good evening.

>> Thank you so much for watching HealthLine on PBS Fort Wayne, I'm your host Mark Evans.

We're going to open the phones here in just a short time.

We'd like to have your calls this evening.

Our topic tonight very important especially for men prostate problems and we'll talk even more about problems other than the cancer in prostate so you'll be surprised and we're going to talk to Dr. Scott Palmer here, a urologist.

He's back on the show.

Great to see you again, sir.

Thanks.

Great to be back.

Absolutely.

Always good to have here.

We always have several calls and we are going to encourage that tonight.pThe number is on n right now at 866 (969) 27 two zero call any time in the show.

It's a 30 minute show we don't step down for commercials because we are public television.

>> Dr. Paula, just to kind of build the platform for a show, could you explain what your specialty is as a urologist?

>> Sure.

Sure.

Well, it's it's basically a surgical subspecialty where you focus on the diseases of the urinary tract and also the kidney stones, various cancers, prostate cancer.

You mentioned kidney cancer, bladder cancer.

>> So we work with both genders and all age groups which was one of the appeals for me.

>> So it's a wide range of things that we deal with pevery day.

And so it's it's a rewarding profession and good I'm very glad to hear that.

>> Now we are going to discuss more in depth during the show prostate cancer.

But that is something that we you and I have discussed on this program.

Many times.

>> Can you give a status update on the death rate on prostate cancer so we can talk about that a little bit?

>> Sure, sure.

Well, it's as you and I were talking about before, it's it's it's been a controversial thing for many years in terms of whether or not prostate cancer screening which we've had since the middle 80s actually saves lives and it took us a long time to start to see a trend towards saving lives.

But it has been very controversial and there's been a fair amount of criticism over the years in terms of whether we should be doing PSA, which is the blood test for prostate cancer screening or other types of tests and whether that really benefits men in the long run into something that we have always struggled with.

But multiple studies over the past several years are starting to show a trend in the right direction.

So we think that prostate cancer screening is worthwhile but it is something that every patient should have a good discussion with either their primary care doctor or the urologist in terms of the pros and cons and how you do that and what are the potential benefits versus the risks of either just doing screening or treating and what is it currently the third deadliest cancer rate in men?

>> It's actually the second.

Second yes.

But again it is improving gradually and part of that is skewed by we also have a older patient population.

So prostate cancer oftentimes is a disease later in life .

So as the population rises, the age rises, we're going to have a higher degree of prevalence.

>> I was having a discussion with you in the green room right before the show that one of my great uncles died of prostate cancer and we're talking back and we're talking Morten's probably about 60 years ago starting to date myself but when I was a kid you'd never heard of prostate cancer and when people talked about prostate cancer when they did it would be prostate cancer, you know, so you could tell in the decades following that how prevalent it has become.

And back then, I mean even as my mother was a registered nurse and my father was a retired Air Force corpsman medical corpsman, I never heard them discuss other than my uncle prostate or prostate cancer.

I didn't know if it was because I was a child.

>> I wasn't supposed to know what a prostate was or whatever that was.

But I've noticed that throughou the decades following the research that has been done and it has become more prevalent and I was asking you have we always had prostate cancer or is this something that is just kind of popped up as an environmental issue or population?

>> And you said that right on it was probably because of a population situation?

>> Well, I think it's probably a combination of things a little both when you combine an aging population along with prostate cancer screening now that we've had for about 40 years.

Yeah, that has led to a higher diagnostic age and trying to catch prostate cancer earlier.

But it remains a controversial thing and it's something that we probably will always trouble with in terms of , you know, how aggressive we are with screening.

And a bigger question is when to stop screening.

Right?

Right.

Well, and that's something you need to talk about with your physician, I guess.

Absolutely.

Well, let's go and move on to some other areas of the prostate and problems with the prostate and honestly I really can tell you very many as many shows as I've done with you and some other physicians let's go ahead discuss that.

>> What kind of issues can men men have with their prostate?

Well, the process is right below the bladder and so it is part of the urinary tract and so many men will start to notice as they age and the prostate becomes either larger or the shape or the muscular tone can start to interfere with urination.

And so by far the most common complaint that we receive from men that is prostate related would be something with the urinary system, whether it be a slow or extreme having to go more often and having to go more urgently know nighttime urination is a common complaint.

Now I do tell patients nighttime urination oftentimes is complicated.

That can be due to lots of things and I will tell patients if you do treat your prostate, whether it's with surgery or medications in the nighttime urination gets better.

You always want to think of that as a bonus because it may not but often times it does .

And so it's something that as time goes on more and more men do notice that they just don't urinate as well as they used to and that can become a quality of life issue.

You know, if you're in the bathroom, you know, 15 times a day or getting up a lot at night or you know, you walk into the bathroom to go and you're staying there for five minutes while five guys come in and leave at the time you're in there.

You know, so there's a number of issues that will get men to kind of seek help and oftentimes they'll start with their primary care doctor but ultimately oftentimes end up and seeing us.

>> What are some of those conditions called as far as urination?

Yeah, well the other prostate issues well with urination you hear the term BPH?

>> Yeah, I came across I mean well it's a it's an acronym stands for benign prostatic hyperplasia.

>> Right.

But we've we've learned over the years that the size of the prostate alone or the term hyperplasia basically means enlargement are growing rapidly dividing cellular prostate.

But it's more than just a size .

The shape is also a factor.

The tone is a factor as well.

In fact one of the more common classes of medications that are used for the prostate are called alpha blockers and they basically work by acting like a muscle relaxer for the prostate.

So it's not just a matter of just the size but certainly as a man's prostate gets larger the chance of having urination issues goes up.

But BPH is by far the most common term you hear applied of that.

>> OK, and just because you're having trouble urinating doesn't mean you have prostate cancer.

So you should know those arms shouldn't be going off.

Yeah, and that is actually one of the more common things that I discuss in the office prostate cancer.

Can it cause urination issues?

Yes, but typically that's going to be more in later stages more advanced disease.

Prostate cancer for the most part really should be considered a silent disease.

A man could have prostate cancer for years and I have any idea that it's there now some men can have urination issues and have prostate cancer but they're not necessarily related.

They can have both but it's not that one is causing the other.

>> All right.pLet's talk about e treatments that are involved, the treatment options for those experience bothersome urination issues.

>> What's the most common by far is to start medication and there are a couple of popular classes of medications that we use for the prostate.

I mentioned the Alpha blockers.

One of the more popular ones there is called Flomax or tangelos in its generic term but there's a number of them on the market and again they work by basically relaxing the tone of the prostate.

>> But that can do is it can reduce or give you a better flow, better emptying in as far as side effects, occasional side effects.

I would say the most common that I hear is kind of a sinus congestion like a like a flu like like a stuffy kind of feeling interesting.

Yeah.

It's going to be probably a little bit of dizziness or lightheadedness especially if you stand up quickly.

And then the third thing would be depending on which when you're taking is some men will have trouble with so they may reach but nothing comes out.

I always warn guys about that it's a fairly common side effect and for many guys it's not bothersome but they should know about that ahead of time.

The other class that we commonly prescribed, they actually physically shrink the prostate very slowly over time and that those medications are pretty well tolerated again they can cause some issues, some guys might notice less sexual desire or sometimes a little bit of erectile dysfunction, especially if they've been on there for quite some time.

But they can't be beneficial for guys in terms actually physically shrinking that prostate.

But those are by far the two most common classes of medications that we use now there are some men who have more of a bladder component to the urination so oftentimes kind of add in a bladder medication for alcohol for overactive bladder and so some men actually do well a combination of both.

>> So they take prosti medications and a bladder medication.

Now I'm just curious you can take those medications to relax everything.

>> Is that going to promote leakage?

Almost never.

OK, no actually surprisingly you often have just the opposite because when you kind of take the workload off the bladder so if a bladder is having to work hard to urinate that because of the bladder become more and more unstable or if the bladder is becoming distorted by the prostate itself as it grows when you start to reduce the workload on the bladder for lack of a better way of putting it, the bladder becomes happier and so on.

A bladder becomes happier.

>> You tend to have less of those sudden urges in dribbling before you get to the bathroom.

I see.

I see.

OK, very good.

We have a call coming in right now and it's Sam.

Sam prefers to be offline and I'll go ahead and read his question for you Doctor and says Does everyone have the same timetable to catch prostate cancer or is it different for everyone?

>> That's a great question because I was going to ask something yeah, it's a very good question and actually it's actually very different for people.

>> So with prostate cancer like with most cancers, what you'll see is a different grades or different levels of aggressiveness.

>> And so in prostate cancer for men who have what we call kind of non aggressive, a very, very low risk prostate cancer, many years where you have to worry about the prostate cancer.

>> In fact, many guys won't even treat their prostate cancer in a situation like with all cancers you can have some cancers that are more aggressive.

So their timetable obviously is going to be a lot different then you have to factor in the patient.

So somebody who is younger and healthier, they're going to want to be more aggressive with their prostate cancer.

If you have a man who's late in life let's say a man who's you eighty three diagnosed with a kind of what we call a low risk prostate cancer are not aggressive prostate cancer for most men that age and health their prostate cancer is never going to be an issue for them.

>> So just watching it might is a nice option.

>> But to answer your question, yes.

So the timetable is going to be very different between patients and hinging on his question is there a particular time in a man's life where he really needs to be alert about any type of prostate issues or those are going to crop up and they're going to experience those as far as chronologically and age in terms of urination or prostate cancer.

>> Let's go with prostate cancer first.

Well, on prostate cancer I mean there's a number of factors that come into play.

So you're talking about prostate cancer screening.

So when should advance our prostate cancer screening?

The American Urological Association recommends getting a baseline sometime in the early fifties and maybe going to annual or every every two years starting age fifty five.

But at the same time though if you have a man who is considered higher risk for that for prostate cancer for example, if you're African-American or if they have a strong family history we recommend starting earlier what about urination problems?

When do those usually crop up?

Well I think you know it varies quite a bit but I would say, you know, if you look at the big picture, probably men in there starting in their late 40s is a common time period where you start to see it and kind of getting worse and worse up in their 60s and 70s.

>> Now why don't we hear of more and thank goodness we don't but more cases of prostate cancer among younger men?

>> Well, it's like a lot of cancers.

I mean basically it's a cancer is machinery that breaks down in your cells.

So as time goes on, as we age our cells are constantly dividing and so it's kind of like having a car that's the parts are working over and over and over again.

So the longer you own the car the more likely it is to break down.

So many cancers are basically the breakdown of genetic material so as you age the chance of having a genetic breakdown increases and so many cancers are higher have a higher rate of existence later in life than they do early on and with prostate cancer if it was to spread what is the most likely area it's going to spread to typically I mean it can go a variety of places but bone is by far the most common that we see so lymph nodes and bones.

So basically when you're round to what we call stage somebody let's say somebody has a higher risk disease you're concerned about we look at the bones and also look at lymph nodes in the building and things like that.

It can go other places as well see the liver or the lungs and things like that but that's much less common.

>> OK, very good.

All right.

We have another call coming in.

>> It's Marshall Marshall.

I think you want to ask your question yourself so you go right ahead, sir.

Yeah, I was on the Marshall now I think I've prostate problems but difficulty urinating is not one of them.

But I do have kind of severe pain in the and area and also dull ache and a lower abdomen or heaviness and and the pain like in the or between the and test area can be severe and sharp like a sort having run through that.

So it could be painful but it lasts very short.

>> What could be causing that?

Well it's a kind of an open question.

There's a variety of things that can lead to pain or discomfort down there you'll hear the term prostatitis which is a commonly used term for men who have inflammation or infection of their prostate with prostatitis.

So it's a it's a difficult diagnosis to make sometimes because we don't have a real reliable diagnostic test for that.

>> And if you go back in our field 50, 60, 70 years, the common way of managing that would be to simply assume that it's prostate infection and put guys on antibiotics or two or three months at a time.

We have learned especially over the past twenty , twenty five years that it may those cases it may not be the prostate itself, it may be the muscles and nerves around the prostate and there are different terms that we use for that.

One of the common ones is called chronic pelvic pain syndrome.

There's also what's called spastic pelvic floor syndrome Levator Anei syndrome but they're basically all variations of the same theme.

But in trying trying to pin down pain that area is not always easy.

You can try prostate treatments, prostate medications and see if they help in cases where you have things like fevers or burning with urination.

Obviously you want to check a urine, make sure there's no bacteria in the urine and again sometimes you will prescribe antibiotics just as a shot in the dark and see what happens.

But we have to remember to the itself and the whole area and all those pelvic muscles can also trigger pain so it can take a while to kind of sort that out.

>> Thank you for your call Rosano.

I want to ask you bike riding can that aggravate the prostate?

>> Well, anything that puts pressure on the prostate or causes a vibration can definitely stimulate some inflammation and yes it can.

So a good example would be there's a number of patients every time they ride a motorcycle for example, or go on a long bike ride or even a long car ride, we'll have trouble urinate in days.

>> Oh well now we were talking about some of the medical treatments for prostate problems and there is also surgical treatments as well.

I do have a question I believe it has to do with urination problems thing called a lift and I don't want to give away your brand name but for the sake of explaining it right.

But that's fairly new, isn't it?

It's relatively new.

It's been around I think for about ten years.

And how does that work?

Well, basically there are a little implants they kind of remind me of when you buy clothes and you're taking the tags off the clothes there's these little plastic pieces that hold the tags on your clothes.

They kind of look a little bit like that but they have a metal end and more of a plastic end.

>> But the way they basically work is they're kind of pinching the size of the prostate together which opens up the middle of the prostate.

>> So so surgical treatments that we do to help men urinate better they all kind of had the end result that's similar where you're trying to open up the middle of the prostate, make it easier for the urine to come through.

But there's a variety of different ways of doing that.

So the technique you're describing, you're actually pinching those lines together to kind of pull apart the sides which opens up the middle and it's a nice procedure in terms of you know, it's easy to go through not a real involved recovery .

Oftentimes catheters are not as Ussery.

The downside though is not for everybody.

You kind of have to pick and choose your patients in terms of the shape of the prostate and and look at what their goals are and what kind of symptoms they're having and go over the pros and cons both ways.

The other thing too is it's not necessarily going to be a you know, something's going to last for twenty years.

You may last four or five, six, seven years.

But for many men that's that's plenty and in fact most procedures that we do for the prostate don't last forever.

>> But depending on what we do though some last longer than others some other surgical procedures.

>> Well, many, many men asking me about the what's called the Roto-Rooter treatment as a kind of a common term.

You hear that usually what they're referring to there is a rocedure called Terp which is an acronym it stands for trans urethral resection of the prostate been around for many years I think over a hundred years now.

>> It's been around for a long time.

Obviously the the equipment that we use and the fact have a lot better over the years I imagine it was a hundred years ago.

>> Yes.

So it's gotten a lot better over the years.

>> But again it's a way of opening up the prostate.

So in a terp procedure what you're actually physically doing removing portions of the prostate from the inside and that's most commonly done with a device that actually causes a current to go through is electricity.

So you're literally kind of carving it out.

It's almost like using kind like a you see those cheese cutters?

They have wires.

Yeah.

So it's kind of like that but you're actually carving out the inside of the prostate now is that done?

It's going to be done in invasively right?

Yes, it's all done through a scope in the urethra so there's no incisions now there are procedures we do sometimes with the incisions especially for very, very large prostate.

But by and large most of those are down through the urethra.

>> Well, since we've talked about most of the medical side in the some of the surgical procedures go along with that I want to ask now what are the when should men consider pursuing I guess making the decision between the medical and the surgical treatments?

>> Yeah, and that's that's a discussion that we have a lot and I think a lot of it boils down to personal preference and also boils down to side effects and you the effect of the treatments as well because typically what I'll do is I'll start off by taking medications and then you have to decide from there are the medications doing a good job for me?

Am I happy with the medications ,the side effects, bother's or not?

And then from that point there to kind of decide where they want to move on to a surgical procedure.

Now that said, occasionally men will say, you know, I'm not really interested in taking pills.

I'd rather just do something to fix it and go on from there.

So there are some men that will go straight to surgery as well.

So it's very much a personal preference.

>> Let me ask you this.

Well, we have another call coming in from Fred.

What are the risks associated with not getting something treated like this?

>> Well, the biggest risk is going to be again going back to the workload on your bladder.

So if you're making your bladder work hard when you think about your bladder has to generate pressure to get the urine out, the pressure itself can lead to problems over time that you may not even be aware of for quite some time and that would be things like the bladder becoming thickened.

Not wanting to hold as much or relax as well are becoming more and more unstable, causing a lot more urgency and some of that damage can be permanent.

So as the bladder becomes more and more damaged over time, you may not even be aware of that if the pressures become very high that it can actually transmit to your kidneys and in more severe situations you start to damage the kidneys themselves.

>> Here's a kind of off the cuff question but is it dangerous to hold urine in your bladder for a long period of time?

>> For the most part, no.

No because when you go out to go you will go yeah.

>> That's I think that's kind of a normal thing.

It's a good question though but no, I think for most people holding it is not really the issue now when you start getting into more like pediatric urology and kids and some more severe cases depending on the child holding it for really long periods of time can be a problem.

You have to work with parents on how to work with them.

But for your average person that say driving a truck or something is holding it before you have to pull over to the bathroom if you're on an assembly line or something, know that typically is not going to cause any damage.

>> Very good.

Let's go to line three with Fred.

Fred, what is your question for Dr. Palmer?

Thank you for taking my call.

I'm 85 years old and have did you hear me?

>> Yeah, Fred just listening through your phone not your speaker on the television because we have a little bit of a delay.

>> But go ahead with your question.

Listen through your phone, OK?

OK, I'm an 85 year old man.

I have time of frequent urination, OK?

And I think according to some of the information on the screen, are you asking if there is a correlation between fibrillation and frequent urination?

Is that correct?

Yes.

And I would say sometimes I urinate and 40 minutes later I need to urinate again and sometimes my heart beats much more severe than other times.

So I'm wondering is there any connection between the blood flow and the urge to urinate?

>> All right, Fred, let's see if the doctor can address that as it is an interesting question.

I mean I can't think of a direct connection, Fred.

I think when you look at the nervous system though, anything that impacts one part of what's called your autonomic nervous system could definitely impact the others.

So you know, anything that kind of interferes with your heart function, a good example would just be anxiety.

If somebody has anxiety they can have more heart issues and then they also have more urination issues.

But I can't think of anything that would directly cause the two to be connected necessarily.

But if you are having more and more trouble urinating, I think the first in your mind make sure that you're getting your bladder empty and that would require a little scan that we do in the office and then go from there.

But if you haven't tried treating your prostate that might be a nice option for you.

But again it depends on the-sit.

So check in the urine making sure it looks normal checking to make sure you empty.

But as far as the fibrillation, there could be a neurologic connection there to some degree.

But I can't think of a direct connection.

>> Fred, thank you so much for your phone call tonight.

Dr. Palmer, I want to ask you about excuse me some of the things I've seen and advertising some supplements that are supposed to supposedly supposed to help prostate issues and there's a particular is there a root what is it called and can you tell me what that is?

>> Well, there's a there's a number of that probably the most popular one I guess question not the most often and saw Palmetto.

>> That's it.

That's it.

Yes.

I mean you say it would ring a bell.

Yeah, there's actually a number a number of them on the market.

Well, you know, if you look at the actual science, you know, the science has not shown that it really you know, the supplements do much and particularly saw Palmetto there were two very good randomized trials looking at saw Palmetto about they say about six or seven years ago and they both showed no effect whatsoever.

Now that said, I have had patients over years swear by it.

You know, they take it they think it helps.

And what I always tell them is if you think it's working, that's fine.

That's it's not going to hurt anything.

But there's there's a number of them on the market and I think it kind of boils down to, you know, whether or not you think it's worth the money to spend on that because you know, some of those supplements are not inexpensive.

And so I think you have to make that decision yourself but they're not going to hurt I don't think but there's not a lot of science backing them.

>> But should you consult your physician if you're going to take one of those?

Well, I think you have to I don't think you necessarily have to right away.

I if you want to try it on your own for a while, I think that's perfectly fine.

I think for the most part they're considered relatively safe.

The bigger question is whether they're clinically effective.

>> OK, Dr. Scott Palmer, thank you so much for being here again tonight.

Hope to have you back again.

It's a very important topic more than welcome.

>> Glad to be here.

All right.

Next Tuesday night we'll see you again.

We'll have another show and Jennifer Blomquist will be here talking about diabetes.

Please join us.

Until then, thank you for watching.

>> Thank you for your calls.

Good night and good