“It continues to grow over time in most men. Different parts of the prostate can start to have abnormal growths. The big concern is that prostate cancer can form. About one in eight men have a lifetime risk of developing prostate cancer,” Dr. Rinker explains. He adds that prostate cancer is the second-leading cause of cancer death in men.

Genetics, family history, old age, ethnicity, smoking and obesity put you at a higher risk. And Dr. Rinker adds that prostate cancer largely comes with no symptoms, making screenings all the more important. If you do have symptoms, those can mimic traits of an enlarged prostate, such as difficulty urinating, blood in semen or pain around the groin.

Screenings

Dr. Rinker says men should start talking to their primary care provider about prostate cancer screening at age 40. He says the method that most men know – a digital rectal exam – has actually fallen out of favor with medical professionals.

“We really didn’t find that the digital rectal exam was very effective,” Dr. Rinker opines. “There’s a lot of user bias with how well [a provider] is at examining. Maybe they won’t be able to detect a larger, late state lesion as well.”

Instead, the standard is a prostate-specific antigen (PSA) blood test. This measures the level of a protein produced by the prostate in your blood.

“It can be added to your routine bloodwork. Nothing more than that. It could save your life,” Dr. Rinker says.

If the test finds elevated PSA levels, a provider might recommend a prostate MRI (magnetic resonance imaging). As the name suggests, this is noninvasive imaging that gives providers a clear picture of the organ.

“This can lead to a reduction in biopsies that are unnecessary,” Dr. Rinker says.

The bottom line

Dr. Rinker repeats advice that men have heard plenty: know your body, know your family history, choose healthy behaviors and see your provider regularly.

“The whole goal of [educating people on screenings] is catching cancer earlier. If you do that, you have more treatment options. You have a better chance to cure the cancer,” Dr. Rinker says. “In some cases if it’s a low-grade cancer, you may choose to not to treat it at all. We can monitor it. We can re-image it or utilize a PSA test to see if it changes.”

Learn more

Read more about cancer treatment and prevention on the OSF HealthCare website. Cancer care at OSF includes services at local cancer centers and clinics like the one Dr. Rinker works at, plus the OSF Cancer Institute in Peoria, Illinois.

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Best defense against prostate cancer: screening

The American Cancer Society (ACS) says other than skin cancer, prostate cancer is the most common cancer in men in the United States.

The good news? Prostate cancer, when caught early, is also one of the easiest to treat.

Salman Syed, MD, a radiation oncologist with OSF HealthCare, describes today’s current treatment options as “exceptional,” noting that most men diagnosed with prostate cancer at an early stage are successfully treated and remain cancer-free after therapy.

The best way to detect prostate cancer early is through screening with a PSA (prostate-specific antigen) test, Dr. Syed explains.

PSA is a protein produced by the prostate that can be measured with a simple blood test. Higher PSA levels may indicate prostate cancer or other prostate conditions. "It correlates with the amount of prostate tissue that you have," Dr. Syed adds.

“In general, we like to see PSA levels below four, but the interpretation depends on a patient’s age and overall risk,” Dr. Syed says. “Some men can develop prostate cancer even with a relatively low PSA, which is why screening decisions should be individualized and discussed with a physician.” 

If you have a strong family history of prostate cancer, you may need to start PSA testing at a younger age. “Current guidelines recommend discussing PSA screening as early as age 40 to 45 for men with higher-risk features, including a family history of prostate cancer, African ancestry or certain inherited genetic mutations.”

Inherited mutations such as BRCA1 or BRCA2 can increase the risk of developing prostate cancer, among other cancers, and can be passed down from parent to child. So, knowing your family history and if you or your parents have genetic mutations is helpful in assessing your cancer risk, Dr. Syed suggests. 

Doctors might also use genomic testing, which analyzes the activity of certain genes within a prostate tumor. These tests help determine how aggressive the cancer is likely to be, allowing physicians to tailor treatment to each patient.

“In some cases, genomic testing helps us safely avoid unnecessary treatments,” Dr. Syed explains. “In others, it tells us when we should treat more aggressively to give the patient the best chance of cure.” 

New and improved ways to diagnose, treat prostate cancer

The OSF HealthCare oncology program has several advanced technologies that help detect prostate cancer earlier and treat it more precisely, often with fewer side effects.

“One of the biggest advances we’ve seen in prostate cancer care is the ability to combine better imaging with more targeted treatments,” Dr. Syed says. “That allows us to detect cancer earlier and personalize treatment, so patients get exactly what they need.”

One example is the multiparametric MRI (mpMRI), an advanced imaging test that provides a highly detailed look at the prostate. This scan can identify suspicious areas that may not be visible on standard imaging, helping doctors detect prostate cancer earlier and guide more targeted biopsies and treatment.

Another breakthrough is PSMA PET/CT, an advanced scan that can detect extremely small amounts of prostate cancer throughout the body. Because it is far more sensitive than traditional imaging, it helps doctors locate recurrent or metastatic disease earlier and plan treatment more accurately. 

OSF HealthCare also offers proton therapy at OSF HealthCare Cancer Institute in Peoria. Proton therapy is an advanced form of radiation that allows physicians to deliver radiation to the tumor while reducing exposure to nearby organs such as the bladder and rectum. 

"With proton therapy, we can often reduce the dose to surrounding healthy tissues compared with conventional radiation," Dr. Syed explains. "That can translate into fewer long-term side effects and better preservation of quality of life for many patients." 

Another highly advanced option available at OSF is high-dose-rate (HDR) brachytherapy, which delivers radiation from inside the prostate.

“HDR brachytherapy is one of the most precise forms of radiation therapy available for prostate cancer,” says Dr. Syed. “Because we deliver radiation from inside the prostate itself, we can sculpt the radiation dose very tightly around the tumor while minimizing exposure to nearby organs like the bladder and rectum. At OSF, this treatment is typically completed in just two sessions, which allows us to deliver a very powerful and focused treatment over a short period of time while maintaining excellent cure rates.” 

Together, these advanced tools allow the OSF oncology team to diagnose prostate cancer earlier, personalize care and deliver highly effective treatment while minimizing side effects. 

Radiation versus surgery: Is there a better option?

In terms of radiation versus surgery, Dr. Syed says they are both highly effective treatment options.

"In terms of cancer control, surgery and radiation have very similar success rates for most patients," says Dr. Syed. "The choice often comes down to differences in side effects and what best fits a patient's lifestyle and priorities."

Rectal irritation, like diarrhea and looser stools during treatment, and other side effects are possible during radiation, but that improves over time, Dr. Syed points out. 

Side effects from surgery include temporary erectile dysfunction (ED), which is regained after surgery. As well as urinary incontinence (accidental urine leakage caused by lack of bladder control), which can tend to last post-surgery as well. Men are encouraged to wear supporting underwear (Depends) to prevent urinary leakage. 

The best starting point is a conversation with your oncology team to discuss what your lifestyle looks like.

If you are actively working and can't have urinary incontinence, radiation will likely be the recommendation. If you have urinary issues already, there are certain radiation options that would be better for you. 

Exercise helps decrease your risk of cancer. Dr. Syed recommends maintaining a healthy weight and staying up to date with your health maintenance and primary care provider, as well as avoiding alcohol and smoking.

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“Mom! I have to go!”

“Hold it!”

It's an exchange you probably had as a kid on long car rides. But Uwais Zaid, MD, says it’s not just a funny vacation story. A person of any age or profession can find themselves holding their urine for a long time.

“In the medical field, we see this all the time,” says Dr. Zaid, a urologist who sees patients at OSF HealthCare. “When you’re rushing from patient to patient, doctors, nurses and technicians might not go to the bathroom as much as they should. They hold their urine the whole day.”

Dr. Zaid is sharing his playbook: why this phenomenon happens, how to fix it and what can happen if you don’t.

Why do we hold our pee?

Dr. Zaid says some people hold their urine simply based on the situation. They’re on a long car ride, and stopping will make them late. Or they might be at a dinner party and don’t want to seem rude by leaving the table.

“Then there’s another subset of people who just don’t have the desire to urinate. There’s something medically wrong,” Dr. Zaid explains. “As we get older, we can get dementia and be forgetful. So sometimes people just forget they need to urinate. Sometimes, you can have lack of bladder sensation from neurological conditions like multiple sclerosis. Or they might have had their bladder stretched for so long due to things like an enlarged prostate or scar tissue in the urethra.”

The consequences

In the short term, holding your pee will make you feel uncomfortable and antsy. We all know the feeling. Dr. Zaid has even heard from patients, “The feeling doesn’t bother me that much. What’s the problem?”

A few problems, the doctor says.

“It does increase your risk of urinary tract infections [UTIs]. Your bladder is almost like a swamp instead of flowing like a river. You have stagnation of urine,” Dr. Zaid says. “It can increase the risk of bladder stones. Also, the bladder is connected to the kidneys. It’s one fluid column. So if your bladder gets really distended, it can back up and hurt your kidneys. You can get kidney swelling.

“And when the bladder is chronically distended, you can get pouches called bladder diverticuli. Those pockets can hold on to urine and be sources for infection,” Dr. Zaid adds. Over time, these pouches can also lead to worse urinary control and even the inability to pass urine.

If holding your urine and not getting treatment for it lead to, for example, the kidney issues Dr. Zaid outlined, serious health problems and, rarely, even death are possible. Dr. Zaid says that shouldn’t scare people into drastically altering their bathroom habits. But it is something to be aware of.

Prevention and treatment

So what should be the best practices when we start thinking about the toilet?

• Before you even head for the bathroom, Dr. Zaid urges you to take care of your bladder and kidneys by staying hydrated. The U.S. Centers for Disease Control and Prevention (CDC) says daily water intake recommendations vary by person. So it’s a conversation you should have with your primary care provider. But, the CDC has general tips about staying hydrated and the dangers of drinking sugary or caffeinated drinks often.
   
• Plan ahead. For example, if you have a long commute, leave early to make time for rest stop breaks, and avoid drinks like soda. If you have a busy day at work, make a promise to yourself that you’ll take breaks to use the restroom. You can set a reminder alarm on your phone to nudge you.
   
• Try the “double void.”
  
  “You get to the toilet. You get done peeing. Wait 30 seconds, and then try to get a little more out,” Dr. Zaid suggests. “But don’t bear down and push because that creates trauma for your pelvic floor.”
   
• For older adults who might simply forget to use the bathroom, make sure they have someone checking in on them. Make sure they are empowered to speak up about their health. Setting an alarm reminder and having a clear path to the toilet can also help.

If someone consistently avoids or forgets to urinate or experiences symptoms like frequent UTIs, discomfort or difficulty emptying the bladder, it’s time to see a doctor.

Dr. Zaid says the first thing a urologist would do is look for anything blocking the urine. For men, this could be an enlarged prostate, scar tissue in the urethra, a bladder stone or tumor or trauma to the bladder area. For women, it could be a prolapse, when the bladder falls through the vagina.

“We can look inside the bladder with a camera. We can do a urodynamic study, which tells us about bladder function,” Dr. Zaid says.

Doctors would then form a treatment plan depending on what’s found. For example, bladder stones could be a “wait and see” situation. Or, a doctor could perform a procedure to remove the stones or break them apart and allow them to pass. Dr. Zaid says this is sometimes done with a laser in a minimally invasive procedure.

Dr. Zaid says in some more serious cases, the bladder stops working entirely.

“It’s something we can’t often fix. It’s really frustrating,” Dr. Zaid says.

Those people, he says, would need a catheter. It could be a short-term one to help drain the bladder or a long-term one to help correct the problem for a while.

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It can be an embarrassing ailment, but experts say it’s time to talk about it.

Urinary incontinence is when a person leaks urine by accident.

Uwais Zaid, MD, a urologist at OSF HealthCare in Alton, Illinois, says urinary incontinence can wreak havoc on a person’s social life and intimacy with partners. In other words, you can’t go out and have a good time with friends if you don’t know when you’re going to suddenly “go.”

“It can be associated with medications. It can be associated with aging,” Dr. Zaid says. “It can be associated with certain surgeries. A lot of our cancer survivors, whether they're from prostate cancer, cervical cancer, uterine cancer…they can have effects to their urinary control.

“Things as normal as having children,” Dr. Zaid adds as a cause.  “Over time [childbirths] can wreak havoc on the pelvic floor and on the urinary sphincter, and you can have urinary accidents as a result.”

While incontinence is often associated with older people, Dr. Zaid says all those precursors apply to any age.

Dr. Zaid says urinary incontinence breaks down into four groups.

• Stress: This is when the bladder sphincter does not work as well. Simple things like coughing, sneezing, laughing or bending over could provoke a release of urine.
• Urge: “When the bladder has a mind of its own,” Dr. Zaid remarks. This is when you have to go and you just can’t make it to the bathroom in time. Dr. Zaid adds that hearing or seeing certain triggers like running water or jingling of keys as you rush to enter your home might provoke urge incontinence.
• Overflow: This occurs when your bladder is full. This is the opposite of urge incontinence, Dr. Zaid says, and is associated with infections and kidney issues.
•  Functional: This applies to someone who may have normal bladder control but can’t get to the toilet in time due to physical limitations like arthritis.

A health care provider will ask you about your symptoms and health history to see which type of urinary incontinence is ailing you. Testing would typically follow. Each type of incontinence, generally, has its own treatment plan.

• Stress: A provider may recommend pelvic floor physical therapy as treatment. For women, a small device can be inserted to stop leaks. Surgery is also an option.
• Urge: You may be told to cut back on caffeinated food and drink, spicy food and alcohol. Medicine and surgery are also options.
• Overflow: “That's where we need to make sure we're not missing anything like a blockage - for women, a prolapse and for men, an enlarged prostate.” Dr. Zaid says.  “A stone in the bladder. A tumor in the bladder. And we also need to make sure the kidneys are functioning okay.”
• Functional: Since people with this type of incontinence may have a normal bladder, external solutions are necessary. For example, keeping your route to the bathroom clear of obstacles like chairs and doors. For older adults with physical limitations, have a walker handy for when the need to go arises.

Other tactics include urgency suppression, when you distract yourself from thinking about urinating. You could take long, relaxing breaths or sit completely still.

Timed voiding is when you schedule times to urinate. Dr. Zaid says this can work in both directions. If you are urinating too frequently, set a timer on your phone to go every hour. Then when you get comfortable, you can increase the time. If you are holding on to your urine too long, set a plan, get comfortable then decrease the time.

The bottom line: if something seems off about your bathroom visits or if friends or family remark “You’re sure in there a lot,” see a doctor.

“If you’re chronically wet down below, it increases your risk of fungal infections and skin breakdowns,” among other serious health issues, Dr. Zaid says.

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Gotta go? Try these six bladder tips

To paraphrase George Carlin: It’s 50% universal.

At some point in their life, many men will have to think about benign prostatic hyperplasia (BPH), commonly known as an enlarged prostate. BPH often means the flow of urine from the bladder is blocked by the prostate gland growing inward, leading to frequent and annoying trips to the bathroom. But BPH can also lead to more serious problems of the bladder, urinary tract and kidneys.

According to the National Kidney and Urological Disease Information Clearinghouse, the most common prostate problem for men over 50 is prostate enlargement. By age 60, more than half of men have BPH, according to the American Urological Association. By age 85, the number climbs to 90%.

Luckily, BPH is treatable.

Ronan Lev, MD, is a urologist who provides care through OSF HealthCare in Alton, Illinois. His practice was recently designated as a Center of Excellence by UroLift®, an organization that introduced a quick, minimally-invasive procedure to deal with an enlarged prostate and allow for an easier recovery with fewer complications such as erectile dysfunction. The Center of Excellence designation is provided to individual physicians who have achieved a higher level of training and experience with the UroLift system. In Dr. Lev’s case, he has performed more than 200 UroLift procedures.

Dr. Lev says minimally-invasive procedures such as UroLift signal a shift in BPH strategy toward bladder preservation.

“In the past, we were very happy about symptoms relief. Everything was focused on symptoms relief. And if you said, ‘I'm feeling better, took a pill,’ that was fine for us,” Dr. Lev says. “What we learned over time is that it was causing some damage to patients because as medications were failing, their bladders were making up the difference. Because the bladder is a very, very strong muscle, and we can’t appreciate how strong our muscle is working.”

Dr. Lev’s message to men: See a doctor if something doesn’t seem right down there.

“Men have a tendency to pare down their issues and say, ‘Oh, it's not an issue. It's not a problem,’” Dr. Lev says. “But if they really think about it, I would say most men compare themselves to yesterday. They don't compare themselves to what it was a year ago. If they would think about that, they would realize that it's a lot worse than they really think.

“If we can do a procedure in the office under very mild sedation and improve your quality of life,” Dr. Lev explains. “When you're 90, every day counts, not what's going to happen in a couple of years. So we if we can improve your quality of life, that's really crucial.”

At OSF HealthCare in Alton, the UroLift procedure will be done on an outpatient basis. However, UroLift is not yet available in every community served by OSF HealthCare. You can learn more about urology and find an OSF HealthCare urologist here.

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