Prostate Health: Insights from Dr. Lee on Common Concerns

Hello, Dr. Lee has some more questions?

Response from Dr.
Hsin-Yi Lee, Urologist: Given your age, it is unlikely that you are experiencing true benign prostatic hyperplasia (BPH), and medications like Alfuzosin are generally not necessary.
Alfuzosin does not prevent the development of prostate enlargement.
If you are genuinely concerned about enlargement, I recommend that after the age of 40, you have annual check-ups with a urologist to discuss any issues.
Retrograde ejaculation does not have any significant impact on your health.

Prostate health is essentially tied to overall bodily health, and there is a lot of information available online that I won't reiterate.
Regarding your previous inquiry about conditions that may resemble BPH, your recent examination included a transrectal ultrasound.
However, is there a possibility of misdiagnosis with the transrectal ultrasound? If it is not true enlargement, what other conditions might present similarly? The blood test results indicated that your PSA levels are normal, suggesting that there are no abnormal growths.
You mentioned drinking less water, which could lead to mild dehydration of the kidneys; however, I believe you may not need medication for this, as the medications you researched are typically prescribed for patients who already have significant urinary difficulties and are generally older.

At your age, it may be sufficient to rely on maintaining a healthy lifestyle and avoiding irritant foods.
You also mentioned having undergone a colonoscopy previously, which was normal, but the doctor diagnosed you with irritable bowel syndrome (IBS).
The medications you mentioned seem to have a sympatholytic effect, which could potentially cause side effects affecting bowel habits.
After stopping Alfuzosin, you noticed an improvement in your bowel movements.

You also mentioned that you woke up late today and were concerned about taking Betanidine, which is a stronger medication.
You wondered if delaying the dose would affect its efficacy.
However, since stopping the medication, it appears that your bowel issues have resolved.
Previously, while on these medications, you experienced bowel movements without abdominal pain, but now you feel more discomfort and increased bowel activity after stopping Betanidine.
This suggests that you may not currently require medication, as the doctor advised, and regular follow-ups to discuss your condition with your physician are recommended.

Mr. Chen, 30~39 year old female. Ask Date: 2022/10/14

Dr. Li Xinyi reply Urology

Generally speaking, if a transrectal ultrasound measures the prostate size to be greater than or equal to 30 cubic centimeters, a doctor may indicate that there is an issue with prostate enlargement.
However, it is not that straightforward; this can be related to the patient's age, the shape observed, and the areas of hyperplasia.
In other words, while the overall measurement may indicate an enlarged prostate, the shape or the areas of hyperplasia associated with age may not be problematic.
Therefore, considering your age, we would not typically suspect that you have urinary obstruction due to prostate enlargement.
Based on your description, it seems more likely that you are experiencing issues related to the autonomic nervous system, which may be associated with everyday stress and lifestyle habits.
You might also want to monitor your heart rate; if it is consistently elevated (more than 22 beats in 15 seconds after resting for 20 minutes), it is advisable to consult a neurologist for further evaluation and discuss it with your physician.

Reply Date: 2022/10/14

More Info

Understanding prostate health is crucial, especially for men in their 30s and beyond. As you mentioned, your PSA levels were slightly elevated, which can be concerning. However, it’s important to note that elevated PSA levels can be influenced by various factors other than prostate cancer.
Firstly, PSA (Prostate-Specific Antigen) is a protein produced by both normal and malignant cells of the prostate gland. While elevated PSA levels can indicate prostate cancer, they can also be influenced by benign conditions such as benign prostatic hyperplasia (BPH) and prostatitis (inflammation of the prostate). In your case, the PSA levels of 4.911 and 4.67, along with a Free PSA of 13.21, suggest that further investigation is warranted, but they do not definitively indicate cancer.

Several factors can lead to elevated PSA levels:
1. Prostatitis: This is an inflammation of the prostate gland, which can be caused by bacterial infections or other non-bacterial factors. Symptoms may include pelvic pain, painful urination, and sometimes fever. This condition can significantly elevate PSA levels.

2. Benign Prostatic Hyperplasia (BPH): As men age, the prostate gland often enlarges, which can lead to increased PSA levels. This condition is non-cancerous and is quite common in older men.

3. Recent Sexual Activity: Engaging in sexual activity within 24-48 hours before a PSA test can temporarily raise PSA levels. This is something you mentioned, and it’s a valid consideration.

4. Prostate Manipulation: Activities such as a digital rectal exam (DRE), prostate massage, or even vigorous cycling can lead to a temporary increase in PSA levels.

5. Urinary Tract Infections (UTIs): Infections can also cause inflammation and elevate PSA levels.

6. Age: PSA levels naturally increase with age, so what is considered a normal level can vary depending on age.

Regarding your concerns about prostate health and the potential for prostate enlargement or other issues, it’s wise to follow your doctor’s recommendations for regular check-ups, especially as you approach the age of 40. Regular monitoring can help catch any potential issues early.

You also mentioned concerns about medications like Betanecol (貝坦利) and their side effects, particularly regarding bowel movements. It’s important to communicate with your healthcare provider about any side effects you experience. Medications that affect the autonomic nervous system can indeed influence bowel motility and urinary function. If you find that stopping the medication improves your symptoms, it may be worth discussing alternative treatments or lifestyle changes with your doctor.

In terms of lifestyle, maintaining a healthy diet, staying hydrated, and engaging in regular physical activity can all contribute positively to prostate health. Avoiding irritants such as caffeine and alcohol may also help manage symptoms related to both urinary and bowel health.

Lastly, if you have concerns about the accuracy of your diagnoses or the necessity of certain medications, seeking a second opinion can be beneficial. It’s essential to feel confident in your treatment plan and to have open communication with your healthcare providers.

In summary, while elevated PSA levels can be concerning, they are not solely indicative of prostate cancer. Various benign conditions can influence these levels, and regular monitoring and lifestyle adjustments can play a significant role in maintaining prostate health. Always consult with your healthcare provider for personalized advice and treatment options tailored to your specific situation.

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