Many men are hesitant to go to the urologist. Some think they should accept urinary or erectile issues as unavoidable side effects of aging. Others decide to wait until their symptoms worsen, even though their quality of life is affected. Dr. R. James Yu urges men not to dismiss urinary and erectile issues as just a “fact of life.”
In this podcast, he discusses when a man should consider seeing a urologist and what symptoms to look for. He also covers PSA tests, prostate hyperplasia and how to collaborate with your physician to make the treatment decisions that are best for you.
Selected Podcast
Men’s Health: Key Things to Know as You Age
Featured Speaker:
Learn more about R. James Yu, MD
R. James Yu, MD, Medical Director of Robotic & Urologic Oncology Services
R. James Yu, MD, is a Urologist and the Medical Director of Robotic & Genito-urinary Oncology Services at MarinHealth Medical Center.Learn more about R. James Yu, MD
Transcription:
Bill Klaproth (Host): As men get older, they may not think about seeing a urologist. However, taking of their prostate urinary and sexual health, as men age is very important. And here to talk with us about men’s health is, Dr. R. James Yu, a urologist and the medical director of Robotic and Urologic Oncology Services at Marin General Hospital. Dr. Yu, thank you so much for your time today. So, when is the right time for men to start seeing a urologist or is it only when there is a problem?
Dr. R. James Yu (Guest): Well, good to be here, thank you for having me. Well, it all depends on what kind of symptoms that the men have, commonly, in terms of for screening things that we’ve looked for, prostate cancer screening has been, obviously, a very controversial topic in the past few years, but it’s something that we definitely recommend to help look for prostate cancer and identify it. Early enough, so that we can treat it if needed, that’s a common reason that while we see patients, another common reason is for urinary symptoms or erectile dysfunction.
And so, these are things that as men get older, they commonly need to deal with and face. And we usually would recommend seeing a urologist if those symptoms have impacted your quality of life and wanted to do something about. So, a lot of it will depend on your relationship with your primary care doctor, and those discussions, in order to get a referral, come and see us, but we also welcome people who just want to come and talk about some of these issues that they might be facing as they get older.
Bill: So, those are kind of the big three then, right? Prostate cancer screening, urinary symptoms, and erectile dysfunction. So, what are some of the symptoms to look for in each of those before seeing a urologist?
Dr. Yu: Sure. So, for prostate cancer, usually it will not cause any symptoms at all, unless it’s really advanced, and that’s why we would advocate having a blood test called the PSA. A blood test done to help look for prostate cancer. Usually we would recommend starting that, at least at the age of plus 50, in some patients we will have a family history, such as a first-degree relative that has prostate cancer. Sometimes we even end up checking it a little bit earlier in their mid-forties, but that’s something that the primary care doctors often times will do, and I’d recommend talking with your primary care doctor to get that blood test done. Many patients here in this community already have this regularly checked, and so, when they come to see us, it’s usually for a reason, whether it’s a little bit high or there’s something churn about it.
From a urinary standpoint, common symptoms include, frequency of urination; where you have to often during the daytime, urgency; where you have difficulty holding it and you’re running to bathroom in order to make it, so that you don’t leak into your pants. Night time waking up, in terms of night time frequency is a common issue, a weak stream, and I think it’s actually been amazing couple of years because we’ve had a couple of innovations, technical innovations, to help treat men with these kind of symptoms that don’t necessarily cause significant side effects. And so, many men have been moving forward with some of those procedures.
And then lastly, erectile dysfunction. That’s often times, a progressive issue over the years, where men may notice that their ability to achieve an erection or maintain an erection has also declined, and that’s something that we…sometimes will need to evaluate your testosterone levels, see what other kind of medical issues that they have, and have a discussion about what are the options at that point in time.
Bill: And then, how do you generally treat an issue with medication or can lifestyle changes improve certain conditions?
Dr. Yu: It depends on the problem. Often times, we usually will try and stick with behavioral modifications or lifestyle modifications, in order to help them improve whatever symptoms it is that they’re describing. However, usually by the time they come and see us, their symptoms are so severe that some of the lifestyle changes don’t make the impact that they’re looking for. In which case, we usually will start with various medications to help with urinary symptoms or medications to help with erectile dysfunction, and then kind of goes from there, but that’s usually the first line that we start with.
Bill: Well, we’ve certainly seen the ADS on TV on men’s health, that’s for sure. You can’t watch a game without seeing something for erectile dysfunction or urinary issue like frequency and urgency.
Dr. Yu: Yeah, absolutely. Actually, June was just men’s health month, and so, there’s been a big push from…nationwide for men to focus on their health. I think being a man myself, I understand that we are often times biased towards the status quo, we would rather…if it’s not really making a huge impact on our lives, we tend to not go see a doctor, that’s just the way that most men tend to think. And so, I think it’s great that we have these ADS on these TV, that we have these men’s health awareness month where we can talk about education and prevention, and that kind of stuff. And so, it’s actually… I think men’s health has made substantial improvement over the past couple of decades.
Bill: And, Dr. Yu, how do you tell the difference between normal ageing and when there’s a real problem?
Dr. Yu: Well, I think, unfortunately the ageing is part of the problem. There are many common things that afflict men as they get older, whether it be heart disease, or what not. Those are things that we try and stay on top of, and I think similarly with prostate health, with erectile dysfunction, we… In general, if you treat it on the earlier side, you tend to have better outcomes. And so, I wouldn’t just say, “Well, I’m getting older, this is just a fact of life,” I’d say, “If you’re getting older, and you’re starting to notice more urinary problems, more erectile dysfunction, that’s the time to talk about it.”
So, that we talk about what are your options. You don’t necessarily have to wait till you can’t pee at all to come see a urologist. There are obviously many more steps before that actually occurs, where we can actually make a difference, and actually positively impact your quality of life, and that’s where urology is such a great field for me is that, we are positively affecting people and I’m able to help them with their quality of life. So, that they can go out and enjoy all of the wonderful outdoors of Montalvin and the Bay area. And so, I wouldn’t wait necessarily till it becomes a major issue before you come to see a urologist.
Bill: Let me ask you this, Dr. Yu, do men sometimes not want to go see a urologist because they fear they may lose sexual function? Like, “Oh, if I go to see him, he’s going to treat me with something or this is going to happen and I’m going to know. I don’t want to go see the urologist.” Is that common for men to feel that way?
Dr. Yu: Yeah, I’m sure many men feel that way. There are many reasons why I think men are hesitant to go see doctors, but I think to reassure patients, every single, I guess disease process has, and the evaluation and treatment will have their own kind of risks and benefits to that. And that’s where the discussion with the urologist ahead of time to kind of weigh these options, and weigh the risk kind of comes in because if we need to, for the extreme example, if we need to help you be able urinate again with the possible risk of impacting maybe some of your erectile function. Then that’s the discussion that we can have together, to see if it’s worth it to go down that route. And that’s why it’s no…these days it’s not like, in the old days, where it’s just a doctor telling you what to do. At least within our practice, informed consent, and this informed decision-making part of it, is a huge piece of our practice, and we want the patient involved in this decision-making. And so, they can understand the risk, understand the risk of, for example, like your example of erectile function, but there’s other risks, risk of leakage of urine, risk of low libido. There are risks with everything that we do within medicine, even taking a blood pressure pill, and the doctor’s job to kind of educate the patient, to let them know what these risks are, so that they can make an informed decision about what to do.
Bill: So, you’re really more of a partner or a guide in this situation which is terrific. Dr. Yu, thank you for time today. If you have any of the symptoms we’ve discussed, speak with your physician, and if you don’t have a physician, you can find one at, MarinGeneral.org, that’s MarinGeneral.org. This is The Healing Podcast, brought to you by Marin General Hospital. I’m Bill Klaproth, thanks for listening.
Bill Klaproth (Host): As men get older, they may not think about seeing a urologist. However, taking of their prostate urinary and sexual health, as men age is very important. And here to talk with us about men’s health is, Dr. R. James Yu, a urologist and the medical director of Robotic and Urologic Oncology Services at Marin General Hospital. Dr. Yu, thank you so much for your time today. So, when is the right time for men to start seeing a urologist or is it only when there is a problem?
Dr. R. James Yu (Guest): Well, good to be here, thank you for having me. Well, it all depends on what kind of symptoms that the men have, commonly, in terms of for screening things that we’ve looked for, prostate cancer screening has been, obviously, a very controversial topic in the past few years, but it’s something that we definitely recommend to help look for prostate cancer and identify it. Early enough, so that we can treat it if needed, that’s a common reason that while we see patients, another common reason is for urinary symptoms or erectile dysfunction.
And so, these are things that as men get older, they commonly need to deal with and face. And we usually would recommend seeing a urologist if those symptoms have impacted your quality of life and wanted to do something about. So, a lot of it will depend on your relationship with your primary care doctor, and those discussions, in order to get a referral, come and see us, but we also welcome people who just want to come and talk about some of these issues that they might be facing as they get older.
Bill: So, those are kind of the big three then, right? Prostate cancer screening, urinary symptoms, and erectile dysfunction. So, what are some of the symptoms to look for in each of those before seeing a urologist?
Dr. Yu: Sure. So, for prostate cancer, usually it will not cause any symptoms at all, unless it’s really advanced, and that’s why we would advocate having a blood test called the PSA. A blood test done to help look for prostate cancer. Usually we would recommend starting that, at least at the age of plus 50, in some patients we will have a family history, such as a first-degree relative that has prostate cancer. Sometimes we even end up checking it a little bit earlier in their mid-forties, but that’s something that the primary care doctors often times will do, and I’d recommend talking with your primary care doctor to get that blood test done. Many patients here in this community already have this regularly checked, and so, when they come to see us, it’s usually for a reason, whether it’s a little bit high or there’s something churn about it.
From a urinary standpoint, common symptoms include, frequency of urination; where you have to often during the daytime, urgency; where you have difficulty holding it and you’re running to bathroom in order to make it, so that you don’t leak into your pants. Night time waking up, in terms of night time frequency is a common issue, a weak stream, and I think it’s actually been amazing couple of years because we’ve had a couple of innovations, technical innovations, to help treat men with these kind of symptoms that don’t necessarily cause significant side effects. And so, many men have been moving forward with some of those procedures.
And then lastly, erectile dysfunction. That’s often times, a progressive issue over the years, where men may notice that their ability to achieve an erection or maintain an erection has also declined, and that’s something that we…sometimes will need to evaluate your testosterone levels, see what other kind of medical issues that they have, and have a discussion about what are the options at that point in time.
Bill: And then, how do you generally treat an issue with medication or can lifestyle changes improve certain conditions?
Dr. Yu: It depends on the problem. Often times, we usually will try and stick with behavioral modifications or lifestyle modifications, in order to help them improve whatever symptoms it is that they’re describing. However, usually by the time they come and see us, their symptoms are so severe that some of the lifestyle changes don’t make the impact that they’re looking for. In which case, we usually will start with various medications to help with urinary symptoms or medications to help with erectile dysfunction, and then kind of goes from there, but that’s usually the first line that we start with.
Bill: Well, we’ve certainly seen the ADS on TV on men’s health, that’s for sure. You can’t watch a game without seeing something for erectile dysfunction or urinary issue like frequency and urgency.
Dr. Yu: Yeah, absolutely. Actually, June was just men’s health month, and so, there’s been a big push from…nationwide for men to focus on their health. I think being a man myself, I understand that we are often times biased towards the status quo, we would rather…if it’s not really making a huge impact on our lives, we tend to not go see a doctor, that’s just the way that most men tend to think. And so, I think it’s great that we have these ADS on these TV, that we have these men’s health awareness month where we can talk about education and prevention, and that kind of stuff. And so, it’s actually… I think men’s health has made substantial improvement over the past couple of decades.
Bill: And, Dr. Yu, how do you tell the difference between normal ageing and when there’s a real problem?
Dr. Yu: Well, I think, unfortunately the ageing is part of the problem. There are many common things that afflict men as they get older, whether it be heart disease, or what not. Those are things that we try and stay on top of, and I think similarly with prostate health, with erectile dysfunction, we… In general, if you treat it on the earlier side, you tend to have better outcomes. And so, I wouldn’t just say, “Well, I’m getting older, this is just a fact of life,” I’d say, “If you’re getting older, and you’re starting to notice more urinary problems, more erectile dysfunction, that’s the time to talk about it.”
So, that we talk about what are your options. You don’t necessarily have to wait till you can’t pee at all to come see a urologist. There are obviously many more steps before that actually occurs, where we can actually make a difference, and actually positively impact your quality of life, and that’s where urology is such a great field for me is that, we are positively affecting people and I’m able to help them with their quality of life. So, that they can go out and enjoy all of the wonderful outdoors of Montalvin and the Bay area. And so, I wouldn’t wait necessarily till it becomes a major issue before you come to see a urologist.
Bill: Let me ask you this, Dr. Yu, do men sometimes not want to go see a urologist because they fear they may lose sexual function? Like, “Oh, if I go to see him, he’s going to treat me with something or this is going to happen and I’m going to know. I don’t want to go see the urologist.” Is that common for men to feel that way?
Dr. Yu: Yeah, I’m sure many men feel that way. There are many reasons why I think men are hesitant to go see doctors, but I think to reassure patients, every single, I guess disease process has, and the evaluation and treatment will have their own kind of risks and benefits to that. And that’s where the discussion with the urologist ahead of time to kind of weigh these options, and weigh the risk kind of comes in because if we need to, for the extreme example, if we need to help you be able urinate again with the possible risk of impacting maybe some of your erectile function. Then that’s the discussion that we can have together, to see if it’s worth it to go down that route. And that’s why it’s no…these days it’s not like, in the old days, where it’s just a doctor telling you what to do. At least within our practice, informed consent, and this informed decision-making part of it, is a huge piece of our practice, and we want the patient involved in this decision-making. And so, they can understand the risk, understand the risk of, for example, like your example of erectile function, but there’s other risks, risk of leakage of urine, risk of low libido. There are risks with everything that we do within medicine, even taking a blood pressure pill, and the doctor’s job to kind of educate the patient, to let them know what these risks are, so that they can make an informed decision about what to do.
Bill: So, you’re really more of a partner or a guide in this situation which is terrific. Dr. Yu, thank you for time today. If you have any of the symptoms we’ve discussed, speak with your physician, and if you don’t have a physician, you can find one at, MarinGeneral.org, that’s MarinGeneral.org. This is The Healing Podcast, brought to you by Marin General Hospital. I’m Bill Klaproth, thanks for listening.