Big prostates, PCa--unrelated but commonly found in the same patients, expert says

Also join the must-see AnCan webinar on DNA and prostate cancer

By Howard Wolinsky

Gather ‘round, UriNation.

And hear Dr. Dean Elterman, a urologist at the University of Toronto/Princess Margaret Medical Centre, give the what’s what of urinary issues from his webinar held July 31 for Active Surveillance Patients International (ASPI).

I love the title. “Pissed Off: The many things that can go wrong with urination.” (Disclosure: I wrote the title and helped moderate the meeting, so I am biased.)

The session is not to be missed by any man with a urinary system: https://aspatients.org/meeting/pissed-off-the-many-ways-urination-can-go-wrong/

So that means most of us of a certain age would benefit from this webinar featuring Dr. E’s knowledge.

Urinary issues are a plague on men as we age. An enlarged prostate (benign prostatic hyperplasia or BPH) is the most common urinary problem we face. About 80% of men have BPH by age 80 sending us to the pisser many times overnight. Half have this problem by age 50.

(AAUrology.)

I had a close friend—the late, great Gene McDaniels, a medical writer with Associated Press--who in his 80s claimed that he went to the bathroom to urinate 80 times per night. He was exhausted and, well, pissed off.

(Some of that attitude had to do with Gene’s general outlook as a professional curmudgeon. But I have no reason to doubt that BPH vexed him a lot.)

Contrast the 80-90% incidence of BPH by age 80 with the 12.5% of us who will be diagnosed with prostate cancer in our lifetime.

According to the University of Pennsylvania, symptoms of BPH may include:

• Dribbling at the end of urinating.

• Inability to urinate (urinary retention).

• Incomplete emptying of the bladder.

• Incontinence.

• Needing to urinate two or more times per night.

• Pain with urination or bloody urine (these may indicate infection)/

• Slowed or delayed start of the urinary stream.

Elterman dispelled the myth that LUTS (lower urinary tract symptoms) are symptoms for prostate cancer. Ignore what the media and even some health organizations say about this.

(Read more about that issue in an article I wrote for Undark from MIT: https://undark.org/2022/11/24/what-public-health-messaging-gets-wrong-about-prostate-cancer/)

The ActiveSurveillor.com is a blog about low-risk prostate cancer.  So I’m focusing on in patients with lower-risk prostate cancer.

So what did Elterman have to say about urinary problems in patients like us who are on Active Surveillance or who opt for radical surgery?

How common is urinary incontinence following a radical prostatetctomy (RP)?

Elterman said:  “Almost all men will have some form of temporary urinary incontinence after a radical prostatectomy.  We're talking in the first days to weeks after. 

“We usually measure continence rates after a year. And with really good surgical treatments now using minimally invasive treatments, whether it's open or robotic, the continence rates are high. I'll put it over 90 percent. Probably about 10 percent will have incontinence lasting over a year. It used to be higher. And again, it depends on surgeons’ (individual) rates, but incontinence rates are fortunately lower than they used to be historically.”

The rates for post-RP impotence, unfortunately, have not improved as much.

In 2021 in the U.S., 60% of men with low-risk prostate cancer choose AS, close monitoring. Only 16% of men diagnosed with low-risk prostate cancer still choose RP.

Elterman said that following an RP, about 40 percent of men will have erectile dysfunction.

Again, he stressed that BPH and prostate cancer are not related though they can overlap in the same men.

“(BPH and prostate cancer) coexist, just because you're a man and you're getting to a certain age in your life,” he said.

The late George Burns, playing God in “Oh, God,” in the 1997 movie, described his biggest mistakes. He listed ostriches, tobacco, and avocados. “Made the pits too big,” he said.

He could well have included the prostate.

Elterman said these days fewer than 2% of patients undergoing TURPs--​​transurethral resection of the prostate, an operation mainly performed to treat men with an enlarged prostate --are diagnosed with prostate cancer based on biopsies of “prostate “chips” retrieved from the procedures. 

(Guac. Maybe with chips?)

But there is some good news here: “ The vast majority [of chips] are going to be Gleason 6,” said Elterman.

“The takeaway is just because you're on active surveillance, doesn't mean you can't treat your very common and very bothersome urinary symptoms and BPH,” he said.

One last thing. Myth-buster Elterman said there is no scientific proof that we need eight glasses of water daily. My family constantly is hounding me to drink more water to avoid dehydration.

He said only about four glasses a day is all that is required. 

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Dr. Morgan in AnCan webinar on DNA and PCa

By Howard Wolinsky

Don’t miss the AnCan webinar at 8 p.m. Eastern July 31 to help us navigate the genetics and genomics jumble featuring genetic guru Dr. Todd Morgan from UMichigan.

To register for the program, entitled “How and why PCa genomic tests work ... What's Inside the Black Box?", go to: https://tinyurl.com/ancanpcagenwebinar

The program is aimed at the full spectrum of patients with prostate cancer, from low-risk to high-risk.

Morgan will cover the difference between inherited and somatic testing, who should undergo genomic testing, and his randomized trial comparing the leading genomic tests, Decipher, Prolaris, and Oncotype DX. 

If you have some questions for Dr. Morgan, write to Joe Gallo at joeg@AnCan.org

Can’t make it? No worries. Just register, and we’ll send you the webinar.