Thanks for bringing the PSA up for discussion. I meant to post something along the following lines during November as part of ‘Movember’ but never quite got round to it.
Men’s health, especially in terms of urinary and sexual symptoms are often kept private, but, as you can see from this conversation they are common place.
It’s important to note, as has been highlighted, that interpretation of PSA results is not always an exact science. There are a number of factors that can increase one’s PSA and those include both prostate cancer AND benign prostatic hyperplasia (BPH). Infections, catheters, ejaculation and even cycling can also cause temporary rises in PSA.
Importantly, a high PSA does not necessarily mean that you have prostate cancer AND, a normal PSA does not necessarily always preclude prostate cancer (although does provide a level of reassurance).
The British Association of Urological Surgeons does some excellent advice sheets and may I suggest that those who are considering asking their GP for a PSA test read it: https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/PSA advice.pdf
They also do one for those who have a raised PSA level (remember that what is classed as raised is age category dependent): Raised PSA
Unfortunately, the best way to distinguish between a benign (non cancerous) prostate and a cancerous prostate in the GP setting (in the context of a raised PSA) remains the finger up the bottom test (also called a PR examination or DRE). Although somewhat undignified, please remember we do an awful lot of these and it’s not something to worry/be embarrassed about.
In terms of biopsies, most are now done under local anaesthetic (sometimes with the addition of some sedation) through the perineum (skin between the anus and scrotum). This carries a reduced infection risk from the older TRUSS (trans-rectal) biopsies and allows for better sampling. These, although uncomfortable are typically well tolerated.
Prostate cancer is a very wide spectrum of disease and PSA values do not necessarily correlate with the grade (aggressiveness) of disease. There are lots of treatment options available.
Urinary symptoms in older men are common and can be debilitating. Are you one of those men whose trips out are completely guided by where the next toilet is? Could you previously pee over a five bar gate and now struggle to hit the back of the bowl? Are you having recurrent infections? Are you leaking or dribbling at the end of your stream leading to damp patches or smells? Do you get a sudden urge to go and have to race to the loo and sometimes not get there in time? Are you up 3-4 times per night and therefore not getting proper sleep?
All of these symptoms are common but the sorts of things we keep very quiet. Please do go and have a chat with your doctor about them (even if you wait for hours on the phone or weeks for an appointment, just go and have the chat). There are lots of management options available that can very much improve one’s quality of life.
Four final things but probably most importantly:
1. If you see ANY blood in your wee, even once, take it seriously and go and see your GP ASAP plus go along with the next investigations.
2. If you start leaking urine at night (waking up with a wet bed etc.) go and see your GP asap (could be a sign of a type of urinary retention which can cause damage to your kidneys).
3. Self check your testes regularly - if you find any lumps and bumps, get them checked out (this goes for the younger readers as well). Here’s how to do it: https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Testicular self examination.pdf
4. New erectile dysfunction - lots of causes but later in life mostly down to cardiovascular issues. Go and have a chat with your GP - firstly there are things that can be done to improve symptoms, secondly, they may assess you for other underlying conditions etc and by doing so may be able to commence preventative measures for heart attacks and strokes.
If my urological night shift ramblings lead to just one person seeking help or advice for any of the above they will have been worth it.
Men’s health, especially in terms of urinary and sexual symptoms are often kept private, but, as you can see from this conversation they are common place.
It’s important to note, as has been highlighted, that interpretation of PSA results is not always an exact science. There are a number of factors that can increase one’s PSA and those include both prostate cancer AND benign prostatic hyperplasia (BPH). Infections, catheters, ejaculation and even cycling can also cause temporary rises in PSA.
Importantly, a high PSA does not necessarily mean that you have prostate cancer AND, a normal PSA does not necessarily always preclude prostate cancer (although does provide a level of reassurance).
The British Association of Urological Surgeons does some excellent advice sheets and may I suggest that those who are considering asking their GP for a PSA test read it: https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/PSA advice.pdf
They also do one for those who have a raised PSA level (remember that what is classed as raised is age category dependent): Raised PSA
Unfortunately, the best way to distinguish between a benign (non cancerous) prostate and a cancerous prostate in the GP setting (in the context of a raised PSA) remains the finger up the bottom test (also called a PR examination or DRE). Although somewhat undignified, please remember we do an awful lot of these and it’s not something to worry/be embarrassed about.
In terms of biopsies, most are now done under local anaesthetic (sometimes with the addition of some sedation) through the perineum (skin between the anus and scrotum). This carries a reduced infection risk from the older TRUSS (trans-rectal) biopsies and allows for better sampling. These, although uncomfortable are typically well tolerated.
Prostate cancer is a very wide spectrum of disease and PSA values do not necessarily correlate with the grade (aggressiveness) of disease. There are lots of treatment options available.
Urinary symptoms in older men are common and can be debilitating. Are you one of those men whose trips out are completely guided by where the next toilet is? Could you previously pee over a five bar gate and now struggle to hit the back of the bowl? Are you having recurrent infections? Are you leaking or dribbling at the end of your stream leading to damp patches or smells? Do you get a sudden urge to go and have to race to the loo and sometimes not get there in time? Are you up 3-4 times per night and therefore not getting proper sleep?
All of these symptoms are common but the sorts of things we keep very quiet. Please do go and have a chat with your doctor about them (even if you wait for hours on the phone or weeks for an appointment, just go and have the chat). There are lots of management options available that can very much improve one’s quality of life.
Four final things but probably most importantly:
1. If you see ANY blood in your wee, even once, take it seriously and go and see your GP ASAP plus go along with the next investigations.
2. If you start leaking urine at night (waking up with a wet bed etc.) go and see your GP asap (could be a sign of a type of urinary retention which can cause damage to your kidneys).
3. Self check your testes regularly - if you find any lumps and bumps, get them checked out (this goes for the younger readers as well). Here’s how to do it: https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Testicular self examination.pdf
4. New erectile dysfunction - lots of causes but later in life mostly down to cardiovascular issues. Go and have a chat with your GP - firstly there are things that can be done to improve symptoms, secondly, they may assess you for other underlying conditions etc and by doing so may be able to commence preventative measures for heart attacks and strokes.
If my urological night shift ramblings lead to just one person seeking help or advice for any of the above they will have been worth it.
