Paul Szmal: Our guest on FLX Morning is Dr. David Schnapp from AMP Urology in Auburn. In our last segment, we were talking about people's reluctance to discuss urinary symptoms with their doctor. I think some people might have some level of embarrassment, you know, when it comes to those issues and oftentimes we'll see patients who, you know, come in and say, well, I have incontinence and why are you here? Because my wife, my wife told me to come, you know, but I think when it comes to prostate issues and urinary issues, I'm seeing that less and less.
Now, of course, there might be a lot of people out there who never get in, those people that are listening to this program now who have these problems that don't come in, so I can't really judge who's out there, you know, living in the community that suffers from these issues that that don't want to come in and never get seen because of that. But yeah, I think it's definitely a concern.
We've talked many times in men about BPH, benign prostatic enlargement. Remind us about how the prostate often grows in older men and what BPH is and where that is along the steps to a possible cancer.
David Schnapp: Well, yeah, prostate cancer is always something we worry about. It's, you know, essentially the most common cancer in men. We pick up a tremendous volume of prostate cancer, you know, in this community, certainly. I see patients every day in the office and I rarely can recall a day that goes by where I'm not having a conversation with the patient about their prostate cancer or having to tell them that they were just diagnosed with prostate cancer based on a biopsy that we did in the office.
So if you have urinary symptoms, then prostate cancer screening, of course, should have been done already. But certainly, if you've never had a PSA or a digital exam, you need to be seen, at least by your primary care doctor. Make sure you confirm that your primary care doctor did a PSA on you within the past 12 months that was normal, and if not, then you should be asking for it.
Paul Szmal: We've also, of course, discussed the treatments for BPH, and they've certainly advanced. Two major ones we've discussed, prostate artery embolization and the Urolift system. Remind us about your options for treatment here.
David Schnapp: So those two treatments that you just mentioned are newer, minimally invasive therapies for BPH that are very effective. Prostate enlargement has been treated with medications for years and years and traditional surgery for many, many years, such as a transurethral resection of the prostate, which is the sort of old-fashioned gold standard treatment for BPH where we go in with a scope in the operating room under anesthesia, and we actually scrape out the prostate tissue that's causing the obstruction and the symptoms.
Oftentimes now we can avoid doing surgery by using some of these newer techniques, like you mentioned, the Urolift, where we go in with these clip implants to pull the tissue back away from the urine passage. It takes just a few minutes, and it's an outpatient procedure and can often be very, very effective if the patients are selected properly.
Prostate artery embolization that you mentioned is a newer treatment that we offer now in our Syracuse office. We have an interventional radiologist that works with us, and what they do is, much like a coronary artery catheterization or any type of angiography, a small intravenous or intraarterial catheter is inserted in the groin, and using dye we can localize the arteries to the prostate and then go ahead and inject the substance once those arteries have been properly identified to clot them off and thus reduce the flow, the circulation to the prostate. By doing that, you actually allow the prostate to atrophy or shrink over a period of time and symptoms improve.
Of course, patients with symptoms that have never been treated with medical therapy, the typical medications we use for BPH are either alpha blockers like Flomax, Alfusosin, Silodosin, Rapaflo, or 5-alpha reductase inhibitors such as Finasteride or Dutasteride. Those two different classes of medications are often used before we even consider any type of intervention or procedural treatment for BPH.
Paul Szmal: What are the risk factors for prostate cancer? Is there anyone who's most prone to getting it?
David Schnapp: Yeah, sure. Family history is a big risk, so if you have a first-degree relative that has prostate cancer, father, brother, certainly you're at a significant increased risk over the general population. Forgetting prostate cancer and screening is much more critical in those patients. There are also certain demographic groups. African-American men are at increased risk, so those men need to certainly pay attention and possibly be screened at a younger age. So those are the two main factors I would say, but of course anyone with symptoms that are sort of coming on and getting worse should make sure that they've at least had a discussion with their primary care doctor and double-check that they had a PSA blood test that was normal.
And one thing I should mention is when you look at PSA, you shouldn't just look at the absolute value of PSA. You should be looking at the trend of your PSA over time. So people use four as the cutoff because that's the normal reference range on most of the lab reports, and you know fortunately or unfortunately now we have access to all of our medical records at all times, and that often leads to people, you know, looking at their own records and interpreting them themselves. That's not always the best way to go because if you look at your PSA, you have to consider your age, you have to consider your symptoms, you have to consider your family history plus or minus when you're looking at that number, and having a PSA of less than four may not always be considered normal when you look at it.
The reference range of the lab states that that's normal. So for example, age related PSA, a PSA of three may not be normal in somebody who's 50 years old. So you really need to look at these numbers and have somebody who knows what they're doing explain them to you in the proper context.
Paul Szmal: Find out more at ampofny.com or with Dr. David Schnapp in an upcoming FLX Morning.
