- Do you know what the most misunderstood organ
in the male body is?
- The prostate!
- Hey how did you get in here?
I'm gonna say a word, and you tell me the first
thing that comes to your mind.
Prostate.
- What is it?
(Laughing)
- Most people don't know where it is.
- Lower, somewhere over here.
- Back here somewhere.
- I have no idea.
- If they know where it is, they don't know
what it does.
- It gets cancer and causes me problems as I get older.
- And if they know what it does, they don't know how
it does it. And if finally they know how it does it,
they don't know what can go wrong with it, so
I'm going to answer all those questions, and more,
starting now.
(Piano music)
Do only males have a prostate?
- I believe so? I don't know, is that a trick question?
- Ladies, I'm sorry to say, only guys have a
prostate. It causes us a ton of problems.
The prostate is a small walnut sized gland
that sits right below your blad-
why am I explaining this to you when I can show you
using my trusty side-kick, the male reproductive
system.
You have the bladder, the rectum, the anus, the
prostate, the penis, the urethra, the testicle, and
that's the prostate, but let me explain to you
the flow of urine and sperm, because they go exactly
through the prostate. That's right, so your urine is
stored in the bladder here, and then in gets released
into the urethra, right here, and it goes down, all the
way and out your penis, right? Then you have the
ejaculatory duct, which comes all the way from around
the testicle, and that comes in to here, and also
comes into the urethra. It's like the merging of two
highways, and when these highways merge, it becomes
one path, the urethra, and this is where the sperm
and urine both come out from.
All right, we'll come back to this.
(Cat meowing)
Let's talk about what the prostate actually does.
The main job of the prostate is to secrete a
milky white fluid that nourishes and protects your
sperm. Approximately thirty percent of your semen is
made up of this fluid. This fluid is alkaline or basic,
which means it has a high pH, so it protects the sperm
in the acidic environment within the vagina. It
basically allows your sperm to reach and fertilize the egg.
Fun fact: Did you know, "prostatitis", in Greek
literally means "protector" or "gaurdian". This guy
knows his stuff.
The prostate needs testosterone, specifically
dihydrotestosterone. It needs it to function properly,
and to mature your prostate when you're younger, but as
we'll see later, overtime extended exposure to the hormone
can create problems with your prostate.
The prostate, just like any other organ, can have things
go wrong with it. Most commonly you'll hear the acronym
"BPH", and that stands for benign prostatic hyperplasia.
Let's take that one work at a time, though Benign, meaning
innocent, prostatic, meaning prostate, duh, and
hyperplasia, meaning an increase in the number of cells.
Basically what happens is, as men age, the prostate gets
bigger in size, because of new cell creation. Now let
me explain that a little bit further with the help of
my trusty side-kick.
(Snaps)
You have a transition area in your prostate, but let me
show you up close. This transition zone surrounds
the urethra, and the urethra is the area that the urine
comes through, from the bladder, into the penis, so it's
this area right here that actually has new cell formation,
and those new cells end up putting pressure, by pushing
onto the urethra, therefore making it difficult for urine
to pass through this little tunnel.
As you can imagine, this is very uncomfortable, as it
prevents you from urinating properly. Some common symptoms
as a result of this can be excess urination at night,
weak stream, dribbling of urine, difficulty urinating, and
as a result of this you can get retained urine in the
bladder, and when you have retained urine in the bladder,
that can lead to infection, stones, or even bladder rupture.
Now there are treatments to fix this problem, most
commonly being medicines. Now being a family medicine doctor
I often treat people with these medications, and there are
two classes of medication that we reach for when we
treat benign prostetic hyperplasia. Number one are those
that focus on relaxing the smooth muscle surrounding the
urinary tract within the prostate. The second class of
medications are ones that focus on blocking the
dihydrotestosterone, which makes the prostate increase
in size due to the creation of new cells. By blocking this
you basically shrank the prostate down. There are also
minimally invasive treatments available utilizing
radio waves, lasers, micro-waves, and that's why it's
important to have a conversation with your doctor
if you're facing any one of these issues.
(Piano music)
Next up, prostate cancer. Number one cancer males,
number two leading cancer death in males. Basically
speaking, prostate cancer is an uncontrollable accumulation
of abnormal cells. Generally prostate cancer is diagnosed
in men over the age of fifty. On autopsy, up to eighty
percent of men over the age of 70 will have some sort of
prostate cancer. In fact, most people live with prostate
cancer, and end up dying from other causes as it's
usually a very slow growing cancer. Local or regional
prostate cancer has a five year survival rate of
one-hundred percent, and a ten year survival rate of
ninety-eight percent, and a fifteen year survival rate
of ninety-six percent. Now prostate cancers that have
spread to other body parts, or metastasized to other body
parts, have a worse survival rate. The five year survival
rate being around thirty percent. What is metastasis,
and why is it bad? Well some of those abnormal prostate
cells, that are creating the tumor, can actually break
away from the prostate and travel to other body parts,
via the blood, or lymphatic system, and when that happens,
those cells start to proliferate within that area, and
cause dysfunction.
(Piano music)
Diagnosis of prostate cancer is made by a combination
of imaging plus biopsy. When you get a biopsy,
the doctor will get report back with your gleason score.
The gleason score goes from two to ten, rating how
aggressive your cancer is, with ten being the most
aggressive type. The treatment of prostate cancer is decided
on a case by case basis. Recently we've made a lot of
strides in using what we call a period of watchful
waiting, or active surveillance in non-invasive, and
low gleason score tumors. Deciding upon active surveillance
or other treatments is a very nuanced matter, and it's
really important that you have a healthy cline of
communication between you and your doctor.
(Piano Music)
The PSA test is a blood test that checks for the
prostate-specific antigen within your blood. The PSA
is something that both normal, and abnormal cells within
your prostate secrete. We have a normal range that we
expect this number to fall into, and if you have cancer
it's possible that number can go up. Also if you have an
inflamed or enlarged prostate, that number can go up as
well. Here's the dilemma with the PSA blood test.
You want to catch prostate cancer early if it's an
aggressive cancer, because the earlier you catch it, the
better your chances of survival. A large percentage of
prostate cancer's that we find using PSA's would've never
caused symptoms for patients within their lifetimes,
so on one hand you want to catch as many aggressive cancers
as you can, as you can treat, and on the other hand, you
don't want to catch cancers that are not necessarily gonna
do any harm. There is no universal recommendation on who
should get a PSA test. This is because the test can carry
some benefit, but can also carry significant harms. If the
test comes up positive, you can be over-diagnosed with
prostate cancer, meaning that you'll find a cancer that
would've never caused you any problems in your lifetime.
You could also get a false positive, leading to a
biopsy that wasn't necessary, and carries it's own set
of complications. And worst of all, at least worst of all
in my opinion, you can get a false negative, which means
that you actually have a cancer, but the test falsely
reassures you that you do not. Being a family medicine
doctor, I firmly believe in prevention. I want to prevent
problems before they happen, I want to catch cancers early,
and be as aggressive as possible, but I want to make sure I
do that without increasing the harms over that benefits.
In my opinion, I think PSA testing is just too much of
an imperfect tool to recommend it to my patients.
I think that the PSA test is inaccurate, because at times
it can be falsely elevated with inflammation, or an
enlarged prostate, which occurs to many men as they age.
You can have low readings, because of obesity or certain
medications you take, so I don't want to expose my patients
to unnecessary harms, unless I'm certain of the benefits.
That doesn't mean you shouldn't get your PSA checked,
what it does mean is that you should have a very, very
specific conversation with your doctor on whether or not
this test is right for you. I've had patients say, but
I have a family history, shouldn't I get a PSA test at this
specific age, or this specific age, and the answer is
probably not, but then again we just don't know the answer
to it, because we don't have the proper research to give
you an honest answer, and again, I've said this before,
a good expert knows when to say I don't know. There exists
another preventative measure that's very commonly associated
with prostate cancer, and that's the DRE. The digital
rectal exam, and it's exactly what you think it is. It's
a digit, a finger, from the behind, to make sure that the
prostate doesn't have an masses, it doesn't have an
unusual shape, it's not larger than normal. While
this test is widely used, its evidence for finding cancers
and for extending life, is relatively weak.
Now that doesn't mean the test is useless, because
it definitely has some utility, but it's important
that you discuss with your doctor whether or not you need
the prostate exam, or if it's something you could pass on.
This has been the prostate in a nutshell. Specifically
a walnut nutshell, because the prostate is the size of a...
You guessed it, a walnut.
My goal in making this video is not to scare you, it's to
empower you to make quality healthcare decisions for
yourself, or your family members.
I have worked with the Movember Foundation, I have worked
with the Prostate Cancer Foundation, recently just did
the Blue Jacket Fashion Show with them, for Men's
Fashion Week. If you want some more information about
prostate cancer, or the prostate in general, I'm putting
some links down below in the description box.
If you learned something from this video, please give it
a like. Share with your friends and family, because we
could all benefit from some extra medical knowledge.
And as always, if you have a question or unique experience
with prostate cancer, leave it down below in the comments.
As always, stay happy and healthy.
(Piano music)