PSA Testing-What Every Man Needs to Know

Prostate specific antigen is a simple blood test that can be a metric for prostate health.  It is a good screening test for prostate cancer.  This blog will discuss the PSA test and what you need to know to make a decision to obtain this common test.

Let’s start by reassuring men that having an elevated PSA level does not necessarily mean you have prostate cancer.

PSA is also likely to be increased with benign enlargement of the prostate gland as well as prostate infections or prostatitis.

It is important to emphasize that the PSA test is not a specific prostate cancer test, but it is a vital first step in screening for the potential presence of cancer.

The other factors that can cause PSA levels to rise:

• Age: PSA levels can increase gradually as you age
• Prostatitis: Inflammation of the prostate gland, due to infection or some unknown cause
• Benign prostatic hyperplasia (BPH): This condition refers to an enlarged prostate.  More prostate means more cells making prostate specific antigen, increasing the potential for an elevated PSA.
• Urinary tract infection: can irritate and inflame prostate cells and cause PSA to go up
• Medications: Some medications like Proscar, Avodart, or Propecia can falsely lower your PSA.  This too is important to remember.  If you are on any of these medications, talk to your doctor.  The general rule of thumb is to double your PSA for an accurate score.
• Sex/ejaculation:  This can cause a mild elevation in the PSA, but should return to normal after a few days. That is why I usually recommend that men refrain from sexual intimacy for 48 hours prior to PSA testing
• Prostate trauma: Anything that causes direct trauma to the prostate such as riding a bike, having a catheter inserted into the blader, a prostate biopsy, or a cystoscopy which is a look using a lighted tube through the urethra (tube in the penis that transports semen and urine) can increase the PSA temporarily.

A PSA level of less than 4.0 ng/mL is normal, while changes of more than 2.0 ng/mL over the course of a year could be an indicator of the presence of prostate cancer.

I point out that there is a familial or inherited basis of prostate cancer and also an increased risk of prostate cancer in African-American men.  In these men who are are at a greater risk of prostate cancer, I suggest annual testing with a digital rectal examination and a PSA test after age 40.  For all others, I suggest testing begin at age 50.

For men who have an elevated PSA test, then a discussion with the doctor about repeating the test in a few weeks or proceeding to an ultrasound examination and a prostate biopsy is in order.

Bottom Line: PSA testing is a non-specific test used to screen for prostate cancer.  Not all elevations of the PSA test indicate cancer.  Further testing and close monitoring as well as a prostate biopsy is in order.  For more information, speak to your doctor.

Prostatitis: When It Hurts Down There

One of the most common infections affecting men is infections of the prostate gland. This is the gland that is the size of a walnut located at the base of the bladder that surrounds the urerthra or the tube in the penis that transports urine from the bladder to the outside of the body.

There are two kinds of bacterial prostate infections: acute and chronic, but only a few of men with symptoms of prostatitis actually have a documented bacterial infection.

An acute infection of the prostate is characterized by high fever, lower abdominal pain, marked urinary frequency, urgency, muscle aches and pains, pain going down the inner aspect of the thigh, and sometimes urinary retention. The patient looks very ill and the prostate is exquisitely tender on rectal examination. Because it is very difficult for antibiotics to penetrate the prostate and cure the infection, it is important that you take culture specific antibiotics for about six weeks. If the symptoms don’t subside within a few days of starting antibiotics, it is important to be sure that a prostatic abscess is not present as this is a urologic emergency and requires a surgical procedure to drain the abscess. At this stage, it can be difficult to be sure on examination, but an abdominal ultrasound or CAT scan can usually make the proper diagnosis.

In chronic bacterial prostatitis, the symptoms are more subtle. The patient’s main complaint is usually frequency of urination, aching in the prostate or testicles and pain of fullness in the lower abdomen. Patients with chronic bacterial prostatitis usually have a history of a bacterial urinary tract infection. The diagnosis is made by doing a special examination of the urine and prostatic secretions known as bacterial localization cultures. This is done by splitting the urine sample into different segments. You begin to urinate and catch the first few drops in a specimen container. Then you continue to urinate and obtain a sample in the middle of urination (a mid-stream sample). You stop urinating and then your doctor examines the prostate with his finger in the rectum. He presses on the prostate with a technique called prostatic massage. This causes some fluid, called expressed prostatic secretions, to leak from the tip of the penis. These secretions are put into another container and, finally, you finish urinating and the last urine specimen is obtained. All of the samples are sent for analysis and culture. If there are white blood cells or pus cells and bacteria in the prostatic secretions, but not in the urine, a diagnosis of chronic bacterial prostatitis is made. Treatment is prescribing culture specific antibiotics for 6-12 weeks.

Bottom Line: Prostate infections are a common affliction of men. The diagnosis is made with a careful history and physical examination. For bacterial infections the treatment is antibiotics that are specific to the bacteria in the prostate.

When It Hurts When You Ejaculate-Coming and Going

It is not an uncommon complaint for men to have pain at the time of ejaculation. This is almost always a result of inflammation and can be resolved with medication. Pain at the time of ejaculation can be felt in the area between the anus and the scrotum or in the urethra, a tube that runs from the bladder to the end of the penis. The condition can cause discomfort in the testes and certainly interferes with sexual pleasure.

Painful Ejaculation can be caused by an inflammatory condition of the prostate gland which can make the prostate feel sore and irritated, STDs may cause inflammation in the prostate and the urethra and cause pain with ejaculation and pain with urination, obstruction to the ejaculatory ducts that get distended and then cause pain when the seminal vesicles contract at the time of ejaculation, and finally, psychological problems can manifest themselves as painful ejaculation.

To find the cause of painful ejaculation, a semen sample and urine sample taken after ejaculation (post ejaculation urine analysis) is examined. A sample of the urethral lining is taken to see if there is any infection, such as a sexually transmitted infection. A test that looks at the inside of the bladder and urethra (cystoscopy) may also be done, although this is not a usual procedure for diagnosing painful ejaculation. For some men it can be hard to describe the exact location of the pain.

Treatment
If no physical cause is found, some behavioral techniques to relax the muscles in the pelvic area may help some men. When the cause is prostatitis the use of medications such as ‘alpha blockers’, muscle relaxants, analgesics, and some anti-inflammatory drugs may help. Specific antiviral and antibiotic medications can be given if the cause of painful ejaculation is due to an infection such as herpes.
If the cause is psychological, counseling may help deal with any underlying concerns.

Bottom Line: Painful ejaculation is not life-threatening, but may affect sexual pleasure and can cause a man distress, anxiety and lower self esteem. In most instances the cause can be determined and effective treatment is available..

Eating and Exercising Your Way To Prostate Health and Preserving Your Potency

Location of prostate gland at the base of the bladder and surrounding the urethra

I am frequently asked by my patients “What can I eat to reduce my risk of developing prostate cancer?” This is one of the most common questions I am asked by men concerned about prostate health. Undoubtedly, many hope that their doctor will rattle off a list of foods guaranteed to shield them from disease. Although some foods have been linked with reduced risk of prostate cancer, proof that they really work is lacking, at least for now.
Aim for a healthy eating pattern
Instead of focusing on specific foods, dietitians, physicians, and researchers tout an overall pattern of healthy eating — and healthy eating is easier than you might think. In a nutshell, here’s what experts recommend:
1. Eat at least five servings of fruits and vegetables every day. Go for those with deep, bright color.
2. Choose whole-grain bread instead of white bread, and choose whole-grain pasta and cereals.
3. Limit your consumption of red meat, including beef, pork, lamb, and goat, and processed meats, such as bologna and hot dogs. Fish, skinless poultry, beans, and eggs are healthier sources of protein.
4. Choose healthful fats, such as olive oil, nuts (almonds, walnuts, pecans), and avocados. Limit saturated fats from dairy and other animal products. Avoid partially hydrogenated fats (trans fats), which are in many fast foods and packaged foods.
5. Avoid sugar-sweetened drinks, such as sodas and many fruit juices. Eat sweets as an occasional treat.
6. Cut down on salt. Choose foods low in sodium by reading and comparing food labels. Limit the use of canned, processed, and frozen foods.
7. Watch portion sizes. Eat slowly, and stop eating when you are full. One of my best suggestions that I have tried to adopt is to eat my entre from a smaller salad plate which makes the portion look bigger. Also, try eating with your non-dominate hand as this will slow down your eating. Finally, after you eat your first portion, wait 10-15 minutes before taking a second portion. This allows your brain to catch up with your stomach and will give you a feeling of satiety without overeating.

Stay active
In addition to eating a healthy diet, you should stay active. Regular exercise pares down your risk of developing some deadly problems, including heart disease, stroke, and certain types of cancer. And although relatively few studies have directly assessed the impact of exercise on prostate health, those that have been done have concluded, for the most part, that exercise is beneficial. For example:
1. Based on questionnaires completed by more than 30,000 men in the Health Professionals Follow-up Study, researchers found an inverse relationship between physical activity and BPH symptoms. Simply put, men who were more physically active were less likely to suffer from BPH. Even low- to moderate-intensity physical activity, such as walking regularly at a moderate pace, yielded benefits.
2. Using data from the Health Professionals Follow-up Study, researchers also examined the relationship between erectile dysfunction (ED) and exercise. They found that men who ran for an hour and a half or did three hours of rigorous outdoor work per week were 20% less likely to develop ED than those who didn’t exercise at all. More physical activity conferred a greater benefit. Interestingly, regardless of the level of exercise, men who were overweight or obese had a greater risk of ED than men with an ideal body mass index, or BMI.
Italian researchers randomly assigned 231 sedentary men with chronic prostatitis to one of two exercise programs for 18 weeks: aerobic exercise, which included brisk walking, or nonaerobic exercise, which included leg lifts, sit-ups, and stretching. Each group exercised three times a week. At the end of the trial, men in both groups felt better, but those in the aerobic exercise group experienced significantly greater improvements in prostatitis pain, anxiety and depression, and quality of life.

Bottom Line: There’s not much you can do about your genetics or what you inherited from your parents. But there’s a lot you can do by eating healthy and exercising regularly. Your prostate gland will thank you.

This article was modified from an article appearing in The Harvard HealthBeat on October 4, 2011 http://www.HarvardProstateKnowledge.org.

Protect Your Prostate With a Good Diet

What can I eat to reduce my risk of developing prostate cancer? This is one of the most common questions urologists hear from men concerned about prostate health. Undoubtedly, many hope that their doctor will rattle off a list of foods guaranteed to shield them from disease. Although some foods have been linked with reduced risk of prostate cancer, proof that they really work is lacking, at least for now.
Aim for a healthy eating pattern
Instead of focusing on specific foods, dietitians, physicians, and researchers tout an overall pattern of healthy eating — and healthy eating is easier than you might think. In a nutshell, here’s what experts recommend:
Eat at least five servings of fruits and vegetables every day. Go for those with deep, bright color.
Choose whole-grain bread instead of white bread, and choose whole-grain pasta and cereals.
Limit your consumption of red meat, including beef, pork, lamb, and goat, and processed meats, such as bologna and hot dogs. Fish, skinless poultry, beans, and eggs are healthier sources of protein.
Choose healthful fats, such as olive oil, nuts (almonds, walnuts, pecans), and avocados. Limit saturated fats from dairy and other animal products. Avoid partially hydrogenated fats (trans fats), which are in many fast foods and packaged foods.
Avoid sugar-sweetened drinks, such as sodas and many fruit juices. Eat sweets as an occasional treat.
Cut down on salt. Choose foods low in sodium by reading and comparing food labels. Limit the use of canned, processed, and frozen foods.
Watch portion sizes. Eat slowly, and stop eating when you are full.
Stay active
In addition to eating a healthy diet, you should stay active. Regular exercise pares down your risk of developing some deadly problems, including heart disease, stroke, and certain types of cancer. And although relatively few studies have directly assessed the impact of exercise on prostate health, those that have been done have concluded, for the most part, that exercise is beneficial. For example:
Based on questionnaires completed by more than 30,000 men in the Health Professionals Follow-up Study, researchers found an inverse relationship between physical activity and BPH symptoms. Simply put, men who were more physically active were less likely to suffer from BPH. Even low- to moderate-intensity physical activity, such as walking regularly at a moderate pace, yielded benefits.
Using data from the Health Professionals Follow-up Study, researchers also examined the relationship between erectile dysfunction (ED) and exercise. They found that men who ran for an hour and a half or did three hours of rigorous outdoor work per week were 20% less likely to develop ED than those who didn’t exercise at all. More physical activity conferred a greater benefit. Interestingly, regardless of the level of exercise, men who were overweight or obese had a greater risk of ED than men with an ideal body mass index, or BMI.
Italian researchers randomly assigned 231 sedentary men with chronic prostatitis to one of two exercise programs for 18 weeks: aerobic exercise, which included brisk walking, or nonaerobic exercise, which included leg lifts, sit-ups, and stretching. Each group exercised three times a week. At the end of the trial, men in both groups felt better, but those in the aerobic exercise group experienced significantly greater improvements in prostatitis pain, anxiety and depression, and quality of life.

This article was excerpted from https://mail.google.com/mail/?shva=1#inbox/132cfb68cd03a854

Your Prostate Infection May Be Caused By Your Peptic Ulcers

Treatment for chronic bacterial prostatitis is fairly straightforward: antibiotics for four to 16 weeks.  But what if you have symptoms of both chronic prostatitis and peptic ulcers?  One reader asks:  “I’ve had problems with both chronic prostatitis and peptic ulcers. My doctor said that the two could be related. How can that be?”

The underlying cause of chronic prostatitis remains unknown about 90 percent of the time. Microorganisms suspected of causing chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS)  include Escherichia coli, Enterobacter and Pseudomonas aeruginosa.

A relatively new suspect is Helicobacter pylori (H. pylori), which is the most common microorganism in human bacterial infections around the world. This bacterium lives in the lining of the stomach and can cause inflammation and immune responses.

People with certain health problems are more likely to have detectable signs of H. pylori in their blood. These health problems include heart disease, rosacea, chronic bronchitis and asthma.

A recent study in the Scandinavian Journal of Urology and Nephrology linked H. pylori to CP/CPPS. For the study, researchers took blood from 64 men with CP/CPPS and 55 without. They found that 76 percent of men in the CP/CPPS  group tested positive for antibodies against H. pylori, versus 62 percent of the men in the control group.

This was the first study to link CP/CPPS with H. pylori, so the relationship between the two is far from proven. But if further studies show a link, it suggests that treatment for H. pylori-induced peptic ulcers may be beneficial for H. pylori-induced CP/CPPS as well.

Reported in the John Hopkins Medical Newsletter

Flossing Your Teeth and Prostate Disease-There Just Might Be A Connection

Who would have thunk that flossing would be prostate gland protecting?  It has been well-documented that inflammation in the mouth, i.e., gum disease is linked to heart disease, diabetes, rheumatoid arthritis, and now even Alzheimer’s disease.  Now good research from Case Western Univeristy in Cleveland, Ohio has made a connection between gum disease and prostate health. The researchers from the dental school and the department of urology and the Institute of Pathology at the hospital found those with the most severe form of the prostatitis also showed signs for periodontitis, or severe gum disease.  It is theorized that reducing inflammation in the mouth-by daily flossing may also reduce prostate gland inflammation.  As my wonderful Jewish mother would say, “It may not help but it vouden’t hoit!”  So if you are looking for one more reason to start flossing, you now have one.

Excerpted from Journal of Periodontology, the official journal of the American Academy of Periodontology

“Just Say No” to Sex…Before Your Next PSA Test

For men over age 50 who are going to have a PSA test for prostate cancer, ejaculation within the past two days may artificially raise PSA levels. Men should be aware of the time of their last ejaculation and tell their doctors the last time they had an ejaculation in case results are high. Finally, while the digital rectal exam or other aspects of a prostate exam shouldn’t interfere with PSA levels, I suggest that blood be drawn before the rectal exam as a precaution.

Nutrition for Your Prostate Gland

Prostate cancer is the most common cancer in American men causing nearly 250,000 new cases each year. It is the second most common cause of death in American men, killing nearly 40,000 men annually. However, with regular examination consisting of a digital rectal exam and a PSA blood test, prostate cancer can be detected early and treated. There are other healthy life-style changes that can be easily done that may even help prevent prostate cancer.

1. Start taking vitamin D, E and selenium supplements. Although further research is needed to confirm their effectiveness, studies have demonstrated that all three, vitamin D, E and selenium, show promise with regard to prostate cancer prevention when taken regularly.
2. Eat more soybeans (or soybean products) and other legumes. Elevated levels of testosterone may increase your risk for developing prostate cancer. The phytoestrogens-nonsteroidal plant compounds that act like estrogen in the body and thus can help to regulate imbalanced hormone levels-contained in these foods may help to prevent prostate cancer; genistein, an isoflavone also found in soy foods, helps to normalize hormone levels and thus may reduce prostate cancer.
3. Drink green tea. Antioxidant compounds in green tea may help prevent prostate cancer; some have even been found to kill prostate cancer cells in test tubes, while others have blocked enzymes that promote prostate cancer.
4. Get plenty of fiber. Fiber can eliminate excess testosterone in the body; thus, a high-fiber diet can aid in the regulation of your body’s hormone levels and may help reduce the risk for prostate cancer.
5. Reduce your intake of meat and saturated fats. Follow a low-fat diet: diets high in saturated fat ­animal fat in particular-and red met have been found to increase the risk for prostate cancer. Eating a low-tat diet also helps to prevent obesity, a condition that may also increase prostate cancer risk.
6. Eat more broccoli, cauliflower, cabbage, brussel sprouts and greens. A recent study found that men who ate cruciferous vegetables more than once a week were 40% less likely to be diagnosed with prostate cancer than men who rarely ate them.
7. Eat cooked tomatoes. Lycopene, the carotenoid pigment that makes tomatoes bright red, possesses powerful antioxidant properties and has been linked in some studies to a decreased risk for prostate cancer.
8. Limit your dairy consumption. Diets high in dairy products and calcium may be associated with small increases in prostate cancer risk. Moderate your dairy consumption, and don’t overdo calcium­ supplements or foods fortified with extra calcium.
9. Get regular aerobic exercise. Regular aerobic exercise has been associated with reduced risk levels for prostate cancer: exercise also helps prevent obesity and other health-related complications that obesity causes.
10. See your physician for prostate cancer screenings regularly. While regular screenings can’t reduce your risk for prostate cancer, changes in diet and exercise can. They help ensure early diagnosis so that prostate cancer can be treated as effectively as possible. My best advice is to get screened annually if you are over the age of 50, if you have a family member who has prostate cancer, or if you are an African-American man.

Bottom Line: Prostate cancer may have a relationship with diet.  I cannot tell you for certain if you follow these instructions you will not develop prostate cancer.  But as my wonderful Jewish mother would say, “It may not help, but it voidn’t hoit!”

11 Suggestions For Decreasing Prostate Symptoms

The prostate gland is walnut sized organ at the base of the bladder.  In order men the gland increases in size and causes symptoms such as going to the bathroom frequently, dribbling after urination, and getting up at night to urinate.  Here are a 11 suggestions that you might consider to relieve those symptoms.

1.  Don’t drink anything several hours before you go to sleep.

2.  Avoid caffeinated beverages such as coffee and tea as the caffeine acts as a diuretic

3.  Limit your alcohol consumption especially at the dinner meal.

4.  Avoid spicy foods.

5.  Take medications such as your diuretics or water pills early in the day when going to the bathroom to urinate is not such an inconvenience.

6.  Avoid antihistamines and decongestants

7.  Don’t hold off going to the restroom

8.  Use the clock to help with urination. Make an effort to urinate every 3-4 hours.  Putting your bladder on a schedule is very helpful and a good habit to have.

9. Go and then go again. Stand at the toilet and empty your bladder, walk away from the toilet for a minute or two and then return and try emptying the bladder again.

10. Avoid cold seats such as at football games in the winter.

11. If you bike ride, especially for long distances, stand on the pedals every 10 or 15 minutes to take the pressure off of your prostate gland.

Bottom Line: These steps won’t cure the enlarged prostate but they will lessen the symptoms.  If your symptoms persist, consider a visit to your urologist