Selected Podcast
Tips for Prostate Health
Kenneth Essig, MD discusses the AUA and USPSTF recommendations for prostate cancer screenings. He shares the signs/symptoms that do and do not suggest prostate cancer, the impact diet, herbal remedies, and medicines have on preventing prostate cancer and options for further diagnosis if an elevated PSA is detected. Learn more about BayCare's men's health services.
Featured Speaker:
Learn more about Kenneth Essig, MD
Kenneth Essig, MD
Kenneth Essig, MD, specializes in urology. He has contributed numerous articles for publication to journals including the Journal of Urology. Dr. Essig’s clinical interests include overactive bladder issues, pelvic health and prostate health. He is a member of the American Medical Association and the Florida Medical Association.Learn more about Kenneth Essig, MD
Transcription:
Tips for Prostate Health
Melanie Cole, MS (Host): According to the CDC and the National Cancer Institute, aside from non-melanoma skin cancer, prostate cancer is the most common cancer among men in the United States. The good news is that prostate cancer is very treatable, and physicians now have many tools in their tool box to successfully diagnose and treat this very common cancer. My guest today is Dr. Kenneth Essig. He’s a urological surgeon at BayCare Health. Dr. Essig, tell us a little bit about the incidence and prevalence of prostrate cancer that you see every day.
Kenneth Essig, MD (Guest): Good afternoon Melanie. Prostrate cancer is one of the most common things seen in my office. It is thought to effect men increasingly as they age. There are some reports that suggest that men in their 80s, over 70% of those men have some areas of cancer in their prostate. If we look at men in their 70s, 60 to 70% of those men will have small areas of prostate cancer in their prostate. It’s very common, it’s very prevalent. However, it’s not typically very lethal. The vast majority of people who have areas of prostate cancer in their prostate do not die from the prostate cancer. In fact, they're often not even effected by that prostate cancer. So, it is common to have prostate cancer. It is not common to be affected by prostate cancer.
Host: Then speak about screening, if you would. Tell us about the American Urological Association and the U.S Preventative Services Task Force recommendations for screening.
Dr. Essig: Both organizations have come out with recommendations. These recommendations have been altered over the past few years. Currently the U.S Task Force is giving a C rating to the screening methodology in that they suggest that there is not overwhelming evidence that prostate screening has a great deal of good overall to the patient. In the past, they had given it a D rating, but they upgraded that to a C rating.
The American Urological Association takes a similar stance by saying that they feel that if we target the right demographic or the right age group, screening can be valuable. They recommend screening between the ages of 50 and 69, but not beyond that. Patients who are older than that or younger than that, they do not recommend screening. Patients who are within those time frames, within those age groups, they are recommending that screening be discussed with the doctor. The risks of screening as well as well as the benefits.
Host: So then tell us a little bit about PSA. Once a man is screened, tell us what that screening looks like in your office.
Dr. Essig: So, screening typically takes three forms. The first form is do we want to do the screening. Screening can be very valuable, especially with patients who have family histories of prostate cancer. There are some people prefer not to undergo screening because historically speaking, screening has led us as physicians to overtreat or to treat prostate cancer in patients who ultimately would not have been affected by the prostate cancer.
So first and foremost is to have that discussion of the risks and benefits of even doing this screening. Screening is not perfect, but it does give us a better clue as to which patients we need to be more concerned about prostate cancer. Once we’ve had the discussion, and if the patient does wish to undergo screening, the screening is done by a prostate exam, which is a rectal exam, and by PSA testing.
Again, PSA testing is by far not a perfect test. That are patients who have elevated PSAs and turn out not to have prostate cancer. In fact, if we look at the statistics, patients with PSAs over four are considered to be abnormal. However, if you look at all the patients with PSA between four and ten, only about one-third of those patients will have prostate cancer. So, by no means is PSA a perfect test. It can be elevated in patients who do not have prostate cancer. It can be normal in some patients who do have prostate cancer. So, it is helpful. It is a clue, but it is certainly not a be all and end all that definitively tells us whether or not there is prostate cancer in a given patient.
Host: Then if you do detect prostate cancer in a patient, doctor, tell us a little bit about some of the treatment options that are available. Whether you're doing watchful waiting or some of the newer treatments that are out there.
Dr. Essig: Okay. So, as we said, there are many patients who are diagnosed with prostate cancer who do not want or really even need aggressive treatment. So, the least aggressive form of treatment is active surveillance or watchful waiting. Basically, that consists of simply keeping an eye on the patient with regular exams of the prostate and regular checking of the PSA. Initially every six months, then after a few years if things are stable, going to once a year. If things remain stable, there are patients that can continue with this surveillance with many, many years. Really the rest of their lives without any invasive treatment.
Invasive treatment can take the form of radiation. It can take the form of surgery. Both of those have pros and cons. With radiation, there can be irritation to the bladder or the rectum, but there is about an 85% cure rate. Similarly, with surgery, the cure rate is about 85 even to 90%, but there are risks that involve erectile dysfunction and urinary leakage.
There are other less commonly used modalities such as freezing of the prostate called cryotherapy. In years past, we used a targeted radiation more commonly than we do now called brachytherapy. Those are some of the more common forms of treatment. Again, they revolve around either radiation to the prostate or surgery to remove the prostate. The more common way of removing the prostate now is robotically. There are some controversies- surrounding the overall benefit of use of the robot. I personally have removed prostates using a robot and the standard way. As I said, there are some pros and cons to both the standard way of removing the prostate and to the robotic method of removing the prostate. If removal of the prostate is the intended way of treating, that’s certainly a conversation that the patient should have with their treating urologist.
Host: Dr. Essig, what questions would you like patients… If the patient comes in to see you, and men they're not typically excited to come see you, and sometimes it’s their partner that gets them in there to see you in the first place. Whether it’s for the screening or a checkup or treatment options. What questions would you like them to ask you about prostate cancer, some of those side effects, whether that’s erectile dysfunction or incontinence? What would you like them to ask you?
Dr. Essig: Well the first question I would like to have them ask and address with the patient is “now that I’ve been diagnosed with cancer, how is this going to affect my life? Both the diagnosis and the treatment.” Because both have strong impacts on not only the patient, but on the people around them. So, I want that patient to leave my office with a very clear understanding of how the treatment is going to affect their lives and how the prostate cancer itself may or may not affect their lives. In other words, is the treatment going to eradicate the cancer? If so, what is the likelihood? Or if not, what is the likelihood of recurrence of the cancer if we do one form or treatment?
Or if we decide to do something like active surveillance. What is the chance that the cancer is going to spread and grow versus the possibility that this cancer is going to remain silent or indolent and not pose a threat to their lives? So, I think each patient who has been diagnosed with prostate cancer is owed the answers to those questions.
Host: Then wrap it up for us because this has really been great information to hear about the different screening recommendations and what questions you want patients to ask you. Wrap it up with your best advice about prostate cancer in this day and age, and really what people can expect on the horizon.
Dr. Essig: There are a lot of exciting new potential treatments out there. I think one of the things that we as urologists have come to realize is that there are many people that actually do not need to be aggressively treated, that can be watched. Prostate cancer very typically is not a death sentence. Unlike many other cancers, it’s a cancer that people live with for many decades without treatment but with close observation and surveillance by the doctors. Now that we are treating prostate cancer in less invasive ways, the actual treatments are less invasive. The side effects are less. The incontinence rates are less. The erectile dysfunction rates are less. When those side effects or problems do occur, there are things that we can do about those particular side effects.
So, while nobody wants to have the diagnosis of cancer, the diagnosis or prostate cancer clearly sends a very different message to the doctors that are treating it than it even sent maybe ten years ago. With better outcomes across the board for patients who are either treated aggressively, treated with minimally invasive approaches, or treated simply with surveillance.
Host: Great information. Thank you so much Dr. Essig for joining us today and sharing your expertise and explaining it all so very well for us. Thank you again. You’re listening to BayCare HealthChat. For more information, please visit baycare.org. That’s baycare.org. This is Melanie Cole. Thanks so much for tuning in.
Tips for Prostate Health
Melanie Cole, MS (Host): According to the CDC and the National Cancer Institute, aside from non-melanoma skin cancer, prostate cancer is the most common cancer among men in the United States. The good news is that prostate cancer is very treatable, and physicians now have many tools in their tool box to successfully diagnose and treat this very common cancer. My guest today is Dr. Kenneth Essig. He’s a urological surgeon at BayCare Health. Dr. Essig, tell us a little bit about the incidence and prevalence of prostrate cancer that you see every day.
Kenneth Essig, MD (Guest): Good afternoon Melanie. Prostrate cancer is one of the most common things seen in my office. It is thought to effect men increasingly as they age. There are some reports that suggest that men in their 80s, over 70% of those men have some areas of cancer in their prostate. If we look at men in their 70s, 60 to 70% of those men will have small areas of prostate cancer in their prostate. It’s very common, it’s very prevalent. However, it’s not typically very lethal. The vast majority of people who have areas of prostate cancer in their prostate do not die from the prostate cancer. In fact, they're often not even effected by that prostate cancer. So, it is common to have prostate cancer. It is not common to be affected by prostate cancer.
Host: Then speak about screening, if you would. Tell us about the American Urological Association and the U.S Preventative Services Task Force recommendations for screening.
Dr. Essig: Both organizations have come out with recommendations. These recommendations have been altered over the past few years. Currently the U.S Task Force is giving a C rating to the screening methodology in that they suggest that there is not overwhelming evidence that prostate screening has a great deal of good overall to the patient. In the past, they had given it a D rating, but they upgraded that to a C rating.
The American Urological Association takes a similar stance by saying that they feel that if we target the right demographic or the right age group, screening can be valuable. They recommend screening between the ages of 50 and 69, but not beyond that. Patients who are older than that or younger than that, they do not recommend screening. Patients who are within those time frames, within those age groups, they are recommending that screening be discussed with the doctor. The risks of screening as well as well as the benefits.
Host: So then tell us a little bit about PSA. Once a man is screened, tell us what that screening looks like in your office.
Dr. Essig: So, screening typically takes three forms. The first form is do we want to do the screening. Screening can be very valuable, especially with patients who have family histories of prostate cancer. There are some people prefer not to undergo screening because historically speaking, screening has led us as physicians to overtreat or to treat prostate cancer in patients who ultimately would not have been affected by the prostate cancer.
So first and foremost is to have that discussion of the risks and benefits of even doing this screening. Screening is not perfect, but it does give us a better clue as to which patients we need to be more concerned about prostate cancer. Once we’ve had the discussion, and if the patient does wish to undergo screening, the screening is done by a prostate exam, which is a rectal exam, and by PSA testing.
Again, PSA testing is by far not a perfect test. That are patients who have elevated PSAs and turn out not to have prostate cancer. In fact, if we look at the statistics, patients with PSAs over four are considered to be abnormal. However, if you look at all the patients with PSA between four and ten, only about one-third of those patients will have prostate cancer. So, by no means is PSA a perfect test. It can be elevated in patients who do not have prostate cancer. It can be normal in some patients who do have prostate cancer. So, it is helpful. It is a clue, but it is certainly not a be all and end all that definitively tells us whether or not there is prostate cancer in a given patient.
Host: Then if you do detect prostate cancer in a patient, doctor, tell us a little bit about some of the treatment options that are available. Whether you're doing watchful waiting or some of the newer treatments that are out there.
Dr. Essig: Okay. So, as we said, there are many patients who are diagnosed with prostate cancer who do not want or really even need aggressive treatment. So, the least aggressive form of treatment is active surveillance or watchful waiting. Basically, that consists of simply keeping an eye on the patient with regular exams of the prostate and regular checking of the PSA. Initially every six months, then after a few years if things are stable, going to once a year. If things remain stable, there are patients that can continue with this surveillance with many, many years. Really the rest of their lives without any invasive treatment.
Invasive treatment can take the form of radiation. It can take the form of surgery. Both of those have pros and cons. With radiation, there can be irritation to the bladder or the rectum, but there is about an 85% cure rate. Similarly, with surgery, the cure rate is about 85 even to 90%, but there are risks that involve erectile dysfunction and urinary leakage.
There are other less commonly used modalities such as freezing of the prostate called cryotherapy. In years past, we used a targeted radiation more commonly than we do now called brachytherapy. Those are some of the more common forms of treatment. Again, they revolve around either radiation to the prostate or surgery to remove the prostate. The more common way of removing the prostate now is robotically. There are some controversies- surrounding the overall benefit of use of the robot. I personally have removed prostates using a robot and the standard way. As I said, there are some pros and cons to both the standard way of removing the prostate and to the robotic method of removing the prostate. If removal of the prostate is the intended way of treating, that’s certainly a conversation that the patient should have with their treating urologist.
Host: Dr. Essig, what questions would you like patients… If the patient comes in to see you, and men they're not typically excited to come see you, and sometimes it’s their partner that gets them in there to see you in the first place. Whether it’s for the screening or a checkup or treatment options. What questions would you like them to ask you about prostate cancer, some of those side effects, whether that’s erectile dysfunction or incontinence? What would you like them to ask you?
Dr. Essig: Well the first question I would like to have them ask and address with the patient is “now that I’ve been diagnosed with cancer, how is this going to affect my life? Both the diagnosis and the treatment.” Because both have strong impacts on not only the patient, but on the people around them. So, I want that patient to leave my office with a very clear understanding of how the treatment is going to affect their lives and how the prostate cancer itself may or may not affect their lives. In other words, is the treatment going to eradicate the cancer? If so, what is the likelihood? Or if not, what is the likelihood of recurrence of the cancer if we do one form or treatment?
Or if we decide to do something like active surveillance. What is the chance that the cancer is going to spread and grow versus the possibility that this cancer is going to remain silent or indolent and not pose a threat to their lives? So, I think each patient who has been diagnosed with prostate cancer is owed the answers to those questions.
Host: Then wrap it up for us because this has really been great information to hear about the different screening recommendations and what questions you want patients to ask you. Wrap it up with your best advice about prostate cancer in this day and age, and really what people can expect on the horizon.
Dr. Essig: There are a lot of exciting new potential treatments out there. I think one of the things that we as urologists have come to realize is that there are many people that actually do not need to be aggressively treated, that can be watched. Prostate cancer very typically is not a death sentence. Unlike many other cancers, it’s a cancer that people live with for many decades without treatment but with close observation and surveillance by the doctors. Now that we are treating prostate cancer in less invasive ways, the actual treatments are less invasive. The side effects are less. The incontinence rates are less. The erectile dysfunction rates are less. When those side effects or problems do occur, there are things that we can do about those particular side effects.
So, while nobody wants to have the diagnosis of cancer, the diagnosis or prostate cancer clearly sends a very different message to the doctors that are treating it than it even sent maybe ten years ago. With better outcomes across the board for patients who are either treated aggressively, treated with minimally invasive approaches, or treated simply with surveillance.
Host: Great information. Thank you so much Dr. Essig for joining us today and sharing your expertise and explaining it all so very well for us. Thank you again. You’re listening to BayCare HealthChat. For more information, please visit baycare.org. That’s baycare.org. This is Melanie Cole. Thanks so much for tuning in.