Ashlee Williams, MD (Host): Did you know that prostate cancer is the second most common cancer in men worldwide? While it often grows slowly, it can be serious, especially if it spreads beyond the prostate. The good news, when detected early, prostate cancer is highly treatable.

Welcome to The Healthier You Podcast. I'm Dr. Ashlee Williams. And today, I'm joined by Dr. Dock Winston, a board-certified urologist and men's health specialist at Kaiser Permanente. We'll be talking about prostate cancer, the risk, the symptoms, screening guidelines, and treatment options that every man and those who love them should know.

Dr. Winston, thank you so much for being here today.

Dock Winston, MD: Thank you, Dr. Williams, for this important conversation.

Host: It is such an important topic. Let's just start with the basics. Dr. Winston, what is prostate cancer and how common is it?

Dock Winston, MD: Prostate cancer starts in the prostate gland, a small organ that sits just below the bladder that produces those semen. It is one of the most common cancers in men, especially those over 50, according to the American Cancer Society. About one in eight men will be diagnosed with prostate cancer in their lifetime, but most prostate cancers grow slowly and don't cause symptoms in the early stage.

Host: So, what are some common symptoms of prostate cancer, especially if we're looking at early versus the late stage? Is there a difference?

Dock Winston, MD: Great question. Early stage prostate cancer often has no symptoms, which is why regular screening is so important. Most advanced cases, men might notice difficulty urinating or a weak stream. They may notice frequent urination, particularly at night. They may even notice blood in their urine or their semen. Also, they may notice pain in their back, hips or pelvis, and they may experience new-onset or worsening erectile dysfunction. But again, many of these symptoms can be caused by other conditions like enlarged prostate that isn't necessarily prostate cancer, just an enlarged prostate, and that's why patients should talk to their doctor if they experience any of these symptoms.

Host: Okay. Can you talk a little bit about who is most at risk for developing prostate cancer?

Dock Winston, MD: Age is the biggest risk factor for prostate cancer. The risk increases significantly after the age of 50. Other risk factors to be aware of includes family history. If a brother or a father had prostate cancer, then your risk is doubled. Also, race is a factor. We know that African American men are more likely to develop prostate cancer and have it at a younger age. And additionally, diet and lifestyle make a big difference, particularly a diet high in red meat or dairy, or low in fruits and vegetables, increases the risk of prostate cancer.

Factors that are not a risk that people may have heard about is having a vasectomy. For some time, there was fault that having a vasectomy increased the risk of prostate cancer. But thankfully, we have learned that that is not the case.

Host: Let's talk a little bit about screening. When should men start getting screened and what does that entail?

Dock Winston, MD: Great question. This decision to screen depends on age, risk factors, and personal preferences. In general, men at average risk should start discussing screening with their doctor at age 50. And then, men at higher risk, particularly African American men, men of African descent, or those with a family history, should really talk to the doctor around the age of 45.

And screening usually involves two tests. One is a blood test known as the PSA test, which measures something called prostate specific antigen levels. That basically is a marker for prostate health. Another test could will be the digital rectum exam, which is a physical exam, which basically checks if the prostate feels normal or not.

Now, these tests are not perfect by themselves. However, they are the best way for us to screen for prostate cancer. And then, once someone is screened for prostate cancer in terms of how often, in general, if someone's an average risk, they can then be screened every two to four years. And for people who are at higher risk for prostate cancer, particularly those with a family history, in general, I recommend having their screening repeated every one to two years.

Host: So, let's say you're screened for prostate cancer and you have a positive test and you're diagnosed with prostate cancer. Can you talk a little bit about treatment options for prostate cancer?

Dock Winston, MD: Yes. Happy to. I do want to stress that when it comes to prostate cancer treatment or any cancer treatment, there's no one-size-fits-all. There are many factors that your physician will evaluate to determine the best treatment for you. But in general, for prostate cancer, the options tend to include active surveillance, which is generally reserved for those people with a slow-growing cancer, which we can monitor over time. Another option may be surgery, which involves removing the prostate gland in its entirety. Another option may be radiation therapy, which targets cancer cells with high energy rays.

Additional treatment options for more advanced cancers may include hormone therapy, which can slow the growth of cancer by lowering testosterone, which is the primary fuel for prostates or chemotherapy or newer immuno agents, which are used for really more advanced cases.

Overall, the majority of men who are diagnosed for prostate cancer will have an excellent prognosis and be able to live long healthy lives, even if they need treatment. The key really is catching it early and to really choose the right care plan for you.

Host: Yes, I think that's a really important point, that there's multiple options for treatment of prostate cancer, and you have to really tailor it to the person in the particular diagnosis of the type of prostate cancer that they have. Can you talk a little bit about the different side effects that someone might have with the different treatment options?

Dock Winston, MD: Sure. So for active surveillance, there's really no palpable physical side effects, because you're having to get blood tests and maybe imaging tests every so often. I will say that for a lot of patients on active surveillance, it's really the emotional part that could be taxing. And I generally tell patients who elect for active surveillance is that if it's going to really bother them to just keep an eye on it, then that's really not a good option for them.

In terms of surgery, the most common side effect could be leakage of urine, also known as urinary incontinence and/or erectile dysfunction. And both of those side effects are usually limited to the first year or two after treatment. For patients who are ongoing radiation therapy, they may also notice some impact with their urination and their erections, but generally not to the same level as surgery. And then, for patients who are ongoing on hormone chemotherapy, they may see some differences in their hormones. But again, prostate cancer treatment is tailored to the individual, and the discussion is balancing the effective treatments with the quality of life of the patient.

Host: Taking a step back from prostate cancer, are there any ways that men can support their prostate health?

Dock Winston, MD: Wonderful question. There are many proactive steps that men can take to optimize their prostate health. One is eating a balanced diet, rich in fruits, vegetables, healthy fats, and limiting consumption of high processed foods and meats. Also, exercising regularly. That doesn't necessarily mean going out with running marathons. It can be as simple as just taking a nice stroll for 20 to 30 minutes a day, and then building from there. Also, maintaining a healthy weight, not smoking, and then limiting alcohol consumption. And then, just overall regular checkups and talking openly with your doctor about your urinary and your sexual symptoms.

Host: These are all great tips. Thank you so much for your time, Dr. Winston. Here are some key takeaways from today's episode. One, prostate cancer is common, especially in men over 50, but it's often treatable when caught early. Two, many men have no symptoms in the early stages, making screening so important. Three, risk factors include age, family history, race and lifestyle. Four, treatment options range from active monitoring to surgery and radiation. Five, healthy habits and regular checkups can help protect long-term prostate health.

For more expert advice, visit kp.org/doctor and catch more episodes of Healthier You wherever you get your podcasts. If you found this episode helpful, be sure to subscribe and share it with others. Thank you. And from all of us at Kaiser Permanente, be well.