Don’t Fight the Nite With Prostate Enlargement

 

Nearly every man over the age of 50 experiences symptoms of prostate gland enlargement.  The symptoms are going to the bath room frequently, poor force of the urine stream, dribbling after urination and perhaps the most troublesome of all is getting up at night to urinate.  Every night, between 12 and 15 million men in the U.S. are likely to have loss of sleep because of an enlarged prostate gland.  This article will discuss the purpose of the prostate gland and what treatment options are available for this common condition.

The prostate gland is typically the size and shape of a walnut and is located in the lower part of the pelvis, below the bladder. It envelops the urethra, the tube through which urine flows from the bladder out of the body. When the prostate gland grows bigger – which happens to virtually every man as he ages – it can compress the urethra and make it difficult to pass urine.

Benign enlargement of the prostate gland does not cause prostate cancer or affect a man’s ability to have, but if the symptoms bother you, seek treatment. If left untreated, BPH can lead to urinary retention and cause bladder, urinary tract and kidney problems.

Coping Techniques.

Try behavioral changes. Perhaps the easiest suggestion is limiting your fluid intake at night and not drinking anything for two hours before bedtime.  I also caution to decrease those foods and beverages that are diuretics (and will therefore prompt you to urinate more), such as coffee, caffeinated tea, herbal tea, lemon juice, chocolate, pineapple, grapes and cherries.

If those behavioral changes don’t help much, consider medication. A change in habits will help some but not all men with BPH, and for those whose symptoms aren’t relieved, medication is an option.  The most commonly used medications are alpha blockers, (Flomax) which can relax the muscle at the base of the bladder and the prostate, and 5 alpha reductase inhibitors, (Proscar) which can, over a period of months, shrink the prostate.  Like nearly all medications, they do have side effects.  For example, alpha blockers can cause the man taking them to faint and by decreasing his blood pressure when moving from laying down to standing upright quickly.  Alpha blockers also can cause sexual side effects like decreasing the volume of the ejaculate or having no ejaculation at all.  The 5 alpha reductase inhibitors can cause sexual dysfunction, such as impotence. Some physicians are also prescribing tadalafil, commonly known by its brand name Cialis, which is often marketed as a drug that treats erectile dysfunction, but can also help to relax the muscles in the prostate gland and thus relieve urinary symptoms.

If behavioral changes and medication don’t work or cease to be effective, surgical procedures are an option.  Until recently the two most common procedures are a transurethral resection or TURP, in which an instrument is inserted up the urethra to cut out the part of the prostate that’s blocking urine flow, and a laser procedure, which vaporizes the tissue obstructing the urethra. Both procedures are typically effective but carry the risk of side effects such as erectile dysfunction. Other, newer procedures, such as the UroLift System, in which a urologist places tiny implants in the prostate to increase the opening of the urethra and allow for greater urine flow.  This procedure can be accomplished in the outpatient or ambulatory treatment center or even in the doctor’s office.  The advantage of the UroLift is that there are no sexual side effects and the results are noted almost immediately after the procedure.

Bottom Line:  The enlarged prostate gland affects millions of American men.  It significantly impacts a man’s quality of life.  Help is available.  Speak to your doctor.

The Skinny On Screening for Prostate Cancer

Prostate cancer is the second most common cancer among men (after skin cancer), according to the American Cancer Society. It is the second most common cause of death in following lung cancer and causes nearly 30,000 deaths annually in the United States.  The good news is that often prostate cancer can be treated successfully, especially when caught in its early stages.   More than 2 million men in America count themselves as prostate cancer survivors, according to the American Cancer Society.

At the present time screening for prostate cancer is controversial in the medical profession.  There are physicians who believe that testing all men for prostate cancer outweighs the benefit because it may find some very slow growing cancers in some men that could be left alone without any negative consequences. My personal opinion is that prostate cancer screening should be done but requires education and a decision made between doctor and patient.

My belief is that if prostate cancer is detected early, it has a favorable  prognosis. If men ask me what are the early signs of prostate cancer, the answer is that there are NO early signs of prostate cancer when it is confined to the prostate gland.  That is why men need to have an examination or the digital rectal examination and a PSA test.

Risk factors help determine who should be screened when

The protocol starts by evaluating men for their risk factors for developing prostate cancer. Risk factors include: age (after age 50 risk of prostate cancer rises rapidly); race (men of African-American and Caribbean descent are at higher risk); and family history (men who have a father, brother, or uncle with prostate cancer are at a higher risk of developing prostate cancer and should be screened on a regular basis) Men should be screened every year until they reach age 70 or 75. For most men who reach age 70 and all their screening tests are normal, the chances of their developing a cancer that would impact their well-being or their longevity is really low.

Managing the elevated PSA test

If your screening detects a possible cancer, your doctor will order a biopsy. This is done in the office under a local anesthesia and takes 10-15 minutes.  If the biopsy detects prostate cancer, then the next step is to determine the aggressiveness of the cancer or how likely it is to spread or grow.  For men with low-risk tumors that are not going to put their health or longevity at risk, I will often recommend surveillance, which means regular testing of the PSA and a follow up biopsy in 12-18 months.  As long as the PSA remains stable and there is no evidence of escalation of the cancer, then these men can be safely followed and only treated if the cancer appears to be growing or the PSA is steadily increasing.  Men with more aggressive tumors may need surgery and\or radiation. You and your doctor will make the best treatment decisions for you together.

Bottom Line:  Prostate cancer is a common cancer and can easily be diagnosed with prostate cancer screening.  Not all men need to be screened, but if you are between 50 and 70 years of age, speak to your doctor about the benefits of screening and make an informed decision if screening is right for you.

The Care and Feeding of the Enlarged Prostate Gland

If you are a man, then you have a prostate gland.  If you have a prostate gland, then you are likely to be one of the 14 million American men who experience bothersome symptoms beginning around age 50.  This article will discuss the diagnosis of the enlarged prostate gland and what are some of the available treatment options that can reduce the symptoms associated with this common condition.  It is a walnut sized organ at the base of the bladder and surrounds the urethra or tube that is in the penis and transports urine from the bladder to the outside of the body.  It is common and even normal for the prostate gland to become enlarged as a man ages. Though the prostate continues to grow during most of a man’s life, the enlargement doesn’t usually cause problems until middle age or around 50. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have symptoms of BPH.

The prostate gland encircles the urethra like a donut, so problems with urination can occur if the gland restricts urine flow through the urethra. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose.

The following changes occur over a period of time.

• The bladder wall becomes thicker and will contract without the owner’s permission causing urgency of urination.
• The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination.
• Eventually, the bladder weakens and loses the ability to empty itself. Urine remains in the bladder.

The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

Some problems associated with BPH are

• Urinating more often during the day
• Need to urinate frequently during the night
• Urinary urgency, which means the urge to urinate is so strong and sudden, you may not make it to the toilet in time and soil your clothing-very embarrassing!
• The urine stream is slow to start
• Dribbling after urination
• A sensation that the bladder isn’t emptied after urination
• Lack of force to the urine flow, which makes aiming more difficult
• The sensation of needing to go again a few minutes after urinating

Diagnoses

You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine check-up. The doctor can determine the size of the prostate gland during a physical examination.

The diagnosis is made with several of the following tests:

Symptom Score

This is a brief questionnaire that provides a numerical value to the symptoms associated with urination.  The higher the score (maximum is 25), the more symptoms a man has and the more likely he will want to have treatment for relief of his symptoms.

Urinalysis

A urine sample is taken to look for signs of blood and infection.

Digital Rectal Examination (DRE)

Your doctor inserts a gloved finger into the rectum to feel the condition of the prostate that lies close to the rectal wall. If your doctor feels something suspicious such as a lump or bump, further tests will be carried out. Other tests are needed to enable a more accurate diagnosis. 

Prostate Specific Antigen (PSA) Test

A blood sample is taken by your doctor to check for prostate specific antigen (PSA), which is produced by the prostate and is increased by cellular abnormalities within the prostate.

As men get older the prostate gland grows and so the PSA is likely to rise. A high PSA may indicate some type of prostate disease. The level can be raised due to inflammation of the prostate (Prostatitis) and enlargement of the prostate gland (Benign Prostatic Hyperplasia or BPH).

Urine flow rate

This test consists of a man urinating in private over a funnel which measures the volume of urine and the time that it takes to empty the bladder.  The urine flow rate is expressed in milliliters per second.  Normal is greater than 15 ml\second.

Urodynamics

Sometimes the doctor will ask a patient to urinate into a special device that measures how quickly the urine is flowing. A reduced flow often suggests BPH.

Imaging studies

The ultrasound examination evaluates the size of the prostate gland which often determines the treatment option which is best for your situation.  It is a painless examination consisting of the insertion of a small pencil-size probe into the rectum and uses sound waves to determine the appropriate treatment for prostate gland enlargement.

Cystoscopy

In this exam, the doctor inserts a small tube through the opening of the urethra in the penis. This procedure is done after a solution numbs the inside of the penis so all sensation is lost. The tube, called a cystoscope, contains a lens and a light system, which help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.

Treatment options

1. Watchful waiting-If the person has BPH but is not bothered by the symptoms, the patient and the doctor may decide to simply wait and monitor the condition regularly. This option requires regular check-ups with the doctor – usually once a year – to see if the condition is getting any worse.

2. Drug therapy–Your doctor may advise drug therapy which aims at shrinking the enlarged prostate. The doctor will select the medication that best suits the condition, keeping in mind the person’s general health condition, medical history, medications taken for other conditions and quality of life considerations.

3. Minimally invasive treatments-The prostatic urethral lift or UroLift is an implant of several polyester sutures connected by two small metallic tabs that opens the prostate gland located in the urethra and improves the flow of urine thus decreasing the symptoms of the enlarged prostate gland. UroLift has been approved by the FDA to relieve the symptoms of the enlarged prostate gland. There have been nearly xx thousand of men who have had the treatment which reports favorable results up to 4 years. Most insurance companies will now pay for the UroLift procedure 

4. Surgery-Surgery is another option for the treatment of BPH. The most common type of surgery for BPH is TURP (Trans Urethral Resection of the Prostate). This procedure requires an admission to the hospital, a general anesthesia, a urinary catheter for several days, and the risk of sexual problems afterwards.

Bottom Line:  Nearly all men will experience the problems associated with the enlarged prostate gland.  The enlarged prostate gland impacts a man’s quality of life.  Help is available and nearly all men can be helped.  If you have symptoms associated with urination, speak to your doctor.

Don’t Beat the Band to Treat the Enlarged Prostrate Gland

The prostate is just a walnut sized gland that forms a part of the male reproductive system. The gland is constructed of two lobes, or areas, surrounded by an outer layer of tissue. For reasons not entirely understood, the prostate gland becomes enlarged, causes problems with urination, and affects a man’s quality of life.  That may be the bad news.  The good news is that there are ways to treat it.

 

The prostate can be found in front of the rectum and just beneath the urinary bladder, where urine is stored. The prostate also encompasses the urethra, the duct by which urine passes out from the body. For most men, the nightly bathroom runs can be the very first indication of an enlarged prostate. Other symptoms might include problem beginning a flow of urine, leaking or dribbling.

 

During the early stage of prostate enlargement, the urinary bladder muscle becomes thicker and forces pee through the narrow urethra by contracting more strongly. Like grey hair, an enlarged prostate is just a natural byproduct of getting older, doctors say.

Although it is just not known why only some males develop an enlarged prostate, it is clear that increasing age is the primary risk factor. The problem is, the nightly bathroom runs can be frequent, finally edging their way into the day routine. I recommend seeing your doctor if you develop urinary difficulties because of an enlarged prostate.

 

Benign prostatic hypertrophy is a non-cancerous enhancement of the prostate gland, often found in men over the age of fifty. Problem in passing urine or pain when passing urine, a burning or stinging feeling when passing urine, strong, regular urge to pass urine, even when there is just a small amount of urine are the signs of benign prostatic hypertrophy.

 

Treatment for an enlarged prostate is dependent upon the symptoms and signs and their severity. In case you have significant problems, like urinary bleeding, persistent bladder infections, urinary bladder and kidney harm, your physician will likely recommend treatment.

 

In case your prostate is enlarged, but your symptoms are not too bothersome, treatment might not be necessary. This is referred to as watchful waiting.  If you and your doctor select this option, you will be asked to return about once a year for a symptom check, a prostate exam and a PSA test or prostate specific antigen test which is a screen test for prostate cancer in men between the ages of 50 and 75.

 

There are two kinds of medication that help to control the signs of an enlarged prostate, they are alpha blockers and alpha reductase Inhibitors.

The alpha blockers work by calming the muscles at the neck of the urinary bladder making urination easier. Alpha reductase inhibitors work be actually shrinking the size of the prostate gland.  An enlarged prostate now is just easier to treat if the treatment begins early. These medications have side effects including reducing the volume of the ejaculate at the time of sexual intimacy.  The alpha blockers also affect the ability to have cataract surgery which is very common in older men.  Finally, the drugs must be taken for the rest of man’s life.

 

Now there are minimally invasive treatments such as lasers, prostatic urethral implants or UroLift to open the prostate to allow an improved flow of urine from the bladder to the outside of your body, and the use of steam or water vapor to heat the prostate tissue to reduce its size and affect urine flow.

 

Finally, there are surgical procedures to remove the prostate tissue.  The most common is the transurethral resection of the prostate or TURP.  These operations require admission to the hospital, a general anesthesia so the patient doesn’t experience any pain, the use of a catheter for a few days, and several weeks or moths to return to normal activity.

 

Your doctor will explain the different treatments and which might be best for your situation.

 

FAQs on the Enlarged Prostate

 

What is BPH?
 Benign prostatic hyperplasia is commonly known as enlarged prostate. BPH is a non-cancerous condition in which prostate cells grow, enlarging the gland and causing it to squeeze the urethra. A variety of symptoms may result, including difficult, frequent or urgent urination.

When Should I Seek BPH Treatment?
If you are experiencing BPH symptoms that are affecting your quality of life, such as losing sleep because you need to wake during the night to urinate, you are unable to urinate, you are unable to delay urination, have hesitancy, or a weak urine stream, check with your urologist to discuss if it is time to seek treatment.

BPH is not cancerous and is not life threatening, but it does create bothersome symptoms can significantly impact quality of life.

What Are the Long Term Risks of BPH?

If left untreated, BPH can progress and cause subsequent medical issues. When the bladder does not empty completely, you become at risk for developing urinary tract infections. Other serious problems can also develop over time, including bladder stones, blood in the urine (hematuria), incontinence, or urinary retention. In rare cases, bladder and/or kidney damage can develop from BPH.

What are the Treatment Options?

Based on the AUA Guidelines for the treatment of BPH, there are four recommended treatment options: Watchful Waiting, medications, in-office therapy, and surgery.

Are In-Office Therapies Safe?

Yes, these treatments are safe. UroLift has been cleared by the FDA to treat BPH. In-Office BPH Treatments are associated with few side effects and adverse events.

Are In-Office Therapies Effective?

Based on clinical studies, in office procedures is proven to be a safe, effective and durable option for BPH with very few side effects.

Are In-Office Therapies Covered By Insurance?

Medicare and many commercial insurance plans provide coverage for the UroLift procedure. Ask your doctor’s office to assist you by providing the information your insurance plan may require.

Do In-Office Therapies Hurt?

Some men describe the UroLift as causing some discomfort, while most men report no discomfort at all.

Will I need a catheter after the treatment?

Most patients will not need a catheter after the procedure.

Can I go home right after the procedure?
 Yes. You should arrange for someone to drive you home because you may have been given some medication to help you relax during the procedure. Your urologist will give you post-treatment instructions and prescriptions and explain the recovery period to you.

Bottom Line: BPH is a common problem and effective treatments are available.  For more answers, speak to your physician.

Complications of the Large Prostate Gland

 

The most common condition affecting millions of middle age American men is benign enlargement of the prostate gland.  This is called benign prostatic hyperplasia or BPH, which is a non-cancerous enlargement of the prostate. For reasons not entirely known, the prostate increases in size around age 50.  As the prostate gland grows, the gland compresses the urethra, which is the tube that transports urine from the bladder to the outside of the body.

Over time, the growth causes the urethra to become so compressed that it becomes difficult for men to empty the bladder.   The symptoms associated with enlarged prostate gland include frequency of urination, urgency of urination, dribbling after urination and even the complete inability to urinate or allowing only a small amount of urine to exit the bladder.

Bladder stones are formed when crystals inside the bladder collect together and harden to form a stone.  They often occur when the bladder is not fully emptying, so the urine that is left behind remains in the bladder for long time and coalesce and form stones.

Symptoms of bladder stones include frequent urination throughout the day, lower abdominal pain, a burning sensation when urinating, urine that appears cloudy or contains blood, and urgency of urination.

Urinary retention is the inability to fully empty your bladder. Acute urinary retention is a medical emergency, so it does require immediate medical attention.

There are two main types of urinary retention.  If there is an obstruction such as a bladder or kidney stone, then urine cannot properly be released, resulting in urine remaining in the bladder after urination. In this case, urinary retention can be life threatening, and you will require immediate medical intervention and the insertion of a catheter to relieve the blockage.

The most common cause of acute urinary retention is the enlarged prostate which compresses the urethra or the tube from the bladder that transports urine from the bladder to the outside of the body.

Non-obstructive urinary retention is caused by the weakening of the bladder muscles or nerve problems disrupting the communication between the bladder and the brain. Causes of non-obstructive urinary retention include stroke, pelvic injury or trauma, nerve diseases, impaired muscle or nerve function, and spinal cord injury that affects the nerves to the bladder.

Chronic urinary retention mainly affects men as a result of prostate enlargement. Although the condition is not life threatening, it can lead to permanent kidney damage. In chronic urinary retention, a man is unable to fully void their bladder, so urine stays within the bladder, increasing the risk of urinary tract infections.

Symptoms of chronic urinary retention include urinary frequency, urgency and hesitancy, nighttime urination, symptoms similar to a urinary tract infection, and lethargy and emotional irritability.

Urinary tract infections are often associated with urinary retention. Symptoms include cloudy or foul-smelling urine, blood in urine, difficulty urinating, pain while urinating, nausea, vomiting, shaking and chills, and fever.

Hematuria, or blood in urine, is frequently a benign condition, but there may be a risk of a more serious condition, too. For men with documented blood in the urine which is confirmed by a urine examination, you will will need some additional testing such as urine culture, a radiologic examination of the kidneys, and a cystoscopy or a look in the bladder with a lighted tube.

As the bladder retains urine, it continues to stretch. Excess stretching weakens the bladder muscles, making it impossible for the bladder to contract.  If this is left untreated, then permanent damage to the bladder muscle will occur and even if the obstruction is relieved the bladder muscle cannot contract and the man may be left with a permanent urinary catheter or may have to catherize himself several times a day.

Bottom Line: Every man over age 50 should see his doctor every year to check his prostate and to obtain a PSA blood test which is a screening test for prostate cancer.  Nearly every man can be treated with either medications or minimally invasive procedures that can often be done in the doctor’s office.

Tomatoes and Not Potatoes May Help Prevent Prostate Cancer

For many years I have been focused on nutrition and various urologic diseases, especially prostate cancer.  Although the relationship between prostate cancer and diet is certainly a consideration, the use of tomatoes may be one of the strongest preventive options a man can take to avoid prostate cancer.

There are many health advantages of eating more tomatoes, which includes a lower risk of prostate cancer and other cancers as well. While the good news is Americans eat more tomatoes and tomato products than any other non-starchy vegetable, about 90% of adult men fail to consume the 2.5 cups of vegetables per day recommended by the 2010 Dietary Guidelines for Americans.

Tomatoes contain a high antioxidant content, specifically lycopene. Lycopene has been the subject of many research studies regarding its protective effect against prostate cancer.

In men with prostate cancer, lycopene supplementation has been shown to be safe and tolerated well in doses up to 120 mg per day for up to one year. Toxicity is generally very mild, with diarrhea as a possible side effect at very high doses.

There appears to be a protective effect of tomatoes and tomato products on the prevention of prostate cancer as well as improvements in biomarkers of disease status, including the PSA levels.

A unique characteristic of tomatoes is that unlike the nutrients in other fresh fruits and vegetables, lycopene is more bioavailable after tomatoes are cooked and processed. This fact opens up even more possibilities for individuals to enjoy the benefits of lycopene.

According to the US Department of Agriculture National Nutrient Database for Standard Reference, ½ cup of tomato paste contains 18.84 mg of lycopene, while an equal amount of tomato sauce has 17.12 mg, spaghetti sauce has 15.82 mg, and tomato juice has 10.88 mg of lycopene.  One-half cup of raw tomatoes, however, contains only 2.32 mg of lycopene. Non-tomato products that contain lycopene include watermelon (1/2 cup has 3.44 mg) and grapefruit (1/2 fruit contains 1.75 mg).

More recent hypotheses have looked at the advantages of whole tomatoes, which are excellent sources of vitamins A and C, fiber, and potassium, and identified other protective elements beyond lycopene. Vitamins A and C are potent antioxidants, while fiber has been shown to reduce cholesterol, and potassium is helpful in lowering blood pressure and possibly reducing bone loss.

Experts in nutrition and cancer note that the preponderance of evidence suggests that consumption of whole tomatoes and tomato products should be preferentially recommended because of greater consistency of documented positive outcomes with the whole tomato and the concomitant supply of other important essential nutrients.

Given that tomatoes and tomato products are already dietary favorites, increasing their consumption can achieve several goals, including reduction in the risk of prostate cancer and other diseases, and helping Americans achieve the recommended daily intake of 2.5 cups of vegetables.

Bottom Line: Prostate cancer is the most common cancer (besides skin cancer) in men and the second most cause of death in men following lung cancer.  Men can be easily diagnosed with a PSA test and a digital rectal exam.  Man can also decrease their risk of prostate cancer by consuming lycopene, an antioxidant, which is plentiful in tomatoes.

Testosterone and the Prostate Gland-Hormone Replacement Is Safe For Your Prostate Gland

I am also asked if using testosterone, injections, topical gels, or pellets, will worsen urinary symptoms in men suffering from testosterone deficiency.

Millions of Americans suffer from testosterone deficiency.  They have symptoms of loss of energy, erectile dysfunction, loss of libido, loss of muscle mass, and emotional mood swings.  The diagnosis is easily made with a testosterone blood test.

A recent review finds no evidence that testosterone replacement therapy causes or worsens urinary tract symptoms or increase the size of the prostate gland.

Although the Endocrine Society and other associations have suggested severe urinary symptoms as a contraindication to TRT treatment, investigators found little evidence to support it worsening urinary symptoms in men using testosterone replacement therapy.

The investigators discovered that men with mild urinary sympmtoms experienced either no change or an improvement in their symptoms following TRT.

Remarkably, the study explained that the therapy may actually improve voiding symptoms.

Bottom Line:  Testosterone replacement therapy is safe in men with urinary symptoms and will not worsen those symptoms but may actually improve their symptoms.

Source

Kathrins M, Doersch K, Nimeh T, Canto A, Niederberger C, and Seftel A. The Relationship Between Testosterone Replacement Therapy and Lower Urinary Tract Symptoms: A Systematic Review. Urology S0090-4295(15)01053-3. doi:10.1016/j.urology.2015.11.006.

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.

Prostate Cancer prevention-Diet and Exercise

I am often asked what can patients do to prevent prostate cancer. Prostate cancer is the most common cancer in men, and is the second leading cause of death from all cancers in the U.S. following lunch cancer, which is the most deadly cancer in men. In fact, half of men in their 80s have prostate cancer. While this may sound scary, the good news is that prostate cancer is usually slow growing and if caught early on, can be treated and stopped.

The truth is that prostate cancer is regarded as one of the most curable cancers, if caught early.

Signs of prostate cancer

Let me start that from the onset, early prostate cancer may have NO signs and NO symptoms.

If prostate cancer is advanced or spread beyond the prostate gland the signs may include:

• Trouble urinating
• Decreased force in the stream of urine
• Blood in your urine or semen
• Pain in your lower back, hips or thighs
• Discomfort in the pelvic area
• Erectile dysfunction
• Elevated prostate-specific antigen test (PSA)

You may assume your urinary symptoms are a sign of a bladder infection or a kidney problem, but get it checked out. This can be especially true for younger men. While most cases of prostate cancer occur in men over 50, if you have difficulty starting a urine stream, have weak flow or have to go frequently, especially at night, get it checked out. It may not always be prostate cancer but does require an evaluation by a urologist.

Trouble urinating might simply indicate that your prostate is enlarged due to benign or non-cancerous causes. Having an enlarged prostate is not a sign of prostate cancer nor does it increase your risk of getting it.

Annual prostate screenings

Prostate cancer screenings work, especially for men ages 50 to 69. In recent years the formal recommendation for prostate screenings has changed. The U.S. Preventative Task Force on Health now says annual prostate screenings are not advised across the board, and are rather an item to be discussed and decided between a patient and doctor on an individual basis. If you have a family history, it’s a good idea to get checked regularly.

During a prostate screening, the doctor will test your PSA level, which is a simple blood test which measures a protein produced by your prostate gland. The higher the number, the greater chance you might have prostate cancer. (You should know that not all elevated PSAs point to cancer — some are caused by infections and even an enlarged prostate gland can elevate the PSA test.) Then, a physical exam is completed.

Preventing prostate cancer

Some risk factors for prostate cancer can’t be prevented, such as genetics and race. If you have a relative such as father, uncle, brother, or cousin with prostate cancer, then your risk is higher for prostate cancer. Also, African-American men have a higher incidence of prostate cancer and need to be screened at an earlier age.

While one in six men are diagnosed with prostate cancer at some time in their lives, that number increases to one in three for African Americans. Also, if you have a first degree relative who had prostate cancer — a dad or brother — your risk is doubled or tripled.

There are things you can do to prevent prostate cancer and cancer in general. Did you know that exercising three hours a week has been shown to greatly reduce your cancer risk overall? Eating well has similar results.

Live a healthy lifestyle: eat well, watch your weight and exercise frequently. By adopting a healthy lifestyle, you’ll decrease your risk for prostate cancer and other cancers as well.

 

Bottom Line: Prostate cancer is a common medical condition. Leading a health lifestyle with frequent exercise and a good diet can decrease your risk of developing prostate cancer.