Prostate Health Issues: Symptoms, Treatments, and Concerns

Q: Prostate Health Issues: Symptoms, Treatments, and Concerns

A concerned citizen： Hello, I empathize with your situation. <br>Prostate biopsy does carry a very small risk of sepsis. <br>Additionally, a bladder puncture should not cause any sexual dysfunction and is unlikely to affect urination. <br>Urinary issues would only arise if there

Prostate issues?

Dear Dr.
Hsu,
I have been experiencing prostate issues for the past three to four years at a teaching hospital in Taipei.
My PSA levels have consistently been elevated, ranging from 5 to 7, with a free PSA ratio around 11.
My prostate size is approximately 40 grams.
I have been on medication for over a year, including antibiotic treatment, but my PSA levels have remained around 6 to 7.
Subsequently, I underwent my first biopsy (10 samples), and the conclusion was benign prostatic hyperplasia (BPH).
The doctor mentioned that if the free PSA ratio does not decrease in three months, I would need a second biopsy.
Unfortunately, I developed septic shock and was hospitalized for two weeks at another hospital, nearly losing my life.
Upon reviewing the reports from the original hospital, the conclusion remained BPH.
1.
During the emergency treatment, a catheter was inserted directly through the bladder.
After my recovery (about six months to a year), I noticed that I hardly have any semen during ejaculation.
Is this normal? Aside from fertility concerns, what impact does this have on my health?
2.
When I returned to see my original doctor (who also seemed to have psychological barriers), he bluntly stated that after two biopsies, prostate cancer was unlikely.
My PSA levels have fluctuated from 8.2, 7.4, 6.5, 4.9, 4.4, 2.5, 1.9, and then began to rise again to 2.9, 4.2, 4.7, 5, 4.7, 4.7, 5.4 (approximately every three to four months).
Over the past two years, I have been taking both alpha-blockers and 5-alpha reductase inhibitors like Avodart (the later PSA tests have doubled), but I still experience frequent urination.
Sometimes, I feel a strong urge to urinate even when I have over 100 cc of urine.
However, I am hesitant to undergo another biopsy.
I would like to ask if my bladder's capacity to hold urine will decrease over time? Additionally, I sometimes wake up with lower back pain that subsides after an hour or two.
Could this be a symptom of prostate cancer?
I would greatly appreciate it if you could respond to my questions when you have the time.
Thank you very much!

Yi wei xiao lao bai xing, 50~59 year old female. Ask Date: 2010/10/25

Dr. Xu Weikai reply Urology

A concerned citizen: Hello, I empathize with your situation.
Prostate biopsy does carry a very small risk of sepsis.
Additionally, a bladder puncture should not cause any sexual dysfunction and is unlikely to affect urination.
Urinary issues would only arise if there were pre-existing problems or if the biopsy led to fibrosis of the prostate.
Your fluctuating PSA levels mostly indicate inflammation rather than prostate cancer.
If you are truly worried and experiencing severe symptoms, you might consider a prostatectomy.
For urinary issues, a urodynamic study could be considered.
If there are any unclear points, feel free to ask again, and we can further discuss and research together.
This response is from Dr.
Hsu Wei-Kai, Chief of Urology, Taitung Hospital, Department of Health, Executive Yuan.

Reply Date: 2010/10/25

More Info

Understanding prostate health issues is crucial for men, especially as they age. Prostate health can significantly impact quality of life, and it is essential to recognize symptoms, explore treatment options, and address concerns effectively.

Symptoms of Prostate Issues
Prostate problems can manifest in various ways, including:
1. Elevated PSA Levels: A PSA (Prostate-Specific Antigen) level between 4-10 ng/mL is considered borderline, while levels above 10 ng/mL may indicate a higher risk of prostate cancer. Your PSA levels fluctuating between 5-7 ng/mL suggest ongoing monitoring is necessary.

2. Urinary Symptoms: These may include frequent urination, urgency, difficulty starting or stopping urination, and a weak urine stream. You mentioned experiencing urgency even with a bladder capacity of over 100 cc, which can be distressing.

3. Sexual Dysfunction: Changes in ejaculation, such as reduced semen volume, can occur due to prostate issues or treatments. This can affect sexual satisfaction and may raise concerns about fertility.

4. Back Pain: While lower back pain can be related to various conditions, persistent pain, especially if it is accompanied by other symptoms, should be evaluated further.

Treatment Options
1. Medications: You have been on medications, including alpha-blockers and 5-alpha reductase inhibitors like Avodart. These can help reduce symptoms of benign prostatic hyperplasia (BPH) but may take time to show significant results. It’s essential to have regular follow-ups to monitor PSA levels and adjust treatment as necessary.

2. Surgery: Surgical options, such as transurethral resection of the prostate (TURP), can relieve urinary symptoms but come with risks, including infection and complications like the one you experienced. It’s understandable to be hesitant about further biopsies or surgeries after such a traumatic experience.

3. Monitoring: Regular monitoring of PSA levels is crucial. If your PSA continues to rise, further evaluation may be warranted, including imaging studies or additional biopsies, despite your apprehension.

Concerns Regarding Sexual Health and Cancer
1. Ejaculation Changes: The reduction in semen volume post-surgery can be concerning. While it may not directly impact overall health, it can affect sexual function and emotional well-being. Discussing this with a urologist can provide insights into potential treatments or therapies to help manage these changes.

2. Cancer Concerns: The fluctuating PSA levels and your history of BPH raise valid concerns about prostate cancer. While your doctor has indicated that the likelihood of cancer is low, it’s essential to remain vigilant. Symptoms like persistent back pain and changes in urinary habits should be evaluated to rule out any serious conditions.

3. Bladder Capacity: Over time, bladder capacity can change, especially with chronic urinary issues. If you are experiencing increased urgency or discomfort, it may be beneficial to consult a urologist for a comprehensive evaluation, including bladder function tests.

Conclusion
Navigating prostate health issues can be complex and emotionally taxing. It’s essential to maintain open communication with your healthcare provider, express your concerns, and seek second opinions if necessary. Regular monitoring, lifestyle modifications (such as diet and exercise), and adherence to prescribed treatments can help manage symptoms effectively. Additionally, consider discussing any psychological impacts of your condition with a mental health professional, as emotional well-being is an integral part of overall health.
If you have further questions or need clarification on specific treatments or symptoms, don’t hesitate to reach out to your healthcare provider for personalized advice.

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