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Health Matters: Providence St. Joseph Hospital | 11 W hile it seems such a small thing, it has an important purpose. The prostate gland is part of the male reproductive system that, when healthy, is about the size of a walnut. Its main purpose is to produce semen, the fluid that carries sperm from the testicles during ejaculation. "Once a male is past reproductive age," explains Hari Sawkar, MD, a urologist at Providence St. Joseph Hospital, "the prostate can sometimes cause more problems than benefits. The most common condition, which often begins in the 50s, is enlarged prostate, also called benign prostatic hyperplasia (BPH)." Basically, according to Dr. Sawkar, "the more cycles of testosterone a prostate is exposed to over time, the more it will grow. So it's really just a part of aging." As a prostate expands, it may start to squeeze on the bladder neck and become obstructive. "That's why men over 60 might have difficulty urinating, says Dr. Sawkar. "And the longer your prostate is obstructing, the more it can cause the bladder—which, after all, is a muscle—to get less efficient. Which can cause kidney dysfunction." Men with health conditions such as high blood pressure, high cholesterol or diabetes or who are overweight are at higher risk. Treatment of BPH includes medication, which often is sufficient, but if the gland gets too big, surgical options may be called for. The typical surgery is transurethral resection of the prostate (TURP). Now there is a brand-new option—offered at Providence St. Joseph—called Aquablation, which is done endoscopically and robotically using high- pressure water to remove tissue. (See page 7.) PROSTATE CANCER The other troubling prostate issue is prostate cancer, which, says Dr. Sawkar, "is the most common type of cancer in men and the second- highest cause of cancer death in men next to lung cancer." Most men don't die from prostate cancer, however—the five-year survival rate is 98%, because once detected, the cancer can be removed before it spreads. The three main risk factors for prostate cancer are: Age. As men approach the age of 50, risk increases. Race. African American men have double the risk of Caucasian men. Family history. "Observational studies have shown that men with a father or brother who has prostate cancer have twice the risk," says Dr. Sawkar. As for any dietary or lifestyle factors that may affect prostate cancer: "We've looked at a lot of things—low-fat diets, high-fat diets, obesity—and there doesn't seem to be a clear link, outside of smoking. The mainstay of prostate health for prostate cancer is going to be early detection." Dr. Sawkar says that he recommends men over age 50 start to discuss with their doctors the pros and cons of screenings such as rectal examination and a PSA (prostate-specific antigen) blood test. The American Urology Association recommends annual screening between ages 55 and 69. But the PSA—which for decades was the gold standard—has come under scrutiny because it may find slow- growing cancers that are not life-threatening. "We were picking up too much cancer," says Dr. Sawkar. If a cancer is determined to be less aggressive and not at risk of spreading, doctors and their patients often are choosing "active surveillance." If treatment is the best option, the prostate will be removed; now there are robotic surgeries that are less invasive, especially at Providence St. Joseph, says Dr. Sawkar. "We are one of the few hospitals doing a robotic procedure called single- port surgery. The entire surgery is done through a two-centimeter incision, so there is less pain and less recovery time. It makes the urologists here unique. And people are seeking us out." For referral information, please email Kelly. Frontino@stjoe.org or call 714-771-8000, extension 4261. The Modern Prostate At Providence St. Joseph, men with prostate conditions have more options than ever before. WORKING OUT INCONTINENCE Following prostate cancer surgery, also known as a prostatectomy, many men experience urinary incontinence, due to damage to the pelvic floor. Doctors recommend postoperative physical therapy for those muscles. "Many of the muscles that support urinary continence are weakened by the surgery," explains Providence St. Joseph urologist Hari Sawkar, MD. "Pelvic floor PT helps men strengthen those muscles, relax them if necessary and reestablish their urinary continence." Techniques typically involve exercises such as Kegels to strengthen the pelvic floor muscles, utilizing verbal and hands-on cues, and even biofeedback to help men strengthen and relax those "hidden" muscles. In a recent study, 87% of individuals who had some kind of pelvic floor dysfunction after surgery found significant improvement in function and a decrease in pain after a program of physical therapy. For more information on our rehabilitation program, call 714-734-6288. Dr. Hari Sawkar

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