The Dr. Geo Prostate Podcast

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.

What if the biggest mistake men make after a prostate cancer diagnosis is not eating the "wrong" food - but becoming so afraid of food that eating itself becomes stressful?
In this solo episode, Dr. Geo draws on more than two decades in holistic and integrative urology to cut through the noise around prostate cancer nutrition. Rather than promoting another rigid diet, he explains how food choices interact with physical activity, stress, metabolic signaling, and long-term sustainability. The goal is not perfection. It is to create a healthier internal environment while still enjoying life, family, and food.
In this episode, you'll learn...
Why no single food causes or cures prostate cancer.
How exercise and stress may change the way your body responds to food.
Why Dr. Geo favors a plant-forward Mediterranean pattern while allowing strategic flexibility.
How to think about protein, fish, red meat, processed foods, saturated fat, and fasting after diagnosis.

If prostate cancer nutrition has left you overwhelmed, this episode offers a simpler framework for deciding what to eat - and what actually matters most.
Chapterts
00:00 Food Myths Intro
00:55 Podcast Disclaimer
01:34 Why Nutrition Confuses
03:34 Principle One No Guilt
04:46 Stress Exercise Absorption
08:57 No Magic Foods
12:55 How Cancer Signals Work
16:40 Processed Foods And Portions
21:02 Best Diet Patterns
25:11 Protein And Muscle
28:38 Meat Poultry Fish
31:23 Carbs And Fats
35:48 Fasting And Overeating
37:17 Thrive After Diagnosis
👉 subscribe to RX3 Thursdays- https://bit.ly/3UyPJ2M
___________________________________
🌱 Partner Offers
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
AG1 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 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.

Dr. Geo welcomes Dr. Peter Bajic, Medical Director for Urology at Cleveland Clinic Main Campus and Director of Men's Health at the Glickman Urological Institute, for an evidence-based conversation about erectile dysfunction, testosterone, Peyronie's disease, and the biggest myths in men's sexual medicine.
They explore why erections reflect cardiovascular health, why "venous leak" is often misunderstood, how GLP-1 medications may temporarily influence testosterone during weight loss, and when testosterone replacement therapy is actually appropriate.
The episode also covers Peyronie's disease, treatment options including daily tadalafil and traction therapy, and practical lifestyle changes that can improve both sexual function and long-term health.
If you've ever wondered whether ED is psychological, physical, hormonal—or all three—this episode delivers clear answers backed by today's science.
In this episode you'll learn:

Why erectile dysfunction often predicts cardiovascular disease
The truth about "venous leak"
How erections actually work
Psychological vs. physical causes of ED
GLP-1 medications and testosterone explained
When testosterone replacement is appropriate
The biggest myths about Peyronie's disease
Daily Cialis beyond erectile dysfunction
Lifestyle strategies that improve sexual health
The latest treatments available for men

Timestamps
00:00 Introduction: ED may be your first warning sign
02:45 Why erections are a window into overall health
06:20 Psychological vs. physical erectile dysfunction
13:15 GLP-1 medications, weight loss & testosterone
18:30 Combining GLP-1 therapy with testosterone replacement
28:45 The truth about "venous leak" explained
40:05 Why most men do NOT have true venous leak
43:10 The best approach to treating erectile dysfunction
49:20 Understanding Peyronie's disease
54:20 Can Peyronie's disease be prevented?
58:00 Why daily Cialis may be one of men's most useful medications
1:01:00 Xiaflex, surgery & future Peyronie's treatments

___________________________________
💪 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.