i hope you enjoyed our show and are learning more about health and how to be a healthy you. see you next time. althy you. see you next time. i'm eric shawn, time for now for "sunday housecall." >> i'm arthel neville. joining us is dr. david samadi from lenox hill hospital and chief of robotic surgery. >> dr. marc siegel, professor at medicine at nyu's langone medical center. author of the inner pulse, unlocking the secret code of sickness and health. 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 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.

we also want to have a very similar thing. 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. and that's what i think -- >> ask me about my psa number, i would be like, i don't know. and what does it mean anyway? >> 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. he's very good at deciding not to operate. further questions go to pro -- prostate cancer 911.com. >> aren't you supposed to keep track of the numbers and if there's a spike, that could be a

warning? >> that's right. that's a very good point. 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. you look at the trend also. 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, that 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 same? we know 60% is low risk. for those we may do watch and 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. because of a point david just made. 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. the point about following trends. that's what a smart doctor does. we're as good as the information we have. psa is information we need. >> 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. >> we are going to talk about this now. 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. grappling and how her experience might be able to help thous there's a reason no one says "easy like monday morning." sundays are the warrior's day to unplug and recharge. what if this feeling could last all week? with centurylink as your trusted partner, it can. our visionary cloud infrastructure and global broadband network free you to focus on what matters. with custom communications solutions and dedicated support, your business can shine all week long.

test. 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 abroad. 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 part 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. where you may not know who's giving you this treatment. david is stalking about a treatment called hifu, high frequency ultrasound treatment. that's really unproven for the prostate. you can check who the doctor is, what the facility is. there's a lot of ways to double check that go through a doctor 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. i. coming up, the doctors will tell us if we should be concerned.

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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 endoscopic 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 ambulatory 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 at everything 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 necessarily 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. i think in the setti there an anesthesiologist involved? >> how do you find this out. do they have everything that hospitals have? 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 ambulatory 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 you that information. >> can you ask that? >> yes, you can. >> the other thing i want to u, something you may or may not know there is something called v.i.p. syndrome and as doctors we get our share of these patients that come in. they can be demanding and they may want to bend the rules. we saw it with michael jackson. all she had to say is, make sure i'm comfortable before this procedure and maybe someone can get intimidated and give her more of a drug. this is probably not what happened we are guessing. as doctors, we want to be careful we treat everyone the same and not extra care. that is when you get into trouble. >> it is under investigation. the bottom line, there are many procedures not in the hospital. >> let me go through that, we don't know the facts on the case of joan rivers or what procedure she got or what procedure was

that was undergone. we are guessing. she is 81. she would be scened by her internist or cardologist before. that is a old i play, how sick is this person? what are the risks in this case? the procedure is risk and it has been studied no matter the age. this is a safe procedure. the problem comes with the anesthesia. the american association says the anesthesia especially with propofol, we want moderate sedation. so with someone older you watch the patient and monitor the anesthesia closely. i would not send my 81-year-old

parents to a stand alone clinic. >> without go do a hospital? >> absolutely. david's point is right, you must take it patient by patient. in general, someone over 80 i prefer -- even in the rare case something goes wrong it is easier to spend in a hospital to get them on a breathing machine and do c.p.r. in the hospital is easier. >> she probably had a strong heart. she was under good care. i think the cascade of the how it went as a result of this endoscopy, they manipulatedvokal cords and they spasm and you do not get objection yen and it is panic, and the oxygen drops and the saturation drops follow by c.p.r. and we know what happened. this is a guess. it is "under investigation." i agree with mark if you have

someone like eric holder, heart disease, you go for routine. is there a routine? no. >> bottom line, do it in the hospital. >> for the public, get procedures you need but be careful. morning is free. there is always a risk. >> the advantage is for privacy and convenience. that is why people go to the centers. she was a great comedian and used laughter to help people and their soul and this is the best medicine owe there and we hope to continue her legacy and continue to laugh. >> we lost the laughter with her passing. new evidence of the response of fruit to your help and how it can cut down or your risk of a deadly disease that killed one in four americans. one in four. in four

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>> really, it is that simple? do you want to cut your risk of heart disease, heat a fruit each day. dr.siegel? >> i like this information. we are very pro food on the show

pardon of our mediterranean diet. this is over 400,000 people studyied over seven years, a chinese study and it showed those that had a fruit a day cut down the risk of heart disease by 40 percent. 40 percent. why? fruit has fiber. we talked about that. it causes your sugar to be absorbed in a better place. it has chemicals that are good for your body includingant -- including antiobjection -- antioxidants and post menopausal women have a lower risk of stroke if they eat a lot of potassium. >> does it matter what type of fruit? a banana? a cup of blueberries? >> absolutely. >> if there was an award for what you are supposed to eat, the winner goes to...this study

was done and berries were the winner of all. strawberries. blueberries. they all have a lot lot of antioxidants, you take 400 grams of fruits and vegetable as day the risk of heart disease is reduced. >> how were of that? >> in the herb department, peppermint and saffron and then walnuts. coffee in beverages and espresso because of the caffeine, and dark chocolate made the list. that is the emmy award for fruit and vegetables. an apple a day keeps the doctor

away. >> that does it for us. theuzz >> on the buzz beater another journalist killed by terrorists as the media step up the war of words over isis. president obama join -- taking mounting criticism. >> president, the world has disappointed him and he is turning his back on the world and on the people who elected him, on all of us. >> the idea we have been winning the war against terrorism is ludicrous. >> as the pundits pound the president would ordered fresh airstrikes yesterday against isis? is there a media drumbeat for war? >> a dramatic reversal on immi