Transcription:
Taking Care of Your Prostate

Melanie Cole (Host): Today’s topic is prostate health, and all men regardless of age, should be aware of their prostate health. My guest is Dr. Carson Wong. He’s a urologist with Memorial Health System. Dr. Wong, what is the prostate? What does it do?

Carson Wong, MD, FRCSC, FACS (Guest): Well, good morning first of all and thank you for the opportunity. The prostate is an organ that is unique to men. It is roughly the size of a walnut and it is involved with the male reproductive system. It has one function and its sole function is to produce the seminal fluid for obviously, procreation. There is a specific protein that is produced by the prostate called the prostate specific antigen or more commonly known as PSA. That protein functions to liquify semen following ejaculation.

Melanie: So, what happens to a man’s prostate as they age? Do they naturally get larger? Is this a common occurrence? What happens?

Dr. Wong: Well, as we men have more birthdays, the tendency is for our prostates to somewhat enlarge. Now that’s a bit of an oversimplification and by that, I mean that size of the prostate doesn’t necessarily correlate with men having difficulty with urination. But any man who has gone through the decades will probably willingly or unwillingly admit but usually the spouse will definitely admit that difficulty with urination does develop. The driving force for this potential enlargement of the prostate tends to be time-related or age-related exposure to the male hormone testosterone. I call it kind of like the gasoline that drives the car.

Melanie: So, it’s time for a man to see a urologist at what age and men are so hesitant Dr. Wong, I mean it seems that it’s their partner that has to shove them in to see someone like you because they are just so afraid of whatever it is you are going to test them for and I don’t understand it. Women, we’ve been seeing our doctors since we were sixteen so, is this the case? Do you see that men are hesitant and at what age should they start to come see you?

Dr. Wong: Absolutely. I think our female counterparts have been much better at self-awareness and being proactive about their own healthcare. But traditionally, what you are saying is definitely true. But in recent times, I think that men’s health issues have become more socially acceptable. That was probably initiated by some prominent individuals who themselves have experienced the prostate issues, potentially prostate cancer and have increased public awareness. We have Men’s Health magazines now and the fact that we are talking about this on this medium right now, emphasizes the fact that potentially it’s more socially acceptable and men are more willing to accept it. Although it is not common locker room talk historically.

Melanie: No.

Dr. Wong: And you’re right, it’s usually the spouse that encourages or pushes the husband to do that. I think there’s a fear. A fear of the unknown number one and number two is hearsay is dangerous because everyone knows someone who’s had a potentially not so pleasant experience and that gets propagated and so that only further accentuates the fear, not only of the unknown but fear of the process of being evaluated. And thirdly, is that there is a certain machismo that comes along with that Y chromosome in that it’s not something that like I said, in the locker room, that they are going to share with a buddy to say heh, you know what, I’m really struggling with my urination or other male issues.

Melanie: Sure, and they don’t want to talk about that digital exam that you’re going to talk about.
Dr. Wong: Exactly. And that’s what I was referring to when I said not only the fear of the unknown, but the fear of the process. So, but in general, men should be checked at the age of 50 and this is a general sweeping statement. And by 50, how you get checked is you get a digital rectal examination as you say, and you also get a blood test and that blood test is called a serum PSA or which I hinted at earlier the serum prostate specific antigen. Both components are required for screening, not one alone. Not one stand alone. And so, and that is the most sensitive for determining if there is something that requires further attention. Having said that, men who have a family history of having prostate cancer for example; these men need to be screened slightly earlier and that tends to be a decade earlier starting at the age of 40. In addition to having a family history, men of African American descent are known to have a higher incidence or frequency if you will, of prostate cancer and that group of men also need to be screened starting at the age of 40.

These statements are only related to generalized screening. And there has been confusion about that in recent years so, that’s why I kind of need to clarify that for you right now. For men who experience let’s say a weaker stream, having to pee more frequently than usual during the day, small amounts, those who have to get up at night to go pee or potentially have difficulty with emptying their bladder; these men now have symptoms. Symptoms that have developed which probably the quote generally is well I’m not peeing like when I was 18 and for these men; regardless of age, they should seek attention. Because now it’s not just a screening, it’s an evaluation of something that has changed. And that something is some of these things that they experience with regards to their voiding.

Melanie: So, Dr. Wong, if you do a PSA, tell us about those numbers and if you determine that this man has BPH, if he has a bit of an enlarged prostate, does that necessarily mean that they have cancer because that’s what men are afraid to hear, is if they have got an enlarged prostate, oh my gosh does that mean I have cancer? Explain that PSA number a little bit.

Dr. Wong: Okay well when one gets evaluated whether it’s screening or whether it’s with symptoms; the important thing as you outlined is to differentiate whether it is BPH or benign prostate hyperplasia or noncancerous enlargement of the prostate versus prostate cancer. And I always kind of maintain to patients that you would rather deal with something and address something proactively when it’s a quality of life issue and having those voiding symptoms that we talked about, tends to be a quality of life issue as opposed to waiting until it is a medical issue. Because when it’s a quality of life issue, one still maintains the ability to make personal choices because quality of life affects everyone differently. If it gets neglected and becomes something that becomes a medical issue and by medical issue I mean left unchecked some of these things can progress to difficulty with urination or inability to urinate, blood in the urine, recurrent infections, stones, kidney failure, prostate cancer; that’s when it becomes a medical issue and at that point, as a urologist all I can do is counsel you as far as well these are your options but something definitely needs to be done and the ability for you to make the decision whether or not you would like to proceed is somewhat hindered, because it’s no longer a quality of life issue, but it has become a medical issue.

With regards to the PSA, the PSA number first of all has – it varies in that multiple things can influence the PSA value itself and that’s what’s giving it kind of a bad rap if you will, over the years. for example, if you are severely constipated, have a hard bowel movement, if you have an active infection in the urine or if you experienced ejaculation within the last 48 hours; that could falsely elevate that PSA value. So, those are things that we have to be cognizant about and when we see someone, and someone gets a blood test, it’s not just simply looking at that value; that’s what I mean by an oversimplification. We need to look at that value and we need to look at that value over time. And that way we get a trend and then if we see changes in that trend then that also should trigger our antennae as far as if there is something that needs to be evaluated further.

Melanie: That’s an important point that you just made Dr. Wong is that it’s that baseline and so that you can evaluate it and see the trend. So, please speak to us, summarize this, wrap it up for us about prostate health; if men were to want to keep their prostate healthy, are there some things that you would recommend as a urologist that they can do? Does nutrition play a role or exercise or smoking, alcohol use? Give us some prevention tips, some good healthy prostate tips.

Dr. Wong: Well, I wish I could. There are certain conditions in the genitourinary tract, certain cancers that absolutely I can tell you heh, if you quit smoking, if you potentially if you drink more fluids and all that sort of stuff and eat more fruits and vegetables, that kind of thing, that could potentially help mitigate your risk of developing issues. Unfortunately, with the prostate, that’s not as straightforward and I’m not able to give you anything specific in that nature. However, I can tell you that constipation, caffeine, spicy foods, things like that can absolutely irritate your prostate and potentially worsen some of the difficulties with urination that we have outlined such as frequency, urgency and getting up at night to go pee.

The best thing for prostate health is to be proactive and to adhere to screening – the screening that was outlined earlier and if one is to develop symptoms like getting up at night to go pee and kind of waking the other half up in doing so or noticing that it takes longer to empty your bladder and if you have difficulty in emptying your bladder at that point, when it is a quality of life issue; that is when you should seek attention, seek a healthcare professional whether it’s a urologist or a primary care physician or your internist or whoever you see. It’s important to have it evaluated at that time, so that we can address it early, during the quality of life phase and also God forbid, if there is something that requires further attention to be referred appropriately.

Melanie: Thank you so much Dr. Wong for such important information for men and their partners to hear. You’re listening to Memorial Health Radio with Memorial Health System. For more information please visit www.mhsystem.org that’s www.mhsystem.org . This is Melanie Cole. Thanks so much for listening.