Episode Details

What if your prostate symptoms aren’t actually being treated—just managed?

In this episode, Dr. Geo sits down with Dr. Brian Helfand, Clinical Professor at the University of Chicago and a leading expert in prostate care, to break down aqua ablation, a water-powered, precision therapy that’s changing how we treat BPH (benign prostate enlargement)—and potentially even prostate cancer.

What You’ll Learn

1. Why Medications May Not Be the Best First Step

• Most prostate medications manage symptoms—but don’t fix the problem
• Long-term use may come with side effects and limited improvement
• Many men stay on meds for years without real resolution

2. The Shift Toward Personalized Prostate Care

• Not all urinary symptoms come from the prostate
• Key contributors include:
• Diabetes
• Sleep apnea
• Anxiety
• Treating the whole patient, not just the prostate, leads to better outcomes

3. What is Aqua Ablation?

A minimally invasive procedure that uses a high-pressure water jet to remove excess prostate tissue.

Key Features:

• Robotically controlled for precision
• Guided by real-time ultrasound imaging
• No heat (unlike lasers or steam)
• Customized treatment plan for each patient

4. Why Aqua Ablation is a Game Changer

Compared to traditional procedures:

✅ Lower risk of sexual side effects

✅ Minimal risk of incontinence

✅ Faster recovery

✅ Highly durable results

Results:

• Significant improvement in urinary symptoms (~15-point IPSS improvement)
• Very low retreatment rate (~0.4% per year)

5. The “Money Shot” Conversation (Yes, It Matters)

• Preservation of ejaculation is a top priority for many men
• Aqua ablation preserves it in 90%+ of cases
• Many other procedures result in permanent dry orgasm

6. Who is a Candidate for Treatment?

There is no single number or test.

Dr. Helfand looks at the full picture (“gestalt”):

• Symptom severity (IPSS)
• Patient bother level
• Urinary flow strength
• Post-void residual (PVR)
• Overall health

👉 Bottom line: If symptoms are bothering your life, you’re a candidate for discussion.

7. What About the Bladder?

• Not all urinary issues are prostate-related
• Bladder function must be considered
• Urodynamics are only used in complex cases, not routine ones

8. The Future: Prostate Cancer Applications

Early data suggests aqua ablation may:

Improve urinary symptoms

Potentially reduce cancer burden in some patients

Could evolve into a whole-gland treatment approach

⚠️ Still emerging—but very promising

💡 Key Takeaways

Medications are not always the best long-term solution

Treat the patient, not just the prostate

Aqua ablation offers a precision, low-side-effect alternative

Sexual function preservation is a major differentiator

The future may include dual treatment for BPH + prostate cancer

👨‍⚕️ About the Guest

Dr. Brian Helfand

Clinical Professor, University of Chicago

MD, PhD

Author of 270+ peer-reviewed studies

Expert in prostate cancer and precision medicine

📞 Phone: 847-503-3000

🌐 Website: Endeavor Health (under development)

This conversation goes beyond procedures. It challenges the traditional “medication-first” approach and explores how personalized, data-driven care can transform outcomes for men.

👉 View complete episode show notes, resources, and transcript at DrGeo.com

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