Dr. Scholz, can you explain what BPH is? So that's an enlarged prostate, but how does
that really affect a man in his everyday day-to-day?
Actually, it often doesn't affect men very much. We have a lot of men that come in because
their PSA is running high and they have no idea they have an enlarged prostate. You'd
think that every urinary difficulty that people have is blamed on big prostates, and, of course,
how ridiculous that is because women can have urinary difficulties and they don't even have
prostates. So, the issue comes down to sometimes when the prostate gets large, it can compress
the urinary passage that goes from the bladder out the penis and cause blockage—slow-flow—and
sometimes the prostate gets so large that is starts pushing into the bladder and the
residual capacity is reduced. So, that means that men are going to be going to the bathroom
more frequently than they would normally because their bladder isn't as big because it's being
replaced by a large prostate. So, these are just some of the things that large prostates
are known to do, but most men don't have any symptoms at all. They have a big prostate,
they may run a high PSA, but they don't really have any difficulties.
So, when we say an enlarged prostate, the normal average man's prostate size is 40cc;
what would be considered a large prostate?
Well actually, young men have 20cc prostates, so as guys get older, almost everyone's prostate
starts getting bigger and when you get to about 60-65 which is the age that I start
seeing men for prostate cancer, by then the prostate gland has gotten to about 40cc, but
they can be as large as 100-200cc in some men, and, of course, in my practice, I see
that a lot because those are the gentlemen that end up getting high PSAs, prostate biopsies,
and being diagnosed with prostate cancer. So, we have a lot of men who have enlarged
prostates. I'd say the typical amount of enlargement beyond the average 40cc is probably in the
60-80cc range.
Is there a certain group of men who would be more susceptible to BPH or is that not
known?
Yeah, we don't really know the cause. It probably is partly familial. There's been some suspicion
that low-grade infections cause some sort of a reaction and the prostate gets bigger.
It's purely speculative, and the cause of BPH is really not well understood.
So, we get a lot of questions on helpline where men may have BPH and then maybe they've
been diagnosed with that, but they're concerned they have prostate cancer because of the PSA
levels. So, can you explain how men can differentiate that with their doctor?
Yeah, so PSA is a non-specific test. It can be high from prostate cancer, BPH, prostatitis,
and we look at the size of the gland, as we've been talking about, and divide that by ten,
and that tells you what you would expect the PSA to be in a normal man who doesn't have
prostate cancer. So, a man with a 60cc prostate may have a PSA of around 6 and we would consider
that normal. That's not an elevated PSA even though when you look at the lab report it
says if it's about 4 that you have a high PSA. That high PSA is just a general rule
of thumb because it's nor incorporating how big the prostate is.
In regard to prostate cancer, if a man is diagnosed with prostate cancer but he also
has an enlarged prostate, are there any treatments that will not be available to him because
the prostate is so large?
Yeah, so there's advantages and disadvantages from a prostate cancer point of view. If you
have a very large prostate it becomes somewhat more tricky to do surgery and radiation because
you're treating a much larger area. On the other hand, if someone is thinking of one
of these newer investigational focal treatments, it's actually helpful to have a big prostate—there's
more margin for error. If you're going to try to take out a certain section of a small
prostate, you may end up taking out the whole prostate, and the goal with these focal treatments
is to try and help men not lose their sexual function. So the men with big prostate have
an advantage in that regard if they're thinking about doing focal therapy.
So, do men that have enlarged prostates, are they more predisposed to having prostate cancer?
Well, because their PSAs run high, they end up getting more prostate biopsies and as we've
talked about in other videos, men have—the more you biopsy them, the more prostate cancer
you find. The low-risk prostate cancers are everywhere in the male population. So, men
with big prostates get diagnosed more frequently. It doesn't mean that having a big prostate
leads to cancer. It just leads to the diagnosis of cancer. The types of cancers that they
get on these biopsies that are—we'll call them unnecessary biopsies—are low-grade,
and so when you look at the overall outcome from cancers in general in men that have been
diagnosed with prostate cancer, the men with big prostates do better and people suspect
it's because they're just finding these low-grade cancers and that you have a larger pool of
favorable cancers and so the statistics look better. There have been others that hypothesized
that the big prostate has an inhibitory effect on cancer, in general, and this is all speculation.
No one really knows the answer, but it's not a disadvantage to have a big prostate when
you're dealing with prostate cancer. It's probably an advantage.
Thanks for watching. If you would like more information about prostate cancer or any of
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