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Integrative Medicine

Welcome Jessica McIninch, PsyD Providing Ketamine-Assisted Psychotherapy at Hill Park

Dr. Jessica McIninch is a licensed clinical psychologist of 18 years that is certified in the practice of psychedelic-assisted psychotherapy via the Center for Psychedelic Therapies and Research program at the California Institute of Integral Studies. Jessica is the owner and psychological director of Temenos, a psychedelic-assisted psychotherapy center in Petaluma, California, where she has provided ketamine-assisted psychotherapy for the past 5 years.

Dr. McIninch views psychedelic medicine work to be the singularly most rewarding aspect of her career thus far, describing it as potentially a catalyst, life-changing treatment for many people suffering from depression and anxiety.

In Jessica’s words, “I have never before seen in my 18 years as a psychologist the accelerated healing that can occur in psychedelic-assisted psychotherapy. It is such an honor to be a part of the psychedelic movement and I am delighted to bring this treatment to Hill Park’s patients.”

Jessica incorporates neuropsychological principles to amplify the effectiveness and durability of psychedelic-assisted psychotherapy and views psychedelic integration work to be equally as important as the psychedelic medicine experience itself.

Recently, Jessica was selected by MAPS (Multidisciplinary Association for Psychedelic Studies) to begin providing MDMA-assisted psychotherapy. As a Psychologist for the MAPS Expanded Access program, Jessica is providing MDMA assisted psychotherapy for individuals suffering from severe PTSD. This program, located in Washington DC, is the final phase required to achieve FDA approval of this medicine. As one of 20 clinicians in the world selected for this program, she is excited to bring this treatment to Hill Park once it becomes approved by the FDA.

Dr. McIninch is now providing Ketamine-Assisted Psychotherapy (KAP) at Hill Park.

Food As Medicine, Natural Immune Health

Chinese Immune Herb Chicken Soup

In China it is common to throw tonic herbs in soup to enhance immunity, longevity, and general good health. The root herbs Astragalus, Codonopsis and Dioscorea are general Qi tonics, benefitting digestion, nutrient absorption, cardiac function and enhanced energy. Lycium and Longan are blood tonics and enhance calming. Wood Ear alleviates dryness and benefits circulation. Lotus Seed is a mild tonic and sedative. Polygonatum is a yin tonic and restores moisture to dry membranes. Sargassum is a yin tonic and relieves swelling.

Ingredients

  • 2 lbs Chicken, skinless with bones  -OR-  1 lb Tofu, added with the vegetables
  • 1 packet Chinese Immune Herbs – available at the Natural Remedy Store
  • 2 cloves Garlic, crushed
  • 2 slices fresh Ginger
  • 1 tsp Salt
  • Fresh vegetables as desired: Carrots, Celery, Green Onion, Leafy Greens, Squash
  • 1 Tbsp Soy Sauce/Tamari  -OR-  3 Tbsp Miso Paste
  • 1 Tsp Sesame Oil
  • 1 Tsp Wine or mild Vinegar

Makes 4 hearty servings.

To make the soup, place Chicken in a medium sized pot and add enough water to cover. Bring to a boil and remove any residue that floats to the top at that time.

Add the whole package of herbs, crushed Garlic, fresh Ginger, and Salt. The amount of each can be adjusted to your own taste – the amounts given provide a mild flavor. Bring back to a slow boil, cover and simmer for 50 minutes or longer. You can also use a Crockpot, Instant Pot, or any slow cooker on the slow cook setting.

Add sliced fresh vegetables such as Carrots and Celery (for a more warming effect, use Green Onions), Leafy Greens, and Squash; if substituting Chicken with Tofu, add it now. Simmer again for 10-15 minutes to soften, then add Soy Sauce/Tamari or Miso Paste, Sesame Oil, and Wine or mild Vinegar. Remove from heat and serve.

All the herbal material is edible except Astragalus, the thinly sliced flat herb which will remain firm with a woody appearance. For individuals recovering from a debilitating illness or experience, the soup can be taken daily for about a week to help restore strength. Others may enjoy a bowl a week for nourishing the blood and getting a boost of energy.

Traditional Chinese Concepts of Soup Ingredients

The mention of organs or Blood, Qi, etc. are traditional Chinese descriptions as translated from Chinese, not the Western definition or purpose in a Western sense of that organ. Spleen does not refer to making white blood cells, but is instead often tied to aspects of digestion. Main organs are paired and are associated with a meridian. The meridians are representative of an energy, and are labeled after these organs. Below are some references that can be used to understand the physiology and energetics of the ingredients used in Chinese Medicine.

  • Chicken: Taste is sweet, nature is warm, benefits spleen and stomach. The meat nourishes Qi and blood and tonifies the kidney and essence. It is used therapeutically for blood deficiency, emaciation and persistent illness.
  • Tofu: Cooling, lubricating, and benefits the spleen and stomach.
  • Miso: Sweet and salty, of a neutral nature and benefits the stomach, spleen and kidney.
    • Miso and Tofu are used to treat disharmony of the stomach, with loss of appetite, diarrhea, and abdominal discomfort.
  • Garlic: Pungent and sweet, warm, and benefits spleen, stomach and lungs. Promotes digestion (especially of meats) and is helpful in treating coughing due to lung infections.
  • Carrot: Sweet and neutral. Benefits spleen, liver and lung. Used for indigestion, vision and cough with fever.
  • Squash: Sweet and cooling, benefits spleen, stomach, lung and is used for coughing and promoting urination.
  • Celery: Pungent and sweet, cooling in nature. Benefits liver, stomach and bladder. Used for fever, agitation and loss of appetite. 
  • Greens: Slightly astringent, cool and benefit spleen and liver.
  • Green Onion: Pungent and warm. Benefits stomach and lungs. Used for dispersing chill, relieving congestion and relaxing muscle tension.

Herbal Ingredients

  • Astragalus: Taste is sweet, nature is mildly warm, and it benefits the spleen and lung. It is used for all kinds of Qi deficiency syndromes, especially when there is excessive sweating.
  • Codonopsis: Taste is sweet, nature is mildly warm, and it benefits the lung and spleen. It is used for all types of Qi deficiency syndromes, especially when there is weak digestion. It is commonly used by Chinese herbalists as a substitute for Ginseng.
  • Dioscorea (Chinese Yam): Taste is sweet, nature is mildly warm, and it benefits the spleen, lung, and kidney. It is used for treatment of diarrhea and frequent urination.
  • Lycium (Goji Berry): Taste is sweet, nature is neutral, and it benefits the liver and kidney. It is used for weakness due to overwork and aging, for weak vision, and for chronic cough.
  • Longan: Taste is sweet, nature is warm, and it benefits the heart and spleen. It is used for deficiency of blood, with poor memory, heart palpitations, and weakness.
  • Wood Ear (Black Fungus): Taste is sweet, nature is neutral, and it benefits the lung, stomach, and liver. It is used for dry cough, dry throat and mouth, and for other symptoms of dryness.
  • Lotus Seed: Taste is sweet and astringent, nature is neutral, and it benefits the spleen, kidney, and heart. It is used for loss of appetite and diarrhea due to weak digestion, for frequent urination, and for restlessness.
  • Polygonatum (Solomon’s Seal): Taste is sweet, nature is mildly cold, and it benefits the lung and stomach. It is used for any kind of yin-deficiency syndrome, typically manifesting as fidgeting, dry mouth and throat, and dry cough.
  • Sargassum (Seaweed): Taste is salty, nature is cold, and it benefits the stomach, liver, and kidney. It is used to dissolve phlegm and relieve swelling.

Download the Chinese Immune Herb Chicken Soup Recipe as a PDF

Adapted from Jintu – Chinese Herbal Chicken Soup ITM www.itmonline.org/jintu

Healing with Whole Foods: Oriental Traditions and Modern Nutrition, Paul Pitchford

Daily Health Tips

Notes On Holiday Parenting

by Madeleine Morrison, ND

Happy Holidays! As we dive into the Season, some parents and caregivers may have noticed that your children are having more colds and flus or tummy troubles. 

Holidays can mean bigger meals and more sweets. In addition, our kids sleep less and stay indoors more frequently. Our digestive system works best with the “rest and digest” portion of our autonomic nervous system. 

  • A few deep, slow calming breaths between bites in addition to slower eating can enhance the body’s ability to properly turn on the digestive juices. 

To enhance the immune system; 

  • Getting adequate sleep is ultra important as is exercise and outdoor time. Here in California we have access to outdoor spaces and activities and some pools are open year round. Having fun ball games outside, walks to look at colorful lights, trips to the park all enhance our immune system and help children and parents sleep better. 

Communication Tips

Notice how your kids are doing – watch for their cues. Are they overstimulated? Do they need quiet, sit down, or cuddling time for a bit? Take some time to walk around the block to take a break and ask them how they are feeling. Children tell us how they are doing primarily through their behavior, even from across the room, try to read your kids’ cues to give them what they need for smooth days.

Take Care Of Yourself 

Short tempers and anxiety often rise with seasonal, family and even friendly gatherings. Be mindful of your own energy and moods. Eat and drink smart for the season. Make time for yourself to get some exercise and sleep. 

Games and Puzzles

Games are a great way to bring the multi-generations together for fun. Have family or friends bring along their favorite game or puzzle and take turns playing or split a large group into smaller ones of mixed families to get to know new members of the group and reconnect with others. Plan a few games and be prepared and have fun!

A Note About Food ISSUES

To decrease the stress on cooks and shoppers, ask members of your party to send an email with their dietary needs. This is a great way to introduce new foods to children and have inclusion of various options. My family gathering included a person who eats no chicken, a vegan, a celiac person, and kids that eat oysters! Accommodations can be hard but parents of the kiddos and the person themself is happy to answer any questions. Many kids with food sensitivities do not appreciate being left out or made to feel different. 

Your child seems food reactive or digestively challenged 

Tummy troubles are very common and not well addressed by mainstream medical communities. As Naturopathic doctors we have extensive training in these issues. 

If you wonder why your child is a picky eater, has odd reactions after eating certain foods, or has frequent infections, ear aches, eczema, ADD/ADHD, or many other issues, this can often relate back to food sensitivities that can be tested for with a finger prick or blood draw. 

If your child has more gas and tummy aches, constipation or diarrhea, consider a comprehensive stool analysis, which provides information regarding good and bad gut bacteria, yeast, other bugs and parasites. This can also tell us how well they digest their food and looks for possible inflammatory markers. 

Taking care of these issues with children often leads to easier digestion and diet choices for them later in life. Food is our friend, not our enemy. 

With these tips and ideas you might find yourself having a more peaceful holiday season.  When you get in over your head, REST, call someone to watch the kids and if your children get sick, we are here to help.

About the Author

Dr. Madeleine Morrison is a traditional Naturopathic Doctor with a depth of family practice experience that specializes in pediatrics, women’s health, endocrinology, autoimmune diseases, and gastrointestinal conditions. She provides full pediatric care including well-child visits from birth onward, and welcomes acute and chronic family medicine concerns for patients of all ages.

Daily Health Tips

Sun Safety Tips

by Dr. Madeleine Morrison ND
First things first:
Check Your Sunscreen Ingredients, Reapply and Cover Up
Check your skin regularly for new moles or growth or changes in an existing mole. Ask your primary health care provider how often you should see a dermatologist. Here in California, annual visits depending on age and skin type are the norm. Fair-skinned people may start visits early, depending on history of sun exposure.
The best defense against too much harmful ultraviolet radiation is a combination of protective clothing, shade and good timing (before 10am and after 4pm). Stanford University dermatologists who reviewed data from a national CDC survey found that people who relied solely on sunscreen for sun protection got more sunburns than people who reported infrequent sunscreen use but wore hats and clothing to shield themselves from the sun. They also found that people rarely use a combination of strategies, such as protective (wearing sunglasses and sunscreen), avoidant (seeking shade, avoiding the outdoors), and covering-up (wearing a shirt, hat, or pants).
Cancer and the Sun
Basal cell carcinoma (BCC) – most common type. Looks flesh colored, pearl like bump, or pinkish patch of skin. BCC usually develops after years of sun exposure or indoor tanning. Catch it early as its growth can penetrate other local tissues such as nerves and bones.
Squamous cell carcinoma (SCC) – second most common type. Often looks like a firm red bump, scaly patch, or a sore that heals and reopens. Common in light-skinned people. Tends to form on skin that gets frequent sun exposure, rim of ear, face, neck, arms, chest, or back. Can spread so catch it early.
Actinic keratosis – not cancer but considered pre-SCC. Red, dry, scaly patch. Get checked to prevent SCC.
Melanoma – will spread and can be fatal. Often develops in a mole or suddenly appears as a dark spot on the skin. A – asymmetry, B – border irregular, C – color (darker areas but other shades as well), D – diameter larger than a pencil eraser, E – evolving spot is changeable size, shape and color. Can develop in areas that get less sun exposure, but more common in sun exposed areas.
American Academy of Dermatology Association aad.org
SUN USE ADVICE
Don’t get burned. Sounds easy, but avoiding extra measures and misplaced trust in sunscreens can lead to sore, blistered or peeling skin and raises your skin cancer risk.
Extra Measures
  • Cover up. Shirts, hats, shorts and pants provide the best protection from UV rays.
  • Find shade – or make it. Picnic under a tree, read beneath an umbrella or take a canopy to the beach. Keep infants in the shade – they are still developing the tanning pigments, known as melanin, that protect skin.
  • Plan around the sun. Go outdoors in early morning or late afternoon, when the sun is lower. UV radiation peaks at midday.
  • Sunglasses aren’t just a fashion accessory. Good shades protect your eyes from UV radiation, which may cause cataracts.
A Moment on Solar Ultraviolet Radiation
Solar ultraviolet radiation is divided into three categories by wavelength, UVA, UVB and UVC. The shortest UVC is dispersed through the ozone-oxygen cycle. The UVA and part of the UVB reach the planet’s surface.
The Good: Exposure to sunlight is vital in 7-dehydrocholesterol’s conversion to pre-vitamin D3 in human skin. Low vitamin D3 yield is attributed to the efficiency of UVB radiation. Which is affected by; skin pigmentation (more melanin, more blockage, lower vitamin D), sunscreen application, time of day, season, latitude, altitude and air pollution.
The Bad: Chronic exposure to UV irradiation brings immunosuppression, photoaging and carcinogenesis. The exposure involves immune system modulation, accumulation of genetic changes, and can lead to skin tumors.
Ironically the tanning is a defense in itself by creating pigmentation of the skin. As well, increasing vitamin D aids in the modulation of the immune system.
The Bad: The UV filters (chemicals in sunscreens to filter out UV rays) are not fully broken down by ordinary wastewater treatment methods, aquatic ill effects are being documented. Additionally, oxybenzone probably leads to reef bleaching and other UV chemical filters have been found in fish species and may prove toxic. (Hence; “Reef Safe Sunscreens”).
He et al. Natural components in sunscreens: Topical formulations with sun protection factor (SPF)
Biomedicine & Pharmacology 134 (2021)111161
Wear Sunscreen
Picking a good sunscreen
Some sunscreens prevent sunburn but are less effective at reducing all UV rays, such as UVA rays that cause other types of skin damage. Make sure your sunscreen offers broad spectrum protection.
*SPF values are an unreliable measure of a sunscreen’s all-around effectiveness. A good sunscreen should provide equal broad-spectrum protection, protecting against both UVA and UVB rays. But the SPF value reflects only how well a product will protect from UVB rays, the main cause of sunburn and some skin cancers such as squamous cell carcinoma. UVA rays are possibly just as dangerous but are not tested in America as part of the SPF ratings. Our FDA has not changed regulations as they have in Europe to reflect full protection.
Don’t fall for high SPF labels. Pick a sunscreen with an SPF between 15 and 50+. Studies show higher SPF numbers can tempt you to stay in the sun too long– and even if you don’t burn, your skin may suffer from long-term damage. Consider a more protective product if you are near water or at high elevation and make sure to reapply often. Sunscreens only work when they sit on the skin, as time passes and the UVB rays hit the skin, penetration into the skin is enhanced, leaving you vulnerable.
Avoid sunscreen with vitamin A. Government data shows that tumors and lesions develop sooner on skin coated with creams containing vitamin A, also called retinyl palmitate or retinol. Avoid any sunscreen whose label includes retinyl palmitate, retinol or vitamin A.
Avoid oxybenzone, homosalate, avobenzone ingredients that readily penetrate the skin and have been shown to disrupt the hormone system. Instead look for sunscreen lotions with zinc oxide and titanium dioxide, the only two sunscreen ingredients categorized as safe and effective by the Food and Drug Administration.
On the Horizon in Research
Research is expanding into looking for natural substances that show promise in blocking UV rays, they can be added to the mineral based safe sunscreens. Additionally, some of the natural substances are antioxidants that may help diminish the damage to the skin cells and DNA that occurs from exposure. These include lignin, silymarin, and some marine algal species. Considering the toxicity of chemical sunscreens, using natural antioxidants for UV filtration may provide a reliable alternative with added benefits.
He et al. Natural components in sunscreens: Topical formulations with sun protection factor (SPF)
Biomedicine & Pharmacology 134 (2021)111161
Don’t combine sunscreen with bug repellent. If you need bug repellent, buy it separately and apply it first.
Don’t spray. Sprays cloud the air with tiny particles that may not be safe to breathe. It is also difficult to apply an even layer of mineral sunscreen that is thick and uniform enough to ensure proper UV protection.
Reapply often. Sunscreen chemicals sometimes degrade in the sun, wash off or rub off on towels and clothing. Sunscreen should be reapplied at least every two hours – more often if you have been swimming or sweating. So remember when hiking or biking that you need to stop and reapply.
Men Need a Kick in the Sunscreen. In 2021, the American Cancer Society estimated about twice as many American men are expected to die from melanoma as women and surveys show that only 48 percent of men report routine sun avoidance, compared to 68 percent of women.
**Got your vitamin D? Many people don’t get enough vitamin D, a hormone manufactured by the skin in the presence of sunlight. Your health care provider can test your vitamin D levels and recommend supplements if they’re low.
Next Blog will be about the Vitamin D Conundrum.
Sun safety tips for kids
A few blistering sunburns in childhood can double a person’s lifetime chances of developing serious forms of skin cancer. The best form of sun protection is a hat, shirt and shade. After that, protect kids with a sunscreen product that’s effective and safe.
Special precautions to take with infants and children
Infants
Infants under 6 months should be kept out of direct sun as much as possible. Their skin is not yet protected by melanin. When you take your baby outside:
Cover them up with protective clothing that’s tightly woven but loose fitting, and a sun hat. Mom or dad’s UV protective shirts can work as a baby cover up.
Make shade. Use the stroller’s canopy or hood. If you can’t sit in a shady spot, use an umbrella.
Avoid midday sun. Take walks in the early morning or late afternoon.
Follow product warnings for sunscreens on infants younger than 6 months. Most manufacturers advise against using sunscreens on infants or advise parents and caregivers to consult a doctor first. The American Academy of Pediatrics says that amounts of sunscreen can be used on infants to avoid sunburns when it isn’t possible to find shade.
Toddlers and children
Sunscreens are an essential part of a day in the sun. But young children’s skin is especially sensitive to chemical allergens, as well as the sun’s UV rays.
Test sunscreen by applying a small amount on the inside of your child’s wrist the day before you plan to use it. If an irritation or rash develops, try another product. Ask your child’s doctor to suggest a product less likely to irritate your child’s skin.
Slop on sunscreen (remember it works by covering the skin, not as well when it sinks in) and reapply it often, especially if your child is playing in the water or sweating a lot.
Sun safety at school
Send sunscreen to daycare and school. Some childcare facilities provide sunscreen, but you can buy your own to make sure it’s safe and effective. You can share EWG’s safe sunscreen tips and product suggestions with your child’s school and caregiver.
*For pale children, find out your child’s school’s sun safety policy.
Teens
Teenagers (I was one of these with baby oil), who covet bronzed skin are likely to sunbathe or visit tanning salons, both of which are a bad idea. Researchers believe that increasing UV exposure may have caused the marked increase in melanoma incidence in women born after 1965.
*Tanning salons expose the skin to as much as 15 times more UV radiation than the sun, and tanning bed use has been directly linked to increased rates of melanoma in women.
Be a good role model for your teens – let them see that you protect yourself from the sun.
Let me leave you with 2 head scratchers
Vitamin D activation requires sun, but sun can really damage skin
Melanin protects our skin yet sun exposure helps create melanin
**EWG’s sunscreen database evaluates the safety and efficacy of SPF-rated products, including sunscreens for recreational use and SPF-rated daily-use moisturizers and lip products. They give the best ratings to products that provide broad spectrum protection – that is, protection from both UVA and UVB rays – with ingredients that pose fewer health concerns when absorbed by the body. Consumers can shop for EWG VERIFIED® sunscreens, making it easier to choose products that are safe and effective.
SOURCES: EWG.org
Alternative Cancer Care, Integrative Medicine, Men's Health, Naturopathic Medicine, Uncategorized

Prostate Biopsy: Is it Necessary? How to Decide and What to Do

by Eric Yarnell, ND

If you have an elevated PSA level and it has been recommended that you have a biopsy, consider these important tips before you do.

First, it is becoming more and more clear that a prostate MRI should be done before any biopsy. There are several reasons why:

    1. Many MRIs show there is no cancer, and thus a biopsy would be a waste of time.
    2. If an MRI does show a spot that might have prostate cancer, the biopsy can be targeted to that area instead of being somewhat random.
    3. Almost always, this means a prostate biopsy can be limited to just 1–3 samples being taken, instead of the standard of 12 or more.
    4. The MRI can also show other important information such as the size of the prostate, if the seminal vesicles, urinary bladder, lymph nodes, or bones in the area are being affected.

Overall, prostate MRIs help reduce the number of prostate biopsies, which is a very good thing, while providing lots of other information ultrasound-guided biopsies can’t deliver, or aren’t as good at assessing.

It is crucial that the MRI is done on a 3 Tesla strength machine (older MRI machines had 1.5 Tesla magnetic fields and are not sufficient for seeing the prostate). If you have concerns about the contrast material used in MRIs, we have natural therapy options to help counter the low risk of side effects they may cause.

A proper MRI will give what is known as PI-RADs score. This is a standardized assessment of how likely it is that serious prostate cancer would be found on a biopsy. Generally speaking only PI-RADS 4 or 5 lesions should be biopsied, and sometimes even these prove not to be cancer. If there is only a PI-RADS 3 lesion, then usually it means no biopsy is needed and a repeat MRI should be done in a year (almost always without contrast on this follow-up imaging). PI-RADS 1 and 2 lesions never need to be biopsies.

There are other tests Dr. Yarnell can discuss with you as well to help determine if a prostate biopsy is necessary in the first place.

Second, if the MRI shows an issue or a prostate biopsy is going to happen, it is imperative that it be a transperineal, not a transrectal biopsy. Currently over 90% of prostate biopsies are done through the rectal wall, which does provide good and fairly easy access to the prostate. However, this brings with it a quite high risk of infection, including potentially deadly sepsis. This risk is so high, that the entire country of Norway has essentially abandoned transrectal prostate biopsies, and in 2021 the European Association of Urology agreed, saying only transperineal biopsies should be done. In this type, the needle or needles are placed through the skin between the base of the penis and the anus. While a bit more challenging for the urologist, it provides just as good information and is dramatically safer.

Dr. Yarnell can help explain all these options to you, and help advocate with your urologist to make sure you get an MRI when appropriate. If it appears a biopsy is recommended, Dr. Yarnell will help support you getting a transperineal prostate biopsy focusing only on problem lesions, and not a transrectal prostate biopsy or a fishing expedition all over your prostate. Furthermore, he can provide natural treatments to go with the biopsy to reduce the already very low risk of side effects even further.

Some patients are concerned that a biopsy will spread cancer. Two studies have looked into this concern with prostate biopsies. One found that while very rarely you could find evidence of prostate cancer cells in the blood after a biopsy (just 4 cases out of 42 studied). This supports the long-held naturopathic notion that the immune system can take out a few errant cells that might escape during a biopsy. Another study found that in just 2% of prostate biopsies was there any evidence of cancer cells being pushed around inside the prostate by the needle. Given that the rate of prostate cancer mortality has gone down despite the near tripling of the number of prostate cancer biopsies being performed, it is highly unlikely that prostate biopsies cause any significant amount of cancer spread. Again, Dr. Yarnell can recommend some supplements to help reduce this already extremely low risk if you wish.

If you want a forward-thinking doctor who really puts patients first, stays up-to-date on the latest findings, and can implement a science-informed natural approach to prostate problems of all kinds, then call and make an appointment to see Dr. Yarnell.

 

References

Bastacky SS, Walsh PC, Epstein JI (1991) “Needle biopsy associated tumor tracking of adenocarcinoma of the prostate” J Urol 145(5):1003–7. 

Midiri F, Vernuccio F, Purpura P, et al. (2021) “Multiparametric MRI and radiomics in prostate cancer: A review of the current literature” Diagnostics (Basel) 11(10):1829.

Moreno JG, O’Hara SM, Long JP, et al. (1997) “Transrectal ultrasound-guided biopsy causes hematogenous dissemination of prostate cells as determined by RT-PCR” Urology 49(4):515–20.

Wolinsky H (2023) “Death Spurs Country’s Shift to Safer Prostate Biopsies” Medscape Medical News, March 15, https://www.medscape.com/viewarticle/989696