery vs. radiation: How do you choose?42:00 – Does doing more prostatectomies make a better surgeon?43:00 – The #1 question to ask your prostate surgeon51:00 – What are good erectile-function outcomes after surgery?55:00 – Nerve sparing: the surgical details that may affect erections59:00 – The 3 questions to ask BEFORE prostate surgery1:03:00 – Active surveillance for Gleason 6 / Grade Group 11:06:00 – Focal therapy: Where does it fit?1:10:00 – Erectile dysfunction & incontinence after prostate surgery1:11:00 – Prostate surgery after radiation or focal therapy1:12:00 – PSMA PET scans, recurrence & salvage treatment🔗 RESOURCES & RESEARCHDr. Jim Hu — Weill Cornell Medicinehttps://weillcornell.org/jimhuFollow Dr. Hu on X:@jimhumdPREVENT Trial — JAMA Oncologyhttps://jamanetwork.com/journals/jamaoncology/fullarticle/2823969Memorial Sloan Kettering Prostate Cancer Nomogramhttps://www.mskcc.org/nomograms/prostateUK TRANSLATE Prostate Biopsy Study — The Lancet Oncologyhttps://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(25)00100-7/fulltextMichigan Urological Surgery Improvement Collaborative (MUSIC)https://musicurology.com/programs/prostate/MUSIC brings together academic and community urology practices across Michigan with the shared goal of improving prostate cancer care and patient outcomes.___________________________________💪 Exclusive MembershipWant deeper insights? Join The Dr. Geo Prostate Podcast Exclusive Membership for curated transcripts, detailed show notes, expert resources, and member perks. → https://drgeo.com/membership___________________________________📌 Follow and Connect📺 YouTube → Dr. Geo Prostate Podcast — https://www.youtube.com/@DrGeoProstatePodcast🎧 All Episodes → Captivate.fm Archive — https://dr-geo-prostate-podcast.captivate.fm📸 Instagram → https://bit.ly/DRGEO-INSTA-YT📘 Facebook → https://bit.ly/POD-FB-DrGeo💼 LinkedIn → https://bit.ly/DRGEO-LINKEDIN-YT🛒 Supplements → XY Wellness https://bit.ly/3uJPC7Z | Mr. Happy https://bit.ly/3TE7tWE🌐 DrGeo.com Website → https://bit.ly/43khht0___________________________________📣 Hashtags#DrGeoProstatePodcast #ProstateHealth #ProstateCancer #MensHealth #IntegrativeUrology #Urology___________________________________⚠️ DisclaimerThis podcast is for educational purposes only and not medical advice. The views expressed are Dr. Geo’s and not those of his employer(s) or affiliated organizations. Use of this content is at your own risk. Geovanni Espinosa, N.D., assumes no liability for direct or indirect consequences, including economic loss, injury, illness, or death.

What if one of the hardest parts of androgen deprivation therapy is not simply low testosterone—but the loss of estradiol that comes with it?Dr. Richard Wassersug brings a rare dual perspective to that question.He is a PhD evolutionary biologist, former professor of anatomy and neurobiology, prostate cancer quality-of-life researcher, co-developer of an androgen deprivation education program, and a patient who has used transdermal estradiol for more than two decades. His experience helped drive a deeper investigation into whether estrogen delivered through the skin could suppress testosterone while avoiding some of the burdens associated with standard LHRH-based ADT.In this episode, you’ll learn:🟠 Why men need estradiol for **brain, bone, sexual, and overall health.**🟠 What the **PATCH research** suggests about transdermal estradiol, cancer control, and quality of life.🟠 Why **hot flashes, poor sleep, fatigue, and cognitive symptoms** may reflect more than testosterone loss.🟠 What men should know about **gynecomastia, monitoring, exercise, and shared decision-making** before considering this emerging strategy.decision-making before considering this emerging strategy.Chapters 00:00 ADT Side Effects Question00:54 Podcast Disclaimers01:33 Meet Dr Wassersug03:59 Diagnosis And Early Treatment04:58 Finding Estradiol Research07:29 Lupron Side Effects And Sleep08:48 Why Men Need Estradiol11:00 Switching To Estradiol15:13 NEJM Patch Trial Breakdown20:53 Gynecomastia And Management24:07 Real World Patient Stories25:20 Sponsor Message Break27:51 Access Barriers And Limits29:03 ADT Protocols and Sleep31:32 Estradiol Targets and Ratios37:23 Patch vs Gel Dosing39:10 Combining ADT With Estradiol42:52 Who Benefits Most44:18 PATCH Study Scope and Add-Ons47:33 Getting Estradiol Prescribed50:23 Suffering Mindset and Sexual Health54:48 Active Surveillance Trial Ideas___________________________________💪 Exclusive MembershipWant deeper insights? Join The Dr. Geo Prostate Podcast Exclusive Membership for curated transcripts, detailed show notes, expert resources, and member perks. → https://drgeo.com/membership___________________________________📌 Follow and Connect📺 YouTube → Dr. Geo Prostate Podcast — https://www.youtube.com/@DrGeoProstatePodcast🎧 All Episodes → Captivate.fm Archive — https://dr-geo-prostate-podcast.captivate.fm📸 Instagram → https://bit.ly/DRGEO-INSTA-YT📘 Facebook → https://bit.ly/POD-FB-DrGeo💼 LinkedIn → https://bit.ly/DRGEO-LINKEDIN-YT🛒 Supplements → XY Wellness https://bit.ly/3uJPC7Z | Mr. Happy https://bit.ly/3TE7tWE🌐 DrGeo.com Website → https://bit.ly/43khht0___________________________________📣 Hashtags#DrGeoProstatePodcast #ProstateHealth #ProstateCancer #MensHealth #IntegrativeUrology #Urology___________________________________⚠️ DisclaimerThis podcast is for educational purposes only and not medical advice. The views expressed are Dr. Geo’s and not those of his employer(s) or affiliated organizations. Use of this content is at your own risk. Geovanni Espinosa, N.D., assumes no liability for direct or indirect consequences, including economic loss, injury, illness, or death.

Most men who undergo a prostate biopsy may not have cancer found at all—and the bigger mistake may be rushing from a single elevated PSA straight to the needle.Dr. James Wysock, an NYU urologist with deep expertise in prostate cancer diagnostics and image-guided biopsy, explains why the modern biopsy decision is no longer about PSA alone. Repeat testing, prostate MRI, PSA density, blood and urine biomarkers, and expert image targeting can dramatically change who should be biopsied and how that biopsy should be performed.Just as surprising: transperineal biopsy is not automatically “better” in every case. It clearly lowers infection and antibiotic exposure, but biopsy accuracy still depends heavily on imaging, fusion quality, sampling technique, and operator experience.In this episode, you’ll learn...Why one elevated PSA should often be repeated before escalating testing.Why MRI may be the most important next test when biopsy risk remains concerning.How transperineal and transrectal biopsies really compare.How new fusion, needle and tissue-preservation technologies could make future biopsies shorter, more precise and less invasive.___________________________________💪 Exclusive MembershipWant deeper insights? Join The Dr. Geo Prostate Podcast Exclusive Membership for curated transcripts, detailed show notes, expert resources, and member perks. → https://drgeo.com/membership___________________________________📌 Follow and Connect📺 YouTube → Dr. Geo Prostate Podcast — https://www.youtube.com/@DrGeoProstatePodcast🎧 All Episodes → Captivate.fm Archive — https://dr-geo-prostate-podcast.captivate.fm📸 Instagram → https://bit.ly/DRGEO-INSTA-YT📘 Facebook → https://bit.ly/POD-FB-DrGeo💼 LinkedIn → https://bit.ly/DRGEO-LINKEDIN-YT🛒 Supplements → XY Wellness https://bit.ly/3uJPC7Z | Mr. Happy https://bit.ly/3TE7tWE🌐 DrGeo.com Website → https://bit.ly/43khht0___________________________________📣 Hashtags#DrGeoProstatePodcast #ProstateHealth #ProstateCancer #MensHealth #IntegrativeUrology #Urology___________________________________⚠️ DisclaimerThis podcast is for educational purposes only and not medical advice. The views expressed are Dr. Geo’s and not those of his employer(s) or affiliated organizations. Use of this content is at your own risk. Geovanni Espinosa, N.D., assumes no liability for direct or indirect consequences, including economic loss, injury, illness, or death.

What if the biggest mistake men make after a prostate cancer diagnosis is not eating the "wrong" food - but becoming so afraid of food that eating itself becomes stressful?In this solo episode, Dr. Geo draws on more than two decades in holistic and integrative urology to cut through the noise around prostate cancer nutrition. Rather than promoting another rigid diet, he explains how food choices interact with physical activity, stress, metabolic signaling, and long-term sustainability. The goal is not perfection. It is to create a healthier internal environment while still enjoying life, family, and food.In this episode, you'll learn...Why no single food causes or cures prostate cancer.How exercise and stress may change the way your body responds to food.Why Dr. Geo favors a plant-forward Mediterranean pattern while allowing strategic flexibility.How to think about protein, fish, red meat, processed foods, saturated fat, and fasting after diagnosis.If prostate cancer nutrition has left you overwhelmed, this episode offers a simpler framework for deciding what to eat - and what actually matters most.Chapterts00:00 Food Myths Intro00:55 Podcast Disclaimer01:34 Why Nutrition Confuses03:34 Principle One No Guilt04:46 Stress Exercise Absorption08:57 No Magic Foods12:55 How Cancer Signals Work16:40 Processed Foods And Portions21:02 Best Diet Patterns25:11 Protein And Muscle28:38 Meat Poultry Fish31:23 Carbs And Fats35:48 Fasting And Overeating37:17 Thrive After Diagnosis👉 subscribe to RX3 Thursdays- https://bit.ly/3UyPJ2M___________________________________🌱 Partner OffersProLon 5-Day Fasting Mimicking Diet — Enjoy fasting benefits with food. Supports cellular renewal, metabolic health, and fat loss. Special offer for our listeners: Get the ProLon kit for $148 → https://bit.ly/3TVehAxAG1 by Athletic Greens — 75 high-quality vitamins, minerals, probiotics, and adaptogens in one daily scoop. Supports gut health, immunity, energy, and focus. Try it here → https://bit.ly/3mA2tVV___________________________________💪 Exclusive MembershipWant deeper insights? Join The Dr. Geo Prostate Podcast Exclusive Membership for curated transcripts, detailed show notes, expert resources, and member perks. → https://drgeo.com/membership___________________________________📌 Follow and Connect📺 YouTube → Dr. Geo Prostate Podcast — https://www.youtube.com/@DrGeoProstatePodcast🎧 All Episodes → Captivate.fm Archive — https://dr-geo-prostate-podcast.captivate.fm📸 Instagram → https://bit.ly/DRGEO-INSTA-YT📘 Facebook → https://bit.ly/POD-FB-DrGeo💼 LinkedIn → https://bit.ly/DRGEO-LINKEDIN-YT🛒 Supplements → XY Wellness https://bit.ly/3uJPC7Z | Mr. Happy https://bit.ly/3TE7tWE🌐 DrGeo.com Website → https://bit.ly/43khht0___________________________________📣 Hashtags#DrGeoProstatePodcast #ProstateHealth #ProstateCancer #MensHealth #IntegrativeUrology #Urology___________________________________⚠️ DisclaimerThis podcast is for educational purposes only and not medical advice. The views expressed are Dr. Geo’s and not those of his employer(s) or affiliated organizations. Use of this content is at your own risk. Geovanni Espinosa, N.D., assumes no liability for direct or indirect consequences, including economic loss, injury, illness, or death.

Dr. Geo welcomes Dr. Peter Bajic, Medical Director for Urology at Cleveland Clinic Main Campus and Director of Men's Health at the Glickman Urological Institute, for an evidence-based conversation about erectile dysfunction, testosterone, Peyronie's disease, and the biggest myths in men's sexual medicine.They explore why erections reflect cardiovascular health, why "venous leak" is often misunderstood, how GLP-1 medications may temporarily influence testosterone during weight loss, and when testosterone replacement therapy is actually appropriate.The episode also covers Peyronie's disease, treatment options including daily tadalafil and traction therapy, and practical lifestyle changes that can improve both sexual function and long-term health.If you've ever wondered whether ED is psychological, physical, hormonal—or all three—this episode delivers clear answers backed by today's science.In this episode you'll learn:Why erectile dysfunction often predicts cardiovascular diseaseThe truth about "venous leak"How erections actually workPsychological vs. physical causes of EDGLP-1 medications and testosterone explainedWhen testosterone replacement is appropriateThe biggest myths about Peyronie's diseaseDaily Cialis beyond erectile dysfunctionLifestyle strategies that improve sexual healthThe latest treatments available for menTimestamps00:00 Introduction: ED may be your first warning sign02:45 Why erections are a window into overall health06:20 Psychological vs. physical erectile dysfunction13:15 GLP-1 medications, weight loss & testosterone18:30 Combining GLP-1 therapy with testosterone replacement28:45 The truth about "venous leak" explained40:05 Why most men do NOT have true venous leak43:10 The best approach to treating erectile dysfunction49:20 Understanding Peyronie's disease54:20 Can Peyronie's disease be prevented?58:00 Why daily Cialis may be one of men's most useful medications1:01:00 Xiaflex, surgery & future Peyronie's treatments___________________________________💪 Exclusive MembershipWant deeper insights? Join The Dr. Geo Prostate Podcast Exclusive Membership for curated transcripts, detailed show notes, expert resources, and member perks. → https://drgeo.com/membership___________________________________📌 Follow and Connect📺 YouTube → Dr. Geo Prostate Podcast — https://www.youtube.com/@DrGeoProstatePodcast🎧 All Episodes → Captivate.fm Archive — https://dr-geo-prostate-podcast.captivate.fm📸 Instagram → https://bit.ly/DRGEO-INSTA-YT📘 Facebook → https://bit.ly/POD-FB-DrGeo💼 LinkedIn → https://bit.ly/DRGEO-LINKEDIN-YT🛒 Supplements → XY Wellness https://bit.ly/3uJPC7Z | Mr. Happy https://bit.ly/3TE7tWE🌐 DrGeo.com Website → https://bit.ly/43khht0___________________________________📣 Hashtags#DrGeoProstatePodcast #ProstateHealth #ProstateCancer #MensHealth #IntegrativeUrology #Urology___________________________________⚠️ DisclaimerThis podcast is for educational purposes only and not medical advice. The views expressed are Dr. Geo’s and not those of his employer(s) or affiliated organizations. Use of this content is at your own risk. Geovanni Espinosa, N.D., assumes no liability for direct or indirect consequences, including economic loss, injury, illness, or death.