WBLQ AM 1230 Interview with Dr. Joseph Brito

Transcript

• 00:00Good morning Doctor.
• 00:01Jailbroke with us morning.
• 00:03I'm here. Oh good.
• 00:04Great to have you on this morning.
• 00:07You are a urologist at
• 00:09Lawrence and memorial correct?
• 00:11Then tell us a little bit about
• 00:14yourself how long you been doing
• 00:16it and what brought you to that.
• 00:19That particular field sure. So
• 00:21first of all, I'm a Rhode
• 00:23Islander born and raised.
• 00:25I grew up in Bristol.
• 00:27In my training down in Washington
• 00:29DC and then came back to Yale
• 00:31for a fellowship in oncology,
• 00:33specifically spending year down at Yale,
• 00:35New Haven Hospital.
• 00:36And then I've been practicing here in New
• 00:39London at L&M for the past three years.
• 00:41You asked why I got into urology.
• 00:43I get that question a lot,
• 00:45but Urology is an interesting field.
• 00:47We are surgeons.
• 00:48First and foremost, you know,
• 00:50focusing on the care of the urinary track.
• 00:53So basically everything from the
• 00:54kidneys down to the genital area,
• 00:56and we use a lot of Technology.
• 00:59We kind of take care of some disease
• 01:01processes that can be fairly difficult,
• 01:03I think,
• 01:04to handle for a lot of guys,
• 01:06and so
• 01:07it's a pretty rewarding field.
• 01:09So I guess there were lots of questions
• 01:11I'm going to go out of order a little bit.
• 01:15Maybe they're the same talk about
• 01:16screenings and we talk about
• 01:18prostate cancer, but there's also
• 01:20an enlarged prostate creates.
• 01:21It's not cancer so much as it does
• 01:24create a number of problems as well.
• 01:26Talk to me a little bit about
• 01:28prostate health.
• 01:29One of the things people are on
• 01:31and look for before that would get
• 01:34them to go to a urologist to get
• 01:37checked out. Sure, so I think you
• 01:39made an important distinction,
• 01:40which is that most of the time when
• 01:43men have symptoms urinary symptoms,
• 01:45it's more in keeping with an enlarged
• 01:47prostate which is called benign
• 01:49prostate enlargement and that is
• 01:50very different than prostate cancer,
• 01:52which I think is important for men to know.
• 01:55You know most of the time when we see
• 01:58patients symptomatically in the office,
• 02:00it's for difficulty urinating
• 02:01slower urine stream.
• 02:02You know, having to get up multiple
• 02:04times at night or rush to the bathroom,
• 02:07and those are very treatable conditions.
• 02:09So you know most of the time we
• 02:11we try to tell men get into the
• 02:13office sooner rather than later.
• 02:15Like most things,
• 02:16it's easier to treat these
• 02:18things early on prostate cancer
• 02:19and prostate cancer screening,
• 02:21obviously relating to the
• 02:22same part of the body,
• 02:23but generally speaking, prostate cancer,
• 02:25at least currently,
• 02:26is detected when there are no symptoms.
• 02:28You know, that's something that is screened.
• 02:30Or with generally a blood test,
• 02:33which is called PSA stands for prostate
• 02:36specific antigen and for the vast
• 02:38majority of men there are no symptoms
• 02:40of prostate cancer when it's diagnosed.
• 02:43It's just an abnormal blood test or
• 02:46an abnormal exam findings.
• 02:47When at when the test
• 02:49comes back positive,
• 02:50what happens at that point?
• 02:52Is it always surgery?
• 02:53No? So let me talk
• 02:54a little about the test first.
• 02:56I think it can be fairly misleading and is
• 02:59a big source of anxiety for a lot of men.
• 03:02First of all, so the PSA test I'll be the
• 03:05first to tell you is not a great test.
• 03:08You know it can be elevated for many
• 03:10reasons which have nothing to do with
• 03:13cancer but in abnormal finding on that test
• 03:15does indicate that you should generally
• 03:17see urologist and get that worked up.
• 03:19If you are diagnosed with prostate cancer,
• 03:22there are many treatment
• 03:23options available now.
• 03:24There's a lot that depends on what
• 03:27the specifics of your biopsy show.
• 03:29There may be a finding of very low grade
• 03:32or low risk prostate cancer which may
• 03:34not need any active treatment at all,
• 03:37but more just following that cancer
• 03:39long longitudinally to make sure it
• 03:41doesn't become something more serious.
• 03:43Now the more aggressive types of
• 03:45prostate cancer we generally are
• 03:47treating with either surgery or
• 03:49radiation or a combination of the two.
• 03:51And sometimes with hormone treatments as
• 03:53well. So I wanted to go back a
• 03:56little bit when to when somebody
• 03:58comes in and they have a have.
• 04:01PSA is positive they come in
• 04:04and you mentioned that it's not
• 04:06not a perfect test by any means.
• 04:09What happens from there to determine
• 04:11whether or not it is probably
• 04:13where does the diagnosis come in?
• 04:16When you say definitively where
• 04:17it is prostate cancer so you
• 04:20know first and foremost if you have?
• 04:22A PSA test that comes back abnormal and
• 04:25different labs will tell you different
• 04:26numbers that are considered abnormal,
• 04:28but for the most part in most
• 04:30laboratories of PSA level,
• 04:31over four will be flagged as an abnormal
• 04:34result that can depend on a lot of factors.
• 04:37As I said earlier, including your
• 04:38age and the size of your prostate.
• 04:40But when you come into our office
• 04:43with an abnormal PSA, first of all,
• 04:45we'll need to examine you.
• 04:46You know that's done with a digital
• 04:48rectal examination to feel the prostate,
• 04:50which can be felt through the rectal wall.
• 04:53But to get a definitive diagnosis
• 04:55of prostate cancer,
• 04:55you need to have a prostate biopsy,
• 04:58and that can be done in
• 05:00a couple different ways.
• 05:01Classic Lee,
• 05:02it was done with an ultrasound guidance.
• 05:04We tend to rely more now on MRI an
• 05:06what's called an MRI Fusion biopsy,
• 05:09which allows us to target specific
• 05:11areas in the prostate and is a
• 05:13bit more sensitive and specific.
• 05:15We're going to. We're going to take
• 05:18a quick break when we come back.
• 05:21I want to talk a little bit more about that.
• 05:24The end, the prostate cancer,
• 05:26and how serious it is and how.
• 05:29What it's what it's rated success?
• 05:31Can the surgery success is moving
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• 07:44Second, good morning.
• 07:45Welcome back to the morning show at
• 07:497:52 in the morning and Zach.
• 07:52What's the temperature?
• 07:5316 * 67 degrees?
• 07:55And whether this is Doctor Joe Bruno.
• 07:58He's a urologist, he is with.
• 08:01With Lawrence and memorial you
• 08:03do any work at at Wesley. We
• 08:06have part of our practices in Westerly.
• 08:09There are two physicians there.
• 08:10Doctor, Letty and doctor enquist were all
• 08:13part of the same group with with
• 08:15the prostate surgery be done.
• 08:17If somebody were diagnosed in Wesley,
• 08:19where would that surgery be done? Would it be
• 08:22at Westerly hospital so?
• 08:25Hello. Hello, did we lose him
• 08:29but he lost them so this is
• 08:32what you call so there he is
• 08:34we got your back you there
• 08:36did I disappear you disappeared but you're
• 08:39back again that was it's Magic, Yeah. To
• 08:42answer your question right now we're
• 08:44doing all the robotic surgeries
• 08:47here at L&M. The surgical robot is
• 08:50currently not at Westerly Hospital.
• 08:52This is tell me about the
• 08:54prostate cancer, it seems,
• 08:56is very treatable absolutely.
• 08:58What's the rate of success
• 08:59or at what point is it?
• 09:01I guess at some point it gets so
• 09:04advanced it's more difficult to treat,
• 09:06but the rate of success for prostate
• 09:09surgery has to be in the 90%.
• 09:11It's quite high.
• 09:12So like like most cancers,
• 09:13it depends a lot on when something
• 09:16is diagnosed in terms of how
• 09:18treatable or curable it is.
• 09:19The vast majority of prostate cancers
• 09:21diagnos now at very early stages,
• 09:23which in some ways becomes a problem
• 09:25because as I mentioned earlier,
• 09:27most of these patients
• 09:29don't have symptoms so.
• 09:30It can be hard to commit to a treatment
• 09:32for something when you're when you're
• 09:35not experiencing symptoms from it.
• 09:37But to answer your question,
• 09:38for patients who are taken to
• 09:40prostate surgery, you know,
• 09:41especially for patients in this
• 09:43sort of intermediate grade category,
• 09:45which are the most common surgical patients,
• 09:47the cure rates are 95% or better.
• 09:50When did at what point are?
• 09:52Are there any symptoms that people
• 09:55should be looking at that might in
• 09:58fact get them to go into a urologist or
• 10:01to ask to be referred to a urologist?
• 10:04Absolutely so I think, as I mentioned
• 10:06earlier, most of those urinary symptoms men
• 10:09experience are from benign enlargement,
• 10:11but occasionally they can be from
• 10:13cancer as well, so you know if you
• 10:16are experiencing urinary symptoms,
• 10:18especially if they seem to
• 10:20be getting worse overtime.
• 10:21You should certainly let your doctor know.
• 10:24Or if you see urologist,
• 10:25let your urologists know.
• 10:26Now there are some symptoms that prostate
• 10:29cancer can cause overtime. For instance,
• 10:31if you're having blood in your urine.
• 10:33If you're starting to have,
• 10:35you know new pains throughout your body.
• 10:37Prostate cancers.
• 10:38When they spread,
• 10:39they tend to go to the to the skeleton,
• 10:41and so men will experience
• 10:43occasionally what we call bone pain,
• 10:45which is sort of like a deep,
• 10:47deep pain.
• 10:48Sometimes that can lead to fractures as well,
• 10:51bone fractures,
• 10:51and you know those are fairly advanced cases,
• 10:54but.
• 10:54Certainly,
• 10:55if those symptoms are experienced,
• 10:57you definitely want to let
• 10:59your doctor know about them the.
• 11:01Is there a percentage?
• 11:02Orrorin obviously is a disease
• 11:04that comes when people, I presume.
• 11:07Now maybe I'm making a presumption,
• 11:09but but I'm I'm presuming that
• 11:11this is one that is more prevalent
• 11:14in older, older men. That's
• 11:16correct. There are actually anatomic studies
• 11:18that were done several years ago to look
• 11:21at the prevalence of prostate cancer,
• 11:23and if you look at at prostate cancer by age
• 11:27as men get up into their 70s eighties 90s,
• 11:30it becomes very, very common.
• 11:32We're talking up to 70 eighty 90% of men.
• 11:35If you were to look at sort of an
• 11:38anatomic specimen after death now,
• 11:40the key is that most of those men aren't
• 11:42actually dying of prostate cancer.
• 11:44You know, there so.
• 11:46So what becomes our difficulty as urologist
• 11:48is to determine which of these cancers
• 11:50need to be treated in, which don't.
• 11:53And that's sort of an evolving
• 11:54area in urology currently,
• 11:56but our goal and really all doctors goal
• 11:59should be to not do any harm right?
• 12:01To do no harm.
• 12:03And so our goal is to.
• 12:05Only treatment that we think will
• 12:07benefit from treatment and often we
• 12:09sort of even stop screening men as
• 12:11they get up into their 70s and 80s
• 12:14because they probably won't benefit
• 12:16from prostate cancer treatment
• 12:17at that age are the things that they can
• 12:20do from a nutritional standpoint that
• 12:22can improve their prostate. So that's
• 12:25another area where there's
• 12:26a lot of research right now.
• 12:28And of course every patient
• 12:30wants to know what they can do.
• 12:32By and large, we don't have any specific
• 12:35dietary recommendations to make.
• 12:36There is some data to suggest
• 12:38perhaps that soy products,
• 12:40or perhaps that certain products high in
• 12:42antioxidants might be helpful in general.
• 12:44What I tell patients is what's
• 12:45good for your heart is probably
• 12:47good for the rest of your body,
• 12:49so you know following sort of low
• 12:52fat Mediterranean type dietze
• 12:53will certainly not harm you.
• 12:54We don't have data to tell you specifically,
• 12:57it will benefit your prostate cancer
• 12:59however, so
• 12:59I always like to check in and
• 13:01see where does single Malt
• 13:03Scotch Fit in on that scale?
• 13:05Cures all prostate can see I knew that.
• 13:08Yeah, there you go.
• 13:10Cures everything else too.
• 13:11One with some of the other
• 13:14things that you treat,
• 13:15her urologist just doesn't treat
• 13:17prostate cancer prostate problems.
• 13:18One of the some of the other areas that
• 13:21you're involved in.
• 13:23So it's a very wide range. You know.
• 13:25We take care of basically any
• 13:28medical issues involving the kidneys
• 13:29all the way down to the tip of
• 13:32the penis in men and involving
• 13:34the female urinary tract as well.
• 13:36So that includes things like kidney stones,
• 13:39things like kidney tumors,
• 13:40urinary complaints like incontinence,
• 13:41or overactive bladder.
• 13:43You know testicular cancer in men,
• 13:45so there's a pretty wide
• 13:47variety of conditions.
• 13:48One was probably
• 13:49the most prevalent area we
• 13:51talked about men's health.
• 13:53What about in Women's Health?
• 13:55Well, it's interesting.
• 13:56I would certainly say this time of year.
• 13:58The most common thing we're
• 13:59seeing is kidney stones,
• 14:01and there seems to be a surge
• 14:02towards the end of the summer,
• 14:04which I think is probably for for
• 14:06somewhat obvious reasons that people
• 14:08tend to be a little more dehydrated
• 14:10and probably have a little bit of
• 14:11a poorer diet in the summertime.
• 14:13But kidney stones used to be a very
• 14:15male centric disease that has changed
• 14:17quite a bit over the past several years,
• 14:19to the point that it's basically 5050. At
• 14:21this point, it's really interesting
• 14:23because we're hearing more and more.
• 14:24I've heard a lot of cases of kidney stones.
• 14:27And I was surprised to seem like they were.
• 14:30There were an awful lot of this
• 14:32that seem to be at this time here,
• 14:35so why now instead of other
• 14:37times of the year? Well, we
• 14:39think in general the change in kidney
• 14:42stone prevalence in the United States,
• 14:44which is a very well documented trend,
• 14:46has a lot to do with Dyett, you know,
• 14:49the American diet tends to be high salt,
• 14:52kind of high fat, high sugar content,
• 14:54and all of those will increase the.
• 14:57Prevalence of kidney stone formation.
• 14:58It essentially kidney stone
• 15:00formation is sort of like a
• 15:02chemistry problem in the body,
• 15:03so if you put in the wrong ingredients,
• 15:06you'll end up.
• 15:07You'll end up forming stones and
• 15:09dehydration plays a role there as well,
• 15:11so you know in the summertime it's hotter.
• 15:13People tend to be doing more outside
• 15:15and sweating more, so there's
• 15:17likely a component of
• 15:18dehydration as well the.
• 15:19SARS they've never had a kidney stone
• 15:21and I'm thankful I haven't because
• 15:24Sanderson is quite painful. Yes,
• 15:25it's awful. I've never had one either,
• 15:28thankfully, but I will tell you
• 15:30I've taken care of many women who
• 15:32have been pregnant before and have
• 15:34told me the kidney stone pain is
• 15:36much worse than having a child,
• 15:38so it's it's a unique type
• 15:40of pain for sure.
• 15:42I don't intend to have a child either,
• 15:44but neither kidney stone or a child, right?
• 15:47Yeah, so. But with that Doctor Berger,
• 15:50we are at at the end of our
• 15:52at the end of our segment.
• 15:54I want to thank you for
• 15:55being with us this morning.
• 15:57Interesting and important stuff.
• 15:58This is a urologist at Lawrence
• 16:00and memorial and we talked about
• 16:02prostate cancer and I think also
• 16:03as important as discussion about
• 16:05kidney stones because we think that's
• 16:07become a little bit more prevalent.
• 16:08And so I guess my correct me if
• 16:10I'm wrong that people need to make
• 16:12sure that they remain hydrated
• 16:14for all of these things.
• 16:16It's got to be a real positive.
• 16:19Absolutely
• 16:19yeah, absolutely.
• 16:20Gotta take care of your body.
• 16:21You know, drink, drink water
• 16:23and you know everything will for
• 16:25the most part sort itself out.
• 16:26But if your symptoms are getting worse,
• 16:28just please tell your doctor
• 16:29and you know we're always
• 16:31happy to see you. Thank
• 16:32you very much and now. Zachary,
• 16:35what time is it is time for the news.