What is a PSA Test and When Should You Get It?

The PSA test measures the level or amount of PSA (prostate-specific antigen) in blood. The prostate-specific antigen is a protein synthesized by both non-cancerous and cancerous tissue in the prostate — a tiny gland found below the bladder in men. After it is produced, the PSA finds its way into semen and in small quantities in the blood. But since cancerous cells produce more PSA than non-cancerous cells, the test is carried out to detect high levels of PSA in blood, which may indicate the existence of prostate cancer.

What are the benefits of the PSA test?

Early detection of certain types of prostate cancer is critical for successful treatment and recovery. When the PSA test shows elevated levels of the antigen in blood, it may help to identify prostate cancer that is likely to grow quickly or spread to other parts of the body. In turn, the test helps to catch and treat such cancers early before they begin causing serious symptoms or become life-threatening. Also, by enabling early detection of prostate cancer when the necessary treatment is less aggressive, the test reduces the risk of certain adverse effects of treatment, such as urinary incontinence and erectile dysfunction.

What are the risks associated with the PSA test?

Carrying out the test itself comes with very little risk. It requires only a simple drawing of blood used to run the test in a laboratory. However, once the results of the test are out, there are a number of potential downsides involved. For instance, since false positives are quite common and elevated PSA results may have other causes other than prostate cancer, including prostate infection (prostatitis) and enlarged prostate (BPH), the test results may expose some patients to unnecessary or inappropriate treatments.

Some types of prostate cancer don’t produce much PSA, which means that a test may incorrectly indicate that you don’t have the cancer (a false negative). And follow-up tests for checking out the underlying causes of an elevated PSA test are often stressful, invasive, time-consuming or expensive. Furthermore, living with a localized or slow-growing prostate cancer — one that doesn’t require treatment — can cause stress and anxiety.

When should you get your first PSA test?

Before you get the first PSA test, it is recommended that you discuss the benefits and risks of the test with your doctor. During the discussion, a comprehensive review of your risk factors and preferences is done. For example, the urologist will consider your age, race, size of your prostate, medications you are taking (dutasteride and finasteride affect PSA levels), and how frequently your PSA levels change when making a decision about getting the test.

At St. Pete Urology, we advise men who are at higher risk of the disease, such as African American men and those with a brother or father who have had the cancer, to get their first test at the age of 40-45. Having the test before you reach 50 helps us to establish your PSA baseline and thereafter monitor the changes in your PSA levels to determine whether or not you’ll need annual PSA screening and prostate biopsy. If your blood PSA level is very low, we’ll put off any further PSA tests. But if you are a man of moderate to low risk of the disease, we recommend you get your first PSA test at age 50 or older (generally between 55 and 70).

What happens if your first PSA test result is high?

If you don’t have symptoms of prostate cancer, another PSA test may be recommended if your first test showed an elevated PSA level. The second test is used to confirm the validity of the original finding. But if the second PSA test still gives elevated PSA level, the urologist may direct that you continue with more PSA blood tests and digital rectal exams (DREs) at frequent intervals to monitor any changes in your prostate over time.

If your blood PSA level continues to rise over time or the urologist finds a suspicious lump in your prostate during a DRE, additional tests may be suggested to establish the nature of the problem. For example, a urine test may be run to find out if you have a UTI (urinary tract infection). Imaging tests like X-rays, cystoscopy or transrectal ultrasound also may be recommended. Then if prostate cancer is suspected, the urologist carries out a prostate biopsy — collecting multiple samples of tissue from your prostate by inserting hollow needles into the gland and withdrawing tissue. The tissues are examined under a microscope by a pathologist to confirm the cancer.

Treatment of prostate cancer

The type of treatment recommended for prostate cancer usually depends on whether it is early-stage or advanced-stage disease. For early-stage cancer the options include watchful waiting, radical prostatectomy, brachytherapy, conformal radiotherapy and intensity-modulated radiation therapy. At St Pete Urology, watchful waiting means no immediate treatment is offered but the cancer is closely monitored through regular PSA tests. Prostatectomy involves surgically removing part of or the entire prostate; brachytherapy involves implantation of radioactive seeds into the prostate to deliver specific amounts of radiation to the tumor. Conformal and intensity modulated radiotherapies deliver targeted amounts of radiation to the tumor with minimal damage or exposure of healthy tissues.

For advanced-stage prostate cancer, which is typically a more aggressive tumor that grows quickly and spreads faster to other areas of the body, treatment includes chemotherapy and androgen deprivation therapy. Chemotherapy can eliminate cancer cells that have spread to other parts of the body. Likewise, androgen deprivation therapy (androgen suppression therapy or ADT) is used to reduce the effect of androgens — male hormones that stimulate cancer growth — thereby slowing down or stopping cancer growth.

At St Pete Urology, we talk to our patients openly and candidly about the risks and benefits of the PSA test before we can advise them to get it. We also discuss the results of the tests, give our recommendations for those with positive results and typically repeat the PSA test for those with negative results. Our patients have always told us that our attention to detail, quality of interactions and efficiency during their visits is unmatched. If you would like to know more about the PSA test, visit the “St Pete Urology” site.

What kinds of prostate problems are common in men over 50?

The prostate is a tiny walnut-sized gland that surrounds the urethra. But with hormonal changes that come with age, men of all ages usually experience changes in their prostate. As a result of these changes, prostate issues are quite common in men, particularly older ones. For example, the prostate often grows and swells with age, compressing the urethra and causing urinary issues.

Benign Prostatic Hyperplasia

With the prostate, there are usually two main issues: benign prostatic hyperplasia and prostate cancer. For men older than 50, benign prostatic hyperplasia (BPH) is the most frequent prostate issue. BPH, also called an enlarged prostate, means a non-cancerous increase in the number and size of prostate cells — so basically, it is an unhealthy increase in prostate size. While what triggers BPH isn’t well understood, it is believed that factors such as aging, inflammation, fibrosis and hormonal changes are the causes of the condition.

An enlarged prostate presses hard on the urethra and makes urination difficult. In men with the condition, symptoms include:

  1. Frequent urination, particularly at night.
  2. Difficulty starting a urine stream.
  3. Dribbling after passing urine.
  4. Weak urine stream, or a stream that starts and stops.
  5. Inability to empty the bladder completely.

But BPH also may have rare and more severe symptoms like:

  1. Urinary tract infection
  2. Blood in urine
  3. Inability to urinate

Prostate cancer

Prostate cancer is another frequent condition in men. In fact, it is the most common cancer after skin cancer, with about 1-in-6 American men being diagnosed with the disease during his lifetime. And like BPH, the cancer is most common in older men, with two-thirds of men diagnosed with the condition usually over age 65.

The cause of prostate cancer isn’t clear, but risk factors include age, family history, race and diet. The cancer grows slowly and rarely shows symptoms, so most men may never know that they have developed the disease until it is in advanced stage. But that also means only around 1-in-35 men with the cancer dies of the disease. Nevertheless, while some prostate cancers grow slowly and often require no or minimal treatment, there are other types that are quite aggressive and spread really quickly.

When caught early, there is a better chance of successfully treating the cancer. However, since it has similar symptoms to BPH, the condition is quite difficult to diagnose and by the time men see blood in their urine or feel chronic pain in their thighs, hips or lower back, it is often quite late. That is why it is critical for men of average to high risk of the cancer to have annual screening as early as appropriate.

Actually, for men of average risk of prostate cancer, the discussion to begin screening should start at the age of 50. While for those of higher risk, it is prudent to begin this discussion a little earlier, though not earlier than 40. But before screening, it is vital to discuss the risks and benefits of the testing with the doctor so the test offered meets the personal preferences and values of the patient.

For more information on prostate problems and how to prevent, diagnose and treat them, visit the “St Pete Urology” site.

Should You Screen for Prostate Cancer?

A visit to St Pete Urology to screen for prostate cancer is also an opportunity to have a variety of health issues resolved. St Pete Urology operates according to the principle that most health issues affecting men are interconnected and can only be treated effectively through a comprehensive and multidisciplinary approach. When you visit our urologists for prostate cancer information, screening, diagnosis and treatment, we extend our role to include screening for signs of mental health disorder, make efforts to influence behavior change and speak with you candidly about psychological and medical care beyond our direct involvement in treatment of urologic disease.

At St Pete Urology, we are committed to safe, holistic and effective care for all our patients. We handle diagnosis and treatment of prostate cancer using the latest technological, medical and psychosocial approaches.

Tackling mental health issues during prostate cancer screening

Helping patients with mental health problems is a familiar territory for urologists at St Pete Urology, Fl. For instance, during prostate cancer screening, the urologists also screen for signs of distress, educate patients on their diagnosis, treatment and potential side effects, and provide support through referral to psychosocial services or rehabilitation programs. For men experiencing urinary tract symptoms, the urologist may conduct a functional analysis to assess the effect of the symptoms on everyday activities, recommend practical solutions such as Kegel exercises, and provide psychosocial referrals to help deal with issues related to interpersonal relationships and self-esteem. Working with our urologists not only provides the opportunity to detect and treat urological problems like prostate cancer, but also for early detection and treatment of mental health disorders.

Should you undergo prostate cancer screening?

Prostate cancer is a very common cancer so it is very important to get checked for its presence. While screening tests will not show with certainty that you have cancer, they help to find warning signs and help to detect the cancer when it is still at an early stage, making treatment easier and more effective. If one of the screening tests gives an abnormal result, you will need a biopsy of prostate tissue to confirm whether or not you have cancer. Men who want to be checked are tested using the PSA (prostate-specific antigen) blood test and the DRE (digital rectal exam).

1. PSA (Prostate-specific antigen) blood test

PSA (Prostate-specific antigen) is an essential substance made by the cells of the prostate, typically by both normal and cancerous cells. It is predominantly found in semen. However, it also may be found in small quantities in blood. The majority of men with no prostate cancer do have PSA levels below 4 nanograms-per-milliliter [abbreviated as ng/mL] of blood. Those with higher PSA readings have a greater likelihood of developing cancer of the prostate.

While the PSA usually goes up beyond 4ng/mL as prostate cancer develops, a reading below 4 is not a guarantee that you do not have the cancer. In fact, about 15 percent of men whose PSA is under 4ng/mL are found to have the cancer upon a biopsy. Similarly, men with PSA between 4 and 10 have 25 percent chance of having the cancer, while those with PSA above 10 have a 50 percent chance of developing prostate cancer. If you have elevated PSA, your urologist may indicate that you either wait for a period of time and you repeat the test or take a prostate biopsy to confirm the cancer.

2. DRE (Digital Rectal Exam)

During a DRE (digital rectal exam), your urologist will insert a gloved and lubricated finger into your rectum in order to feel or detect any hard areas, nodules or bumps on your prostate, which may be due to cancer. Prostate cancer usually starts at the back of the prostate and this can be felt through a rectal exam. The DRE may be a bit uncomfortable, particularly for men with hemorrhoids, but it is not usually painful and often takes a very short time. Although the DRE is less accurate than PSA in screening or detecting prostate cancer, its ability to occasionally find cancer in men whose PSA values are normal makes it a vital component of prostate cancer screening.

Making screening decisions

It is important to work closely with your doctor in order to make informed screening decisions. At St Pete Urology, we recommend that men should screen for prostate cancer at:

  1. Age 50 for those men who are at average risk of getting prostate cancer and are still expected to live for more than 10 years.
  2. Age 45 for men who are at high risk of developing prostate cancer, such as African Americans and men whose first-degree relative [father, son or brother] had the cancer before the age of 65 years.
  3. Age 40 for men with even greater risk, especially those who have had more than one first-degree relative get prostate cancer at a very early age.

For more information, visit the “St Pete Urology” site.

2 Effective Screening Tests for Prostate Cancer

Prostate cancer is the most frequently diagnosed non-skin cancer in men in the United States, currently carrying a lifetime risk for diagnosis of around 15.9 percent. In most cases, prostate cancer shows a good prognosis even when not treated, though some may be quite aggressive. Presently, the lifetime risk of death due to prostate cancer is 2.8 percent, and the condition is quite rare in men younger than 50. In fact, very few men die of the cancer before age 60, and more than 70 percent of the deaths due to the cancer occur after age 75.

Even though prostate cancer typically grows very slowly or not at all, it is still advisable to start screening early before the symptoms appear. Early prostate cancer screening may help to discover any aggressive type of the cancer and ensure prompt treatment. Today, there two most effective and recommended tests for screening are prostate specific antigen (PSA) test and digital rectal exam (DRE).

PSA

All contemporary recommendations for prostate cancer screening incorporate the prostate specific antigen (PSA) levels in serum because there is convincing evidence that PSA-based screening detects many cases of asymptomatic prostate cancer. Studies also have shown that a vast majority of men who have asymptomatic cancer detected through the PSA test have tumors that either will fail to progress or will grow so slowly that they would have shown no symptoms for the patient’s lifetime. If your PSA level is high, your urologist will recommend either waiting for a period and then repeating the test or doing a prostate biopsy to confirm if you have the cancer. When interpreting your PSA results, your urologist will consider many factors, such as race, age and family history.

Digital Rectal Exam (DRE)

During DRE, the urologist inserts a gloved, lubricated finger into the rectum to feel for any hard areas or bumps on the prostate, which might indicate cancer. The exam may be slightly uncomfortable, but is never painful and just takes a short time. While the digital rectal exam may be less effective than the PSA in detecting prostate cancer, it sometimes can detect cancer in men with normal PSA levels. For this reason it is a critical component of prostate cancer screening.

What next after screening?

PSA and DRE tests are simply used to detect the warning signs of prostate cancer, but in reality they do not actually confirm if you have cancer. If the test results are abnormal, your urologist will use a prostate biopsy for confirmation. If there is cancer, a prostate biopsy also will help determine the aggressiveness and influence the urologist’s decision as to whether or not you need treatment. Not every patient must be treated and those with non-aggressive cancer will just be actively monitored. The decision on whether you get treated is very important and is usually based on results of these tests. For more information on early prostate cancer diagnosis and treatment, visit the site, St Pete urology.

What is The Prostate and Prostate Enlargement?

The prostate gland (commonly called prostate) is a small, chestnut-sized organ in men located beneath the bladder and in front of the rectum (back passage). The urethra, the tube that passes urine from the bladder to the penis, runs through the prostate. By producing a fluid called prostatic fluid that makes up around 15-30 percent of the total volume of semen, the prostate plays a significant role in the function and viability of sperm cells and is critical for a man’s fertility.

Prostatic fluid contains citric acid, zinc, spermine and prostate-specific antigen (PSA), which protect and enrich sperm and reduces acidity of the vaginal canal. Muscles of the prostate usually press into the urethra during ejaculation, helping sperm to move through the urethra.

What is prostate enlargement?

While the prostate is usually a small gland, it typically grows bigger with age. In fact, from birth to early 20s, the prostate grows by around 8 times its initial size. Then from around the age of 25 to early 50s the prostate doubles in size and continues to grow gradually. It is this second phase of growth of the gland which, in later years, results in a non-cancerous condition called benign prostatic enlargement (BPE) or benign prostatic hyperplasia (BPH).

As the prostate grows larger, it causes the muscles at the base of the bladder to become thicker and pressures the urethra to become narrower. By squeezing the urethra more tightly, the enlarged prostate makes it difficult to urinate. The bladder also may become more sensitive, causing a need to pass urine more frequently and suddenly. In some cases, prostate enlargement may cause a blockage that triggers repeated urinary tract infections, bladder or kidney damage, and acute urinary retention (sudden inability to pass urine).

How common is prostate enlargement?

Although prostate growth continues almost throughout a man’s life, the resulting enlargement does not usually cause serious problems until late in life. An enlarged prostate hardly causes symptoms before the age of 40, but some symptoms occur in half of men in their 60s and in up to 90 percent of men in their 70s and 80s. In the United States, as many as 14 million men experience lower urinary tract problems related to benign prostatic hyperplasia while at least 400,000 annual hospital stays involve a diagnosis of prostate enlargement.

You are more likely to have BPH if:

  • You are 40 or older.
  • You have a family history of BPH.
  • You lack physical exercise.
  • You have erectile dysfunction.
  • You have medical conditions like type-II diabetes, obesity, circulatory and heart disease.


Common symptoms of prostate enlargement include:

  • Urinating 8 or more times a day (urine frequency).
  • Inability to delay urination (urine urgency).
  • Trouble starting to urinate.
  • A weak or interrupted urine stream.
  • Inability to empty your bladder completely (urine retention).
  • Dribbling at the end of urination.
  • Accidental leakage of urine (urinary incontinence).
  • Pain during urination or after ejaculation.
  • Unusual color or smell of urine.
  • Blood in urine.

Most of these symptoms are not specific to benign prostatic enlargement and may be caused by bladder problems, prostatitis, urinary tract infections (UTIs), or a more serious problem such as prostate cancer. Therefore, men with such symptoms should seek immediate medical attention.

Diagnosis and treatment of prostate enlargement

When you visit a GP or a specialist such as urologist, various steps will be taken to determine the cause of your symptoms. The doctor will take your medical, personal and family history, ask questions about the symptoms and their effect on your life and conduct a physical examination to check the size, feel and shape of your prostate. The urologist also may request tests such as prostate-specific antigen (PSA) and ultrasound scan to rule out any serious complications.

There are many treatment options for BPH. For instance, the doctor may recommend lifestyle changes, bladder training exercises or medications (such as muscle relaxants and hormone blockers). The doctor also may perform surgery to correct the problem.

At St. Pete Urology, we have a highly skilled team of urologists with a great deal of experience diagnosing and treating BPH and other urinary problems. We fix these issues quickly, safely and effectively, helping you to resume your normal life and activities. For more information on treatment of benign prostatic hyperplasia, visit the site, St Pete Urology.

When Should You Get A PSA Test?

When should you take the Prostate-Specific Antigen (PSA) test? The question of screening is typically a personal and complex issue that requires a consultation with a urologist. Currently, the medical community does not share a unanimous opinion regarding the benefits of prostate cancer screening.

Most physician-led groups, like the American Urological Association and the American Society of Clinical Oncology, insist that PSA screening ought to be considered within the context of a man’s life expectancy and level of risk given other prior or existing medical conditions. Other groups have advised that PSA screening for healthy men under 40 comes with a risk of harm that may outweigh the benefits depending on the patient’s medical history.

When should you start screening?

The decision on when to start screening should depend on your overall health, level of risk, life expectancy, and desire for treatment should you be diagnosed with prostate cancer. While the time to start screening depends on individual factors, the age of 40 years is a reasonable time to begin, particularly for those with genetic predispositions or a family history of cancer. Likewise, for healthy men at high risk, such as African American men with a family history of prostate cancer, starting at age 40 is advisable.

For men at average risk, a urologist may recommend the initial DRE or PSA test at age 40 or 45, while some urologists may recommend starting at age 50. In general, most men have discussed PSA testing with their doctor by the time they reach age 50. This means that men above 40 years should consider discussing PSA screening with their urologist to determine if and when the test is right for them. All men should develop a proactive prostate health plan based on their family history and lifestyle.

When should you visit a urologist?

The above recommendations are specific to prostate cancer screening for healthy men showing no symptoms. If you are diagnosed with prostate cancer and a confirmation is made using a biopsy, your urologist may recommend routine PSA testing for risk assessment and post-treatment monitoring.

The right time to start PSA screening is an individual decision that depends on your risk level and family history. Visit your urologist to discuss the timing of this important medical test for men. For more information on the screening and treatment of prostate cancer, visit St Pete Urology in St Petersburg, Florida.

Promising New Procedure for Men With Enlarged Prostates

A minimally invasive procedure designed to shrink prostate tissue with a series of nine-second blasts of steam offers men a new treatment for urinary symptoms commonly associated with enlarged prostates.

The procedure, called Rezūm (pronounced “resume”) and developed by NxThera Inc. of Maple Grove, Minn., became widely available in the U.S. in the second half of 2016. Thermal energy in the form of steam is applied to the prostate with a needle. As it cools it releases heat energy into the tissue, killing cells and shrinking the prostate overall by about a third, says Bob Paulson, NxThera’s chief executive.

Some 50% of men over the age of 50 have enlarged prostates, which can produce symptoms such as increased urgency to urinate during the day and frequent urination, which disrupts sleep at night. Sufferers often must choose between surgery or medication, both of which have side effects, including sexual dysfunction.

The NxThera therapy is the second major innovation in recent years for men with enlarged prostates. The other, an implanted device called UroLift, was introduced in the U.S. in 2013 by NeoTract Inc. of Pleasanton, Calif.

After years of little improvement in the minimally invasive treatment of enlarged prostates, men now have two new options “that leave your sexual function intact,” says Claus G. Roehrborn, a professor and chairman of the department of urology at the University of Texas Southwestern Medical Center in Dallas and a co-author of published studies on both treatments.

Middle ground

Physicians say Rezūm can be used on a wider range of prostate anatomies than the UroLift implant. The procedure, which costs about $2,000 and generally is covered by insurance, can be done in a doctor’s office in just a few minutes. To dull pain, lidocaine may be injected into the prostate, and most doctors will offer a sedative for patients who want one. After the procedure, most patients need to wear a catheter for two or three days but can return to daily activities immediately.

While the results of a two-year clinical trial published by Dr. Roehrborn and colleagues show that Rezūm provides significant relief from symptoms, it isn’t clear how long the improvement will last.

“The durability issue is what’s going to sink or swim this procedure,” says study co-author Kevin T. McVary, chairman and professor of urology at Southern Illinois University School of Medicine, in Springfield, Ill. Both minimally invasive options are likely less effective than surgery, Dr. Roehrborn says, because surgery removes the most tissue.

Still, for many men, the steam treatment offers an appealing middle ground between the risk of surgery and the hassle and side effects of taking daily medication, which can cause dizziness and fatigue.

“I tried Flomax for about two years but the side effects were too annoying,” says Stephen Gooding, a 60-year-old utility supervisor from Grayson, Ga., who says the drug made him dizzy and constipated. He had the Rezūm procedure in October, and now “I feel like I did 30 years ago.”

In the two-year study of 197 men, funded by NxThera and published online in the Journal of Urology in December, patients who had the Rezūm procedure showed a significantly greater improvement in symptoms at three months compared with patients who had a sham procedure. At the end of two years, patients treated with Rezūm showed a 51% reduction in urinary symptoms (as measured by a seven-question survey), compared with the beginning of the study.

Over the two years, about 4% of the patients who underwent Rezūm had to have a repeat procedure or surgery to treat their condition. Early in the trial, physicians were new at performing the procedure and didn’t always remove enough tissue, says Cindy Ogden, vice president, clinical affairs at NxThera.

So far, Rezūm appears to spare men sexual side effects. In the surgical procedure known as transurethral resection, 70% to 80% of men generally get a condition called retrograde ejaculation, also called dry orgasm, says Dr. McVary.

In the Rezūm study, about 3% of the patients who underwent the procedure experienced no ejaculatory volume afterward, and 5.3% experienced a decrease in ejaculatory volume, according to data provided by NxThera. Ejaculatory volume can fluctuate over time in men with enlarged prostates, so it isn’t clear the reductions were caused by the procedure, Dr. McVary says. Overall in the study, there was no average change in ejaculatory volume, he adds.

Larger prostates

A major advantage of Rezūm is that it can be done on most types of anatomies. UroLift isn’t approved by the Food and Drug Administration to treat the median, or middle lobe of the prostate, which contributes to symptoms in about 10% to 30% of patients, Dr. Roehrborn says.

The FDA hasn’t cleared Rezūm or UroLift for prostates weighing more than 80 grams. So NxThera can’t market its procedure for larger prostates, though doctors can legally use it on such patients if they choose.

Early results in clinical practice on large prostates appear “promising” and a study on prostates up to 150 grams is expected to begin later this year, says Ricardo Gonzalez, a urologist at Texas Medical Center in Houston, who will be a principal investigator on the research. About a quarter of men seeking treatment for prostate-related urinary symptoms have prostates greater than 80 grams, he says.

Business executive Jim Bracke, 69, says that, with just a Tylenol and the lidocaine shot, discomfort from Rezūm’s steam blasts felt no more intense than “warm water spilled on the groin.” He drove himself home after the procedure, and says he’s thrilled that he no longer needs to check out a bathroom the moment he arrives at a restaurant. And as long as he doesn’t overdo it, he adds, “I can have beer, and coffee and chocolate and still sleep through the night.”

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3 Essential Facts About Surgery For Prostate Cancer

When prostate cancer is detected early enough, before it has spread beyond the prostate gland, surgery is often recommended as the cure. Also known as prostatectomy, surgery for prostate cancer involves removal of the entire prostate and nearby lymph nodes. The surgery not only aims to remove the cancer but also to provide a close look at the pathology of the cancer. It ensures that treatment is completed within a shorter period of time compared to other options such as radiotherapy. Surgery also has immediate psychological benefits in patients who take comfort in knowing that the cancer has been removed.

3 Essential Facts About Prostate Cancer Surgery

1. There are two basic approaches: Open and Laparoscopic.

To remove the cancer, the urologist gains access to the prostate and associated lymph nodes either by open radical prostatectomy or laparoscopic prostatectomy (either manually or robot-assisted). Open radical surgery for prostate cancer is the procedure whereby an incision, roughly 10 centimeters in length, is made in the patient’s lower abdomen (belly button to pubic bone) or in the skin between anus and scrotum (perineum) in order to access the prostate and affected lymph nodes. In laparoscopic surgery the urologist may use either a small camera and instruments (laparoscope) to make several small incisions or perform the surgery with robotic equipment that provides 3-D vision and dexterity.

2. Robot-assisted prostatectomy gives better precision and outcome.

Robotic prostatectomy is performed using a robotic interface (the da Vinci System), with the surgeon sitting at a control panel and moving robotic arms to operate via several minute incisions made in the patient’s abdomen. The da Vinci system ensures less pain, minimal blood loss and shorter recovery time than open surgery. For surgeons, robotic surgery ensures more maneuverability and greater precision in the movement of surgical instruments.

3. The success of the operation depends on the surgeon’s skill and experience.

Like any surgery, prostate surgery is associated with risks regardless of the approach used. Therefore, whether you opt for open or laparoscopic surgery, you must find an experienced and highly skilled urologist capable of conducting operations with minimal risks. The surgeon should be capable of performing operations that ensure that nerves near the prostate are not harmed. Remember, in some cases, the urologist will have to remove small amounts of tissue that contain lymph nodes near your prostate or will remove the prostate gland together with the seminal vesicles and vas deferens. So the more skilled and experienced the surgeon, the higher the chance of success.

For more information on successful surgery for prostate cancer, visit the website of St Pete Urology in St Petersburg, Florida.

Should You Take Medicine for Treating Enlarged Prostate?

As a man ages, his prostate may become larger, a disorder known as Benign Prostatic Hypertrophy (BPH). While an enlarged prostate is neither a serious nor a life-threatening condition, it can cause urinating problems in men aged 50 years and older. Men with urinary problems should immediately see their doctor for a prompt and accurate diagnosis because symptoms of BPH are similar to those of prostate cancer. A patient should also see a doctor immediately when experiencing fever, chills, back pain, side pain, abdominal pain, bloody or cloudy urine, or pain when urinating.

Treatment of Enlarged Prostate

After a diagnosis of prostate enlargement, the urologist evaluates the severity of symptoms before recommending treatment. You are expected to participate in the decision making process to ensure you get the best treatment possible. Generally, no medications are prescribed for enlarged prostate unless the symptoms are severe, bothersome or accompanied by problems such as bladder stones or bladder infection. In fact, around 4 out of 10 men usually have no symptoms or have their symptoms improve without medications or surgery and only require lifestyle changes to manage BPH. Conversely, 1 in 4 men in their late 50s, 1 in 3 men in their late 60s, and 1 in 2 men in their late 70s and beyond can expect to have bothersome symptoms that require medications or even surgery.

Watchful Waiting

Should you take medications for treating enlarged prostate? After the diagnosis of BPH, you will have to choose either watchful waiting or medicine as your primary treatment, though surgery is sometimes necessary for serious symptoms. The best treatment option for men with minimal and less bothersome symptoms is watchful waiting. It involves combining lifestyle measures that prevent or relieve symptoms of BPH with visits to the urologist at least once a year for physical examination, testing and symptom status review.

Men managing BPH through watchful waiting must limit the amount of fluid they consume at any given time, avoid drinking fluids after 7 p.m., avoid beverages containing caffeine, avoid delaying urination, cut back on salty or spicy foods, limit alcohol intake, engage in regular physical activity and Kegel exercises, avoid cold weather and keep themselves warm, control their weight, control their blood sugar level, eat diets rich in vegetables, and avoid over-the-counter antihistamines (decongestants).

You should opt for watchful waiting if:

  • (a) You experience mild and less bothersome BPH symptoms.
  • (b) The side effects of the medicine may bother you more than the mild symptoms of BPH.
  • (c) You can attend regular medical checkups (at least once a year).
  • (d) You can effectively use special bathroom techniques, cut back on your fluid intake and change your lifestyle.

Medicines

If your symptoms are severe or worsen during watchful waiting, you should consider taking BPH medications. The three types of drugs commonly used for treating enlarged prostate are alpha-blockers, 5-alpha reductase inhibitors and phosphodiesterase-5 inhibitors. Alpha-blockers are fast-acting drugs that relax prostate muscles and relieve urination problems within a few days or weeks. They include terazosin (Hytrin), doxazosin (Cardura), prazosin (Minipress), silodosin (Rapaflo), Alfuzosin (UroXatral) and tamsulosin (Flomax). Drugs called 5-alpha reductase inhibitors such as dutasteride (Avodart) and finasteride (Proscar) cause shrinkage of the prostate and improve symptoms, albeit after several months. Phosphodiesterase-5 inhibitor called tadalafil (Cialis for daily use) has also been approved for use in treating BPH.

When using a prescription for managing enlarged prostate, you will take the pills every day for life, have regular medical checkups, and use special bathroom techniques such as relaxation and double voiding. The medicines will reduce the risk of urinary retention, relieve symptoms and minimize risks of future surgery. However, prescriptions are often expensive and come with certain side effects such as trouble getting an erection, diminished sex drive, tiredness, dizziness, and stuffy nose.

Conclusion

When you have problems urinating, you should immediately see a doctor as you may have an enlarged prostate. At the urology clinic, the doctor will perform a physical exam and run a few tests to find out if you have BPH. If BPH is confirmed, the urologist will explain to you the treatment options available, such as watchful waiting, medications and or surgery for serious cases. The treatment option chosen will depend on the severity of symptoms and your desire to improve the quality of your life. You should consider watchful waiting if you have mild symptoms and want to avoid the adverse effects of drugs. However, in case of severe BPH symptoms, you should take medications to relieve symptoms and possibly prevent the need for surgery in the future. For more information on treating an enlarged prostate, visit St Pete Urology in St Petersburg, Florida.