Carl Maronich (Host): Welcome to the Meaningful Medicine Podcast, a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. I'm Carl Morone at your host. And today, we're fortunate to be joined by Dr. Philip Marks, a urologist with Novant Health Urology in Wilmington. Dr. Marks, welcome to the podcast.

Phillip Marks, MD: Thanks for having me.

Carl Maronich (Host): Yeah. We're gonna be talking about prostate health and large prostate, but maybe we start with talking about what the prostate is and what its function should be.

Phillip Marks, MD: Well, the prostate is a small gland that surrounds and is below the bladder opening. And is prime function is fertility. It provides a transport mechanism for sperm cells and semen. However, as we age, it tends to perform in different ways and it tends to enlarge with age and can cause urinary complaints. So, early on, needed for fertility and as a transport medium for sperm cells. And as we age, it tends to be more troublesome.

Carl Maronich (Host): So, let's talk about how common in a large prostate is in men. Is it a common condition?

Phillip Marks, MD: It's one of the more common conditions that we see in our practice. Most middle aged men, starting around the age of 50, will experience some symptoms of prostatic enlargement. And in fact, about 70% of men if they live to the age of 80 will experience some urinary complaints are treatable to an enlarged prostate.

Carl Maronich (Host): So, is it frequency of urination that changes over time? Is that the biggest issue?

Phillip Marks, MD: It is one of the issues that men tend to complain about, but it might be a range of symptoms from difficulty urinating, slow urinary stream, hesitation in starting the urinary stream, feeling like they're not emptying well or urgency, "I gotta go, Gotta go quickly."

Carl Maronich (Host): I'm gonna guess because of the fertility component, there's some sexual issues as well, potentially with the prostate.

Phillip Marks, MD: It can be. Certainly with medications and or treatment, there can be some untoward sexual side effects, which are easily mitigated with treatment.

Carl Maronich (Host): So if someone's having these symptoms, what should their course of action be?

Phillip Marks, MD: Well, it depends how bothersome. Studies have shown that screening for enlarged prostate endo prostate cancer should occur in most men by the age of 50. And that screening should include a check for the urine, a so called urinalysis; a PSA screening blood test initially; lab work chemistries, make sure kidney function is within normal limits. And if there are significant symptoms, then we can take that a little bit further.

Carl Maronich (Host): What are the causes generally for an enlarged prostate? You mentioned age being one of them. Are there other causes?

Phillip Marks, MD: Well, it is an affliction of age sure. And in most men, an inevitability that will cause some problems. But certain medications can exacerbate symptoms such as medicines for diabetes or diuretic use that's used for hypertension or congestive heart failure. But there's no other medication that will enlarge the prostate faster. However, some men will take testosterone replacement therapies, and that can hasten the growth of the prostate.

Carl Maronich (Host): You mentioned screenings, and those are generally conducted by the primary care provider. So therefore, regular checkups are an important thing.

Phillip Marks, MD: Right. Regular checkups are very important. That should also include a digital rectal examination to get a feel of the prostate and make sure there are no lumps or bumps or irregularities.

Carl Maronich (Host): What are some of the frontline treatments for an enlarged prostate?

Phillip Marks, MD: If somebody is symptomatic, then we can consider at least behavioral therapy initially. And what that means is maybe minimize fluids prior to bedtime. So, we get up less often at night. Maybe before traveling, we would choose fluids that are not diuretic producing such as coffee, tea, or soft drinks. But as symptoms persist and within six weeks of at least a trial of behavioral therapy, initially, we try medications.

Carl Maronich (Host): And I understand that you're doing some new treatments that aqua ablation if I'm saying that correctly. Maybe you can talk a little bit about that.

Phillip Marks, MD: Sure. So when frontline medications fail and patients are still symptomatic or develop side effects related to medication, we'll evaluate the men for a more aggressive approach with surgery or procedures. aqua ablation is a new form of treatment that combines robotics, artificial intelligence, and cystoscopy, and all of the elements that we're all well familiar with. And it's been marvelous in terms of outcome, ease of use, considerably more precise than traditional surgery is.

Carl Maronich (Host): Are there certain patients who are better candidates for the aqua ablation than others?

Phillip Marks, MD: Yes, good question. The patients, prior to any kind of procedure, we will do some studies that involve cystoscopy, which is a visual inspection of the entire urinary track and we will take some sort of volume determination, meaning how large is the prostate? There are patients who have prostates that are quite small, but still have symptomatology that may not be good candidates for acro ablation So, the idea of volume determination may help us decide which procedure is most suitable for the in general, the benefit of aqua ablation is that it can treat virtually any size prostate gland.

Carl Maronich (Host): Certainly there must be other procedures and treatments as well that someone may be a candidate for.

Phillip Marks, MD: Right. There are a host of treatments that we use in our armamentarium when we decide that somebody needs to have prostate procedure. There are minimally invasive procedures that we can actually do in the office, such as UroLift and resume And they act in a different way than ablation. Outpatient procedures such as laser therapy for the prostate are commonly utilized as well. The traditional and gold standard is called A-T-U-R-P-A terp which actually removes the obstructing tissue allowing for free of flow.

Carl Maronich (Host): Doctor, we haven't used the C word yet as it relates to enlarged prostate, so maybe you could talk about what is the connection to cancer and an enlarged prostate? And what are the obvious concerns there?

Phillip Marks, MD: Well, there's actually no physiologic connection. However, for men who are being screened for an enlarged prostate, part of the evaluation is a PSA blood test, a digital rectal examination. So, we tend to find more cancers because the patients come in for screening. So, the more men that we see, the more men that we examine, and the more men that we actually test, we'll find more cancers.

But physiologically, there's no direct relation to the development of cancer and having an enlarged prostate. However, you can have both. You can have both at the same time as well.

Carl Maronich (Host): Through your patient base, are there common questions, maybe even myths that come up related to the enlarged prostate?

Phillip Marks, MD: Of course. I would say the most common myth that we see or misinformation is that all treatment for prostate will result in some type of sexual dysfunction, and that's not accurate. The benefit of aqua ablation that we find is that it preserves ejaculatory function, preserves sexual function, and sudden untoward side effects that we may see with other forms of treatment.

Carl Maronich (Host): We talked earlier about regular checkups, an important thing. Some symptoms, more frequent urination, those kind of things. Don't ignore those. Make sure you're seeing your doctor, that would be the advice?

Phillip Marks, MD: Oh, most certainly. And if there's any bleeding of any kind, that should be evaluated. Change in the patient's normal urinary habits should also be evaluated, but urinalysis should be a great screening tool. PSA blood tests should be done periodically. Guidelines now suggest that, at the age of 50 for low risk patients, PSA baseline should be obtained. And then, every several years, it should be checked for monitoring.

Carl Maronich (Host): All great advice. Doctor, let me ask how you got into the specialty of Urology and what drew you to that?

Phillip Marks, MD: Well, it's well suited for my personality for sure. But I think when we're training, we align ourselves, surgery, non-surgery. The beauty of Urology, at least for me and for the patients that I see, is that I could really make an impact in my community, cause I could see patients of all ages, from children to adults to males and females, common urologic problems that are endemic to the region. There are surgeries. There's a lot of primary care and Urology in the office, and it's remarkably rewarding when patient responds to treatment.

Carl Maronich (Host): It's great that patients have someone who's so passionate about that. Dr. Philip Marks, urologist with Novant Health. We appreciate your time today on the podcast.

Phillip Marks, MD: Oh, thanks so much.

Carl Maronich (Host): And if you've enjoyed the podcast, please share it on your social channels and check out the entire library of podcasts for more topics of interest. I'm Carl Marone It's your host. This has been Meaningful Medicine. Thanks for listening.