i'm eric shawn, time for sunday house call. joining us is dr. david samadi from lenox hill hospital and chief of robotic surgery. >> dr. marc siegel, professor at medicine at nyu's hangg head cal center. doctors, always great to see you. >> good to see you. >> september is an important month for men, prostate cancer awareness month, the second

leading cancer killer for men in the u.s. researchers say a key is early detection. dr. samadi you're a prostate cancer specialist. september, time to wear blue in honor of that. how can we prevent prostate cancer? >> first of all, i appreciate you and marc wearing the blue color. this is the month that we educate a lot of men out there to get their psa tests, pro state specific antigen test, the best way to prevent it is to get tested and know your blood test, go for your exam and make sure the doctor checks your prostate, find out whether there's any abnormalities or nodules. we've spoken about prostate cancer on this show and many shows all the time. the numbers speak for themselves, 30,000 men die every year. this is one out of six men in america have prostate cancer. it's a silent killer and there are no symptoms. you may have it and absolutely don't know what's going on. people may not really -- this may not take effect. today for the first time, i came

up with a whole mission. we saw exactly how effective the als movement and the ice bucket. no buckets, but what we'll have is take 200 women volunteering all over u.s. and they'll work with me directly. we call this on facebook women for prostate health, women for prostate health just went up. i always think if you want to get something done, give it to women. the reason for that is because women are very much aware of screening. they go for mammograms, they go for pap smears and they are really gate keepers for health. >> ask me about my psa number, i would be like, i don't know. >> it's a good idea to get women involved. women are the ones that can nudge the husband, boyfriends, bothers, et cetera. dr. siegel, at what age do you start getting these prostate cancer testing and how often should you get tested? >> it's a great question. talking about internists or primary care doctors being the

gatekeeper. they don't get to see david or urology right away. someone that comes to me over the age of 45, i immediately screen them. i might even start earlier if they're african-american or have a history of prostate cancer. that increases my suspicion. every man over the age of 45 is not only faced with a psa in my office, but also a prostate examination because, you know, arthel, i found a lot of nodules in people that have normal psas. what psa is it's prostate tissue. it's good we have it. if it goes up, it could be indicative of infection, enlarged prostate or of prostate cancer. if i have a suspicion of prostate cancer, then i would send the patient to a specialist like dr. samadi. the question then comes, does he want to do a biopsy, remove the prostate? there's a lot of prostate cancer that doesn't need removal. further questions go to pro

sta prostatecancer911. >> aren't you supposed to keep track of the numbers and if there's a spike, that could be a warning. >> that's right. when marc was talking about the 45-year-old man. yesterday i operated on a 43-year-old man. he went for life insurance. the psa was high. a normal number for him should be less than 2.5. >> is that for anybody? >> no. that's exactly the point. for a 65-year-old man,psa should be less than four. you need to be in the hands of experts who deal with prostate cancer all the time, look at the trend. the question is, is every prostate cancer the e? we know 60% is low risk. for those we may do watchnd wait and more active surveillance. there's 40% that are moderate or aggressive and they need surgery. one of the reasons i prefer surgery over radiation -- this is not surgeon that wants to operate all the time, i like the fact that with surgery you get a very accurate staging. you get the cancer out.

your psa after surgery, eric, has to be zero, the patient's psa has to be zero. i use radiation in case cancer comes back, i use radiation as plan b. i can give radiation after surgery. but if i do radiation, and we see a lot of ads about cyber knife and radiation, you may not be able to do surgery after radiation. that's a good point. >> the u.s. preventive services task force has come out against psa for screening. let me tell you why i disagree. we are doctors here, we're not blood tests. we're observing a trend. if i got an abnormal psa, i might not send you for a biopsy. i might just follow it. that's what a smart doctor does. we're as good as the information we have. >> for the month of september, just for this month, people can go to prostate cancer 911.com if they're diagnosed and we'll give them free consultation. that has helped every year,

every september. marc has joined that mission. i hope arthel can join the women, too. >> yes, absolutely. you need 200 volunteers. i'm in. a difficult challenge facing thousands of cancer patients. what to do when the treatment you require is not available here in the u.s.? coming up, the story of one woman grappling with just that and how her experience might be able to help thousands of others in the same position. you know what else i can do on my phone? place trades, get free real time quotes and teleport myself to aruba. i wish.

ugh. heartburn. did someone say burn? try alka seltzer reliefchews. they work just as fast and are proven to taste better than tums smoothies assorted fruit. mmm. amazing. yeah, i get that a lot. alka seltzer heartburn reliefchews. enjoy the relief. now to an emotional story of a woman battling for her life. her name is sherry del monte maloney. she's been diagnosed with stage four cancer. she recently underwent a trial at a cancer center near her

hometown in buffalo, new york, but now says her last hope in an experimental treatment that's only available in germany. her friends and family have set up a fund to help raise money that she needs to get there. her story is also highlighting the challenges many cancer patients in similar situations go through on a daily basis. we want to start with you, dr. siegel. sheri is going to germany. the question a lot of people would ask and we hope this works out for the best for her, is it safe, though, for other people to try this? >> great question. let's start by this point. i want to start by saying it depends on what the treatment is. in her case she's not getting something i want to talk about here called park inhibitors. there are experimental treatments out there that block genetics in the tumor, that block stem cell growth in the tumor, that block the tumor from growing called targeted therapies that the fda is currently studying here in the united states. if you can't get into one of the clinical trials for those, you may have to go overseas.

i'm for that. but there's also alternative treatments available, arthel, around the world that are not proven, that may not help. and then there's no regulation on them. i think the fda plays a very important role regulating treatments. unfortunately sometimes they have to really prove safety. it takes a long time. this woman, 36 years old, has had breast cancer for five years, resistant to chemo, surgery and radiation. she has four young beautiful children. she should be able to pursue anything possible. i understand both sides of this. the fda has to be a limiting step. if i had breast cancer, stage four like that, god forbid, i would want to go wherever i thought i could be helped. >> that's a great point. dr. samadi, if the u.s., as we're told, has the best medical care in the world, why are they forced to go someplace else to go overseas, and is that safe? >> as a cancer surgeon, i wish her well. this is a tough cancer. she's fighting stage four. anyone that can help her to get

to where she has to go, you have all of our support. u.s. has the best medical health care system and we believe that. the problem with medical tours and you see people go there -- the reverse is true, we have a lot of international patients that come and see us here, is because number one, cost is a huge issue. access to health care, we see the cost of health care is on the rise. maybe you don't have access to it. maybe the access is there but it's not available fast enough for you, the next available time for surgery or chemo could be six months from now. finally quality is important. these clinical trials may or may not exist here or we may have something that they don't have over there. you should go wherever you can to get the care. part of the problem with medical tourism, what happens if there's a complication ab booed. you go to another country, orthopedics, people go to mexico to get this prostate surgery, and there are major complications. is there communications between the doctors over there -- after

she comes back, is there a follow up with the doctors there and here. that's important. always make sure you do your homework, find out which facility you're going to. there's a joint commission international. you have to go to that site and find out that the hospital or clinic is point of that joint commission international. this is important and you go for it. the fda's process is very complex. we don't always get a lot of drugs we need. >> in europe, there are things that they have that we don't have here. >> there's a huge difference between going to germany or france where they have advanced solutions and some of the pharmaceutical companies are based there that make the solutions versus going some place like mexico. david is stalking about a treatment called hifu, high frequency ultrasound treatment. you can check who the doctor is, what the facility is. there's a lot of ways to double check that go through a dock here here that knows about it.

roswell park where she is in buffalo, is a top cancer center. she could ask people there what do you think of the treatments in germany. >> what's going to happen is the doctor in germany has to give all the information, and that's part of the deal, to the doctors over here, that continuity of care is extremely important and we wish her all the best. >> absolutely. certainly hope it is a success, of course. >> there's something called fighting for sheri at youcaring.com, medical fund-raising. she has a fund-raiser in new york this week. >> thank you. meanwhile, as we have been reporting today friends and family are saying good-bye to joan rivers, this as there are new questions of the care she received at the outpatient facility where she reportedly suffered a heart attack. that raises the questions about having a medical procedure in an office and not in a hospital. coming up, the doctors will tell us if we should be concerned. she's a dietitian.

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back now to "sunday house call," on our weekly segment about should i worry, this viewer writes i'm due to have an end scopic procedure this week at an outpatient facility. should i worry? in light of what happened with joan rivers, should you worry about going to an outpatient facility and having a procedure versus doing the same thing in a hospital? >> eric, first of all, prayers to melissa and her family for such a tragedy. the short answer to your question is people should not worry about going to ambulatoriry surgery. it's safe and there are many studies that have done compared

to the hospital, when it's on joint commission and they look aefrt thing soup to nuts, it is safe to have this. there's published data about this. having said that, you have to treat every patient individually. i don't think it was necessary her age. i want to ask marc what was the indication for endoscopy, whether it was for vocal cord, is it a reflux? so what that she was hoarse, et cetera. the indication of that is important. it wasn't propofol that killed her. people get propofol every day all the time. she's had many plastic surgeries, no issue about that. was there an an theseologist involved. >> i'm going for a colonoscopy not at the hospital. do they have the trauma center, what if something goes wrong? >> under joint commission you should have these cautionary steps in place. you should also do your homework. find out for example how many

complications have been, how many perforations, how many times patient has been transferred from this particular ambulatoriry surgery to the hospital in the last six months. >> how do you find that out? >> you have to talk to your doctor and they have to give yo. it's public information. something else you may or may not know, there's something called vip syndrome or celebrity syndrome. as doctors, we get our share of these kinds of patients that come in. they could be sometimes demanding, they may want to bend the rules. we saw it a little with michael jackson. but all she had to say was make sure i'm comfortable before this procedure and maybe somebody can get intimidated and give a little more propofol. this is probably not what happened, we're just guessing at what went on. as doctors, we want to make sure we treat everybody the same way and not extra care, because that's when you get into trouble. >> it's under investigation, and the bottom line is there are a lot of different procedures not in hospitals. >> let me go through that again.

we don't know all the facts on joan rivers' case yet. we don't know if she got propof propofol, we don't know the procedure. i suspect it was an endoscopy, i suppose it was propofol. she is 81 years old. she had be screened by her surgeon beforehand. endoscopies are notorious for picking up problems and keeping people alive. it's been studied, it doesn't matter what age it is. no matter what age, this is a safe procedure. the problem comes with the anesthesia. the american society for gas o gastrointestinal says, we want moderate sedation where the patient can be easily awakened. with an elderly patient, 81 years old, you would give less, you would watch the patient much more closely and monitor the

anesthesia much more closely, and i personally, by the way, would not send my 81-year-old patients to a stand-alone facility. >> can you go to a hospital? >> absolutely. i can't say that as a rule, by the way. i can't say there aren't exceptions. you have to take it patient by patient. in general, someone over 81 years of age, i prefer to have it -- because even in the rare case that something goes wrong, it's easier to respond in a hospital, to get them on a respirator in a hospital, to do cpr and resuscitation in a hospital is easier. >> look, i think she probably had this strong heart. we know she had a heart disease, she was under good care. i think the cascade of the way things went as a r of this e endoscopy was maybe some sort of laryngeal spasm. it goes into spasm, you don't get enough oxygen and then it becomes a panic situation. you follow it with cpr and we

know what happened. this is all guesses because it's under investigation. i agree with mark that if you have an older person, heart disease, a rrrythmia, you're gog for something routine. >> maybe the bottom line is do it in the hospital sometimes. >> i have to go. i'm sorry, doctor. >> get the procedure you need, but be careful. there is always a risk. >> the reason for going there was privacy and convenience. that's one of the reasons people go to these centers. let me also say she was a great comedian. she used laughter to help people and this is the best medicine out there. we hope to continue her legacy and continue to laugh. >> we lost some laughter with her passing. we're going to talk about this when we come back. there is new evidence on the importance of fruit to your health. how it can significantly cut down on your risk of a deadly disease that kills one in four

americans, one in four americans. we can talk about that when we come back. i don't know if you've ever taken the time to learn a little tiny bit of somebody else's native tongue? that opens up the doors to trust. my name is kanyon. i'm a technician here in portland oregon. every morning, i give each one of my customers a call to give them a closer eta. and when i called this customer, i discovered that he was deaf. then i thought of amanda. i've known american sign language

since i was about 8 years old. it's like music for your eyes. and i thought that was an amazing gift to have, to be able to communicate with the deaf. my friend kanyon asked me to help him explain how today's appointment will go. he was nodding his head and giggling a little bit. i earned his trust that day, i guess.

back now, "sunday housecall," so it really is that simple? you want to cut your risk of heart disease, eat a fruit every day. so dr. segal, an apple a day

really keeps the doctor away? >> i like this information. we are very pro-food on this show. it's part of our head tramedite diet. over 40,000 people were studied over seven years. it showed that those who had a fruit a day cut down their risk of heart disease by 40%. why would that be? fruit has fiber in it, it causes your sugar to go to a better place. it has antioxidants in it. it has very low calories. we talked about why die bekabet can have it. there is a study out in a magazine called "stroke" that men and women who eat a lot of potassium have a lower risk of stroke. why is that important? because fruit is loaded with potassium. >> does it matter what fruit you have, a banana, a cup of

blueberries, does that count? >> so the study was done, and berries, as you know, was the winner of all of them. strawberries, blueberries, they all have a lot of anti-oxidants. bananas are right next to them because of the potassium. if you take 400 grams of fruits and vegetables today it's a risk of heart disease. >> how much is that? we only have 30 seconds. sorry. >> in the herbs department, peppermint and saffron came up on top. with the nuts, the almond was number one. espresso came up on top. in the vegetables department, artichoke and chili pepper came out on top, and finally the dark chocolate made the list. that's your menu for

antioxidants. >> an apple a day keeps the doctor away. >> how much is that 400 grams? >> an apple or a bowl of cherries or blueberries. >> that's going to do it for us. we have not seen any immediate intelligence threats to the homeland from isil. >> i think the president is really out of touch with reality when it comes to what's happening in the world. it is not a flashback to 2012. president obama and his former republican challenger mitt romney hitting the airwaves this morning sounding off on everything from isis to 2016. we will have a live report. as the president gets ready to set out his isis report, the military launches new airstrikes against iraq, aiming