Joey Wahler (Host): If you're a man and live long
enough, it's likely to eventually affect you. So as part of Men's Health Month
in June, we're discussing prostate enlargement and its treatment. Our guest,
Dr. Jeffrey Loh-Doyle. He's a Urologist at USC Urology, a part of Keck Medicine
of USC. This is the Ridgecrest Regional Hospital podcast. Thanks for listening.
I'm Joey Wahler. Hi, Dr. Loh-Doyle. Thanks for joining us.

Jeffrey Loh-Doyle, MD: How are you? Thanks for having
me.

Host: Great to have you aboard. So first we just alluded
to it. So to start, just how common is an enlarged prostate condition?

Jeffrey Loh-Doyle, MD: After the age of 40, the odds of
you having any symptoms related to in enlarged prostate, if you're a male is
pretty high. I'd say that if you don't have symptoms, you're actually in the
extreme minority. So most men are going to experience some problems related to
their prostate if they live long enough.

Host: So to quickly backtrack, for those unfamiliar,
what exactly is the prostate gland? What does it do?

Jeffrey Loh-Doyle, MD: So the prostate is an organ that
exists in all men that sits between the bladder and the urethra. So that's your
urine channel. And the prostate itself is responsible for producing most of the
fluid for when you make semen or you ejaculate. So why it's there? Well, it's
very beneficial, obviously, if you want to have a child.

And so it's very important during those child rearing ages. Now
that function still exists until someone dies. I mean, the prostate still
produces that same fluid, but as someone gets older, the prostate tends to
increase in size. So it certainly has a role, but it also gets larger with age.

Host: And so begs the question of course, what is it
that causes the prostate to enlarge?

Jeffrey Loh-Doyle, MD: So it's under various hormonal
controls, but testosterone is thought to be a major controller of prostate
enlargement, but also genes. I mean, someone may just have a predilection to
having an enlarged prostate based on what their genetics would say.

Host: And so what are the symptoms? We hear about
frequent urination, particularly in the middle of the night? Tell us about that
and anything else please.

Jeffrey Loh-Doyle, MD: So the prostate can enlarge, and
what happens is that it all of a sudden creates a restriction in urine flow,
and so that makes our bladders, which is responsible for two things, for
storing urine and eliminating urine, to work harder. So how the bladder
responds can also manifest as symptoms. So as you said earlier, you can have
frequency, you can have urgency, you may need to wake up more often at
nighttime, and that's because a bladder is now working harder to actually
eliminate urine against a restriction.

Well, if there's a restriction in flow, it's also going to
cause symptoms of slow urine stream, what we call hesitancy, dribbling of urine
afterwards. And so there's a really big variety of symptoms that a male patient
may experience, which may be because of an enlarged prostate.

Host: Gotcha. But to be clear, urinating multiple times
nightly doesn't necessarily mean there's an enlarged prostate, right? You might
just be getting up for some other reason, a baby crying, whatever, sleepless
night, and you just happen to go to the bathroom. I guess what I'm wondering is
when we talk about frequent urination in the middle of the night, does that
usually mean that it's the fact that you have to go to the bathroom that's
waking you up or how does that work?

Jeffrey Loh-Doyle, MD: You hit the nail on the head. So
waking up at nighttime can be caused by lots of things. And so you really have
to parse out in clinic. And when we ask a patient, well, are you urinating
because you've woken up? Or are you being awoken because you needed to urinate?
That's really a key question.

Having to wake up frequently at nighttime to urinate may also
be caused by other medical conditions, such as being on a diuretic medication
like Lasix as part of heart disease treatment or blood pressure management. If
you're making more urine at nighttime, well, you're going to actually have to
wake up at nighttime. Patients that have diabetes also may wake up more frequently
at nighttime because they have to empty their bladder more frequently. And
lastly, and this is very, very common, is sleep apnea. So sleep apnea can cause
someone to make more urine at nighttime and also cause them to wake up more
frequently.

Now we have to eliminate those causes when we assess a patient,
and if by process of elimination they don't have those things, then maybe that
frequency at night may be because of an enlarged prostate. So really it's
critical when we see patients to kind of assess all those other medical issues
that may be at play.

Host: Sure. So having said that, when we talk about
these symptoms, if you do have them, because it is an enlarged prostate, let's
say you're middle aged guy, you start to feel some of these things; what's the
likelihood that it's going to get significantly worse, and how quickly might
that happen? Or is there a point where it levels off for a while?

Jeffrey Loh-Doyle, MD: Patients typically start
experiencing some change in how they urinate around the age of 40, at least in
our experience. Now, you may have someone that can pee just great until they're
80. So it really affects people individually and the way that it can impact
someone is very individualized.

You may have a slow, steady progression, you may have a plateau
effect. You may have all of a sudden you're peeing fine and now you can't
urinate. I mean, so we see that presentation. We see each one of those things.
The typical presentation, the vast majority, is someone that will present with
a slowly worsening stream. It's a slow progression, but we also see other ends
of the spectrum as well.

Host: So once this occurs, how about the possibility of
either stagnating it or reversing it somewhat? Can either of those things be
done?

Jeffrey Loh-Doyle, MD: So those things can happen. And
so number one is, the first line of defense is typically a patient will see
their primary care physician, and many primary care physicians can, number one,
just prescribe first-line medications to stabilize or improve symptoms. Now, I
always tell someone that a lot of the medications aren't necessarily a fix, but
they're a bandaid or they can just make things more tolerable.

The root of the problem is the prostate in a lot of folks, and
so you have to decide whether you want to actually address the problem, which
is prostate enlargement. And so that's based on an individual conversation that
we have with patients. But fortunately, we have a tremendous amount of tools in
our toolbox to fix prostate enlargement.

Host: So speaking of that, you mentioned medication, be
it medication or surgery if needed or prescribed. What are those options?

Jeffrey Loh-Doyle, MD: Patients will typically come to
us saying, I've got a blank slate or I've been started on a medication. What
else can we do? I'm still bothered. Well, number one, we always have patients
fill out an objective questionnaire that details in what ways are they bothered
by how they urinate, and that helps us decide what medications are available
and which would be perfect for them. There's medications that exist just to
target frequency and urgency, and there's also medications that exist to
improve flow. There's also medications that exist to shrink the prostate. They
typically have very minimal side effects, but they're not zero.

I mean, there are side effects with many of these medications
that patients are made aware of. And so you really have to risk, or at least
the patient has to weigh, am I willing to accept side effects for the sake of
peeing better? Because in most cases, how someone is urinating isn't
necessarily a life-threatening condition.

It's more a quality of life thing. Now, having said that, for
whatever reason, we also see patients in Ridgecrest coming in with problems. So
these are medical problems that are related to having an enlarged prostate. And
so our job is to make sure that those problems don't exist. So what does that
mean? I actually have patients coming in that are holding on to way too much
urine.

So when they urinate, they're actually just skimming off the
top. They're not fully emptying. And so, what can that do? That can actually
cause bladder distension, bladder stretching, and kidney damage. So our job is
to rule out dangerous things related to the prostate. And so once we kind of
assess those things, we can decide well, are medications appropriate or do we
need to kind of move forward with surgeries, which are a little bit more
definitive?

Host: And so if surgery is needed, what's involved
there?

Jeffrey Loh-Doyle, MD: You know, over the past 10, 20
years, there's been lots of different therapies to treat an enlarged prostate,
and they range from being minimally invasive to quite invasive. Now, over the
past 10 years, there's really been a renaissance in terms of how many minimally
invasive procedures now exist to treat an enlarged prostate, which is great for
patients.

The reason why they came around was to decrease
hospitalizations, morbidity, as well as to address some of the sexual side
effects that traditional treatment options had. So what does that look like? A
lot of treatment options that existed from a large prostate caused ejaculatory
dysfunction and erectile dysfunction.

So we solve a peeing problem, but then we create a sexual
problem. And so a lot of resources have been committed over the past 10 years
to develop more minimally invasive techniques that kind of eliminate or at
least minimize those risks of sexual dysfunction. So here in Ridgecrest, we
offer several minimally invasive therapies that work very well for prostates
that are of a mild to medium size. And we can talk about those. But there's
also great options that exist for enlarged prostates that are very large. But
those typically require inpatient hospitalizations and specialized instruments
that, we also just do here in Los Angeles at USC.

So oftentimes we have patients that have large prostates and
they just make the trek down here and they get state-of-the-art stuff as well.

Host: Gotcha. A couple of other things. For those that
don't know, the test for an enlarged prostate, I guess the best way doc to
describe it is people are leery of it, but it's at least maybe the quickest
test in medicine, isn't it?

Jeffrey Loh-Doyle, MD: One of the quickest tests. Now,
do I like doing it? No. Do patients like having it done? No, but I think it's
necessary. So there's two things that we typically get when we assess a patient
for their prostate. Number one is we look at lab data. So there's a great test.
It's called a PSA, and we use that as a screening marker for prostate cancer,
but also it can be a surrogate for how large someone's prostate is.

Now there's not a necessarily a direct correlation, but at
least it kind of clues us in into who are the people that we need to keep an
eye out on for a risk for prostate cancer versus who are the folks that just
have an enlarged prostate? So that's number one. Number two is we also examine
the prostate.

So how do we do that? We place a single finger in someone's
rectum and we feel the prostate. That tells us two things. Are there any tumors
that are palpable? And number two, how large is someone's prostate? And that
tells us information. That will tell us, well, are medications likely to work
or are they not likely to work? Number two. If we decided on doing a procedure
or a surgery, what type of procedure would be helpful for a patient?

Host: And we're talking for those again that haven't had
it done, you're using your finger and determining all this in literally, what,
like two seconds, right?

Jeffrey Loh-Doyle, MD: Maybe one and a half seconds.

Host: I, I overshot it a little bit, but the interesting
thing I think that you said there is that it's just as unpleasant for the
doctor as it is for the patient, but it has to be done, right?

Jeffrey Loh-Doyle, MD: Yeah. We don't enjoy doing it,
but it's something that should be done.

Host: Sure. Of course we're laughing because it's good
when possible to make light of these different tests. So finally, just to kind
of sum things up here, what's your message about the quality of life someone
can have if they have an enlarged prostate, but it is properly treated?

Jeffrey Loh-Doyle, MD: So how someone responds to
medication or surgeries is really dependent on are the appropriate treatment
options being given and I don't try to minimize surgery, but over the past 10
years, there's been great techniques that have been introduced that we even
offer here in Ridgecrest that can treat urinary symptoms very effectively with
the goal of improving quality of life, but also minimizing medications.

I mean, there's lots of patients that have come to us with a
whole laundry list of medications. Doc, I'm on 12 medications and it's very
easy for me to add two medications to someone's list, but you have to take a
step back and say, is this correct for the patient? Is 14 medications
necessarily a good thing for them?

So those are the things that we kind of take into account. Can
we balance surgery and those risks, which are quite minimal in certain
respects, but is it worth it to avoid medications? And I think that the answer
is yes in a lot of folks. So having said that, can we improve quality of life?
Yes. Can I make someone perfect? No, I never really guarantee perfect. Because
that's really defined by the individual. A lot of folks are looking to pee like
they did in their twenties. I don't know that it can happen, but can I at least
make it so that you can enjoy your life so that you're peeing more effectively?
Yeah, I think we can.

Host: Well, that's certainly great news and I'm sure
very comforting for people to hear. Folks, we trust you are now more familiar
with enlarged prostate treatment. Dr. Jeffrey Loh-Doyle, thanks so much again.

Jeffrey Loh-Doyle, MD: Thanks for having me.

Host: And for more information, please call
760-463-8930. Again, that's 760-463-8930. Now, if you found this podcast
helpful, please share it on your social media. I'm Joey Wahler. Thanks again
for listening to the Ridgecrest Regional Hospital Podcast.