Mitchell Humphreys, M.D., a urologist at Mayo Clinic, answers the important questions you may have about prostate cancer.
Video timeline: 0:00 Introduction 0:16 How do you know how fast my cancer is growing? 0:49 Is prostate cancer sexually transmitted? 1:04 Is prostate cancer hereditary? 1:36 What can I do to prevent or slow prostate cancer? 2:03 Is there a risk of cancer spreading if I have a biopsy of my prostate? 2:20: When should I stop screening for prostate cancer? 2:46 How can I be the best partner to my medical team? 3:12 Ending
Prostatitis seems to be a catchall diagnosis varying anywhere from clear cut acute bacterial infection of the prostate gland with burning on urination, fever, positive cultures, and response to antibiotics, through recurrent nagging symptoms that can include pain on urination, urine flow obstruction, sexual dysfunction, blood in the urine, and chronic pain syndromes affecting the pelvic region.
Prostatitis constitutes perhaps 10% of urology practice, and is often frustrating to patients and physicians alike.
Symptoms are shared with BPH and prostate cancer, which are more clear-cut entities with standard diagnosis and treatment.
Prostate and bladder stones can give similar symptoms on rare occasions. STDs can be a diagnostic consideration in people with multiple sexual partners, and with international travel, we mustn’t forget parasitic infections.
From the patient’s standpoint, the important thing is to find a good urologist who can sort out the symptoms and find a proper diagnosis and treatment plan.
Please refer to the following Cleveland clinic article for a more orderly discussion.
Blood in your urine can be a startling sight, one that prompts concern over your health. While it doesn’t always mean something serious, several serious things can cause it. And that means you should contact your doctor right away.
It’s also important to understand what’s going on in your body. You may see a range of colors — from pink or slightly dark urine to bright red or cola-colored liquid. You may also see clots, which can come from your prostate, urethra, kidneys or ureters (tubes connecting your kidney to your bladder).
Benign prostatic hyperplasia, or benign enlargement of the prostate, is the most common prostate problem that will affect almost all men as they age. There are many treatment options available that range from medications to surgical options that destroy excess tissue. Learn more about them in this helpful video from Cleveland Clinic.
Chapters: 0:00 Introduction 0:10 What is BPH? 0:45 What are treatment options for BPH? 0:60 What are some medications used to treat BPH? 1:43 What are some surgical options used to treat BPH? 3:43 Call your doctor if you notice any of these symptoms
Benign prostatic hyperplasia is the most common condition that affects the prostate gland. While it can make things quite uncomfortable for those who are living with it, BPH is noncancerous and treatable. Learn more about it in this helpful video from Cleveland Clinic.
Chapters: 0:00 Intro 0:16 What is BPH? 1:11 What are common symptoms of BPH? 1:58 What causes BPH and who is most affected? 2:25 Does having BPH mean you have prostate cancer? 2:50 Why you should talk to your healthcare provider
Focal One® high-intensity focused ultrasound uses high-intensity sound waves to destroy a cancer tumor. It’s delivered through a rectal ultrasound probe. There are no incisions. Most patients need no pain medication after treatment. And there are fewer side effects than with radiation therapy or prostate removal.
Finasteride is a medication that I was given by my urologist, after my operation for an enlarged prostate with restricted urine flow. It was used to prevent the re-growth of the prostate, and subsequent recurrence of urinary obstruction.
It is also recommended to treat male-pattern baldness. That it is used to treat male problems suggests that it has something to do with testosterone, and indeed it does. Finasteride (proscar) is a 5-alpha reductase inhibitor, preventing testosterone from being converted to dihydrotesterone, the active form, in the prostate and the skin.
Finasteride is well studied, and has been found to decrease PSA in the blood, and is suspected of interfering with the use of PSA as a screening device for Prostatic Cancer. It has also been suspected of increasing severe, high grade cancer. These findings have been refuted in later papers.
It has also been found to decrease sexual function, which it has in my case. I have continued it for several reasons.
First, my urine flow remains fine. Second, the bulk of the data indicates that it hinders prostatic cancer formation; and in a previous posting, I stated that Prostatic cancer in 88 year-olds is almost universal. Third, we are continuing in a Covid 19 pandemic.
One of the markers for severe infection is male-pattern baldness, which finasteride prevents. I did find in my reading about finasteride that there is a 1 mg. dose, and I am taking 5 mg..
When the Covid epidemic slows, I will probably opt for the 1 mg. Dose, which produces a significant effect, though of course less than the 5 mg. Less medication is usually better.
For Patients with BPH opting for medical treatment, Finasteride is usually recommended along with an alpha adrenergic agonist to relax the bladder sphincter.
For the men out there, facing an ever-increasing likelihood of BPH, or wanting to slow down baldness, you may eventually be making the decision whether or not to take this effective medication.
I have known about the Prostate gland, which surrounds the urethral channel exiting the bladder, since med school. I have seen evidence of its enlargement in the increasing time it takes older men to empty their bladders.
When my dad had his prostate surgery, he said that he could blast the porcelain right off the toilet, I could then appreciate for the first time that enlargement of the prostate caused a weak urinary stream.
When I started waking up at night 3 or 4 times to urinate, it really hit home. I had to get something done. My Urologist was a very good one, like all of my doctors. As the old saying goes, the best is none too good when it comes to your health.
On my first visit, he ordered a “Urodynamic” study. In this test, done by a visiting nurse who had the equipment, a small catheter, or tube, ws passed into my bladder, after loading myself with water until I could hold it no longer. The pressure in my bladder was measured, the speed with which I evacuated my bladder was measured, the volume of urine I passed was measured, as well as the volume retained in the bladder.
With these numbers, my bladder volume, residual, and the resistance to flow was calculated. I was shown to have a small bladder, too much residual retained after I emptied it, and an excessive resistance to the flow of urine out of the bladder.
I have not seen the urodynamic studies mentioned in the modern workup of BPH, and it may not have been critically necessary. I did appreciate his thoroughness, however, and factored in the study when he gave me the options of medicine vs. surgery.
were two medicines mentioned, an alpha adrenergic agonist, and finasteride, an anti-androgen. Since I would have to take both meds the rest of my life, I chose surgical enlargement of the urinary passage through the prostate, known technically as a “roto rooter job”. I, too, noticed the power of my urinary stream after the surgery.
A good friend of mine, also a physician, took medicines for many years, in spite of increasing trouble urinating, getting up at night, and frequent bathroom trips during the day. He eventually went to see a urologist after he had to go to the ER for completely being unable to pass urine.
The Urologist declined to do surgery on the basis of his health, the unusually large size of the blockage, and degree of obstruction. He used a catheter to relieve himself several times a day for the rest of his life. Had I been in his shoes, I would have tried to find a willing surgeon somewhere, perhaps at a university med school.
But then again, I wouldn’t have waited so long. These days many more options are available, and the appended article discusses some of them. –
Prostate cancer is perhaps the most common cancer in men. It increases in incidence with age, and if you live long enough, most men will contract prostate cancer. A family history of cancer and obesity are also risk factors. But many times the cancer is so slow growing that it will not kill you. In the age of modern, aggressive medicine, the treatment has often been worse than the disease.
Treating Cancer EARLY is much more successful. The PSA test was one of the first really sensitive blood tests for cancer, and it was once performed routinely, on a yearly basis, usually at the time of your annual physical.
The PSA (Prostate-Specific Antigen) test is VERY sensitive,however. In responding to an elevated PSA, very slow growing tumors would often be treated aggressively, creating more morbidity than the untreated tumor would have caused.
The treatment seemed to be worse than the disease. Many physicians stopped doing the PSA test altogether, relying on symptoms, or detecting an abnormality on RECTAL EXAM to trigger an investigation. Some years ago, a physician friend of mine elected to stop PSA testing, and two years later was discovered to have METASTATIC Prostate cancer. It had already spread to his bones, and he eventually died of that cancer.
This encouraged me to continue with PSA screening, though it is still considered optional. Very recently, a test has been developed which I think tips the scales back toward annual PSA testing. EXOSOMES are little (10-120 nm.) particles that effuse from many cells, especially cancer cells.
They contain a variety of DNA, RNA, proteins and lipids which allow the cells to communicate with one another. Recently, a company, ExoDx, was created to take commercial advantage of Exosomes in the diagnosis of various diseases, by testing body fluids.
Their test, ExoRx Prostate EPI test of urine, has been shown to be helpful in distinguishing AGGRESSIVE prostate cancer from the slower growing kind, when the PSA test is in the “grey zone” between 2 and 10 ng/ml. PSA test results above 10 ng. were always acted on, especially if the numbers were increasing. I would be surprised if the PSA did not reenter the annual testing protocol.
The annual digital rectal exam in men older than 50 years will continue to be done, although it is not very sensitive, and is often not abnormal until the cancer is more advanced. Pain in the prostate area, blood in the urine or semen, and trouble urinating are symptoms worth investigating, but if cancer is detected, it may well be advanced and harder to treat. With abnormal tests,
Risk factors or suspicious symptoms, further testing is often done. Ultrasound or biopsy may be indicated. Sometimes the biopsy is guided by MRI, to increase the likelihood that the cancer, if small, is included in the tissue sample taken. Examining the cells of the biopsy sample will yield a “gleason score” which grades the aggressiveness of the cancer.
This in turn dictates the treatment, which may include different extents of surgical removal, radiation, hormonal or chemotherapy treatment. None of this is pleasant, and you are better off, of course with prevention.
Our old friends, DIET AND EXERCISE are thought to be helpful. Although not proven, eating lots of fruits and vegetables, and maintaining a healthy weight are recommended.
Finasteride, one of the drugs in my medicine cabinet is mentioned as a possible aid. I will be discussing this later. I suggest that you press the green box with the magnifying glass, and type the name of the drug to see if i have discussed it. –Dr. C.
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