urinary symptoms

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Ted Schaeffer is an internationally recognized urologist who specializes in prostate cancer. In this episode, Ted delves deep into the realm of prostate health, starting with strategies for vigilance and effective management of the issues that can arise with aging, including urinary symptoms, prostatitis, pelvic pain, and prostate inflammation. Ted sheds light on the popular drug finasteride, renowned for its dual purpose in prostate shrinkage and hair loss prevention, as well as the contentious topic of post-finasteride syndrome. Ted then shifts to the topic of cancer, explaining how androgens, genetics, and non-genetic factors contribute to the pathogenesis of prostate cancer. He provides valuable insights into cancer screening, examining blood-based screening tools like PSA and the use of MRI in facilitating biopsies and their interpretation. Finally, he explores the various treatment options for prostate cancer, including surgical interventions, androgen deprivation therapy, and more.

We discuss:

• Changes to the prostate with age and problems that can develop [3:45];
• Behavioral modifications to help manage nocturnal urinary frequency and other lower urinary tract symptoms [8:30];
• Pharmacologic tools for treating nocturnal urinary frequency and lower urinary tract symptoms [16:30];
• Surgical tools for treating symptoms of the lower urinary tract [26:15];
• HoLEP surgery for reducing prostate size [32:30];
• Prostate size: correlation with cancer and considerations for small prostates with persistent symptoms [40:30];
• Prostatitis due to infection: symptoms, pathogenesis, and treatment [46:45];
• Prostatitis caused by factors besides infection [58:45];
• How to minimize risk of urosepsis in patients with Alzheimer’s disease [1:05:00];
• Prostate cancer: 5-alpha reductase inhibitors, how androgens factor into pathogenesis, and more [1:10:00];
• Post-finasteride syndrome [1:18:15];
• The relationship between testosterone and DHT and the development of prostate cancer over a man's lifetime [1:26:30];
• How genetic analysis of a tumor can indicate the aggressiveness of cancer [1:35:15];
• Pathogenesis and genetic risk factors of prostate cancer and the use of PSA to screen for cancer [1:37:45];
• Non-genetic risk factors for prostate cancer [1:45:45];
• Deep dive into PSA as a screening tool: what is PSA, definition of terms, and how to interpret results [1:56:30];
• MRI as a secondary screening tool and the prostate biopsy options [2:13:15];
• Ted’s ongoing randomized trial comparing different methods of prostate biopsy [2:24:00];
• Determining when a biopsy is necessary, interpreting results, explaining Gleason score, and more [2:27:00];
• Implications of a Gleason score of 7 or higher [2:46:45];
• Metastasis of prostate cancer to different body locations, treatment options, staging, and considerations for patients' quality of life and survival [2:53:30];
• How prostate cancer surgery has improved [3:09:30];;
• Questions to ask your neurologist if you are considering prostatectomy for cancer [3:21:45]; and
• More.

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Are you experiencing symptoms like burning and itching around your vulva and vagina, or painful sex? Or perhaps you have the urge to wee more often or are plagued by recurrent urinary tract infections?

Joining Dr Louise this week is trailblazing US urologist and sexual health doctor Dr Rachel Rubin, to address these common menopause symptoms and the relief vaginal hormones – often used alongside systemic HRT – can bring.

Dr Rachel explains why we need to stop using terms like vaginal dryness and vaginal atrophy, which hugely downplay the impact of declining hormones on your whole genitourinary system.

‘When we say women have vaginal dryness, we minimise their symptoms, we minimise that it's no big deal, that you can just use a little lubricant, a little moisturiser,’ says Dr Rachel.

Plus, Dr Rachel and Dr Louise also discuss DHEA – a hormone treatment which converts to estrogen and testosterone in the vagina – and the benefits this can bring to women struggling with genitourinary syndrome of the menopause (GSM), again often alongside systemic HRT.

Dr Rachel’s three tips if you are struggling with GSM:

1. Know that if you have any symptoms that affect your vagina, vulva or urinary system and you’re over the age of 45, you deserve a vaginal hormone product.
2. Talk to your healthcare professional about access to this treatment that can prevent urinary tract infections, decrease your frequency and urgency of needing to urinate, decrease your pain in intercourse and lead to better lubrication, arousal and orgasm.
3. Keep using your localised hormone replacement: it is a safe product, so can be used long term to sustain the benefits.

 Click here to visit Dr Rachel’s website, and follow her on Instagram @drrachelrubin.