Before prostate surgery, there are 3 questions you should ask your surgeon—and “How many surgeries have you done?” isn’t enough.

In this episode of The Dr. Geo Prostate Podcast, Dr. Geo sits down with renowned prostate cancer surgeon Dr. Jim Hu, Ronald P. Lynch Professor of Urologic Oncology at Weill Cornell Medicine, Vice Chair of Clinical Research, and Director of the LeFrak Center for Robotic Surgery.

The conversation starts where many prostate cancer journeys begin: an elevated PSA.

Do you really need a biopsy? Should you get an MRI first? What about PSA density, the 4Kscore, or newer urine tests? And if a biopsy is necessary, should you choose transperineal instead of transrectal biopsy?

Dr. Hu explains why he now favors the transperineal approach and discusses findings from the PREVENT and UK TRANSLATE trials, including infection risk, antibiotic use, cancer detection, pain, and the learning curve physicians face when adopting the procedure.

Then the conversation turns to one of the biggest decisions a man with prostate cancer may ever make:

Surgery or radiation?

And if you choose surgery, how do you know whether your surgeon is actually good?

Dr. Hu explains why simply asking how many prostatectomies a surgeon has performed may not tell you what you really need to know. Instead, patients should be asking whether their surgeon actually tracks urinary continence and erectile-function outcomes.

Because two surgeons can perform the same “robotic prostatectomy” very differently—and those differences may matter to your quality of life.

In this episode, you’ll learn:

• What an elevated PSA really means—and what may come before biopsy

• How MRI, PSA density, 4Kscore, and urine biomarkers can help guide decisions

• Why Dr. Hu favors transperineal prostate biopsy

• What the PREVENT and TRANSLATE trials tell us about prostate biopsy

• Why avoiding antibiotics may be another advantage of transperineal biopsy

• The learning curve patients should consider when choosing who performs their biopsy

• How to think about prostate surgery vs. radiation

• Why robotic technology doesn’t automatically mean better surgical outcomes

• Why surgical volume alone may not predict continence or erectile-function recovery

• The questions to ask before choosing a prostate cancer surgeon

• Why surgeons should track their own patient-reported outcomes

• How surgical technique, nerve handling, and cautery may affect recovery

• Where active surveillance and focal therapy may—or may not—fit

• Why treatment choice matters if prostate cancer eventually returns

• What patients should understand about salvage prostatectomy after radiation or focal therapy

If you’ve recently been diagnosed with prostate cancer—or you’re trying to decide whether to have a biopsy, surgery, radiation, focal therapy, or active surveillance—watch this conversation before making a decision you can’t easily take back.

Chapters

⏱️ KEY TIMESTAMPS

00:00 – The prostate cancer decisions you can’t easily take back

08:00 – Elevated PSA: Do you really need a biopsy?

12:00 – How MRI can help some men avoid biopsy

16:00 – PSA density, MRI & deciding whether to biopsy

17:00 – Transperineal vs. transrectal prostate biopsy

19:00 – PREVENT & TRANSLATE studies: infection and cancer detection

22:00 – The learning curve for transperineal biopsy

26:00 – Why transperineal biopsy may avoid antibiotics

36:00 – Prostate surgery vs. radiation: How do you choose?

42:00 – Does doing more prostatectomies make a better surgeon?

43:00 – The #1 question to ask your prostate surgeon

51:00 – What are good erectile-function outcomes after surgery?

55:00 – Nerve sparing: the surgical details that may affect erections

59:00 – The 3 questions to ask BEFORE prostate surgery

1:03:00 – Active surveillance for Gleason 6 / Grade Group 1

1:06:00 – Focal therapy: Where does it fit?

1:10:00 – Erectile dysfunction & incontinence after prostate surgery

1:11:00 – Prostate surgery after radiation or focal therapy

1:12:00 – PSMA PET scans, recurrence & salvage treatment

🔗 RESOURCES & RESEARCH

Dr. Jim Hu — Weill Cornell Medicine

https://weillcornell.org/jimhu

Follow Dr. Hu on X:

@jimhumd

PREVENT Trial — JAMA Oncology

https://jamanetwork.com/journals/jamaoncology/fullarticle/2823969

Memorial Sloan Kettering Prostate Cancer Nomogram

https://www.mskcc.org/nomograms/prostate

UK TRANSLATE Prostate Biopsy Study — The Lancet Oncology

https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(25)00100-7/fulltext

Michigan Urological Surgery Improvement Collaborative (MUSIC)

https://musicurology.com/programs/prostate/

MUSIC brings together academic and community urology practices across Michigan with the shared goal of improving prostate cancer care and patient outcomes.

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⚠️ Disclaimer

This podcast is for educational purposes only and not medical advice. The views expressed are Dr. Geo’s and not those of his employer(s) or affiliated organizations. Use of this content is at your own risk. Geovanni Espinosa, N.D., assumes no liability for direct or indirect consequences, including economic loss, injury, illness, or death.