An Update on the Prostate

Dr. Matthew Resnick, Assistant Professor of Urology and Health Policy and Medical Director of Clinical Intelligence in the Office of Population Health, discusses the most common conditions related to the prostate gland - one of which is prostate cancer - and current views on screening for prostate cancer.

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Bridgette Butler:  Welcome to this edition of the Vanderbilt Health and Wellness wellcast.  I'm Bridgette Butler with Health Plus.  September is Prostate Cancer Awareness Month.  Here to speak with us today is Dr. Matthew Resnick, Assistant Professor of Urology and Health Policy and Medical Director of Clinical Intelligence in the Office of Population Health.  Welcome, Dr. Resnick.

Dr. Matthew Resnick:  Thank you very much.

Bridgette Butler:  Dr. Resnick, what is the prostate gland?

Dr. Matthew Resnick:  The prostate gland is a male genital organ.  It lives in between the bladder and the urethra, which is where the urine passes to get from the bladder to the outside world.  The prostate gland is largely charged with manufacturing fluid that is expressed in ejaculation, seminal fluid, that, for reproduction, is important for keeping sperm viable.

Bridgette Butler:  What are some common health conditions related to the prostate gland?

Dr. Matthew Resnick:  There are two major health conditions that are associated with the prostate gland.  So, the first is benign prostate hyperplasia, or BPH, which is really noncancerous growth of prostate tissue, which happens generally in older men as they age.  BPH is associated with common urinary symptoms, so symptoms like urinary frequency, going to the bathroom frequently, urinary urgency, feeling like you have to go to the bathroom quickly or you are not going to make it, waking up at night to pee, or really just having a hard time feeling like you are emptying your bladder all the way.  Again, urinary symptoms are really common as men age and the most common cause of urinary symptoms that are bothersome to men in older age is benign growth of the prostate gland.  The second condition that is commonly associated when men think of the prostate is prostate cancer.  Prostate cancer is the most common, non-skin cancer in the United States.  There are about 160,000 new cases a year of prostate cancer diagnosed.  Prostate cancer is what we call a really heterogeneous disease, meaning that many men will have prostate cancer in their lifetime and really only a small portion of men will die from their prostate cancer, and you know, that has fueled a lot of discussions around the role of screening or the role of early prostate cancer detection.

Bridgette Butler:  So, there is screening that one can do for prostate cancer?

Dr. Matthew Resnick:  That's right.  Prostate cancer can be identified, and is most commonly identified in the U.S., with a blood test that is called a PSA test.  So, prostate cancer screening involves, both typically, a digital rectal exam, so, a rectal exam where your doctor will take a feel of the prostate to identify any areas that feel abnormal and that is done in concert with a PSA test, which is a blood test, and that blood test has a wide range and we generally use a threshold of 4 to consider normal, which is lower than 4.  Greater than 4 is historically considered abnormal.  There are a lot of controversies around the role of early prostate cancer detection, largely because of what I just said, meaning, many men will be diagnosed with prostate cancer in their lifetime and only a small proportion of those men will actually develop what we call "clinically-significant prostate cancer," or prostate cancer that really threatens their life.  So, you know, the other challenge is that a screening test is really meant to identify men at risk for development of prostate cancer and just by virtue of the fact that the PSA level is elevated certainly does not mean that a man has prostate cancer.  Generally, that is followed with either an imaging test, like an MRI, and/or a biopsy of the prostate.  Now, one of the challenges with PSA testing is that most people with elevated PSA do not have prostate cancer, which means that we end up subjecting a lot of men to invasive, uncomfortable confirmatory testing in the form of a biopsy, that, understandably, results in quite a bit of anxiety.  When we walk that out a little bit, even in men who are diagnosed with prostate cancer, the risks of treatment are not insignificant, meaning that there are a number of risks and those aren't risks related to mortality and death, but they are risks related to functional outcome.  So, things like urinary function and sexual function can be adversely impacted by prostate cancer treatment.  So, at the end of the day, we really have to weigh the benefits and the risks of identifying cancer, which may or may not cause someone harm, balanced against the potential harms associated with treatment.

Bridgette Butler:  At what point should somebody consider, should a man consider talking with his primary care physician about screening for prostate health?

Dr. Matthew Resnick:  It's a really good question.  There really is no consensus about who should be screened for prostate cancer and when.  You know, the decision to be screened for prostate cancer is really a personal one and is really driven by, you know, an individual's perception of the risks associated with early detection versus the potential benefits.  So, what I would recommend is that it is worth a discussion with your primary care doctor about what that balance looks like for you.  There are certainly groups who are at higher risk of developing prostate cancer and those individuals should take particular care in having this conversation with their primary care doc.  So, African American men are at particular risk for developing prostate cancer as are individuals with a strong family history of prostate cancer, so, folks with a father or a brother or multiple first-degree relatives.  Again, a father/brother with prostate cancer should really pay particular attention to their prostate cancer risk and really initiate that conversation with their primary care doc.

Bridgette Butler:  It sounds like it is important to work in conjunction with your primary care doctor when it comes to prostate health as with many other types of health.

Dr. Matthew Resnick:   Unquestionably.

Bridgette Butler:  Alright.  Thank you so much for your time today and your insights on prostate health, Dr. Renick.

Dr. Matthew Resnick:  Of course.  Thank you!

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