Gleason score explained and risk stratification

What if thousands of men are losing their sexual function treating a cancer that was never going to kill them?

In this episode, I sit down with Dr. Shawn Zimberg — board-certified radiation oncologist and medical director at Advanced Radiation Centers of New York — to unpack the truth about prostate cancer screening, overtreatment, and what every man over 40 needs to know.

Dr. Zimberg reveals that the prostate cancer industry has an overtreatment problem — and genomic testing is exposing which tumors need aggressive treatment and which don’t. We break down why PSA is broken, why Gleason scores don’t tell the full story, and how cadaver studies show men from their 20s to 80s harbor prostate cancer cells that never become clinically significant.

We also dive into the science behind radiation therapy, the BioProtect balloon spacer (Dr. Zimberg has performed nearly 2,000 — more than anyone in the world), and the cutting-edge radioligand therapy changing outcomes for stage 4 prostate cancer.

If you’re a man, love a man, or work with men in health or performance, this is essential listening.

About the guest:
Dr. Shawn Zimberg is a board-certified radiation oncologist, medical director at Advanced Radiation Centers of New York, and director of radiation oncology at Bronx Care Hospital. He trained at Memorial Sloan Kettering and has pioneered the use of rectal spacer technology in prostate cancer treatment, having performed nearly 2,000 PioProtect balloon procedures — more than any other physician in the world.

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I’m Louisa Nicola — clinical neurophysiologist — Alzheimer’s prevention specialist — founder of Neuro Athletics.

My mission is to translate cutting-edge neuroscience into actionable strategies for cognitive longevity, peak performance, and brain disease prevention.

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Topics discussed:
00:00:00 Introduction: The Prostate Cancer Overtreatment Crisis 00:02:11 Understanding the Prostate: Anatomy and Function 00:04:43 The Cancer Paradox: Size Does Not Equal Risk 00:07:43 Radiation Oncology: The Specialty Explained 00:11:08 Lifetime Risk and Genetic Factors 00:15:32 PSA Testing: The Gold Standard Screening Tool 00:20:36 The Diagnostic Journey: MRI and Biopsy Techniques 00:25:27 The Ejaculation Study: Myth or Reality? 00:33:15 Gleason Scores Decoded: Understanding Aggressiveness 00:37:03 Molecular Profiling: Looking Under the Hood 00:39:27 Treatment Pathways: Surveillance, Surgery, or Radiation 00:41:02 Active Surveillance: When Watching is Appropriate 00:43:31 Stage 4 and Radio Ligand Therapy: The New Frontier 00:48:21 Testosterone and Prostate Cancer: The Complex Relationship 00:52:38 Radiation Therapy Explained: DNA Damage and Healing 00:55:28 The Bioprotect Balloon: Revolutionary Rectal Protection 00:56:07 The Therapeutic Ratio: Maximizing Cure, Minimizing Damage 00:46:39 Robotic Prostatectomy and Surgical Options 01:06:36 Prevention and Early Detection: What Men Need to Know 01:08:28 Closing Thoughts and Where to Find Dr. Zimberg

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