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Healthy Guide
PROSTATE HEALTH / BPH
What Men Should Know About BPH Gyan Pareek, MD
Enlarged prostate, also known as benign prostatic hyperplasia (BPH), is a common condition that men experience.
As men age, the prostate grows. This increases the likelihood of symptoms, such as: • an urgent or frequent need to urinate • a slow or weak urinary stream • trouble completely emptying the bladder • difficulty or delay in starting urination • a urinary stream that starts and stops
For more information, contact the Minimally Invasive Urology Institute: 401-739-5400 | MIUItmh@lifespan.org | Lifespan.org/MIUI
While BPH is not often a topic of conversation, it is more common than you might expect. In fact, 50 percent of men who are age 50 or older may have symptoms. This increases 10 percent for each additional decade of life: 60 percent of men age 60, 70 percent of men age 70, etc.
Treatment options While there is not a test to diagnose BPH, symptoms guide treatment. The treatment for each patient is based on each man’s individual symptoms, prostate size, age, and tolerance of
potential side effects of treatment. Fortunately, we have a variety of treatments for enlarged prostate available at our Minimally Invasive Urology Institute (MIUI).
• Medications: Often, medications are given as an initial treatment for BPH. Some patients may not be able to tolerate the side effects of these medications. These may include
lightheadedness, dry mouth, low blood pressure, falls, headaches, erectile dysfunction,
retrograde ejaculation, reduced libido, nausea, or vomiting. If these occur and become burdensome, other treatment options should be explored.
• Transurethral resection of the prostate (TURP): This is a procedure designed to remove excess tissue that is blocking urine flow. The procedure may be performed on an outpatient basis or may include an overnight stay in the hospital.
• UroLift: This is an outpatient procedure that helps to create an unobstructed passage of urine. The procedure uses suture-like implants to move prostate tissue that is blocking urine flow,
without any cutting, heating, removal of tissue, or sexual dysfunction. Patients resume normal urinary function and daily routines within about one week.
• GreenLight laser prostatectomy: A minimally invasive and highly effective procedure that
uses a laser to remove prostate tissue that is blocking the flow of urine. It is performed on an outpatient basis.
• Simple prostatectomy: For men who have extreme enlargement of the prostate, or for those
with a significant obstruction or urinary retention concerns, there is another option – a simple prostatectomy. A robot-assisted simple prostatectomy is a minimally invasive approach to
what was traditionally performed as an open surgery. The robot-assisted simple prostatectomy allows the surgeon to more precisely remove the inner part of the prostate. The benefits of
performing this surgery with robot assistance include smaller surgical incisions of one inch or
less, less blood loss during surgery, reduced need for blood transfusion, less pain and discomfort, a shorter hospital stay, and faster overall recovery. The MIUI performed the first robot-assisted
simple prostatectomy in New England and is one of only a few institutes to offer this treatment.
For more information, contact the Minimally Invasive Urology Institute: 401-739-5400 | MIUItmh@lifespan.org | Lifespan.org/MIUI
There are also lifestyle changes you can make to minimize the symptoms of BPH. If you smoke, quit. You should also avoid or limit foods or drinks that can irritate the bladder, including: • alcohol • caffeine • spicy foods • chocolate • citrus • carbonated drinks Many men will cut back on how much water they drink in an effort to reduce frequent trips to the
bathroom. Actually, this can negatively affect you. It is important to stay hydrated throughout the
day. If you are getting up multiple times overnight to use the bathroom, try to avoid drinking large amounts of fluids right before bedtime.
There is no need for men to suffer the effects of an enlarged prostate. With new and evolving
minimally invasive procedures, our team will work with you to identify the best treatment options to help you get back to your life.
Minimally Invasive Urology Institute Delivering Excellence in Urologic Patient Care, Education & Research
Nationally-Ranked Urologic Care, Specialized for Each Patient The Minimally Invasive Urology Institute (MIUI) at The Miriam Hospital offers specialized urologic
care through a variety of treatment options including minimally invasive laparoscopic and robotassisted procedures.
Minimally invasive procedures use advanced technology to reduce damage to surrounding tissue while performing surgery.
This type of surgery is performed through small keyhole incisions, with a miniature camera that magnifies the image on a video monitor in the operating room.
This state-of-the-art technology expands the surgeon’s visibility and provides a range of motion that is superior to the range of motion in the human wrist.
For more information, contact the Minimally Invasive Urology Institute: 401-739-5400 | MIUItmh@lifespan.org | Lifespan.org/MIUI
Prostate Cancer and Separating Fact From Fiction Elias S. Hyams, MD
After skin cancer, prostate cancer is the most commonly diagnosed cancer in men in the United States.
Prostate cancer has varied behavior – it can be slow growing and not affect health or longevity,
or it can be aggressive and potentially lethal. This presents a challenge: how do we identify more aggressive types of prostate cancer in a window of curability, while sparing men with slow-
growing prostate cancer unnecessary testing and diagnosis? Fortunately, sophisticated tools have emerged to help us better understand which men are at highest risk.
Here are some common questions and answers about prostate cancer to ensure men have the facts, rather than fiction, about this disease.
For more information, contact the Minimally Invasive Urology Institute: 401-739-5400 | MIUItmh@lifespan.org | Lifespan.org/MIUI
Should I have prostate cancer screening? “Screening” is checking men for their risk of cancer before any symptoms arise. This is important for prostate cancer because symptoms typically only appear once a prostate cancer is more
advanced. PSA, or “prostate specific antigen,” is the most common screening test for prostate cancer. It is a chemical made by the prostate that is measured through a blood sample. The
main limitation of PSA is that it can be elevated for reasons unrelated to cancer, such as prostate enlargement or inflammation. Nonetheless, it is a quick, inexpensive, and useful starting point for
discussion. PSA is generally drawn in a primary care provider’s office after a discussion of risks and benefits of screening, in light of a man’s age, other risk factors, and preferences.
Should you, a friend or a loved one have a screening PSA? The answer is not simply “yes” or “no.” Guidelines from professional societies, including the
American Cancer Society, state that men should have discussions with their doctor regarding screening somewhere between ages 40 and 50, depending on their risk factors.
While age is the biggest factor for prostate cancer there are other important risk factors to consider, these include:
• African American descent • a father or brother with prostate cancer diagnosed before age 65 • multiple relatives with other malignancies • lifestyle and dietary habits Men at higher risk should start the conversation sooner, as early as age 40 to 45. Men without risk factors should consider screening starting at age 50.
Men should not be screened into their later years. If a man has an acceptable PSA and lacks
other risk factors by age 70 to 75, the evidence suggests that further screening is unlikely to find dangerous cancer, and is more likely to detect a slow growing, age-related cancer that isn’t consequential to a man’s health.
What should I do if my PSA is elevated? Unfortunately, there is no single “cutoff” for a normal PSA. The number will be influenced by age,
prostate size, some medications, and other factors. Your doctor can help interpret your PSA in light of your overall risk and decide whether a discussion with a urologist is warranted.
For more information, contact the Minimally Invasive Urology Institute: 401-739-5400 | MIUItmh@lifespan.org | Lifespan.org/MIUI
A urologist will review your risk factors and give you options for further testing. The doctor may
reassure you that your numbers are acceptable and you can be monitored. Other blood and urine tests may be sent (“biomarkers”) that help assess risk more accurately than a PSA. You may be
referred for a prostate MRI to look non-invasively at the prostate to determine if your risk is elevated. If there is sufficient concern, a urologist may recommend a prostate biopsy to determine whether cancer is present.
What is a prostate biopsy and does it hurt? A prostate biopsy is typically an office-based procedure done with local anesthesia, in which a
small needle is placed in the prostate to obtain samples of tissue. This is generally done using a
combination of images from ultrasound and magnetic resonance imaging (MRI) to target the areas of greatest concern. The procedure can be done across the rectal wall (transrectally) or across the skin behind the scrotum (transperineally). Generally 12 biopsies are taken, with additional biopsies as needed. The procedure is relatively quick, lasting 10 to 15 minutes.
Comfort and safety are prioritized, with generous numbing medication and antibiotics to prevent infection. Most men are pleasantly surprised by its tolerability. It is not uncommon for there to be
some blood in the urine, bowel movements, and/or semen afterward, which typically resolve quickly. Critically, biopsy is reserved for men with the highest risk, for whom the relatively minor risks and discomforts of biopsy are warranted to ensure there is not a greater threat.
If I have prostate cancer, what are my options? It depends. If a slow growing type of cancer is detected, men are encouraged to pursue
“active surveillance,” a monitoring approach to avoid unnecessary treatment in the short- and
possibly the long-term. If there are signs of aggressiveness, it is recommended that men have a
multidisciplinary team of experts from urology, radiation oncology, and possibly medical oncology. Treatment options may include surgery (typically by a robotic-laparoscopic approach), radiation therapy (various types of external beam radiation therapy or brachytherapy), or others.
Fortunately, there has been tremendous progress in prostate cancer therapies to improve cure rates while preserving quality of life, including urinary and sexual function. Men vary in their
preferences for treatment and risk factors for certain side effects, thus a “shared decision-making” approach to educate men on options and guide them to the best treatment is encouraged.
For more information, contact the Minimally Invasive Urology Institute: 401-739-5400 | MIUItmh@lifespan.org | Lifespan.org/MIUI
Men and PSA: To Test or Not To Test? Miminally Invasive Urology Institute
Prostate cancer is the most common cancer and the second leading cause of cancer death
among men. The disease is most common in men over the age of 65, and African-Americans are at increased risk. One in seven men is diagnosed with prostate cancer.
Prostate cancer is a slow-growing cancer, meaning it may not cause any noticeable symptoms until the disease has reached an advanced stage. Once prostate cancer progresses or spreads
outside the prostate gland, it’s usually more difficult to treat, which is why diagnosing the disease early, while it is still confined to the prostate, and still treatable, is key to survival. That’s why a prostate specific antigen (PSA) test is so important.
What is a PSA test? PSA tests measure blood levels of prostate-specific antigen, a protein produced by the prostate gland. The higher a man’s PSA level, the more likely it is that he has prostate cancer. However,
For more information, contact the Minimally Invasive Urology Institute: 401-739-5400 | MIUItmh@lifespan.org | Lifespan.org/MIUI
there are other benign medical conditions that can cause a man’s PSA level to rise, and some men who have prostate cancer have normal PSA levels. As with the decision to screen, our team believes that physicians and men should make a shared decision whether to proceed with a biopsy to confirm the diagnosis. A government panel questioned whether this test improves cancer survival. They determined that PSA screening leads to widespread over-treatment, unnecessary procedures, and complications like incontinence or impotence, which outweigh the benefits of testing. Recently, the U.S. Preventive Services Task Force recommended against routine prostate-specific antigen (PSA) screening for prostate cancer. As a result, this has left many men confused and wondering how to defend themselves against a cancer that’s expected to claim the lives of more than 28,000 men this year. Even with these limitations, the urologic community continues to recommend PSA screening in a large majority of men. That’s because there has been a measurable reduction in death from prostate cancer over the last three decades that can be directly correlated to the introduction of PSA as a screening tool. Although the test isn’t perfect, the PSA, combined with a digital rectal exam, imaging if appropriate and a biopsy is the best way to diagnose prostate cancer. Rather than discouraging men from having a PSA test, we believe in a personalized approach based on each man’s age, medical history, and other risk factors. We also feel that a discussion about the pros and cons of screening is the best strategy. In fact, a confirmed diagnosis of prostate cancer may not require treatment. Because prostate cancer is relatively slow growing and some malignant tumors may not be life-threatening, “active surveillance,” or regular monitoring for cancer progression, can be the best course of action. Treatment options may include surgery, generally considered the gold standard for high-risk disease. Outcomes and recovery for the different surgical options (robot-assisted laparoscopic radical prostatectomy, laparoscopic radical prostatectomy, and open radical prostatectomy) vary and are discussed more here. Other treatments may be chemotherapy, radiation, or hormonal therapy. The real issue isn’t whether prostate cancer should be diagnosed, but rather when those cancers should be treated versus actively observed. Lives will be saved by selecting the appropriate men for screening and treatment and providing education so they can make informed decisions about their healthcare. What’s most important is a discussion with your physician about the pros and cons of all your treatment options.
For more information, contact the Minimally Invasive Urology Institute: 401-739-5400 | MIUItmh@lifespan.org | Lifespan.org/MIUI
It’s in the Genes: the Link Between Prostate Cancer and Breast Cancer Christopher Tucci, MS, RN-BC, CURN, NE-BC, FAUNA
Did you know a family history of a certain type of breast cancer can increase a man’s risk of developing prostate cancer?
Many aren’t aware of the link between those two cancers, although they do share a few
similarities. Prostate and breast cancer are both the second-most common cancers in men and
women, respectively. Approximately 13 percent of women will develop breast cancer while about 12 percent of men will be diagnosed with prostate cancer.
It’s in the genes The relationship between breast cancer and prostate cancer is all in the genes. The human
body contains about 20,000 different genes. Each gene contains what is known as DNA– that
For more information, contact the Minimally Invasive Urology Institute: 401-739-5400 | MIUItmh@lifespan.org | Lifespan.org/MIUI
is commonly thought of as the blueprint to the human body. Sometimes genes can mutate, increasing the risk of certain cancers.
Two gene mutations often in the spotlight for breast and ovarian cancers are called BRCA1 and
BRCA2. (BRCA1 is an abbreviation for BReast CAncer gene 1 and BRCA2 stands for BReast CAncer gene 2.) Because genes are inherited from both parents, men and women alike have the BRCA1
and BRCA2 genes and will pass these on to their children. It is important to note that it is not the
BRCA1 or BRCA2 gene itself that increases the risk of certain cancers – it is the mutation of a gene that does.
Men with BRCA1 and BRCA2 gene mutations experience more aggressive forms of prostate cancer, with a higher risk of cancer recurrence and a lower overall survival rate. Men with BRCA1 gene
mutation have a seven to 25 percent risk of prostate cancer, while men with BRCA2 mutation have between a 20 and 60 percent lifetime risk of developing prostate cancer.
Family medical history Knowing your family history is essential! Men should ask both parents if there is a family history of
breast, ovarian or prostate cancers. If either parent is aware of BRCA1 or BRCA2 gene mutations or if there is a history of prostate cancer, men are at increased risk and should have a conversation
with their healthcare provider. If there is a family history of BRCA1 or BRCA2, a blood test can help identify any gene mutations.
Other risk factors Besides BRCA1 and BRCA2, there are other risk factors for prostate cancer. Those include: • a family history of prostate cancer, specifically a first-degree relative who was diagnosed with prostate cancer before age 60
• black race • smoking • obesity or a sedentary lifestyle • high-fat diet • alcohol use
For more information, contact the Minimally Invasive Urology Institute: 401-739-5400 | MIUItmh@lifespan.org | Lifespan.org/MIUI
Get screened It is important for men to have a conversation with their provider to discuss whether screening is appropriate for them.
• Men at high risk for prostate cancer should start screening between the ages of 40 and 45 with a PSA blood test and rectal exam by their healthcare provider.
• For most men without risk factors, we recommend having a conversation with your provider and beginning screening at age 50 with a PSA test and rectal exam.
For more information on prostate cancer, visit our website.
For more information, contact the Minimally Invasive Urology Institute: 401-739-5400 | MIUItmh@lifespan.org | Lifespan.org/MIUI