1
00:00:00,400 --> 00:00:04,960
Speaker 1: There's research out on prostate and large prostates. This isn't cancer.

2
00:00:05,040 --> 00:00:08,680
Speaker 1: It's a common, non cancerous prostate condition. It affects almost

3
00:00:08,680 --> 00:00:13,400
Speaker 1: one hundred and ninety four thousand South Australian men aged

4
00:00:13,440 --> 00:00:18,680
Speaker 1: over fifty and it can compromise and is compromising their physical, mental,

5
00:00:18,760 --> 00:00:22,000
Speaker 1: and social health and well being, according to the latest

6
00:00:22,120 --> 00:00:25,840
Speaker 1: research out. Doctor Dan Spernat is a urologist and he

7
00:00:26,040 --> 00:00:27,760
Speaker 1: joins me now, Dan, good morning.

8
00:00:28,480 --> 00:00:30,280
Speaker 2: Good morning, Matthew, thank you so much for having me.

9
00:00:30,440 --> 00:00:32,040
Speaker 1: That is a lot of people, and that's just in

10
00:00:32,080 --> 00:00:35,479
Speaker 1: South Australia. So this is a common condition. Do all

11
00:00:35,520 --> 00:00:37,239
Speaker 1: men suffering a large prostate?

12
00:00:38,680 --> 00:00:42,000
Speaker 2: Eventually most of us will so by the age of

13
00:00:42,080 --> 00:00:45,440
Speaker 2: eighty around eighty percent of us will, but at fifty

14
00:00:46,280 --> 00:00:48,919
Speaker 2: forty percent of us will. So it's a really really

15
00:00:49,000 --> 00:00:52,440
Speaker 2: common condition and massively affects people's quality of life.

16
00:00:52,960 --> 00:00:56,640
Speaker 1: What do we need to look out for so people.

17
00:00:56,360 --> 00:00:59,040
Speaker 2: Can present with a combination of symptoms, And the way

18
00:00:59,080 --> 00:01:01,400
Speaker 2: we look at it is that there are the obstructive

19
00:01:01,440 --> 00:01:05,800
Speaker 2: symptoms often first, and they're the poor flow, the difficulty

20
00:01:05,800 --> 00:01:09,319
Speaker 2: in initiating a urine strength. And the way I explain

21
00:01:09,360 --> 00:01:11,560
Speaker 2: it to my patients is that if you're at the

22
00:01:11,640 --> 00:01:16,880
Speaker 2: urinal at the footy and you're finding that you're going

23
00:01:16,920 --> 00:01:19,640
Speaker 2: to the toilet, someone's coming in after you and finishing

24
00:01:19,720 --> 00:01:23,600
Speaker 2: before you. That means your stream's pretty slow, and that's

25
00:01:23,640 --> 00:01:26,640
Speaker 2: often one of the first symptoms. But as the disease progresses,

26
00:01:27,280 --> 00:01:32,000
Speaker 2: the bladder fails to really to compensate for this blockage

27
00:01:32,160 --> 00:01:36,480
Speaker 2: and it becomes very thick and muscular, and then bladders

28
00:01:36,480 --> 00:01:40,920
Speaker 2: become unstable, and that's when they contract irregularly and make

29
00:01:40,959 --> 00:01:43,200
Speaker 2: people go to the toilet very frequently. So in that

30
00:01:43,280 --> 00:01:45,600
Speaker 2: phase of the disease, they might find themselves going to

31
00:01:45,640 --> 00:01:49,280
Speaker 2: the toilet every hour, day and night. The earths to

32
00:01:49,320 --> 00:01:51,680
Speaker 2: go even when there's a very small amount of urine

33
00:01:51,680 --> 00:01:54,960
Speaker 2: in the bladder. It's a very very troubling disease.

34
00:01:56,640 --> 00:01:59,760
Speaker 1: Can an enlarged prostate be avoided at.

35
00:01:59,720 --> 00:02:04,920
Speaker 2: All, so it's a bit of a controversial area. So

36
00:02:04,960 --> 00:02:10,080
Speaker 2: there are medications which can shrink prostate down and certainly

37
00:02:10,160 --> 00:02:15,239
Speaker 2: do benefit symptoms, but they have some very unusual side effects,

38
00:02:15,760 --> 00:02:19,480
Speaker 2: so what's best is always to discuss it with your urologist,

39
00:02:20,360 --> 00:02:23,760
Speaker 2: and there are medications to help relax the bladder, relax

40
00:02:23,800 --> 00:02:27,400
Speaker 2: the prostate, or surgery which can help open up the

41
00:02:28,160 --> 00:02:33,520
Speaker 2: blockage and allow you to urinate much more naturally. Again,

42
00:02:33,760 --> 00:02:37,280
Speaker 2: sometimes you use a combination of medications and surgery, and

43
00:02:37,520 --> 00:02:40,480
Speaker 2: all these things are very treatable, But what we want

44
00:02:40,520 --> 00:02:43,240
Speaker 2: to really emphasize to people is that it's not one

45
00:02:43,280 --> 00:02:47,000
Speaker 2: size fits all, and depending on exactly what your symptoms

46
00:02:47,040 --> 00:02:50,360
Speaker 2: are will determine which treatment we'd recommend.

47
00:02:50,480 --> 00:02:53,960
Speaker 1: Okay, surgery, what does that involve. We're not talking about

48
00:02:54,000 --> 00:02:56,600
Speaker 1: removing the prostate anymore, or is that only done in

49
00:02:57,160 --> 00:02:58,079
Speaker 1: terms of cancer?

50
00:02:58,280 --> 00:03:06,480
Speaker 2: What happens? So for cancer treatment, the surgery is robotic prostatectomy,

51
00:03:06,520 --> 00:03:10,960
Speaker 2: where we remove the entire prostate and then join the

52
00:03:10,960 --> 00:03:14,720
Speaker 2: bladder back onto the ureterra. But the surgery for an

53
00:03:14,800 --> 00:03:19,919
Speaker 2: enlarged prostate is much more is much much smaller, and

54
00:03:20,240 --> 00:03:25,120
Speaker 2: there are minimally invasive techniques which can involve a procedure

55
00:03:25,160 --> 00:03:28,440
Speaker 2: where you actually steam the internal part of the prostate

56
00:03:28,880 --> 00:03:32,480
Speaker 2: and allow the prostate to naturally die back and open

57
00:03:32,560 --> 00:03:35,800
Speaker 2: up that channel. And that's just a day surgery procedure.

58
00:03:36,560 --> 00:03:38,880
Speaker 2: There's a procedure that works a little bit like a

59
00:03:38,920 --> 00:03:42,080
Speaker 2: cuff link where you staple the prostate open. For men

60
00:03:42,840 --> 00:03:46,600
Speaker 2: with just mildly to moderately enlarge prostate and that works

61
00:03:46,680 --> 00:03:49,280
Speaker 2: very well as well. And again it's the day surgery procedure,

62
00:03:49,640 --> 00:03:50,120
Speaker 2: but that.

63
00:03:50,160 --> 00:03:52,200
Speaker 1: Doesn't shrink the prostate, does it?

64
00:03:52,320 --> 00:03:57,280
Speaker 2: Ultimately it doesn't, So the I guess the more thorough

65
00:03:57,280 --> 00:04:02,160
Speaker 2: operations for men with more symptoms involves actually removing the

66
00:04:02,200 --> 00:04:05,080
Speaker 2: middle third of the prostate, and we do this through

67
00:04:05,120 --> 00:04:08,680
Speaker 2: the end of the penis, and it can be done. Traditionally,

68
00:04:08,760 --> 00:04:11,040
Speaker 2: it was done with a hot wire loop and required

69
00:04:11,080 --> 00:04:14,880
Speaker 2: a couple of days in hospital, but more recently lasers

70
00:04:14,920 --> 00:04:19,200
Speaker 2: have been developed over the past twenty years, and consequently

71
00:04:19,240 --> 00:04:22,600
Speaker 2: we've got laser therapies such as green light laser vaporization

72
00:04:22,680 --> 00:04:25,440
Speaker 2: of the prostate, which only requires one night in hospital.

73
00:04:25,600 --> 00:04:28,279
Speaker 2: And that's the procedure that I prefer the most.

74
00:04:28,400 --> 00:04:31,760
Speaker 1: Okay, why is that? Is that the most effective or

75
00:04:32,200 --> 00:04:33,040
Speaker 1: any other reason?

76
00:04:33,920 --> 00:04:37,280
Speaker 2: Well, it results in the shortest length of stay in hospital.

77
00:04:38,080 --> 00:04:41,080
Speaker 2: So the average length of stay is only twenty three hours.

78
00:04:42,000 --> 00:04:47,200
Speaker 2: The patient only has a catheter for approximately twelve hours

79
00:04:47,240 --> 00:04:49,279
Speaker 2: after surgery, so it's a very short amount of time

80
00:04:49,279 --> 00:04:53,599
Speaker 2: to have to discomfortable cafetering. It's the safest from the

81
00:04:53,680 --> 00:04:56,200
Speaker 2: point of view that a lot of patients are on

82
00:04:56,240 --> 00:04:59,640
Speaker 2: blood thinning medication these days for heart issues, and we

83
00:04:59,680 --> 00:05:03,159
Speaker 2: can continue those throughout the treatment program. We don't have

84
00:05:03,240 --> 00:05:06,719
Speaker 2: to stop them. And the fluid that we use to

85
00:05:06,920 --> 00:05:10,320
Speaker 2: distend the bladder is just normal saline, so there's no

86
00:05:10,520 --> 00:05:13,960
Speaker 2: risk of diluting down the electrolytes in the blood. So

87
00:05:14,480 --> 00:05:16,400
Speaker 2: that's why I like it. I think it's the safest

88
00:05:16,400 --> 00:05:17,279
Speaker 2: treatment available.

89
00:05:17,720 --> 00:05:22,039
Speaker 1: Should would people who do this continue to take the

90
00:05:22,080 --> 00:05:24,440
Speaker 1: medication you mentioned there's a couple of courses.

91
00:05:25,440 --> 00:05:27,599
Speaker 2: Well, there are a couple of different options, and it

92
00:05:27,640 --> 00:05:31,520
Speaker 2: depends a little bit on exactly what the patient symptoms are.

93
00:05:31,720 --> 00:05:36,359
Speaker 2: So if a patient mainly has obstructive symptoms like poor

94
00:05:36,400 --> 00:05:40,800
Speaker 2: flow or difficulty starting urination, then they can be ceased

95
00:05:40,880 --> 00:05:45,960
Speaker 2: after the surgery. If patients have also have the overactive symptoms,

96
00:05:46,000 --> 00:05:51,160
Speaker 2: the frequency of the urgency, the nighttime urinating, then often

97
00:05:51,200 --> 00:05:54,240
Speaker 2: it's useful to continue the medication to relax the bladder

98
00:05:54,240 --> 00:05:56,800
Speaker 2: for a few months after the surgery, just to help

99
00:05:56,839 --> 00:06:01,000
Speaker 2: the bladder retrain, basically, because the bladder been pumping really

100
00:06:01,080 --> 00:06:03,600
Speaker 2: hard against this block is just big and thick and muscular,

101
00:06:04,400 --> 00:06:06,960
Speaker 2: and what we need to do is get that muscle

102
00:06:07,240 --> 00:06:09,640
Speaker 2: to waste. So just like when you don't go to

103
00:06:09,680 --> 00:06:12,040
Speaker 2: the gym and don't exercise for a few months, all

104
00:06:12,080 --> 00:06:15,080
Speaker 2: the muscle mass goes away. That's what we need to

105
00:06:15,120 --> 00:06:19,200
Speaker 2: achieve in the bladder. So we do that by unblocking

106
00:06:19,200 --> 00:06:22,359
Speaker 2: the prostate, so opening up that channel, the bladder doesn't

107
00:06:22,360 --> 00:06:25,480
Speaker 2: have to pump as hard anymore. But while that change

108
00:06:25,520 --> 00:06:29,479
Speaker 2: is occurring, we keep those medications going and it helps

109
00:06:29,680 --> 00:06:30,839
Speaker 2: the patient with their symptoms.

110
00:06:30,960 --> 00:06:33,920
Speaker 1: And what happens with an enlarged prostate, what causes it

111
00:06:33,960 --> 00:06:37,000
Speaker 1: to enlarge is a diet? Is it lifestyle? What happens

112
00:06:37,080 --> 00:06:38,159
Speaker 1: is a genetic.

113
00:06:38,600 --> 00:06:41,960
Speaker 2: Well, it's a combination of factors, so it is genetic.

114
00:06:42,040 --> 00:06:46,200
Speaker 2: So some people are more prone to getting an enlarged

115
00:06:46,200 --> 00:06:49,640
Speaker 2: prostate than others, although it is very common. So it

116
00:06:49,680 --> 00:06:52,560
Speaker 2: does affect It does affect most of us, in most

117
00:06:52,560 --> 00:06:56,800
Speaker 2: men in their lifetime. But the issue is that there's

118
00:06:56,839 --> 00:06:59,520
Speaker 2: a hormone that makes our hair fall out and our

119
00:06:59,520 --> 00:07:02,400
Speaker 2: prostate growth. Now that that hormone level is the same

120
00:07:02,440 --> 00:07:04,440
Speaker 2: in all of us. It increases as we get older,

121
00:07:04,480 --> 00:07:06,760
Speaker 2: but it's about the same in all of us. What's

122
00:07:06,839 --> 00:07:10,320
Speaker 2: different is the number of receptors we have. So what

123
00:07:10,360 --> 00:07:13,040
Speaker 2: you'll see some men have, you know, lose all their

124
00:07:13,040 --> 00:07:16,560
Speaker 2: hair at a very young age, and that reflects a

125
00:07:16,680 --> 00:07:19,440
Speaker 2: large number of receptors on the hair follicle, and they

126
00:07:19,520 --> 00:07:22,480
Speaker 2: may or may not have more or less receptors on

127
00:07:22,480 --> 00:07:25,040
Speaker 2: their prostates. So you might find some men, because of

128
00:07:25,040 --> 00:07:28,640
Speaker 2: their receptor number, grow a massive prostate even when very young,

129
00:07:29,120 --> 00:07:33,000
Speaker 2: and other men will only have very mild growth. It

130
00:07:33,080 --> 00:07:34,200
Speaker 2: just depends on the individual.

131
00:07:34,840 --> 00:07:38,640
Speaker 1: Okay, So changing a diet to say, a vegetarian diet

132
00:07:38,680 --> 00:07:40,840
Speaker 1: getting rid of meat for instance, no difference. So it

133
00:07:40,840 --> 00:07:43,680
Speaker 1: won't you won't make an effect on you know, your

134
00:07:43,720 --> 00:07:46,960
Speaker 1: prostate enlarging or whatever the change may have been, dropping coffee,

135
00:07:47,040 --> 00:07:47,640
Speaker 1: whatever it is.

136
00:07:48,320 --> 00:07:51,280
Speaker 2: Well, but now so changing your diet to a vegetarian

137
00:07:51,360 --> 00:07:54,360
Speaker 2: or a vegan diet won't make any difference. But what

138
00:07:54,400 --> 00:07:56,400
Speaker 2: we do know is that there are certain foods which

139
00:07:56,480 --> 00:07:59,240
Speaker 2: irritate the lining of the bladder and make it unstable

140
00:07:59,320 --> 00:08:03,040
Speaker 2: and give you that urgency frequency in nighttime urinate. And

141
00:08:03,080 --> 00:08:05,920
Speaker 2: that is things like caffeine, so t coffee and Coca

142
00:08:05,920 --> 00:08:09,240
Speaker 2: cola obviously being the bigger fenders there. Okay, but I

143
00:08:09,240 --> 00:08:12,680
Speaker 2: think it's also really important for patients to understand that

144
00:08:12,720 --> 00:08:17,480
Speaker 2: these symptoms of frequency urgency, especially if associated with blood

145
00:08:17,480 --> 00:08:20,880
Speaker 2: in the urine can also signify something far more sinister,

146
00:08:21,520 --> 00:08:25,679
Speaker 2: and we always worry in this situation anyone with blood

147
00:08:25,680 --> 00:08:28,239
Speaker 2: in the urine that there could be a bladder cancer.

148
00:08:29,040 --> 00:08:31,640
Speaker 2: So what we really want to emphasize to all people

149
00:08:31,720 --> 00:08:34,040
Speaker 2: is if you've got symptoms, please come and get checked out.

150
00:08:34,120 --> 00:08:37,080
Speaker 2: Don't ignore them, come and see us. It's not a

151
00:08:37,080 --> 00:08:39,920
Speaker 2: big deal. We see this all the time. There's nothing

152
00:08:39,920 --> 00:08:42,400
Speaker 2: to be embarrassed about, and we certainly want to see

153
00:08:42,400 --> 00:08:44,360
Speaker 2: people early rather than late. All right.

154
00:08:44,760 --> 00:08:47,079
Speaker 1: I know with blood tests because I've had a few.

155
00:08:47,760 --> 00:08:49,079
Speaker 1: You know, as you go through and you have the

156
00:08:49,120 --> 00:08:54,760
Speaker 1: annual check or whatever, Medicare doesn't allow for more than

157
00:08:55,160 --> 00:08:57,280
Speaker 1: is it one every two years, just refreshment memory on

158
00:08:57,320 --> 00:09:00,160
Speaker 1: that a blood tests the is it called the PSA test,

159
00:09:00,320 --> 00:09:03,000
Speaker 1: and they don't allow for so if you do more

160
00:09:03,040 --> 00:09:06,400
Speaker 1: than one every two years, they would to bill you

161
00:09:06,480 --> 00:09:06,839
Speaker 1: for it.

162
00:09:07,200 --> 00:09:09,960
Speaker 2: Now, well only if you don't have symptoms though, so

163
00:09:10,000 --> 00:09:13,160
Speaker 2: that's just for screening. So if you're just doing a

164
00:09:13,200 --> 00:09:17,280
Speaker 2: PSA test for prostate cancer screen which is exactly what

165
00:09:17,280 --> 00:09:19,320
Speaker 2: we'd want all men to do over the age of

166
00:09:19,360 --> 00:09:22,480
Speaker 2: fifty or over the age of forty five, if they've

167
00:09:22,520 --> 00:09:27,520
Speaker 2: got a family history, but if you've got any urinary

168
00:09:27,520 --> 00:09:32,040
Speaker 2: symptoms then you are eligible for a medicare abatable PFAT.

169
00:09:32,240 --> 00:09:34,440
Speaker 1: Well there it is all right. So that's important because

170
00:09:34,440 --> 00:09:36,000
Speaker 1: I think you want to encourage people to do it,

171
00:09:36,120 --> 00:09:40,240
Speaker 1: not penalize them for checking. And that's absolutely one on

172
00:09:40,280 --> 00:09:43,400
Speaker 1: the Australian government. But anyway, there it is. Dan, appreciate

173
00:09:43,400 --> 00:09:43,760
Speaker 1: your time.

174
00:09:44,720 --> 00:09:46,439
Speaker 2: Thank you so much, Matthew, you have a wonderful day.

175
00:09:46,559 --> 00:09:50,160
Speaker 1: Doctor Dan Spyerrnat, who is a urologist on the issue

176
00:09:50,160 --> 00:09:51,920
Speaker 1: of prostate enlargement