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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⚠️ 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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⚠️ 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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___________________________________

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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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What if prostate cancer surgery meant fewer incisions, faster recovery, and more precise cancer control? Today I’m joined by Dr. Michael D. Stifelman, Chair of Urology at Hackensack University Medical Center and a pioneer in robotic surgery with 4,000+ robotic procedures. We unpack how single-port robotics, real-time margin assessment, and AI are reshaping outcomes—while protecting continence and erections.

Dr. Stifelman traces robotics from the early-2000s “pioneer phase” (and heavy skepticism) to today’s standard of care, explaining why reproducibility, visualization, and tissue-sparing dexterity made the difference. We compare surgery vs. radiation (and focal therapies), when each shines, and why sequencing often matters—especially in higher-risk disease. He shares emerging tech like single-port prostatectomy, intra-operative margin evaluation (e.g., Histo-style scanning), quantitative surgical analytics, and even remote robotic assistance. We also talk “trifecta” outcomes, the role of genomics in Gleason 7 decision-making, and why lifestyle medicine and optimizing the tumor micro-environment go hand-in-hand with any treatment.

Time-Stamped Highlights

00:00 – Why fewer incisions + faster recovery are now real in prostate surgery

05:40 – Work–life changes that improved health (sleep, exercise, biking)

09:10 – Open vs. robotic: why reproducibility (teachability) matters

11:05 – Robotics adoption curve: from early resistance to mainstream

19:05 – Outcomes today: continence and erections after modern surgery

20:10 – “Yes, I’m a surgeon—and here’s my bias.” Radical honesty with patients

22:05 – Offering the full menu: surveillance, focal (HIFU/cryotherapy), surgery, SBRT, proton

25:40 – High-risk (Gleason 8–9): why surgery-first can preserve options & avoid long ADT

34:00 – Dexterity & visualization: why robots spare nerves with less trauma

35:10 – Real-time margin assessment during surgery to reduce positives

40:00 – The “trifecta” (cancer control, continence, erections) and patient priorities

42:10 – Genomics to risk-stratify Gleason 7 and guide surveillance vs. treatment

45:00 – Future: nerve activation mapping & fluorescence to “light up” cancer

46:10 – Single-port prostatectomy: smaller access, faster return of function (select patients)

49:00 – Quantifying surgery with analytics; tele-mentoring & remote console potential

52:30 – How to find Dr. Stifelman & closing advice

___________________________________

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___________________________________

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___________________________________

📌 Follow and Connect

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What if prostate cancer treatment weren’t months of daily radiation—but five ultra-precise sessions guided in real time by MRI? Today, Dr. Michael J. Zelefsky (Professor of Radiation Oncology, NYU Grossman School of Medicine) explains how MRI-LINAC and adaptive planning are redefining accuracy, reducing side effects, and personalizing care. A pioneer behind IMRT and image-guided radiotherapy, Dr. Zelefsky breaks down SBRT vs. IMRT, protons vs. photons, HDR brachytherapy, when to add hormone therapy, and how genomics + AI are shaping what’s next.

In this conversation, Dr. Zelefsky charts the evolution from long-course radiation to short-course SBRT with outcomes comparable to 7–9 week regimens—thanks to precision imaging and planning. He clarifies where IMRT ends and SBRT begins, why protons haven’t shown superiority over photons in prostate cancer, and where HDR brachytherapy (Ir-192) shines—especially as a boost in higher-risk disease. We dig into dose equivalence (why 5×8 Gy can match ~80–90 Gy long-course), risk-based treatment + ADT duration, and how Decipher/Artera scores can refine decisions. Most exciting: MRI-LINAC with continuous motion monitoring keeps the prostate in a virtual “bullseye,” enabling whole-gland treatment with focal boosts today—and potentially true focal therapy tomorrow as biologic imaging and AI mature.

Time-Stamped Highlights

00:00 – Welcome

02:00 – Why Dr. Zelefsky’s work is so respected; career arc and impact

04:00 – What changed: CT/MRI planning → 3D-CRT → IMRT → SBRT

12:45 – IMRT vs. SBRT: definitions, session counts, who gets what

19:10 – Energy sources overview: photons, protons, brachytherapy

20:30 – Protons vs. photons: evidence, indications, cost, access

24:00 – HDR brachytherapy (Ir-192) as a temporary “in-and-out” boost

28:00 – Dose logic: why 5×8 Gy (~40 Gy) ≈ long-course 80–90 Gy

29:30 – Risk groups (low/intermediate/high) and when ADT is crucial

33:00 – ADT durations (6–36 months): what trials actually showed

37:00 – Genomics (Decipher/Artera): resolving risk discrepancies

39:00 – What MRI-LINAC adds: real-time adaptive planning

43:00 – Continuous Motion Monitoring (CMM): beam stops if target moves

47:00 – Treat whole gland + boost the DIL (FLAME study approach)

49:00 – Toward focal therapy with better biologic imaging + AI

54:00 – How to choose: values, side-effects, lifestyle, comorbidities

01:01:00 – Final guidance: don’t be overwhelmed—multiple good option

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HIFU (high-intensity focused ultrasound) is one of the most talked-about focal therapies in prostate cancer—but who is it really right for? In this conversation, Dr. Matthew Cooperberg (UCSF)—a leading voice in urology, epidemiology, and integrative prostate cancer care—breaks down patient selection vs. energy modality, how modern imaging (MRI, fusion, RSI) drives precision, what genomics (e.g., Decipher) can and can’t tell us, and how salvage options compare after focal therapy vs. radiation. We also tackle lifestyle factors, trial design, and why midlife PSA screening (ideally <1 between ages 45–55) remains crucial.

👉 View more at DrGeo.com

00:00 – Welcome + episode setup (HIFU overview, aims of focal therapy)

04:10 – The real first question: Who is a candidate? (selection > modality)

05:10 – What “focal therapy” means (lesion-only, margin, hemi-ablation) + imaging progress

06:25 – Recurrence after focal therapy: targeting, dose, or biology? Follow-up biopsies

07:40 – Genomics (Decipher): predicting recurrence; how results change counseling

09:30 – Lifestyle & microenvironment: can diet/exercise influence outcomes?

11:00 – Salvage after focal vs. radiation: fibrosis, feasibility, quality of life

14:00 – Cryotherapy vs. HIFU: image guidance, control, and why HIFU advanced

16:00 – Imaging upgrades (MRI fusion, RSI, C-13 spectroscopy) and treatment constraints

17:00 – IRE (irreversible electroporation): role for apical tumors, early results

18:00 – TULSA, water/thermal concepts, focal radiation, partial prostatectomy: what’s known

20:00 – Smarter trials: active surveillance ± focal therapy for borderline cases

22:00 – The counseling hierarchy: decision first, technology second

24:30 – Proton vs. photon incentives; why advertising confuses choices

26:30 – UCSF’s program: mostly HIFU; where IRE fits; adding new machines prudently

28:30 – The real bottleneck: sub-millimeter targeting; AI-guided ablation future

33:00 – HIFU mechanics: probe size, apex/anterior reach, distance constraints

35:00 – “I want HIFU for Gleason 8”: agency, nuance, and when we advise against it

38:00 – A cautionary case: negative biopsy → later mets—what it teaches us

40:30 – Millennials, risk tolerance, and why PSA at 45–55 (<1 is ideal) matters

44:00 – Growth vs. spread: which high-grade tumors can we treat focally?

46:00 – How low vs. high genomic scores tilt decisions (and their limits)

47:30 – Where to find Dr. Cooperberg + parting PSA advice

___________________________________

ProLon 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/3TVehAx

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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. →