Urinary Symptoms: When to Consider Prostate Cancer Screening

Residual urine, may I ask again?

Dr.
Hsu, I apologize for bothering you again.
I have been researching information related to prostate cancer online, which mainly mentions that individuals over the age of 50, with a PSA level greater than 4, may experience symptoms similar to benign prostatic hyperplasia, including urinary issues such as difficulty urinating, weak urine flow, frequent strong urges to urinate, hematuria, burning sensation during urination, and residual urine, among others.
However, symptoms are often not obvious, and further examinations such as a digital rectal exam, prostate ultrasound, and biopsy are needed for a definitive diagnosis.

In my case, I have similar symptoms of not feeling completely empty after urination, occasionally wetting my underwear, and sometimes waking up at night to urinate, where I have to wait a while before I can urinate.
The flow tends to decrease towards the end, often dripping (which has been the case since my student days).
As for the frequency and volume of urination, they seem to be normal, though I do urinate more frequently in winter.

Additionally, as you mentioned, I do not pull my pants down too much, which can sometimes cause a slight obstruction at the penis, and I often feel the urge to urinate quickly.
However, I would like to understand if, given my age and these symptoms, I should proceed with a PSA test and a digital rectal exam.
Is there a possibility of cancer? Thank you (as you mentioned in a previous inquiry, you considered the possibility of prostate cancer).

aadda, 30~39 year old female. Ask Date: 2013/01/24

Dr. Xu Weikai reply Urology

Hello, if you are truly afraid, please go for the relevant examinations.
If there are any unclear points, feel free to ask again, and we can discuss and research further.
Online responses can only serve as a reference; if necessary, you should seek medical attention at a healthcare facility.
This message is from Dr.
Hsu Wei-kai, Director of the Urology Department at Taitung Hospital, Ministry of Health and Welfare.

Reply Date: 2013/01/24

More Info

When considering the possibility of prostate cancer screening, particularly for someone in their 30s, it is essential to understand the context of your symptoms and the general guidelines for prostate cancer screening. Prostate cancer is indeed more common in men over the age of 50, and the standard screening recommendations often include a prostate-specific antigen (PSA) test and a digital rectal exam (DRE) for men in this age group. However, your concerns about urinary symptoms warrant a closer look.

Understanding Your Symptoms
You mentioned experiencing urinary issues such as a sensation of incomplete emptying, occasional nocturia (waking up at night to urinate), and a weak urinary stream. These symptoms can be indicative of benign prostatic hyperplasia (BPH), which is a non-cancerous enlargement of the prostate that is common as men age. However, they can also overlap with symptoms of prostate cancer, especially if there are changes in urinary habits or if new symptoms develop.

Age and Risk Factors
At 36 years old, the likelihood of developing prostate cancer is relatively low, but it is not impossible. Factors such as family history, race, and certain genetic predispositions can increase the risk. If you have a family history of prostate cancer or other risk factors, it may be prudent to discuss this with your healthcare provider.

PSA Testing
The PSA test measures the level of prostate-specific antigen in the blood, which can be elevated in various conditions, including prostate cancer, BPH, and prostatitis (inflammation of the prostate). A PSA level above 4.0 ng/mL is often considered a threshold for further investigation, but it is not definitive for cancer. Your recent PSA levels of 4.67 and 4.911 ng/mL are slightly elevated and warrant further evaluation, especially given your urinary symptoms.

Digital Rectal Exam (DRE)
A DRE is a physical examination where a healthcare provider checks the prostate for abnormalities. This test can help identify issues that may not be apparent through PSA testing alone. Given your symptoms and elevated PSA levels, a DRE would be a reasonable next step.

When to Consider Further Testing
If your healthcare provider finds abnormalities during the DRE or if your PSA levels remain elevated, they may recommend further testing, such as a prostate biopsy, to rule out cancer. It is important to have an open discussion with your provider about your symptoms, concerns, and the potential need for these tests.

Conclusion
In summary, while prostate cancer is less common in younger men, your urinary symptoms and elevated PSA levels suggest that further evaluation is warranted. A discussion with your healthcare provider about the need for a PSA test and a DRE is advisable. They can provide personalized recommendations based on your symptoms, family history, and overall health. Early detection and intervention are crucial, so addressing these concerns proactively is essential for your peace of mind and health.

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