WBLQ AM 1230 Interview with Dr. Joseph Brito

September 21, 2020

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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
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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.