The Dr. Geo Prostate Podcast

🔹 Register FREE for the Prostate Summit 2.0:👉 https://drtalks.com/summit/prostate-cancer/?oid=104&amp;ref=3642&amp;uid=918In 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 PointsThe emotional and spiritual side of working with thousands of menWhy your why matters more than the diet, protocol, or treatment choiceThe 3 buckets of prostate cancer and why care must be personalizedHis 4 pillars of healing: lifestyle, nutrition, fitness, and stress masteryHow fasting, cruciferous veggies, mushrooms, herbs, and targeted nutraceuticals help build resilienceWhy exercise is non-negotiable, and how sitting all day harms prostate and metabolic healthThis episode blends heart, science, and practical strategy to help men live longer and better with prostate cancer.Chapters00:00 – Intro02:00 – The “why” behind Dr. Geo’s work07:00 – A powerful patient story &amp; legacy12:00 – The 3 buckets of prostate cancer18:00 – Food, fasting &amp; “It Days”23:00 – Exercise, sitting &amp; movement32:00 – Mushrooms, herbs &amp; targeted nutraceuticalsFrom the upcoming Prostate Summit 2.0🔶 FREE EVENT – PROSTATE SUMMIT 2.👉 Register here: ⬇️👉 https://drtalks.com/summit/prostate-cancer/?oid=104&amp;ref=3642&amp;uid=918___________________________________🌱 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<a...

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 Highlights00:00 – 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.________________________🌱 Partner OffersProLon 5-Day Fasting Mimicking Diet → https://bit.ly/3TVehAxAG1 by Athletic Greens → https://bit.ly/3mA2tVV💪 Exclusive MembershipUnlock curated transcripts, detailed show notes, expert resources, and perks.Join here → https://drgeo.com/membership📌 Follow and ConnectYouTube → https://www.youtube.com/@DrGeoProstatePodcastAll Podcast Episodes → https://dr-geo-prostate-podcast.captivate.fmInstagram → https://bit.ly/DRGEO-INSTA-YTFacebook → https://bit.ly/POD-FB-DrGeoLinkedIn → https://bit.ly/DRGEO-LINKEDIN-YTXY Wellness Supplements → https://bit.ly/3uJPC7ZMr. Happy → https://bit.ly/3TE7tWEWebsite → https://bit.ly/43khht0📣 Hashtags#EnlargedProstate #ProstateHealth #MensHealth #DrGeoEspinosa #ProstateProblems #BPH #ProstateEnlargement #UrinaryHealth #IntegrativeUrology #ProstateCancerAwareness⚠️ DisclaimerThis 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⏱ Chapters00:00 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 &amp; Dutasteride explained
05:30 Hair Loss &amp; 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 &amp; 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________________________🌱 Partner OffersProLon 5-Day Fasting Mimicking Diet → https://bit.ly/3TVehAxAG1 by Athletic Greens → https://bit.ly/3mA2tVV💪 Exclusive MembershipUnlock curated transcripts, detailed show notes, expert resources, and perks.Join here → https://drgeo.com/membership📌 Follow and ConnectYouTube → https://www.youtube.com/@DrGeoProstatePodcastAll Podcast Episodes → https://dr-geo-prostate-podcast.captivate.fmInstagram → https://bit.ly/DRGEO-INSTA-YTFacebook → https://bit.ly/POD-FB-DrGeoLinkedIn → https://bit.ly/DRGEO-LINKEDIN-YTXY Wellness Supplements → https://bit.ly/3uJPC7ZMr. Happy → https://bit.ly/3TE7tWEWebsite → https://bit.ly/43khht0📣 Hashtags#EnlargedProstate #ProstateHealth #MensHealth #DrGeoEspinosa #ProstateProblems #BPH #ProstateEnlargement #UrinaryHealth #IntegrativeUrology #ProstateCancerAwareness⚠️ DisclaimerThis 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.Chapters00:00 How the Immune System Fights Prostate Cancer02:00 Why dendritic cells matter; generals vs NK/T “soldiers”07:00 The “double-loading” breakthrough and fail-safe concept14:00 Trials in difficult cancers; safety and early signals18:00 Prostate cases: CRPC responses; lesions regressing22:00 Combining with ADT and focal radiation; timing27:00 Critical need for viable tissue; preservation tips34:00 Patient journey: review → tissue + apheresis → 3 doses/6 weeks41:00 Peri-lymphatic delivery; what patients feel; follow-up/boosts49:00 Cost, access, insurance help; foundations; closing takeawaysKey TakeawaysDendritic 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.________________________🌱 Partner OffersProLon 5-Day Fasting Mimicking Diet → https://bit.ly/3TVehAxAG1 by Athletic Greens → https://bit.ly/3mA2tVV💪 Exclusive MembershipUnlock curated transcripts, detailed show notes, expert resources, and perks.Join here → https://drgeo.com/membership📌 Follow and ConnectYouTube → https://www.youtube.com/@DrGeoProstatePodcastAll Podcast Episodes → https://dr-geo-prostate-podcast.captivate.fmInstagram → https://bit.ly/DRGEO-INSTA-YTFacebook → https://bit.ly/POD-FB-DrGeoLinkedIn → https://bit.ly/DRGEO-LINKEDIN-YTXY Wellness Supplements → https://bit.ly/3uJPC7ZMr. Happy → https://bit.ly/3TE7tWEWebsite → https://bit.ly/43khht0📣 Hashtags#DrGeoProstatePodcast #ProstateCancer #ProstateHealth #MensHealth #IntegrativeUrology #SBRT #Oligometastatic #RadiationOncology #PSMAPET #ADT⚠️ DisclaimerThis 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.Key Points✅ 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.⏱️ Time-Stamped Highlights00:00 – 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” &amp; explainability: why robust external validation matters for trust.15:10 – Access &amp; 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.___________________________________🌱 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. →...

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.___________________________________🌱 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...

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.Timestamps00:00 – 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 mortality45:00 – 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.___________________________________🌱 Partner OffersProLon 5-Day Fasting Mimicking Diet — Enjoy fasting benefits with food. Supports cellular...

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 Highlights00:00 – Why fewer incisions + faster recovery are now real in prostate surgery05:40 – Work–life changes that improved health (sleep, exercise, biking)09:10 – Open vs. robotic: why reproducibility (teachability) matters11:05 – Robotics adoption curve: from early resistance to mainstream19:05 – Outcomes today: continence and erections after modern surgery20:10 – “Yes, I’m a surgeon—and here’s my bias.” Radical honesty with patients22:05 – Offering the full menu: surveillance, focal (HIFU/cryotherapy), surgery, SBRT, proton25:40 – High-risk (Gleason 8–9): why surgery-first can preserve options &amp; avoid long ADT34:00 – Dexterity &amp; visualization: why robots spare nerves with less trauma35:10 – Real-time margin assessment during surgery to reduce positives40:00 – The “trifecta” (cancer control, continence, erections) and patient priorities42:10 – Genomics to risk-stratify Gleason 7 and guide surveillance vs. treatment45:00 – Future: nerve activation mapping &amp; fluorescence to “light up” cancer46:10 – Single-port prostatectomy: smaller access, faster return of function (select patients)49:00 – Quantifying surgery with analytics; tele-mentoring &amp; remote console potential52:30 – How to find Dr. Stifelman &amp; closing advice___________________________________🌱 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...

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 Highlights00:00 – Welcome 02:00 – Why Dr. Zelefsky’s work is so respected; career arc and impact04:00 – What changed: CT/MRI planning → 3D-CRT → IMRT → SBRT12:45 – IMRT vs. SBRT: definitions, session counts, who gets what19:10 – Energy sources overview: photons, protons, brachytherapy20:30 – Protons vs. photons: evidence, indications, cost, access24:00 – HDR brachytherapy (Ir-192) as a temporary “in-and-out” boost28:00 – Dose logic: why 5×8 Gy (~40 Gy) ≈ long-course 80–90 Gy29:30 – Risk groups (low/intermediate/high) and when ADT is crucial33:00 – ADT durations (6–36 months): what trials actually showed37:00 – Genomics (Decipher/Artera): resolving risk discrepancies39:00 – What MRI-LINAC adds: real-time adaptive planning43:00 – Continuous Motion Monitoring (CMM): beam stops if target moves47:00 – Treat whole gland + boost the DIL (FLAME study approach)49:00 – Toward focal therapy with better biologic imaging + AI54:00 – How to choose: values, side-effects, lifestyle, comorbidities01:01:00 – Final guidance: don’t be overwhelmed—multiple good option🌱 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. → <a...

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 &lt;1 between ages 45–55) remains crucial. 👉 View more at DrGeo.com00:00 – Welcome + episode setup (HIFU overview, aims of focal therapy) 04:10 – The real first question: Who is a candidate? (selection &gt; 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 &amp; 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 (&lt;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___________________________________🌱 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. →<a href="https://drgeo.com/membership?utm_source=chatgpt.com" rel="noopener...