Ask Us Anything About… Enlarged Prostates

Scott Gilbert – Penn State Health. This has asked us anything about enlarged prostates. I’m Scott Gilbert. So, there’s this small gland in guys, it’s typically the size of a walnut that it’s located just below the bladder. It surrounds the urethra, the tube that drains urine from the body. Now, of course, I’m talking about the prostate gland that guys probably think about maybe once a year, probably when the doctor says, time for me to check your prostate. An enlarged prostate is not necessarily dangerous, but it can certainly make for an unpleasant lifestyle. And if left unchecked, complications could develop. There are more treatment options than ever though for this. And we’re going to talk about those and all this other stuff today with Dr. Herrera Caceres. He is a urologist at Penn State Health, Holy Spirit and Hampton Medical Center’s. Dr. Herrera Caceres. Very glad to have you with me today. Let’s start by talking about the job of the prostate gland. Why do we need it? What does it do?

Dr. Herrera Caceres – Hi, Scott. Thank you very much for the invitation. So, the prostate gland, as you said, is sitting right outside of the bladder. So, when the bladder squeezes urine out, it has to go through that prostate and the function of it is it’s a gland that produces some substances that nurture the semen or this, this sperm. And when we produce it in the testicles, it goes through some tubes into the prostate. And then when, when the, the ejaculation comes, the sperm comes out along with some of the fluid that is produced in the prostate and allows it to swim and find its way into, into the female organs.

So, it has a very specific function, obviously, what are some common symptoms to an enlarged prostate? And how might a man know if his prostate is starting to become enlarged?

Dr. Herrera Caceres – So, this happens at a usually at a young age around 45 or so, people start having some symptoms that most of the times we ignore because they’re not severe. Usually, we start waking up more often at night or we feel like we go more often than before. And even we noticed that the stream might be a little bit weaker than what it used to be. Most of the times it doesn’t affect as much at first because it’s a progressive condition that as the prostate growth, the symptoms could get more severe and start affecting your quality of life. But usually at first, it’s just noticing increased frequency and weaker stream or maybe just waking up at night. Those would be the most are these always a sign of an enlarged prostate

Scott Gilbert – Are these always a sign of an enlarged prostate or could there be a sign of something else? I mean, it sounds like they are kind of classic symptoms of this though. Right?

Dr. Herrera Caceres – Yeah. No, certainly they can be from two components. One is the bladder and the other one is the prostate. Right? We need the bladder to have the strength to push the urine out and we need the prostate to allow that passage. So, either if the, if the bladder is weak, then we can start having some symptoms or if the prostate grows and starts blocking the outlet of the bladder, then these symptoms can appear. So, we need to investigate and make sure.

Scott Gilbert – This has Asked Us Anything About… Enlarged Prostates from Penn State health. This is something that affects so many guys. So, we wanted to get online and talk about this today with Dr. Herrera Caceres a urologist here at Penn State Health. And of course, take your questions. So, whether you’re a guy or whether you have a guy in your life, who you think might have some symptoms of this or even if you just have general questions, feel free to drop those in the comment field below this Facebook post and we will get you answers either live in real time or even after the fact if you’re watching a recording of this program. So, Dr. Herrera Caceres, we know that a large prostate is quite prevalent, as you mentioned, as men age, what causes a prostate to become enlarged though, other than it would seem age, other, other risk factors or behavioral issues that can come into play?

Dr. Herrera Caceres – Honestly, not, not many risk factors. It’s mostly just the fact that as we grow, we’re, the prostate is exposed to testosterone longer, right? As men, we produce testosterone, that’s one of the main hormones that we have in as opposed to females that don’t have such levels of testosterone and the prostatic tissue kind of feeds from testosterone. So, as we’re exposed with the longer we are, then the longer allow it to grow. So, the prostate growth and starts obstructing the bladder outlet. So, it’s really just the fact that we’re men and that we have testosterone, unfortunately.

Scott Gilbert – Right. Right. That’s what struck me is, as I was researching for this is just how common this is. I mean, I think we all know people who have suffered from this at some point, but this is almost a rite of passage with aging, isn’t it?

Dr. Herrera Caceres – That’s right. That’s right. Honestly, I always, I always see it as part of aging. I mean, some people feeling more than others, some people feel it sooner at a younger age than others. But I would, I feel that if we ask the right questions, most men around an age of 50 or 70 or even older, most men have some kind of symptoms already showing. And they don’t, fortunately they don’t always affect the quality of life, but that’s something that just comes with age.

Scott Gilbert – So, mainly we need to talk to the patients, right? I mean, as you previously mentioned, the fact that the prostate is enlarged doesn’t mean that we need to treat it.

Dr. Herrera Caceres – So, we based the treatments on, on the affection of the quality of life on the symptoms, referred by the patients. And part of the work up that we, that we do is that we frequently get some kind of imaging to assess the size and the anatomy of the prostate. And that alongside with the symptoms referred by the patients, that’s where we decided we need to give some treatment and which treatment is the most ideal in in each scenario, right?

Scott Gilbert – This has asked us anything about enlarged prostates from Penn State Health. We welcome your questions for Dr. Herrera Caceres, he’s a urologist here at Penn State Health. Just drop them in the comment field and we’ll be sure to get to those here. I understand that there are some potential long term complications for some patients with enlarged prostates. That can include things like urinary tract infection or even kidney damage. When do those kind of things become a factor?

Dr. Herrera Caceres – So, as we were saying, the prostate starts growing and some, some it creates some obstruction in the bladder outlet so that can cause some retention of urine, right? When we pee we expect to have the bladder empty right after we pee. But if, if we can see on this imaging, if the prostate grows, you can see that the passage is more narrow and therefore, it requires more of a strength from the bladder to push the urine past the prostate. And if the bladder is not strong enough or if the blockade is significant, then we have to, we start retaining urine, we start retaining 100 CCS, 200 CCS in the bladder after we pee so that allows the bacteria to grow right inside the bladder and cause infections. And if this happens long enough and we don’t treat it, it can also increase the pressures in the urinary system and affect the kidneys that start dilating themselves. And of course, that can lead to kidney failure if we’re not careful and lead on treaty on time. So that’s what those are the things that we have to keep an eye on and make sure that there are no long-term complications.

Scott Gilbert – So, at the very least, this can cause some lifestyle issues, modifications, make frequent urination. But it can also, as you mentioned, lead to the buildup of bacteria in the bladder and elsewhere and that obviously can, lead to some very negative things. At what point should somebody seek help? If they suspect that they may have some of these symptoms or an enlarged prostate, you know, what’s the difference between well, I’m just getting up a little more often than usual overnight? It’s no big deal versus I should get in to see someone.

Dr. Herrera Caceres – So, personally, I would recommend that as soon as you start having some symptoms, you talk to someone that can make the assessments and make sure that you’re emptying your bladder, that your kidneys are okay. The reason being is that it’s very easy for us to get used to the symptoms, get used to the way we pee and we just accept it as part of aging or as part of changes in life and we can let this go to the point that one day we just can’t pee anymore. Right? And that’s, that’s, it’s a bit that at that point is a little bit too late. So, we need to, we need, I would recommend that we assess before when we start noticing these changes instead of getting used to them and just forget forgetting about it. We should just have an assessment and make sure that we can go slowly and make sure that we give treatments on time.

Scott Gilbert – Let’s face it. There’s also a bit of a stigma here. Right? I mean, in terms of, is there a hesitation among some guys to come forward and say, I’m having some of these symptoms because they’re not fun to talk about. Right?

Dr. Herrera Caceres – It’s not something you brag about, right? But you know, it’s part of life and we just have to accept it as what it is. Unfortunately, we have an option, a variety of treatment options that we can offer and that we can, if we get things on time, we can tailor the treatment based on the, on the individual that we have in front of us and we can avoid these complications. So, yeah, certainly there is a resistance. But if we treat it on time, we can, we can avoid complications.

Scott Gilbert – You’re watching, Ask Us Anything About… Enlarged Prostates from Penn State Health. Scott Gilbert alongside Dr. Jaimie Herrera Caceres. He’s a urologist at Penn State Health Hampton Medical Center and also Holy Spirit Medical Center. Both of them on the West Shore. We welcome your questions for him in the chat here. We do have a question here from Jewel. She’s asking whether diet affects your prostate. Also, I would add to the list, things like exercise, smoking, some of those common behaviors, any of this factor into prostate health.

Dr. Herrera Caceres – So, it’s funny that it’s such a frequent condition, but we still don’t have all this like all the risk factors or ways to manage it or prevented all that well targeted or, or assessed. In terms of diet, there are some things that have been mentioned that could help such as reducing animal protein, reducing the amount of red meat that we uh is associated to a change in the anatomy of the prostate, uh is associated to smaller glands and that can relate to the amount of symptoms that we have. Right? And that could also that has also been associated with the risk of having prostate cancer. Again, these are things that have not been fully clarified. But research suggests that these things can help, right? Mainly that avoiding a lot of dairy products, avoiding red meat. That’s something that has been related to both symptoms.

Scott Gilbert – Shifting from prevention to treatment, what are some of the treatment options for enlarged prostate? And we know for example, there are medications out there, right?

Dr. Herrera Caceres – Yeah. No, we’re very fortunate in the sense that in the past all the patients would have to go for surgery or some, some kind of procedure to open the prostate. But nowadays, we have very effective medications such as, um, some that shrink the prostate, others that open the passage of the, of the prostate and that allows us to avoid the surgery or any other procedures in many of these men.

Scott Gilbert – We have another question here. This one’s coming from David. He’s asking about another treatment option, which he’s asking whether you believe in the Euro lift, he believes it’s called, um, to open the prostate. What can you tell us about that?

Dr. Herrera Caceres – Yeah, I know the, the Euro Lift is we have been using it for a few years now and the way it works is basically we staple the prostate outwards so that it opens that passage and it works very well in selected and selected men. All these treatments require the most important part of it. The most important aspect of it is that we choose the right patient for the right procedure, right? Or the right procedure for the right patient, I should say. So, Ero a very good option In many men, we just have to know the anatomy of the, of the gland, assess the amount or the severity of symptoms.

Scott Gilbert – And in those cases, in which the patient is right, it has been considered a surgical or rather invasive procedure or is it somewhere on the continuum there?

Dr. Herrera Caceres – No, no. In fact, it’s, it’s considered one of those minimally invasive procedures in which we don’t actually have to go in and cut anything. We just have to, we just go in with a camera, we find the prostate and we start throwing the staples out work and, and that allows that passage that opened, that opens that passage in the process. So, it’s a very good option alongside some others that are available such as Euro Lift our Resume in which we use water vapor to reduce the size of the prostate or others, such as, iTind which is a temporary extent that we put inside and we leave there for one week and then we pull it out, make sure that there’s nothing else inside.

Scott Gilbert – Let’s talk a little more about that. I tend procedure Dr. Herrera Caceres because it was earlier this year that Penn State Health started to offer this rather innovative treatment again at, at our West Shore hospitals. And can you talk a little more about that? You mentioned it’s a small stint. It remains in place temporarily about a week. Can you talk about what exactly it does for the individual?

Dr. Herrera Caceres – Yeah. So, I think is personally, I think it’s a very good device in which uh we basically go in with a camera. The patient is under light sedation. The twilight that we use for endoscopy is and colonoscopies and all these things. It’s just a mild sedation. We go in with a camera and we open stent that we place in the prostate, and we lived there for one week. It has a string that is hanging out and then we see the patient, the patient goes home the same day wakes up basically from the procedure, goes home and then we meet again in the clinic and we pull it out in the clinic and the patient pee and the way that works is basically by the pressure of the stent being open in the, in the prostate, it carves into the prostate and makes the cuts that allowed this opening to be larger.

Scott Gilbert – And that’s a long-term solution, right? Even though it’s just in for a week, it creates changes that will last for a very long time then.

Dr. Herrera Caceres – Yeah, I mean, it’s, it’s a relatively new device but the research shows that at least for three years, the effects of the stent remain, right. So, so the outcomes are uh preserved for at least three years, which is, which is very comparable to other devices and even to uh more invasive procedures that we, that we do. So, I think it’s uh it’s a very promising device. And uh and again, in well selected patients.

Scott Gilbert – You’re watching, ask us anything about enlarged prostates from Penn State Health. I’m Scott Gilbert alongside Dr. Herrera Caceres. He’s a urologist here at our Hampton Medical Center and also, Holy Spirit Medical Center. And also, he’s the guy who’s doing that iTind procedure we just talked about. So we’ll put some information in the comment section of this Facebook post. So, you can look into it some more if it’s something that interests you. But you know, we did recently do a Medical Minute on various treatment options for enlarged prostate. And this of course was one of them. And of course, we also have a news story about, about iTind as well. Let’s talk about some of the other treatment options if we could. I know that you mentioned there is, you know, that may not be the procedure for everybody. So are there some more um invasive procedures, perhaps that some people may undergo that, you know, in the long term, also proved successful for them.

Dr. Herrera Caceres – Yeah. Yeah. I mean, the most classic way is the terp many people have heard about it because it’s something that we do very often, and we basically go in and we cut the prostate from the inside. So, we start cutting chips and we cored the prostate. So that, that in that inner part of the prostate is no longer there and allows the passage of urine. It’s a very good procedure. Were able to respect good amounts of tissue. And the downside of it is that you do need to have some cutting, right? So that implies some bleeding and we do need to, we do leave catheter for one or two nights while the patient is in the hospital. And uh and after that, we pull it out and make sure that the patient can avoid and p and then we send the patient home. It’s a very effective procedure. We’ve been doing it for many years, and we know a lot about it. Uh with just the downside being the fact that we caught there is some bleeding and that you have to stay in the hospital with a capital for one or two nights. But in general terms is a very good procedure. There are some others such as hold it that, that in which we use a laser to a nuclear the prostate. Instead of cutting from the inside, we actually cut down to the, to the capsule of the prostate and we remove the inner part of it and then we break it down in the bladder and remove fragments in the bladder. That’s also a very good procedure that, allows us to treat larger glands, prostate that are a larger size. And, and it’s, it’s a very good option as well. Again, it’s, it’s a little bit more invasive than iTind or Euro lift or resume. Right. But, but in selected patients, that’s, that’s a very good option to consider.

Scott Gilbert – Sounds great. And that’s the key word, right? Options. There are options for patients out there. There’s no one option that’s gonna be the right option for everyone. But there are multiple options available ranging from medication to that surgical procedure to iTind anything else to that we should touch on as well in terms of treatments because I mean, again, it sounds like we’ve got a lot of those options offer hope to patients with enlarged prostate. It sounds like,

Dr. Herrera Caceres – Yeah, I just think Scott that we have to, we have to choose the right thing for each patient. For example, some people do very well with the medications, and they control their symptoms and they are not bothered by side effects. Uh, and some other, even though they respond to the medications, they may not tolerate the side effects very well. Because this, these medications, they all have some downsides, right? I mean, they can affect the ejaculation. They can, give some dizziness or lightheadedness, decrease the libido. There are some things that come with the medication treatment that we may not want and that people may not tolerate and in those cases we can use, I feel that’s one of the sweet spots for these minimally invasive procedures because they don’t imply hospital stay. They, they don’t they don’t cause any bleeding, they don’t burn any bridges in terms of needing another procedure in the future. And we can use them in these patients, even though their symptoms are not very severe. We can do these procedures to take them off from the medication and avoid the side effects from those, right? So, I feel those that would be a sweet spot for this kind of minimally invasive treatments. And if the plan is too large or if the anatomy is not favorable, we do have those other options. As I mentioned, the classic terp or the whole lip that, that are very effective in those scenarios. And there are more of a definitive kind of treatment as we resect, more teacher, right?

Scott Gilbert – That sounds great. Well, all great information, Dr. I appreciate your time today and talking with us and everybody who tuned in, we will share some links in the comments section of this Facebook post so that you can learn more about some of the procedures and some of the other things we talked about today as it relates to treatment for enlarged prostate from Penn State health. Thanks so much for tuning in to ask us anything about enlarged prostates from Penn State Health. I’m Scott Gilbert.