WBLQ AM 1230 Interview with Dr. Joseph Brito
September 21, 2020Information
August 17, 2020: Dr. Joseph Brito spoke with WBLQ AM 1230 (Washington, Kent, and Newport Counties in RI, and New London and Windham Counties in CT) about prostate cancer and urology.
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- 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
- 05:33back in just a couple of minutes.
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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.