Prostate Cancer (Part 1): Screening Without the Scare Tactics

18:58Dr. Jesse Mills:Tell me what medicine I'm thinking about. And the reason this just came up is because I had dinner with somebody when we were at the CES in Vegas, and she was telling a story about her brother, who's a very well-known newscaster who had a misdiagnosis of prostate cancer because he'd been taking this drug and his PSA was artificially low. So tell me what I'm thinking. It's the best way to play this game, Dr. Brizzi.

19:26Dr. Wayne Brisbane:Sure. No, no, no. So you think about But finasteride is the drug. There's also a sister drug called dutasteride. I want to take one step back and then we'll take, I'm going to step into and answer that question quickly. So one step back is, you know, the PSA is a protein that's very, you know, we have these serine kinases all over the body, but the prostate really for this particular form of it is very important at the prostate. And so we can use that to diagnose prostate cancer. But as you have alluded to, there's other forms or there's other ways that the PSA can be elevated. And there's traditionally three.

20:01Dr. Wayne Brisbane:So prostate cancer, prostatitis, and then kind of prostate size, I'm going to say, just so, you know, as the as the prostate gets bigger, there's more cells, more PSA goes up. And then also as men age, you know, the PSA goes up. There's probably this PSA leak phenomenon where your PSA gets a little more leaky. It's not necessarily a problem, but it's very common as men age that their PSA goes up naturally. OK, so nothing to worry about. But in general, when we see the PSA goes up, you can again, that's the idea of a thermometer. If you're exercising, your temperature would go up. Doesn't mean you're sick.

20:33Dr. Wayne Brisbane:OK, or if you know, when I was a kid, at least, you know, put it next to a light bulb and get it heated up before. So I didn't have to go to school. So there's other things.

20:41Dr. Jesse Mills:I said you never, but it's a cute story.

20:44Dr. Wayne Brisbane:But but there's reasons, you know, you can you can get the temperature to go up. even when you're not sick. But in combination with other things, like let's say you have a cough or a headache or something like that, then the temperature takes on this, you say, okay, this fits a picture of you have a sickness. Now, PSA is the same way. It goes up for lots of different reasons. But this particular drug, finasteride and dutasteride, actually suppresses PSA production at the level of the prostate. It's a drug that blocks the transition from testosterone to dihydrotestosterone. And that's important at the level of the prostate because it allows the prostate to shrink a bit, but it also is important at the hair follicles.

21:20Dr. Wayne Brisbane:And so that can prevent male pattern balding. So very, very good drugs, very few side effects, especially at low doses. Initially, this was noticed there was two huge studies, one with finasteride, another with its sister drug, dutasteride. And the initial thought was that we were going to prevent prostate cancer by giving this drug because it was kind of starving the prostate cancer out. and it did help with preventing low risk prostate cancer, but we noticed that guys with higher risk prostate cancers were starting to pop up in the population who is taking the drug. Now there's a lot of ink spilt on whether it was the drug or whether it was just easier to find, but the take home for guys today in 2026, if you're on finasteride or dutasteride, your PSA won't respond nearly as quickly to a cancer.

22:10Dr. Wayne Brisbane:And so if you just, it's not super hard, but you have to at least tell your urologist or your internal med doc, your PCP that you're on that medication, because you at least have to double the PSA value. And if you've been on it for a few years, you might have to quadruple the PSA value. So just, and this has actually burned me in my practice. It's something you just have to, you just, I all, this is all I do every day. and I have been tricked by dutasteride and finasteride because they suppress the PSA just so much. So it really, really the PSA becomes a very, it's a broken thermometer if you're on those meds.

22:43Dr. Wayne Brisbane:And so they're not bad meds. I think they're great meds. You should, you should take them. But just make sure that you don't rely on PSA for its diagnostic properties if you're on those meds.

22:53Dr. Jesse Mills:That's great.

23:28Jordan Runtagh:Thank you. your patients. Visit labcorp.com to partner with LabCorp and simplify complex patient profiles. When people turn to telehealth or weight loss, they're looking for real support. That's why more people are choosing orderlymeds.com. Orderly Meds connects you with real doctors and access to proven GLP-1 medications like semaglutide and terzeptatide. No guessing, just a more supportive experience and all shipped directly to your door in discreet packaging. Do your research, ask questions, then visit orderlymeds.com slash podcast for an exclusive of offer. That's orderlymeds.com slash podcast.

24:04Jordan Runtagh:Individual results may vary. Now medical advice eligibility required. See site for details. This is Dr. Laurie Santos from the Happiness Lab with Dr. Laurie Santos. On the Happiness Lab, we often focus on why dramatic lifestyle overhauls don't last, but small, manageable changes do. That's what I like about Hero Bread. It's a simple swap that doesn't require willpower or constant decision-making. Hero makes sliced bread, bagels, tortillas, and more, with zero to five grams of net carbs per serving, zero grams of sugar, and up to 19 grams of protein, while still delivering the familiar, comforting experience people associate with bread.

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25:28Jordan Runtagh:Are you kidding me? An oil change is the last thing you have time for. So drive into Take 5 and let our techs change your oil, check your tires, top off your fluids, and have you back on the road pit stop fast. All while you stay in your car. No putting your entire schedule on hold. No upsells, no problem. So you can get back to your to-do list. Or not. Find your nearest shop at Take5.com. Take 5, the stay in your car 10-minute oil change.

26:04Dr. Jesse Mills:all right so let's do this so i'm a 55 year old guy i actually am a 55 year old guy i'm incredibly healthy you see this guy at the gym frequently you're impressed with how robust he is this is not a personal story by the way yeah it's because i don't want to get too personal because it's not you know it's not me i promise but his physician sends him to you because his psa went up It was 1.8 last year, all good, right? And it went up to 4.1 on this year's annual lab screening. So appropriate referral to Dr. Brisbane to see about this PSA bump. I'm going to add value to our listeners and also add educational purpose here.

26:38Dr. Jesse Mills:Let's just say also that he started on testosterone therapy last year. He had to keep up with you at the gym. He saw what you were squatting. He was like, I got to look like Brisbane. So I need TRT. My testosterone was low. It was actually 184 nanograms per deciliter, which is about 200 points lower than kind of minimum thresholds for screening, at least by European guidelines, maybe 120 or so by American guidelines. But the bottom line is the guy had low testosterone, PCP, appropriately put him on TRT, and his PSA now is 4.1. First of all, let me be the urologist, because I do a lot of testosterone therapy, as you know, in my clinic.

27:14Dr. Jesse Mills:and say I referred him to you, did I just give this guy prostate cancer by starting him on testosterone and having that PSA go from 1.8 to 4.1? Let's unpack what's happening. Talk to me about androgen receptors, saturation models, and then walk us through what this case is starting out to for you. What's on your mind? Sure.

27:36Dr. Wayne Brisbane:So to start off kind of saying, did you give this guy prostate cancer? I'm going to come back to that kind of mental model of that car. And the answer is I kind of squarely say no. You know, we don't think that testosterone causes prostate cancer. It would be like, I'm going to use the gas tank as the analogy. So, you know, the gas tank, you can only fill it with so much gas and then it's full. It's ready to go. If you fill it with more, it just spills over the side.

27:59Dr. Jesse Mills:Gas is testosterone.

28:01Dr. Wayne Brisbane:Exactly. Gas is testosterone. Thanks for clarifying that. And we think that the prostate's kind of similar. You know, the cancer is from one of those genetic drivers, either something you were born with or something that developed from a spontaneous mutation. That's the gas pedal down, brake pedal's broken, and that's causing the growth. But the gas is the testosterone, and you can't give the prostate super sensitive to testosterone. So even if at a testosterone level of like 150 to 200, all the receptors in the prostate are saturated. The gas tank is full, okay? So even at low levels, the gas tank's full for the prostate.

28:39Dr. Wayne Brisbane:And so one of the things that's very useful when there's broken cars everywhere, okay, so we're talking about a different guy now. This is guys who have had metastatic prostate cancer, and there's cancer cells everywhere. So you think about all these little broken cars. We can pull the gas tank on all those cars by giving a medication that pulls the testosterone out of the body. And so that can be an extremely effective cancer tool. But in the setting of localized prostate cancer, we think that it's probably the genetic driver and the gas tank is just the testosterone. So that helps you understand one of the common misconceptions.

29:17Dr. Wayne Brisbane:I'd also think that the primary care doctor did the right thing, right? So your PSA, NCCN guidelines would say this guy, he's got a PSA between 1 and 3. He should do annual screening. And so he was at 1.8. They checked it again a year later. It had had considerable acceleration.

29:32Dr. Jesse Mills:and so that would that would trigger a referral yeah so that you're kind of touching on what sometimes we refer to as a PSA velocity and so even if I made this a little bit more nuanced and say his PSA was 0.9 and then it went to 2.9 he's still under three but is that velocity concerning you year over year is that still something that triggers a little more advanced

29:54Dr. Wayne Brisbane:screening just based on PSA alone totally so the speed the speed of ascent is very important we We call that PSA velocity. And the other thing, you know, that we'd probably do is just something super common sense. We'd probably check it again a month later. Just to say, you know, sometimes it's common. PSA, like we said, it's like a thermometer. You can get the thermometer to go up for certain reasons. So we say, hey, you know, just avoid sex. No, make sure you didn't have any, you didn't have the flu at that same time. You know, it probably doesn't matter, but avoid riding your bike for three days and just kind of take it easy and we'll check again.

30:28Dr. Wayne Brisbane:Just make sure there was no false positives. Great.

30:31Dr. Jesse Mills:So bullet points here for people out there taking notes are that if your PSA has been on a good trend for a while, has not gone up that 0.75 or one a year, and it spikes, repeat it. Don't have your doctor send you right to the biopsy suite to say, hey, can we take a look at this in a month or so and make sure it's real? and two if your doctor reassures you that your PSA is still under four but it jumped greater than that 0.75 or one a year maybe just weekly or strongly advocate for yourself that you heard this podcast with a prostate cancer expert that said maybe you need a little bit more investigation

31:10Dr. Wayne Brisbane:yeah and and I would say that you know the NCCN guidelines now use a PSA of three even to initiate initiated an evaluation. So speed of rise, or if you, you crest three, I would say for my, for my particular practice that, that at least we should take a look at it. Doesn't mean we're going to a biopsy, but we should, we should take a look. So I'm sure that's what our next step will be.

31:31Dr. Jesse Mills:Yeah. Well, I mean, and that's actually really interesting because the ticket for one of those 75 % of guys that had elevated PSA, didn't have prostate cancer was a pretty invasive test. So before you are a guy that's in your office right now, before we even get to the diagnostics, I mean, if this were 2004, you would say, hey, I'm going to schedule you for your prostate biopsy, transruptor ultrasound. Before we get to diagnostics, what other screening out there are there? And I guess I would ask you, is MRI a screening tool or is that a diagnostic tool or is it a little bit of both? is micro ultrasound that you've been pioneering, screening, diagnostic, both.

32:13Dr. Jesse Mills:Are there any other biomarkers that are better than PSA that maybe we can get this guy to not necessarily run off to the biopsy suite? Of course.

32:23Dr. Wayne Brisbane:Absolutely. So the answer is yes. And just like, you know, using our example, if you got a fever, let's say you're 102 and you went to the emergency room and you felt pretty good, maybe you were on a jog, you'd be pretty suspicious of a surgeon who came to you and said, I'm going to take out your appendix. And you'd be like, I feel okay. Like maybe we should do a couple more tests. And that's the same thing in prostate cancer, right? So the PSA being elevated straight to the biopsy, I think is a bit 20 years ago. And right now, very clearly, the next best step on almost every single guideline, and I'm only saying almost because I'm leaving a little wiggle room, every guideline that I know of is to go to a prostate MRI.

33:04Dr. Wayne Brisbane:And so that is to, and prostate MRI is basically your best delineating test to say, is this something to worry about or something not to worry about? So, and that's an NCCN, AUA, European guidelines, the Canadian, UK, but the MRI is an extremely powerful way of looking for prostate size. So we can say, hey, is it just a big prostate? Looking for any spots that need to be biopsied. So maybe there is a spot, maybe this is one of those guys who does have a spot and we, concerning for prostate cancer. And then also, you can use that MRI data now, and we published one, there's others, but you can put it into a risk calculator.

33:42Dr. Wayne Brisbane:So you put age and your PSA and your, you know, your prior digital rectal history, if you have it, and your MRI parameters, and it will spit out with multiple variables, not just the MRI, what your risk of prostate cancer is. And so that is a way to turn the MRI, not only from an imaging tool, but also into one of the better biomarkers. And at this time, it pretty much outperforms any biomarker on the market.

34:04Dr. Jesse Mills:Yeah, I'm glad you brought up. I can't believe we almost left screening without talking about the digital rectal exam or the physical exam, the finger wave, whatever other things people have. You know, that actually is, as you know, it's a big barrier. There are a lot of men and not, you know, want to get in. It doesn't really matter whether we get into it. There's a lot of scare, fear, anxiety about getting the rectal exam. Where does that line up in 2026? Is it still necessary? Is it still part of our guidelines? Talk to me through that. If a guy is like, there's no way you're ever going to do that exam on me, it's just too uncomfortable, too whatever.

34:39Dr. Wayne Brisbane:Yeah.

34:40Dr. Jesse Mills:Talk to me about that.

34:41Dr. Wayne Brisbane:Yeah. So the digital rectal exam as a screening test doesn't have a lot of utility. It's very good if it's positive. If you do a digital rectal exam and there's a large concerning lump, that's an important finding, especially if the PSA is low. Let's say there's a guy on finasteride. And you're saying the PSA doesn't seem to work as well. I'll do a digital rectal exam to figure that out, to kind of parse those pieces. Or it's very still important for staging. And staging, we'll get to later on another day. But staging is where is the cancer relative to the wall of the prostate? And your finger still is a really good way to kind of figure that out because it's sensitive.

35:19Dr. Wayne Brisbane:But our fingers, especially on mass, meaning when I try and I'm going to try and take care of a population of men and I have to, you know, regulate the digital rectal exams for multiple physicians, it really breaks down as a test. And so the PSA to MRI, no digital rectal exam is very acceptable, also guideline acceptable. And so if guys don't want a digital rectal exam, please don't let that be the barrier to your cancer screening because you don't need one. You can get one in certain situations if the clinician feels like it's helpful, but it doesn't need to be just a thing that you do.

35:51Dr. Jesse Mills:Yeah. Where do you line up on some of the urinary biomarkers, exosomes, some of these tests for screening? Do they help? Because MRIs are not perfect. Well, they're not. They're also, they're not 55 bucks, right? I mean, MRIs are, you're taking a blood test, which is$30 and then you're going to tack on an$1 ,800 plus exam with MRIs or any stutter step from health services or a public health expenditure that could save a few MRIs along the way?

36:21Dr. Wayne Brisbane:Absolutely. So if you're looking at this from a diagnostic accuracy standpoint, then MRI is still the best. It has the best specificity, meaning it can help you find cancers, has the best sensitivity, meaning you can exclude cancers, and it gives you anatomic information, meaning that if there's a spot, you can help design where you're going to put the needles a lot more accurately. But like you mentioned, it's expensive. It's not comfortable. Some guys have hip implants. Some guys are claustrophobic. There's contrast. It takes time. It's not comfortable. There's urinary tests that we can literally mail to your house and you can pee in a cup and send it back.

37:00Dr. Wayne Brisbane:And those tests are very good for their negative predictive value, meaning if they come back negative, there's a very good chance that you do not have prostate cancer. And so we absolutely can use those if you're interested in as a population, trying to reduce the number of MRIs. And we can also use them in the setting of equivocal MRIs. And this comes back that MRI is not perfect. Sometimes guys who, and we can get into this, have a negative MRI, but there's some concern. The PSA is too high, family history is really strong, and especially in there's certain zones in the prostate where MRI doesn't perform so well.

37:34Dr. Wayne Brisbane:So we have this concern. and we can use a biomarker in addition to that to help us as a tiebreaker between biopsy. And so they definitely have their place, and they can be cost-saving, and they can be an adjuvant or adjunct test MRI, and they're very, very useful. But at this time, I would say if I could only pick one or if I could only have two things, I would pick PSA and I would pick MRI.

37:56Dr. Jesse Mills:Wow. Okay. And I think you're going to segue into our next episode because it sounds like what you're saying is there is a way to turn MRI from screening to diagnosis. In other words, there's, I don't know, maybe a grading system or something out there that some smart people have figured out. Maybe some smart people at UCLA have been working on this that I really want to pick your brain on, because I think that's really exciting that you now have a non-invasive way, as you said, for the right person that doesn't have an artificial hip, they can throw off the diagnostic ability to look at these.

38:33Dr. Jesse Mills:We'll get into that grading system here in a little bit. But man, that's really cool. I mean, that's amazing that you can give guys either peace of mind or actually focus in on what's going on. And then are you gonna walk me through micro ultrasound and where that, because I mean, again, that's where some of your research is amazing. And as you know, we've been talking about collaborating by using that technology, even in our infertility population and seeing if we can do better sperm localization in the testicle because of how powered it is. So I'm really excited about that.

39:04Dr. Wayne Brisbane:Let's go back. You know, you're a 55-year-old. He comes in. PSA is, you know, 4.1. We repeat it. Let's say it's 3.9. And I get this several times. It's like, am I safe now? It looks like it's going down. And the answer is PSA does have some variability, and it's not perfect as a test. So it's important to remember that a repeat within one point is pretty stable. So that's an important kind of thing to I get a lot in clinic. So I would still if you went up to there, up to, you know, 4.1 and you're at 3.9 as a second draw, you're still elevated. And we would get that guy a prostate MRI if he had claustrophobia, if he had hip implants, especially bilateral hip implants.

39:47Dr. Wayne Brisbane:one hip implant we can get around, but bilateral hip implants, we would probably offer him a urinary biomarker. There's some other blood-based biomarkers. IsoPSA has come in. It's another one that has a very good negative predictive value. And there's others, 4K. Actually, there's a whole slew of them. So I don't have a strong opinion and neither am I reimbursed by any of these companies. But it's important to say, if your doc has one that he likes or she likes, I'm cool with that. But not going straight to biopsy is the key. And then we can also offer micro-ultrasound. So micro ultrasound is an extremely high resolution ultrasound.

40:19Dr. Wayne Brisbane:Usually ultrasound images about five megahertz, which is a hurt is, you know, one cycle per second and megahertz would be a thousand cycles per second. So we're now usually about 5 ,000 cycles per second of the ultrasound pulses for a normal ultrasound that you'd visualize for like a, for a baby in a pregnant woman. This, as you go up, your resolution goes up. So you can see structures that are small better. It's the same kind of thing if you're looking at, for those who look at regular microscopes versus electron microscopes, it's the same kind of idea. As you look at a wavelength using light versus a wavelength that uses an electron, you get better resolution.

40:57Dr. Wayne Brisbane:And so this micro ultrasound uses a 29 megahertz transducer, so it's extremely high resolution. And so we can visualize, hopefully, directly the prostate cancer. And it's a newer technology. It doesn't have the same longevity as MRI, but it's great for guys who can't do an MRI. And we published a large multi-center trial comparing MRI to micro-ultrasound and found that they equivalently diagnosed prostate cancer. That was a good win. I still think MRI has some benefits as like a population test, but we're hoping that with some advances in AI that micro-ultrasound will prove to be a very low-cost, point-of-care cancer screening solution.

41:40Dr. Wayne Brisbane:That's what my research is hoping to provide.

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42:44Jordan Runtagh:Do your research, ask questions, then visit orderlymeds.com slash podcast for an exclusive offer. That's orderlymeds.com slash podcast. Individual results may vary. Now medical advice eligibility required. See site for details. This is Dr. Laurie Santos from the Happiness Lab with Dr. Laurie Santos. One of the things we talk about a lot on this show is behavior change and how small, easy swaps actually stick. That's why Hero Bread is such a great example of making progress without overthinking it. Hero makes everyday bread products with 0 to 5 grams of net carbs per serving, 0 grams of sugar, and up to 19 grams of protein.

43:23Jordan Runtagh:And they still feel satisfying to eat. It's bread that fits into real life. Visit Hero.co, check out their products and reviews, and use my code HAPPINESS for 10 % off your first order. All figures are per serving, not a low-calorie food. See Nutrition Facts for more info. When your schedule sounds like this...

43:47Jordan Runtagh:Are you kidding me? An oil change is the last thing you have time for. So drive in to Take 5 and let our techs change your oil, check your tires, top off your fluids and have you back on the road pit stop fast. All while you stay in your car. No putting your entire schedule on hold. No upsells, no problem. So you can get back to your to-do list. Or not. Find your nearest shop at Take5.com. Take 5, the stay in your car 10-minute oil change.

44:23Dr. Jesse Mills:well jordan i think we've made it through screening any thoughts come up that that you want to talk about that hit your head when we were going through how do we how do we work up a prostate cancer prior to diagnosis i mean i had a few written down i mean this is sort of more

44:36Jordan Runtagh:prior to that stage and it's a real rookie question but that's kind of my specialty Are there any...

44:42Dr. Jesse Mills:The perennial rookie. Exactly.

44:44Dr. Wayne Brisbane:Are there any dietary or even environmental factors that can meaningly raise or lower risk? Yeah, we do think so. I'll say a caveat. There was a really, really well done study called the meal study. It was led out of the UC San Diego. And it specifically was looking at guys with low risk prostate cancer and randomizing them between a high vegetable diet versus kind of whatever they were eating. you know, just whatever you like. And they followed them for three years, I want to say, and then biopsied them again to see if there was any impact on this low risk prostate cancer. And there really wasn't.

45:21Dr. Wayne Brisbane:We've done some studies in fish oil that showed some changes and stuff like that. So if there is something, it's something that you have to apply over many, many years. It's not a short term fix where you can say, I'm going to, you know, become a vegan for a month and really change my prostate cancer, drink some green tea and really change my prostate cancer. This is a lifestyle over many, many years. But there's lots of kind of population level data over big groups of men and women, specifically men because it's prostate cancer, where we're looking at those who tend to get cancer and those who don't, and specifically prostate cancer, and those who will be more vegetable-based diets.

45:58Dr. Wayne Brisbane:You don't necessarily vegan, but more vegetable-enriched diets, and those who are exercising definitely have lower incidences. And so that probably manifests as those are the things you can do, but it's a long-term lifestyle commitment.

46:12Dr. Jesse Mills:Yeah. So Jordan, you set me up for my segment on separating fact from fiction here, which is if Dr. Brisbane had it in him to make Dr. Brisbane's all-in-one prostate cancer prevention supplement, because there's a market for it. Obviously the supplements are a multi-billion dollar market, without talking about whether you can sleep at night, because the amount of coffee you drink, you probably don't sleep at night anyway. But is there anything you would pack into that supplement and with any good conscience sell to your patients and to the population writ large?

46:48Dr. Wayne Brisbane:That's a great question. I don't think so at this point. I would give them chocolate because it's delicious.

46:56Dr. Jesse Mills:There you go. Yeah, it's got polyphenols and those are really good for you. Yeah, because you brought up the omega-3 versus omega-6 story, which sounds like there's not as much of a story as maybe we hope. And it sounds like it's such a long game that it's really tough. I mean, one of the things in general with supplement studies and population studies and looking at areas where people live longer, have lower incidences of cancers, prostate cancer, sort of like the soy story, right, is that you're looking at one thing that you want to extract out of an overall lifestyle, right? So maybe it's not the soy, but maybe it's living in Okinawa and enjoying sunrise and sunset on both sides of the island and not having to get run over by a bird scooter on your way to work and just having an overall lifestyle.

47:44Dr. Jesse Mills:And by the way, we also eat more soy than the average American diet. And is that sort of what you're alluding to as well, that there is not really anything you can pack into a supplement to prevent cancer?

47:55Dr. Wayne Brisbane:I think that's very nicely said.

47:58Dr. Jesse Mills:Other than exercise, which is a great supplement. Yeah. Which always wins.

48:01Dr. Wayne Brisbane:One of the joys that we have in our clinic as urologists is we basically get a chance to watch men age. If you become 90, you're going to have something urologic in your life. And so we get to see men age well and some men age poorly. And Jesse, you can let me know if you think this is the common factor. But I have never seen a 90-year-old who's walking, healthy, vibrant, who is not in the gym at least three to four times a week.

48:27Dr. Jesse Mills:Yeah, no, for sure. Or in the garden or in the Santa Monica Bay swimming, you know, and that's also good for your immune system, because if you can fight off E. coli and Klebsiella and Pseudomonas from the Santa Monica Bay, you can survive anything. So, yeah, well, this is great. I think it's time to just let you go for a little bit, get a cup of coffee, and maybe we'll see you in a little while to hit the diagnosis. Because I got to worry this, you know, one of the other things about these segments, we always ask if a guy's going to be okay with this. And so after the diagnosis, you're going to have to tell me how our guy does.

49:00Dr. Jesse Mills:So, Dr. Brisbane, thanks so much for covering the screening. I'll see you back here in a little bit to talk about diagnosis. us and Jordan let's roll them out with a little long transit guitar work and we'll see you back real soon thanks Wayne looking forward to it thank you

49:23Dr. Jesse Mills:let's talk about it let's talk about it

49:34Dr. Wayne Brisbane:let's talk about it

49:46Jordan Runtagh:The Mail Room with Dr. Jesse Mills was a production of iHeartRadio. It was executive produced by Jordan Runtog. It was edited, mixed, and mastered by Bahid Frazier. And the theme was provided by Long Transit. If you liked what you heard, please subscribe and leave a review. For more podcasts from iHeartRadio, check out the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows. This program is intended for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Consult your health care provider for any medical or other related questions or concerns.

50:26Jordan Runtagh:The views and discussions aired on this podcast are those of Dr.

50:29Dr. Wayne Brisbane:Mills and do not represent the official positions of UCLA or UCLA Health.

50:41Jordan Runtagh:Are you trying to get weight loss support through telehealth, but it feels overwhelming and rushed? Check out orderlymeds.com now. Orderlymeds.com was built to be different. Here, you connect with real doctors who take the time to understand your goals, review your eligibility, and guide you through a plan that's right for you. Orderly Meds provides access to proven GLP-1 medications like semaglutide and terzepatide, including both name brand options and personalized compound versions when appropriate. So you have choices backed by clinical oversight, not guesswork. It's a simpler, more supportive telehealth experience designed around people who want clarity, care, and confidence in their weight loss journey.

51:20Jordan Runtagh:And your medication is delivered directly to your home in discreet packaging. So your experience stays private from start to finish. Do your research. Ask the right questions. Then visit orderlymeds.com slash podcast for an exclusive offer. Again, that's orderlymeds.com slash podcast. Individual results may vary. Not medical advice. Eligibility required. See site for details. This is Dr. Laurie Santos from the Happiness Lab with Dr. Laurie Santos. One of the things we talk about a lot on this show is behavior change and how small, easy swaps actually stick. That's why Hero Bread is such a great example of making progress without overthinking it.

51:58Jordan Runtagh:Hero makes everyday bread products with 0 to 5 grams of net carbs per serving, 0 grams of sugar, and up to 19 grams of protein. And they still feel satisfying to eat. It's bread that fits into real life. Visit hero.co, check out their products and reviews, and use my code HAPPINESS for 10 % off your first order. All figures are per serving, not a low-calorie food. See Nutrition Facts for more info. With the Venmo debit card, a taco in one hand, and ordering a ride in the other means you're stacking your rewards. Nice! Get up to 5 % cash back with Venmo Stash on your favorite brands when you pay with your Venmo debit card.

52:39Jordan Runtagh:From takeout to ride shares, entertainment, and more. Pick a bundle with your go-tos and start earning cash back at those brands. Do more stash, get more cash. Venmo Stash bundle terms and exclusions apply. See terms at venmo.me slash stash terms. Max$100 cash back per month. I'm U.S. Transportation Secretary Sean Duffy. We all get distracted when we drive, whether it's from our phones or kids in the backseat bickering. But how we handle these distractions can be a matter of life or death. Before you get on the road for your next road trip, please put your phones on silent and take a mental note to focus on driving.

53:20Dr. Wayne Brisbane:Paid for by NHTSA.

53:23Jordan Runtagh:This is an iHeart Podcast. Guaranteed human.