Maggie McKay (Host): Prostate health, something many people don't even think about until well into their adult years. But it does need to be discussed and understood when you hear how many men are affected in some way or another.

Welcome to Total Health Talks, your Cook County Health Podcast, where we empower your journey to better health. I'm your host, Maggie McKay. And today, we're going to talk with Dr. Florian Stroie, urologist and Director of Men's Health and Sexual Medicine at Cook County Health. It's so good to have you here today, doctor. Thank you for joining us.

Florian Stroie, DO: Maggie, the pleasure is all mine. Thank you for the opportunity to be here today.

Host: You know, when you get to a certain age, it's amazing to me how many men are affected by prostate health, whether it's prostate cancer or something else. So to start with, what exactly is a prostate?

Florian Stroie, DO: The prostate gland is really a walnut-sized organ. It's located under the bladder in men, and it surrounds a portion of your urinary tube. The main function of the prostate is to make fluid for ejaculation, and this fluid then nourishes and activates sperm so that fertilization inside a woman can take place.

Host: And what are some common prostate problems that men face?

Florian Stroie, DO: The size of the prostate gland really does change throughout a man's life. At birth, the gland is very small and then it grows rapidly during puberty. By about your 30s, the prostate gland does reach its adult size. However, as us men get older, we can experience a condition called benign prostatic hyperplasia or BPH. And what does this mean? It means that the total number of cells in your prostate increases, which can cause enlargement of the prostate gland, getting to a blockage of the urine channel or the narrowing of that channel. And then, this leads to a number of urinary symptoms or complaints. Other common conditions of the prostate are, of course, prostate cancer and prostatitis, which is an inflammation of the prostate gland.

Host: And I can't tell you how many times I've heard people say, "Well, he has prostate cancer, but it's so slow-growing that he'll die from something else other than prostate cancer." Is that a myth or is that accurate?

Florian Stroie, DO: Certainly very true. And we hear that all the time. And there's really been a lot of research in the prostate and men's health domains in general, in terms of optimizing, okay, who are the ones who are going to develop prostate cancer? In other words, divide the pool as to who's higher risk versus lower risk so that they're not undergoing unnecessary screening. After talking with you and taking into account your risk factors, your symptoms, a physical exam, and laboratory testing, we can more easily guide you on what are some of the things to consider and provide reassurance when it's needed.

Host: So, who is it that develops prostate problems in general and how common are they?

Florian Stroie, DO: Well, BPH, it's very common. About two out of three men or around 75% will experience what we call lower urinary tract symptoms from BPH. A very large majority of men do struggle with this condition, because it really can impact your day to day life in a variety of ways. You're waking up frequently to urinate at night. You're tired the next day because of it. You're really having to run to the restroom when you need to urinate because you just can't hold it or sometimes even you leak urine on yourself. Thankfully, we have plenty of treatment options to help you. Those range from lifestyle changes to medications to highly effective, minimally invasive procedures.

Host: And when should men see someone about their prostate?

Florian Stroie, DO: Great question. Common warning signs of prostate problems that should really make you want to see a urologist or a primary care doctor are pain in the penis, the testicles, the perineum, a frequent urge to pee, pain with urinating, slow stream or dribbling, difficulty starting to pee and, of course, getting up at night to pee frequently, as well as erectile dysfunction. Talk to your doctor if you experience any or all of those symptoms.

Other symptoms that should prompt a doctor's visit is pain During or after ejaculation, blood in the semen, pain in your groin or perineum, like we talked about and, of course, symptoms like erectile dysfunction, which is the inability to obtain or maintain an erection can also be associated with prostate problems.

Your urologist will really be able to assess your symptoms and see what the next best steps are for you. The most important part is really for you to realize that you don't have to live with these symptoms. They can be easily managed by somebody such as myself or your urologist.

Host: And what if someone doesn't urinate as well as they used to? Is that a sign that maybe there's trouble?

Florian Stroie, DO: Absolutely. It certainly can be. And if you're displaying any of the symptoms that we just talked about, be sure to consult with your urologist or primary care doctor. One thing I really want to highlight is that even non-cancerous prostate conditions like benign prostatic hyperplasia or enlargement warrants timely medical attention. So, don't delay seeking any sort of treatment.

In regards to prostate cancer, like most other cancers, prostate cancer is usually more easily treated when detected at an early stage. Visit your urologist. You know, it's important. They'll be able to pinpoint exactly what's causing your symptoms and recommend the course of treatment that's best suited to your specific needs.

You know, Maggie, one of the really great things about choosing a urologist at Cook County Health is that you'll be benefiting from people who are writing the literature on prostate health, men's health. So, you can be assured that you're having someone that is a leader in your field, provide you the highest level of attention you need, and it would be our pleasure to care for you.

Host: I hear you loud and clear when you say, "Catch it early. Don't put it off," because when you do put it off and your prostate grows, doesn't that make everything more complicated, for instance, surgery?

Florian Stroie, DO: It certainly can, and something that we consider all the time. It's one of the things that we really do our homework on beforehand. We dot our I's, cross our T's, make sure we have all of the information we need to really pinpoint you in the best sort of pathway that we think will provide you the best sort of outcomes.

Host: And what are some tips or advice for keeping a healthy prostate? Diet and exercise, for instance.

Florian Stroie, DO: Yes. I get asked this all the time. And frankly, there's been a lot of research in this area. And it really highlights what I consider to be a systemic concept or an idea. There's no replacing a good healthy lifestyle. Some of the literature does point in the direction. We don't yet have hard evidence and that is why we can't exactly point to a specific diet. But that is why we do have the general recommendation of eating fruits and vegetables as substantially beneficial to the prostate health. Certain lifestyle factors such as tobacco use, being overweight and having poor nutrition, they all seem to play a role in your prostate health.

For now, Maggie, the best advice I can give you that you can start doing today to optimize your prostate health is, number one, get to a healthy weight and stay there. You have to maintain a good body shape because that really indirectly affects our urinary plumbing system, including our prostate. Exercise, of course, is fundamental. And to tie in a little bit of men's health to that, it also helps hormonally. A man who exercises, who sleeps better at night gets a better release with testosterone and certain other elements that are positive in this equation. And lastly, number two, Maggie, is eat healthy food. It includes colorful fruits, vegetables, as well as whole grains. And of course, limit those processed meats, limit those sugar-sweetened drinks and, of course, the highly processed foods.

Host: What if a patient comes to you and they say, for instance, "My dad had prostate cancer or issues, how can I prevent that from happening to me?"

Florian Stroie, DO: Absolutely. And we touched on this a little bit, in terms of my job is dividing that pool, the patients who are higher risk versus those who are lower risk. We want to specifically target the patients who are higher risk and pursue subsequent evaluation and workup. But those individuals that perhaps are lower risk, we don't want to subject them to unnecessary screening. And so, we really take into account all of your risk factors, all your symptoms. Of course, when we examine you and perform laboratory testing, it can easily guide us into pursuing that next step. And of course, you know, we communicate that with you along the way throughout the whole process.

Host: So, is it hereditary? Like if the dad has it, is the son most likely going to get it?

Florian Stroie, DO: You know, not most likely. We certainly do look at hereditary factors. A strong family history of prostate cancer absolutely can be a risk factor. It does not mean you will get prostate cancer, but it is a factor that we consider in that equation. It does tip the scales, so to speak, in terms of when we may start offering prostate cancer screening to gentlemen at any given point in time.

Host: Is there an age that you suggest starting to screen or only if they're having symptoms?

Florian Stroie, DO: That's a question I get asked in my office all the time, Maggie. What exactly is a prostate checkup? What is prostate cancer screening and, what does it really mean? Screening for prostate cancer is really much easier than you might think. Just a little bit of background information here, outside of skin cancer, prostate cancer is the most common cancer in men in the United States. But like we said, each man's risk of prostate cancer can vary. It can change based on his age, based on his race, or even his ethnicity. Most men do experience, like we said, some kind of prostate problem during their lifetime. But important to see a specialist who can work alongside you and is able to tease out prostate cancer from the other non-cancerous conditions of the prostate that we talked about earlier in our segment. Spending a second to talk about, "Okay, screening. What is screening, when do we recommend it?"

And most importantly, I have to tell you, and all of our patients tuning in, is that it should be individualized, and it is a decision made between you and your doctor. Our national organizations recommend we begin prostate cancer screening to patients between the ages of 45 to 50. Now, if you have certain risk factors, such as black ancestry, you have certain mutations, or you have a very strong family history of prostate cancer, like we talked about before, we generally do offer screening beginning at the age of around 40.

So, you're probably wondering, "How do you screen people, Dr. Stroie? What do we do?" Really what that is, is a rectal exam and a blood test called a PSA, or the prostate specific antigen. If you're considering whether any of these risk factors could apply to you, remember, like we said earlier, having one or more of them does not necessarily mean you'll get the disease. But you should be sure to get your prostate cancer screening that your doctor recommends.

And as we mentioned, you know, it's also important to know that men without these risk factors can still get prostate cancer certainly. I wanted to just throw in a plug here at Cook County Health, we really do provide a full range of diagnostic testing for prostate cancer as well as all of the other conditions of the prostate that we talked about, including the non-cancerous ones. If you've received a diagnosis you're unsure about or are worried about a certain diagnosis, we understand. Look, every second matters and we want to support you every step of the way.

Host: And it doesn't necessarily mean you have cancer if you're having prostate symptoms, right?

Florian Stroie, DO: That's correct. Prostate symptoms can be caused sometimes by cancer, sometimes by what we said earlier is that growth of the prostate that over time, as men get older, it can grow and grow, and it can really impede or block or narrow that urinary channel, that plumbing system. It could be cancer. It could be non-cancer and figuring out what it is does take some evaluation and work up from your doctor as well.

Host: So, don't put it off. If you have symptoms, go talk to your doctor. Don't be afraid of the screenings. Is there anything else you'd like to add in closing, Dr. Stroie?

Florian Stroie, DO: What I like to tell patients, and I have the privilege of seeing patients much younger for other conditions, I tell them, "Look, in your sometimes late 30s, certainly in your 40s, and most likely in your 50s as well, you'll be noticing a change the pattern of how you urinate." And most men think that that's just part of getting older and something that they need to live with. Certainly, that's not the case. A pattern in how you urinate and you all of a sudden waking up more oftentimes at night to urinate, you're tired, you're not getting the adequate amount of sleep that you need. These symptoms can really affect a man's life.

So, don't wait. Come see us the second you start noticing a change in how you urinate, a change in the different patterns that you're normally used to. We'll work with you and we'll identify what exactly is causing some of these symptoms. And really, we're at a point in the 21st century here, where we have some excellent medications, excellent sort of lifestyle things that I can educate you on, as well as some very exciting, very minimally invasive procedures to manage your symptoms.

Host: Well, it sounds like Cook County really has all the bases covered when it comes to prostate issues. So, that is reassuring. Thank you so much for your time and sharing your expertise. It's been a pleasure and very educational.

Florian Stroie, DO: Maggie, the pleasure was all mine. I have to say I've had a lot of fun chatting with you today,. And I'm excited for the next segment.

Host: Absolutely, I look forward to it. Again, that's Dr. Florian Stroie. As we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast, share and connect with us on social media. Again, that's cookcountyhealth.org/podcast. Stay tuned for more engaging discussions. I'm Maggie McKay. Signing off from Total Health Talks. Stay well.