Search for tag: "maybe"

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: Welcome to the "Sideshow" on "Who Cares About Men's Health." We're going to talk about an article that I found about sleep. This is kind of interesting. But the first question I have for you guys, Troy and Mitch, is would you like a sleep consultant? Would you like to have somebody in your life that would help you make sure that you're getting the optimal amount of sleep?

Mitch: Are they sitting and watching me sleep or . . . Because that's the first thing I thought of. I don't know if that's accurate, but just what do you mean?

Troy: Yes. There are people who do that.

Mitch: I know. But it just sounds . . .

Troy: They're also called stalkers, but yeah.

Mitch: Just pull up a chair and watch me toss and turn.

Scot: That's right. Maybe you should lay on your left side, Mitch, for a little bit. I notice you seem uncomfortable on your right side.

Mitch: Right.

Scot: "Thanks, sleep consultant."

Troy: I'm going to say no, I would not want that just, because it would just make me more frustrated than I already am. I know my sleep is not good.

Scot: So this is kind of interesting. In the Olympics, Olympic teams, a lot of times they have coaches and trainers and physical therapists and massage therapists and all that so they can perform at the height of their abilities. In Tokyo, the U.S. weightlifting team had another person on the team to help athletes perform at the top of their game. It was a sleep performance director. They're the only Olympic team to have such a thing on their staff. And this person's job essentially . . . He said, "I'm a sleep doper, is what I am. I just try to manipulate using people's natural rhythms and sleep to make sure that they get the maximum amount of sleep and recovery."

Troy: Sorry, which team was this?

Scot: The U.S. weightlifting team.

Troy: Oh, wow. And only the weightlifting team. It wasn't like the soccer team or anyone else?

Scot: Yeah. This year, it was just the weightlifting team. So Jeffrey Durmer, Dr. Jeffrey Durmer, he's a neuroscientist who specializes in sleep, and he's been doing this since 2013. He's been a sleep consultant that helps optimize athletes' performance through sleep programs and just using natural physiology and science to improve the sleep.

I thought this was an interesting thing. He said, "What we found is the concept of overtraining syndrome really is not about overtraining. It's about under-recovery." And when we talk about the core four, we talk about activity, nutrition, emotional health, and sleep as important components to your health. And I think that really underlines how important sleep is, first of all, that Olympic team had a sleep consultant, and then this notion of under-recovery.

Something else that the doctor said that I really, really liked was this notion of, "Don't think of going to sleep as ending your day. Think about it as getting ready for tomorrow." You guys like that?

Troy: I like it. Here's my thought on sleep. And it's funny, I was just thinking about this today. Sleep is the new smoking. I feel like we're going to look back . . . honestly, I think we're going to look back in 30 years and be like, "What were we thinking?" in terms of our approach to sleep, in terms of often disregarding it. Obviously, we're seeing changes there, but we feel like, "Oh, anyone who sleeps eight hours a night is weak. I admire people who sleep five hours a night and look how productive they are."

And I think in 30 years, we're going to look back and be . . . kind of how we look at smoking in the 1950s and '60s now. You look back at the doctors who would smoke and appear in ads and be like, "Smoking is healthy." It's funny. Maybe I thought about that because I'm actually listening to a book on the history of tobacco right now.

Yeah, I feel like sleep is the new smoking. And in 30 years, we're going to be like, "Wow, we were stupid."

Scot: The doctor said that the most important part of his job as a sleep performance director is first educating the athletes about the benefits and necessity of sleep. So there's this mentality, like you referenced, Troy, "I'll sleep when I'm dead," or when you're an athlete, you've got to use all those waking hours to train.

Troy: Yeah.

Scot: So that's the first thing. And then the second thing is to actually help the athletes and the individuals sleep better. And we've talked about some of this stuff before, but I think it's worth repeating. I would like to have a sleep expert on and talk about this notion of, out of the three of us, maybe one of us does better going to sleep at 3:00 in the morning and sleeping their eight hours until whenever they get up. This notion of you have to get up at 6:00 in the morning or 5:00 in the morning, that doesn't necessarily work because everybody has their own kind of natural sleep rhythms, if you will.

Troy: Yeah. But it's fascinating to me too, and I think we talked to Kelly Baron about that, the idea that there are short sleepers out there. People who function just fine on three, maybe four hours a night. And her response was that, "No, they don't. These people don't exist. They just have learned to be tired." They've learned to be tired, and that's how they function.

We all need sleep. We're not superhuman. And it's so prevalent in the medical profession. That's what's so hard for me. It's just this idea that it's crazy how . . . As medical professionals, sure, I'm going to tell patients who need sleep, but among our profession, how we disregard that. And we even look at people who prioritize that as weak or unfit.

I think in our society, larger society, it's in so many areas people disregard it. And certainly in the tech industry, I think there's a lot of that there where it's like, "Yeah, you can work all day and party all night, or work all night too and get by on four hours of sleep," and that's the definition of success. So, hopefully, that'll change.

Scot: Yeah, the short sleeper notion that Dr. Baron talked about, I think about that a lot. The notion that they've done research. There are still these people in the world that say, "I only need four hours of sleep, and I work great. I actually do better than if I sleep too much."

But what their research found that I wanted to also throw out there is they do things to really keep themselves awake. They drink a lot of caffeine beverages, or a lot of sugar beverages, or they really amp up their excitement level and their intensity to try to push through it.

So it's not necessarily they don't need fewer hours of sleep. It's just they found strategies to get around that and cheat sleep a little bit, which, as you said, cheating sleep, not a good idea.

Troy: Yeah. And I think as they studied those people, too, they found that they engage in multiple what they referred to as microsleeps during the day, where essentially, their brain is turned off. Their eyes are open, but their brain is off, which is a little scary if you're driving. That happens and they may try napping or just . . . essentially, involuntarily napping, just doze off for 10, 15 minutes just to try and . . . Their body is trying to compensate.

Mitch: Well, for me, when I'm hearing Troy talk about the social impact of how it's cool not to sleep, etc., I think the one that I get tripped up on a lot is, "Am I sleeping right?" And for sleep to be such a standard biological process, there's a part of me that's like, "Oh, I have to have the most perfect sleep hygiene. Am I sleeping right? How do I optimize whatever?"

And so I guess what I wonder is, does the consultant help you figure out how to do that? Because that would be great, especially if you're trying to personalize and figure out what works best for you, rather than just what works for everyone.

Scot: This consultant in this article did give some suggestions, so I'll go ahead and go through those. We have heard some of them. There's a couple of them that I hadn't heard before.

So wind down before bed. Slow down 30 to 45 minutes before you go to sleep. This individual suggested setting an alarm even to remind yourself to do that. How many times have you been like, "Oh, geez. I've got to go to bed now"? You don't get that 30 to 45 minutes to wind down. So meditation, reading, stretching, anything that helps you settle.

The second suggestion is to cool your core. So take a warm shower or a bath and then rapidly cool your body in the air.

Troy: Oh, interesting.

Scot: And that helps you fall asleep faster. Also, belly breathing will help with that as well.

Troy: Haven't heard those before.

Scot: Treat the bedroom as a recovery sanctuary. So the technology stays out. We've heard that, right?

Troy: No TV.

Scot: You can't be reading that stuff. Yeah, not only the light of the technology, but sometimes the content when you're scrolling and looking through the comments of Facebook or social media

Troy: Yeah, it gets your blood pressure up.

Scot: Don't add anything until you've eliminated stuff. So light, noise, heat, bed discomfort, or objects that stimulate wakefulness.

Include sleep as part of your training. This was the notion that sleep is your basis for your performance the next day. So think of your sleep as the beginning of tomorrow, instead of the end of today.

And then be mindful of your own sleep habits and patterns. Are you giving yourself enough time to sleep with a regular routine?

And if you still are doing all these things, you're winding down, you're trying to get the eight hours, and you're getting to bed on a consistent time, you're getting up at a consistent time, and you still don't feel rested, then they suggest you get professional advice from a sleep physician.

So there are a couple extra tips for how to make your sleep a little bit better. Any final thoughts on that?

Troy: Yeah, it's got some interesting points in there. Again, I hadn't heard that about the shower and then cooling your body core down after that. That's an interesting concept.

The other stuff, like you said, Scot, the screen time, that makes great sense, and having that 30- to 45-minute wind-down time, definitely essential just to slow the brain down, decrease all the external stimuli, and then be ready to go to sleep.

Scot: Hey, this is Scot. Thanks for checking out the "Sideshow" episode. By the way, I've got a couple of extra little sleep tips. So these are some thoughts and concepts that have come up over the course of the podcast tying back into the core four, and just remembering how your activity, your nutrition, your stress, your sleep, and your genetics can impact your health. They all interrelate. They're not separate things.

So, over the course of the podcast, we've learned nutrition can also have an impact on your sleep. So take a look at how late you're eating, how close to bedtime you're eating, how much you're eating.

We've talked to Thunder Jalili about intermittent fasting. And if you stop eating before bedtime a few hours, sometimes that can help you sleep. I know it definitely changed the way that I sleep when I stopped eating, say, at 6:00 p.m. versus having a snack at 9:00 p.m. or 10:00 p.m.

Another one of the core four is activity. So getting some activity can help you with your sleep. Again, I know from personal experience if I get the activity that I need to get during the day, but not too much because if you overtrain, that can actually limit your sleep, but getting some activity, making sure that you get out and being active will help you with your sleep as well over time.

Of course, stress can really impact your sleep. So we have some old episodes on some better tools to deal with stress you might want to check out. Or you might want to get some sort of help and find somebody you can talk to to get those tools to deal with stress.

Alcohol and other substances can impact your sleep as well. Alcohol is notorious because a lot of people think it actually helps them fall asleep, but research has shown that you do not sleep as well after you've had alcohol. You don't get into that deep sleep. So that could be another cause. And other substances you might want to check out for smoking or drugs.

And then there could be some medical conditions that some of the symptoms might be sleep-related. They impact your sleep. Obviously, the obvious one is you have to get up and go to the bathroom. It could be something going on with your bladder, your kidneys, or it could be a health condition that you're not aware of.

So if you're not sleeping, those are some other things you can check out. A good first step is to go to your primary care physician and just let them know that you're not sleeping very well, and you can start working through some of those things.

You can also check out some of our past episodes where we talked about sleep. Episode 6, we talked about if sleep trackers work or not. Episode 11, how to beat your insomnia. So some tips there from our sleep expert, Kelly Baron.

And then Episode 44, tips for better sleep. And those are some of the sleep hygiene things that we briefly talked about here, but we have a little bit more of an expanded conversation with sleep expert, Kelly Baron.

And then Episode 45, that's your mental health toolbox episode. Just such a great fallback episode with some exercises, some breathing exercises that might help you as well.

All right. Thanks for checking out the show. Next week, we're really super stoked because we're going to have a migraine update. We had a show about men and migraines and we learned . . . Well, we knew Troy had migraines, but we learned that Mitch also suffered from migraines, even though he wasn't admitting it to himself. And they both went to a doctor to find out more to see if they can get help, and we'll find out about that next week on "Who Cares About Men's Health."

One last thing, if you know somebody that would get use out of this podcast, please do us a favor and share it with them whether it's on social media or in person just by saying, "Hey, I've got a really cool podcast you might enjoy," if there's a specific episode that might help somebody. It's the best way to help us get into the ears of more men and help more men care about their health.

Other ways you can reach out to the show if you want to contact us include hello@thescoperadio.com. You can go to our Facebook page facebook.com/whocaresmenshealth. And then we also have our listener line. You can leave a message at 601-55SCOPE. That's 601-55SCOPE.

Thanks for listening. Thanks for caring about men's health.

Announcer: Have a question? Ask it. Send your listener question to hello@thescoperadio.com.

Interviewer: It's time for another listener question and we're here with Dr. Kirtly Parker Jones. Dr. Jones, the question sent in was, "Could my baby be allergic to my breast milk? I've noticed that he's not really absorbing it, he's not really taking it, but he's fine with formula milk."

Dr. Jones: To start at the beginning, babies cannot be allergic to your breast milk.

Interviewer: The answer is just no?

Dr. Jones: The answer is no. However, there are proteins in what you eat that are absorbed into your bloodstream that then come out in the breast milk, and certainly there are flavors in what you eat that come out in the breast milk. In fact, there are flavors of what you eat when you're pregnant that flavor the amniotic fluid, and the baby is already kind of drinking your garlic or your hot sauce, or whatever it might be. The babies will not be allergic to your breast milk. Newborns don't actually form an allergic response. So it takes a while for babies to be able to even form an allergic response.

So, if newborns are throwing up, you start to really worry that maybe they have a problem with their stomach. So sometimes babies actually have a weakness in their stomach that allows the fluid to come back up. So some babies actually have to be fed kind of thickened milk or have to be slept tilted like people who have reflux. So babies can have reflux and newborns can have reflux until they're a little older. So babies can have reflux and that can make them throw up, and it's not they're allergic, it's just that they can't keep the fluid down.

Secondly, there are some babies with congenital malformations that cause a blockage in the esophagus. This is very rare and it's devastating. So there's a blockage in the esophagus and the fluids go down into their lungs. This is called a TE, a tracheoesophageal fistula. Once again, it's the baby that's not actually absorbing because it's going down the wrong way.

Now, let's take babies a little bit older. They actually can be allergic and develop an allergy to things that are in your food, and the most common is milk. So milk proteins in milk, of course, when . . . oh, cow's milk, there is something called casein and this is a protein that a mom might actually have in her blood and that the baby might actually develop an allergy to. That being the case, babies might get a little distended, they might be a little uncomfortable, and sometimes, they may even have a rash around their rear where it's kind of irritating.

Now, what about the baby that seems to be fine with formula and not so well with breast milk? Well then, the questions is, is the baby getting better suckling with the nipple . . . the formula? Is there something in the mother's food that's flavoring her breast milk? Meaning is she eating a lot more garlic, or is she eating spicy things that are getting through and the baby doesn't like the taste? And then the question is, is the mother putting anything on the nipple that the baby doesn't like the taste of? So we put all these lotions on our bodies and women put lotions and Bag Balm, which doesn't really taste very good. Bag Balm is something they put on nipples of cows when the nipples break down with nursing cattle, and so that may not taste very good.

So what are you putting on the skin and the answer is nothing, is the baby actually latching on well? So sometimes the baby has to struggle getting the whole nipple in their mouth, but it's easy to put the nipple from the bottle. There are many cultural norms about what you should and should not eat because of what goes in your breast milk, like don't eat cabbage because it will make your baby bloated. Well, unfortunately, cabbage won't make your baby bloated. It might make you bloated, but not your baby.

Of the things that they worry about, cow's milk is the first and about 2% to 3% of babies might actually be allergic to the cow's milk that their mother has in their food. And if a baby seems like it's not absorbing or is irritated by the breast milk, the question is what is it? And you have to kind of take things away. The top ones are peanut, soy, and cow's milk, but there may be other things. So moms need to eat carefully. The baby may not like garlic in their breast milk. By the way, wine goes right through the breast milk, too, so be careful.

So the long and the short of it is the baby is not allergic to your breast milk, but it can be allergic to what you're eating. There are lots of cultural superstitions about what mom should and shouldn't eat, and what should go in the breast milk. There's not much science, but if you take away one thing at a time and see if the baby does better, you might figure out what it is. And of course, your pediatrician can really help you work this out.

Announcer: Have a question? Ask it. Send your listener question to hello@thescoperadio.com.

Interviewer: Could it be a thyroid problem that's sabotaging your diet and weight loss plan? We'll find out next on The Scope.

Announcer: Medical news and research from University Utah physician and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: You've been trying to lose weight but you're just not seeing the results that you would like to see and you've been at it for a little while. Now, you're starting to wonder if there's something else in play like maybe it's a thyroid problem that's sabotaging your weight loss. Dr. Dev Abraham is the Medical Director of the Utah Diabetes and Endocrinology Center. So could a thyroid problem sabotage my diet and weight loss plan?

Dr. Abraham: There's a little misconception with regards to thyroid and weight connection. If you look at the older textbooks, it is very categorically stated that it is the cause of weight gain. So in another words, if someone gains weight, they must have thyroid problem. It's not necessarily true in modern times for several reasons.

The number one reason is in olden days they didn't have an accurate way of testing thyroid dysfunction with blood tests, let alone reliable, reproducible blood tests. In the last 15, 20 years duration, we have super accurate thyroid blood tests so it's very easy to determine whether weight change a person may experience is due to thyroid or not.

If you look at how much weight patients gain when you don't take thyroid hormones for months, it's really a small amount on an average of few pounds. If someone gains 50 pounds, 100 pounds over a span of a year or two years, it's uncharacteristic for a thyroid hormone imbalance to do that.

Interviewer: It's something else at that point.

Dr. Abraham: It is usually something else. But thyroid is often the first test that's often done because it's a very simple and easily available test. And it's also very, very treatable. So even if that much weight gain cannot be attributed to thyroid, if these patients have mild abnormality of the thyroid we still try to treat it first because it's a simple remedy.

Interviewer: So in the instance of somebody trying to lose weight and we're taking them at their word that their diet is on, their exercise is on, but they're not losing weight, could it be a thyroid problem that's causing that?

Dr. Abraham: It should definitely be tested, but if the test comes negative for thyroid dysfunction, that virtually rules out thyroid as a cause for the weight fluctuations.

Interviewer: And as a physician, how often have you seen thyroid being responsible for somebody not being able to lose weight or putting on weight unexpectedly?

Dr. Abraham: A very, very small percent.

Interviewer: Oh, really?

Dr. Abraham: Yes.

Interviewer: So it's a whole different kind of thinking than it was?

Dr. Abraham: It is, absolutely. If you look at the amount of weight gain that the society is experiencing, which is stated to get worse, it's quite astronomical. If only thyroid is the problem for this weight gain, we literally would be able to cure obesity.

Interviewer: With a pill.

Dr. Abraham: With a pill.

Interviewer: And that's what we want.

Dr. Abraham: And that hasn't occurred because the thyroid is usually not the single main cause.

Interviewer: So it sounds like, unfortunately, if I've been trying to lose weight and I'm not losing weight and I think everything else is right, it's probably not going to be my thyroid.

Dr. Abraham: That is a fair statement to make with a few exceptions. If there is a strong family history of thyroid dysfunction, in particularly female members of the family, or if there has been unexpected thyroid abnormality after childbirth, in those subjects, at least a test should be done before making that determination whether it is the thyroid or not. But it is accurate, in most patients if there is weight fluctuations, that's independent of thyroid. At least in the current day situation.

Interviewer: So look someplace else? Maybe I just need to exercise a little harder.

Dr. Abraham: Well, exercise is extremely important to lose weight but if you, for example, walk on a flat surface, you expend the equivalent of a slice of breads worth of calories. So one extra pound weight gain during Christmas, for example, can have the equivalent calories of about 3,500 calories. Which is about walking on a steady pace for about 35 miles.

So to expect weight loss purely by exercise is a very difficult process. But a combination of caloric restriction and adding some exercise has a multiplying effect with regards to weight loss. So most of the programs that are offered through the Utah Diabetes and Endocrinology Center focus on a whole health improvement with regards to dietary modification, exercise and caloric restriction without becoming deficient in micronutrients.

Interviewer: And sometimes it just takes time?

Dr. Abraham: It does take a longer time than most patients anticipate with weight loss and they give up sometimes. And that's what we try to encourage, any small loss is still a step in the right direction.

Interviewer: What about those individuals that they have been really religious but they're not losing anything? They're not gaining but they're not losing.

Dr. Abraham: It's a very complicated mechanism of why an individual gains weight. What we're beginning to understand is that there is a reset mechanism of how much calories does one need to feel full. In other words, these are probably mechanisms and centers in the brain that reset and we always feel hungry when there are enough calories that are retained in our system that we haven't burned yet. So researchers are still working on it. So it appears to be multiple factors that are involved.

Interviewer: And your piece of advice to that person still trying to lose that weight?

Dr. Abraham: A multi-pronged or multi-disciplinary approach works the best. You cannot change your genetics, it's too late to choose your parents, but at the same time, you can work with what you have if you have a plan about it. Sometimes, it does involve including professionals who are skilled in those fields to guide patients to decide the right thing. Not one cap fits all in this situation. So we try to modify what works best for each patient.

Announcer: TheScopeRadio.com is University of Utah Health Sciences Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com

Dr. Tom Miller: Screening for prostate cancer.

Dr. Blake Hamilton: Oh my.

Dr. Tom Miller: Why the oh my?

Dr. Blake Hamilton: This is a very controversial subject.

Dr. Tom Miller: This is Dr. Tom Miller. We are going to be talking about prostate cancer screening next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Tom Miller: Hi, I'm here with Dr. Blake Hamilton. He's the medical director for the urology clinic, and he's also associate director for the division of urology. Let's talk about it. Is prostate cancer screening with P.S.A. testing something that's time has come and gone?

Dr. Blake Hamilton: No, I don't think so. It's a shifting environment to be sure, but I think it still has relevance.

Dr. Tom Miller: You know, the national guidelines, or a couple of the guidelines out there now say that you really don't need to screen men for prostate cancer using the blood test, the P.S.A., prostate specific antigen test. That's based on a couple of large studies, I believe. The outcomes of those studies, one in Europe, one in the United States, didn't back up the idea that using this test could save lives best that the studies showed.

Dr. Blake Hamilton: We have to go back and understand the history of P.S.A. P.S.A. is a protein that's produced by the prostate. It has a role. It has a function. We learned many years ago, three decades ago, that it goes up in prostate cancer, and when you treat prostate cancer it goes down. It became used as a marker for recurrence of treated prostate cancer. It continues to be very reliable. It's one of the best blood markers that we have for cancer.

Dr. Tom Miller: No question. I think we all know that we find more prostate cancer using this test. The question is does it save lives in the long run.

Dr. Blake Hamilton: The two studies that you refer to, depending on how you interpret them, show that there was not enough difference between the group that was screened and the group that was not screened. There are several problems with those studies. One is that they may not be mature enough. They had an average follow up of eight, nine, ten years, and the arms are separating. If we get to 15 years I think we'll see a difference. I think we'll see a clear separation between those two arms. The other problem is there are some methodological problems in how the patients were accrued. It's complicated. I think the real issue is that some people with prostate cancer will suffer immensely and die, and many will not. What we really need to do is do a better job of trying to predict who needs treatment and who doesn't. I think that what's happened over the last couple of decades is when men are diagnosed with prostate cancer based on P.S.A. screening they automatically have gotten treatment. So, in a sense as a community we've over-treated men with prostate cancer.

Dr. Tom Miller: I think part of the concern is also the potential complications of the surgery or the other treatments available for prostate cancer. I mean it's not a benign procedure, and there are outcomes that are difficult for the patient. I think that is coloring the judgment of some of the task force groups that are looking at screening guidelines currently.

Dr. Blake Hamilton: The problem is you still have some 250,000 men who will be diagnosed with prostate cancer this year in the United States. There will be some 35,000 of those who will die from prostate cancer. To say that prostate cancer screening with P.S.A. has come and gone would be throwing the baby out with the bathwater. What we need to do is keep the screening but make better decisions about when to biopsy and when to treat prostate cancer. Already we're seeing a significant decline in the number of men who are being treated, and that's appropriate. But, we've got to keep looking for the ones that are going to be lethal cancers, because they're real.

Dr. Tom Miller: Let's talk practicalities. Are you saying that we should continue to follow the past guidelines which say begin screening in men at the age of 50, and then continue screening every year with P.S.A. testing?

Dr. Blake Hamilton: There are now many alternatives to that.

Dr. Tom Miller: Right.

Dr. Blake Hamilton: One alternative, which comes from the U.S. preventive services task force, is to not screen at all. The American Urological Association has modified their guidelines to suggest that we screen maybe not every year but every two years in men between the ages of 55 and 70 where we think that we'll find the highest yield in the patients for whom it will really matter. Screening in 80 year olds, not important. Screening in the younger generation, not enough data to show evidence that it helps or makes a difference.

Dr. Tom Miller: Younger generation meaning 50 years old and above?

Dr. Blake Hamilton: Less than 55.

Dr. Tom Miller: Less than 55.

Dr. Blake Hamilton: Although there are many researchers who would argue that between 45 and 55 should be included. The guidelines as we have them now would be that those men in that 15 year window, and screening not as intensely as we have in the past, but not to give it up.

Dr. Tom Miller: Let's say that your P.S.A. is elevated. What should the patient do? Should they go then to a urologist who specializes in prostate cancer? A lot of this, as you say, is going to depend on the expertise of the specialist taking care of this type of problem.

Dr. Blake Hamilton: I think most urologists have the ability to evaluate an elevated P.S.A. and make a decision on a biopsy. There continue to be a variety of opinions out there. If you have a single elevation in the P.S.A. I think it's reasonable to wait some time and repeat it and think about what that means.

Dr. Tom Miller: So, screening is something that you believe we should continue. You think it's a good idea.

Dr. Blake Hamilton: Yes, I think we should continue screening but do it judiciously and appropriately, and then think carefully without automatic treatment of those who are diagnosed with prostate cancer.

Dr. Tom Miller: A final thought. What about that time honored rectal exam? Do we still have to do that on patients? It's the brunt of so many jokes.

Dr. Blake Hamilton: Yes, it is. Unfortunately, there are some bad prostate cancers that have low P.S.A.s and are only found on physical examination, so we're going to continue doing that exam, Tom.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.