The Male Room with Dr. Jesse Mills

In the third and final installment of our prostate-cancer trilogy with UCLA urologic oncologist Dr. Wayne Brisbane, Dr. Mills walks a 55-year-old patient through the modern treatment menu—active surveillance, focal therapy, surgery, and radiation—and why “having prostate cancer” doesn’t always mean “operate immediately.” Dr. Brisbane breaks down how doctors risk-stratify tumors (including what Gleason scores really mean), why PSA “ups and downs” can trigger anxiety, and how newer tools (from genomic tests to MRI-guided radiation) help personalize decisions. They also get real about side effects and recovery, from muscle-sparing prostatectomy techniques that can speed urinary control to the “sunburn in the bladder” sensations some men feel after radiation. The takeaway: treat the cancer the way it’s asking to be treated—and don’t be afraid to slow down, get second opinions, and choose the option that best matches your life.
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On Part 2 of our prostate cancer series, Dr. Mills welcomes back UCLA urologic oncologist Dr. Wayne Brisbane to walk listeners through what happens after a PSA bump — touching on how doctors use prostate MRI, biomarkers, and shared decision-making to determine who really needs a biopsy. Dr. Brisbane demystifies the MRI experience (yes, the loud, tight tube), explains what those 1–5 “PIRADS” scores actually mean, and breaks down modern biopsy options—including why the transperineal approach can lower infection risk. Then it’s on decoding Gleason scores, grade groups, and “risk stratification”— and explaining why, for many men, this is a highly treatable, often curable disease when caught early.
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In the first episode of our three-part Prostate Cancer series, Dr. Jesse Mills and Jordan Runtagh sit down with UCLA urologic oncologist and surgeon-scientist Dr. Wayne Brisbane to tackle the most confusing—and most important—starting point: screening. What does an “elevated PSA” actually mean, why is it controversial, and how do you avoid unnecessary panic (or unnecessary procedures) while still catching cancer early? Using a real-world “55-year-old patient journey,” they break down PSA as a prostate “thermometer,” when to repeat a test, what role MRI plays today, and how newer tools like urine biomarkers and micro-ultrasound are reshaping early detection—before the series moves on to diagnosis and treatment.
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Dr. Mills is joined by reproductive urologist Dr. Jim Smith, a longtime colleague and leading expert in male fertility and men’s health. Together, they break down what a semen analysis actually measures, why quality and timing matter, and why men shouldn’t wait a year into the fertility journey to get checked. Dr. Smith also explains sperm cryopreservation — who should consider banking, how long it lasts, and why access remains a major barrier. Plus, they'll bust the biggest myths about what “kills” sperm, explain why semen can be a window into overall health, and offer a surprisingly practical prescription for better fertility.
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Dr. Mills sits down with hormone therapy physician and entrepreneur Dr. Peter Fotinos to unpack the difference between “hormone replacement” and true hormone optimization. They dig into how studies like the Women’s Health Initiative shaped decades of fear, and why symptoms and lived experience sometimes matter more than a single lab cutoff. The conversation also tackles common pitfalls of “testosterone mill” medicine (including routine aromatase inhibitors), plus what’s changing in women’s hormone care and why testosterone matters for women beyond libido. Finally, Dr. Fotinos shares how he’s scaling more responsible, check-in-driven telehealth—and what proactive medicine can look like for the everyday guy staring down metabolic syndrome.
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