Melanie Cole, MS (Host): England's King Charles received treatment recently for an enlarged prostate. What causes an enlarged prostate and how does this affect a man and his quality of life? Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole and joining me today is Dr. Sevan Stepanian. He's a Urologist on the medical staff of Henry Mayo Newhall Hospital.

Dr. Stepanian, thank you so much for joining us today. I'd like you to start by giving the listeners a little lesson on the prostate. What does it do? And what happens to the prostate as men age?

Sevan Stepanian, MD (Guest): Well, thank you, Melanie, for having me on. I appreciate the opportunity. The prostate is a small walnut shaped organ that men have that sits right beneath the bladder and surrounds the urethra, which is the tube that we void through. It's an organ that's part of our sexual function or contributes to our sexual function in that it releases some fluid that's part of the ejaculate.

It's a non vital organ. And there are a couple of things that can happen as we get older to the prostate. Most commonly what happens, is a non-cancerous growth of the prostate; what we refer to as BPH or benign prostatic hypertrophy and what most men refer to as an enlarged prostate.

Host: Well, thank you for telling us about that. Now, symptoms. What would signal that a man should come and see a urologist and while you're telling us some symptoms, Dr. Stepanian, is it true that men don't often seek treatment until their symptoms that you're going to tell us about become quality of life limiting and it's usually their partners who shove them into the doctor so that they see somebody?

Sevan Stepanian, MD (Guest): Yeah, that's, that's absolutely correct. It's actually a huge issue in men's health in general, is delays in care and sometimes just lack of care. We tend to, men I should say, tend to put off care and oftentimes these symptoms will be set aside. We will tend to deal with them. And, sometimes it can be signs and symptoms of something more serious.

So it is important to listen to your body and have regular medical care. Specifically as it relates to the prostate, the symptoms of an enlarged prostate are ones that we hear commonly, frequent urination during the day or during the night, sudden urges to urinate, sometimes difficulty urinating with a weak flow. Getting up more at night to go to the bathroom. Sometimes in severe cases, the complete loss or the inability to urinate, all really, common symptoms. And you're absolutely right. A lot of this is driven by partners who are frustrated by these sorts of symptoms that can then impact their quality of life,

Host: Well, that certainly is true, and I can attest, it's not easy to get our partners and our spouses to go see the doctor for any reason. So you're right, that is an issue in healthcare with men in general. I mean, we women, come on, we've been dealing with all this stuff since we were young kids, so I don't know what the problem is, but okay, I digress.

Now let's talk about screening. When a man does come in, and as part of his annual physical, what kinds of screening are available for the prostate?

Sevan Stepanian, MD (Guest): Right, so, there are a couple conditions that can affect the prostate and enlarged prostate is one. Sometimes an infection of the prostate or prostatitis is another, but prostate cancer is certainly one that's extremely common and is something that we screen for routinely in this country.

Typically, prostate cancer screening occurs once per year, usually in the 40s or 50s, depending on your family history of having prostate cancer in it. Generally this screening involves blood testing, something called a PSA test, which stands for prostate specific antigen, which is a protein that the prostate produces and some degree of it is released into the bloodstream.

And the other part of screening is a physical examination, which is a rectal examination or a finger in the bottom to feel the prostate. So that's classically what is used to screen for prostate cancer in this country and typically occurs once a year, starting at the age of anywhere between 40 and 50, depending on your family history.

Host: And that's the other thing, the digital that you just mentioned, that's what they're most afraid of. And that's why they don't come in, because that particular test, and it really only takes a second. So it's so important that men go visit and get these regular checkups. So now what happens if an enlarged prostate is left untreated? How does it affect quality of life?

Sevan Stepanian, MD (Guest): Yeah, so it's important to know that the prostate is going to continue to enlarge as we age. And so if the symptoms become present as they do in most men, so about 50 to 60 percent of men between the ages of 50 and 60 are dealing with some degree of these symptoms associated with an enlarged prostate, that if they're not managed, they typically will get worse over time because of the pathology involved.

The disease itself is just one that progresses. And so when the symptoms progress, it really is a sign that your bladder is having to work harder than it should and push urine past an obstruction. And the worry is, that that obstruction and that hard work over years and years and years can feed back and actually impact the bladder itself and cause it to malfunction, which can lead to the inability to urinate completely and can sometimes in really rare situations, but possible, lead to the inability to correct that and can sometimes lead to other urinary symptoms that are more challenging to correct like urgency and frequency and urinary leakage.

Host: So then tell us about some of the treatments. And if a man gets in to see you, in a good timely fashion and you find that he has an enlarged prostate or BPH, please tell us some of the treatments that are out there.

Sevan Stepanian, MD (Guest): Yeah. So the first step is really kind of assessing the severity of the problem. And so we have various ways to do that. And that first visit typically will involve a fairly long discussion regarding the symptoms, questionnaires that we use to assess the symptoms, questionnaires that we use to assess how impactful the symptoms are on quality of life.

Other testing to see if the bladder is able to empty appropriately. And then depending on the severity of symptoms, there are a host of different management strategies, and I wouldn't necessarily call them all treatments. Sometimes management strategies can involve simple modifications to behaviors that may be contributing to these symptoms.

When symptoms become more severe, typically first line treatments involve medicines, and there are a variety of different medicines that are available. These medicines typically control symptoms, but often don't change the disease process. They have some side effects, as all medications do.

Past medications, if they're not working well, or if there are tolerability issues with them, there are many procedural based therapies available. Some that are really minor and minimally invasive and some that are more aggressive and it becomes a very personalized approach to what the best treatment is or the best management is for any particular individual that walks through the door

Host: Well, I think you just really identified the main message here because it truly is about quality of life, treating the whole man. So when you're talking about that, Dr. Stepanian, how do you treat the whole man and fit this into the picture of a comprehensive approach? Because it does have to do with whole body wellness, quality of life, happiness and partner's happiness. And as you said, this all goes together. Give us your best advice for men listening and people that love them about getting these things checked.

Sevan Stepanian, MD (Guest): I'm glad you mentioned that because I often see men who are referred to me for certain numbers that may be off, an enlarged prostate that maybe measures a certain size. But I tell men this commonly in the office, that you're more than just a prostate, you're a human being. So we have to treat you comprehensively and really think about every individual's position in life, what their symptoms are like, relationships, and fold that into our decision making, and then present what we feel are options that we feel are reasonable for them. And so, the first step is really seeking that assessment, and understanding that the symptoms that you may be dealing with don't just have to be put up with.

There are lots of therapies out there, and it doesn't necessarily mean that if you see urologist that you're going to get offered a very aggressive surgery or that you're going to necessarily be put on a medication. It's a discussion, it's an assessment, it's a discussion about what could happen in the future, it's educational, and ultimately it's about, like you said, treating the individual as a whole and making sure that quality of life is maintained and that patients are safe.

Host: Great episode and so informative. It was really a great key message, Dr. Stepanian. And thank you so much for joining us today and sharing your incredible expertise. And you can learn more about prostate health and get other health tips at Henry Mayo Newhall Hospital's online health library. You can find it at library.henrymayo.com. And that concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Thanks so much for tuning in today.