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Scott Webb (Host): As men get older, it's important that we get regular physicals and are screened for prostate cancer. And joining me today to discuss the prostate and the importance of early screening is Dr. Kevin Spear. He's a Urologist at Summa Health. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. So Doctor, thanks so much for joining me today. Let's start here. What is the prostate and what does it do?

What is the prostate? What does the prostate do?

Dr. Spear: So, what the prostate does, it has an enzyme and it really liquefies the ejaculate. That's what it's really doing. The ejaculate comes through the prostate, into the prostate and that's what it really does. That's it's function. So it's not a needed for life or something like that.

Host: Yeah. And obviously though, if you have a problem with your prostate that can lead to bigger things like prostate cancer and we'll get to that, but what are some of the keys to good prostate health?

What are the keys to good prostate health?

Dr. Spear: Well, one is a realization of what it's doing or what it can do. And the prostate does enlarge as you get older, as men get older and that could lead to symptoms and the symptoms men would realize or potentially realize are issues with urination. So you could have the stream is weaker frequency, urgency of urination. Those would be the general things regarding enlarged prostate.

Host: And so, is there anything specifically that we can do to maintain a healthy prostate or is it really just more sort of tied into overall general health genetics, family history?

Dr. Spear: Yeah. So that's, it's related to all those things. So any pretty much anything in health is benefited by a good diet and exercise, but there are some things that increase the risk and one is family history, obesity. Those are things that are related to just increasing in size and issues with the prostate. And as we go on later, talk about prostate cancer, there's several others. So you know, healthy lifestyle is really is a benefit in general.

Host: Yeah. And that's something that we're learning, whether it's COVID-19 related or not, that just generally eating better, exercising. There's a lot of things that we can just do for ourselves. And there's just so many health benefits to just being healthier. Right?

Dr. Spear: Exactly.

Host: You mentioned some of the warning signs and, and you know, I'm 52 and have sort of thought about or accepted over the years that, well, if you have to get up to go to the bathroom a couple of times during the night that that's not necessarily out of the ordinary, but I'm not sure that that's true. So what are the warning signs for a man that they may have an issue or may have an enlarged prostate?

What are the warning signs of prostate issues?

Dr. Spear: One would be the main one is the stream seems weaker, but this is somewhat imperceptible over a period of time, your kind of don't realize it. But then also urgencies, most men start getting urgency as they get older. And as you did in 60 seventies, there is more and more prevalence of that getting up at night that could be multifactorial, but could be related to that. But those would be the main symptoms.

Host: Okay. So let's assume that somebody has an issue or believes they have an issue, you know, with their prostate, that it may be enlarged that it's causing some of the symptoms that you're talking about. So let's tie that in now and talk about prostate cancer. I know that it's the most common malignancy really, other than skin cancer diagnosed in men. So let's talk about diagnosing prostate cancer, the latest in treatment options.

Dr. Kevin Spear on prostate cancer

Dr. Spear: As you stated, the most common cancer men besides skin in general, one in nine men will develop prostate cancer sometime over their lifetime. And the issue though with prostate cancer, one reason why it's very important for men to be aware of it is that it's silent. There isn't signs. So that's a big deal. So many patients come in and say, I feel fine. Like there isn't any issue or I don't have bloody urine. I don't have anything. And that's not really even blood in the urine isn't really related to prostate cancer in general. So there's no signs or symptoms that say you have X. That means while I think you have prostate cancer, I should check. So the diagnosis, how we do it is really screening, and screening was under some scrutiny, especially years ago somewhere between eight and 10 years ago, there was a government study that came out and really said, really shouldn't be doing this screening.

And the reasons behind that were because if someone had ultimately had an elevated PSA and had a biopsy, 30% of the biopsies are positive, 70 negatives. And when they're saying that's too many, like the test isn't great. But as a test we have, and then also 30% of people that are positive, they all got treated. Nowadays, things are more sophisticated and we're weaning people out. Having people get things that are called like active surveillance, things like that. So not everyone is just automatically getting treated, but to answer the first question is really people should get screened. And it's something that's, it's a blood test called prostate specific antigen. So it is important, even though it was scrutiny to it, it is a test that we feel strongly you should get, but there are guidelines on when to get it, when to stop, all those things like that.

Host: Yeah, definitely. And so when we talk about treatment, even though you said, you know, over time, you begin to treat people differently or exploring more nonsurgical options. What are the options for men who do have prostate cancer?

What are some treatment options for prostate cancer?

Dr. Spear: One is something that's been more and more popular of the past several years, five years or so. And it's more and more and more prevalent is something called active surveillance. So if you have a low grade, not aggressive cancer, and there's not much volume of it in the prostate that we just watch it. And also we have genetic tests that can be actually done on the actual tumor cells that could tell us, does the microscopic look of it, is that the same as the genetics of it? How do we think it's going to be acting in the future? And if those are all low risks, you have a really low chance of any issue with it forever. And we just filed a PSA. So that's a great thing. And then other options are minimally invasive surgery with robotic surgery and that's big a advance, and then others are radioactive BBS or seeds we call them, or external beam, radiation therapy. Those would be the main treatment choices.

Host: Wow. It sounds like there are at least a number of options, both surgical and nonsurgical and, you know, minimally invasive, which is, seems to be the trend. Everybody seems to like that a lot. So let's talk about erectile dysfunction. I know it's a somewhat complex issue because it can be caused by both or either mental and physical issues, right?

Dr. Kevin Spear on erectile dysfunction

Dr. Spear: Correct. Yes. So there's a subset or mental, but there's a lot that are physical. And they do correlate with things that also increase risk of prostate cancer such as heart disease, diabetes. So these things are all related. And in general, up to 40% of 40 year olds have some issue of erectile dysfunction and then 70% of 70 year olds. So as you get older, more issues and the vast majority of people are having a vascular issue with a hydraulic mechanism that gives erections. And so there are things that can be done to help prevent. And again, this would help things like prostate cancer and that would be diet, avoiding smoking, controlling high blood pressure, cholesterol, monitoring for diabetes, limit alcohol. So there's a lot of things and something to illustrate it is that a man that has a 42 inch waist has a 50% higher chance of having erectile dysfunction than someone with a 32 inch waist. So that alone just shows there's some correlation there with, basically obesity.

Host: The body is so interesting, isn't it? It's so fascinating to me that if someone were suffering from erectile dysfunction, you know, that that could be a sign of other things, other perhaps comorbidities, it's really fascinating. It's so interesting. So Doctor, as we wrap up here today, whether we're talking about the prostate or rectal dysfunction, just in general, from your perspective, what can men do to stay healthy and to live longer healthier lives?

What can men do to stay healthy and live healthier lives?

Dr. Spear: Yeah. So first of all, I would listen to medical advice. So I would listen to hopefully your primary care, but don't shy away from screening and screening of the prostate. That is something that would benefit. The bigger thing that's overriding with all of these diseases, and many others are just your health, really try to pay attention to your diet, exercise, as far as erections and other side notes, I would avoid natural supplements that promise to give you interaction or increased testosterone or something like that. Those really are not effective, but diet has been shown in many, many disease processes to really, really make a difference.

Host: Yeah, I think that's the bottom line. You know, we talked about earlier that if you want to avoid some things or you want to limit or lower your risk, be healthier, eat healthier, you know, eat healthier foods, get more exercise.

Dr. Spear: Exercise. Exactly.

Host: Yeah. We just need to take care of ourselves. Of course, there are things that are beyond our control, whether it's genetics, family history, those kinds of things. And maybe those are good reasons to be screened earlier for things, but the things within our control let's do those things, especially during COVID right now, while a lot of us have some extra time, a word home and we're, you know, treating ourselves to comfort foods, what a great time to exercise. Right?

Dr. Kevin Spear on exercise

Dr. Spear: Exactly. And then it goes along with COVID because there was a study that looked at exactly this, if someone ran an hour and a half per week or three hours of outdoor work per week, 20% lower chance of erectile dysfunction, but that's amazing.

Host: It really is amazing, you know, doctor, I think we have some other things to talk about and hopefully we'll do that next time. We'll have you back on again, but we'll leave it here today. Thanks so much for your time and your expertise and you stay well. For more information or to book an appointment, visit Summahealth.org. And if you've found this podcast helpful and informative, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb, stay well. And we'll talk again next time.