What every man needs to know about prostate cancer

Podcast transcript

INTRO
Welcome to Docs in a Pod presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Rajay Seudath and Carmenn Miles will share information to improve your health and well-being. And now here are Carmenn Miles and Dr. Rajay Seudath.

CARMENN MILES
Hello, everyone, and thank you so much for joining us today on the award winning Docs in a Pod presented by WellMed. I'm Carmenn Miles and I'm excited to jump into another great conversation centered around health and wellness topics that really matter, especially for our seniors. If you're listening in for the first time, you can catch episodes of this award winning podcast every Saturday on your favorite listening platform. As a matter of fact, Docs in a Pod is also now available on Amazon Music, audible, iHeartRadio, and Spotify soon to follow. So hey, there's really no excuse. You can find us just about anywhere, including on the radio in several Texas markets. Again, each week we share practical health information that hopefully helps all of us live healthier, happier lives. So, we're thrilled that you're tuning in today, and we've got a great topic for discussion and that is understanding the male prostate. What every man should know. Before we get started, let me take a moment to introduce my co-host for today, Dr. Rajay Seudath. He is no stranger to the show. He's a proud Tampa native. Dr. Seudath is board certified in family medicine and the lead physician at the University location for Optum. He brings great passion to primary care. He's a wealth of knowledge and makes health issues simple and easy to understand. And that, my friends, is precisely why we love having him as a resident co-host on the show. What's new Dr. Seudath? We haven't chatted in forever. Where have you been? Catch us up.

DR. RAJAY SEUDATH
I was in Japan. I just came back about two weeks ago. So, everything is back to normal. I'm over my jet lag and happy to be on the show again.

CARMENN MILES
Fantastic. I'm glad you found some time to get away and get some R&R. Let's take just a moment to introduce our esteemed guest today, Dr. Steven Bauer from, WellMed at Division in San Antonio, Texas, my hometown. Dr. Bauer is a board certified internal medicine physician dedicated to providing comprehensive, patient centered care. He earned his medical degree from UT Southwestern Medical School in Dallas, Texas, and completed his residency training at the University of Tennessee at Memphis. Dr. Bauer is certified by the American Board of Internal Medicine and as I previously stated, currently practices at WellMed at Division where he focuses on helping patients achieve and maintain their best health through preventive care and chronic disease management. Welcome to the show, Dr. Bauer. I'm always curious to know what you providers do outside of medicine with the 10 minutes of spare time that you have each day, because you guys are some busy, busy folks. What do you do in your spare time?

DR. STEVEN BAUER
Well, a lot of honey-do projects. We live on a pretty big plot of land and a lot of outdoor projects, gardening, a lot of that, so that's probably what I do to spend most of my time. I watch my kids play video games sometimes. I like to play racket sports.

CARMENN MILES
So, getting your exercise in and doing your daddy duties as well.

DR. STEVEN BAUER
Yeah, weÕre hanging in there.

CARMENN MILES
Well, good. Welcome to the show. I think for the first time, we're discussing a small gland that plays a big role in men's health, the prostate. So, whether you're a man concerned about your own health, a family member wanting to learn more or simply curious about human biology as a whole, stay with us, listeners. This episode is for you. Dr. Bauer, many men have heard of the prostate, especially in relation to aging and urinary concerns or prostate cancer, which is our focus today. Over the next half hour, which will fly by, by the way, we really could use a couple of hours on this subject. But let's explore the anatomy and function of the prostate. Some chronic or common prostate conditions, some warning signs to watch for and treatment options and really some practical ways to support prostate health. Let's just start with understanding the prostate. What is it? Where is it located? Most importantly, what is the role of the prostate?

DR. STEVEN BAUER
It's a gland thatÕs lower in the pelvic area or the in frontal portion of the pelvis. It's a soft gland. It surrounds the urethra, which empties the bladder and usually about a couple of inches of the urethra, maybe a little bit less than that, kind of traverses through the prostate. It's a gland that secretes a variety of nutrients to help sort of add vitality and longevity to the sperm after it's produced in the testicles. It also functions with ejaculation itself in terms of the contractile apparatus. It's sort of a bit of a cut off valve for the urinary flow itself. As we get older, it tends to enlarge, and that's due to the fact that over the years is more testosterone exposure that promotes the growth of the prostate. That growth tends to occur more in the centralized portion of the prostate. That leads to urinary flow issues. You'll see folks who tend to stay longer at the urinal, having a harder time or taking longer time to empty their bladder. That's due to that enlargement and starts putting pressure, restricting flow through the urethra that traverses the prostate. That's by far the most common condition we see, Benign Prostatic Hyperplasia. BPH is what we call it. We do fortunately have medications that can significantly help the symptoms. ItÕs a very common disorder that we see and it can sometimes lead to obstruction of the urine. Some people have to present to the emergency room in more catastrophic cases.

CARMENN MILES
Dr. Bauer, let's take just a moment to welcome those who may have just joined us. You're listening to the award winning Docs in a Pod presented by WellMed. You can catch episodes of this award winning podcast every Saturday on your favorite listening platform. As a matter of fact, Docs in a Pod is now available on Amazon Music, Audible, iHeart radio with Spotify soon to follow. We're also available on the radio on several Texas markets. I'm Carmenn Miles alongside co-host Dr. Rajay Seudath and our guest today, Dr. Steven Bauer, who is sharing all we need to know about the anatomy and function of the prostate. Common prostate conditions, specifically prostate cancer, some of the warning signs, treatment options and some practical ways to support prostate health. Dr. Bauer, understand you mentioned the urethra earlier. I think it's important that we all understand the relationship between the prostate and urethra and this, I think, will help explain many of the symptoms we'll discuss in just a few moments. As you were explaining before the break, the prostate in younger men is usually about the size of a walnut. As men age, that gland can grow larger, right?

DR. STEVEN BAUER
Yes.

CARMENN MILES
It is common, but not always a sign of cancer. But because that prostate surrounds the urethra, that growth can lead to some urinary symptoms, right? So, the urethra, if you can imagine, is maybe like a drinking straw that passes through the center of the prostate. When that prostate enlarges, it can compromise or squeeze that urethra, making urination more difficult.

DR. RAJAY SEUDATH
Like Dr. Bauer was saying, as that gland enlarges, it does kind of narrow the outflow of the bladder. So, for some men, that doesn't pose an issue. You can have an enlarged prostate and there's no issue with emptying. It becomes an issue, though, when suddenly, now you're not emptying as well as before. So, when you're in your 20s, you're in your teens, your bladder fills up to 100%, your pee, it goes down to 0% or close to zero. But as we get older and that prostate starts to put more pressure on where the outflow of that bladder is, you might go to 100% full and now when you empty your bladder, you're only emptying the 30%. So now it's going to fill back up a lot faster. So, that's one of the things that we can see as a symptom. If it's, I can't go an hour and a half without having to pee, part of that could be an outflow issue. Part of that could be another bladder spasming issue. Then another thing is, doc, whatever I pee like, it just never feels like I'm ever empty. Like I got a strain or I got a push on my lower abdomen to try and push that stuff out. So, when we hear things like that, when we hear patients say that kind of those kind of words, have those kinds of experiences, thatÕs kind of cluing us in as to what's going on. Then again, if urine is hanging out in the bladder for a long period of time, eventually it could start to grow bacteria and then we can get discomfort, pain, blood in the urine, that kind of stuff. So, that's one of the ways that an enlarged prostate can start to have symptoms.

CARMENN MILES
Dr. Bauer, do you want to continue with that conversation?

DR. STEVEN BAUER
Oh, yes. With the prostate you have the central zone, that's kind of the area of prostate tissue immediately surrounding the urethra. Then you have the peripheral zone. It's kind of more on the outside. Symptoms are not really quite frequent in early stage prostate cancer or more localized prostate cancer disease because 70% of the tumors are on that outside zone in terms of the central zone. When gentlemen present with symptoms due to prostate cancer, it tends to be more locally advanced, spreading more within than we'd like to see. About 70% are detected by other means like routine exam, PSA levels, that type of thing.

CARMENN MILES
I'm curious to know what influences the prostate to change over time with age and what symptoms alert men that there could be an issue? In fact, let's plan on taking a break now, and then we can come back and address some of those influences. Again, let's take a quick break, but please stay with us as we continue this great discussion on the male prostate and specifically prostate cancer. You're listening to Docs in a Pod presented by WellMed. We'll be right back.

AD
For over 35 years, WellMed has redefined health care for older adults and people on Medicare. We're physician led and nationally recognized as an Age-Friendly Health System. Our doctors take time to listen and support your unique needs, working with Medicare and select Medicare Advantage plans to keep you healthy and independent. With 24/7 nurse support, telemedicine, in-home, and office visits, care is always within reach. WellMed. Compassionate care, proven results. Visit wellmedhealthcare.com to learn more.

CARMENN MILES
We're back on Docs in a Pod. I'm your host, Carmenn Miles, with co-host, Dr. Rajay Seudath and our esteemed guest today, Dr. Steven Bauer from WellMed at Division in San Antonio, Texas. If you just tuned in, we're discussing the male prostate, what every man should know about prostate cancer. Take it away, Dr. Bauer.

DR. STEVEN BAUER
As far as incidents in the country in 2024, almost 300,000 new cases were diagnosed. Unfortunately, 35,000 deaths were caused by prostate cancer. Lifetime risk of developing prostate cancer is 13%. The risk of dying is 2.5%, although that seems a little inflated to me. In my population, I don't think it's that high. The median age of diagnosis is age 67. Like I said before, 75% of prostate cancers localized to the gland itself when diagnosed. We do see it more commonly in African American individuals with 173 cases per 100,000 individuals. In Caucasian folks, 97 cases per 100,000 people. Overall, it was decreasing in incidence between 2007 and 2014 by about 6.4%. We're seeing an uptick over the last decade of 3% per year or so. Hopefully that also that gives you some kind of idea about the incidence of it commonly occurs.

DR. RAJAY SEUDATH
It's kind of interesting about that 3% increase. I wonder where that's coming from in that time period, because people have just become more sedentary and things like that. I wonder if that could possibly become part of it with social media and Uber Eats and all those kinds of things that could be contributing to it.

DR. STEVEN BAUER
Yeah, I didn't really delve into that, but that's a good question.

DR. RAJAY SEUDATH
It's just a question for thought. I know we were talking a little bit on the break about screenings and PSAÕs and things like that. The US task force, they don't recommend getting a PSA and a rectal exam just because you turn 50. They don't recommend it for everybody. It can lead to false positives. Then you have to go get a biopsy. Biopsies are not benign, right? They have an element of risk. You're taking a sterile needle and going into a sterile organ from a non-sterile place, which is the rectal cavity. So, there's risk for infections, corneas gangrene. People have even had orchiectomies, where you have to remove their testicles, because of this complication from a biopsy and now this person can't have kids all because this test was positive. So, I see where they get the idea of not wanting to expose people to an unneeded test that could possibly cause a problem. But there's been times, even in my own practice, where a young man tells me, my dad had prostate cancer. We check if it's elevated and then we get them early diagnosed. So, in my practice, it's been a conversation between the patient and the doctor. How's it been with you, Dr. Bauer?

DR. STEVEN BAUER
Yeah. Those particular guidelines, they do recommend a shared discussion, like mentioning the positives and negatives, like you described. Certainly, there's that population that's at higher risk. Like I said, African Americans, people with germline mutations, like, let's say they had a family member had cancer at an early age and they got screened. They had a cancer gene that came up positive. So, those you want to start early. Also, those who have multiple family members, particularly 2 or 3 first degree or second degree relatives who've had prostate cancer. They're certainly higher risk. The USPTF guidelines don't really give you any guidance as to when to start. The other the other organizations like the American Urological Association, they recommend starting between 40 and 45 in those high risk groups. American Cancer Society recommends starting at age 40. I think the National Cancer Comprehensive Care Network recommends age 40 for high risk as well. So, you definitely want to get an earlier start. But again, you have this discussion and mention that there is a possibility you could undergo some unpleasant procedures. I have to say, in five years, I had a couple gentlemen that had prostate biopsies and they had to go to the hospital because of blood infection. It does happen out there, so you got to keep that in mind. Sometimes you can get a like a baseline PSA and if it's less than one you can feel pretty good. Your chances of developing prostate cancer are very low. I had some something written down here to quantitate that. Studies have been done to look at that if it's less than one, but that a good rule of thumb is less than 3% over a 10 year period of developing prostate cancer. It's like 1% of dying from prostate cancer if the PSA is less than one. So, you could use as a baseline and say, yeah, I'm pretty good. I'll see you in five years.

DR. RAJAY SEUDATH
There you go. I'll add a little anecdote. We often tell patients when they're going to get their PSA, I don't want to have any climaxes, no sexual activity and things like that. I had a gentleman, he looked at me and he said, doc, three days without any sexual activity. I mean, how am I going to do that? I was like, well, I don't know. He said, well, I guess I'll just hang out with ugly people or something. The things you hear as a doctor, it's amazing.

DR. STEVEN BAUER
Yeah.

DR. RAJAY SEUDATH
That kind of leads me into the second idea, there's been some studies where they show that frequency of climax, ejaculation, whether through intercourse or masturbation, has shown some decreases in the risk for cancer. That being contrasted with someone who has 4 to 7 climaxes a month to the higher climax frequency, which is like 20 times per month, they can have a reduction in that prostate cancer risk. So, it's interesting to hear about that. The other thing I had seen was, I have a lot of gentlemen who cycle and, in that regard, some people are worried. I'm sitting on my prostate. There's a lot of pressure. Is that increasing my risk for prostate cancer? I had to look up the studies and there really is no correlation between moderate cycling and development of prostate cancer. So, I think the facts are definitely in on that. If a person enjoys cycling, they absolutely can do it and not worry about having a risk in their prostate cancer.

DR. STEVEN BAUER
Actually, riding a bike in itself can falsely elevate your PSA, so if you know you're going to get a PSA, you may want to lay off the bike riding for a few days at least. Sexual activity within 24 hours can increase your PSA. Riding horseback. Any type of activity where you're mounted on something, that will tend to increase the PSA. I'll ask my patients when they come in with a slightly elevated PSA, were you riding the bike or that type of activity? Sometimes they'll say, yeah, and we'll just repeat it.

DR. RAJAY SEUDATH
Yep. I think that's one of the things that I wanted to touch on with that. Sometimes you'll hear gentleman talking about saw palmetto and prostate booster and these kinds of things to try and promote prostate health. Have you had any experience with patients bringing that to your attention?

DR. STEVEN BAUER
Yes, sir. South Palmetto, it does have one of its components sort of structurally similar to what's in our prescription medications, like Tamsulosin or Flomax. So, it does sort of relax the smooth muscle within the urethra, so it opens up flow through the prostate. I do find that they are effective. Not quite the punch that the prescription medications have. Maybe fewer side effects.

DR. RAJAY SEUDATH
Maybe. We were talking about the Tamsulosin and those kinds of medicines. Flomax is one of the medicines a lot of our patients are on at the over age 65. We were talking about the BPH, the natural prostate enlargement as we age. So, it's not necessarily cancer, but it can cause those issues where we're not emptying as we take those medicines, Flomax especially. Initially, it can help to open up the bladder and let you drain better. But over time, it has further effects on the prostate as well.

DR. STEVEN BAUER
Yeah. I mean, in terms of overall maintaining maintenance of flow long term, it's one of the symptomatic medications. Now, we do have the medications over a long term that can shrink the size of the central portion of the prostate. I mean, you have to be pretty patient with it. It may take a few months for you to see the clinical benefits of it. That that can cause a structural change in the prostate itself. But overall, like you said, with the Tamsulosin, you may just see better bladder health because you're not dealing with obstruction. Sometimes the lower portion of the bladder can become more irritable with obstructive urinary symptoms, and you get more of the incontinence urgency type symptoms. So, the Flomax can settle that down over time.

DR. RAJAY SEUDATH
Definitely. I've seen a lot of our patients when we start them on that it's like, man, I'm peeing like I was in my 20s again. It's always it's always happy to see that type of response when they're happy to get it.

DR. STEVEN BAUER
Getting up a few times a night as well. Some of these folks may get up 4 or 5 times a night because they're not emptying during the day.

DR. RAJAY SEUDATH
Absolutely.

CARMENN MILES
Gentlemen, you're not going to believe it, but it is time for us to wrap up this show. Like I said, we could speak on this topic for a couple of hours. Thank you both for taking time out of your busy schedule to share this important information on the male prostate and prostate cancer. Healthy habits, I imagine, such as exercise, balanced nutrition, weight management, and regular health care visits can obviously contribute to better overall prostate health. The most important message that I'm taking away is, don't ignore changes in urination, pelvic discomfort, or other concerning symptoms. Early evaluation often leads to better outcomes. Thank you for joining us, listeners, for today's discussion on the male prostate. If you found this episode helpful, consider sharing it with friends, family members, or anyone interested in learning more about men's health. You're listening to the award winning Docs in a Pod presented by WellMed. You can find us every Saturday on all major podcast platforms and on the radio in several Texas markets. We will catch you right here next week. Until then, stay well.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by. WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

Conditions & diseases Podcasts