He’s a premiere urologist and microsurgeon. Dr. Harry Fisch sits down with Dr. Oz to discuss why the penis is one of the best indicators of the male body's health. They also discuss what medications might be involved in penile dysfunction, as well as the truth about what every man needs to know about a prostate exam, and why you shouldn’t be afraid to book your appointment. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.
Having a guy tell jokes while doing a prostate exam, it's a whole different experience.
Well, you know, I'm on Howard Stern every now and then.
We just did prostate karaoke.
You know where we did an ultrasound of the prostate while people were singing?
One of the biggest segments.
But it was medically related because people really, you know, they loved hearing about that sort of thing.
Prostate karaoke.
We had five people singing while we were doing it.
I tell you, I think they hit the high notes.
They hit the high notes.
Of course they would.
Hey, everyone. everyone.
I'm Dr. Oz, and this is the Dr. Oz Podcast.
We'll see you next time.
Harry Fish, a perfect name for what he does.
One of the nation's premier urologists, microsurgeon, investigator, and a very close friend of mine.
Superb tennis player, I might point out.
Frankly, he's pretty much good at everything he does.
A clinical professor of urology and reproductive medicine at New York Presbyterian, Weill Cornell.
And one of the biggest practices taking care of Men's health, but these days, much more than that.
And I want to get into a lot of the issues that I'm getting asked questions about.
But probably the best way to lead into Harry and get a deeper understanding of this provocative individual is to talk about a recent book he wrote called Size Matters, The Hard Facts About Male Sexuality That Every Woman Should Know.
You'll notice as Harry talks that everything he says is a pun or has a double entendre.
So welcome to the show.
That is true.
Thanks, man, but I really appreciate it.
All right, let's talk a tiny bit about male sexual health, but I want to talk about the female condom that's really cool that you've gotten involved with, something that most women out there are sort of horrified by the thought of, but this thing's sort of cool, cool enough to talk about in public.
And I want to talk about prostate cancer, a downer topic that is so misunderstood, so concerning, yet 90% of men, if they live long enough, will get it.
So lots of stuff to talk about, but let's start off with the most interesting thing, the angle of the dangle.
I explained to everybody what that is, where you came up with these crazy ideas and what women need to know about male sexual health.
You know, angle of the dangle is interesting.
That was one of the first shows we did was, I said, as men get older, the penis actually is not as firm as it used to be.
So it used to point, let's say, north, and then it would point west, and by the end, it points all the way south.
So that was the angle of the dangle.
That was a nice way of saying that, geez, blood flow decreases as you get older.
By the way, it's all about blood flow, right?
And, you know, in the book, Size Matters, it's interesting that you brought that up.
That's an interesting book because it's questions and answers about sexual health and nobody knows anything about sexual health.
Now, it's not like I went to school and learned about it, but I did learn it in the practice over 25 years.
And, you know, the reason I got to tell you why I wrote that book I, you know, my, Karen, my wife, as you know, said to me years ago, she said, you got to talk to the kids about the, you know, birds and the bees, the sexual health.
Why didn't Karen do it?
She did to my daughter, to Melissa, but, you know, but not to my boys.
She goes, look, it's your turn.
You're the, you're the expert on this.
And I, I couldn't, I couldn't.
I remember I spoke to my oldest son, David.
I said, David, listen, we're at the, just finished from the jet game.
We're in the car.
I said, you know, mom wants me to talk to you about, you know, sex.
You go to Jets games?
I'm a Jet fan.
Oh my goodness.
Keep going.
But, so I said, do you have any questions?
He said, no.
I said, okay, that's it for me.
They were done, you know?
That's a fact.
That's a fact.
So I wrote the book Size Matters because it's every question and answers that adults need to know once they're having sex.
It's not like, you know, how to prevent a pregnancy or how to prevent an STD. These are the real issues that comes up in my office and, you know, things that everybody needs to know.
Because when you tell somebody, talk to your kids, you don't know what they know.
No idea.
No.
You know, you say, wait, talk to your kid.
I don't want you talking to any kid until you're qualified to have some information about this.
So that's why Size Matters was a simple book for everybody that has questions about it.
It's actually one of the best books I've ever read.
It was funny.
Full of really valuable information, but because it's on the edge, by definition, talking about stuff like this, but you smoothed it out.
You made it really accessible.
So let's get into some of the subtlety.
One thing you taught me in the book was that women blame themselves when their men have Seemingly less interest.
And they gauge less interest because the erections aren't what they used to be.
The angle of the dangle.
And you challenge that assumption, arguing that 80% of the time, maybe more, it has much more to do with the physiology of the male than the emotional connection, intimacy that he's sensing with you.
That's absolutely right.
You know, a lot of times, I remember watching TV, it was I figured it was a couple, and the guy was just clearly obese, unhealthy.
Jackie Gleason.
To the moon.
To the moon, Alice.
That's right.
It was Jackie and Alice.
But this guy was so sick, and they were talking about their sex life, how they weren't having sex, and so somebody was saying, in fact, you know the person who was saying, but I won't mention it, you need to talk a little more.
Now, communication is critical.
There's no question.
I wrote a third book, The New Naked, that talks about that.
And by the way, just my ADD, there's a chapter about communicating.
I like to tell men, there's a whole chapter, shut the F up.
Because men interrupt all the time.
And listening means not interrupting.
Anyway, that's a whole different topic.
We'll come back to that.
We'll come back, exactly.
So this person was ill, and they're talking about, well, you need to communicate more.
You need to communicate more.
You need, like, This guy has diabetes, high blood pressure, ready to die.
He's not having sex.
There's a reason.
And I always say that female sexual dysfunction is a function, many times, of male sexual dysfunction.
And men, you got to know that it exists.
It exists as you get older.
You know, testosterone declines 1% per year after age 40. Of course, if you have a bigger belly, it's a lower testosterone.
In fact, you were the one that said the penis is the dipstick of the body's health.
Now, I use that line all the time.
I thought I stole it from you.
I thought I stole it from somebody.
It wasn't my idea.
I don't know who I... I thought it was yours.
It was one of ours.
We go back a long way.
But anyway, so the point is women blame themselves because they tend to blame themselves.
But it really...
I cannot tell you how many times I see people who need, you know, medications to have an erection...
And just don't understand the physiology and don't understand how they're punishing their own bodies with the foods they're eating or the lack of exercise.
And of course, the psychological, the mental depression.
It's amazing what happens, you know, especially in New York.
I think everybody's on something, you know, for that.
So, which have side effects.
All these medications have side effects.
So, and that's why I talk about the book.
But give an example.
A guy goes and has high blood pressure and, you know, gets put on a beta blocker.
Beta block is the worst thing I see.
Yeah, it's a problem.
It's a problem for sexual function.
And yes, a lot of people do need it, but if you can get off it, it's a big deal.
If you're on an antidepressant, Prozac or Wellbutin, whatever, delays ejaculation.
Men can't ejaculate.
Now, these are things that are kind of important.
You're kidding me.
I didn't know that.
I'll give you another one.
I'll give you another one.
Sudafed.
Now you take Sudafed for your nose.
Sudafed can cause, especially if you're older, erectile dysfunction.
In fact, we give Sudafed for men who have prolonged erections.
People have that?
Well, medically induced.
You know, some people take injections.
So we give that.
So basic medications that you take and many people take can adversely affect sexual function.
And women cannot blame themselves for that.
They don't realize it.
Because the doctor doesn't have to spend the time.
That's what this show is all about, right?
That's what the Dr. I show is all about.
Giving basic information to couples, to people that they just can't get from their doctor.
The doctor's not going to spend time talking to them.
All right, but we're going to spend time with you on this.
Someone comes to your office, they've got erectile dysfunction.
They're there with their spouse.
Walk me through the workup.
I know part of it is looking at the size of their belly.
The line that I did proudly come up with was the idea that for every 35 pounds you lose, you gain one inch of length.
Because you can see it again.
And that's an epiphany that I didn't understand.
I remember sitting in my office at Columbia and you walked in there explaining it to me that the belly fat comes alive, chews up all your testosterone, converts it to estrogen, you become a chick, basically.
That's why you get man boobs.
That's right.
I call them mitts.
Mitts?
Man tits.
I'm sorry, is that allowed?
Oh, I'll call you Howard Stern.
He's gonna want to show back.
You know, I remember when I went to visit you at your office and you had bushels of pistachio nuts.
And I'm just eating it.
I can't even imagine.
I said, what are you selling this stuff?
I remember I asked you, are you selling pistachio nuts from your office?
That's right.
I just couldn't believe it.
Anyway, you do eat everything you say, you do.
I love nuts.
I always keep two in my pocket.
I don't say that in my office.
However, you make such a good point.
I could tell what the problem is about 80% of the time as the guy's walking in.
First of all, the sexual function is related, again, to weight and testosterone.
So the bigger the belly, the lower the testosterone.
Not just you can't see the pains, but the bigger the belly, the lower the testosterone.
Pure and simple.
Explain that for a second.
Explain how testosterone is made and why it's converted.
Well, we know testosterone, a lot of people may not know, but it's made in the testicles and it's converted in the belly and the fat of the body.
However, it's converted to estrogen at a much higher rate in the belly fat.
So you really, I mean, it's like a sink.
If you have a big belly, and you know, so many people have these big bellies, and you just lose your testosterone.
You lose your testosterone, guess what?
Your libido is not there.
You're not going to want to have sex.
You become like a blob.
You know, you're watching football and just eating.
I mean, I watch football, but you're just sitting on the couch, and you're just a blob, and you're falling asleep all the time.
Well, that's not a good thing.
No.
So I know that immediately when they walk in.
The other thing is...
The second thing I look for is how a couple interacts with each other.
Like...
Does the man interrupt?
Is his back to his wife or his girlfriend when they're talking?
You know, is there some sort of animosity there?
And it's easy to see it.
And if a man interrupts his wife or girlfriend on a regular basis, that's a big problem.
That's why I wrote the book and the chapter, again, as I said, shut the F up.
Because there's just no respect.
So respect is a critical part.
You know, how to have sex is also important.
Foreplay, we talk about, I always say foreplay starts in the morning, put the dishes in the dishwasher.
You know, it's not so complicated.
That's right.
That's right?
It's a 24-hour cycle for women, I'm told.
It's unbelievable.
It starts.
That's right.
Longer for some.
It's an away game.
But anyway, you know, so I see them and I examine people.
Let's say they don't have a big belly, whatever.
Nobody examines the testicles.
You know, you go to a doctor, they examine your thyroid, the liver, this, that.
Nobody's examining the most important organ in the body for men, which is the testicles.
It's right out there, hanging out.
Nobody examines them.
It's unbelievable.
You know, our internists are mutually, they're not checking.
It's nothing.
It's unbelievable.
But yet, sometimes they're hanging too low.
You know, they have varicoceleus or engorgements of the veins.
You know, I had a patient, actually it was your friend, which I won't mention.
Oh my goodness.
We have a lot of the same friends.
So this guy walks in and his testicle is by his kneecap.
And I'm going, what the hell?
I've never seen anything like that.
And he goes, yeah, it's terrible.
You know, when I sit down in the toilet, it hits the water.
I mean, what?
I mean, oh gosh.
You talk about low-hanging fruit.
It's unbelievable.
He had a huge varicose, which is an engorgement of the veins around the scrotum.
So we surgically corrected it.
And scrotum now is like absolutely normal.
He still thanks me to this day.
He goes, I just can't believe I was walking around.
It changed his life.
He was embarrassed, the whole thing.
Of course.
And plus, the heat pack, the heat of the veins decreased testosterone and sperm production.
The testicles, in fact, I had the theory that men sweat or men, the whole body really relates to the testicles because the testicles are outside the body.
They need to be cooler.
Anything that heats it up too much, like a heat pack, well, the testicle's trying to run away.
You're sweating more.
I mean, you know, so the body acts by getting rid of that testicle as far as possible to keep it cooler.
Anyway, so those are the things that I look for.
And of course, you know, the size of the testicles as well.
There's lots more to come after the break.
Let's talk about the female side of the equation.
So a lot of women are talking about hormone replacement therapy for menopause symptoms, but there's also the reality of changes in lubrication in women and the like.
I don't know if you get much into that, but I do know you get into the fertility issues.
And this female condom idea, I think, is pretty cool because it's empowering to women.
So since we're on the topic of sexuality, let's get into it.
And by the way, the product is called Female Condom.
Think about that.
Yeah.
The name of that.
No one had taken it yet?
Was still available the name?
Well, you know, as a professor of reproductive medicine at Cornell and professor of urology, two departments, I never even heard of this condom until I got involved with the company by accident.
You know, we did something by accident.
In all fairness, we...
Let me see this thing.
He's handing it to me.
Is that the actual thing there?
That's the vagina.
Oh, that's just the model.
That's the model.
I was thinking it's sort of big for a condom.
It's just the model.
Wow.
So what ends up happening, and I'll tell you, nobody has heard of the female condom, but it was developed in the 80s, and it changed over the years.
It's funny.
Becky Kurth, which you know is...
She's my doctor.
She's my doctor too.
She's tough as nails.
I asked Becky, I said, Becky, what do you tell women if they want to protect themselves against an STD? She said, you have a man wear a condom.
I said, what?
Really?
You are so empowered that you tell a man to wear a condom?
You can't trust men for this.
When a man wants to have sex, he's just thinking about sex.
He's not thinking about putting a condom on.
Distracted.
And one of the things that got me, and I'll talk a little bit more about the condom in a second, is I asked a young woman who was trying this, who was trying to get some information about that, And, uh, Mehmet is, uh, he's playing with the condom.
I just got, I finally wrestled it.
First of all, there's the box.
There's about, there must be 20 in here.
There's 12 in those.
12. This is very encouraging for a guy would buy this.
Just the thought of 12. No, women, women are buying this.
No, but what this is.
No, I thought there's gonna be one condom in this box.
There's 12 of them here.
This is much better news than I expected.
This is an internal condom.
And this, it's like a diaphragm with a sheath.
Yeah, I'll show you how to put that in.
Come here.
When I say Australia put it in, I have a vagina here.
So essentially...
It's a plastic vagina, by the way.
Some people call this a travel companion.
Oh gosh, it's terrible.
Stay focused.
It's not Howard Stern.
So you put this in, the cervix is at the other end, literally, like you're putting in a diaphragm, goes all the way in.
And that's it.
This is outside on the...
So it's a spherical structure with plastic.
There was another spherical structure.
You hold it here.
You have sex.
And then you just...
But that doesn't slide around?
No, no.
Initially, during penetration, you hold it in.
You hold the top.
The penis goes in.
And then that's it.
And then you're just having sex.
But every time you put it back in again, you've got to reattach it?
No, no, no.
Once it's in, that's it.
You're done.
It sticks there.
It sticks there.
And the amazing thing is the number one sexual...
STD is what?
It's human papillomavirus, the warts.
That's the number one.
Well, this is the only product that actually has the most coverage for HPV. Have you tried this personally at home with Karen?
You know what?
I have tried it.
It takes a little use.
You have to try it three times.
It's almost like people say it's like a tampon or contact lenses.
I don't wear contact lenses.
But you can't just tell somebody, put the contact lenses in.
Now, I'll tell you something amazing is men love this.
And there's a study from South Africa.
Of course, men love this condom.
Why?
Because they don't have to wear a condom.
And women like it because it's not made out of latex.
It's internal.
So latex is rubber, hence the term rubbers.
So this is not made out of rubber.
This is nitrile, which is the surgical gloves.
So the sensation is there.
And a lot of men do not feel...
Like there's a condom there.
What's the lubrication?
There's something in there.
Silicone lubrication.
Very simple.
So, and by the way, it's a very good point.
You said about the dryness, right?
Most women get dry.
95% of women will be dry regardless of age at one point or another.
So if you're, let's say, middle-aged, whatever that is, you know, and somebody just told me about it.
70. Three stages of life, right?
There's youth, middle-aged, and boy, you look good.
Gosh.
Gosh.
How many people have told you that?
That's not a good thing, man.
That's right.
Boy, you look good.
Boy, you look good.
Anyway, back to the lubrication.
So if you have an external condom and you have a penis thrusting in and out that's made out of rubber, it hurts.
It hurts a lot of women, particularly for anal sex as well.
It hurts.
So this is an internal condom.
So there's a lot less friction that hurts.
So women enjoy more.
Men, of course, enjoy more as well because they don't have to put a condom on.
So let me get back to what I said about Becky, where she said, well, we've been telling a man to wear a condom.
It shocked me, because women have to take care of their own reproductive health.
And the thing about not relying on men is important, because, and this is what a woman told me when they were having sex.
What do I know from young people having sex?
They said, one of the things that is remarkable about this is there's no negotiations with the man.
Because this condom is placed before you have sex.
It can be placed hours before.
But, you know, a lot of people are just before sex.
And I said, what do you mean negotiation?
He goes, well, when I'm having sex in the middle, we have to stop.
And we have to negotiate about the guy putting a condom on.
Because most guys will not wear condoms, particularly after a month in a relationship.
50% they're not wearing it.
That's why we have an STD epidemic.
But when she said, you had me at no negotiation.
Which I thought was fascinating.
So women have it on and it's done.
And that's the beauty of it.
I know you're interested in other parts of the world where there's really a problem with sexual transmitted diseases because there's no treatments available oftentimes and women have to control their own destiny because otherwise they're dealt with both the problems of unwanted children as well as infections.
Absolutely.
Before I say that, there is an STD epidemic based on the CDC in the United States.
There's 20 million new cases of STDs a year.
20 million?
20 million new.
Oh.
The word epidemic, STD epidemic, came from the CDC. I'm not saying it.
It's unbelievable.
And we're seeing a rise in just about everything.
Now, you mentioned about ex-US, right?
In Africa, we sell about 50 million of these condoms a year.
How many?
50 million.
There's four buyers, essentially.
USAID, UNFPA, the United Nations, South Africa, and Brazil.
The problem there is HIV. It's growing at an incredible rate.
Now, here's what bothers me, man.
We have mutual friends.
One of them is on the board, is in charge of the Red One Foundation.
And the Red One Foundation is all about, if people have HIV, they get AIDS, they get the virus, then they get medication for it.
Antiretroviral medication immediately.
So I said, "Hey, what about preventing HIV by using condoms?" They go, "Well, that's not our mission." So it seems to be cooler to be giving medications once you already have HIV.
You need to prevent HIV.
So that's why we're selling a lot of these through, you know, essentially free to everybody, to 110 countries around the world, essentially given by the United Nations and United States Agency for Internet Effort Development.
So it's a big deal.
But the one thing that people don't realize is in the United States, we do have that epidemic.
And one thing that's important to know, when I first got involved with this, I was wondering, well, why aren't more people know about this?
Turns out, you know, if you ever go to the pharmacies, there's 100 male condoms.
Yep, I've seen them.
Every now and then, on the bottom, you might see the female condoms.
Well, we took it off the shelves.
It's no longer there.
It's available by prescription.
So, again...
Why?
A couple of reasons.
First of all, nobody bought it off the shelves.
It was expensive, right?
It was $2 to $3, maybe more.
It was actually like $4.
And nobody knew about it, and nobody was able to really be educated about it.
Class 3 medical device.
It's available by prescription, and you can get a free prescription, by the way.
So you get a prescription, you get this mailed to you.
It's unbelievable.
We even have an app.
We developed an app with a company called HeyDoctor, H-E-Y-D-O-C-T-O-R. It's an app.
And you can get a free prescription by going there and using a code TRYIT, T-R-Y-I-T. And then you get a free prescription.
Now, they also have prescriptions for acne, for all sorts.
It's telemedicine.
Mm-hmm.
So was this a lifelong dream of you to make female condoms?
Were you in high school thinking, God, I could be the female condom king of the country?
I was in Brooklyn in the candy store thinking, how the hell do I get out of here?
That's all I was thinking.
Oh my goodness.
People say to me, why did you become a dog?
I said, I didn't want to make egg creams for the rest of my life.
That's a true story.
I mean, we had a candy store on Coney Island Avenue and I'm going, there's got to be better than that.
We have a lot more to talk about, but first, let's take a quick break.
All right, let's shift gears to the prostate.
Something that folks fear, they run from.
I've done shows ad nauseum about getting PSA tests and, oh, don't change our mind.
The government only tells you to check your prostate with PSAs.
We don't do it anymore.
Get an exam with the fingers.
Don't do an exam with the fingers.
I just want to understand.
Give us a lowdown.
If I'm 50 and healthy, what should we do?
And then walk me through what these arguments are about.
Well, first of all, 50 and healthy, I had a patient, again, everything's anecdotes, but it's true.
I had a patient who was 50 years old, and he was seeing all these doctors.
And I go, why are you seeing all these doctors?
He goes, I'm past the maintenance-free years.
Because, you know, up until like 40, you're not thinking about anything.
But at 50, that's when things happen.
It's unbelievable.
You've got to get a colonoscopy.
You've got basic sort of things.
So, you know, you definitely need a doctor that's going to do a prostate exam, most important, with a finger.
Not everybody does an ultrasound like I do, but I do both.
I examine with the finger and with the ultrasound.
And I'll give you a story that just happened last week.
But, and in terms of PSA... Why do the finger exams?
People always keep telling me not to bother, that the cancers are often inside the prostate.
You can't feel on the outside.
And you're getting a PSA test anyway, so why bother?
Well, if you feel a nodule, well, that's a bad sign.
You know, a nodule, one out of four times will be prostate cancer.
And by the way, it's already, it's a little bit late.
So, but you should examine it because you might be able to feel it.
Why is that debated?
I don't debate it.
I don't know who's debating that.
Everybody says you guys should do a prostate exam.
There's no question about that.
And doing a prostate exam, not just for the nodule, for the size of the prostate, you get some indication of the size.
I could tell you it's really not the best way.
The best way is the ultrasound.
You know, women get ultrasound.
You know, what bothers me is prostate cancer and breast cancer are the same disease.
Same incidence, same one out of six to one out of seven women get breast cancer.
One out of six, one out of seven men, depends how you, you know, will get prostate cancer.
One out of six women who get breast cancer will die of breast cancer.
One out of six men who get prostate cancer will die of prostate cancer.
It's the same sort of disease.
Women get ultrasounds, they get mammography.
Men, don't even do a rectal exam.
What are you talking about?
Well, just forget it.
Just go drop dead.
I mean, you can't say that.
But you have to know the limitations of every single test that you do.
So a prostate exam, as I just said, you can feel a nodule, maybe too late.
Sometimes the tumor can be early on and you need an ultrasound or a PSA test.
Now, before I get to the ultrasound, the PSA test can be wrong many times because PSA is elevated with an enlarged prostate and an infection.
I just had a patient who, all he does was ride a bicycle.
He rides about 100 miles a week.
And his PSA was elevated.
I said, you know why your PSA is elevated?
Because something is smacking your prostate all the time.
Every time you pedal.
Right!
And infections are very common.
Women have urinary tract infections.
Men have prostatitis.
It's the same concept.
Every time a woman has a UTI, urinary tract infection, the guy has the same bacteria in the prostate.
You know how I know that?
No.
When I finished residency, I was going to go into infertility, and I was doing semen cultures, and I worked at the Pennywise Bootoff Women's Medical Center in Long Island.
Never forget that.
So women were coming in with urinary tract infections.
I said, you know what?
I'm going to do a semen culture on all the men, because urine cultures on men...
It's diluted.
You don't pick it up.
Every time, not 90%, 50%.
100% of the time, a woman had a UTI. The man's prostate grew out the same organism.
Oh my goodness.
100% of the time.
So it sits there.
And in some minutes, it activates for whatever reason.
Body doesn't respond by getting rid of it.
And you've got a prostatitis.
A lot of men don't even know they have a prostate.
They go to the bathroom all the time.
Oh, I've got an enlarged prostate.
I've got a going problem.
Most of the time, it's an infection problem.
And they don't even know it.
So the basic things, and when you have an infection, the PSA can go up.
How do you diagnose it?
I do a semen culture.
First you do a urine culture, but a lot of times it doesn't come back positive.
I always do a semen culture.
A lot of doctors don't know how to do that, but it's not hard.
You just order a semen culture in your lab or in our lab.
We know already what to do.
And that's how I pick up STDs as well.
Because sometimes you get an STD test, it's a urine test.
I can't tell you how many times urine test comes back negative and the semen comes back positive because it's coming from the prostate.
Why bother doing a urine test?
I don't do a urine test.
I mean, I do because it's there, but if I'm doing a semen culture, you don't need that urine test.
It's more fun anyway.
That's right.
It takes the stress off of the...
So my point is, back to the prostate...
Got to get the PSA, but just understand that a big prostate will have an elevated PSA, an infection will have an elevated PSA, and prostate cancer can have an elevated PSA. But you also have to know that aggressive prostate cancer may not have an elevated PSA. Why not?
Because the most aggressive is undifferentiated.
And then it doesn't produce PSA. So the higher Gleason, the bad ones, the worst, have no elevated PSA. Oh, I thought the reason that the prostate cancer produced PSA was from irritating the prostate.
No.
It actually produces itself.
Correct.
Well, you have metastatic disease.
You've got PSA formed elsewhere.
Of course, right.
Of course.
So the highest Gleason, which is the worst prostate cancers, don't produce it.
So you have to be careful.
So what do I do differently?
I do an ultrasound of the prostate.
And we just said, you know, Woody, the person you were just interviewing before, We had a patient in common.
He had an elevated PSA. Prostate looks okay.
I biopsied him.
Five years ago, buy nothing PSA. Every year I do an ultrasound on him.
I picked up a five millimeter.
Five millimeter.
Look at my fingernails.
It's one centimeter.
It's half of my fingernail.
In a big prostate, we saw something abnormal.
We biopsied it.
He had high-grade cancer just in that spot, nowhere else.
This is where technology is really helpful.
His life...
This is not wood.
What is this?
You got wood anywhere?
No, not wood.
You're in the studio.
It's too flammable.
Back of my head.
Good point.
So the point is, his life may very well be spared because we did the ultrasound biopsy and found it very early.
And, you know, I still get chills about that because we found it.
It may not be cost-effective.
You know, maybe Medicare is not, but that's how you're going to pick it up.
So real quick, so a guy goes to a doctor.
He gets examined with the fingers.
Odds are he's not going to find anything that's all that life's changing, but it might.
He gets the PSA test.
It comes back high.
He's not the panic.
What do you do?
Oh, first thing I do, I get a urine culture and a semen culture, right?
And then I discuss his symptoms because he may be going to bed.
Is he riding a bicycle?
Right?
And also, on the ultrasound or the finger, you want to know how big the prostate is.
Because a big prostate can cause...
But let's assume he doesn't have a big prostate.
The first question I ask is, does he have a urinary tract infection?
I say, does your wife or girlfriend, does she have urinary tract infections?
It happens all the time.
Right.
So you have to really eliminate that.
I usually treat them with antibiotics, even if it does not come back positive.
And then I see if the PSA goes down.
I also do a test called a 4K score test, which is a PSA on steroids, if you will.
K is calocrine.
So PSA is a calocrine protein for calocrine proteins.
It gives you a much better indication whether you have a cancer that will kill you or not.
So a lot of times if I get an elevated PSA, I'll treat with antibiotics or look for an infection.
And then I'll also get the 4K score test.
All right.
So let's say that all comes back suspect.
You're not sure what's going down.
Then you go for the biopsies.
Correct.
And you take six needle holes.
Twelve.
Twelve now.
Twelve shots.
And it comes back and you try to get...
Now, whenever I have a friend who's going through this, one of them always comes back borderline.
Gleason 6. Gleason 6. Right, right, right.
And I've been saying this for a long time.
We've had a conversation about that years ago.
Gleason 6 is like DCIS and breast cancer.
A lot of times...
Just explain what DCIS is.
Carcinoma in situ in the breast is that things are changing.
When we were residents years ago, and we trained in different places, but we were doing mastectomies all the time on probably things that were not cancer, right?
They were fearful they could become cancer.
That's right.
We thought they were on the edge of cancer, but they were thinking about cancer only.
That's correct.
We should have named them something else.
So Gleason 6, a lot of times, is not cancer, right?
And I'm not even sure that we should be calling it cancer.
In Canada, they don't consider it cancer at all.
What do they call it?
Not cancer.
They call it Gleason 6, but they want to make a point that if you could watch something.
It's not cancer if you could watch it, right?
So it's watchful waiting and looking and making sure that the prostate does it.
But the more we've done that, the more we realize men don't die of Gleason 6 prostate cancer.
Do Gleason 6s get better and go away?
No, they don't go away.
So you just have it for the rest of your life, but it doesn't cause it?
That's correct.
But you better keep following up because like this patient I was just talking to before, he did have a Gleason 6 in a different location and I biased him and he had a Gleason 8 on the other one.
So a lot of times a Gleason 6 is people go, I got cancer, I got to go take it out.
No, that's not true.
Gleason 7s are the ones, and 40% of quote-unquote prostate cancer is Gleason 6. Think about that, guys.
It's almost half of all the people who think they've got prostate cancer have something that you're telling me watchful waiting might be better.
Do you ever operate and take out a Gleason 6 cancer?
I don't.
First of all, I don't do prostate cancer surgery anymore, but the point is most people are not doing it right now.
Most people are doing watchful waiting.
In fact, Because there's complications with the surgery.
That's the important thing.
But if you have a Gleason 7 or Gleason 8, which is bad, we picked up Gleason 10s, and these are bad, but most of them are going to be Gleason 7s.
Those need to be removed if you're young and you have at least a lifespan of 10, 15 years.
Like, a lot of people say, well, should I get radiation therapy?
Well, how long do you want to live?
Like, so many times we see people who have radiation therapy and have side effects from it, and then the prostate comes back 10 years later, and then you're really in trouble.
Right, right.
So, as you see it, are we headed in the right direction with prostate treatment in America?
The treatment, yes.
The biggest advances has been in metastatic prostate cancer, by the way, which is kind of interesting.
All the chemotherapies, which are, in fact, I'm involved with a company called Veru, V-E-R-U, and we're starting our clinical trials in Johns Hopkins in August, September, where we have an oral medication, which is an antitubulant.
I don't want to get too fancy, but it's It's a chemotherapy like docetaxel, which is intravenous.
This is an oral medication for metastatic prostate cancer.
And a lot of the advances have been in earlier treatment of metastatic.
So in that respect, treatment is better.
But Mehmet, as you know, it's all in avoiding prostate cancer.
Do anything you can to avoid it.
That's where the treatment needs to be.
And that's where we're not there yet.
That's what we like.
Your question, should we do a PSA, rectal exam, ultrasound?
Yes, yes, and yes.
Because we want to avoid prostate cancer because it's a killer.
The secret to making the best egg cream.
I do know the secret.
I know.
You're a Coney Allen boy.
What is it?
I do know because, you know, growing up in Brooklyn, And my father had a candy store on Avenue N in Coney Island Avenue, and I worked there, and, you know, it was 25 cents a net cream.
And you don't see those stores, the candy stores anymore.
There's a few in the city.
There's the Lexington Coffee Shop on Lexington 83rd.
He actually knows how to make a net cream.
First thing you got to do is, and it's...
It was bad.
I don't want to say bad.
It's almost like I... It's like a magic trick.
I don't...
I'm scared of telling you.
Oh, please.
But I'm going to tell you.
No one's going to hear.
No one's going to know.
It's just me and you.
You have to use a glass.
First of all, it has to be a glass cup, you know, cup, whatever, not styrofoam.
The milk has to be a high fat content.
So it's a mixture between whole milk and half and half.
Okay.
You put it together.
It has to be semi-frozen.
Then you put the seltzer in.
In this order.
Then you put the chocolate syrup.
And then you stir it.
And you don't sip it.
I'm not from Greenwich, Connecticut.
I'm from Brooklyn.
You drink it.
You know what I mean?
And it's just, it's the best.
There's no question.
So how did the word egg get in there then?
If it's egg cream, but there's no egg in it.
That's a good point.
There was an article in New York Times years ago.
I always thought of that because being an expert on egg creams.
That's right.
Years ago, there was an egg in it.
Years ago.
Oh, there was.
Yeah, the New York Times wrote about that.
I can't verify that.
And if anybody knows better than me, but the New York Times did a story years ago used to be an egg in it.
All right.
Not complicated.
Now, let me hear your best new joke.
This guy, I'll tell you, when you go off on a trip, if we travel together, you just turn it over to Harry, he'll keep you going.
The best joke that you're allowed to tell.
You know, I have...
Can I tell two quick jokes?
One is Lisa's joke, which I think is the best.
Your wife has the best joke.
And I stole it, so I'm going to tell it as though it's my joke.
I did a prostate exam on a person, and as I was doing it, there was a piece of lettuce sticking out of the butt.
And I said, Joe, you know, you got a piece of lettuce sticking out of your butt.
He goes, ah, that's the tip of the iceberg.
Oh, gosh.
That's my wife's joke?
That's Lisa's joke.
Oh, please.
She's the most demure, innocent.
I'll tell you one you can tell on, you know, on radio.
The last one's going to get chopped.
And it's actually, it is a, you know, you might not be able to, but I think you will be able to.
So a couple just gets married and they never had sex before.
So they're going to their hotel room and they're going to have sex and the guy's taking his clothes off and...
And he takes his shoes and socks off, and the wife says, my toes look mangled.
I said, what's the matter with your toes?
He says, when I was a kid, I had Tolio.
I said, Tolio?
You mean polio?
He goes, no, Tolio.
That's why the toes look like that.
Okay, fine.
Takes his pants off.
His knees are mangled.
She goes, what's with your knees?
He goes, well, when I was a kid, I had measles.
He goes, measles?
You mean measles?
He goes, no, measles.
That's why my knees look like that.
Takes his underwear off.
She says, don't tell me.
Small cocks.
Ha ha ha!
Broom, boom.
Harry Fish, meteorologist extraordinaire, innovator, inventor, lots of other great things.
Thanks for all the people you've taken care of, the lives you've saved, for sharing with us a little bit of the secrets of how you take care of all kinds of problems that men come to you with.
