00:00:00 Dr. John Ludlow, a urologist with nearly 30 years of experience, joins the conversation with Nate. He shares his background growing up in Southern California and surfing, which he recently did in California to recharge. Dr. Ludlow then discusses his practice in Holland, Michigan, focusing on men's health, testosterone deficiency syndromes, and benign prostate diseases. He emphasizes the importance of patient communication, preventative care, and patient outcomes. Dr. Ludlow also mentions his desire to create a men's healthcare center catering to the 20s, 30s, and 40s, as he believes this age group is more focused on prevention and wellness.

00:05:00 Dr. John Ludlow discusses the shift in healthcare priorities among younger generations. He mentions that these individuals are more focused on health maintenance, prevention, and wellness, and prefer electronic methods for scheduling appointments and accessing healthcare information. Dr. Ludlow then touches on preventative measures, emphasizing the importance of a healthy diet, regular exercise, stress reduction, and good sleep habits. He encourages a plant-based diet, avoiding processed foods, and getting enough rapid eye movement sleep. While catching up on missed sleep is important, Dr. Ludlow stresses the importance of establishing a consistent sleep routine for overall health.

00:10:00 In this section of the podcast episode titled "Low Testosterone, Prostate Checks, and Robots...Oh My!", Dr. John Ludlow discusses the importance of sleep for neurological and urological health, and the benefits of a balanced diet, specifically regarding protein intake and its correlation with disease. He emphasizes the importance of quality protein for overall health and recovery from exercise. The conversation then shifts to testosterone, with Dr. Ludlow explaining the historical perspective of testosterone and its relationship to prostate cancer, and how it is now recognized as a real disease process that can be managed through healthy lifestyle choices. He also cautions against "strip mall testosterone clinics" that may overcharge for tests and treatments.

00:15:00 Dr. John Ludlow explains the importance of proper evaluation and treatment for low testosterone levels. He encourages men who suspect they have low testosterone to seek professional help rather than relying on supplements without proper testing and follow-up. Dr. Ludlow emphasizes that symptoms such as poor libido, lack of energy, and muscle loss are important indicators of testosterone deficiency, and that regular testing and symptom assessment are crucial for effective treatment. He also mentions the potential issue of estradiol levels in some men, which can compromise the response to testosterone, and the importance of evaluating the underlying cause of low testosterone levels.

00:20:00 Dr. John Ludlow discusses the potential risks and downsides of testosterone supplementation, particularly in bodybuilders from the 80s and 90s who used to inject large amounts of testosterone frequently. He explains that this practice can lead to pituitary and testicular issues, as well as side effects like shrinkage of testicles, acne, increased red blood cell count, and potential risks of blood clots. Dr. Ludlow also mentions that the medical community has moved away from the one-every-two-weeks dosing method and towards a more steady-state approach with lower doses. The conversation then shifts to the importance of prostate checks for men, given that prostate cancer is the most common solid tumor in men and the second leading cause of cancer deaths in the US, with 275,000 diagnoses and 30,000 deaths expected in 2023. Dr. Ludlow emphasizes the importance of regular prostate checks for men as they age and encourages doctors to advocate for these checks more often.

00:25:00 In this section of the podcast episode titled "Low Testosterone, Prostate Checks, and Robots...Oh My!", Dr. John Ludlow discusses the importance of proper prostate cancer screening, particularly through PSA tests and rectal exams, starting at the age of 45 for those at higher risk. He emphasizes the significance of early detection and regular monitoring for patients diagnosed with low-grade, slow-growing prostate cancer, as treatment comes with downsides. Dr. Ludlow also mentions the controversy surrounding PSA testing in the past and the importance of careful diagnosis and follow-up for patients. He explains that monitoring for low-risk patients typically involves PSA tests every three months, repeat MRIs, or biopsies in a year.

00:30:00 Dr. John Ludlow discusses the approach to treating prostate cancer, specifically active surveillance and focal therapy. He explains that for some patients, monitoring the cancer without immediate treatment may be appropriate, and if the PSA rises or the cancer progresses, then treatment options such as robotically assisted prostatectomy or radiotherapeutic methods will be considered. Dr. Ludlow mentions that there are advocates for active surveillance in the Urology Community, and focal therapy, which involves treating only the affected area of the prostate, is an option that can minimize side effects like incontinence and erectile dysfunction. However, it requires a high-volume center that specializes in focal treatments. The due diligence for determining the best treatment for a specific patient involves considering the type and stage of the cancer, as well as the patient's individual needs and preferences. As a surgeon, Dr. Ludlow is incentivized to perform prostatectomies but aims to be unbiased and present all available options to his patients.

00:35:00 Dr. John Ludlow emphasizes the importance of informed decision-making for patients dealing with prostate cancer. He encourages patients to seek second opinions from other urologists and radiation oncologists, emphasizing that every patient's situation is unique. Dr. Ludlow believes that patients should be educated about their disease and treatment options, and that the best decision is an informed one. He also shares his experience with the evolution of prostate surgery, mentioning how robotic procedures have become the standard of care despite his initial skepticism.

00:40:00 In this section, Dr. John Ludlow discusses the use of robots in prostate surgeries and the role of artificial intelligence (AI) in the field of urology. He explains that robots in prostate surgeries are guided by physicians, who benefit from improved visualization and reduced blood loss. However, there is a significant learning curve for surgeons to master the procedure. Dr. Ludlow expresses his appreciation for the tactile sense in surgery but looks forward to the next iteration of robots that will incorporate tactile feedback. He believes that AI will play a role in robotic surgery, allowing the robot to see what the surgeon sees and participate in the procedure. However, the implementation of AI in robotic surgery will take time due to the high cost of robots and the need for new attachments. Currently, AI is making a broader impact in urology through prostate MRIs and pathology, where it can accurately assess abnormal lesions and grade them, and in certain treatment arenas, such as radiation therapy for prostate cancer, where it can determine the need for hormone therapy and the length of treatment.

00:45:00 Dr. John Ludlow explains the role of artificial intelligence (AI) in healthcare, particularly in pathology and radiology. He expresses concern about the smaller margin of error when AI is involved, but acknowledges its growing importance and potential in healthcare. Dr. Ludlow also touches on the use of virtual reality in healthcare treatments and surgeries, and shares his thoughts on the future of robotic technology in medicine. He believes that technological innovations will significantly impact healthcare, and that proactive measures to prevent diseases, rather than reactive treatments, will become more prevalent in the future.

00:50:00 Dr. John Ludlow discusses the advancements in genetic manipulation, specifically the Nobel Prize-winning CRISPR process, which can identify and correct genetic diseases such as CLE cell anemia. He reflects on how the understanding of genetics and DNA has evolved over the years, particularly in relation to prostate cancer. Dr. Ludlow then shares a personal anecdote about treating Lance Armstrong, a famous cyclist, for a rare type of testicular cancer called corocarcinoma, which had spread to his brain. Despite the challenges, Armstrong's treatment at Indiana University, where Dr. Ludlow was working, involved innovative surgical and chemotherapy approaches, ultimately resulting in his survival.

00:55:00 In this section of the podcast episode titled "Low Testosterone, Prostate Checks, and Robots...Oh My!", Dr. John Ludlow shares a story about a world-class athlete who was diagnosed with testicular cancer and underwent brain surgery. Despite the doctors' concerns, the athlete decided to leave the hospital and continue his recovery at home. The patient had a chemotherapeutic regimen called BEP, which includes the drug BOMY, known for damaging the lungs. Although the treatment has evolved, it can still pose a problem for some patients. The discussion then shifts to testicular cancer and its treatability, with Dr. Ludlow mentioning that there is limited data on the role of diet, exercise, good sleep, and stress reduction in preventing or mitigating the disease's progression. He also mentions ongoing research at UC San Francisco that looks into these factors' impact on prostate cancer progression.

01:00:00 Dr. John Ludlow discusses the challenges of advising patients to change their diet, exercise, or quit smoking, and shares his personal experience of cutting back on work hours as a urologist. He mentions that his wife, who is a militant vegetarian and a great cook, plays a significant role in his dietary choices. Dr. Ludlow also talks about his partial retirement, working 5 to 10 days a month, and the financial freedom it provides him. He expresses his love for interacting with patients and discussing men's health, and shares how staying active through cycling and other activities keeps him healthy in his sixties.

01:05:00 Dr. John Ludlow shares his personal experience of maintaining an active lifestyle with the support of his family and the importance of financial planning for retirement. When asked about financial strategies they implemented during their careers, Dr. Ludlow admitted his lack of knowledge in investing and finances, emphasizing the need for expert advice. He and his wife sought the help of a financial advisor, who laid out a long-term plan, including 401k and 457b investments, and regular consultations. Their approach led to financial security and the ability to help their children with education and purchase properties. Dr. Ludlow emphasized the importance of trusting professionals in their respective fields and seeking second opinions for expert advice.

01:10:00 In this section, host Nate Crannell discuss the importance of seeking a second opinion, particularly in financial planning. While most listeners are familiar with the concept in healthcare, he encourages considering it for financial plans as well. Each Wednesday Nate offers three free one-hour slots for a second opinion of listeners' financial plans. During this time, he will reevaluate financial goals and risk tolerance, ensure tax mitigation strategies are in place, and provide confidence in financial outlook. These sessions fill up quickly, so listeners are encouraged to email Nate or visit his website to schedule a time.