Interviewer: Frequent urination, the feeling that you always need to go to the bathroom, a weak stream dribbling, waking up in the night to go to the bathroom could all be the symptoms of an enlarged prostate. It's called benign prostatic hyperplasia, or an enlarged prostate, and it's more common than a lot of men realize.
Dr. Stephen Summers is a urologist at University of Utah Health and he's going to give us the information we need to help you if you're suffering from any of those symptoms.
So the first question that I do want to ask has nothing to do with the symptoms, but it has to do with a kind of a misconception. Is an enlarged prostate and prostate cancer the same?
Dr. Summers: No, they're not. It's interesting because I get this question frequently and a lot of men come to me with concern for possible prostate cancer with some of those urinary symptoms you were just talking about.
Certainly, you can have both conditions at the same time. You can have prostate cancer as well as an enlarged prostate causing urinary obstruction and the symptoms that we relate with that. But they're really two separate issues that both need to be addressed and handled often simultaneously. The age groups that are at risk for prostate cancer also happen to be the men that are most often suffering from lower urinary tract symptoms or the symptoms that we most commonly associated with BPH.
Interviewer: Just because I have those symptoms doesn't necessarily mean that it's prostate cancer. That sounds like it could be a fear that men have. Out of the men that come to you with those symptoms, how often is it prostate cancer versus just an enlarged prostate?
Dr. Summers: Yeah, prostate cancer is an extremely common cancer. That said, most of the men that I see with those symptoms do not have prostate cancer. And so, certainly, we ask questions to find out more history and evaluate them for prostate cancer, but we're also looking at other things. Aside from benign prostate enlargement, men can have infections that can cause similar symptoms. You can have a scar or a blockage in the urethra that causes similar symptoms.
BPH is the most common thing that causes all those symptoms and the most common thing I see with men, but it's important that you speak with your doctor and even see a urologist to evaluate for some of those other causes as well.
Interviewer: Sure. Is this true? Some men with those symptoms just figure that it's a part of getting older and there's really not anything that can be done about it. Does that happen a lot?
Dr. Summers: Yeah, so just as we were talking about the increased prevalence of it, a lot of men may not be bothered by the disease itself and their symptoms are very mild. And at that point, they may be right. It's a fact of getting older and their symptoms wouldn't lead to any long-standing problems.
The hard thing is there is a subset of men who have worsening symptoms and maybe have those symptoms younger. If those symptoms are left unchecked or untreated, it can lead to long-term problems.
For example, if a person has a prostate enlargement that obstructs the bladder from emptying, over time the bladder changes and the muscle itself gets thickened, it becomes stiff, it's less pliable, and ultimately the bladder fails and doesn't work. And so then a person is left without a functional bladder and they cannot urinate. Even if we were to go on and treat the prostate, they still cannot urinate and they may be dependent upon a catheter.
Interviewer: Wow, that is a reason to get that thing looked at, isn't it?
Dr. Summers: It certainly is. And I can't tell you how many times I've had men come in who have ignored the symptoms for a long time, thought it was no big deal. Maybe they have a work environment where they can use the bathroom as is out in the wild or whatever. And lo and behold, they have a pretty significant problem. And at some point, those changes become irreversible and no matter what I do, I can't change that.
The other step even further than that is if once the bladder fills, then the urine backs up and you start having kidney problems as a result. And I've seen men with kidney failure that need to go on and have dialysis or even a kidney transplant all because of their prostate problems and their urinary problems that they've neglected for so long.
Interviewer: The symptoms that we talked about, the frequent urination, feeling that you always need to go to the bathroom, a weak stream, dribbling, waking up in the middle of the night, do these all kind of come on at once, or is this more of a gradual thing, so much so that maybe some men don't even notice that there's an issue right away?
Dr. Summers: That's a great question, Scot. It's that gradual, insidious onset that I think can be deceiving to a lot of men. Symptoms may start out very mild and they're so slow changing that you get used to it. You adapt to it. And it may be that you don't even notice that you're having those symptoms, and it's a loved one often that will point out and say, "Boy, you're going the bathroom a lot more frequent than you used to," or, "It's taking you a lot longer," or, "It seems like we can't go through the store without you looking for a restroom." And it's those kinds of comments that I think are very important to hone in on and remind people that there may be a problem that needs to be evaluated.
Interviewer: So it can oftentimes be just kind of this slow onset, so much so that you don't even notice. Then when it becomes to the point where it's critical, does that kind of generally hit just all at once? How does that play out? Do you get what I'm asking?
Dr. Summers: I get what you're asking. Yeah, it can go both ways. So sometimes men may not have . . . they may have symptoms that they ignore for any number of years, and then there's an inciting event that triggers a major problem. So that event can be in a urinary infection, it can be surgery, it can be the start of a new medication, and all of a sudden, they get to the point where they may go into what we call urinary retention, where they cannot urinate at all. And that becomes an emergency and one where we see patients in the emergency room in extreme discomfort.
Other patients, it's very slow and they get to the point where they're getting up four or six times a night. And that's when they come in kind of seeking help because the symptoms have just gone on for so long that it's interfering with their sleep.
So it goes both ways. Certainly, I think the earlier that you can address the problems, the much easier it is to fix. And more importantly, you can avoid some of those long-term effects that we talked about on the bladder and the kidney function.
Interviewer: I was reading some stuff online that some men that get this that it kind of just all of a sudden hits, then you're using a catheter to help drain the bladder, and that doesn't sound like a whole lot of fun. And it sounds like if you kind of get in early enough, not only can you avoid some of the potential downsides you talked about earlier, but maybe a lot of pain in a particular moment if you get to it early enough. Is that true?
Dr. Summers: That's certainly true.
Interviewer: Yeah. Okay. It doesn't sound like a lot of fun.
So it sounds like one of the major risk factors is just, as you get older, the prostate just naturally starts growing. So I saw something . . . I think you said, what, 60% of all men over 60 tend to get it, and then the older you get, it goes up and up and up, right?
Dr. Summers: It does.
Interviewer: So, other than that, are there any risk factors that might cause a man to get this?
Dr. Summers: The prostate continues to grow as we age, and it's highly influenced by androgen levels. And that is, in large part, influenced by genetics. And so, if a person has a higher genetic predisposition or family history of prostate disease, they're much more likely to have similar type symptoms.
Interviewer: Lifestyle too can impact it, right? Because I know that that is one of the treatment options, which we'll get to in a second briefly, because we do have a special podcast we're going to do just on treatment options. But like obesity or diabetes or not enough exercise, those types of things can contribute as well. Is that a major contributor or not so much?
Dr. Summers: Yeah, it certainly can be. Take obesity for example. So obesity, it's unfortunately very common in our society. And with that, you get increased pressure that's put on the bladder, which is only going to make those symptoms worse. And so, if a person can lose weight, then you can markedly reduce some of the frequency and urgency symptoms.
Similarly, different diets. Caffeine is a common culprit for many of us. And the more caffeine that you consume, it has both a diuretic effect as well as an irritant to the bladder and will only cause increased frequency. And so, if you're already having some baseline urinary frequency and difficulty with those symptoms, you add any of these lifestyle components onto that, things are only going to get worse.
Interviewer: And some of those lifestyle changes you have seen make a difference for some men.
Dr. Summers: Yes. So weight loss, exercise helps, limiting caffeine, limiting alcohol. Spicy foods can wreak havoc on the bladder.
Interviewer: So everything but the spicy foods is just stuff that should be doing anyway, right?
Dr. Summers: Yeah. I mean, it's interesting. Healthy living really translates into so many different things across the spectrum of our health.
Interviewer: So lifestyle changes, is that generally the first thing you do, or what's that hierarchy in general look like?
Dr. Summers: Yeah, you're exactly right. So oftentimes we'll talk about lifestyle modification, losing weight, changing diet. Exercise is our first-line therapy because it's low risk, and it has other benefits. When that fails or your symptom improvement isn't where you would like, then we talk about medications. Once you start getting into medications, it's a balance of dealing with side effects with the benefit of the medication. And there are several different classes of medications we use to treat prostate disease. And then we move on toward office-based procedures and surgical treatments for the prostate.
Interviewer: So, when it comes to an enlarged prostate, it's something that all guys are going to get. Maybe some will start showing the symptoms we talked about and some will go on affected. It sounds like you want to go to somebody as soon as you start noticing those symptoms. The quicker, the better. I would imagine you run some tests just to verify that that's actually what's going on, and then you would discuss some treatment options. So it sounds like it's not a one-size-fits-all sort of a treatment.
Would you recommend going to a urologist first if you're noticing these symptoms, or start out with your general practitioner or family doctor?
Dr. Summers: I think you can certainly start with your general family doctor or general practitioner and at least raise the question about your urinary symptoms. Some of the early interventions, the medication and the lifestyle modification, can certainly be prescribed by your general practitioner. I think when your symptoms are more severe a urologist is more ideally suited to treat your disease at that point.
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