What to Expect After Prostate Surgery: Reclaiming Sex, Confidence, and Control

23:30prehab you were literally priming the pump that's right yeah that's right and we have pretty interesting research in the spinal injury field that what we're trying to do is overwhelm that nerve terminal with nitric oxide. And that's what that does, is that you're just priming the pump. You know that it's going to take a hit. So you're basically training your nerves. And then afterwards, you're training your muscle in the penis to be able to be receptive to that nerve input whenever that kicks back in. It's pretty cool, but it also empowers guys to take control of their health, which also is why I spent a lot of time talking to men about their nutrition and exercise, how do they go into the surgery?

24:12Because even though you're taking a nap, in other words, you have a general anesthesia and your surgeon's doing all the work, your body has a stress response cycle. And it's equivalent to running a marathon where you just, it's exhausted, your cortisol levels go up. So stress hormones go up, your blood pressure, even though it's controlled by the anesthesiologist during the procedure, the signals are there that, man, this is super stressful. And so how do you prepare for an athletic event? Well, you train for it. So I'm a huge fan of starting a nutritional program, really the minute somebody gets a diagnosis of prostate cancer.

24:47So as Dr. Brisbane has talked to going through the biopsy, you get the results of the biopsy back, that's when he should start thinking about doing something to improve his nutrition if he doesn't have great nutrition already. So the two big things for me that I always say is that cancer loves sugar. And when we had Dr. Joffrey on a few episodes ago saying sugar is the most addictive substance out there and should be classified as a drug, that's not hyperbolic. And a lot of people when they're stressed, especially they think of this devastating cancer diagnosis, what are they gonna go for? They're gonna go for the donuts, they're gonna go for the sugar that gives them that little dopamine rush.

25:26But we know that controlling men's sugar intake or even women as well for any kind of cancer control. In fact, to the point of sometimes putting them on drugs to lower their blood sugar, like metformin or some of the new GLP agents, that actually can improve their cancer control because if the cancer doesn't have access to high blood sugars, it doesn't divide as rapidly because it needs that, any rapidly dividing cell needs high levels of carbohydrate or sugar. So I'm really harping on guys to limit your sugar intake as much as possible before the surgery and those six months post-op to let you heal.

26:02Protein, super important. So again, every time I make an incision, every time you skin your knee, you know, or you fall off a camel in Doha, for example, or whatever you did. Great pictures you sent, by the way. Yeah, you looked awesome. Camels are taller than you think, though, I gotta say. You can hurt yourself. You can hurt yourself. If you fall off a camel, you just injured stuff, a broken bone, at least a bruise, it takes protein to heal all those things. And if you're going to have an incision and you're going to have some muscle cut into, you're going to have an organ removed and you've got to heal where that organ used to be that what we call the anastomosis or the two tissues we have to sew together so a guy can be continent again, all of that needs protein.

26:45So try to increase your protein intake pretty significantly. Even if it's something as simple as taking a 30 or 60 gram protein shake a day or adding a little extra lean protein. Beans are a great source of protein. Lean chicken also, all that. So whatever it is, but just conscientiously make a big effort to improve your protein so you have that. We can actually measure that a little bit by looking at something called a microalbumin or albumin scores. And most of the time we do that preoperatively to make sure people are a good candidate for surgery. So people that are nutritionally depleted will have low albumin levels and we know that we have to do more to get them up and ready for big surgeries.

27:22So protein, protein, and then exercise. If you're going to run a marathon, even if you're asleep for a few hours while you're getting your prostate removed, you got to exercise. You got to get your heart in shape. If you can walk, really, I try to get people to do a good 30-minute walk at least five days a week to get ready for this. If you're limited in your mobility, then do something, upper body exercise, something that can get in a pool, whatever it is, to try to get your cardiovascular system ready for it. And you're going to do so much better. I mean, it's just outcomes are always improved when people are taking accountability and doing everything they can consciously so that they can do well with that surgery.

27:59Because I could be the best surgeon in the world, but if you don't follow post-operative instructions, if you're not eating well, if you're not sleeping well, you're not going to have as good outcome as somebody that's super motivated. You mentioned continence earlier as well. I was doing, in my role as the every person consulting Dr. Google before seeing an actual physician. I saw a lot out there about pelvic floor exercises helping with, does that help with just bladder control or also sexual function or both? Love me some Kegels, Jordan. Love me some Kegels. Yeah. And there are apps out there.

28:33You know, people are going to say, well, how do you do a Kegel? And I think that the best way I train is before a guy has his prostate out, all I tell the guy to do is the next time you're using the restroom, you're taking a leak, just pinch off that, that urine stream for a few seconds. That's a Kegel, you know, that's really engaging that pelvic floor. And then, and then do it every red light you're sitting at every commercial break. If you're watching TV, then start to do those Kegels and you should kind of do them in sets that physical therapists have very different protocols for what they think, but it usually it's either like four sets of a five second hold or, or 10 sets of a five second hold where you're basically just pinching that muscle, like you're trying to hold off your pee and then relaxing and going back and forth.

29:20And you do that probably three times a day, ideally before you have surgery. So now you know what it feels like. So when the catheter comes out, which we talked about a little bit with Dr. Brisbane, in terms of the recovery from surgery, you're ready to roll. You know, you're ready to be able to hold that so that your urination becomes much easier. And most surgeons today, they're doing a little extra stitch, essentially, the way to think about it, where they tack up that outlet, which is the urethra at the bladder neck level, so that you're fighting gravity a little bit to be able to pee afterwards.

29:57And that helps keep guys continent. So Kegels are very important. And I like what you asked, you kind of set me up, that the muscles that control orgasm also are in that pelvic floor. And so by strengthening those pelvic floor muscles, a lot of guys will have a better orgasm afterwards, which you're gonna say, well, Dr. Mills, I didn't think you orgasmed after you had prostate surgery. We talked about that a little bit, Dr. Brisbane as well. And I'll say, not exactly, Jordan. Actually, you can have super intense orgasms where you get that pelvic floor constriction, you get that euphoric feeling of all of the serotonin and dopamine and oxytocin release, all of that is still very euphoric post-prostatectomy.

30:42You just don't have an ejaculate. So that's the difference is because the prostate provides the majority of ejaculate fluid, the other organ called the seminal vesicles, they provide the rest. All of those have to be removed during prostate cancer surgery. So guys will have what we call a dry ejaculate where they'll still get the feeling and they can have that a lot of times, in fact, before men's erections are back, they actually will have orgasms, which is pretty cool. So they'll be able to feel that sensation even before they're ready to have penetrative sex again. That's really fascinating.

31:17Wow. I mean, and then there's a whole other discussion about, you know, and we talked with Dr. Smith recently about sperm health and banking and who's a candidate for that. So it's all connected. It's all connected. That's on my script that I don't actually have. which is you're right. So when I also talk about prehab, I do talk about what we call oncofertility preservation because, you know, we are diagnosing prostate cancer, some in guys that are still in the wheelhouse of reproductive age in LA that goes up to about age 85, I believe. But, you know, I mean, you know, we have some older dads out here, rock stars, you know, who I'm talking about.

31:56But the truth is that any guy that's having prostate cancer surgery should have at least a discussion about fertility preservation because you're right. I always say a prostatectomy is the mother of all vasectomies. In other words, we have to cut across the vas deferens, but also take out everything attached to the vas deferens, which is the prostate, which are the seminal vesicles. And so man will still make sperm after a prostatectomy, but because he's had essentially one giant vasectomy, they're all stuck in the testicle. And so I can still do a sperm retrieval. I can still do a procedure where I can go directly into the testicle and get plenty of sperm out to use for in vitro fertilization.

32:38But if a man wants to bank sperm ahead of time, just like we talked to Dr. Smith about the ways to get pregnant with frozen sperm, one thing we came up with something called IUI or intrauterine insemination. And so if a guy provides me with ejaculated sperm that I can freeze, then if it's a good enough quantity and quality, then he can still use that ejaculated sperm after prostatectomy to initiate a pregnancy through insemination as opposed to having to go right to IVF. So sperm banking is a critical part of the discussion and no age is too old to have that talk, but you always can't make assumptions about when a guy wants to become a dad or oftentimes when he wants to potentially have more kids.

33:20So they're absolutely right. Sperm preservation is super important in that whole thing. One other thing that comes up a lot that people don't think about and they probably didn't ask their prostate surgeon about is a phenomenon called climacteria, which is kind of what it sounds like. Climax is my orgasm. Uria means urination. And so this is not uncommon for guys to have a little leakage of urine while they're orgasming, which can be pretty socially awkward to say the least, uncomfortable for the man and his partner and not something they have to live with forever. So I'm going to break down the physiology of that a little bit, as well as ways to help improve guys as they're thinking about prostate surgery and this whole prehab program.

34:08And so the phenomenon of orgasm is a pretty cool thing. We talked about this a while back with Natalie Feingold-Goldberg in sex therapy and why some guys have difficulty ejaculating at all, what we call delayed orgasm. And some guys have premature orgasm where they ejaculate too fast. And a lot of that is because it's a reflex. It's a sympathetic derived reflex. So the nervous system, once everything is on the tarmac and ready for takeoff, there's a point of no return. And that point of no return is that sympathetic response. And so what happens in the urethra, which is our common pipe, the pipe to let pee out of our bladder and the pipe to let semen out of our prostate, seminal vesicles, testicles, is a very well-orchestrated dance of sympathetic fibers that close down the bladder neck but relax the opening or the external sphincter so that you can have semen come out but actually not have urine come out in a normal physiologic and anatomic intact male.

35:16So now there is no more semen, but that sphincter still wants to open up, right? But because you've had this reconstructive surgery, the prostate is gone, that opens up and you don't have a prostate and an internal sphincter to hold back the flow of urine. And so a guy's in the, you know, it's just amazing. Like, my God, this is so great. I'm going to have an orgasm after my prostate surgery. Dr. Mills told me about this. It's going to be fantastic. And then squirt, you get a little bit of urine out. And so it's physiologic. It doesn't mean you're incontinent and it just, we have to figure out how to deal with it.

35:52And there's a couple of ways, Jordan, that, that I've had some success over. Most of it is behavioral, which is that if you know a guy's going to have sex, make sure you fully empty, you know, now's not the time to drink coffee or a bunch of beer before sex and have a full bladder. You know, you gotta be, got to manage your fluids because if you don't have much in the bladder at the point of orgasm, ain't much going to come out. But that's not always practical, especially if, you know, somebody's engaged in sex with their partner for, you know, more than 30 minutes before the payoff, then that's a left time for your kidneys to make urine, end up in the bladder, and where's it going to go?

36:28So there are some medications. They're all off-label. There is no FDA-approved therapy for for this. But there are some things that work. One of the classic ones that your doctor might try is something called a tricyclic antidepressant. Omipramine is sort of the gold standard that we use. And why that works is it doesn't, we don't actually very often use it for depression anymore because we have so many better mental health agents, but it also actually tightens up that that sphincter so that it makes sure that you have a fighting chance of not leaking urine by closing up those, what we call the alpha adrenergic receptors in the bladder neck, so that you might have an orgasm without leakage.

37:13So there's some consequence of it. It makes some guys drowsy. It also can give you a little bit of a dry mouth. So there's some issues with it, but it might be worth trying if it's really, really bothersome. And there are surgeries we can do as well to improve this climacteria if it gets to the horrible point. And then lastly, you know, I mean, the old barrier method, it sounds kind of strange and simple, but sometimes it's just enough leakage that a condom would help keep it in place. And so a lot of men, even if they've been intimate with the same person, they're not worried about sexually transmitted infections, they will actually use condoms for a little while as they're having penetrative intercourse to make sure that they're not having that climacteria.

37:53But that's probably more than you ever wanted to know about Climacteria. And it's something that I don't even know what's out there in the literature. We don't talk about it much, but it certainly is a surprise. And certainly an email I get from patients saying, great news, Mills, this is great. Erections are back, so happy. But I got this little issue. And that little issue can be a big issue and also can be a little bit demoralizing to somebody that has returned function, thinking they're on their way, and then they have this urinary leakage with orgasm. But we can treat it. We can figure this out.

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42:44I would be remiss in my duties as the representative of every man on the show if I didn't ask this next question. I would imagine, although I should ask you directly, this is probably a thing after, you know, will my erections come back? I imagine this is the second on the list. Penile shortening or shape changes. Does that occur? If so, how often and to what extent and what can be done for it? Yeah, it does. it does occur. And, and thankfully there are things we can do for it. First of all, it's important for my oncological colleagues to acknowledge, because it wasn't actually really until I was in training, you know, in the early two thousands where they had, they showed papers that you do have a potential demonstrable length loss after prostatectomy.

43:34And some of it makes sense, I guess, in that, you know, your prostate is part of your, your urethral anatomy. In other words, the urethra, which is part of your penis, the prostate is like a donut with the urethra being the hole that goes to the donut all the way to the bladder. And, you know, prostates, they vary in length. Some of them are three inches long. Some of them are an inch long. Some of them are even smaller than that. But we always would say, yeah, you know, but the urethra, there's some redundancy to it. We're not shortening the erectile tissue. So length loss really shouldn't happen.

44:07But it kind of goes back to what we're talking about with smooth muscle atrophy. So a lot of guys, you know, they lose that dangle, that locker room dangle, because they're not getting that smooth muscle blood flow. And so the erect length loss is usually not that much, but the flaccid, like, I swear I looked down at my penis and it used to be much longer before my cancer surgery. Now it's what it is. That is true. But if you go on with smooth muscle atrophy long enough, it develops a condition called corporal fibrosis, which does cause dramatic length loss. It causes penile shortening with erections because that spongy, healthy elastic tissue that used to go up and down at a moment's notice now doesn't really respond the same way if you didn't do that prehab program and really get that smooth muscle engagement during that neuropraxia period.

44:58And the second thing, I like how you set that up with shape changes, because one thing that I've done a lot of research in, pretty well known for in the world, is something called Peyronie's disease, which we're, again, going to talk about at some point multiple times, just because it's such an interesting and such an important topic for men to know about. But in the classical studies of Peyronie's disease, which is when you get scar tissue that develops on the outer layer of the penis, what we call the tunic albigenia, we say about 20%, almost 20 % of men after prostatectomy would develop this scar tissue, which causes shortening.

45:36It also causes changes in the erect angulation of the penis. So the classic guy Peronis will come in, say my penis is shorter and I have a 45 degree upward bend or a side to side bend, or sometimes even a downward bend. And so now I have not only a shorter penis, worse erections, but I also have an angulated penis that makes penetrative sex difficult. So yes, all of those things can happen. All of those things are at least partially to fully preventable. And in another self-aggrandizement moment, another medical student that I worked with and resident over the years, we looked at our research about two, I want to say two years ago or so, three years ago, where one of my physician assistants, Keith Reggett, so I've worked forever, he's just a super smart guy that just spends his day in the clinic taking care of all my guys.

46:29And he said to me one day, you know, because we see so much Peyronie's disease, I probably see 3 ,000 men a year just for that diagnosis alone. And he said, you know, Dr. Mills, it's interesting, but in our prehab population, the guys that we're following for prostate cancer rehabilitation, I'm not seeing that many men develop Peyronie's disease. And the literature says, you know, between 16 and 20 % of guys will develop Peyronie's. And so I said, well, Keith, that's a really interesting observation. Let's look into it. And so we did, and we saw in our data set, some 400 plus guys after prostatectomy, we saw only a 2 % incidence of Peyronie's disease in these guys.

47:12And what that means is that something we're doing with our prehab is protective against a huge risk factor for developing Peyronie's disease, which is radical prostatectomy. So we went from a traditional 20 % rate of penile shortening curvature down to 2%. And I think it's probably that daily Tadalafil. It goes back to that smooth muscle engagement. Cialis itself, or Tadalafil, it has antifibrotic properties. This goes back to research that, again, we did at UCLA over 20 years ago with Jacob Rafer, who's my partner, friend, mentor, and true giant in the field, of medicine, he and his PhD scientist, Nestor Gonzalez, looked at Cialis as a treatment for Peyronie's back in around 2003 when it first came out.

47:58And they showed in vitro, so in test tubes, you could take penile scar tissue and feed it Cialis, it's very simplified, of course, but see that it actually could reverse some of the fibrosis in that layer, in that tunica Albiginian. So any guy that I see that has a risk for Peyronie's disease, certainly every guy that's coming in that has a prostate cancer surgery coming up, that is the pillar of how we prevent length loss, penile scarring, shortening, and Peyronie's disease is with that tadalafil regimen. So right. Yeah, shrinkage happens. We can prevent it. The other thing, if you wanted to be very aggressive, literature is not so great on this, but there's a few papers out there on something called penile traction device, which is like, you know, you're maybe too young, but you have that old soul that you remember what erector sets are.

48:50Do you know? Oh, of course I do. Oh, yeah. So tell the audience what an erector set is for those that are under 40 out there. It's like a souped up Lego set that actually comes with nuts and bolts in addition to, I remember them being metal. There were actually pieces of metal that would be put, maybe they're plastic now. And you would build cranes and all. It was a pretty, it was like a heavy duty Lego set. That's right. Yeah, no, exactly. So that's what a penile traction device looks like is an erector set of sorts. It's got these metal struts on either side of a cylinder that you put on the penis with a little gentle clamp at the head of the penis and then a foundation at the base of the penis.

49:29And then you just increase the struts on that erector set a little bit by little bit so that, you know, every week or however often you're able to gain a little extra length, you pop another little strut into that erector set and you walk around for an hour a day with this penile traction device on. And I can only imagine how many people, I hope you're not driving now or Googling and trying to figure out what penile erector set is, but it's probably trademarked. But anyway, if they're still in, Mattel is probably going to send me some kind of cease and desist. But anyhow, they're big sponsors of UCLA.

50:07So shout out to Mattel and the Children's Hospital. Maybe that'll get me off the hook. Anyway, they work. You know, if you're willing to wear the scaffolding for an hour a day, it may help restore some of that length. The question that we have in the literature on that is, is it one of those things where if you stop doing it, you recidivize? In other words, do you lose some of that length? Because when I see guys in active therapy, I use it a lot in my men that I'm treating for Peyronie's disease. It's pretty impressive. I mean, they really can restore some length and that elasticity. So if a guy is willing to go that extra inch, then yes, for sure, penile traction may be a part of their rehab.

50:53Yeah. We've talked a lot about physical things you can do, medications, but I imagine there's a huge psychological component to recovering after prostate surgery and optimizing sexual health after prostate surgery. Can you talk a little bit about, you know, what that looks like for you, for your patient? Right. And my patient's partner. Exactly. Yeah. Yeah. Yeah. I mean, I think I always, I'm always delighted when I see a patient's partner coming to this visit because I know then that they have support. And I know that there's somebody that, especially if they're sexually active together, then they can hear it out of my mouth that this is a team sport.

51:41And restoring erectile function is not going to usually happen right away. And there may be times when the man is going to be very, very willing and very libidinous and wants to engage in penetrative sex, but he just won't be able to. And it's not a slight against the partner. He or she could be incredibly responsive and incredibly understanding, but ultimately their libido is important as well. And so that's where I think sex therapists are super important. And I always say, you know, you can have sex without an erect penis, right? So you can still be intimate and figure out ways to pleasure each other without focusing on penetrative sex.

52:24And that's where the sexual therapists are super helpful to have that discussion because they can provide that extra level of here's some exercises you can try. But that's just on the sexual part, the survivorship of knowing that you're going through cancer surgery because you want to live a long, healthy life, especially for something like prostate cancer, which still kills more Americans than any other cancer, even though it's also almost as preventable. We really unpacked a lot of that with Dr. Brisbane, Dr. Hoffman on our cancer screening before. And it's true, but you have to say that the psychological ramification of telling a man that there's going to be a period of time when you're not going to have any kind of erection, likely for the first time in your adult life, and there's even a small chance that you're never gonna get that normal erection back and there's a 100 % chance that you're never gonna have an ejaculation again.

53:21That's like check, check and check for seeing how vulnerable that man wants to be to share that with his partner. And what about for all the single guys out there? And there are very good outcome studies that in general, single men don't fare as well as men that are partnered. and that is a huge thing that I have to address in my single male population. That's where cancer support groups can be helpful. That's where a lot of work has been done by the NFL Players Association. There's some amazing work in the professional sports field, cancer survivorship programs all over the country that I really encourage, especially my single guys to tune into.

54:00But right, you have to address the mental health before you can address the sexual health because you cannot dichotomize them. You're absolutely right. But it's a critical part of rehab is to have that discussion so that everybody understands what they're getting themselves into. Yeah, great point. Well, I think as your model patient right now, I think those are all the questions that I had from Dr. Google. But are there any big myths that you have people come into your office and they're sitting across from you and that you really want to put to bed right now when it comes to sexual health after prostate cancer surgery?

54:36Yeah, I think the biggest, I don't know if it's a myth, but a misinformation is that you're never going to be the same again. And that's 100 % true. So I don't want to candy coat any of this. but I also think you have to say you're going through something that is, is so critical to preserve your life that, that it may be worth understanding that the new you is going to be the new you. It's not going to be worse. Yeah. May not be better. It's going to be different for sure, but you have to get through that. And I think the only myths in general that I say is that a lot of guys, and maybe this is more of a, a fact is that I certainly see men.

55:18usually they're older. They went through this a long time ago. They may not have had this prehab counseling and prehab discussions available that say, I wish I never would have gone through that. And that's kind of the most heartbreaking thing I hear because there are men, you know, as much as I can just say how great we are at reconstructive urology at putting a penile prosthetic in or putting a urinary control device of some kind in where they fail. You know, we do get infections. We could do mechanical breakdowns. We do have complications from both surgery and radiation. And I have to own that as a profession and do everything I can to make sure that I meet guys where they're at to help say, okay, now this is where we're sitting today.

56:02But how do we get you to the point where you know that you're cured of cancer and you have a lot of life ahead of you, but it's going to be some work on my part. It's going to be some work on your part to get you to where you do feel as if your quality of life is starting to catch up to your quantity of life. Because for sure, I've seen guys, and Dr. Brisbane talked about this in some of the advanced prostate cancer treatment pathways or algorithms where we have to take testosterone away from a guy to improve his longevity. And, you know, I'm a huge testosterone advocate. We've talked about it.

56:36We're going to continue to talk about it. There's roles for it. but certainly enough guys have said, look, I went on androgen deprivation. I went on that hormone therapy to make sure my cancer doesn't come back. And I'd rather be dead than being on it. I gained weight, I'm depressed. My mind is not as sharp. I have zero libido and I just, I don't want to live like this anymore. So I have to meet guys where they're out there too. And so I think this is more of a call out to physicians than to the patients listening, but is just, you know, listen to your patient about what they want, what are their values.

57:12And that's a key aspect of shared decision-making that sometimes we lose in the oncology world. And I think it's so important to meet guys where they're at. And then if you are a patient, just like we talked about with Wayne, Dr. Brisbane, too, is that if you don't feel comfortable with your surgeon for whatever reason, then, you know, you do have abilities to go out, find somebody else that you really can have a longitudinal relationship because we're going to be there for you as an oncologist, as a rehabilitative and reconstructive urologist. You're going to have a good team in your corner. So yeah, don't not get screened.

57:47Don't not go through the therapy because our goal is to make sure there is another great nonprofit called Project Zero. And that's our goal is to have zero people die from prostate cancer because it is so preventable if screened. And also, we have so many great tools, again, to kind of bring it back to what Dr. Brizon and I talked about is there are even times when we can watch prostate cancer and we don't have to act. We don't have to go through surgery. And I think the regret of a lot of guys, especially in the older series, but when we found prostate cancer, you know, prior to 2005, 2010, we basically took it all out.

58:29And there's no doubt that we over-treated. We talked about that. Now we have so many better molecular diagnostics to know who to treat, who not to treat, that you just got to figure out who that guy is and then steward him through his journey, whether it's an active journey or whether it's a, let's wait and see and see how many quality of life years we got before we have to jump in on the cancer side. So yeah, more information, more information, feeling comfortable with your team, Jordan, just like everything else we do. It's feeling comfortable with the team, brother. Well, I think you led us through a very, very difficult journey, but very important journey with compassion and expertise, as you always do.

59:08Is there anything we missed? Yeah, no, I don't know. I'm subdued. You know, I'm normally so fired up, but I think I'm super fired up in the fact that we have so much more good to do out there. And I'm excited to hear the listener feedback on what action items they got out of this, which, you know, this whole series, both from a how do you screen diagnose treat to how do you prep yourself. I think this all are calls to action for men to know your numbers, make that relationship. And, yeah, let's get fired up. You know, let's do this to the point where guys are knowing their numbers, knowing their data, and getting with the right healthcare guys to get on there.

59:45Man, so, okay, now I'm feeling good again. I'm feeling super pumped. You did it, Jordan. Project Zero. Project Zero, yeah, I love it. That's probably trademarked too, but a shout out for any nonprofit that's out there in the community doing fantastic work, of which there are a lot, to get guys in the door to know their prostate cancer status. That's a home run here. That's the touchdown. And yeah, we did it. You know, we did it again. We hit a hard topic. And I know you can go somewhere with that one too, but it is, the goal. is to make it a hard topic and to keep it hard and to keep it active and to keep it long and the discussions flowing.

1:00:24Doc, you delivered on the mailroom today. Thank you for that. Look at that. Look at that. Right back at you, brother. Well, this is cool. I can't wait to join up again and figure out what we're going to talk about next, Jordan. I can't wait. Looking forward to it, sir. Thank you. Hell yeah. All right, brother. See you soon.

1:01:10The Mailroom 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.

1:01:51The views and discussions aired on this podcast are those of Dr. Mills and do not represent the official positions of UCLA or UCLA Health.

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