There are several symptoms that men may exhibit that call for an evaluation of prostate health. In some cases, men begin to experience changes in urination, such as:
- Increased frequency of urination: A man may start waking two or three times at night to urinate, or may feel an urgency to urinate during the day
- A weak urine flow stream, and/or the experience of having to start and stop urinating several times: At the end of urination, the man may feel as though his bladder has not completely emptied
- Painful urination
- Blood in the urine
In other cases, a man may have a PSA test with an elevated result, most probably completed as a routine part of a physical. If the results of the test show an elevated score, the man will be referred to a urologist for a prostate health workup.
What Happens if I have an Elevated PSA?
First of all, it's most important to know that an elevated PSA does not mean that a man has prostate cancer. The PSA test is not a very accurate assessment of whether prostate cancer is present. Elevated PSAs can be caused by simple enlargement of the prostate, infection in the prostate, or cancer. A much more accurate test, completed after examination when cancer is a possibility, is the 4K Score Test.
Dr. Fisch will perform a physical examination including a digital rectal rectal exam and will discuss the patient's history. Semen and urine cultures will be ordered. A positive result from the cultures indicates that the patient is suffering from a treatable infection. After treatment for the infection, the patient will be retested, using both the PSA test, and a new test, called the 4K score test, which more accurately determines whether a man is at risk of cancer.
If prostate cancer is suspected from the digital rectal exam and an ultrasound of the prostate, Dr. Fisch will conduct a Prostate Biopsy. This medical procedure is completed within Dr. Fisch's office. The results of the biopsy will be discussed with the patient, and and next steps will be identified. If no cancer is identified, the patient will be watched, and PSA and 4K Score Tests will be repeated on a six month schedule.
What is an Enlarged Prostate?
Over time, the prostate will usually get bigger. The prostate gland has a normal volume of 15-20 ml in a young man aged twenty to thirty years old. As men approach 40, the prostate starts to grow. This is a normal process and men will not usually experience symptoms of enlarged prostate.
By the time a man reaches the age of fifty, it is not uncommon for the prostate gland to increase in size to 40-60 grams. At this point, men may start to experience the symptoms of enlarged prostate, which is also called benign prostatic hyperplasia or BPH. The symptoms of BPH or prostate enlargement are often present through changes in a man’s ability to urinate.
It is important to note that an enlarged prostate can indicate an infection or inflammation of the prostate, called prostatitis. As well, an enlarged prostate can be an indicator of prostate cancer. That is one of the reasons men need to see a urology specialist to evaluate anyone having any of the urinary symptoms listed above, or for any man who has an elevated PSA.
Patient Evaluation for BPH and Enlarged Prostate
During the physical examination, Dr. Fisch will take a complete medical history and assess the amount of fluids ingested each day, perform a digital rectal exam, initiate laboratory tests such as PSA, urinalysis, urine culture and semen culture and if indicated, will conduct bladder and prostate ultrasounds to assess the size of the prostate. An ultrasound is a diagnostic imaging test using sound waves to visualize an internal body structure – in this case, the prostate gland and bladder.
While cancer is the main concern, more often these symptoms are a result of infection, BPH, diabetes, or simply from the patient drinking too much fluid volume each day. Treatments may include antibiotics, medications to shrink the prostate, or one of a number of surgical procedures.
After treatment, the patient will be retested. If prostate cancer is suspected, Dr. Fisch will initiate a 4K score test and may recommend a prostate biopsy based on the results. During the entire evaluation, Dr. Fisch will remain in contact with each patient to provide the appropriate information and support.
See the sidebar for an informational video about the 4K Score Test.