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Melanie Cole, MS: As men get older, their bodies change in so many ways. For many men, one of those changes is that the prostate gets larger. My guest today is Dr. Richard Conner. He’s a urologist and a member of the medical staff at Temecula Valley Hospital. Dr. Conner, a little physiology lesson for the listeners. What does the prostate do?

Richard Conner, MD: Well hello Melanie. Thanks for having me. Well the prostate is a gland. It’s a solid organ that secretes fluid. It’s the fluid that’s part of semen that’s ejaculated for sexual function. It just happens to be right in the urinary tract. Urine travels through it. That’s typically what its normal function is. I tell patients it’s kind of where the junction of the male genital tract and the urinary tract come together.

Melanie: So, what happens to the prostate as men age?

Dr. Conner: So, the most common condition as men age is benign enlargement or the prostate. What happens is under the influence of testosterone, the prostrate just continues to grow. It’s a benign growth, but it just keeps growing and growing, and that can cause some problems.

Melanie: So, what would a man notice? What symptoms would signal that they are having an enlarged prostate or BPH?

Dr. Conner: Yeah so, the term BHP, as you mentioned, it stands for benign prostatic hyperplasia or hypertrophy. Some people use that term as well. It can enlarge, and actually about half of men have no symptoms because the prostate just keeps growing and it doesn’t cause any trouble. But in the other half of men as it enlarges, they’ll… Well let me correct that. I should say that half of men don’t have prostate enlargement as they get older. Of the half that do get prostate enlargement, half of those are the ones that don’t have any symptoms. So, one quarter of all men as they age will have symptoms. What those symptoms look like are typically kind of slow stream. Maybe starting and stopping. Having to go to the bathroom more frequently and with urgency. They will feel a sudden urge that you need to rush to the bathroom. One of the most common things that gets people to the doctors is that men are getting up all night having to use the restroom. That’s typically what men will experience.

Melanie: What’s the best screening for men to determine an enlarged prostate or even prostate cancer?

Dr. Conner: Those are kind of two different issues. Certainly, if a man is having the symptoms of difficulty, get in and get checked. We do have a simple questionnaire that we ask patients about symptoms. Usually a urinalysis and a physical examination to check for benign enlargement of the prostate. We can usually diagnose it pretty simply with those types of history and a physical examination. If we’re concerned about cancer, there’s other testing that can be done. We sometimes can feel hard spots or nodules on the prostate that could suggest cancer. There’s also blood tests called PSA, which stands for prostate specific antigens. That’s the test that is just a simple blood test. It’s something that can help us diagnose prostate cancer. That’s a whole controversial area on when to check PSAs, on who to check it on, and those kinds of issues.

What’s interesting is there’s not a correlation of benign enlargement of the prostate and prostate cancer. They are two different conditions. Sometimes what happens is men will be having benign enlargement issues, come to the doctor, and of course we may identify cancer, which may not be causing the symptoms, but of course it’s something that we do identify during the evaluation process.

Melanie: So, if they do have BPH and some of those symptoms and it’s making life a little bit more difficult for them, what are some of the treatment options available?

Dr. Conner: Sure. So, there’s probably kind of four categories of treatment. One is just observation, what we call watchful waiting. If it’s not bothering a man too much and he doesn’t want to undergo treatment and we ruled out serious conditions, a lot of men can just observe the condition. We can keep an eye on it and not do any treatment. Then the second category is medication. The third category is minimally invasive treatments that are used short of actual surgery. Then, of course, the fourth category would be different types of surgery where we essentially try to remove the obstructing part of the prostate that’s causing issues. So, there’s a lot of different treatments in those categories. There’s different medications. All the medications will treat the enlargement as long as the man is continuing to take the medication. If he stops taking the medication, of course it can come back.

So, it is a long-term commitment. Some men are very content with that. Most of the medications have the modest side effects and aren’t too bothersome. So, a lot of men will opt for that. There are some sexual side effects with a lot of the medications, so some men aren’t as happy with that and look for other treatment options. At the other end of the spectrum is surgery where we go in and we can use different techniques like laser or vaporization of the prostate or resection of the prostate, or the TURP. Some people crudely refer to that as the roto-rooter job or the ream job. Some men are familiar with those terms. That may be the most definitive, but it does require anesthetic and a short hospital stay in some cases. There is risk of bleeding and a small risk of other problems like incontinence or maybe ejaculation problems. Those kinds of things can be an issue, although some of the other serious complications are very rare.

Then in the middle category I was talking about about the minimally invasive techniques. We have some different things like microwave treatment or even steam ablation treatment. There is a newer technique called Urolift, which is a different minimally invasive technique. The advantage of it is that its kind of like a mechanical opening of the prostate with these little sutures. They're kind of the concept of a stint, if you will, but not exactly the same. What they do are little sutures that pull open the prostate. What’s unique about that is most all the treatments with lasers and microwaves and steam treatments and all those things, those are designed to ablate, to cook or try to burn away tissue in some fashion. The Urolift is kind of the mechanical opening of the prostate that works quite well. It’s just very little small sutures and surgical clips we use to accomplish that with that treatment.

Melanie: Is this a permanent treatment? Can it be removed?

Dr. Conner: Yeah, great question. It is is long lasting. The longest clinical data we have, at least in the United States because it was originally trialed in the Australia, has durable treatment out for six years and probably beyond what seems to work from them. It seems to last for a long time. However, any treatment does have some risks of men having to come back and have another treatment if some of the prostate were to grow back or if something changed in their prostate. So, any treatment does have some degree of possibility of having to be redone in the future. These little devices can be removed. That’s extremely rare. They don’t cause any problems. They can be removed, but it’s not something that is necessary.

Melanie: You wouldn’t like men to go into it thinking that they're going to want to have it removed or something along those lines.

Dr. Conner: Exactly. Certainly, if we do the procedure, the intent is to keep it in place. Most men, roughly 70 to 80% get a significant improvement in their symptoms. That lasts for several years. For the ones that don’t, and sometimes we do have to consider surgery, or they may stay on their medications. Fortunately, most men come off the medications and don’t need surgery and it works quite well for most of those men.

Melanie: How interesting. What a cool procedure and a fascinating topic. Now, if you would wrap it up for us Dr. Conner with what men can do to keep their prostate in good health and how their partners can get them in to even get checked out by a urologist such as yourself. That seems to be one of the whole compliance problems is that men don’t always want to go in to see somebody like you. So, wrap it up with your best advice about good prostate health and good self-health advocacy.

Dr. Conner: Absolutely. That’s a great question and I appreciate that. I think for men particularly, they do have a lot of resistance to go in to see the doctor for fear that we’re going to do a lot of bad stuff for them or they might hear some news they don’t want to hear. The good news is that most men with prostate enlargement symptoms can be reassured. It’s usually a benign condition that isn’t serious, although it can affect their lifestyle.

I think also so their partners can encourage men to get checked out at least to see the doctor and make sure everything’s okay. We do have a lot of great options that have minimal or low side effects. One of the fears men have is sexual dysfunction. That’s a huge factor. The beauty of the Urolift is there’s no chance of ejaculation issues or erection issues or incontinence. So those risks are basically zero in the studies and in our clinical experience. So, we’re able to at least to offer that to men with confidence that they won't be adversely affected by the treatment.

Melanie: What great advice. Thank you so much for coming on and sharing your expertise and helping men and the people that love them understand that these are treatable conditions and that they have no fear of coming in and getting checked out, and that the treatment options can really make their quality of life better. Thank you so much Dr. Conner for being with us today. You're listening to TVH Health chat with Temecula Valley Hospital. For more information, please visit temeculavalleyhospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for tuning in.