– Do you know what the
most misunderstood organ in the male body is? – The prostate! – Hey how did you get in here? I’m gonna say a word,
and you tell me the first thing that comes to your mind. Prostate. – What is it? (Laughing) – Most people don’t know where it is. – Lower, somewhere over here. – Back here somewhere. – I have no idea. – If they know where
it is, they don’t know what it does. – It gets cancer and causes
me problems as I get older. – And if they know what it
does, they don’t know how it does it. And if finally
they know how it does it, they don’t know what
can go wrong with it, so I’m going to answer all
those questions, and more, starting now. (Piano music) Do only males have a prostate? – I believe so? I don’t know,
is that a trick question? – Ladies, I’m sorry to
say, only guys have a prostate. It causes us a ton of problems. The prostate is a small walnut sized gland that sits right below your blad- why am I explaining this
to you when I can show you using my trusty side-kick,
the male reproductive system. You have the bladder,
the rectum, the anus, the prostate, the penis, the
urethra, the testicle, and that’s the prostate, but
let me explain to you the flow of urine and sperm,
because they go exactly through the prostate. That’s
right, so your urine is stored in the bladder here,
and then in gets released into the urethra, right here,
and it goes down, all the way and out your penis,
right? Then you have the ejaculatory duct, which
comes all the way from around the testicle, and that
comes in to here, and also comes into the urethra.
It’s like the merging of two highways, and when these
highways merge, it becomes one path, the urethra, and
this is where the sperm and urine both come out from. All right, we’ll come back to this. (Cat meowing) Let’s talk about what the
prostate actually does. The main job of the
prostate is to secrete a milky white fluid that
nourishes and protects your sperm. Approximately thirty
percent of your semen is made up of this fluid. This
fluid is alkaline or basic, which means it has a high
pH, so it protects the sperm in the acidic environment
within the vagina. It basically allows your sperm to
reach and fertilize the egg. Fun fact: Did you know,
“prostatitis”, in Greek literally means “protector”
or “gaurdian”. This guy knows his stuff. The prostate needs
testosterone, specifically dihydrotestosterone. It needs
it to function properly, and to mature your prostate
when you’re younger, but as we’ll see later, overtime
extended exposure to the hormone can create problems with your prostate. The prostate, just like any
other organ, can have things go wrong with it. Most commonly
you’ll hear the acronym “BPH”, and that stands for
benign prostatic hyperplasia. Let’s take that one work at a
time, though Benign, meaning innocent, prostatic,
meaning prostate, duh, and hyperplasia, meaning an
increase in the number of cells. Basically what happens is,
as men age, the prostate gets bigger in size, because of
new cell creation. Now let me explain that a little
bit further with the help of my trusty side-kick. (Snaps) You have a transition area
in your prostate, but let me show you up close. This
transition zone surrounds the urethra, and the urethra
is the area that the urine comes through, from the
bladder, into the penis, so it’s this area right here that
actually has new cell formation, and those new cells end up
putting pressure, by pushing onto the urethra, therefore
making it difficult for urine to pass through this little tunnel. As you can imagine, this is
very uncomfortable, as it prevents you from urinating
properly. Some common symptoms as a result of this can be
excess urination at night, weak stream, dribbling of
urine, difficulty urinating, and as a result of this you can
get retained urine in the bladder, and when you have
retained urine in the bladder, that can lead to infection,
stones, or even bladder rupture. Now there are treatments
to fix this problem, most commonly being medicines. Now
being a family medicine doctor I often treat people with these
medications, and there are two classes of medication
that we reach for when we treat benign prostetic
hyperplasia. Number one are those that focus on relaxing the
smooth muscle surrounding the urinary tract within the
prostate. The second class of medications are ones that
focus on blocking the dihydrotestosterone, which
makes the prostate increase in size due to the creation
of new cells. By blocking this you basically shrank the
prostate down. There are also minimally invasive treatments
available utilizing radio waves, lasers,
micro-waves, and that’s why it’s important to have a
conversation with your doctor if you’re facing any one of these issues. (Piano music) Next up, prostate cancer.
Number one cancer males, number two leading cancer
death in males. Basically speaking, prostate cancer is
an uncontrollable accumulation of abnormal cells. Generally
prostate cancer is diagnosed in men over the age of fifty.
On autopsy, up to eighty percent of men over the age
of 70 will have some sort of prostate cancer. In fact,
most people live with prostate cancer, and end up dying
from other causes as it’s usually a very slow growing
cancer. Local or regional prostate cancer has a
five year survival rate of one-hundred percent, and a
ten year survival rate of ninety-eight percent, and a
fifteen year survival rate of ninety-six percent. Now
prostate cancers that have spread to other body parts,
or metastasized to other body parts, have a worse survival
rate. The five year survival rate being around thirty
percent. What is metastasis, and why is it bad? Well some
of those abnormal prostate cells, that are creating the
tumor, can actually break away from the prostate and
travel to other body parts, via the blood, or lymphatic
system, and when that happens, those cells start to proliferate
within that area, and cause dysfunction. (Piano music) Diagnosis of prostate cancer
is made by a combination of imaging plus biopsy.
When you get a biopsy, the doctor will get report
back with your gleason score. The gleason score goes
from two to ten, rating how aggressive your cancer is,
with ten being the most aggressive type. The treatment
of prostate cancer is decided on a case by case basis.
Recently we’ve made a lot of strides in using what we
call a period of watchful waiting, or active surveillance
in non-invasive, and low gleason score tumors.
Deciding upon active surveillance or other treatments is a
very nuanced matter, and it’s really important that you
have a healthy cline of communication between you and your doctor. (Piano Music) The PSA test is a blood
test that checks for the prostate-specific antigen
within your blood. The PSA is something that both normal,
and abnormal cells within your prostate secrete. We
have a normal range that we expect this number to fall
into, and if you have cancer it’s possible that number can
go up. Also if you have an inflamed or enlarged prostate,
that number can go up as well. Here’s the dilemma
with the PSA blood test. You want to catch prostate
cancer early if it’s an aggressive cancer, because
the earlier you catch it, the better your chances of
survival. A large percentage of prostate cancer’s that we find
using PSA’s would’ve never caused symptoms for patients
within their lifetimes, so on one hand you want to
catch as many aggressive cancers as you can, as you can treat,
and on the other hand, you don’t want to catch cancers
that are not necessarily gonna do any harm. There is no
universal recommendation on who should get a PSA test. This
is because the test can carry some benefit, but can also
carry significant harms. If the test comes up positive, you
can be over-diagnosed with prostate cancer, meaning that
you’ll find a cancer that would’ve never caused you any
problems in your lifetime. You could also get a false
positive, leading to a biopsy that wasn’t necessary,
and carries it’s own set of complications. And worst
of all, at least worst of all in my opinion, you can get a
false negative, which means that you actually have a
cancer, but the test falsely reassures you that you do
not. Being a family medicine doctor, I firmly believe in
prevention. I want to prevent problems before they happen,
I want to catch cancers early, and be as aggressive as possible,
but I want to make sure I do that without increasing
the harms over that benefits. In my opinion, I think PSA
testing is just too much of an imperfect tool to
recommend it to my patients. I think that the PSA test is
inaccurate, because at times it can be falsely elevated
with inflammation, or an enlarged prostate, which
occurs to many men as they age. You can have low readings,
because of obesity or certain medications you take, so I
don’t want to expose my patients to unnecessary harms, unless
I’m certain of the benefits. That doesn’t mean you
shouldn’t get your PSA checked, what it does mean is that
you should have a very, very specific conversation with
your doctor on whether or not this test is right for you.
I’ve had patients say, but I have a family history,
shouldn’t I get a PSA test at this specific age, or this specific
age, and the answer is probably not, but then again
we just don’t know the answer to it, because we don’t have
the proper research to give you an honest answer, and
again, I’ve said this before, a good expert knows when to
say I don’t know. There exists another preventative measure
that’s very commonly associated with prostate cancer, and
that’s the DRE. The digital rectal exam, and it’s exactly
what you think it is. It’s a digit, a finger, from the
behind, to make sure that the prostate doesn’t have an
masses, it doesn’t have an unusual shape, it’s not
larger than normal. While this test is widely used, its
evidence for finding cancers and for extending life,
is relatively weak. Now that doesn’t mean the
test is useless, because it definitely has some
utility, but it’s important that you discuss with your
doctor whether or not you need the prostate exam, or if it’s
something you could pass on. This has been the prostate
in a nutshell. Specifically a walnut nutshell, because the
prostate is the size of a… You guessed it, a walnut. My goal in making this video
is not to scare you, it’s to empower you to make quality
healthcare decisions for yourself, or your family members. I have worked with the Movember
Foundation, I have worked with the Prostate Cancer
Foundation, recently just did the Blue Jacket Fashion
Show with them, for Men’s Fashion Week. If you want
some more information about prostate cancer, or the
prostate in general, I’m putting some links down below
in the description box. If you learned something from
this video, please give it a like. Share with your
friends and family, because we could all benefit from some
extra medical knowledge. And as always, if you have a
question or unique experience with prostate cancer, leave
it down below in the comments. As always, stay happy and healthy. (Piano music)