The longer you ignore your prostate and urological health, the greater the severity of the conditions that will accumulate. We asked Dr. Judson Brandeis — acknowledged by SF Magazine as the top urologist in the Bay Area for the past seven years — about the top trends in prostate and urological health, and why men need to take charge of these areas of their healthcare as early as possible.
Dr. Judson Brandeis, MD
Urology Specialist
As a leader in urology, can you explain why prostate health is so vital to men of all ages?
An enlarged prostate affects half of American men over the age of 50, and prostate cancer affects 1 out of every 8 men. When the prostate enlarges (BPH), men experience urinary issues like frequency and urgency, as well as slow stream and nighttime urination. If left untreated, BPH can lead to infections, bladder problems, and kidney failure. Treating prostate cancer can lead to incontinence and erectile dysfunction. These problems are why it is so important to be proactive about your prostate health.
What is the best way to talk to your loved one about prostate health, especially when it comes to erectile dysfunction?
The best way to address prostate health is to accept that almost every man will face prostate issues and erectile dysfunction if they live long enough. The more proactive a man is about his prostate and erectile health, the less likely it will affect his quality and quantity of life. Discussing these medical challenges with a partner can not only be life-saving but can also bring life partners closer by addressing important issues together.
How common is BPH for men and what are some potential causes and risk factors?
BPH affects 50 percent of 50-year-olds, 60 percent of 60-year-olds, 70 percent of 70-year-olds, and 80 percent of men over 80. Initially, men experience a slow urinary stream and difficulty emptying. This progresses to urinary frequency and urgency during the day and getting up at night multiple times to urinate. At this point, it is important to seek medical attention or a man will eventually develop urinary tract infections, blood in the urine, or even need a catheter tube to empty his bladder.
What are the best treatment options for BPH depending on your age?
In the early stages, BPH can be addressed with medication to shrink the prostate (like Finasteride) or relax the prostate (like Tamsulosin) or with supplements containing beta-sitosterol (like SPUNK). For men who progress past this stage, there are in-office procedures, like UroLift and Rezum.
Trelstar® is the only gonadotropin-releasing hormone (GnRH) agonist approved for use in the United States for patients with prostate cancer that differs from natural GnRH by a single amino acid.
If a man is not a candidate for these in-office procedures, there are a variety of procedures to remove the part of the prostate that is causing urinary blockage, including TURP, GreenLight Laser TURP, Saline TRUP, and Aquablation. It is essential to consult an experienced, board-certified urologist who can help you determine what option is most appropriate for you.
What innovations do you expect in the future for ED and BPH health?
Erectile health is a critical indicator of the overall cardiovascular system. ED precedes heart disease by about five to 10 years because the blood vessels going to the penis are half the size of the blood vessels going to the heart, so they get clogged earlier. ED is an early warning system that you need to eat better, exercise more, stop smoking and drinking, get your cholesterol under control, and destress your life.
Beyond that, there are many options for erectile function, including Citrulline-based supplements like AFFIRM, and generic PDE-5 inhibitors like Sildenafil and Tadalafil. Augmenting these oral medications’ effects are new technologies like GAINSWave shockwave therapy and Platelet Rich Plasma injections, which seek to regenerate the blood supply to the penis by stimulating the growth of new blood vessels to the penis.
The use of exosomes from stem cell lines is also under investigation. Peptides like PT141 have also shown effectiveness by using a different pathway to stimulate genital blood flow.
The trend in treating BPH is to move procedures into the office. Rezum and UroLift are performed in the office and have results similar to the surgical options. These treatments can be painful, so many offices offer inhaled nitrous oxide during the procedures to reduce discomfort. The procedures’ goals are to minimize pain, shrink the prostate size, reduce the sexual side effects, and get the patient back to function as quickly as possible. Several companies are working on new technologies to achieve these goals.