Joey Wahler (Host): June is National Men's Health Month, so we're discussing some common myths about conditions men experience. Our guest, Dr. Eric Thomas. He's a Urologist with Southeast Georgia Health System. This is Health Matters from Southeast Georgia Health System. Thanks for joining us. I'm Joey Wahler. Hi there, Dr. Thomas. Thanks for being with us.

Eric Thomas, MD: Thank you for having me.

Host: Well, great to have you aboard. So first, interestingly enough, your prior career was as a freshwater fisheries biologist for the Florida Fish and Wildlife Conservation Commission. And so had you go from that to this, from a career in biology to medicine and urology, it's almost a rhyme, right?

Eric Thomas, MD: Yeah, it was, uh, it was an interesting transition for sure. I loved my career at Fish and Wildlife. I enjoyed being out in the field and working with conservation professionals, but I wanted something more challenging. I'd always wanted to do medicine. So I started going back to school part time while I was working at Fish and Wildlife.

Took the prerequisites for medical school and studied for the MCAT, which is the entrance exam for med school. Took that and was lucky enough to get into Florida State College of Medicine. And, from there, the rest is history. I kind of found urology when I was going through my clinical rotations and just really enjoyed the both the technical aspects of the surgeries, but also enjoyed a lot of the folks I was working with.

And I enjoy urology because we often get to give people very good outcomes, which is something I enjoy doing.

Host: And we're going to dive right in and talk about that now. So as for your current career of urology, let's begin by discussing prostate cancer. Now there's sometimes confusion these days about the most effective form of screening for. What can you clear up for us about prostate cancer screening and prostate cancer itself.

Eric Thomas, MD: Absolutely. So prostate cancer is diagnosed in about 12 percent of men in their lifetime. It's the second leading cause of cancer death among men, but it is a very survivable cancer. So screening does play a role. There are some conflicting recommendations from various agencies. But for most urologists, we recommend screening men, particularly that have a family history of prostate cancer. And we also have a discussion with African American men because they are more at risk to have prostate cancer and more at risk to have advanced prostate cancer. The thing about prostate cancer that I think is the most important to know is that while it is a very common cancer, it's a very survivable cancer.

If it's caught early while it's still confined in the prostate, the chances for cure are very good, and in some cases for lower grade cancers, there's not even anything that needs to be done, it just needs to be observed. So, I think screening is important for folks. It's a simple blood test that's done.

We recommend it no earlier than age 40 for men, but for those that do opt for screening, we check their PSA and if their PSA reaches a certain value, then we have a discussion about them with them about the options to do biopsies or other screening options to try to evaluate their risk for prostate cancer.

But, that is a discussion we have with folks all the time and when we have this discussion, it's folks that have been sent to us from their primary care who have had the screening labs. So a lot of the screening with the blood test is actually done by primary carers, and then we see folks once they've had the initial screen.

Host: And when there is a diagnosis of prostate cancer, correct me if I'm wrong doctor, but quite often if it's a latter stage scenario, it's because of the fact that that particular man did not heed the warnings about going for regular screenings and it was caught too late in time, right?

Eric Thomas, MD: Right. That's very true. We do find, certain patients occasionally that when we find the prostate cancer, it's already spread beyond the prostate. And again, those are still patients that we can manage, and they can expect to get treatments that will keep them around for hopefully many years, but the best chance for cure is before it's spread beyond the prostate, which is where screening comes in.

Host: Gotcha. Okay. How about testicular cancer? Now, what are some common misconceptions from your experience about who it affects and how?

Eric Thomas, MD: I think the biggest misconception is that this is a disease of older men, and actually quite the opposite is true. The most commonly affected men are men in their 20s and 30s. After the age of about 35, the chances start to go down, but it can affect men of any age. So, it's really important for men who find a lump or a mass in their genitals that they come and be seen by a urologist because testicle cancer is very common and we see it in everything from children all the way up to elderly men.

Host: Like, how young are we talking about?

Eric Thomas, MD: We have seen it in young children. There are rare testicle cancers that can occur in young children. They're usually have a different type than the type that we see most commonly in men in their 20s and 30s. But it is something that can affect any male of any age.

Host: And so how would that typically be caught?

Eric Thomas, MD: It's usually found when someone notices a lump in their scrotum and then they show it to one of their doctors. It's almost always a painless hard mass in the scrotum but if you find anything or a doctor finds anything, it should definitely be evaluated by a urologist. Because there are some benign things that can come up in the genitals as well. But the only way to really know that is to be seen by someone with expertise in that.

Host: And before we move on to a few other things, when patients are diagnosed with cancer, especially for those going through it for the first time, what can they typically expect as the next steps?

Eric Thomas, MD: With a lot of the cancers, when they're initially diagnosed, the first thing patients talk about is how much information comes their way. Once we have a diagnosis, we give them a lot of information about what this diagnosis means, where we go from here, and depending on the type of cancer, there are some cancers that we deal with that are treated with surgery alone, and after that, it's just a matter of making sure that it doesn't come back with periodic CT scans or ultrasounds or some type of imaging.

For others, there are cancers that we deal with that may require chemotherapy. And it really just depends on what type of cancer we find, but with folks who are diagnosed with cancer, as long as it's caught early and we stay on top of screening, there is a good chance that they can live many years with this, and that is our goal.

So we always ask folks, you know, when we, when we first diagnose them and we give them all this information, we try to make sure we spend enough time to answer their questions and encourage them to keep a list of questions anytime they talk to us that we can answer for them.

Host: Switching gears a bit, you mentioned earlier how relatively common prostate cancer is in men. So too is an enlarged prostate, right? Which can hurt quality of life. What myths can you debunk there? I would think one has to do with the fact that many believe that an enlarged prostate either means prostate cancer or leads to it, but not necessarily so, right?

Eric Thomas, MD: Right. So enlarged prostates tend to cause issues urinating in men. A lot of guys will notice that they have a weak stream of urine or maybe it takes them a long time to begin urinating. Some folks even say that they can have pain with urinating. When they have these symptoms, it's due to a condition called benign prostatic hyperplasia.

In layman terms, that means an enlarged prostate. It doesn't necessarily correlate with prostate cancer. Men can have very large prostates that have no cancer, and men can have very small prostates that do have cancer. So there's not a great link between the size of the prostate and cancer. But, men that have prostates that are large enough that cause an obstruction of their urine flow can have these urinary symptoms.

And there are many options for treatment for this, depending on the size and shape of their prostate. Actually, one the other myths that we see sometimes is that a large prostate always causes problems. It's more so about the shape of the prostate and whether it's causing an obstruction of urine flow.

In that setting, there are things that we can do for folks that range from medications to all the way up to surgical treatments. And there are a vast array of options for treatment for this. And it really depends on, how the patient, the size and shape of their prostate, but also what their preferences are and we can help walk them through that.

Host: And that being said, as men begin to get older, anything they can do on their own lifestyle wise, diet wise, to ward off an enlarged prostate. I guess most men are going to get one sooner or later, usually later at some point, Right? But is there a way to kind of put off the inevitable or once it does arrive, doc, at least maybe it's not as serious?

Eric Thomas, MD: Right. We don't know of anything specifically that can prevent a prostate from growing in terms of diet or exercise, but in general, healthier men have better control of their symptoms, even if they do have a large prostate. So maintaining proper diet, good exercise, helps prevent other problems that can make this issue worse.

In particular, things we see are for folks who are diabetics, making sure their glucose is well managed, and that can prevent complications with the bladder that can make this condition worse.

Host: Gotcha. Now this next one can be uncomfortable for some men to discuss, erectile dysfunction, also called ED, various causes of it, physical and psychological. So what's the accurate, most key information from your experience that men need to know here?

Eric Thomas, MD: I would say that erectile dysfunction can affect men of all ages, and it can be anything from medication induced to psychologically induced, all the way up to caused from problems with nerve issues, blood flow issues. So there are a host of things that can cause erectile dysfunction. It's not something that only affects older men.

In fact, we start to see an increase in the number of men that have this starting at about age 35 and it tends to, men get older, it becomes more of an issue for them. There are things men can do to help prevent this issue. Again, it comes down to good diet, plenty of exercise. For folks who have high blood pressure, diabetes, making sure those are well managed and actually good cardiovascular health, it had been shown in multiple studies to help prevent the onset of erectile dysfunction.

So all of those things are good preventatives, but it is something that we see in men of all ages and is a very treatable condition as well.

Host: Okay. Finally, incontinence, trouble controlling urine flow, which can also be an embarrassing subject for patients of course, but what must men know concerning this?

Eric Thomas, MD: I think the most important thing to know is that it is something that again, can be treated. So incontinence in men is much less common than it is in women, just because of the structure of the male urinary system. But there are men who experience leaking of urine, and it can be from several causes. It can be related to prostate issues. It can be related to bladder issues. And the benefit of seeing a urologist is they can help to determine what the issue causing the incontinence is. And there are a whole host of treatment options for this. It can include everything from diet and exercise changes, physical therapy. It can include medications, and at times, surgeries can be beneficial for these folks.

Host: And so in summary here, when you consider all of those above conditions, any success story that stands out from a patient or two that you can share with us, because obviously the great part of your job or one of them is helping people get through these conditions and move on with their lives effectively, right?

Eric Thomas, MD: Absolutely. The two that I think stand out most immediately, we had a patient recently that came in with a testicle cancer, and it's something that had been present for a while. We did surgery for him, and we found out that it was a advanced testicle cancer, but we caught it in time that it hadn't spread beyond the testicle.

So, he has a very good chance of cure after this, which is the best possible outcome. Now, he'll need to continue with his surveillance to make sure nothing comes back, but those are the outcomes that we really enjoy seeing. Another similar outcome, I would say, we had a gentleman recently that had gone through a surgery and wasn't able to urinate after the surgery.

 He required a catheter, which is a tube that goes into the bladder to be able to empty his bladder for quite some time after surgery. And after we evaluated him in clinic, we found that it was an enlarged prostate that was causing his issue. We treated him with a surgical procedure, just a couple of weeks ago, actually, and he has done well and is able to urinate on his own and is very happy with the results. And those are the kind of things we really enjoy seeing in our practice.

Host: I'm sure. And finally, I've got to ask you, you're fairly new to the area. So how do you like it so far?

Eric Thomas, MD: We absolutely love it. We moved down here in September of last year, in September of 2023, and we have had a great chance to explore the Brunswick St. Simons Jekyll area. We're very big fans of Jekyll Island. We go out there several times a week, walk the beach, fish off the beach, and just really enjoy the wonderful South Georgia coast. We have been very blessed to come here.

Host: That's awesome. And I've got to ask you too, then being a urologist, when you're out and about away from work, if you run into someone and they know what you do for a living, you ever have a guy pull you aside and on the QT say, listen, doc, it's a little embarrassing, but I've got to ask you about this problem I'm having.

Eric Thomas, MD: We have that all the time. Whether it's folks I've met at the hospital or, you know, folks we meet out with friends, they always ask us about something. So, we always have a good time with that.

Host: After all, you're like a man fixer, right?

Eric Thomas, MD: That's a very good way of putting it. I might have to get a license plate that says that.

Host: Absolutely. Put it right on the business card.

Eric Thomas, MD: Absolutely.

Host: Well folks, we trust you're now more familiar with men's health myths. I'm sure we've cleared up some of those here. Dr. Eric Thomas, a pleasure. Thanks so much again.

Eric Thomas, MD: Thank you for having me.

Host: And for more information, please do visit sghs.org/urology.

Again, that's sghs.org/urology. If you found this podcast helpful, please do share it on your social media. And thanks again for being part of Health Matters from Southeast Georgia Health System.