Richard Pelman worked as a urologist in Bellevue and Seattle for 35 years. He’s now a clinical professor emeritus in the Department of Urology at the University of Washington School of Medicine. Dr. Pelman was formerly the president of the Washington State Urology Society, and he created and continues to chair their Committee on Men’s Health.
Dr. Pelman is a friend of WIBM and a supporter of the effort to pass House Bill 1270, which would establish a Washington State Commission on Boys and Men. (The Washington State Urology Society has formally endorsed the bill.) For Dr. Pelman, the physical and mental health focus of the proposed Commission on Boys and Men is especially relevant and important.
WIBM founder Blair Daly recently spoke on a recorded Zoom call with Dr. Pelman. Below is an excerpt from that conversation. Note: In the video, Richard mentions Episode #10 of his Original Guide to Men’s Health podcast.
‘I think men’s health, then I think prostate. Then I’m lost.’
Below is an edited transcript of the video above.
Blair Daly: In the course of carrying out advocacy for the well-being of boys and men in Washington I’m becoming better informed about what’s important to know specifically about men’s health. But I’m 35 years old, and until a couple years ago I was pretty ignorant about men’s health, despite being a man.
When I think of men’s health as a topic, the prostate comes to mind. But I’m still quite ignorant about what a prostate is. I know that I’ve learned about it before, but apparently I didn’t retain that information; I guess it hasn’t seemed relevant to me.
I was thinking of a contrasting situation, where if we look at campaigns related to breast cancer, for example, and raising funds related to that, and breast cancer screenings that we coach women to do…breasts are something that I know where they are, I know what they look like, and I know what they do. I can’t say the same thing for the prostate. I kind of know where it is in my body, I don’t know what it looks like, and I can’t remember at all what it does. Breasts are so much more of a prominent body part — where it’s easier for people to be interested in them and to care about them and to gain some basic knowledge about keeping them healthy — compared to this mysterious prostate thing.
So I think of the topic of men’s health and then think prostate. Then I’m lost. I can’t picture it!
Dr. Richard Pelman: Yeah, because you can’t see it. [Laughter] It’s one of those organs that a lot of people don’t know what its function is.
It gets some press because of prostate cancer, which is one of the high-ranking causes of death for men behind lung cancer. We didn’t have a very good means of detection for prostate cancer until the PSA test came out (Prostate-Specific Antigen test). It wasn’t great at the beginning, but it was better than what we had. And we’ve refined it and refined it as far as our knowledge of how to use it.
If you’re already in pain, is it too late?
Blair Daly: Is prostate cancer something where if you wait until you’re feeling physical pain from it, then you’re in bad shape as far as your chances for survival?
Dr. Richard Pelman: Yes, most people who are curable don’t know they have prostate cancer. That’s a really good point.
We have a two-part episode on prostate cancer with Dr. Dan Lin, who is one of our urological oncologists at the University of Washington. It’s a great episode. Everything in it is still current. It goes through diagnosis and then treatment. So if people are wondering what they need to know about prostate cancer diagnosis, they can listen to the first half of the episode. If somebody knows someone with prostate cancer and is wondering about treatment options, listen to the whole episode.
We say that the prostate is walnut-size, but it actually grows as we get older, under the influence of testosterone. It’s in your pelvis. It lies between the bladder and the urethra, which is the pipe that drains your bladder. The gland actually surrounds the urethra. So the pipe that drains urine from your bladder goes through the prostate.
As we age and the prostate grows, it can cause obstruction, or what we call benign prostatic enlargement, also known as benign prostatic hypertrophy (BPH). As men age we may notice our stream is getting a little slower, a consequence of the bladder muscle working harder to provide enough force to get urine through.
Blair Daly: So there is such a thing as the prostate growing larger to the extent it affects urination — but it’s not cancer?
Dr. Richard Pelman: Absolutely. That’s much more common than cancer. And there are gradations of that, from “Yeah my stream isn’t as strong as it used to be, but it doesn’t bother me,” to serious retention issues where the prostate grows so large that the bladder muscle loses the ability to squeeze hard enough to overcome the obstruction. You basically can’t pee, and people end up in the emergency room because they can’t go!
Also, the prostate can get infected. That’s called prostatitis, commonly a bacterial infection. So the prostate is susceptible to infection, benign growth, and cancer.
The prostate’s function
The prostate’s function is to contribute the fluid that supports sperm. Sperm come from the testes, but what gets ejaculated is a combination of sperm and prostatic fluid. So the prostate provides the right environment for the sperm to survive.
The reason that digital rectal exams are done is that you can feel the posterior prostate through the rectum. Patients correctly ask, “Aren’t you only feeling half of it?” It turns out that prostate cancer is predominant on the posterior side — the side that can be felt through the rectum.
So we get an idea about the size, contour, and consistency of the prostate through a digital rectal exam and that, in combination with the PSA test (Prostate-Specific Antigen test), is very useful. People who have a consistently low PSA reading and a normal feeling prostate are at very low risk for prostate cancer. It’s always good to go have a test and find out ‘Hey, I just confirmed I’m doing okay!’
See related: Be the First in Washington to Earn This New Men’s Health Certification | Interview with Armin Brott