On Tuesday evening, February 11, the community gathered at Congregation Etz Chaim to hear another informative lecture hosted by Navigating the Medical System Lecture Series. Dr. Edward Moss, Assistant Professor of Clinical Urology at Weil Cornell Medicine and attending urologist at NewYork-Presbyterian Hospital, shared a comprehensive lecture on prostate health. He began by explaining that urology comprises the following structures: two kidneys, a tube that leaves the kidney and goes to the bladder; in a male it goes to the male organs and in a female to the urethra. He explained that the prostate is at the base of the bladder.
The function of the prostate is to make fluid which is nutrition for sperm. The prostate gland secretes this fluid. He taught that the prostate starts growing in all men after age 35. Every man over the age of 35 has an enlarged prostate. Many men up to age 80 will have an enlarged prostate and never need to see a urologist. Of all the organs in the body, he taught, the prostate is the only one that expands to five times its size. It is a silent enlargement and no other organ does this.
He then shared that every man develops prostate cancer by the time he is age 80 and that this is part of the process of aging. So why do we look for this disease at all?
It is not a problem for most men. Sometimes screening and looking for high PSA blood levels can cause problems.
He then explained that prostate cancer can be a serious illness when a man is in his 50s or 60s and needs to be treated. Once a man is in his 70s, it is a question whether to treat it. Some of the investigations are worse than the disease.
He shared that there are excellent medications to slow the disease or cure it with surgery and radiation. “A prostate biopsy can cause problems,” he said.
Some possible signs of prostate cancer include: losing weight, bone pain, difficulty urinating, abnormalities in a blood test. Prostate cancer typically spreads to the bones in the back. Radiation therapy and surgery is effective against this. Also, when prostate cancer has spread to bones, then doctors use hormone therapy. They use medication to block testosterone. He noted that “the majority of prostate issues are from benign enlargement of the prostate.” When treating a man in his 80s or 90s, the physician must balance risk and benefits.
Dr. Moss then spoke more about enlargement of the prostate when it can cause problems. “When enlargement occurs, it can block the flow of urine.” Some symptoms include blood in urine, slow stem of urine, and hesitation before urinating. When the bladder is not totally emptied, then this can cause infection or a bladder stone. Signs of infection include a fever and pain in lower abdomen. Prostatitis is treated with warm baths, antibiotic, and limiting alcohol, stress, and spicy foods.
Dr. Moss then explained that a biopsy can show three possibilities. First, it can reveal there is no cancer. Secondly, it can show there are nonaggressive cells that do not need treatment. Thirdly, it can show aggressive cancer cells that require treatment. With all cancers, he explained, it is important to know what type of cancer it is, as this is the most important feature for prognosis.
A urologist will also perform a blood test to see if the cancer is the aggressive type.
He then spoke about the bladder, which is a muscle. He spoke about frequency of urination and ways this can be treated.
By Susie Garber