Episode Transcript
Speaker 1 00:00:01 Be bold. Take risks. Lead by example. Believe in your power. Say what you feel mean what you say. Hi, I'm Leslie Ann Cion, host of the new podcast series, cion 180. Join me at Cion 180 on this journey of discovery and advancement.
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Speaker 1 00:01:19 Hello and welcome again to C on 180. On our podcast series, we feature Caribbean voices from around the world who are making real differences in their areas of influence. I invite you to check out my website at see on one eighty.com or my Facebook page, or visit your favorite podcast streaming sites for current episodes as well as par shows. You can also visit my Instagram page for weekly updates, tidbits, advice, and interactions with me, your host and fellow listeners. We are now in the fourth season of C on 180 and we have brought you voices of trauma and triumph discussing a diverse range of topics from healthcare to finance and business to leadership, entrepreneurship and motivational. Today's topic, what every man should know about prostate health, demystifying prostate health, embracing general wellness for and with me to chat about this very important topic today is Dr. Adrian Rudd.
Speaker 1 00:02:32 Dr. Adrian Rudd is a consultant urologist at the Celest Bird Medical Center in Antigua and the Medical Surgical Associates. He did his medical training and urology residency at the University of the West Indies, Mona Campus, and also spent time training in the United Kingdom where he is a fellow of the Royal College of Surgeons. He has shared his tremendous urology experience and expertise across several continents, including America, Europe, Africa, and of course right here in the Caribbean. He is a lecturer at the American University of Antigua. He is passionate about cancer care and men's health as he is about traveling and exploring the world. He's a father of two and a fan of the Arsenal Football Club. Dr. Rud, thank you and welcome to SEA on 180.
Speaker 3 00:03:30 Thank you. Thank you for that. Si
Speaker 1 00:03:32 And I have to begin by saying that we are on the opposite ends of the spectrum with respect to, to football clubs as I am a man united fan,
Speaker 3 00:03:42 <laugh>. It would be very interesting later today,
Speaker 1 00:03:46 And I know that rivalry goes all the way back, uh, to historic times.
Speaker 3 00:03:51 Exactly. So,
Speaker 1 00:03:53 So Doc, um, we are introducing this topic, which in our previous chat you said it's such a wide and huge area, um, and we want to tackle it, uh, from a standpoint that we can condense it into 30 minutes. Um, generally we want to be able to help men, um, learn information about their general reproductive health, especially as it re it relates to, to the prostate. Um, but first of all, can you tell me what, as a urologist is your primary function and then of course, what is the role of the prostate in the meal reproductive system?
Speaker 3 00:04:32 Okay, so as a urologist, cuz there are not many urologists around, um, we are surgeons dealing primarily with diseases of the genital urinary tract, and that is the, the kidney, the bladder, the prostate, the penis. We, a lot of our work surrounds the prostate as the number of problems the prostate can cause is quite, quite high. Lots of issues come up with the prostate, namely prostate cancer. Yeah. So a lot of the times I like to tell people that I'm almost like a male version of a gynecologist. Right. But we also do see women, because women do have issues with kidneys, do have issues with kidney stones, bladders, urinary problems, but a large bulk of my work and most urologists work are around men. Now, as surgeons, we primarily do operations, remove kidneys, prostates, bladders, but know more and more as health evolved in the region. We tend to find ourselves advocating for men's health and men's health needs as we generally find, or I personally find that that has been something that's been neglected for generations, for decades. And that's why the state of men's health is where it's at today.
Speaker 1 00:05:53 Yes. Especially in the, in the Caribbean. Uh, doc, one of of the things i i I like to do is to sort of burst open a lot of the issues and myths and taboos concerning, you know, particular topics. And in, in this case, for instance, um, a lot of our audience might feel, well this is sort of like, uh, an old man's topic. Prostate health rarely deals with middle age and older men and doesn't have anything to do with younger men. And then some of our, our men folk, um, with our usual ma machismo may say, well, all you have to do is have a lot of sex and, uh, you have great prostate health. Uh, tell us about these myths and issues and and what are the fears phobias that you, uh, come across in your practice?
Speaker 3 00:06:37 So the general feeling is men do not take care of themselves. Men have poor health-seeking behaviors and it's, it's multifactorial is it that men are taught to be macho. Men are taught not to complain about their problems, men are taught not to go to the doctor. Um, and it's just a cultural situation. Um, there is also the part that I believe the healthcare system has also done a disservice to men as there isn't really much of a reason to encourage men to come and see the doctors. And I always compare it to the women and the gynecologists. Women go to see their gynecologist the minute they start having children, which will be late teens to early twenties. They, they get familiar with accessing the health services and then when they get pregnant, they, they have to form a relationship with an obstetrician. And then they, they, they, they, that's an opportunity to be taught about their body, about health, about taking care of themselves and wellness with regards to the man.
Speaker 3 00:07:43 There's been no time when you've had to tell men, look, come and see a doctor get checked out. So men just roll around for all of their life, never seeing a doctor. It's almost a badge of honor until they present later down in the late fifties, sixties, seventies, in end stage diseases with major, major problems that they were just taught to ignore, to suck it up, to tough it out. Yeah. So this is, it's multifactor, but this is what we have fortunately with, with our advo advocations for, with what we are doing and how we're trying to change in narrative. There's a lot more information. Men are more proactive. We're seeing that changing and the word is getting across, particularly with platforms like this, men that listen and say, oh, okay, maybe I should come and get a checkup. And even if it's not the older man that is listening, you may have the wives, the sisters, the daughters, the sons who say, look, it's not me, but I want my father, I want my brother. I want my uncle to be around and to be healthy and wholesome. And then that drives them to at least start the conversation.
Speaker 1 00:08:52 Yes, very much so. And um, it's, it's, it's not a topic that's just for men, as you said. It's very important that women listen and they are able to pass on the information, um, correct to to to their men folk. Um, so doc, in terms of your practice, uh, in the Caribbean in particular, what are the typical issues that you will see in relation to prostate health? I know that the, uh, common, uh, types of inflammation in large prostate and of course as you mentioned cancer. Tell me more of what you see and maybe more about the age group in which these completes tend to arise.
Speaker 3 00:09:32 So we generally see three main conditions. One enlarged prostates also called bph h or benign clot prostatic hyperplasia. And what that causes is most men from the hit age 44 0 and the prostate enlarges, they will have some change in the urinary symptoms that's guaranteed just by the sheer mass of the prostate growing. They may find the urination is slow, they may find that it's hard to hold it, they may find that they have to wake up a lot at night. That is very, very common. That's usually around middle age to elderly men. And then the second most common thing that we see is the prostate cancer. So we're as whereas BPH and enlarged prostate will not kill you, but will make your life a nuisance. Prostate cancer will kill you. That is a big, big burden. That's a big bulk of the work we do because black men unfortunately are the highest risk for having prostate cancer.
Speaker 3 00:10:35 We have the highest incidents in the region and also our, our mortality, meaning if we're likely to die from it, is also the highest in the world. So there's a lot of debate about it. A lot is strength is going on, a lot of research as to why and how, what can we do about this? But from a significant standpoint, prostate cancer is killing is, is is what is causing most of our deaths in our cancer men. The third thing we see is prostatitis, which is inflammation, the prostate. And that tends to be what the younger men come in with. Discomfort, dome behind the scrotum, abnormal sensations in the pelvis, a little discomfort down there. Very common once again, uh, an annoyance, but not generally life-threatening.
Speaker 1 00:11:25 Yes, doc. You know, as you say that it, it it, it brings me to the point that, you know, we might be speaking as if our audience knows exactly what this is about in terms of the anatomy. Yes. Where is the prostate actually located? And then tell us what is the importance of, of the prostate, uh, gland or organ in, in, in men.
Speaker 3 00:11:45 So the prostate gland is a little walnut or guine sized organ. Yes. Um, it sits in the pelvis or in the lower aspect of the abdomen. It is just below your bladder. It is somewhat be ju it is just behind your pelvic bone or your pubic synthesis, and it is just in front of your rectum and anus. So it is very closely related to lots of important structures and it's somewhat behind your testicles, you know, so it it, it's covered by most stuff and it, it, it's a very important organ that produces secretions, which liquefy the sperm when you ejaculate and help to create, uh, an environment where your sperms can fertilize the egg. Right. So all men have a prostate and it starts fo it starts acting up generally around age 40. It starts enlarging around age 44 0.
Speaker 1 00:12:52 It's, is that a natural cause of, uh, for enlargement as you age?
Speaker 3 00:12:57 Yes. So the, the en the enlargement is very natural and a normal part of male aging. However, for reasons that no one knows, we all believe it has to do with, uh, the ratio of male hormones as you age. It causes further growth in the prostate.
Speaker 1 00:13:14 Right, right. And some of this reluctance that, uh, medical practitioners like yourself, um, have experienced regarding men checking on their prostate involves the type of checking or testing or examination, isn't it? Um, yes. Can you tell us about that and, and why men should not be afraid of
Speaker 3 00:13:35 It? So it has been spoken about quite a bit, the difficulties regarding, um, the digital rectal examination where the glove lubricated finger is inserted up the anus to feel the prostate. The prostate sits just a few centimeters within the anus. And that is why we do that examination. With that examination, we can tell, we can get a lot of information, we can get the size of the prostate, we can tell if it feels hard and nodular suggested of cancer. And it also gives us lots of other information and we can check the stool, the tone of the anus, very helpful. The same way if you're having a problem with your throat, someone has to look in your throat, with your ear, with your nose is the exact same thing. I know a lot of men tend to not like to have that examination done, but it literally takes five seconds. And for the most part, I think once men come in and you, you explain to them the reason for it, and it's not all you do, you know, you, you give them a full check, you have examine the abdomen, the penis, the testicles. They're very grateful to have this examination done.
Speaker 1 00:14:48 Good. I'm glad you're saying that because it's very, very important for them to understand what follows next after that examination. Correct. Because listening to you, you are detecting certain things that will take you onto the next test.
Speaker 3 00:15:00 Correct. And I, I, I generally, I I I I like to, to challenge my colleagues in the medical field to treat men as men, treatment differently, treatment with, um, respect with dignity. Um, too often we think that we could have just told men to ban, man, not just accept anything, but I mean, some people will come in and expect that all they will have examined on them is the prostate and the men just come into the, into the office and just try to bend over the, the desk Yes. To have the finger inserted and you have to tell them, no, no, no, it's more than that. We'll listen to the chest first, feel the abdomen, get you comfortable checking for any lumps in the testicles, any issues on the pains. And then, you know, you conclude with examining the prostate. I think that's a much more comfortable sequence of events than even before a discussion is had. Yes. You know, you're inserting a finger. So
Speaker 1 00:15:57 Yes. In, in other words, there is a sort of transition process before you get to this intrusion, so to speak. Correct? Correct. And you try to make the patient feel comfortable because the vision for the man is that I'm coming into bend over and grouped.
Speaker 3 00:16:11 Yes. This is just what has been perpetuated over the years.
Speaker 1 00:16:15 Yes. And, and doc, would you say that that rectal examination is critical for you in terms of the first, uh, part or phase of your diagnosis? Because we wanna now go into the, the cancerous issues with you. Yes. What, what starts to make your mind move into your area of expertise and say, we have a potential problem here after that examination, and what do you do next?
Speaker 3 00:16:39 Well, even before we get to that examination, any man coming in that is over the age of four zero is a potential patient that may have prostate cancer as young as that, especially if he's black. Okay. After that, we then ask them about their family history. Do you have any fathers, uncle brothers with prostate cancers? Because if there's somebody, a male with, um, a family history of prostate cancers, that increases your risk significantly. Yes. After that, we then ask the patients if there is, has been any issues with, um, any symptoms. And the common symptoms are, you know, blood enduring back pain, difficulty peeing. But the, the, the, the frightening part is that most of the patients will have absolutely no symptoms. So the key is to get men to come out to get checked even before they feel unwell. So wellness checks, right now, when we get down to the examination, we are essentially feeling to see if the prostate feels hard, irregular or body that is one part. And then we do the blood test, the psa, the prostate specific antigen, and then we combine the results of the tool to then determine what is going on.
Speaker 1 00:17:59 Yes. And, and, and so before our men fo get into the office of a urologist, yes. There may be some symptoms, warning signs that they have ignored mm-hmm. <affirmative>, which are indicative of a prostate health problem. What are some of these symptoms and issues that they may experience so we can enlighten them. Don't ignore this, you have to pay
Speaker 3 00:18:21 Attention. Okay. So what not to ignore. Difficulty passing a urine, straining to get the blood in the urine, back pain, persistent, chronic back pain. These are the common things to look out for later on. The back pain can cause spinal collapse and paralysis. You cannot walk, obviously at that time patients will present, but those early signs, the blood in the urine, the difficulty pain, you should have it checked up. No, the, I stress once again, the point where we would like to catch the patients where we have the most opportunity to help to cure is when they have absolutely no symptoms. So once again, what I stress for the men is wellness checks every year around your birthday, once a year, go and see a doctor have and if since it's the prostate, is what has started the discussion and has men thinking, Hmm. When you get to have your prostate check at the same time, check your blood pressure, check your sugar, check your cholesterol, this is where we will get the most value in our treatment.
Speaker 3 00:19:35 This is where we keep you. Well, this is where we pick up illnesses early enough to cure, to make major differences in your life. It's easy when you come very late and there's nothing much we can do. It is unfortunate, it is sad, but this is unfortunate, but we have too much of, there's a shift where the more educated or the more financially comfortable men are, know being more proactive with their health and are coming in earlier and earlier, which is what we like to see, but we would like, I would like to see the whole population shift to that wellness, that that, that that preventative medicine type of approach.
Speaker 1 00:20:19 Yes. Doc, you know, when, when we began the podcast, you, you, you reminded us that they're not many urologists in the Caribbean. And I will have to tell you one of my beefs, I think, um, with our, our expertise, and it's not just within the Caribbean itself, but our Caribbean specialists abroad in different countries, not doing, uh, sufficient to educate the Caribbean public, um, within the Archipelago, um, as to these health issues. And I'm wondering if you see a need for that advocacy, that lobbying, that regionalism, um, especially when you say it's so dominant in, in, in, in black males. Uh, you know, what, what, what are your thoughts on that and and can you be a trailblazer in, in, in this, in this area?
Speaker 3 00:21:06 Well, definitely I think that, um, we, we have lot behind internationally. Internationally, um, and it's a multifactorial region. I mean, I'm very passionate about it. I read a lot about the history where we come from slavery and the poor health conditions, the poor feeding, the poor medical care we got. Um, and we, we, we are just a byproduct of that system. Now, fortunately, there have been major advances and some fields have grown significantly more than this particular field. Urology and men's health, we have a lot of gynecologists, obstetricians, we have a lot more pediatricians. Um, and they, they're doing excellent jobs. But unfortunately men's health has just lagged behind no podcasts such as this. I mean, I, I do several of these talks. I, and I hope to raise the awareness to get people thinking, um, get p get the discussion started. Um, unfortunately it requires a lot of resources.
Speaker 3 00:22:07 It requires a lot of lobbying. It requires policy change, it requires money to do things because, you know, the health, public health especially, is always struggling financially. I mean, we, we exist in a, in a period where me, modern medicine and evidence-based medicine is largely a, a capitalist sort of venture. And the cost of everything keeps going up astronomically day by day, week by week, year by year. And we are always lagging behind. Um, but these, we can go on and on for always about this, but, um, I think at, at the very least, this is where it starts. Yes. People that get the training, people that come back and you're in, you, you, you're not in the ideal environment. We can always have stayed in, in the first world and continue doing this, but then if we don't come back and do this, we will.
Speaker 1 00:23:01 Yes, exactly. It has to be us. It has to come from, um, within the, within the Caribbean community. I mean, you have spoken about alarmingly high, um, incidents of, of prostate cancer in, in Caribbean men for instance, are we going to wait until they're decimated before we take steps? To me, we're constantly being fed information from the North American perspective, but we, let
Speaker 3 00:23:25 Me, sorry. Sorry. We have
Speaker 1 00:23:27 Our people, we have our people in that area like you.
Speaker 3 00:23:30 And, and let me, sorry to cut you on this point, and here's another classic example. So the most of the largest prostate cancer studies, evidence-based men have evidence-based trials have been done in American Europe, which have, which, which, which gave a set of results saying, yes, prostate cancer is significant and screening is helpful. But guess what, most of the men that were involved in these trials were white and Caucasian. They were very, very, very few black men, but all still gesturing that black men have the highest incidents and the highest mortality. Yes. Now, in the Caucasian population, a lot of the world bodies, health bodies have said, well, look, you don't need to screen because it may or may not make a big difference if you screen the men. But this is based on what happened in the Caucasian man. I'm sure if these studies were run, were run in black men, it would yield tremendous benefit to screening because you can pick up cancers early and save their lives. Yes. But we just don't have the financial backing the research capabilities in our region to, to prove this.
Speaker 1 00:24:42 Yes, yes. Very important. I know that we could spend a whole podcast on, on something like that, but I I want to say to you, as you mentioned, early detection, which gives you, um, the patient the chance to have the prostate cancer curd. What happens when you, you get to it too late, doc. Okay. What, what kind of treatment or is there any treatment at that stage?
Speaker 3 00:25:04 Yeah, so prostate cancer is largely fueled and driven by testosterone. So what has been happening is that back in the, in the mid eighties, they found out that if you cut testosterone, you can cut the fuel to the cancer, stop the growth of the cancer and get the, and, and save the lives, or at least give the patient further time to live longer. So if you are picked up too late, many men will be on this treatment, which cuts your testosterone. Back in the day, it was by doing surgery to remove the testicles, medi, surgical castration, which was the cheapest and most effective. Nowadays we have these injections, which fortunately are given every three months, which is actually pretty tolerable to give men a a pretty comfortable, um, quality of life and length of time. Yes. That is generally what we do for late presenters.
Speaker 1 00:26:01 Right, right. And when you remove the, the, the prostate, the prostate, prostate, can it lead to erectile dysfunction? I mean, there are fear that men have genuinely about this, that could be the cause of them not even coming forward because they're afraid to lose, quote unquote, they're
Speaker 3 00:26:20 In, in some. So what ends up happening now is any, anytime you have prostate cancer and you do any kind of treatment to cure it, it will affect two things. Your erectile function and your continents, the ability to keep hold of your urine. Now, usually if you have prostate cancer, it's all about saving your life. The, the issue is now, if you are telling men to come out and get screened and get checked earlier, it means you pick up this disease earlier in younger functional men in which sexual function and, and continent is urinary control, is of utmost importance. But it is a real discussion that you have to have with the patients. Now, treatments have so advanced that the side effects have become less and less. If you have early prostate cancer, we recommend surgery to remove the prostate, and now it is being done robotically where you have robotic assistance, where you have much better vision, you can make more precise movements and precise cuts. However, it's not a 100% guarantee. I like to tell my patients it's almost like trying to remove a peanut from a spider's web. You can be as gentle as possible. The peanut represents the prostate, the web represents the nerves. Any kind of distortion of those nerves will and can affect your continents and how, how good your erections are.
Speaker 1 00:27:49 Yes. And, and for men in the Caribbean, any discussion on erectile dysfunction and inability to have sexual activity would have quite an impact. Correct. One hates to be sensational, but perhaps that has to underpin some of the messaging, uh, from our urologist in the region so that it resonates with the men folk. Uh, so, so, so doc, that leads me to, uh, our final question. Um, as a urologist working in the Caribbean, having worked in, in, in several countries across the globe, what advice would you give for younger men? Thirties men, forties? Yes. On prostate,
Speaker 3 00:28:26 Younger men. Start doing your wellness checks. Start having your general checkups once a year around the time of your birthday, go in and get a general checkup the same way you service your car two, three times a year. You can at least service your body once a year. Walk into a doctor. It doesn't even have to be a urologist, just a general doctor. Get your pressure checked, get your sugar checked. Any problems you have, any concerns here? This is how you get comfortable with the healthcare system. This is how you pick up illnesses early, particularly the, the chronic non-communicable disease, which is a whole other kind of worms. The heart attack, stroke, diabetes. This is what I, I strongly encourage and I, I advocate to all the men, particularly y the younger men. You don't have to wait until 40 to go and start with your prostate checks once a year around the time of your birthday. So you don't forget. You can't remember, was it, when did I go? Which month did I go? You'll remember your birthday. Have that general checkup. That's what we, I would like to leave with them.
Speaker 1 00:29:33 Thank you. Very important parting woods for our men folk in the Caribbean. Thank you so much, doc. It's been a pleasure having you on this podcast and sharing your expertise with our audience. And, uh, we wish you all the best and, and continue to be successful and advocate for men's health causes, particularly prostate health. Thank you. Thank you. Thank you Dr. Adrian Rudd for taking time out to chat with us on this extremely important topic. On Cion 180. We believe in raising awareness and educating, especially on topics like these that don't get much focus and platform. I am sure the men listening learnt something new, and even women now are armed with tidbits and information that they can share with their husbands, sons and fathers. So thank you so much. Thank you for being with us on this podcast C on 180. This is a season four, and we continue to learn from our community of professionals who've graced our platform. Don't forget to hit us up on our social media platforms. We do love hearing from you. Tune in again next Sunday for another episode, or check us out anytime on YouTube and on c on one eighty.com. For all current and past episodes, this ISSAM one 18. Be safe, everybody.
