The Dr. Geo Prostate Podcast

The biggest mistake after prostate cancer treatment may be waiting for erections to “come back” on their own.
Dr. John Mulhall of Memorial Sloan Kettering has spent three decades in sexual medicine, sees roughly 600 prostatectomy patients a year, and served as a senior author on sexual-medicine guidelines. His central message: recovery is a race to protect erectile tissue while nerves heal. After prostatectomy, erection nerves can remain functionally “asleep” for months. During that window, reduced blood flow, oxygenation and stretch can allow penile smooth muscle to deteriorate and be replaced by collagen-rich scar tissue. Radiation follows a different pattern: function may look preserved at first, then decline over two to three years as vascular injury develops.
In this episode, you’ll learn...
Why penile rehabilitation is about preserving tissue, not simply taking a daily pill.
How surgery, radiation, and ADT disrupt erections through different biological pathways.
Why sleep apnea, diabetes, and very low testosterone can reduce recovery.
How reducing performance pressure can rebuild sexual confidence.

📚 Chapters
00:00 Sex Recovery Starts Early
05:28 Why Erections Fail
07:36 Radiation And ADT Effects
11:07 Collagenization Explained
12:39 Modern Penile Rehab Plan
16:14 Choosing A Prostate Surgeon
19:49 Orgasms After Prostatectomy
21:38 Erection Recovery Timeline
24:19 Confidence And Intimacy
34:34 Injection Safety Standards
40:48 Testosterone Before Treatment
45:24 ADT Risks and PSA Monitoring
56:32 When to Consider Implants
59:37 Choosing the Right PDE5 Pill
01:01:23 Trials and Where to Find John
This is the conversation men need before treatment—not months after sexual function has already changed.
Dr. Mulhall X handle@saveyoursexlife
Website: Dr. John Mulhall - MSKCC
📕 Get Dr. Geo’s Free Ebook- A Guide to Improve Prostate Problems Naturally https://bit.ly/DRGEOFreeEbook
📌Thank You To Our Sponsors
Sponsored by PathRight Medical. This episode's guest, Dr. Landon Trost, is the majority owner of PathRight Medical, manufacturer of RestoreX® and RestoreXL®. Dr. Geo Media retains editorial control over the interview and its independent clinical content.
Find the Right Device for You linked to https://bit.ly/3VnIsU0.
___________________________________
💪 Exclusive Membership
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
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📌 Dr. Geo’s Social Media and Websites
📺 YouTube → Dr. Geo Prostate Podcast — https://www.youtube.com/@DrGeoProstatePodcast
🎧 All Episodes → Captivate.fm Archive — https://dr-geo-prostate-podcast.captivate.fm
📸 Instagram → https://bit.ly/DRGEO-INSTA-YT
📘 Facebook → https://bit.ly/POD-FB-DrGeo
💼 LinkedIn → https://bit.ly/DRGEO-LINKEDIN-YT
🛒 Supplements → XY Wellness https://bit.ly/3uJPC7Z | Mr. Happy https://bit.ly/3TE7tWE
🌐 DrGeo.com Website → https://bit.ly/43khht0
📣 Hashtags
#DrGeoProstatePodcast #ProstateHealth #ProstateCancer #MensHealth #IntegrativeUrology #Urology
___________________________________
⚠️ Disclaimer
This podcast is for educational purposes only and not medical advice. The views expressed are Dr. Geo’s and not those of his employer(s) or affiliated organizations. Use of this content is at your own risk. Geovanni Espinosa, N.D., assumes no liability for direct or indirect consequences, including economic loss, injury, illness, or death.

What causes Peyronie’s disease? Can penile curvature be reversed without surgery? And what actually works to restore lost penile length?
In this episode of the Dr. Geo Prostate Podcast, Dr. Geo Espinosa welcomes Dr. Landon Trost, former Chief of Andrology at Mayo Clinic and a leading researcher in Peyronie’s disease and men's sexual health.
Together, they separate science from misinformation and explore the latest research on Peyronie’s disease, Xiaflex injections, RestoreX penile traction therapy, and why early intervention may make a significant difference.
Dr. Trost also shares the research behind combining Xiaflex with RestoreX, why some commonly recommended treatments lack convincing evidence, and what men should understand before considering surgery.
Whether you've recently noticed penile curvature, are experiencing lost length, or are exploring treatment options, this conversation offers valuable insights to help you make more informed decisions about your sexual health.
IN THIS EPISODE, YOU'LL LEARN:
What causes Peyronie’s disease and how genetics may contribute.
The connection between Peyronie’s disease and Dupuytren’s contracture.
Why popular remedies like pentoxifylline, castor oil, and manual stretching may not deliver the results men expect.
When penile curvature requires treatment and why early intervention matters.
How erectile quality and penile trauma may influence risk.
How Peyronie’s disease is diagnosed.
The science behind Xiaflex injections and RestoreX traction therapy.
What clinical trials reveal about restoring lost penile length.
How often RestoreX was used in clinical studies and how long improvements may last.
The potential side effects of Xiaflex and when surgery may be considered.
The psychological impact of Peyronie’s disease and the future of treatment.

📚 Chapters
00:00 Introduction: Can Peyronie’s Disease Be Reversed?
01:40 Meet Dr. Landon Trost
06:30 What Causes Peyronie’s Disease?
07:50 Genetics and Dupuytren’s Contracture 09:15 Common Myths and Ineffective Treatments
15:20 When Does Penile Curvature Need Treatment?
16:50 Why Early Treatment Matters
20:00 Can You Prevent Peyronie’s Disease?
25:30 How Peyronie’s Disease Is Diagnosed
28:00 Early Treatment Options
31:00 Traction Therapy and Restoring Lost Length
32:30 Why Xiaflex + RestoreX Work Better Together
38:15 The Science Behind RestoreX
41:15 How Often Should You Use RestoreX?
🎙️ GUEST
Dr. Landon Trost Clinic - https://malefertilityandpeyroniesclinic.com/about/
Peyronies.com - https://malefertilityandpeyroniesclinic.com/peyronies/
Goniometer - https://en.wikipedia.org/wiki/Goniometer
📕 Get Dr. Geo’s Free Ebook- A Guide to Improve Prostate Problems Naturally https://bit.ly/DRGEOFreeEbook
📌Thank You To Our Sponsors
Sponsored by PathRight Medical. This episode's guest, Dr. Landon Trost, is the majority owner of PathRight Medical, manufacturer of RestoreX® and RestoreXL®. Dr. Geo Media retains editorial control over the interview and its independent clinical content.
Find the Right Device for You linked to https://bit.ly/3VnIsU0.
📌 Dr. Geo’s Social Media and Websites
Instagram: https://bit.ly/DRGEO-INSTA-YT
Facebook: https://bit.ly/POD-FB-DrGeo
LinkedIn: https://bit.ly/DRGEO-LINKEDIN-YT
Website: https://bit.ly/43khht0
XY Wellness- Prostate Health Supplements - https://bit.ly/3uJPC7Z
Mr. Happy- Supplements for Men- https://bit.ly/3RJMX6O
___________________________________
💪 Exclusive Membership
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
___________________________________
📌 Follow and Connect
📺 YouTube → Dr. Geo Prostate Podcast — https://www.youtube.com/@DrGeoProstatePodcast
🎧 All Episodes → Captivate.fm Archive — https://dr-geo-prostate-podcast.captivate.fm
📸 Instagram → https://bit.ly/DRGEO-INSTA-YT
📘 Facebook → https://bit.ly/POD-FB-DrGeo
💼 LinkedIn → https://bit.ly/DRGEO-LINKEDIN-YT
🛒 Supplements → XY Wellness https://bit.ly/3uJPC7Z | Mr. Happy https://bit.ly/3TE7tWE
🌐 DrGeo.com Website → https://bit.ly/43khht0
___________________________________
📣 Hashtags
#DrGeoProstatePodcast #ProstateHealth #ProstateCancer #MensHealth #IntegrativeUrology #Urology
___________________________________
⚠️ Disclaimer
This podcast is for educational purposes only and not medical advice. The views expressed are Dr. Geo’s and not those of his employer(s) or affiliated organizations. Use of this content is at your own risk. Geovanni Espinosa, N.D., assumes no liability for direct or indirect consequences, including economic loss, injury, illness, or death.

Before prostate surgery, there are 3 questions you should ask your surgeon—and “How many surgeries have you done?” isn’t enough.
In this episode of The Dr. Geo Prostate Podcast, Dr. Geo sits down with renowned prostate cancer surgeon Dr. Jim Hu, Ronald P. Lynch Professor of Urologic Oncology at Weill Cornell Medicine, Vice Chair of Clinical Research, and Director of the LeFrak Center for Robotic Surgery.
The conversation starts where many prostate cancer journeys begin: an elevated PSA.
Do you really need a biopsy? Should you get an MRI first? What about PSA density, the 4Kscore, or newer urine tests? And if a biopsy is necessary, should you choose transperineal instead of transrectal biopsy?
Dr. Hu explains why he now favors the transperineal approach and discusses findings from the PREVENT and UK TRANSLATE trials, including infection risk, antibiotic use, cancer detection, pain, and the learning curve physicians face when adopting the procedure.
Then the conversation turns to one of the biggest decisions a man with prostate cancer may ever make:
Surgery or radiation?
And if you choose surgery, how do you know whether your surgeon is actually good?
Dr. Hu explains why simply asking how many prostatectomies a surgeon has performed may not tell you what you really need to know. Instead, patients should be asking whether their surgeon actually tracks urinary continence and erectile-function outcomes.
Because two surgeons can perform the same “robotic prostatectomy” very differently—and those differences may matter to your quality of life.
In this episode, you’ll learn:
• What an elevated PSA really means—and what may come before biopsy
• How MRI, PSA density, 4Kscore, and urine biomarkers can help guide decisions
• Why Dr. Hu favors transperineal prostate biopsy
• What the PREVENT and TRANSLATE trials tell us about prostate biopsy
• Why avoiding antibiotics may be another advantage of transperineal biopsy
• The learning curve patients should consider when choosing who performs their biopsy
• How to think about prostate surgery vs. radiation
• Why robotic technology doesn’t automatically mean better surgical outcomes
• Why surgical volume alone may not predict continence or erectile-function recovery
• The questions to ask before choosing a prostate cancer surgeon
• Why surgeons should track their own patient-reported outcomes
• How surgical technique, nerve handling, and cautery may affect recovery
• Where active surveillance and focal therapy may—or may not—fit
• Why treatment choice matters if prostate cancer eventually returns
• What patients should understand about salvage prostatectomy after radiation or focal therapy
If you’ve recently been diagnosed with prostate cancer—or you’re trying to decide whether to have a biopsy, surgery, radiation, focal therapy, or active surveillance—watch this conversation before making a decision you can’t easily take back.
Chapters
⏱️ KEY TIMESTAMPS
00:00 – The prostate cancer decisions you can’t easily take back
08:00 – Elevated PSA: Do you really need a biopsy?
12:00 – How MRI can help some men avoid biopsy
16:00 – PSA density, MRI & deciding whether to biopsy
17:00 – Transperineal vs. transrectal prostate biopsy
19:00 – PREVENT & TRANSLATE studies: infection and cancer detection
22:00 – The learning curve for transperineal biopsy
26:00 – Why transperineal biopsy may avoid antibiotics
36:00 – Prostate surgery vs. radiation: How do you choose?
42:00 – Does doing more prostatectomies make a better surgeon?
43:00 – The #1 question to ask your prostate surgeon
51:00 – What are good erectile-function outcomes after surgery?
55:00 – Nerve sparing: the surgical details that may affect erections
59:00 – The 3 questions to ask BEFORE prostate surgery
1:03:00 – Active surveillance for Gleason 6 / Grade Group 1
1:06:00 – Focal therapy: Where does it fit?
1:10:00 – Erectile dysfunction & incontinence after prostate surgery
1:11:00 – Prostate surgery after radiation or focal therapy
1:12:00 – PSMA PET scans, recurrence & salvage treatment

🔗 RESOURCES & RESEARCH
Dr. Jim Hu — Weill Cornell Medicine
https://weillcornell.org/jimhu
Follow Dr. Hu on X:
@jimhumd
PREVENT Trial — JAMA Oncology
https://jamanetwork.com/journals/jamaoncology/fullarticle/2823969
Memorial Sloan Kettering Prostate Cancer Nomogram
https://www.mskcc.org/nomograms/prostate
UK TRANSLATE Prostate Biopsy Study — The Lancet Oncology
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(25)00100-7/fulltext
Michigan Urological Surgery Improvement Collaborative (MUSIC)
https://musicurology.com/programs/prostate/
MUSIC brings together academic and community urology practices across Michigan with the shared goal of improving prostate cancer care and patient outcomes.
___________________________________
💪 Exclusive Membership
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
___________________________________
📌 Follow and Connect
📺 YouTube → Dr. Geo Prostate Podcast — https://www.youtube.com/@DrGeoProstatePodcast
🎧 All Episodes → Captivate.fm Archive — https://dr-geo-prostate-podcast.captivate.fm
📸 Instagram → https://bit.ly/DRGEO-INSTA-YT
📘 Facebook → https://bit.ly/POD-FB-DrGeo
💼 LinkedIn → https://bit.ly/DRGEO-LINKEDIN-YT
🛒 Supplements → XY Wellness https://bit.ly/3uJPC7Z | Mr. Happy https://bit.ly/3TE7tWE
🌐 DrGeo.com Website → https://bit.ly/43khht0
___________________________________
📣 Hashtags
#DrGeoProstatePodcast #ProstateHealth #ProstateCancer #MensHealth #IntegrativeUrology #Urology
___________________________________
⚠️ Disclaimer
This podcast is for educational purposes only and not medical advice. The views expressed are Dr. Geo’s and not those of his employer(s) or affiliated organizations. Use of this content is at your own risk. Geovanni Espinosa, N.D., assumes no liability for direct or indirect consequences, including economic loss, injury, illness, or death.

What if one of the hardest parts of androgen deprivation therapy is not simply low testosterone—but the loss of estradiol that comes with it?
Dr. Richard Wassersug brings a rare dual perspective to that question.
He is a PhD evolutionary biologist, former professor of anatomy and neurobiology, prostate cancer quality-of-life researcher, co-developer of an androgen deprivation education program, and a patient who has used transdermal estradiol for more than two decades. His experience helped drive a deeper investigation into whether estrogen delivered through the skin could suppress testosterone while avoiding some of the burdens associated with standard LHRH-based ADT.
In this episode, you’ll learn:
🟠 Why men need estradiol for **brain, bone, sexual, and overall health.**
🟠 What the **PATCH research** suggests about transdermal estradiol, cancer control, and quality of life.
🟠 Why **hot flashes, poor sleep, fatigue, and cognitive symptoms** may reflect more than testosterone loss.
🟠 What men should know about **gynecomastia, monitoring, exercise, and shared decision-making** before considering this emerging strategy.
decision-making before considering this emerging strategy.

Chapters
00:00 ADT Side Effects Question
00:54 Podcast Disclaimers
01:33 Meet Dr Wassersug
03:59 Diagnosis And Early Treatment
04:58 Finding Estradiol Research
07:29 Lupron Side Effects And Sleep
08:48 Why Men Need Estradiol
11:00 Switching To Estradiol
15:13 NEJM Patch Trial Breakdown
20:53 Gynecomastia And Management
24:07 Real World Patient Stories
25:20 Sponsor Message Break
27:51 Access Barriers And Limits
29:03 ADT Protocols and Sleep
31:32 Estradiol Targets and Ratios
37:23 Patch vs Gel Dosing
39:10 Combining ADT With Estradiol
42:52 Who Benefits Most
44:18 PATCH Study Scope and Add-Ons
47:33 Getting Estradiol Prescribed
50:23 Suffering Mindset and Sexual Health
54:48 Active Surveillance Trial Ideas
___________________________________
💪 Exclusive Membership
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
___________________________________
📌 Follow and Connect
📺 YouTube → Dr. Geo Prostate Podcast — https://www.youtube.com/@DrGeoProstatePodcast
🎧 All Episodes → Captivate.fm Archive — https://dr-geo-prostate-podcast.captivate.fm
📸 Instagram → https://bit.ly/DRGEO-INSTA-YT
📘 Facebook → https://bit.ly/POD-FB-DrGeo
💼 LinkedIn → https://bit.ly/DRGEO-LINKEDIN-YT
🛒 Supplements → XY Wellness https://bit.ly/3uJPC7Z | Mr. Happy https://bit.ly/3TE7tWE
🌐 DrGeo.com Website → https://bit.ly/43khht0
___________________________________
📣 Hashtags
#DrGeoProstatePodcast #ProstateHealth #ProstateCancer #MensHealth #IntegrativeUrology #Urology
___________________________________
⚠️ Disclaimer
This podcast is for educational purposes only and not medical advice. The views expressed are Dr. Geo’s and not those of his employer(s) or affiliated organizations. Use of this content is at your own risk. Geovanni Espinosa, N.D., assumes no liability for direct or indirect consequences, including economic loss, injury, illness, or death.

Most men who undergo a prostate biopsy may not have cancer found at all—and the bigger mistake may be rushing from a single elevated PSA straight to the needle.
Dr. James Wysock, an NYU urologist with deep expertise in prostate cancer diagnostics and image-guided biopsy, explains why the modern biopsy decision is no longer about PSA alone. Repeat testing, prostate MRI, PSA density, blood and urine biomarkers, and expert image targeting can dramatically change who should be biopsied and how that biopsy should be performed.
Just as surprising: transperineal biopsy is not automatically “better” in every case. It clearly lowers infection and antibiotic exposure, but biopsy accuracy still depends heavily on imaging, fusion quality, sampling technique, and operator experience.
In this episode, you’ll learn...
Why one elevated PSA should often be repeated before escalating testing.
Why MRI may be the most important next test when biopsy risk remains concerning.
How transperineal and transrectal biopsies really compare.
How new fusion, needle and tissue-preservation technologies could make future biopsies shorter, more precise and less invasive.

___________________________________
💪 Exclusive Membership
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
___________________________________
📌 Follow and Connect
📺 YouTube → Dr. Geo Prostate Podcast — https://www.youtube.com/@DrGeoProstatePodcast
🎧 All Episodes → Captivate.fm Archive — https://dr-geo-prostate-podcast.captivate.fm
📸 Instagram → https://bit.ly/DRGEO-INSTA-YT
📘 Facebook → https://bit.ly/POD-FB-DrGeo
💼 LinkedIn → https://bit.ly/DRGEO-LINKEDIN-YT
🛒 Supplements → XY Wellness https://bit.ly/3uJPC7Z | Mr. Happy https://bit.ly/3TE7tWE
🌐 DrGeo.com Website → https://bit.ly/43khht0
___________________________________
📣 Hashtags
#DrGeoProstatePodcast #ProstateHealth #ProstateCancer #MensHealth #IntegrativeUrology #Urology
___________________________________
⚠️ Disclaimer
This podcast is for educational purposes only and not medical advice. The views expressed are Dr. Geo’s and not those of his employer(s) or affiliated organizations. Use of this content is at your own risk. Geovanni Espinosa, N.D., assumes no liability for direct or indirect consequences, including economic loss, injury, illness, or death.