According to the American Cancer Society, prostate cancer is the second most common cancer in American men. The good news is that prostate cancer is very treatable.
Dr. Joseph Renzuli II, Chief of Urology at South County Health, discusses prostate cancer screenings, diagnosis, and treatment available at South County Health.
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Prostate Conditions & Treatment
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Learn more about Joseph Renzulli II, MD
Joseph Renzulli II, MD, FACS
Joseph Renzulli II, MD, a graduate of Boston University School of Medicine, completed his urologic surgery residency at Yale New Haven Medical Center and is board-certified by the American Board of Urology. Before joining South County Medical Group, he was part of the medical staff at Brown University and Lifespan for 12 years, and currently holds a position as an Associate Professor at the Yale School of Medicine.Learn more about Joseph Renzulli II, MD
Transcription:
Bill Klaproth (Host): According to the American Cancer Society, prostate cancer is the second leading cause of cancer among men after skin cancer, but it can often be treated successfully. Here to talk with us about urology and prostatectomies is Dr. Joseph Renzulli, a urologic surgeon and Associate Professor of Urology at Yale Medical School, and the Chief of Urology at South County Health. Dr. Renzulli, thank you so much for your time today. So what happens to a man's prostate as he gets older?
Dr. Joseph Renzulli, MD, FACS (Guest): Well thank you for having me on your podcast today. I would like to go over the two main differences with regards to prostate diseases when men age. And typically when we think of aging males, for prostate disease, we start to think of men over forty. As you get over forty, we start to see prostate cells change. They can change in a benign fashion or malignant fashion. Fortunately, the vast majority of men who have prostate problems will be benign and not malignant, but there are many men who will develop prostate cancer, and that happens to be the number one cancer in men after skin cancer, so it is a very significant issue.
When we think of prostate diseases that are benign, we usually think of prostate enlargement or acutely people can have prostatitis, which is an inflammation or infection in the prostate. And prostate enlargement tends to lead to many of the symptoms that men present with. So men who are having frequent urination, difficulty urinating, slow stream, getting up at night. Those are often symptoms of prostate enlargement, whereas prostate cancer, it's a silent presentation. The vast majority, well over 90% of men with prostate cancer, will have no symptoms that presentation. They'll have either a PSA that's elevated if they're being screened by their doctor for prostate cancer, or they'll have an abnormal rectal exam. So that highlights the importance of continued screening for men that are over fifty or men that are over forty who are African American, or who have a family history of prostate cancer.
And that's a really important point because if you are not getting screened, then you could certainly miss a diagnosis of early prostate cancer, and that's when it could go on to be more significant and develop symptoms when it has spread to other parts of the body.
Bill: Well those are really important distinctions, Dr. Renzulli. So for men with benign prostate enlargement, that always doesn't mean cancer, is that right? I just want to be clear on this.
Dr. Renzulli: Correct, the vast majority of people who have an enlarged prostate do not have prostate cancer.
Bill: And Dr. Renzulli, that enlarged prostate, that is quite common as men age. Is that right?
Dr. Renzulli: Very common. Matter of fact, if you look at the incidents of BPE, which is benign prostate enlargement, it essentially goes hand in hand with age. So 50% of men over fifty, 60% of men over sixty, 70% of men over seventy will start to have enlargement of the prostate and could have some lower urinary tract symptoms that might be attributable to enlarged prostate. So the incidents of prostate enlargement is much larger than the incidents of prostate cancer.
Bill: Well that's really good to know. So you mentioned in prostate cancer there really aren't any symptoms. How do you find prostate cancer in men?
Dr. Renzulli: So again, the most important thing to make sure of for men over the age of fifty are to be screening for prostate cancer, which includes a blood test called PSA, or prostate specific antigen, or an abnormal finding on a digital rectal exam by their primary care physician. So those are the only two ways currently that we screen for prostate cancer. There are new imaging technologies that are coming about for men that have abnormal findings on exam or abnormal blood tests such as MRI, ultrasound, but really the mainstay is the PSA blood test and the digital rectal exam.
Bill: And what is the difference then in treatment between men with prostate cancer and men with benign prostate enlargement?
Dr. Renzulli: So the treatments are vastly different. For benign prostate enlargement, we have options of medical therapy, so they can take medicine sometimes that can shrink the prostate or allow an easier flow of urine. Then for men who that is not successful in, we have minimally invasive techniques like the laser therapies. There's something called a UroLift, which is a minimally invasive procedure for prostate enlargement. And then there are surgeries such as the transurethral resection of the prostate where you're taking out the middle of the prostate, which is the obstructive component. And then there's even more advanced ones for very large prostates where we do surgery, either open surgery or robotic surgery, to take out the middle of the prostate, but that is very different than taking out the entire prostate when someone has prostate cancer, and we refer to that as a radical prostatectomy because you're taking out the entire prostate, not just the middle portion.
Bill: So who would be a candidate then for a prostatectomy?
Dr. Renzulli: So when we talk about radical prostatectomy or robotic assisted laparoscopic prostatectomy, those are for men with prostate cancer, diagnosis through biopsy, and that's when we are worried that the prostate cancer is higher risk and it could spread over time, so we take out the entire prostate to try and eliminate that risk of spread or to cure the disease.
We do not do radical prostatectomy or robotic radical laparoscopic prostatectomy for anyone that has just benign prostate enlargement.
Bill: Dr. Renzulli, for men undergoing a radical prostatectomy, what is the procedure and recovery like?
Dr. Renzulli: Well the procedure has changed significantly from when we did open prostatectomy to robotic prostatectomy. Now with robotic prostatectomy, it is a much less invasive procedure, people have less blood loss, less blood transfusions, they get to go home after one day in the hospital, their recovery is quicker, they're back to work quicker, and so I think it's revolutionized the way we do prostatectomy.
The problem with prostatectomy is that all men will suffer some degree of incontinence immediately following the surgery and erectile dysfunction, and those two items - or complications, I should say - can take up to six to twelve months before there's resolution, and in a minority of people, there may not be a resolution of those issues, and so they are left with complications after prostatectomy.
Now those complications can still be seen with other treatments too, such as radiation, so the point here is that any treatment you have for prostate cancer runs the risk of complications of incontinence or erectile dysfunction down the road. And that's why the concept of surveillance has become very in vogue now, because if you don't have a very aggressive tumor, then we think watching it may be better because if it's not life-threatening, we don't want to do procedures that then potentially put people at risk for these life-altering complications such as incontinence and erectile dysfunction.
Bill: And that is all certainly on a case-by-case basis, right?
Dr. Renzulli: Exactly, yes it's very case-by-case. More than any other cancer, I think prostate cancer is a case-by-case, and we get people coming in all the time saying, "Well my friend had this done," but you have to understand every tumor of the prostate is so different. It can be very benign, it could be very indolent cancer - not dangerous, not aggressive - but then it can be very aggressive cancer and life-threatening.
So the two men may be sitting there both with prostate cancer, but have very different risk profiles based on how their tumor or how their prostate cancer looked under the microscope, and that's what really guides us in how to treat them.
Bill: Well I guess the good news is- and of course no one wants to hear a diagnosis of prostate cancer, and certainly can be serious and scary. I guess the good news is many men with proper treatment live a long and normal life after prostate cancer. So can you tell us once again, Dr. Renzulli, how important early detection is, and when should men start paying attention to their urologic health?
Dr. Renzulli: I think answering your second question first, men who approach their forties and certainly by fifty should start to pay attention to their health overall for male type malignancies when it comes to prostate cancer. I think that most urologists feel that screening patients at age fifty with PSA and rectal exam are really an approach that one would advocate for. When you have a family history of prostate cancer, or you're African American descent, then starting at forty years of age is more important because those individuals tend to have a higher potential for prostate cancer at an earlier age and it can be more aggressive, so that's why those guidelines have been in place.
And then with respect to getting evaluated, I recommend that people talk to their primary care doctor about screening, to consider blood test with PSA, and rectal examinations by their doctor.
Bill: Great information and great discussion. Dr. Renzulli, thank you so much for your time today, we appreciate it. For more information, please visit www.SouthCountyHealth.org. That's www.SouthCountyHealth.org. This is South County Health Talks from South County Health. I'm Bill Klaproth, thanks for listening.
Bill Klaproth (Host): According to the American Cancer Society, prostate cancer is the second leading cause of cancer among men after skin cancer, but it can often be treated successfully. Here to talk with us about urology and prostatectomies is Dr. Joseph Renzulli, a urologic surgeon and Associate Professor of Urology at Yale Medical School, and the Chief of Urology at South County Health. Dr. Renzulli, thank you so much for your time today. So what happens to a man's prostate as he gets older?
Dr. Joseph Renzulli, MD, FACS (Guest): Well thank you for having me on your podcast today. I would like to go over the two main differences with regards to prostate diseases when men age. And typically when we think of aging males, for prostate disease, we start to think of men over forty. As you get over forty, we start to see prostate cells change. They can change in a benign fashion or malignant fashion. Fortunately, the vast majority of men who have prostate problems will be benign and not malignant, but there are many men who will develop prostate cancer, and that happens to be the number one cancer in men after skin cancer, so it is a very significant issue.
When we think of prostate diseases that are benign, we usually think of prostate enlargement or acutely people can have prostatitis, which is an inflammation or infection in the prostate. And prostate enlargement tends to lead to many of the symptoms that men present with. So men who are having frequent urination, difficulty urinating, slow stream, getting up at night. Those are often symptoms of prostate enlargement, whereas prostate cancer, it's a silent presentation. The vast majority, well over 90% of men with prostate cancer, will have no symptoms that presentation. They'll have either a PSA that's elevated if they're being screened by their doctor for prostate cancer, or they'll have an abnormal rectal exam. So that highlights the importance of continued screening for men that are over fifty or men that are over forty who are African American, or who have a family history of prostate cancer.
And that's a really important point because if you are not getting screened, then you could certainly miss a diagnosis of early prostate cancer, and that's when it could go on to be more significant and develop symptoms when it has spread to other parts of the body.
Bill: Well those are really important distinctions, Dr. Renzulli. So for men with benign prostate enlargement, that always doesn't mean cancer, is that right? I just want to be clear on this.
Dr. Renzulli: Correct, the vast majority of people who have an enlarged prostate do not have prostate cancer.
Bill: And Dr. Renzulli, that enlarged prostate, that is quite common as men age. Is that right?
Dr. Renzulli: Very common. Matter of fact, if you look at the incidents of BPE, which is benign prostate enlargement, it essentially goes hand in hand with age. So 50% of men over fifty, 60% of men over sixty, 70% of men over seventy will start to have enlargement of the prostate and could have some lower urinary tract symptoms that might be attributable to enlarged prostate. So the incidents of prostate enlargement is much larger than the incidents of prostate cancer.
Bill: Well that's really good to know. So you mentioned in prostate cancer there really aren't any symptoms. How do you find prostate cancer in men?
Dr. Renzulli: So again, the most important thing to make sure of for men over the age of fifty are to be screening for prostate cancer, which includes a blood test called PSA, or prostate specific antigen, or an abnormal finding on a digital rectal exam by their primary care physician. So those are the only two ways currently that we screen for prostate cancer. There are new imaging technologies that are coming about for men that have abnormal findings on exam or abnormal blood tests such as MRI, ultrasound, but really the mainstay is the PSA blood test and the digital rectal exam.
Bill: And what is the difference then in treatment between men with prostate cancer and men with benign prostate enlargement?
Dr. Renzulli: So the treatments are vastly different. For benign prostate enlargement, we have options of medical therapy, so they can take medicine sometimes that can shrink the prostate or allow an easier flow of urine. Then for men who that is not successful in, we have minimally invasive techniques like the laser therapies. There's something called a UroLift, which is a minimally invasive procedure for prostate enlargement. And then there are surgeries such as the transurethral resection of the prostate where you're taking out the middle of the prostate, which is the obstructive component. And then there's even more advanced ones for very large prostates where we do surgery, either open surgery or robotic surgery, to take out the middle of the prostate, but that is very different than taking out the entire prostate when someone has prostate cancer, and we refer to that as a radical prostatectomy because you're taking out the entire prostate, not just the middle portion.
Bill: So who would be a candidate then for a prostatectomy?
Dr. Renzulli: So when we talk about radical prostatectomy or robotic assisted laparoscopic prostatectomy, those are for men with prostate cancer, diagnosis through biopsy, and that's when we are worried that the prostate cancer is higher risk and it could spread over time, so we take out the entire prostate to try and eliminate that risk of spread or to cure the disease.
We do not do radical prostatectomy or robotic radical laparoscopic prostatectomy for anyone that has just benign prostate enlargement.
Bill: Dr. Renzulli, for men undergoing a radical prostatectomy, what is the procedure and recovery like?
Dr. Renzulli: Well the procedure has changed significantly from when we did open prostatectomy to robotic prostatectomy. Now with robotic prostatectomy, it is a much less invasive procedure, people have less blood loss, less blood transfusions, they get to go home after one day in the hospital, their recovery is quicker, they're back to work quicker, and so I think it's revolutionized the way we do prostatectomy.
The problem with prostatectomy is that all men will suffer some degree of incontinence immediately following the surgery and erectile dysfunction, and those two items - or complications, I should say - can take up to six to twelve months before there's resolution, and in a minority of people, there may not be a resolution of those issues, and so they are left with complications after prostatectomy.
Now those complications can still be seen with other treatments too, such as radiation, so the point here is that any treatment you have for prostate cancer runs the risk of complications of incontinence or erectile dysfunction down the road. And that's why the concept of surveillance has become very in vogue now, because if you don't have a very aggressive tumor, then we think watching it may be better because if it's not life-threatening, we don't want to do procedures that then potentially put people at risk for these life-altering complications such as incontinence and erectile dysfunction.
Bill: And that is all certainly on a case-by-case basis, right?
Dr. Renzulli: Exactly, yes it's very case-by-case. More than any other cancer, I think prostate cancer is a case-by-case, and we get people coming in all the time saying, "Well my friend had this done," but you have to understand every tumor of the prostate is so different. It can be very benign, it could be very indolent cancer - not dangerous, not aggressive - but then it can be very aggressive cancer and life-threatening.
So the two men may be sitting there both with prostate cancer, but have very different risk profiles based on how their tumor or how their prostate cancer looked under the microscope, and that's what really guides us in how to treat them.
Bill: Well I guess the good news is- and of course no one wants to hear a diagnosis of prostate cancer, and certainly can be serious and scary. I guess the good news is many men with proper treatment live a long and normal life after prostate cancer. So can you tell us once again, Dr. Renzulli, how important early detection is, and when should men start paying attention to their urologic health?
Dr. Renzulli: I think answering your second question first, men who approach their forties and certainly by fifty should start to pay attention to their health overall for male type malignancies when it comes to prostate cancer. I think that most urologists feel that screening patients at age fifty with PSA and rectal exam are really an approach that one would advocate for. When you have a family history of prostate cancer, or you're African American descent, then starting at forty years of age is more important because those individuals tend to have a higher potential for prostate cancer at an earlier age and it can be more aggressive, so that's why those guidelines have been in place.
And then with respect to getting evaluated, I recommend that people talk to their primary care doctor about screening, to consider blood test with PSA, and rectal examinations by their doctor.
Bill: Great information and great discussion. Dr. Renzulli, thank you so much for your time today, we appreciate it. For more information, please visit www.SouthCountyHealth.org. That's www.SouthCountyHealth.org. This is South County Health Talks from South County Health. I'm Bill Klaproth, thanks for listening.