Melanie Cole, MS (Host): Welcome to Bryan Health Podcast.

I'm Melanie Cole and we're highlighting today PSA numbers in men as they relate to prostate health.

Joining me is Dr. Adam Mues. He's a Urologic Oncologist with Urology Partners of Nebraska, a subsidiary of Cancer Partners of Nebraska.

Dr. Mues, thank you so much for joining us today. I'd like to start by explaining to people a little bit about the prostate itself. What happens to the prostate as men age?

Adam Mues, MD: Well, in general, the prostate begins to enlarge as men age, and it starts usually in the late 40s or 50s. And the growth rates are different depending on the individual person, but we know that most men experience some sort of enlargement of the prostate gland with age.

Host: So this is something that happens to pretty much most men, but are there symptoms of something that would indicate prostate trouble at any of these ages?

Adam Mues, MD: Well, the symptoms kind of start out mild and can progress from there. And some of these symptoms are just difficulty with urination, urinating more frequently, an urgency to urinate, a weaker stream, trouble getting the urine stream started, maybe a feeling that they're not emptying their bladder completely.

And so these are some of the symptoms that we start to monitor and we treat if necessary, sort of depending on their severity.

Host: Dr. Mues, I'd like you to speak about prostate cancer screening, the American Urologic Association and Preventative Services Task Force recommendations. When should men start talking to their doctors about this screening?

Adam Mues, MD: Usually between the ages of 45 and 50. We used to use 50 as the initial age to start screening, but some people start screening a little bit earlier than that. And then for people with higher risk, they should start even earlier, usually between 40 and 45. And those are men who have strong family histories of prostate cancer, you know, in their father or uncle or grandfather or who are of African American background.

And then there are some patients who have known genetic syndromes that predispose them to prostate cancer, such as Lynch syndrome. Most men don't know whether or not they have those, but, if you did, that would be someone else who should be screened a little bit earlier.

Host: Does this screening take place every year?

Adam Mues, MD: Screening is once a year. Yes, and consists mostly of the PSA blood test. We also perform a digital rectal exam with that to complement the blood test.

The digital exam is we're basically looking for any bumps or nodules or hard areas on the prostate that may make us think that the patient has a cancer. Coupled with the PSA, it can be very useful.

Host: Well then tell us about the PSA. What is it? And tell us what those numbers mean when we get those results back.

Adam Mues, MD: PSA stands for prostate specific antigen. And it's basically a protein that is detected in the blood that's made specifically in the prostate. And so we use it to get a better idea of certain prostate conditions. And the normal range for all comers for the PSA is zero to four, for most labs. But we take a lot into consideration when we worry about prostate cancer for a certain patient.

 There are some age specific cutoffs that we take into account. And then we look at PSA in different ways. You know, we look at what's called the PSA velocity or, how PSA changes over time. We also look at something called PSA density, which is the PSA relative to the size of the man's prostate. And this can give us some better information about whether or not we think the patient has a prostate cancer.

Host: Can it be something else if those levels are high? What do those high levels indicate? Are there other conditions that are not cancer?

Adam Mues, MD: Yes. In fact, the most common condition is probably just enlargement of the prostate. Something called BPH or benign prostate hyperplasia, which is just age related enlargement of the prostate. That's the most common reason for elevated PSA. Infections in the bladder or prostate can cause the PSA to be elevated as well as, if a patient were to have had a prior or a recent procedure, like a catheter placement or some type of urologic procedure, that can make the PSA rise as well.

Host: Dr. Mues, you said BPH is pretty common. Do many men experience that enlargement and does that indicate cancer is kind of coming next? Or can BPH be really on its own?

Adam Mues, MD: It's really a separate condition. It's on its own. Just because you have that doesn't mean you're predisposed to getting a prostate cancer. Most men with symptoms, prostate symptoms, it is because of just BPH. There aren't really a lot of prostate cancer specific symptoms.

Host: Well then what advice do you have Dr. Mues for men who are anxious about their PSA levels? You tell them that they're a little bit high or a little bit over four, and they're anxious. What's the next step once that level is just a little bit higher than we'd like it to be?

Adam Mues, MD: I think having them make an appointment with a urologist is the best thing to do just to get all of the accurate information. People tend to get very anxious when they don't have all the information. Just having a conversation with most urologists is going to put them at ease, I think.

And, you know, normally with an elevated PSA, we'll repeat the value because there is a certain percentage of them that will drop. Sometimes it's just a false elevation. So it's just kind of about going through the evaluation and deciding on whether or not any additional testing is warranted.

Host: That's a good point that you make about retesting because that can help ease the anxiety as well. . If someone is diagnosed with prostate cancer, whatever their age, because I understand that it's different as men get older, but what's really exciting as far as treatment modalities, because there's so many tools in your toolbox these days.

Adam Mues, MD: As far as treatment goes, the two major types of treatment that are the gold standards are surgery. So radical prostatectomy, removing the entire prostate or radiation therapy for the prostate. And there's different delivery modalities of the radiation that can be an option for a patient.

But some of the newer things, more exciting things are the focal therapy, that we can do now men who have solitary areas in their prostate that we've been able to target, on biopsy. And we can just treat those areas. And there's different energy modalities out there, that are being used. One is a high intensity focused ultrasound, the other is cryotherapy, there's lasers, different things that we're using now to just focally treat these prostate cancers.

And that is good because men do not have as high of some of the symptoms and complications of other treatments for prostate cancer.

Host: How can someone get a PSA test? Is this through the primary care provider or Bryan On Demand Lab, and is this something that they need a referral for to get an appointment?

Adam Mues, MD: Not necessarily. No you can get a PSA by any doctor and primary care doctors order a lot of PSA tests. Or patients can come to our office, make an appointment with the urologist just for an initial checkup and screening and we can order the test.

Host: Do you have any final thoughts for listeners about the importance of getting this screening so that the loved ones who are listening understand to get their men in to see them.

Adam Mues, MD: Yeah, I think it's an easy thing to do. It's just a blood test. You don't have to fast for it. You know, the exam is something most men don't look forward to, but it's fairly quick and easy. And it's just something that with prostate cancer being such a common type of cancer, it's something that's just good to stay on top of. And a lot of it can be done at your initial, annual, primary care visit. You know, I think it's just very important that men stay on top of this.

Host: Thank you so much, Dr. Mues for joining us today. And for more information, you can visit bryanhealth.org/PSA, or you can call Bryan Cancer Program at 402-481-7900. And of course, to listen to more podcasts from our experts, you can always go to bryanhealth.org/podcasts. That concludes this episode of Bryan Health Podcast.

Please always remember to subscribe, rate, and review Bryan Health Podcast on Apple Podcasts, Spotify, iHeart, and Pandora. I'm Melanie Cole. Thanks so much for joining us today.