well good evening.

>> Welcome to HealthLine.

I'm Jennifer Blomquist.

Thank you so much for tuning in.

I appreciate it if you're one of our regulars, you know the routine we're here live in the studio and it's a great show because no matter what the topic is every week you learn something and we also give you an opportunity to call in and ask our guest a question tonight.

We have a urologist here.

He's been with us before and we're going to be talking about something I really wasn't familiar with this before but apparently it's very common benign prostatic hyperplasia.

And so we're going to be talking to Dr.

Scott Palmer about that.

We welcome your questions.

>> Here he is right now.

So thanks again, Dr.

Palmer for coming on.

Thank you.

I just want to remind everybody again I apologize to our regulars because they know the drill.

But if you're if you're new we have two ways that you can communicate with us to get your questions answered.

You can call in and you can ask Dr.

Palmer your questions live .

I really recommend that if you feel up to doing that because maybe he needs to ask you some questions to better answer your questions.

So the number is (969) to seven to zero.

It's still toll free if you put in 866- in front of there you can also call that number if you don't want to ask the question, leave the the call screener will take your question and give it to me and then I can get it answered for you that way and we text now we offer that as an option.

So we've had a lot of people do that in recent months so I'd recommend that as well.

That's a little different number though (969) 27 three zero.

If you feel comfortable, why don't you give us your first name and tell us where your texting from and again, I want to reassure you we keep your phone number private.

>> It does not show up on the screen at all.

So those are the ways to get your questions answered and we hope that you will take advantage of Dr.

Palmer being with us here tonight giving us some some great advice.

So I was surprised.

You know, we've done I've done a program with you before.

We were talking about kidney stones and I I guess I figured that was probably one of your you know, regular you know, a big topics that you deal with cases that you deal with.

But you actually said the benign prostatic hyperplasia or BPH is is is actually a very dominant condition that you deal with.

>> Oh, a kidney stones is definitely something we see a lot of but yeah, men with urination issues especially older men oftentimes it is from the prostate and we see a lot of that and really every day is it something that is it kind of because I know we've talked about this before on this program about with women you know, they might leak a little bit of urine or when they laugh or sneeze and it's just something they kind to put up with.

They maybe because they're a little embarrassed about it.

Is it similar with men?

Is this something that it's not so much that it's uncomfortable but it's just maybe an embarrassment or they just, you know, don't want to deal with it?

>> What how would you categorize it?

Well, I think with what you're describing with the coughing and sneezing and thinking not so much that with men but certainly the typical urinary complaints that people have all the time which is, you know, urgency and frequency or a slow stream or getting up at night, you know, thousands of men deal with that all the time and women do as well.

In fact, we've learned over the years that the bladder plays a big part even in men who have large prostates.

So you have to kind of focus a little bit on both in a lot of it depends on their combination of symptoms but typically especially in older men with larger prostate, you're going to focus on the prostate initially but then you have to tailor it as time goes on based upon their response and their symptoms.

You and I were talking before the show about you know, a lot of people would have a long time relationship with their family doctor, hopefully would feel comfortable talking about any issues that they would have.

But in general are they going to they're not going to really do any kind of a screening for this.

It's it's almost like you were saying up to the patient to make the physician aware and then maybe they would have to come see a specialist.

>> Yeah, I think a lot of that depends on the family physician but many family doctors will have as part of their questionnaires whether you're having any urinary problems.

So I'm certain if you check that they're going to address that the appointment is it a problem though if you know because I and of course there are a lot of commercials on TV now for various products and they will they will mention some of the things you did you know the slow stream frequency urgency is is there any harm in just putting up with that or is that something that should be addressed?

Will it just get worse as time goes on?

>> Well, that's a good question because it depends on the situation.

So if you have men who have a very slow stream they're having trouble getting emptied with they're usually indicating is that their bladder is having to work hard.

OK, so your bladder is a muscle just like your arm or leg muscles and when your bladder has to work hard it becomes thicker.

>> Now that's kind of a good thing if it's your arm or your leg but not so much with the bladder because when bladder muscles become thicker they also become more stiff and they don't relax as well as they should and you end up getting more urgency and more or more frequency due to lack of storage capacity so it can be a problem.

That said, we know that many men that have symptoms of BPH it will spontaneously be better over time but I think especially in men who are having a slow stream and it's getting worse and worse they probably should be evaluated.

>> So what does it involve as far as making a diagnosis and then maybe can we talk about some options they would have in terms of treatment?

>> Well, you know, first you do an exam including a cross examination and that's more or less try to gauge the size now there's not an exact correlation between who have really large prostate sometimes have no symptoms at all and there are men who have smaller states that do so it's not always a size.

Sometimes it's the shape or the tone.

But if you do suspect the prostate, typically you're going to start medical therapy first and see how that goes.

But you have to discuss the the benefits versus the risks and side effects and things like that.

>> And I'm sure in your specialty just like we we do shows with all different kind of specialties you know, cardiologists and orthopedics specialists they always refer to the idea of starting conservatively so you don't just jump in and do a surgery which I think some people maybe that's why they shy away because they think oh I don't want surgery or I don't want something really invasive.

So what would be maybe a more conservative or entry level start for ?

>> That's I think one of the important things that sometimes gets ignored is you look at lifestyle, right?

>> So you're going to look at diet, you know, is somebody consuming a lot of caffeine for example or alcohol, both of which are diuretics.

So your bladder fills up faster and you have to go more often.

>> So you first focus on lifestyle and then the next step if if somebody is not having much success or lifestyle, it doesn't appear to be an issue.

You're going to talk about medical therapy often and there are two primary types of medications for the prostate in terms of classes.

>> OK, I talk about oral medications or injections or would those be something you would try for a few weeks or in sea gauge at that point or it depends a little bit on which ones you take so the most common class is what we call alpha blockers and those work by just relaxing blood vessels and they they tell the nerve endings to kind of settle down.

>> So basically what they do is they're almost like muscle relaxers for the prostate.

OK, and so what happens is as the prostate just kind of relaxes many of them will notice that they have a better flow and less urgency and frequency and more and more that gets combined with erectile dysfunction medications ideally Cialis because we know that there is a benefit with the combination versus either or alone and especially in men who already have some erectile dysfunction on top of it the other kladno that class usually you're going to know if it's going to work.

You're going to know within anywhere between two and seven days and we're quick.

Yeah.

Whereas the other classes they're called five different inhibitors and what they do is they physically shrink the prostate but they work very slowly.

>> Oh so in terms of getting clinical benefit most men are not going to know as much benefit for a probably a good two and a half three to four months on there and then it kind of keeps shrinking over time and it kind of reaches maximum benefit as far as shrinkage after about eighteen months.

>> And I want to talk more about if those options fail what what the next step would be.

But I did want to address a texting question we got so this is from Eddie so thanks Eddie.

He's asking what what age for the symptoms of BPH like what commonly I guess well commonly you're looking at men typically you know, between mid 50s and eighty but we're seeing some men you know, late 30s, early 40s so you get symptoms kind of be on the lookout for sure.

>> Sure.

But you know, classic if you had to pick the demographic the classic demographic would be men probably between 50 and 80 and does it tend to be hereditary?

>> You know, I don't know like if your dad and maybe guys don't talk ladies I mean we do I think we are the moms and the sisters and the answer, grandma is we talk about that stuff but you know, if your dad had that issue, I you know, I don't know if there's been a really, really good study looking directly at that over time but I think it's been presumed for many years that there definitely seems to be a family transmission.

A lot of patients that I see will say yeah, you know, my dad had these issues forty years ago and he had this done or whatever.

>> I hear that a lot.

So you know, I think there's a strong possibility that does run in families along with the like you're saying the lifestyle component to no doubt.

>> All right.

So and again, thank you, Eddie, for the for the question you can call us it's (969) 27 two zero.

>> It's still the toll free call if you put 866- in front of there we can get you on live to talk to Dr.

Palmer.

Like I said, that's always nice because you can converse with you give you a great answer that way if you don't want to ask it live, that's fine too.

When you call in the call screener can take your question and relay it to us and we'll get it answered that way or do it edited and text us again that number a little bit different (969) 27 three zero and we only have Dr.

Palmer here for a short time just until a little before 8:00.

>> So call sooner or text sooner rather than later.

So if those oral medications you were talking about that's the conservative start if that doesn't work, what what are your next options?

>> Well, there's several different surgical options, some have been around for many years and some are relatively new.

>> The kind of the standard procedure that most men are familiar with is what we call Terp which is an acronym Stanzler Trans Urethral Resection of the Prostate and that's been around for many, many years and it's still a very nice procedure but the technology has improved over time and then over the past twenty years you're starting to see more and more what we call minimally invasive techniques.

>> Yes.

Yeah.

Some popular ones would be things like your lift which is basically putting little implants in the prostate that literally what they do is kind of squeeze the prostate so that the inside opens up and has a high success rate.

>> But is that a permanent is that a one and done well usually you know, if you follow men over a long period of time, you know the retreatment rate goes up as time goes on.

But see but you know, there's all kinds of different options, a lot that depends on the size and the shape of the prostate.

There's one called resume which is a steam treatment which you're using heat.

>> Oh, OK.

There's embolization of the prostate which is something that radiologist offer and that's been kind of more and more popular over the past seven, eight years kind of picked up steam but it really kind of boils down to patient selection and trying to figure out which procedure is going to benefit which patient and and again a lot that depends on the size in the shape it sounds like it's yeah, not at all a cookie cutter type of no issue that every patient is is definitely unique so.

Oh absolutely.

If you're going to have one of these surgical procedures are most of those an outpatient situation or what we can kind of recovery with that involved?

>> It depends a lot on the procedure but several especially the millimeter Vaizey ones are typically outpatient procedure is in fact a lot of them are done in the office.

Many urologists would do some of in the office I presume steam therapy and even with the left you'll see some a lot about that.

You'll see some urologists doing them in the office but most in most cases it's just an outpatient procedure at a surgery center.

>> OK, at the end with most of those surgeries you said I know sometimes things can change over time but in general especially if you're dealing with an older patient that something that's going to kind of be a permanent for the most part maybe permanently fixie issue or do they have to you know, you talk about lifestyle impacting you to do they have to make a lot of lifestyle changes in order to keep it effective?

>> Well, you have to remember that the prostate is still there.

You're not you're not you're not moving it like you were prostate cancer.

Right?

So over time you can regrow.

>> And so how long these procedures lasts varies hugely in the more aggressive procedures in terms of like the resections or the ablated procedures tend to last longer but they're also more involved up front.

>> So it's kind of that, you know, pick your poison but even even the minimally invasive procedures like resume in your left for the majority and then are going to last you know, anywhere from four to 10 years.

>> And studies have shown that the retreatment rate it starts to get higher like five, six years down the road.

But again, every guy is different.

>> Yeah, yeah.

That's you know and I hear a lot of people and my children do this you know, they compare themselves to other people, you know well so and so it only took them this long to get better or you know and so I think sometimes it's just kind of a mental thing that we're always looking at how other people experience something.

But this sounds like, you know, it's it's very neek to each patient for sure.

>> Yeah.

I mean and it again it goes back to the size and the shape of the prostate.

It depends to what they're but their goal is so for example, if the goal is to have a better flow and have better empting then if these procedures have a very high success rate and some of them will kick in right away, OK if the goal is to have less urgency and frequency.

Yeah, well it depends and sometimes there's a bladder component to that as well.

And then the third thing I would say is if the goal is to have less nighttime urination that's a lot trickier.

>> Yeah.

And that's going to depend a lot on the patient and sometimes can be a hard thing to manage.

>> Yeah yeah no I know and you know I hear I hear that a lot too about that that's not a good a good thing you and nobody wants to have to have their sleep interrupted.

>> Yeah.

You know it's one of the most frustrating issues for patients to see but it's also frustrating for us because there are all kinds of factors that contribute to that and I think a lot of times there's an assumption that it's either the prostate or the bladder and we see it in both men and women.

Yeah, but in many cases it isn't and so it can be hard to pin down it can be difficult to treat but there are times and men where you do treat the prostate and they're not have urination or peruse a lot.

>> Yeah but sometimes not you know so it's a it's a stubborn problem.

Sounds like it's so well and I we do have somebody else who texted us I want to address that before we go to any other discussion.

So this is from Wessely.

So what a question about I'm not into is it and I can't read that word integrity sheet for a groin rash or how long should should this last?

>> I'm not sure I'm not sure they I think they kind of were interpreting the question.

>> So he's been yeah.

I'm not sure what that is.

Well I'm not exactly sure what kind of sheet West is referring to but an entire dry I guess it was yeah.

>> Yeah but in terms of growing rice a lot of that's going to really depend on what's causing the rash.

So if it's if it's a yeast or a fungus then you have to start looking at some kind of topical treatment, all kinds of statements and creams and powders.

>> If it's because of wetness you know then there's moisture barrier creams and there's all kinds of devices to improve wetness at night.

But again, if it is due to wetness sometimes addressing the underlying problem, this is the way to go.

>> Yeah, you know, I feel like we've come a long way in our society in general because I do see a lot of infomercials and things about products to help with some of these issues that people years ago I mean when my grandparents were living nobody would ever talk about something like that ever.

So you know, it's not the most pleasant topic.

It's not what people probably want to talk about at the dinner table.

But you know, it does impact you every day.

I would imagine, you know, a lot of these issues makes well hard to function normally.

>> You know, I tell patients every day in the office that the happiest patients that we have are the ones that are wet and you make them dry.

>> OK, that sounds right.

>> The trick though is how to get there.

Yeah.

And you know, I for a minute sometimes it's a process and this is Baulderstone both same thing as women you know it can be the bladder or it can be Diederik can be muscles hold the urine in but people that are wet if you can make them dry are always the happiest patients.

>> Yeah.

>> Now it's like I said it's an unpleasant issue but if you can get it resolved yeah I can understand it.

Make a big difference in their in their everyday life .

>> Let's see we got another text I tell you the text hey I'm so glad we start we just started at this winter and it's been great.

>> We've had a lot of people take advantage of it.

All right.

So thank you to Jake.

He texted in and wanted to know we don't normally mention brands of of drugs here but he wanted to know what class of drugs is something called Flomax.

>> Yeah, that's that's a very, very common medication.

In fact, it's probably the most common medication we prescribe for BPH.

>> It's it's in that class I was referring to earlier we were called alpha blockers so that's when you're going to know within a few days typically within two to seven days but it works by basically relaxing the tone of the prostate and it does have a high success rate.

>> I think the main concern for men with medications like Flomax is going to be side effects.

>> OK and typically nothing severe but there can be some bothersome side effects that some guys just don't care for .

>> But for many men, thousands of men it can make a huge difference and how they urinate I mean is there any I guess issue with them trying a bunch of different things?

>> I mean if you're mentioning the alpha blockers, maybe try and give it a couple different of those, you know, or I mean kind of I mean I almost feel like you're be like shopping around for the best remedy but you know and that's something we do all the time and basically there's three primary what we call selective blockers that focus on the prostate and Flomax is probably the most common one but there's other ones there's Lotus and which is very, very similar to Flomax and Alpha uses and which is in the same class now as a physician I think is popular in large part because atleast sexual side effects OK now does it have the same degree of KIC as Flomax?

Well maybe not.

It's hard to say but we but we do you know, try different ones all the time and like I said before to adding daily to Daleville, you know any medications can sometimes be very helpful even in men who don't have OK and then you can also add the medications to shrink the prostate.

>> Yeah but those take time.

Yeah.

If you have a pack your patience for sure.

So they they just show me a sign Dr.

Palmer that we are down to less than five minutes in the show so the time does go by quickly even without commercials it always flies by.

We do have time to get some more questions in if you want to quickly text us something or even call in, that's fine.

I'm going to ask Dr.

Palmer a couple of things about prostate cancer as far as its relation BPH but feel free to call in or text in at any time here in these last few minutes.

>> Is there a correlation between having this condition BPH and does that make you more of a candidate for prostate cancer?

>> That's a really good question.

Years ago I want to say it maybe fifty years ago there was a study that showed a possible mild association but then later studies kind of refuted that saying that in large part that was what we call selection bias for basically men who had BPH and had prostate problems were more likely to be diagnosed with prostate cancer.

So there doesn't appear to be much of a cause and effect relationship.

>> OK, that would be a relief to a lot of people, especially such a common absolutely common ailment on the side.

>> No, too many men are afraid to use the medication that shrink the prostate because if you go on the Internet which of course you know Doctor Google.

Yeah, They'll type in that always a good idea.

>> Yeah well sometimes but they'll type in these medications and you'll see risk for prostate cancer.

Yeah.

And unfortunately it's kind of embedded in our Internet system.

Yeah.

But the reality is studies have shown that those medications have really no increased risk for prostate cancer mortality at all.

>> Yeah.

So that can reassure men who are concerned.

>> I mean it's a good starting point going online I guess but always check with your doctor.

Sure sure.

Let's see if we can squeeze in this last question.

Somebody called in and wanted to know can you can you go over the I'm trying I can't even bother.

>> OK, oblation OK what is that sorry.

>> So OK oblation and Walter I'll get you in a second here but our collaboration is basically where you have an apparatus that's put inside the bladder that's just kind of above the prostate and then you log in the measurements into basically a software and so it's almost like robotic controlled and so what happens then is that the computer takes over and it has a sweeping motion gives off a high intensity jet of water.

>> Oh I shouldn't say water but liquid.

Yeah.

And what that does is it basically kind of destroys the prostate and you're actually putting in the measurements into the computer and automatically knows like how deep to go or how far you want to go lengthwise.

>> And so what you're doing is you're basically playing the prostate with a water jet and so it's been a technique that's picked up steam over the past 15, 16 years or so.

>> It's a little bit like the procedure I think many men prefer this because it's not a resection necessarily it sounds gentler and the studies are shown in men who are concerned about certain sexual side effects.

>> Studies have shown that it has rare side effects.

You're not seeing what accommodations it can be used on very large prostates which you know, we have, you know, just a limited number of procedures for large prostates.

>> Sure.

Yeah, All right.

Yeah, sorry.

My eyes are not what they used to be.

I saw you that night so I'm going to have to wear my glasses next time so but thank you, Walter.

Thank you to everybody.

We had a lot of great questions tonight and I appreciate you calling and texting and it was great to hear from everybody.

So Dr.

Scott Palmer, thank you so much for coming back.

>> I'm glad to be here.

Love to have you back soon.

So very interesting topics.

So thank you again.

I'm Jennifer Bloomquist.

Take care and have a great night.

And we are back here again next Tuesday with another HealthLine live.

>> We'll take your questions for that.

Take care.

Have a good rest of your week.

Bye bye