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Pleasant day........

I am a 58yr. old male.About 4 months ago I started having problems whilst urinating. The stream was weak and at times I "dribbled". I was urinating more frequently than usual although not consuming lots of water. I was getting up at nights an average of three - four times. At times after urinating  I still felt that my bladder needed emptying. I also noticed that my urine was foamy. I visited my doctor who recommended a full blood test. A Bence Jones test came back negative, creatine and albumen levels were within the normal range. Fasting blood sugar was 98. My PSA was 3.6 and increas by 1.6 within 11 months. I visited my urologist who did a digital examination. He said the prostate felt smooth and my PSA (3.6) is slightly enlarged but normal for my age. An ultrasound was done which showed the prostate gland had a volume of 51.99 and a 4mm nodule on the left peripheral area of the prostate.  I questioned this and my urologist said it was aan area where weak echoes was recorded. He said at this time further investigation is not required. For the past 90 days I have been on Proscar. The results as i speak now has improved.  I encouter no pains. My urine flow is strong. I do not ever get up at nights to pee. My stream is constant and I do not dribble.
My only worry now is that at times my urine is still foamy. Thanks for any assistance.

Regards
Shiraz

Answer
Shiraz:

You've seen a urologist, obtained an exam and a diagnosis.  You were given a treatment that apparently is working well.  Occasional foamy urine is not unusual, but if this is persistent it may indicate excessive protein in the urine.  This can be measured in a 24 hour urine collection test.

I am concerned that you've had a significant increase in PSA levels and the ultrasound showed a potentially suspicious nodule.  We would tend to recommend a biopsy in a 58 year old with that history.  You may want to ask your urologist about this or consider a second opinion.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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