Prostate health: Mayo Clinic Radio

Prostate health: Mayo Clinic Radio

welcome back to Mayo Clinic radio I'm dr. Tom shives and I'm Traci McCray June is Men's Health Month finally oh good the purpose of Men's Health Month is to raise awareness of preventable health problems and to encourage early detection and treatment for men and boys now that's a really good idea here are some facts from the CDC that you may not understand oh man oh okay women are a hundred percent more likely to visit the doctor for annual examinations and preventive services than are men does that surprise you not a bad probably not now in 1920 women lived on average one year longer than men but now men on average died almost five years earlier than women I don't know what happened no comment no comment from me it's not an exaggeration to say that on average men live sicker and die younger than American women men need help that's right we live sicker and die younger you need Men's Health Month joining us in studio to talk about one of many men's health issues the prostate gland is doctor Mitch Humphries from Mayo Clinic in Arizona welcome back to the program thank you so much for having me it's great to be back dr. Mitch Humphries always good to have you on the program welcome to Rochester a little warm in Arizona this time of year it's starting to get a little bit toasty down there so what advice would a world-class urologist have for American men so one of the things that I would tell men is that a lot of times as men get older they find that they're not peeing as well mostly because they said well it's just age I'm just not peeing as well so this is normal my dad did it my grandfather did it I get old you know might go to the bathroom with my grandson he's done in two minutes and I'm still staying there five minutes later and so they equate that as the normal process of Aging it's not really the normal process of aging what it's signifying is is the prostate gets bigger it causes obstruction and one of the slow yearning streams may be that first symptom that most men detect in that they also get up more at night to urinate there's several reasons for that one of the most important ones is a lot of times men get knocked true and it's a that just means getting up more at night to go to the bathroom okay and the reason for that is is sometimes especially in men that may have other health problems like sleep apnea you wouldn't think of sleep apnea causing problems with urination that's where you kind of hold your breath at night when you sleep but when you snore and you sleep that right side of the heart gets dilated and then what happens the heart sends a message to your kidneys and says this person's got too much fluid on board you need to make more urine and get the urine out and so men get up more at night to urinate they don't get as good a night rest and it's indicative of what's going on with their heart and the heart can get stretched and it can cause problems so what I would tell men the take-home message from that is don't ignore your urinary system it may be kind of your early warning system that something's going on that you need to fix whether it's in your lower urinate track with your prostate or it could be reflective of your heart and how you're sleeping and other things so it's important to pay attention so we needed a prostate gland to reproduce at one time don't need it anymore it's a useless organ but why does it get bigger as many so the prostate is just a gland and it's one of those glands that's responsive to hormones so the more the prostate is exposed to testosterone or you've over your life the more it will grow basically the prostate takes testosterone and it converts it into dihydrotestosterone which is a fancy way of just how it handles the hormone to grow as it grows it gets bigger in the size itself doesn't really mean much except where that size impacts the urine a channel so if it gets bigger on the outside that's a problem but if it gets bigger on the inside to occlude the gern a channel that's a problem I like to describe the prostate as an orange and orange peel the outer part of the orange that's what prostate cancer grows and then the meat of the orange and men pee through the middle of the meat of that orange like peeing through a doughnut hole and if that doughnut hole gets smaller and smaller because the prostate is getting bigger that creates some of the urinary problems that they have there are certain men who are more likely to develop BPH or benign prostatic hypertrophy enlargement of the prostate then others is it does it run in families there's certainly a family risk with it so it definitely runs in families there's also a bug theories about certain environmental exposure certain lifestyle things of things that you may eat or ingest or be exposed to in your career but usually it does run in families but part of it is men are just living longer and we may be sicker and die younger but we're living longer than we were back when we emerged from the oceans so based on that the prostate gets bigger over time and it certainly does cause problems the other thing that we're seeing now is prostates are getting bigger because as a first symptom of those urinary symptoms primary care physicians and men's health providers are providing medications which is an easy answer to help alleviate those symptoms that doesn't always shrink the prostate so the symptoms may be getting better but the prostate keeps growing bigger and bigger I want to go back to something you said initially when we got started and that you thought well my dad took him longer to go to the bathroom my grandpa are you telling me that men really do have these conversations with the other men in their lives to find out that oh it's normal what's happening taking longer to go to the bathroom is a normal part of Aging our men that surprised me when you said that I really thought this would be something that men would be kind of suffering on their own and wouldn't talk to other people about it just like most things any other other topics that we talked about that's one of the problems for men yeah and I think that they do suffer but what you got to look at is the bathroom situation for men is totally different we all have urinals so when you go to a restaurant or if you go to a sports event or if you go to an airport and you're urinating next to somebody else you know who takes longer to urinate and so it it elevates what they're seen in terms of their life I find that that most men have this conversation from what I hear is on the Golf Course it's all about how many times they have to go the bathroom before the turn mr golfer that makes great point so then you you see that it is changing and then do they come and see you or are they just talking amongst each other going yeah this sucks to get old so it's actually really interesting we did a study looking at trends and surgical treatment of BPH and what we did is we took all the men that had had BPH and we tracked where they are from for a specialized procedure we do for me pH and I thought well all these patients that I'm operating on they there's certain physicians that just keep sending them in over and over but when we looked at it it was a viral spread that just made the country just kind of start turning red were they when we first started doing this procedure back over a decade ago about 65 percent of my patients came from Arizona now in 2018 only about 22% of my patients come from Arizona the rest come from all over the country and all over the world for this procedure we do 4b pH and my largest referral source is patients sending patients and that's unique in a disease right so usually it's physicians sending patients in referring them in but this procedures a little bit specialized in its the patients and one man may have one surgical treatment one man may have an another surgical treatment in another and then they're all peeing on the golf course they're all talking about it and they're like I want to pee like he did I want to be able to write my name in the snow again or the sand depending on where you're from golf in the snow you are golfing in the wrong spot Minnesota golf before we talk about treatment options and in particular the one that you specialize in I want to ask you about what happens if this goes untreated are through some potential complications if you don't either get medication or surgery yeah so so what's interesting is there are certain complications where we say surgery absolutely isn't necessary where you can't urinate anymore your kidneys can start to fail because they can't get the urine out anymore you start to get infections you start to get stones and your bladder from the signs of not being able to get those get the urine out and in the United States the real death mortality of BPH is pretty much a historical disease because patients seek treatment before they get to that end stage and it's treated with medication or they're referred on I also do surgical mission work in Haiti where it's different the same disease of BPH men are dying because their prostates get so big and they can't pee so they get a catheter but they don't have the resources to get more than one catheter so they die from infection or they can't pee in the kidneys start to fail and they don't have access to dialysis so in the United States it's more of a disease of convenience and other more austere parts of the world it's more of a disease that can be lethal all right before we talk about treatment we do need to take a short break but I want to ask you quickly about diagnosis is this a diagnosis that you make by history and rectal exam or their other tests that you need so we do start with history and rectal exam to kind of gauge the symptoms and we have what we call a severity score either an au a symptom score or an international marriage that urological Association American urologic symptom score or international prostate symptom score where it looks at several domains of how they're urinating and we can use that to grade kind of where they are in the treatment paradigm once we have that we do other tests such as a euro flow where men pee into a bucket we see how fast the flow is going we put an ultrasound on the stomach to see how much they're actually emptying their bladder we may do something called a cystoscopy which is putting a teeny tiny telescope through the penis to actually determine the morphology or what that prostate looks like from an anatomic standpoint because not all prostates are they saying they come in different shapes configurations and certain treatments won't work for certain prostates and then sometimes we do an ultrasound of the prostate to get an idea of the size because certain procedures and technologies are only good for small prostates others are better for big prostates what we've learned is it's not one-size-fits-all you have to treat the individual and the individual prostate so all of those things will help you decide on a treatment regimen that's appropriate for the individual correct all right our guest is an expert on men's health and the prostate gland mayo clinic urologist dr. Mitch Humphries from the Mayo Clinic in Arizona time for a short break when we come back we'll talk about treatment options including the Jolla procedure okay welcome back to Mayo Clinic radio I'm dr. Tom shibez and I'm Tracy McCray we are with urologist dr. Mitchell Humphries from the Mayo Clinic in Arizona who is in Rochester visiting and in our studio we've talked about the enlargement of the prostate every man's prostate tends to enlarge we've talked about how you make the diagnosis and now we want to talk about treatment options and I think they're basically to medication and surgery so how do you how do you start and how do you decide so it's all based on the severity the symptoms for the patient so if they say boy this is really bothering me or if they say this isn't that much of an issue I'm okay I can live like this as long as we do an assessment and make sure they're not doing any damage to either their kidneys their bladder or overall then we're okay there are absolute indications for surgery that I alluded to before is if they can't urinate if the kidney functions starting to be affected if they're developing bladder stones or sometimes the prostate get so big just like you get varicose veins on your leg you can run into bleeding situations and once you start to get bleeding from the prostate to fix that so that you don't have any more bleeding sometimes we advocate treatment in those situations as well so a lot of it's based on the symptoms of the patient as well as the medical need for what guides our next steps in terms of treatment do the medications work pretty well and do they have side effects so the medications do work very well there's a host of different medications and we can get into the classes they do have side effects from them the biggest side effect that men complain about from the sight of from the profile of the medications is what's called retrograde ejaculation so instead of during sexual intercourse instead of the semen coming out of the tip of the penis it will go backwards in the bladder because the prostate is relaxed some men do not like that feeling most women prefer that feeling so some of the medications as well will have side effects where they get on that medication I have I have had wives come in afterwards for the FOB checkup and say why didn't we start these medications a long time ago so these are just real conversations that happen to patients okay continue and then there are newer classes of medications and some of them work better in combination the the tricky thing about prostates is you don't always just focus on the treatment of the prostate itself in the enlargement but sometimes that enlargement can cause side effects to the bladder and the way the bladder behaves so you have to treat maybe the bladder becomes overactive and they've got a lot of urine a frequency where they're going every 10 to 15 minutes or a lot of urinate urgency where they got to go and they got to get there right away or there start leaking urine and so sometimes your medication therapy has to be tailored to treat not just the prostate but the downstream consequences of what the prostate is done to the bladder now do these medications just help you urinate better or do they can they actually shrink the prostate so one class of medications in particular can help shrink the prostate that's called Pross car it's a 5 alpha reductase inhibitor it's the same medication we use to grow hair and what it does is it prevents the conversion of testosterone to dihydrotestosterone only in the prostate and that hair follicles so what that will do is it will shrink the prostate and will also decrease the PSA okay you know the answer that's called pro Scott Prosecco or finis trident okay is that the same as flomax no flomax is an alpha blocker which basically the prostate has smooth muscle in it and that flomax will relax that smooth muscle to open up the channel you'll see an effect from flomax within 7 to 14 days where with the prosper you may not see an effect because it works in a hormonal pathway for four to six weeks and you may not see the maximum effect for up to six months and does the press car call it cause retrograde ejaculation all the medications have the ability to cause retrograde ejaculation would surgery be a better option with these side effects of the medication it seems like maybe so depending on the prostate and their symptoms and the severity of their symptoms you may want to consider surgery earlier than the medication treatments especially if that patient has what's called a medium lobe or that prostate grows into the bladder and acts like a flap valve to block the channel medications are not very effective in treating that particular situation in which case surgery is going to be much more efficacious for those patients what's happening to surgery what are you doing so it depends on what surgery were talking about and and that's where BPH gets very confusing because there's a spectrum of treatments and it goes everywhere from very lowly invasive to maximally invasive and minimally effective to maximally effective and so we have these minimally invasive surgical therapies which are office based therapies things that you may hear in the common part called euro lift which is a device that you implant and opens up the channel there's something called resume or steam therapy to create scarring within the prostate to open up that channel if you could think about it people have done it to the prostate but the more effective the surgery the more you are that tissue you remove the longer the results are gonna be the less the retreatment is gonna be what's the surgery that the guys are telling each other you need to go see my guy and have this done that's the whole up I'm home iam laser and nucleation of the prostate and that's what gets us back to that orange model when you think about the orange and the orange peel what we're able to do without making any incisions in the bodies we go and we peel the meted then orange away pushing in the bladder so that small channel through the prostate becomes a wide open almost cavern or cistern and then we put another instrument in there called a morcellator which more slates all that tissue up and pulls it out the advantage of that is one the tissue we get out we're able to look at under the microscope to make sure there is no prostatic disease such as prostate cancer things like that even though a minimal amount of prostate cancer grows in the center part of the prostate while the majority grows in that orange peel but we're able to remove the catheter on the same day or the next day and they're able to get back to their normal activities in seven to ten days so men really appreciate any kind of procedure where they can come in they can leave the same day or the next day they don't have to make friends with their Foley catheter and then they can get back to all their normal activities in seven to ten days without worrying about bleeding or things like that and they're in the retreatment rate on that is less than 1% so it becomes a lifelong solution for them no more need to take medications they don't have to spend the money they don't have to take the time with it and it's a permanent solution for them you have to be pretty skilled to do this operation don't you I mean not all urologist do this it's probably one of the most difficult surgeries in all of urology just because you have to take it to demand channel object and translated into three dimensions once you learn how to do it it's not challenging but being able to identify the planes and things like that there's probably about 25 centers in the United States that do it at Mayo Clinic probably has the highest expense experience in the United States where we've done about over 2500 personally just in Arizona you'll have done 20 I've done over 2500 in Arizona are you making 3d models of their particular prostate or is that going overboard to prepare for each surgery no after 2500 you pretty much there's not much the prostate can throw at you so we don't use models it's all about the identification of the surgical plane that's where the challenge is and then it's all about after that efficiency the nice thing about this procedure is the laser so hemostatic so even if they're on an anticoagulation like aspirin or something that they need to be on for some other health reason you're able to take care of that prostate the other nice thing about the Halep is there's no size restriction you can do small prostates medium-size prostates big prostates small prostates are probably the most challenge and i would say those are probably the ones that don't need this procedure but once they're over a certain size in most prostates normally or 20 to 40 grams prostates anything greater than 80 grams is considered a large prostate the average prostate I see in my practice is about 150 and the biggest prostate I've done with the hole up technique was about 770 that's about an orange it's about a sack of oranges it was it was a big one do they do this procedure at all three sites all three male clinics yes so they've got somebody in Jacksonville doing it they had somebody here in Rochester doing it but they don't currently right now I was up here before teaching somebody in Rochester do it but right now they're looking to fill that position right now all right Arizona in the winter looks like June is Men's Health Month and there's a reason to raise awareness of preventable health problems in men and also to make an early diagnosis and get treatment started as early as possible women live five years longer and they go to the doctor much more often than do men men we need to take a lesson from the women of the world and we've talked about benign prostatic hyperplasia or hypertrophy enlargement of the prostate most men can get by with medication but there are surgical options available and it sounds like would you say the whole of procedure is now the gold standard it is the gold standard the only thing that keeps it from being the gold center is not enough people know how to do it but the outcomes the patient outcomes the less risk the easier recovery whole it by far and the literature supported it all the time over any other potential treatment you better get home because there's probably a lineup of men waiting for heaven you take care of their prostate our thanks to urologist dr. Mitchell Humphreys them from the Mayo Clinic in Arizona

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4 thoughts on “Prostate health: Mayo Clinic Radio

  1. comments are disabled on the penis implants video so…
    i found it very interesting and slightly…very hard to watch but my question is
    what would happen if a man without erectile/blood-flow problems would get one of these?
    would it be…a double dick power up? or more like…"pop! waargh!"

  2. I had no track of time when this video started and when it ended. Thank you so much for the information.

  3. Prostate medicines distrurb stomach, and also do low blood pressure, some time too much low, I think steam process is better

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