You are here:

Urology/Prostate problem.

Advertisement


Question
QUESTION: Dear Sir,
I had external enlargement of Prostate diagnosed by physical checks, & rectal sonography.PSA was 8.78-done on 2nd.Oct.2012,
and prostate mass was 55.7gms with Cystic mass of 1.7cmsx1.3cms in left lobe.No other significant indication except high frequency of urination.
Urologist prescribed Silodosin-8mg and Dutasteride-0.5mg for 30days.PSA came down to 6,but on F/U transrectal study the mass is noticed 66.7gm and Seminal Vesciles are 5.1ml/6.3ml with the length of 3.3/3.2cms respectively.There was no change in Cystic mass in left lobe.This sonography is done on 27th Dec after continuing same medications for last 50days.Urination frequency has already reduced.
urologist expected PSA around 4,but last check indicated 5.95.Hence the rectal sonogrphy was repeated.The post void hold-up of urine which came down from
118ml to 68ml is now observed as 130ml.I am not able to understand the significance of F/U sonography and also feared of unexpected further tests without any direction of treatment.
Would you able to advise as at the age of 75,I am no more interested in going for Biopsy and/or surgery as I have no other problem of health except BP which is controlled at 135/85mmHg taking Amlodipine-2.5mg& Atenolol-25mg each on tablet a day.

With warm regards for your guidance/help.
agdesai

ANSWER: Anil:

Since you are not interested in the potential diagnosis of any prostate cancer, we won't address that except to say that your PSA level is elevated.  I see no reason to repeat the prostatic ultrasouind, but your post void residual urine is borderline elevated even though your symptoms have improved.  It would suggest following the symptoms, PSA level, peak flow and post void residuals.  If these begin to worsen, then a surgery should be considered.

---------- FOLLOW-UP ----------

QUESTION: Dear Sir,

It was indeed a great relief on receiving your so prompt reply.I am really grateful for reviewing my case history and responding as all tests are not only expensive,but time consuming.
Sir,may i inform you that my Urologist is well equipped to check PSA,Urometry and simple sonography.He did check both Kindneys and they are found normal in size & function.R/L;10.5cmsx4.6cms and 9.6cmsx5.4cms.
Prostate size is 5.4x3.8x6.2=64gms,whereas the rectal sonography indicates-67.8gms.
The Uroflow checked thrice on different dates.
Max.flow;14.1/14.6/9.3ml
time:6.4/11.1/19.3secs.
Voided vol:269.3/303.1/393.8ml
Post void vol:118/68/130ml(?).
You would appreciate my anxiety that as a patient I got confused,so sought your help.
Thanks a lot sir!Would you mind to indicate F/U frequency of PSA level and urometry for future purpose.
Sir,with your kind permission,may i tell you,that my water intake is quite high even at night,but night frequency of Urination is now only two/three times,which was earlier four/five times with same water intake at night.
I neither have any burning sensation during/after urination and also able to hold for 2/3hrs after having urge for urination.
Unfortunately,for no reason, the post void hold up went up to 130ml in
last check up!!!!
You may kindly excuse me for such long repeat mail,with request of further guidance.
Thanking you,once again.
With kindest regards,
agdesai.

Answer
Anil:

Repeating the PSA is up to you.  If you are not interested in diagnosing any possible prostate cancer, then why do the PSA at all?

We typically do the flow and post void residual check once a year unless it is abnormal.  In your case, I would recommend at least twice a year but see what your local urologist suggests.

Urology

All Answers


Answers by Expert:


Ask Experts

Volunteer


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

©2016 About.com. All rights reserved.