If you’re a man in your 50s, 60s, or 70s waking up at night to pee, planning your day around bathroom access, or quietly worrying about erections and testosterone, this episode is for you. Dr. Geo sits down with Dr. Ravi Munver (Hackensack University Medical Center) to break down what’s actually driving urinary symptoms, how to tell “prostate vs bladder,” when waiting too long can permanently weaken your bladder, and how today’s BPH procedures compare—especially Aquablation (high-pressure, room-temperature waterjet therapy).

What you’ll learn in this episode

• Why BPH symptoms can start earlier than most men think (and why more men are finally talking about it)

• Why prostate size does NOT equal symptom severity (big prostate ≠ big problem… always)

• How to distinguish “prostate obstruction” vs overactive bladder—and why you can’t reliably do this without proper testing

• The “danger zone”: when untreated obstruction can lead to a weakened/crippled bladder

• Medication options: what each class does, who it’s for, and the most common side effects

• The full “toolbox” of procedures—from office-based options to the most durable surgical solutions

• Why Aquablation is changing the conversation (symptom relief + low sexual side effects + broad size range)

Episode chapters (timestamps)

00:00:00

00:02:00 Why younger men are showing up with urinary symptoms Prostate growth patterns (growth early, pause, then growth again in the 40s); increased awareness, openness, and access to information.

00:07:00 “Blame the organ you have” — prostate vs overactive bladder Why symptoms overlap; why only a clinician can truly differentiate causes.

00:10:00 When should a man see a urologist? When symptoms interfere with life (work, travel, sleep). The real issue is often difficulty returning to sleep.

00:13:00 The risk of waiting: bladder decompensation How long-term obstruction can lead to a weakened bladder and urinary retention.

00:18:00 The holistic patient scenario + why objective testing matters Why symptoms can “seem better” while retention worsens; importance of measuring PVR and other tests.

00:21:00 Medications for BPH—pros/cons

• Alpha blockers: tamsulosin (Flomax), alfuzosin, silodosin (Rapaflo)

• 5-alpha reductase inhibitors: finasteride, dutasteride

• Tadalafil (Cialis) daily 5 mg: dual benefits for BPH + erectile function

00:31:00 The modern BPH procedure toolbox TURP as the historical “gold standard,” plus lasers, robotic options, office-based procedures, and newer technologies.

00:36:00 What men care about most when choosing a procedure Incontinence risk, erectile dysfunction risk, ejaculatory changes, irritative symptoms, and durability/retreatment rates.

00:38:00 Robotic Simple Prostatectomy — what “simple” actually means Removing the obstructing inner tissue while leaving the capsule; major symptom relief for large prostates, with tradeoffs (especially ejaculation).

00:43:00Aquablation explained (high-pressure water therapy) Image-guided treatment planning + robotic waterjet tissue removal with minimal thermal damage.

00:48:00 Durability and size range Discussion of longer-term data vs TURP and why Aquablation can treat very large prostates.

00:51:00 If Aquablation isn’t available—what’s next best? How options shift based on prostate size and the priority to preserve ejaculation vs maximize durability.

00:54:00 Final guidance + where to find Dr. Munver Individualized care; find a urologist who can offer a broad set of options.

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🔹 Register FREE for the Prostate Summit 2.0:

👉 https://drtalks.com/summit/prostate-cancer/?oid=104&ref=3642&uid=918

In this special session from the upcoming Prostate Summit 2.0, Dr. Eric Zielinski sits down with Dr. Geo for a rare, vulnerable and informative conversation about the why behind his life’s work in prostate cancer care.

Key Points

• The emotional and spiritual side of working with thousands of men
• Why your why matters more than the diet, protocol, or treatment choice
• The 3 buckets of prostate cancer and why care must be personalized
• His 4 pillars of healing: lifestyle, nutrition, fitness, and stress mastery
• How fasting, cruciferous veggies, mushrooms, herbs, and targeted nutraceuticals help build resilience
• Why exercise is non-negotiable, and how sitting all day harms prostate and metabolic health

This episode blends heart, science, and practical strategy to help men live longer and better with prostate cancer.

Chapters

00:00 – Intro

02:00 – The “why” behind Dr. Geo’s work

07:00 – A powerful patient story & legacy

12:00 – The 3 buckets of prostate cancer

18:00 – Food, fasting & “It Days”

23:00 – Exercise, sitting & movement

32:00 – Mushrooms, herbs & targeted nutraceuticals

From the upcoming Prostate Summit 2.0

🔶 FREE EVENT – PROSTATE SUMMIT 2.

👉 https://drtalks.com/summit/prostate-cancer/?oid=104&ref=3642&uid=918

___________________________________

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___________________________________

Want 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

___________________________________

📺 YouTube → Dr. Geo Prostate Podcast — https://www.youtube.com/@DrGeoProstatePodcast

🎧 All Episodes → Captivate.fm Archive — https://dr-geo-prostate-podcast.captivate.fm

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Dr. Geo and Dr. Robert Caruso dive deep into what really causes urinary symptoms in men—and why prostate size alone doesn’t tell the full story. Dr. Caruso shares how his “blue zone” Italian upbringing, his 98-year-old mother, and even a family story involving a bear shaped his holistic view of urology, where diet, movement, spine health, constipation, and sleep apnea all matter.

From there, they walk through medications (alpha-blockers, 5-alpha-reductase inhibitors, daily tadalafil) and when each actually makes sense, including surprising cardiovascular and nocturia benefits of PDE5 inhibitors. The conversation then shifts to procedures: bipolar TURP vs classic TURP, and in-office options like UroLift, Rezūm steam therapy, and the newer iTind device—who they’re for, how they’re done, and what to expect for recovery, ejaculation, and long-term results. By the end, you’ll know what questions to bring to your urologist, how to think beyond “just the prostate,” and when vapor therapy or other minimally invasive treatments may be the right next step for your BPH.

Time-Stamped Highlights

00:00 – Why surgery isn’t the only answer for BPH-Dr. Geo introduces Dr. Caruso and frames the episode around minimally invasive, real-world solutions for urinary symptoms.

05:00 – Blue-zone lifestyle, Italian roots, and holistic urology-Dr. Caruso’s upbringing, his 98-year-old mother, and how growing food, movement, and nature shape his approach to men’s health.

15:00 – It’s not “just the prostate”: spine, sleep, and metabolism-How back and neck issues, constipation, diabetes, and sleep apnea can drive frequency and nocturia just as much as gland size.

25:00 – Meds that do more: tadalafil, alpha-blockers, and 5-ARIs-When daily tadalafil can help erections, BPH, and nocturia; who might benefit from alpha-blockers or finasteride/dutasteride—and who probably shouldn’t.

35:00 – From TURP to in-office options: choosing the right procedure-Bipolar TURP for large prostates and median lobes vs. office-based UroLift, Rezūm steam therapy, and iTind—what they are, how long they last, and what to ask your urologist about ejaculation, catheters, and recovery.

________________________

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💪 Exclusive Membership

Unlock curated transcripts, detailed show notes, expert resources, and perks.

Join here → https://drgeo.com/membership

📌 Follow and Connect

YouTube → https://www.youtube.com/@DrGeoProstatePodcast

All Podcast Episodes → 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

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Website → https://bit.ly/43khht0

📣 Hashtags

#EnlargedProstate #ProstateHealth #MensHealth #DrGeoEspinosa #ProstateProblems #BPH #ProstateEnlargement #UrinaryHealth #IntegrativeUrology #ProstateCancerAwareness

⚠️ Disclaimer

This episode is for educational purposes only and not medical advice. Always consult with a qualified healthcare provider. Geovanni Espinosa, N.D., assumes no liability for outcomes based on this content.

Is a big prostate really dangerous? Does it mean prostate cancer—or explain why you’re waking up at night to urinate? Not always.

In this upgraded replay, Dr. Geo breaks down the real story behind prostate enlargement why size isn’t always the issue, how bladder and nerve health factor in, and what questions to ask your doctor before starting medication or considering surgery.

🎯 You’ll Learn

✅ Why prostate size isn’t always the cause of urinary problems


✅ How the bladder and nerves affect flow and frequency


✅ When drugs like Finasteride and Dutasteride are unnecessary


✅ Why an enlarged prostate ≠ prostate cancer


✅ Smart testing options to avoid unnecessary biopsies

⏱ Chapters

00:00 Introduction — How dangerous is an enlarged prostate?


00:45 Normal vs Enlarged Prostate — Walnut vs Orange size explained


01:20 When Size Doesn’t Matter — Obstruction without enlargement


02:00 The Morning Stream Myth — Why slow flow at dawn isn’t always serious


03:00 Bladder-Prostate Synergy — The teamwork behind healthy urination


04:15 Medication Pitfalls — Finasteride & Dutasteride explained


05:30 Hair Loss & Hormones — Side effects of prostate drugs


06:00 Enlarged Prostate ≠ Cancer — Clearing up the myth


07:00 When It Can Be a Problem — Nerve compression & PAE treatment


08:00 Smarter Testing — ExoDx urine test vs PSA


08:45 Questions to Ask Your Urologist


09:30 Closing Thoughts — Live stronger, longer, and better

________________________

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💪 Exclusive Membership

Unlock curated transcripts, detailed show notes, expert resources, and perks.

Join here → https://drgeo.com/membership

📌 Follow and Connect

YouTube → https://www.youtube.com/@DrGeoProstatePodcast

All Podcast Episodes → 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

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Website → https://bit.ly/43khht0

📣 Hashtags

#EnlargedProstate #ProstateHealth #MensHealth #DrGeoEspinosa #ProstateProblems #BPH #ProstateEnlargement #UrinaryHealth #IntegrativeUrology #ProstateCancerAwareness

⚠️ Disclaimer

This episode is for educational purposes only and not medical advice. Always consult with a qualified healthcare provider. Geovanni Espinosa, N.D., assumes no liability for outcomes based on this content.

Dr. Geo speaks with cancer immunologist Matthew Halpert, PhD about Immunocine, a dendritic-cell platform that “double-loads” patient-specific tumor signals to trigger a strong, physiologic immune response. Discussion includes mechanism, prostate cancer cases, how it can complement ADT and focal radiation, eligibility, workflow, and access.

Chapters

00:00 How the Immune System Fights Prostate Cancer

02:00 Why dendritic cells matter; generals vs NK/T “soldiers”

07:00 The “double-loading” breakthrough and fail-safe concept

14:00 Trials in difficult cancers; safety and early signals

18:00 Prostate cases: CRPC responses; lesions regressing

22:00 Combining with ADT and focal radiation; timing

27:00 Critical need for viable tissue; preservation tips

34:00 Patient journey: review → tissue + apheresis → 3 doses/6 weeks

41:00 Peri-lymphatic delivery; what patients feel; follow-up/boosts

49:00 Cost, access, insurance help; foundations; closing takeaways

Key Takeaways

• Dendritic cells orchestrate immunity; NK/T cells execute.
• Precision double-loading overcomes a built-in fail-safe to amplify activation.
• Tissue access and preservation are essential for a broad, personalized target set.
• Pragmatic combination care: ADT and selective radiation can create a therapeutic window and enhance antigen presentation.

________________________

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💪 Exclusive Membership

Unlock curated transcripts, detailed show notes, expert resources, and perks.

Join here → https://drgeo.com/membership

📌 Follow and Connect

YouTube → https://www.youtube.com/@DrGeoProstatePodcast

All Podcast Episodes → 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

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Mr. Happy → https://bit.ly/3TE7tWE

Website → https://bit.ly/43khht0

📣 Hashtags

#DrGeoProstatePodcast #ProstateCancer #ProstateHealth #MensHealth #IntegrativeUrology #SBRT #Oligometastatic #RadiationOncology #PSMAPET #ADT

⚠️ Disclaimer

This episode is for educational purposes only and not medical advice. Always consult with a qualified healthcare provider. Geovanni Espinosa, N.D., assumes no liability for outcomes based on this content.

AI has existed for decades, but modern deep learning is finally delivering precision decisions in clinic. Dr. Spratt details how ArteraAI’s predictive biomarker—validated on long-term randomized data—can spare roughly two-thirds of eligible men from ADT without compromising outcomes. We unpack ADT’s quality-of-life trade-offs, practical training and nutrition strategies to preserve muscle, and where AI is headed next (post-surgery models, higher-risk disease). You’ll also hear a clear framework for shared decision-making so men are treated as people, not just numbers.

✅ AI meets prostate cancer. ArteraAI, developed by Dr. Daniel Spratt’s team, is now part of the NCCN guidelines—helping doctors know which patients truly benefit from hormone therapy.

✅ Two-thirds can skip ADT. Long-term data from the RTOG 9408 trial show most men can avoid the side effects of hormone therapy without affecting outcomes.

✅ Quality of life first. Treatments should improve survival or well-being—if they don’t, they shouldn’t be used.

✅ Lifestyle still matters. Exercise, protein, and resistance training help men on ADT preserve muscle and energy.

✅ The future is personalized. New AI models will soon guide therapy for higher-risk patients and integrate full-body health data for truly tailored care.

• 00:00 – Why AI in prostate cancer now? From buzzword to bedside with ArteraAI.
• 01:30 – Deep learning vs. “human-defined” inputs; beyond Gleason to hundreds of slide features.
• 03:10 – Landmark validation: RTOG 9408 and how the model predicts who benefits from ADT.
• 05:00 – ADT trade-offs: longevity vs. libido, energy, bone/muscle; treat only if it improves life or survival.
• 07:15 – “Exercise is medicine”: the 10-minute rule, protein targets, and resistance training on ADT.
• 09:00 – Current indication: primarily intermediate-risk (Gleason 7) men receiving radiation.
• 10:45 – What’s next: models for higher-risk and post-prostatectomy patients; shorter-course ADT questions.
• 13:00 – “Black box” & explainability: why robust external validation matters for trust.
• 15:10 – Access & coverage: ordering via online portal; CMS coverage; what patients can ask their doctors.
• 17:20 – Shared decision-making: reduce PSA anxiety; treat the person, not the number.

___________________________________

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___________________________________

Want deeper insights? Join The Dr. Geo Prostate Podcast Exclusive Membership for curated transcripts, detailed show notes, expert resources, and member perks. →...

Can high-precision radiation change how we treat metastatic prostate cancer? In this episode, I’m joined by Ronald C. Chen, MD, MPH—radiation oncologist, national guideline author (AUA/ASCO), and clinical-trial leader with 170+ publications—to unpack stereotactic body radiation therapy (SBRT) for disease that has spread to lymph nodes, bones, and beyond. We get practical about who benefits, where SBRT shines, and how to balance treatment intensity with quality of life.

SBRT offers highly focused, short-course radiation that can control limited (“oligo-”) metastatic prostate cancer and delay systemic therapy for many men. Dr. Chen explains when to treat individual nodes/bone lesions versus comprehensive nodal fields, how anatomy determines dose/fraction choices (often 3–5 treatments), and why modern SBRT sometimes reduces the need for concurrent hormone therapy. We cover salvage options after prior radiation (brachytherapy seeds, HIFU, cryo, repeat SBRT, or salvage prostatectomy), the role and limits of PSMA PET, fracture risk and bone health (DEXA), and the evolving data—including the large NRG-GU013 trial—for higher-risk disease. Throughout, we emphasize shared decision-making, realistic expectations, and considering clinical trials when data are evolving.

00:00 – Can SBRT change metastatic prostate cancer care? Meet Dr. Ron Chen.

01:00 – Disclaimer: Views are Dr. Geo’s and guests’—independent of NYU Langone.

07:00 – Recurrence scenarios: prostate-only, nodal, or bone/other; why catching early matters.

12:00 – Five salvage options after prostate radiation: seeds (brachytherapy), HIFU, cryo, SBRT (focal or whole-gland), or salvage prostatectomy.

19:00 – Nodal relapse: treat all pelvic nodes + ADT ± abiraterone vs. SBRT to a few nodes only—how patient priorities drive the plan.

26:30 – Oligometastasis: SBRT alone can control disease for many men ~2+ years on average, delaying hormones.

30:00 – Fractions: why 3–5 treatments is typical and how adjacent bowel/organ anatomy sets the pace.

31:00 – SBRT in 2 fractions for select primary cases looks promising; high-risk SBRT under study (NRG-GU013).

37:00 – Bone mets: SBRT preferred; understanding fracture risk (tumor size, dose, shrinkage).

40:00 – DEXA before ADT; spine SBRT can spare the spinal cord with modern planning.

48:00 – Clavicle/hilar nodes: SBRT near lung/heart/esophagus—safe with careful dose constraints.

56:00 – Why clinical trials matter for “how long on hormones?” and other open questions.

57:00 – Soft-tissue mets (liver/brain): SBRT can help, often alongside systemic therapy.

59:00 – Parting advice: early detection, close follow-up, and hopeful trajectory of care.

___________________________________

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Is androgen deprivation therapy (ADT) always necessary when prostate cancer patients undergo radiation? And if so, for how long—six months, a year, two years? In this insightful conversation, Dr. Geo sits down with Dr. Nima Aghdam, radiation oncologist at NY CyberKnife and NYU Langone, to explore the evolving role of ADT in prostate cancer treatment.

Dr. Aghdam shares his expertise on advanced radiation techniques like SBRT, personalized approaches to ADT duration, and the importance of lifestyle interventions. Together, they highlight how individualized care can improve survival, minimize side effects, and help men thrive beyond diagnosis.

If you or a loved one are facing decisions about radiation and hormone therapy for prostate cancer, this episode offers clarity, evidence-based guidance, and hope.

Radiation vs. Surgery: Both are highly effective; choice often comes down to quality-of-life goals and patient preference.

Lymph Node Positive Disease: Options include focal SBRT or comprehensive external beam therapy; treatment decisions must balance efficacy and quality of life.

Lifestyle’s Role: Exercise and nutrition create a “hostile microenvironment” for cancer, improving both survival and side-effect management.

Radiation Innovations: From rectal spacers to fewer treatment sessions (trials reducing SBRT from five to two fractions), techniques continue to evolve.

ADT Considerations:

Historically prescribed for up to 24–36 months with radiation.

New genomic and AI-based classifiers may allow some men to stop ADT earlier (6–12 months).

Balancing survival benefits with quality of life is critical.

PSA Anxiety: PSA fluctuations don’t always equate to recurrence or mortality. Context and long-term monitoring matter more than isolated numbers.

Finding the Right Oncologist: Beyond equipment and technology, trust and honest communication with your doctor are essential.

• 00:00 – Introduction: Is ADT always necessary during radiation?
• 05:00 – Radiation vs. surgery for localized and advanced prostate cancer.
• 10:00 – Salvage options: what happens if radiation or surgery fails?
• 13:00 – Treating prostate cancer with lymph node involvement.
• 17:00 – Communicating metastasis risk and long-term outcomes to patients.
• 18:30 – Lifestyle interventions as part of prostate cancer care.
• 21:00 – Rectal spacers and preparation for SBRT.
• 23:30 – Advances in SBRT: reducing from five fractions to two.
• 25:30 – Understanding fractions, dosage, and radiation delivery.
• 32:00 – Personalizing ADT: who benefits, and for how long?
• 36:00 – Clinical trials on ADT duration (6, 12, 18, 24+ months).
• 39:00 – Radiation’s long-lasting effects and how ADT fits in.
• 42:00 – PSA recurrence vs. actual risk of mortality
• 45:00 – Patient anxiety and the psychological impact of PSA testing.
• 47:00 – Exercise and lifestyle: evidence for improved survival.
• 49:00 – Supplements, PSA manipulation, and misinformation.
• 51:00 – How to choose a reputable radiation oncologist.
• 56:00 – Evolving evidence: are radiation-related risks lower today?
• 58:00 – Parting words: seeing prostate cancer as a chance for transformation.

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