Video: BPH Explained | Off the Cuff with Mark Moyad, MD, MPH & Steven Gange, MD
Off the Cuff with Mark Moyad, MD, MPH | Transcription
Dr. Moyad: You know, we call it PCRI, but we wanted to talk eventually about BPH, and to me, BPH is arguably the biggest prostate problem in the world.
Dr. Gange: Clearly.
Dr. Moyad: It doesn't mean—I mean not in terms of severity and life-threatening always, but can you tell people a little bit about BPH and why with the kind of epidemic that it really is and why it doesn't get any attention.
Dr. Gange: Well, BPH is probably 10 times more common in terms of a clinical diagnosis than is prostate cancer and it's also important to understand that prostate cancer patients almost all have BPH. BPH is a histological diagnosis first, meaning it's something we see under the microscope, but it manifests as men age with a variety of lower urinary tract symptoms, voiding troubles, difficulties with urination. And so many men with prostate cancer, you know, will have these elements in their, sort of, their clinical presentation, but you know, they think of themselves as cancer patients and maybe misunderstand that BPH is right along there too. And certainly of patients who don't have a prostate cancer diagnosis, BPH is enormously prevalent. Probably 50% of men over age 50 have symptoms. Some symptoms are mild, some are nuisances, some are just horrifying.
Dr. Moyad: Yeah.
Dr. Gange: And I think that the reason it hasn't gotten more press has a lot to do with how men approach their own health care, and you know, men are relatively—well they're certainly less proactive than, say, women are. It's statistically been shown. So, I think that we're partly responsible for our own bladder demise, if you will, because we're inactive in the evaluation and the treatment. We're also pretty afraid of treatment options, which is a lot of why the modalities that are coming along have blossomed.
Dr. Moyad: Yeah, I'm actually really sad that we're scared to be diagnosed or be treated for BPH, and here's my theory: The reason why we shouldn't be sad is because BPH may be responsible for the greatest clouding of a prostate cancer diagnosis since the history of medicine. Since time began. And what I mean by that is, the number one reason for a rising PSA as we age is generally BPH, it's not prostate cancer, right?
Dr. Gange: And this is maybe one of the blessings of BPH is it gets men in the door to get their PSA to eventually receive their therapy for prostate cancer. It wasn't a cancer causing the symptoms because it typically doesn't. Prostate cancer doesn't make prostates big, but BPH does. Bigger prostates tend to be associated with more urinary symptoms.
Dr. Moyad: So, if I'm a guy in my forties and suddenly I find myself in my fifties and I wasn't getting up at all at night, and now I'm getting up two and three times a night, isn't that weird? Isn't that strange? But a lot of guys will say to me, essentially, well I just get up two or three times a night, what's the big deal? And I'm going, well maybe you don't have to get up that often!
Dr. Gange: Yeah.
Dr. Moyad: Right?
Dr. Gange: Well, I don't think that every man with urinary symptoms needs a fix. So, we stratify those urinary symptoms by way of validated questionnaires. When a man comes in to see us, we want to know just how significant your symptoms are, and you know these questionnaires will be used, the IPSS or the AUA symptom index. They're very helpful at kind of gauging where a patient is and not only where he is now, but how he progresses in six months.
Dr. Moyad: And they can do those online and bring them to you, right?
Dr. Gange: Easily, yeah.
Dr. Moyad: So this AUA symptom score and IPSS, you can find them online and then take them to your office, fill them out.
Dr. Gange: Yeah, we start to take notice, you know, when the score is over 7. So 1-7 is considered a mild state of symptoms. The scores cap out at 35, so by the time someone is in their mid 20's to 30's that's a guy who's really bothered, and by that time oughta have some intervention. But a guy who's getting up for the first, you know, is just becoming an issue, gets up once or twice, maybe it's after he's had a little wine with dinner, some caffeine too late in the day, you know this might just be sort of a natural part of getting a little older. Having a little less bladder compliance.
Dr. Moyad: Right.
Dr. Gange: But, as it progresses and there's more symptoms and, you know, the list is long with the things that can manifest. That's when patients need to be seen. And honestly, these are the same guys that we would recommend being seen anyway. It's time for your PSA, your digital rectal exam, you know, let's get in and just do a little checkup.
Dr. Moyad: Do you see BPH run in families? So when dad has it, Bobby and—I don't know—Billy have it? I mean is that—it seems like everything can be passed on genetically these days. Have you seen anything like that?
Dr. Gange: I don't know how you distinguish because manhood is associated with BPH, so it's just so common that while it is potentially hereditary, I think just having the XY [chromosome] situation going on, you know, you're gonna see some BPH. Almost every man under the microscope gets BPH, so we talked about the histological nature of it, and so many of those guys actually have symptoms that I think it's just a little hard to say, well if dad had it you're gonna—you know—probably you are gonna get it.
Dr. Moyad: Yeah.
Dr. Gange: So is your neighbor down the street.