Dr. Chris Yang of NAU Urology Specialists was recently a guest on the Bro Show. He joined The Daniels Brothers to discuss prostate cancer. Addressing the greatly misunderstood role of androgen deprivation therapy via chemical or surgical castration de-mystified by Dr. Yang.
One of the things that they quickly discovered is that Dr. Yang has a five-star rating on Yelp with glowing reviews. Taking us from his beginnings in software, they walk us through when he decided to tackle his medical degree. Dr. Yang did specialty training in sexual dysfunction. Read on for an overview of their discussion below or click here to listen to the podcast.
Let’s talk prostate cancer
The discussion is about prostate cancer. About 2.9 million men have prostate cancer, every year, about 160,000 men find out they have the disease. It is one of the most successfully treated cancers, due to early detection. With any of the cancers discussed, the issues can lie in the side effects of the treatment.
What inspired you to pursue urology as opposed to other medicine?
I knew I wanted to do something surgical and there were a couple of urologists in Galveston who were excited about the field and they got me excited about the field. Plus, urologists have the best jokes out of all physicians. With what we deal with, you have to have a decent sense of humor.
What percentage of your practice is prostate cancer-related?
Probably about five to ten percent.
What comprises the remainder of the issues for the patients you see?
The remainder are other urologic cancers; kidney, bladder, testicular. Kidney stones and other surgical problems with the kidneys. Men’s health, fertility health and other issues such as scrotal pain.
As physicians, we get focused on our system. When I have patients that come in who have pain on their side with a kidney stone, that is what I know best.
For the layman, what is prostate cancer?
You first have to answer what a prostate is. The prostate is an organ that sits below your bladder of men. It’s an organ of reproduction, so it makes some of the seminal fluid. Your urethra runs through the prostate. The prostate is a gland that men have that makes fluid. Prostate cancer is abnormal growth of glands. There are very rare types of prostate cancer that comes from the connective tissue, or the muscle in the prostate. Cancer is abnormal cell growth. Cells that should die aren’t and they grow and spread.
Are they tumors?
Yeah, exactly. Cancers are tumors, but not all tumors are cancers. If you have a benign tumor, that’s not cancer.
With other cancers, people talk about stages. Is that the case for prostate cancer?
Yes, it is. Stage 1 & 2 cancers mean that the cancer is just inside of the prostate. Stage 2 is more aggressive than Stage 1. Stage 3 means that cancer has spread beyond the prostate, but locally. It’s invaded the boundary of the prostate, the bladder or other nearby organs. Stage 4 means it’s metastatic, meaning it has spread somewhere distant to the prostate like the bones or the lungs.
So, if I have a tumor in the lymph system near my prostate, would that be Stage 3 cancer?
That would still be Stage 4.
In terms of success rate, this is distinct from other cancers, but how else is it different from other cancers?
The thing that distinguishes it, and the main thing that we can test for is PSA. PSA stands for Prostate Specific Antigen. It’s a protein that’s made by prostate cancer cells and normal prostate cells. It’s a protein in your bloodstream at all times. If it’s high, it’s suspicious.
Prostate cancer is a slower developing cancer, which can vary treatment based on the age of the cancer patient. Can you talk about that?
You’re right. The majority of prostate cancers are Stage 1 and Stage 2 and those are very slow growing. Meaning, it probably wouldn’t cause a problem in 10 years. Stage 3 and Stage 4 cancers do have the ability to cause other health problems fairly quickly. Right now there’s no easy way to distinguish between those two.
A very high PSA wouldn’t guarantee that I was Stage 3 or 4?
Not necessarily. It would be more likely that you would have Stage 3 or 4.
When you’re a guy over 50 you start hearing about PSA numbers. What’s the scale and how is the number so widely varied?
What is considered the normal range is <4 nanograms per liter in the blood. But there’s a pretty big variation as far as what’s normal. For men who have BPH, which is a non-cancerous enlargement of the prostate, which all men get as we get older, that normal range increases. Just because your PSA is 5 or 6, doesn’t mean you have prostate cancer, but we might get a little suspicious.
My urologist said my prostate size was age-appropriate.
What that means is that when you’re younger your prostate is about 20 or 30 grams, like a walnut. As you get older, with 60 year old, I would expect a prostate to be maybe 40 to 50 grams. It can get much larger, some people can get up to 100 gram or 200 gram with a softball or baseball sized prostate. You don’t really feel the size of the prostate, but it will start to restrict the flow of urine. You can’t feel it externally, but can with a prostate exam. We still only get about half the prostate.
This is a 2-part series to be continued. Check back for the next installment in March or click here to listen to the full podcast now.