#273 ‒ Prostate health: common problems, cancer prevention, screening, treatment, and more | Ted Schaeffer, M.D., Ph.D.

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Oct 2, 2023

Ted Schaeffer, an esteemed urologist and author, explores critical issues around prostate health. He discusses natural aging effects, urinary symptoms, and the impacts of medications like finasteride. Schaeffer dives into the complexities of prostate cancer, emphasizing the roles of androgens and genetics in its development. He elaborates on screening methods, including PSA tests and MRIs, and highlights innovative treatment options ranging from surgical interventions to androgen deprivation therapy—all essential insights for proactive prostate health management.

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ADVICE

Behavioral Modifications for Nocturia

Modify behaviors like reducing fluid intake before bed and avoiding caffeine to manage nocturia.
Track fluid intake and urination times in a voiding diary to identify patterns and potential triggers.

INSIGHT

Causes of Nocturia

Antidiuretic hormone (ADH) surge decreases with age, impacting nighttime urine production.
Peripheral edema and sleep apnea can also contribute to nocturia by increasing fluid in the vascular space.

ADVICE

Medical Management of LUTS

First-line pharmacologic treatment for LUTS includes alpha-blockers like alfuzosin to relax prostate muscles.
For storage symptoms (frequency/urgency), consider antimuscarinics or M3 agonists, but with caution in older men.

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Ted Schaeffer is an internationally recognized urologist who specializes in prostate cancer. In this episode, Ted delves deep into the realm of prostate health, starting with strategies for vigilance and effective management of the issues that can arise with aging, including urinary symptoms, prostatitis, pelvic pain, and prostate inflammation. Ted sheds light on the popular drug finasteride, renowned for its dual purpose in prostate shrinkage and hair loss prevention, as well as the contentious topic of post-finasteride syndrome. Ted then shifts to the topic of cancer, explaining how androgens, genetics, and non-genetic factors contribute to the pathogenesis of prostate cancer. He provides valuable insights into cancer screening, examining blood-based screening tools like PSA and the use of MRI in facilitating biopsies and their interpretation. Finally, he explores the various treatment options for prostate cancer, including surgical interventions, androgen deprivation therapy, and more.

We discuss:

Changes to the prostate with age and problems that can develop [3:45];
Behavioral modifications to help manage nocturnal urinary frequency and other lower urinary tract symptoms [8:30];
Pharmacologic tools for treating nocturnal urinary frequency and lower urinary tract symptoms [16:30];
Surgical tools for treating symptoms of the lower urinary tract [26:15];
HoLEP surgery for reducing prostate size [32:30];
Prostate size: correlation with cancer and considerations for small prostates with persistent symptoms [40:30];
Prostatitis due to infection: symptoms, pathogenesis, and treatment [46:45];
Prostatitis caused by factors besides infection [58:45];
How to minimize risk of urosepsis in patients with Alzheimer’s disease [1:05:00];
Prostate cancer: 5-alpha reductase inhibitors, how androgens factor into pathogenesis, and more [1:10:00];
Post-finasteride syndrome [1:18:15];
The relationship between testosterone and DHT and the development of prostate cancer over a man's lifetime [1:26:30];
How genetic analysis of a tumor can indicate the aggressiveness of cancer [1:35:15];
Pathogenesis and genetic risk factors of prostate cancer and the use of PSA to screen for cancer [1:37:45];
Non-genetic risk factors for prostate cancer [1:45:45];
Deep dive into PSA as a screening tool: what is PSA, definition of terms, and how to interpret results [1:56:30];
MRI as a secondary screening tool and the prostate biopsy options [2:13:15];
Ted’s ongoing randomized trial comparing different methods of prostate biopsy [2:24:00];
Determining when a biopsy is necessary, interpreting results, explaining Gleason score, and more [2:27:00];
Implications of a Gleason score of 7 or higher [2:46:45];
Metastasis of prostate cancer to different body locations, treatment options, staging, and considerations for patients' quality of life and survival [2:53:30];
How prostate cancer surgery has improved [3:09:30];;
Questions to ask your neurologist if you are considering prostatectomy for cancer [3:21:45]; and
More.

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