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QUESTION: dr leslie,my urologist prescribed oxybutynin for overactive bladder.the side effect profile is lousy saying  up  to 10% get urine retention.dont need that.any safer drug for overactive bladder

ANSWER: Frank:

There are lots of drugs for overactive bladder including vesicare, sanctura, enablex, detrol, myrbetriq, etc. but they all tend to take longer to start working and are more expensive.

I don't agree that 10% of men get urinary retention from oxybutynin.  The main problem with oxybutynin is dry mouth and/or constipation.  But many men find they can take the drug with no side effects so it may be worth a try.

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QUESTION: I don't mean to be pushy but I spent hours on internet and cant find out if bph can raise psa to 17.please answer this question about bph raising psa to 17.the prevailing opion is that man 80 years old with psa of 17 should not pursue it cause at that age cancer really has low tendency and psa 17 cant tell wheather cancer is aggressive or not.

ANSWER: Frank:

There is no data on BPH causing any specific increase in PSA or if 17 is too high to be due exclusively to BPH so nobody can say for sure which is why you can't find it.  In my experience, I have seen higher PSA levels without any cancer every being found.  The recommendation on PSA levels in men over 70 is not do regular PSA testing as most of the cancer discovered tend to be low risk and slow growing.  However, now that we know the PSA is elevated, the issue becomes one of longevity predicting.  In other words, how likely are you to live another 10 years?  If this is reasonably likely based on your other health issues, then it may not be unreasonable to do a biopsy and know the outcome.  An alternative may be an MRI study of the prostate which is becoming a new standard for prostate cancer risk.  If negative, then maybe nothing needs to be done.  If positive for a cancer, then proceed with the biopsy.  This is another approach which may become the standard in the near future as MRI testing becomes more reliable and more radiologists are trained in its use for prostate cancer.

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QUESTION: from what I read by people who oppose psa like Thomas  stanleyStanford   psa cannot tell if 17 is advanced cancer they are not that reliable.a lot of literature saying false positive rate is 75%i regret that they sneaked the psa on own urologist said I have a big prostate and I will die of old age don't worry about psa of  chance of it spreading at 17 could take years/or unlikely


I will disagree with some of your statements.  The supposed false negative rate is closer to about 66%, but PSA is not alone.  You can add MRI parametric scanning which has an 80-90% positive predictive value, the "4K" test which measures various types of PSA and HKA to give a risk ratio of advanced disease, and there are at least 3 sets of genomic tests now commercially available that are designed to help with the diagnosis.  

Increased PSA has many causes, most of which are benign.  But arguably it's still the best screening test available for prostate cancer: much better, for example, than mammography for breast cancer in women.

The real issue is treatment.  If you are going to have less than a 10 year life expectancy at this point, then pursuing treatment for any prostate  cancer may not be necessary.  But think how you will feel in 8-10 years if you are suffering from the painful side effects of bone pain from metastatic prostate cancer that could have been detected and treated now!

This becomes a very personal decision that you should make with your family and physician's advice after considering all the pros and cons. Good luck.


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Stephen W. Leslie, MD


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


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.

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

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.

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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