The latest presentation in the Carolina Meadows update series was mostly a guy thing. Dr. Eric Wallen, a urology clinical associate professor at UNC, in an excellent presentation talked about the problems that older men encounter with the prostate and bladder.
The prostate is a gland at the base of the bladder that has largely done its thing during male reproductive years. Unfortunately, it can be the site of infection (prostatitis) any time in a lifetime. The gland does get bigger with age. That is called BPH or benign prostatic hypertrophy.
Prostate in Greek means “one who stands there”. That is an apt anatomical description for the older male at 70 who can’t void the way he did at 20. The difficulty in intermittent voiding at 70 most likely will be due to the prostate getting bigger.
Dr. Wallen emphasized the importance of blood if seen or found in the urine even for the first time. The reason needs to be determined. BPH alone can produce it but so can cancer in the prostate, bladder or kidneys. Infection, especially in the bladder, can also be a cause of hematuria or blood in the urine.
The incidence of cancer parallels the enlargement of the prostate, but it may be present for many years and not cause symptoms. The most sensitive way of finding cancer in the prostate is with blood drawn from the patient. The blood has a marker called PSA (prostate specific antigen).
Although there is some controversy, Dr. Wallen feels it is an excellent annual screening test. If the PSA has risen significantly above normal the prostate can be biopsied with ultrasound guidance. A more recent imaging method to help find the cancer is a combination of CT and radioisotopes.
The long standing surgical treatment for both prostatic cancer as well a BPH has been TURP or transurethral prostatectomy. Fortunately with a 10-percent possibility of incontinence and difficulties with erection after a TURP, it is being replaced with medications.
These help especially in shrinking the prostate and promoting easier urination. If prostatic cancer is present treatment plans still include transurethral resection (possibly by robot), placement of radioactive seeds, or linear acceleration radiotherapy.
Bladder cancer is 3 times more common in men than women and especially if there is a history of smoking in either. There are two types of bladder cancer. One invades the bladder lining. It can be dealt with through instrumental (the cystoscope) resection or if it recurs. Cancer in the bladder wall is formidable. It can spread locally or metastasize. Extensive surgery and radiation therapy may be required.
Dr. Wallen during question time emphasized although he and his colleagues can be quite busy, they work with helpful, well-trained nurse practitioners. They can be readily contacted for advice and putting the patient in touch with a urologist.
A medical update from resident PR Committee member Dr. James Scatliff