Episode Transcript
[00:00:01] Speaker A: From Riverside Health system. This is the healthy you podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients, and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
All right. I am really excited to have with me today in the healthy you studio, Trevor Cable. Trevor is a physician assistant with Riverside urology specialist. Hi, Trevor.
[00:00:38] Speaker B: Hello.
[00:00:39] Speaker A: We are going to be talking on this episode about navigating prostate cancer and when to screen and treatment options.
[00:00:47] Speaker B: Sounds like a plan.
[00:00:48] Speaker A: Sounds like a plan. Welcome. Welcome. Tell me a little bit about how you ended up in the field.
[00:00:53] Speaker B: So I became a physician assistant after being in the fire department for ten years.
[00:00:58] Speaker A: Okay.
[00:00:59] Speaker B: And I had an undergrad degree before I went into the fire department. Never knew that I enjoyed medicine, but when I was in the fire department, I had to become a paramedic. And when I was going through my medic classes, had a wonderful registered nurse paramedic named Anne Mack of registered nurses through the Virginia beach rescue squad.
And so she just made it so exciting to learn about medicine and to study medicine. And I thought then, if I had only known this in undergrad, maybe I would have done something different when I left undergrad, but I didn't. And I was committed to the fire department. But as I aged, I thought it might be nice to use that undergrad degree and learn more medicine.
[00:01:46] Speaker A: Oh, great, great, great. Well, thank you for your commitment. September is prostate cancer Awareness Month, and we're here to provide invaluable information to our viewers on when men should consider, you know, screening and how to navigate the many treatment options available.
So, thank you. All right, let's dive in a little bit further before we jump into everything. Right.
Tell me a little bit about what is prostate cancer.
Give our viewers a little background of what that is. Some people don't always know.
[00:02:23] Speaker B: All right, so first of all, the prostate is for anybody assigned a male at birth. And some men are not aware that they have a prostate or not aware of where it is. And so it's between the rectum and the scrotum, or another way of looking at that is between the bladder and the rectum. And over time, especially as we age, it can just like kind of any part of our body start to have dysfunctional cells and that become cancerous. And so, yeah. So yearly screening is the best way.
[00:02:57] Speaker A: To kind of stay on top of that. Yes. Tell me a little bit about how you ended up in the field of urology.
[00:03:04] Speaker B: So I ended up in the field of urology from.
From Riverside's Tim Connell, who's a recruiter. He kind of told me to stop applying for cardiology jobs because I was not qualified when I first finished PA school. And so I applied for urology, and I met with Doctor Burgess. And doctor Burgess share a lot of. Share some similarities there as far as kind of country boys at heart and smiling all the time, and that can do attitude. And he just sold me on urology. And ever since then, urology is home.
[00:03:39] Speaker A: Okay, so now that we've talked a little bit about what the prostate is and a little bit about the background of your field, let's talk a little bit more about the presence of those cancerous cells, but also how they affect the body and all of those things that occur.
[00:04:00] Speaker B: Prostate cancer is unique in the sense that it doesn't often have symptoms until later stages.
We recommend the yearly screening for, depending on the person, age 50, kind of at the latest, or 45 if you're african american, or if you have a first degree relative, such as a brother or father, that have had prostate cancer diagnosed before age 60, and then even age 40 for those that are even higher risk.
Again, maybe somebody that's had two first degree relatives that have been diagnosed with prostate cancer at a younger age or African American that had prostate cancer, first degree relative that was diagnosed before age 60.
And prostate cancer is unique in the sense that since it doesn't have the symptoms, the only symptoms that you're gonna have typically are once it's outside of the prostate. And at that point, we're talking about metastatic prostate cancer, and that's much more difficult to deal with than if we catch it early?
[00:05:01] Speaker A: I don't know if it's me, but you're hearing more and more about prostate cancer, so I don't know if that means it's on the rise.
And then why is it more prominent in African Americans? Is there research that's kind of identified?
What are some predispositions that make that culture more prone to prostate cancer?
[00:05:24] Speaker B: So the awareness part is good? Yes, it's absolutely good. And then it affects one in eight Mendez.
[00:05:31] Speaker A: Okay.
[00:05:31] Speaker B: Higher likelihood if you're african american. So, yeah. So race is one of those factors, is one of the risk factors.
African american men have a higher likelihood of developing prostate cancer. They have a higher likelihood of developing aggressive prostate cancer, and then also a higher chance of passing away from.
[00:05:50] Speaker A: Is it because it's in that population, potentially maybe later detection.
[00:05:55] Speaker B: So some of it, yeah, so some of that, absolutely.
But then also just genetics. So the three big risk factors, age greater than 50, race, and then the third one is just genetic or like family history.
[00:06:11] Speaker A: Family history. And, you know, I know just from, you know, being a nurse myself and just interacting with my own family members and just people that I meet, there's a big fear of the screening.
[00:06:21] Speaker B: Yes.
[00:06:22] Speaker A: And I try to just reinforce that. We always make you comfortable. Do you want to talk a little bit about that? And I think sometimes that's a barrier for individuals. Not.
[00:06:31] Speaker B: I agree.
[00:06:32] Speaker A: Being screened is because the fear.
[00:06:35] Speaker B: Yes.
[00:06:36] Speaker A: Of the screening itself.
[00:06:38] Speaker B: Prostate cancer screening on a yearly basis involves two things. The blood work, which is the PSA, that's prostate specific antigen, and the other part of the screening that we recommend is the digital rectal exam. And I think when you talk about the fear of the existence, the fear of screening, that's what they're afraid of.
I usually tell people, this is not Hollywood, this is not a movie, this is not anything other than a professional medical exam. And the digital rectal exam, that's digit for finger, not for iPhone. So sometimes I say digital rectal exam, and they pull out their phone, or they're looking at their phone, like, what?
But that physical exam is the finger in the rectum. To feel the prostate takes all of about 10 seconds, generally not painful. And those two tests together, the blood work and physical exam, give us the best chance of telling somebody, hey, you're good for a year, or, hey, something's off here, we need to investigate further.
[00:07:37] Speaker A: Yeah. And I think just in my opinion, I don't know how you feel about this. That's why it's so important to have a relationship with your primary care physician or even your urologist, someone that you trust and that you have a rapport with, really helps in those situations, I believe.
[00:07:55] Speaker B: Yes. And yeah. Whether it's urologist or the primary care, like being able to share that family history and find out, even if you're not 50, if you're 30 and you're following up with primary care on a yearly basis or whatever is recommended, sharing that family history, they can point that person in the right direction and share the expectations with them, kind of give them the best set of guidelines to go forth.
[00:08:19] Speaker A: Right. And I mentioned primary care because that might be where there may be a problem first identified. Right. That requires a referral, potentially. Right. To a urologist.
[00:08:29] Speaker B: Correct. Yeah. So usually we get the referrals because of an elevated PSA so elevated blood work and that blood work, the PSA is very whimsical, so skewed by a lot of things. Prostate cancer, prostate enlargement, prostate inflammation, ejaculation one or two days before the test, riding a bicycle four or five days before the test. So I always tell people, when you see an elevated PSA, the first thing is not to get concerned about it. We're going to retest, we'll re evaluate it, and then we'll go from there.
[00:09:03] Speaker A: And I know we touched on this a little bit. What are some early signs? Like? Sometimes I think they can be confused with maybe a urinary tract infection, you know, urgency frequency. What are some of the early signs and then what are some of the later signs that for awareness that you think would be helpful?
[00:09:21] Speaker B: So with prostate cancer, usually we'll see people in the office for prostate related urinary symptoms. So up a lot at night, weak stream, the sense of urgency, sometimes even urine leakage, because they can't hold back their urine. Those are actually signs more likely of just the prostate growing. The prostate grows for all men or for most men as we age. So the prostate can grow big like a pumpkin, or even small prostates can grow and kind of grow in and so obstruct the flow of urine. So often, or sometimes men will come to the office and say, I must have prostate cancer, or they think that maybe they have prostate cancer because of these urinary symptoms. That's more likely just the prostate kind of doing that.
[00:10:11] Speaker A: I think it gets to be a pumpkin size. Is there something external that would make you aware that it's about a size of pumpkin?
[00:10:17] Speaker B: So, I mean, just like the physical exam sometimes, you know, but it may not be anything.
[00:10:21] Speaker A: Maybe all internal.
[00:10:23] Speaker B: Yeah.
[00:10:23] Speaker A: Yeah. Okay.
[00:10:23] Speaker B: Okay.
So, yeah, so that's just more likely normal prostate tissue. Okay.
Yeah. So the signs of prostate cancer that are really just signs for any general cancer is just unplanned weight loss or, you know, this is kind of out when it's spread outside of the prostate. So unplanned weight loss or. I always tell people or ask people about bone pain. Do they have pain that just is ongoing, doesn't relieve with rest or with medicine, and it's unexplained.
[00:10:53] Speaker A: Maybe some blood in the urine, potentially. And it might not be visible sometimes, right?
[00:10:58] Speaker B: Potentially. But there's a lot of reasons for blood in the urine, too.
[00:11:01] Speaker A: That's true. That's true.
[00:11:02] Speaker B: Which there again, tricky.
[00:11:03] Speaker A: That's tricky.
[00:11:03] Speaker B: Come see your urologist and we can.
[00:11:05] Speaker A: Try to diagnose yourself.
[00:11:08] Speaker B: Blood in the urine is absolutely concerning whether we're talking prostate cancer, bladder cancer, or just enlarged prostate can cause blood in the urine.
[00:11:19] Speaker A: So as it relates to treatment, there seems to be a whole lot of conversation about personalized treatment. So it's not a one size fit. All right, you wanna talk a little bit about that.
[00:11:29] Speaker B: So ideally, you're doing shared decision making with your patients, and we go about kind of planning or choosing treatment options based on their pathology results from the prostate biopsy, and then also using the National Comprehensive Cancer Network, which has guidelines for those pathology results. And then, yeah, there's usually a multitude of treatment options for people to choose from, such as prostate removal. Prostate removal is the gold standard for localized prostate cancer.
There's stereotactic radiation, there's proton therapy.
Yeah. So there's great treatment options for prostate cancer if somebody develops prostate cancer.
[00:12:17] Speaker A: Sounds like, well advanced, right. So I guess there's probably sounds like there's more aggressive options and those all would be a conversation and individualized based on.
[00:12:30] Speaker B: Yes. Yeah. So like I. Right. Not a one size shoe fits all. And then also to take into consideration, you know, the potential side effects or the risk. So some people might only have localized prostate cancer, but, for example, the risk of prostate removal or the side effects of prostate removal is erectile dysfunction is pretty well known, or urine leakage. And although those can improve, some people are, you know, they're flat out against those side effects or trying to minimize those side effects. And so they might choose radiation over prostate removal for that reason.
[00:13:07] Speaker A: It's very informative. Good stuff there.
Let's talk a little bit more about.
How do you say this? The Gleason score.
[00:13:18] Speaker B: The Gleason score, yeah.
[00:13:19] Speaker A: Yeah. Talk about what that is.
[00:13:22] Speaker B: So that is the scoring system that we use for prostate cancer, Gleason. So although it goes to ten, the only numbers that you see are between six and ten, and a Gleason six is kind of, it's kind of slow, slow growing, boring, almost.
[00:13:40] Speaker A: Is that what you want, though?
[00:13:41] Speaker B: Yeah. If somebody's going to be diagnosed with.
[00:13:44] Speaker A: I want a boring score. Okay.
[00:13:45] Speaker B: Yes. If somebody's going to be diagnosed with prostate cancer. Yeah. Six is going to be the most favorable. Gleason ten would be more aggressive. Highly aggressive.
That dictates or that helps dictate the treatment options. And if somebody is diagnosed with Gleason six, sometimes even low volume Gleason seven, they can pursue active surveillance, which is actually not necessarily treatment, to get rid of the cancer, but just monitoring that.
[00:14:15] Speaker A: Prostate cancer treatment options, would that impact their ability, you know, if they still want children, men having had children, etcetera.
[00:14:27] Speaker B: To some extent, but since prostate cancer is usually a later diagnosis in life, most men are beyond that, but correct. Yeah.
[00:14:35] Speaker A: I mean, there's some having some children.
[00:14:37] Speaker B: Pretty late, some having some children pretty late, and then there can be early.
[00:14:42] Speaker A: Early diagnosis, but it doesn't have to impact that potentially.
[00:14:46] Speaker B: Correct.
[00:14:46] Speaker A: There's things that you can do if you know that that's something you want to do.
[00:14:50] Speaker B: Yeah.
[00:14:51] Speaker A: Okay.
[00:14:51] Speaker B: Or plan ahead.
[00:14:52] Speaker A: Plan ahead. Okay. That's good to know. It's just amazing how far treatment has come and the various options.
Anything else you want to add related to that that you think would be helpful for our viewers?
[00:15:07] Speaker B: Just the annual prostate cancer screening is absolutely the best bet of making sure somebody is okay. You know, it doesn't mean that there's not prostate cancer there, but if there's nothing suspicious found, that gives them the best chance and opportunity that they're good for that year, and then we'll follow up with them again the next year and we just. Yeah. Best way to detect early detection.
[00:15:34] Speaker A: Okay. How does physical therapy play a role in treatment?
[00:15:38] Speaker B: So in urology, we use physical therapy a lot, specifically pelvic floor physical therapists, and not just for prostate cancer, but.
[00:15:47] Speaker A: Also, I know women use that for women as well, for bladder dysfunction.
[00:15:51] Speaker B: Bladder dysfunction. Pelvic floor dysfunction. So whether or not somebody's having urine leakage. So urine leakage is one great reason to send somebody to see pelvic floor physical therapy. But the physical therapists are great, even if you're not having urine leakage, just if you're going too often or you're straining with urination. Because ideally, we don't strain when we urinate.
But as far as prostate cancer, we use it or we use the pelvic floor physical therapist or utilize them once the prostate's been removed, because urine leakage is such a prevalent side effect after the prostate's been removed, that men stand the best chance at gaining control of their urine leakage sooner and more efficiently with pelvic floor physical therapy. So sometimes men will say, I already know how to do Kegel exercises. I like to tell them, you read my mind. Kegel exercises are.
I'm not italian. I don't know why I use this example, but I tell them it's like knowing how to cook spaghetti. Okay, that's great. The pelvic floor physical therapists are going to teach you the whole italian cookbook. Okay, so Kegel exercises helps, but they can give you more exercises to strengthen that pelvic floor.
[00:17:04] Speaker A: Okay. I know that's a big thing. After, after you have. Give birth.
[00:17:08] Speaker B: Yes.
[00:17:08] Speaker A: To help build those muscles.
[00:17:11] Speaker B: Yes. And get that. Get that control.
[00:17:12] Speaker A: Yes, yes.
[00:17:13] Speaker B: Be prepared for those coughs or those sneezes.
[00:17:15] Speaker A: Yes, yes. That's good. Good. Great information.
There's been so much information and so many great pearls that you've provided. Again, key takeaway. What I'm hearing is screening, screening, screening. Annual screening. Don't know if you want to add anything to that, but I think things like this, I don't think I know things like this where we're reaching out and connecting with the community and helping them understand the importance is key as well.
I know for me, there's so many things we have to keep up with that are age related, whether it's colonoscopies or now I'm in that age group where I need the bone density and just keeping up with those things and timing around that. So important.
[00:18:00] Speaker B: And the primary cares are great for that because they'll keep you on point as far as what's needed and at what age.
[00:18:06] Speaker A: Yes. And I think, again, we mentioned this is having that relationship and rapport with your primary care physician that can help you navigate where you need to go and who you need to see as things evolve as it relates to urology and other things.
[00:18:23] Speaker B: Agree.
[00:18:25] Speaker A: Early detection.
[00:18:26] Speaker B: Early detection.
Going, going along with those annual screenings. Just sharing. Sharing the word with your friends that, hey, I've had, you know, I've done my prostate cancer screening for the year. How about you?
[00:18:39] Speaker A: Yes.
[00:18:40] Speaker B: Don't be afraid, you know, kind of sharing or whether they joke about it or just play it, you know, share outright, like, hey, don't be afraid, you know, that it's quick, it's painless, and I. Yeah. And it's the best way to know that you're okay.
[00:18:52] Speaker A: Yeah, I think just to reiterate. Great point. It's minimal to no discomfort.
[00:18:58] Speaker B: Yeah.
[00:18:59] Speaker A: Right.
And I think the benefit is, you know, you don't have to worry about all the things that may come if you don't do those things. Which would be more intensive than the protection.
[00:19:11] Speaker B: Right. And more uncomfortable and more.
[00:19:14] Speaker A: Yes, yes, absolutely. So before we wrap up, I'd like to leave our listeners with an interesting fact which we touched on a little bit earlier in our discussion.
But you know that not all prostate cancers require immediate treatment.
And in fact, some forms of prostate cancer are so slow growing that many men will never need treatment and can live out their lives without ever being affected. By the disease.
[00:19:42] Speaker B: Yes. So, and even those men, we still follow up with them if they are diagnosed with prostate cancer just once every six months just to check that PSA, maybe do some imaging, occasional another, you know, an additional biopsy. But yeah, prostate cancer, typically slow growing, great treatment options.
[00:20:02] Speaker A: Yes. And while that may be, it's important to your point to get the screening to make sure you fall in that category, not to assume that you do, right? Yes, absolutely. Great.
Thank you so much, Trevor.
[00:20:15] Speaker B: Yeah, thank you for having me.
[00:20:16] Speaker A: It's a pleasure having you sit down and talk with me today. You can come back anytime. All right.
So thank you for joining us. And to all of our listeners, thank you for listening. If there's a health topic you're interested in learning more about, please let us know and send us an email or an idea to Riverside strong.
Thank you for listening to this episode of Healthy Youth. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
