Prostate health

An interview with Polyclinic urologist Joseph Marquez, MD. 

March 19, 2020


The prostate is a small gland that sits below the bladder and in front of the rectum. It produces a fluid that supports male fertility. The prostate is shaped like a donut and surrounds the urethra, the tube that empties urine from the bladder. 

Because of its location, the prostate can lead to common problems. These include pain or difficulty urinating and blood in the urine. The prostate can also become cancerous.



Expert insights


Urologist Dr. Joseph Marquez was recently featured on KOMO radio. He spoke with Shannon O’Kelley, president of IRG Physical Therapy, about prostate health and prostate cancer. 

Video Component

Narrator: Our next guest, Doctor Joseph Marquez, urologist for the Polyclinic. We’re talking about Men’s Health: Prostate Awareness.

Shannon O’Kelley: Dr. Marquez, welcome to Health Talk.

Dr. Joseph Marquez: Good morning. How are you?

Shannon O’Kelley: I’m doing great. Hey, you’re a urologist. Tell our listeners about your practice, your training, you know, give us the day in the life. I always like to do that, the day in the life of Dr. Marquez. How’s that sound?

Dr. Joseph Marquez: Oh, that’s awesome, yeah. I mean, I didn’t even know what a urologist was going into med school. We’re surgeons and we’re clinicians, and we specialize in the genitourinary tract. So if there’s a problem with the kidneys, bladder, prostate, the genitals, especially if it’s a surgical problem, that’s something we deal with. But we also deal with medical issues like infections and things like that.

Shannon O’Kelley: I think the common listener would say, “Urology, I mean, that’s a male thing,” but it’s also - male and female patients, you see them all.

Dr. Joseph Marquez: Oh yeah, definitely. So kidney stones happen in men and women equally, infections, bladder cancers, so sure. 

Shannon O’Kelley: You know, we’re in November here, and November is Men’s Health Awareness Month. I mean, No Shave November, I’m gonna participate. I’m a little gray right now, but that’s okay. But let’s talk about the prostate. A big deal for men. Tell our listeners, let’s do some anatomy and physiology. Why do we have a prostate and what is it? Why does it become a problem and all that neat stuff.

Dr. Joseph Marquez: Yeah, why do we have it? That’s a great question. [laughs] Like, it even has an answer but, well, it’s a reproductive organ, so it supports basically fertility. That’s its only function. You don’t need to have it for any other reason. So it creates the fluid that’s needed to support the sperm in fertility.

Shannon O’Kelley: But it can become problematic, and tell us about that. Who gets it, and what is prostate cancer, signs and symptoms, and then we’re gonna talk about some treatment. 

Dr. Joseph Marquez: Yeah, so it’s a gland, so any gland makes secretions and that’s primarily what its function is. It’s where it’s located that often causes the problems that we see. So it’s located between the bladder and the urethra, in the male of course. So if it gets enlarged, it can obstruct the urinary flow, it can make it difficult to pee. If it has inflammation, you can have blood in the urine. If it gets infected, it can be painful. And then lastly is it can develop cancers, and in fact prostate cancer is one of the most common cancers to affect men. 

Shannon O’Kelley: Let’s visualize this, I know we’re on the radio, but let’s let our listeners really understand. So the prostate doesn’t surround the urethra, it just sits close to it? Or does it engulf the urethra? The urethra is the tube that goes from your bladder that allows you to pee.

Dr. Joseph Marquez: That’s right. And that goes right through the prostate, in fact we’ll call that the prostatic urethra.

Shannon O’Kelley: Okay.

Dr. Joseph Marquez: So the prostate is almost like a donut shape, with the urethra going right through the middle.

Shannon O’Kelley: Okay, thank you. So if it gets inflamed and becomes enlarged, it puts pressure, compression on the urethra. That’s why you have difficulty peeing or urinating, and the blood can actually cause that urethra to become inflamed and irritated then?

Dr. Joseph Marquez: Yeah, exactly.

Shannon O’Kelley: So those are things you need to kind of look for then, I mean, difficulty urinating, blood in your urine. But there’s no pain with it, is there?

Dr. Joseph Marquez: It depends on what the problem is, yeah. If we’re talking about prostate cancer, in fact, what’s remarkable about the modern era is that most men with prostate cancer are diagnosed without symptoms. They’re diagnosed by blood tests, or maybe a physical exam finding. But actually in my practice, it’s rare that someone sees me with a symptom and that symptom is the first time they’re found to have prostate cancer.

Shannon O’Kelley: Is it fair to say that if you have symptoms, like pain or discomfort, the prostate cancer is probably advanced? I mean, this is one of these cancers that it’s so important to get early detection.

Dr. Joseph Marquez: Yeah, absolutely. I mean, exactly. If the symptoms that someone is experiencing like blood in the urine or obstruction is due to prostate cancer, unfortunately that probably means it’s further along, which is less fortunate than if it got picked up, let’s say, much earlier in the process.

Shannon O’Kelley: Is it fair to say, again, just from a medical standpoint, the blood tests that they’re doing now - what is that called again? Something with an eight or something, isn’t it?

Dr. Joseph Marquez: The most common test is called PSA which stands for Prostate Specific Antigen, and that’s what I think most people are aware of, but there are other tests out there. 

Shannon O’Kelley: The PSA test is pretty accurate. I mean, most family physicians now, I guess I want our listeners to understand that back in the day, you were probably going to get a digital exam at 50 as a male, right? Today they’re just doing blood tests for the most part or how do you feel about those two?

Dr. Joseph Marquez: Well, as a urologist, I really think both are quite important, so I think a PSA blood test and a physical exam in the appropriate candidate, the appropriate patient, is a very good idea.

Narrator: That’s Dr. Joseph Marquez. We’ll have more of our conversation coming up next on KOMO.

Shannon O’Kelley: Dr. Marquez, thank you again for joining us. A urologist at The Polyclinic, I mean, you’re doing a great job describing this prostate situation. So I have symptoms or no symptoms, but let’s say I go to my doctor and I get picked up on my blood screen that I have potential prostate cancer. What’s gonna happen then?

Dr. Joseph Marquez: Well, then typically you’ll get referred to a urologist like myself, and hopefully that urologist is pretty familiar with how to manage a situation like that, because one of the issues with the PSA test, for example, is that it’s not really telling you if you have cancer or not. It’s just telling you if you have a risk for prostate cancer, and a good urologist who’s familiar with how to manage PSA and just prostate cancer detection will be able to put that into context for you. How serious is this risk? What’s the likelihood this is cancer and what’s the likelihood it’s serious cancer? And then what are other things we can do to sort that out?

Shannon O’Kelley: What are the treatment options? I mean, I know cancer care and cancer research and survival rates have increased significantly. You know, I think back 15 years ago, they talked about theses proton bullets they put in there. Now you’re doing some neat, neat, stuff and some advanced stuff, because you wanna preserve the prostate as much as possible, and eliminate any post-surgical consequences, my understanding is.

Dr. Joseph Marquez: Yeah, I mean, as we talked about earlier, the location of the prostate down by the bladder is what puts it in harm’s way for things like surgery, radiation, etc. So a lot of the complications you see from treating prostate cancer comes from the fact that the bladder can get involved, the urethra, the sphincter, the rectum, etc. So whatever treatment you can do, the least, sort of collateral damage is what the goals are. 

Shannon O’Kelley: You have some techniques, or you use some robotic assisted devices that are pretty fascinating stuff.

Dr. Joseph Marquez: Yeah, so something I’m really excited about is called the Artemis MRI Fusion Biopsy robot, and that happens in the stage where we’re trying to either detect a man having prostate cancer for the first time, or if he has prostate cancer but we don’t think that those risks we just talked about with surgery and radiation are going to outweigh - that the risks are outweighing the benefits there, so in those cases, we’ll see if men are good candidates for active surveillance, where we’re not actually treating this cancer. But to do that safely we wanna know exactly, at least as much as possible, how serious the cancer is, and using this Artemis Biopsy robot is one way to do that. We can really look at the prostate, we use an MRI, we take biopsies, we can follow this over time. And so a lot of men these days, especially in my practice, don’t necessarily need to suffer the consequences of surgery or radiation. 

Shannon O’Kelley: That’s really interesting. I mean, so what you’re actually saying is that sometimes you’re weighing the risk of intervention versus the risk of just watching it and protecting the patient.

Dr. Joseph Marquez: Yeah, so I like to think of prostate cancer as five different types of cancer, and some are serious and some aren’t, and the ones that aren’t super serious are maybe best followed over time and not treated. 

Shannon O’Kelley: Any advice for men who are notorious for not seeking out health care and following up on annual physicals? I mean, just get it checked, just go get a PSA, if anything?

Dr. Joseph Marquez: Get it checked, you know, urologists are human, we don’t want to hurt anyone, don’t be afraid of pain or anything like that.

Shannon O’Kelley: Well, you’ve made me really comfortable. I feel really comfortable talking to you, and if you’re like this with your patients, you’re a phenomenal urologist. Thank you for joining us.

Dr. Joseph Marquez: It’s my pleasure. Thanks for having me here. 


How is prostate cancer diagnosed?

Most men don’t have early symptoms of prostate cancer. Diagnosis is typically made by a blood test and/or an exam by a primary care provider. Dr. Marquez believes that using both is the best method of detection.

Men with significant pain or discomfort may have a more advanced case. This is why early detection and regular doctor visits are important. The most common screening test for prostate cancer is the PSA (prostate-specific antigen), but there are others. 

The PSA doesn’t confirm if a patient has prostate cancer, but it does show if there’s increased risk. An experienced urologist can help determine if cancer is present, the type of cancer and the best way to treat it. 

The location of the prostate by the bladder, rectum and urethra can make treatment challenging. Sometimes the risks outweigh the benefits of treatment. Dr. Marquez always aims for treatments that cause the least damage possible.

How is prostate cancer treated?

Serious cases or fast-growing cancers can be treated with surgery and radiation. One tool Dr. Marquez uses is the Artemis biopsy robotic system. It allows him to get samples and MRI images, then track them over time to watch for changes. 

Sometimes, if the cancer is limited and slow growing, ongoing monitoring is the best approach. This frees the patients from dealing with the consequences of more invasive treatments.

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The information provided is for general informational purposes only and is not intended to be medical advice or a substitute for professional health care. You should consult an appropriate health care professional for your specific needs.