Disclaimer: This information is not intended to substitute a consultation with an Urologist.
Evaluation will always start with a good history, physical examination, blood tests, including male hormone profile, PSA and other relevant tests.
Blood test results will vary from patient to patient due to the patient history, age and health and therefore reference ranges cannot be given.
Highly specialised technology and equipment is used in the treatment procedures, some of which include:
Prostate disease is a general term that describes a number of medical conditions that can affect the prostate gland.
- Prostate Enlargement
Prostate enlargement is a common condition associated with ageing. About a third of all men over 50 years of age will have symptoms of prostate enlargement (see below).The urethra is a tube that runs from the bladder through the prostate to the end of the penis. Urine flows through the urethra and out of the body when a man urinates. If the prostate becomes enlarged it can place pressure on the urethra, making it more difficult for the bladder to empty.An enlarged prostate can cause symptoms that can affect the normal pattern of urination. For example, it can:
- make it difficult for you to start urinating
- weaken the flow of urine or cause ‘stopping and starting’
- cause you to strain to pass urine
- cause you to urinate more frequently
- wake you up frequently during the night to urinate
A simple treatment for prostate enlargement is to reduce the amount you drink before you go to bed.
Medications, such as alpha blockers, are also available to help relax the prostate gland muscles, or to reduce its size, making it easier to urinate.
In severe cases that fail to respond to medication, the inner part of the prostate gland that is blocking the urethra can be surgically removed.
Prostatitis is a diverse inflammatory condition where the prostate gland becomes inflamed (red and swollen). Inflammation often occurs as a response to infection, but in many cases of prostatitis no infection can be proved. Symptoms of prostatitis include:
- pelvic pain
- testicular pain
- pain when urinating (this is less common and more likely with a urinary tract infection)
- pain when ejaculating semen
- pain in the perineum (the area between the anus and back of the scrotum), which is often worse when sitting, particularly on hard chairs and bicycle saddles
Prostatitis is thought to affect up to 3 in 20 men (15%) at some point in their lives. Although it can affect men of any age, it is more common in men between 30-50 years of age.
Prostatitis can be treated using a combination of painkillers and other medication, such as alpha-blockers, which can help relieve the symptoms.
- Prostate cancer
Your chances of developing prostate cancer increase with age. Most cases occur in men who are 50 years of age or older. The causes of cancer of the prostate are unknown, but risk factors include age, ethnic origin, family history and diet and exercise. Cancer of the prostate is more common in African and Afro-Caribbean men and less common in Asian men. The reasons for this are not fully understood. Prostate cancer can be diagnosed early before it causes any symptoms. The symptoms of prostate cancer are similar to those of prostate enlargement and include:
- needing to urinate more frequently (often during the night)
- needing to rush to the toilet
- difficulty starting to urinate (hesitancy)
- straining or taking a long time while urinating
- weak flow
- feeling that your bladder has not emptied fully
The outlook for prostate cancer is usually good because, unlike many other types of cancer, it usually progresses very slowly. If treated early, prostate cancer can often be cured.
- surgery to remove the prostate gland
- radiotherapy - using radiation to kill the cancerous cells
- hormone therapy – using medication to block the effects of testosterone (the hormone that stimulates prostate cancer)
These treatment options carry the risk of significant side effects including:
- loss of libido (sexual desire)
- erectile dysfunction (the inability to obtain or maintain an erection)
- urinary incontinence (loss of bladder control)
For this reason, many men choose to delay treatment until there is a significant risk of the cancer spreading. It is usually not possible to cure the cancer if it spreads from the prostate gland to other parts of the body, such as the bones (a process known as metastasis). In this case, the aim of treatment will be to relieve the symptoms and prolong life.
Male infertility refers to the inability of a male to achieve a pregnancy in a fertile female. In humans it accounts for 40-50% of infertility. Male infertility is commonly due to deficiencies in the semen.
- Low male hormone levels due to various causes such as obesity
- Drugs and alcohol
- Strenuous riding, such as bicycle riding and horseback riding
- Medications, including those that affect spermatogenesis such as chemotherapy, anabolic steroids, cimetidine, spironolactone; those that decrease FSH levels such as phenytoin and those that decrease sperm motility such as sulfasalazine and nitrofurantoin
- Genetic abnormalities.
- Genetic defects on the Y chromosome
- Abnormal set of chromosomes
- Neoplasm, e.g. seminoma
- Idiopathic failure
- Testicular cancer
- Acrosomal defects affecting egg penetration
- Unexplained sperm deficiencies account for 30% of male infertility.
- Radiation therapy to a testis decreases its function, but infertility can efficiently be avoided by avoiding radiation to both testes.
- Vas deferens obstruction
- Lack of Vas deferens, often related to a disease (Cystic Fibrosis)
- Infection, e.g. prostatitis
- Retrograde ejaculation
- Ejaculatory duct obstruction
Recognise the warning signs and symptoms of a bladder control problem. Know when you should seek a doctor’s help and how you can get the most out of your visit.
- Indicate a serious underlying medical condition, such as diabetes or kidney problems
- Cause you to restrict your physical activities
- Lead you to withdraw from social interactions
- Increase your risk of falling if you have balance problems and you often rush to the bathroom to avoid leaking urine
- You’re embarrassed by urine leakage, and you avoid important activities because of it.
- You often feel the urgency to urinate and have to rush to a bathroom, but sometimes don’t make it in time.
- You urinate much more frequently than you used to, such as at night, even when you don’t have a bladder infection.
- You often feel the need to urinate, but you’re unable to pass urine.
- You notice that your urine stream is getting progressively weaker, or you feel as if you can’t empty your bladder well.
An urologist specialises in male and female urinary disorders, as well as the male reproductive system.
UROLOGICAL CANCER MANAGEMENT
The subspecialty of female urology is concerned with the diagnosis and treatment of those urinary tract disorders most prevalent in females
Pediatric urology is a surgical subspecialty of medicine dealing with the disorders of children’s genitourinary systems.
PROSTATE SPECIFIC ANTIGENS (PSA)
PSA is a protein circulating in the blood of normal prostate cells as well as prostate cancer cells.
- The PSA test measures the blood level of PSA, a protein that is produced by the prostate gland. The higher a man’s PSA level, the more likely it is that he has prostate cancer. However, there are additional reasons for having an elevated PSA level, and some men who have prostate cancer do not have elevated PSA.
- The PSA test has been widely used to screen men for prostate cancer. It is also used to monitor men who have been diagnosed with prostate cancer to see if their cancer has recurred (come back) after initial treatment or is responding to therapy.
- Some advisory groups now recommend against the use of the PSA test to screen for prostate cancer because the benefits, if any, are small and the harms can be substantial. None recommend its use without a detailed discussion of the pros and cons of using the test.
Cytology is a detailed examination of a urine specimen looking for abnormal blood cells; inflammatory cells; organisms and important cancer cells.
This test is a diagnostic test. Substances such as proteins and glucose can be early signs of various health concerns such as diabetes, kidney diseases and urinary tract infections.
- Colour. Many things affect urine color, including fluid balance, diet, medicines and diseases. How dark or light the color is tells you how much water is in it. Vitamin B supplements can turn urine bright yellow. Some medicines, blackberries, beets, rhubarb, or blood in the urine can turn urine red-brown.
- Clarity. Urine is normally clear. Bacteria, blood, sperm, crystals, or mucus can make urine look cloudy.
- Odour. Urine does not smell very strong, but has a slightly “nutty” odour. Some diseases cause a change in the odour of urine. For example, an infection with E. coli bacteria can cause a bad odour, while diabetes or starvation can cause a sweet, fruity odour.
- Specific gravity. This checks the amount of substances in the urine. It also shows how well the kidneys balance the amount of water in urine. The higher the specific gravity, the more solid material is in the urine. When you drink a lot of fluid, your kidneys make urine with a high amount of water in it which has a low specific gravity. When you do not drink fluids, your kidneys make urine with a small amount of water in it which has a high specific gravity.
- pH. The pH is a measure of how acidic or alkaline (basic) the urine is. A urine pH of 4 is strongly acidic, 7 is neutral (neither acidic nor alkaline), and 9 is strongly alkaline. Sometimes the pH of urine is affected by certain treatments. For example, your doctor may instruct you how to keep your urine either acidic or alkaline to prevent some types of kidney stones from forming.
- Protein. Protein is normally not found in the urine. Fever, hard exercise, pregnancy, and some diseases, especially kidney disease, may cause protein to be in the urine.
- Glucose. Glucose is the type of sugar found in blood. Normally there is very little or no glucose in urine. When the blood sugar level is very high, as in uncontrolled diabetes, the sugar spills over into the urine. Glucose can also be found in urine when the kidneys are damaged or diseased.
- Nitrites. Bacteria that cause a urinary tract infection (UTI) make an enzyme that changes urinary nitrates to nitrites. Nitrites in urine show a UTI is present.
- Leukocyte esterase (WBC esterase). Leukocyte esterase shows leukocytes (white blood cells [WBCs]) in the urine. WBCs in the urine may mean a UTI is present.
- Ketones. When fat is broken down for energy, the body makes substances called ketones (or ketone bodies). These are passed in the urine. Large amounts of ketones in the urine may mean a very serious condition, diabetic ketoacidosis, is present. A diet low in sugars and starches (carbohydrates), starvation, or severe vomiting may also cause ketones to be in the urine.
- Microscopic analysis. In this test, urine is spun in a special machine (centrifuge) so the solid materials (sediment) settle at the bottom. The sediment is spread on a slide and looked at under a microscope. Things that may be seen on the slide include:
- Red or white blood cells. Blood cells are not found in urine normally. Inflammation, disease, or injury to the kidneys, ureters, bladder, or urethra can cause blood in urine. Strenuous exercise, such as running a marathon, can also cause blood in the urine. White blood cells may be a sign of infection or kidney disease.
- Casts. Some types of kidney disease can cause plugs of material (called casts) to form in tiny tubes in the kidneys. The casts then get flushed out in the urine. Casts can be made of red or white blood cells, waxy or fatty substances, or protein. The type of cast in the urine can help show what type of kidney disease may be present.
- Crystals. Healthy people often have only a few crystals in their urine. A large number of crystals, or certain types of crystals, may mean kidney stones are present or there is a problem with how the body is using food (metabolism).
- Bacteria, yeast cells, or parasites. There are no bacteria, yeast cells, or parasites in urine normally. If these are present, it can mean you have an infection.
- Squamous cells. The presence of squamous cells may mean that the sample is not as pure as it needs to be. These cells do not mean there is a medical problem, but your doctor may ask that you give another urine sample.
Sexually transmitted diseases (STDs), or sexually transmitted infections (STIs), are generally acquired by sexual contact.
- Sores or bumps on the genitals or in the oral or rectal area
- Painful or burning urination
- Discharge from the penis
- Vaginal discharge
- Unusual vaginal bleeding
- Sore, swollen lymph nodes, particularly in the groin but sometimes more widespread
- Lower abdominal pain
- Rash over the trunk, hands or feet
- You are sexually active and you believe you’ve been exposed to an STI
- You have signs and symptoms of an STI
- When you consider becoming sexually active, or when you’re 21 — whichever comes first
- Before you start having sex with a new partner
A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract.
- Severe pain in the side and back, below the ribs
- Pain that spreads to the lower abdomen and groin
- Pain that comes in waves and fluctuates in intensity
- Pain on urination
- Pink, red or brown urine
- Nausea and vomiting
- Persistent urge to urinate
- Urinating more often than usual
- Fever and chills if an infection is present
- Pain so severe that you can’t sit still or find a comfortable position
- Pain accompanied by nausea and vomiting
- Pain accompanied by fever and chills
- Blood in your urine
- Difficulty passing urine
Testicular cancer is a disease in which cells in one or both testicles become malignant (Cancerous).
- Uncomfortable feeling in a testicle
- Presence of a painless lump on a testicle – the lump can sometimes be as small as a grain of rice and feel like hard rubber
- An enlarged or swollen testicle
- A change in the consistency of a testicle
- A heavy or aching feeling in the back, lower abdomen, groin, or scrotum
- Any painless lump on a testicle that does not respond promptly to antibiotic treatment
- If the cancer has already spread to the lungs, problems like shortness of breath, chest pain, or cough (even coughing up blood) may develop
- In rare cases, testicular cancer spreads to the brain and can cause headaches and confusion
- Enlargement of breasts with tenderness in cases of testicular germ cell tumours
- In Leydig cell tumours (hormone producing cell in the testes), oestrogen-producing tumours can cause loss of sexual desire or make the male’s breasts to grow
- Also in Leydig cell tumours, androgen-producing tumours can cause growth of facial and body hair at an abnormally early age in boys (American Cancer Society; Testicular Cancer Symptoms).
- shortness of breath (dyspnea), cough or coughing up blood (hemoptysis) from metastatic spread to the lungs
- a lump in the neck due to metastases to the lymph nodes
THE PROSTATE GLAND
The prostate gland is a small gland that is only found in men. It is located between the penis and bladder and it surrounds the urethra (the tube that carries urine from the bladder to the penis).
The prostate gland helps with the production of semen (the fluid that transports sperm). It produces a thick, white fluid that is liquefied by a special protein called prostate-specific antigen (PSA). The fluid is mixed with sperm, produced by the testicles, to create semen.
There are a number of conditions that can affect the prostate gland including:
Pre-testicular factors refer to conditions that reduce hormonal stimulation of the testes including:
Smoking is still controversial in its effect on sperm production.
Inborn faults in the composition of the genetic footprint (DNA) or environmental damage to the DNA molecule might cause sub-fertility.
Testicular factors refer to conditions where the testes produce semen of low quantity and/or poor quality despite adequate hormonal support and include:
Post-testicular factors decrease male fertility due to conditions that affect the male genital system after testicular sperm production and include defects of the genital tract as well as problems in ejaculation:
BLADDER CONTROL PROBLEMS IN WOMEN
Recognise the warning signs and symptoms of a bladder control problem. Know when you should seek a doctor’s help and how you can get the most out of your visit. If you’re one of the many women who experience bladder control problems, don’t let embarrassment keep you from getting the help you need. Leaking urine, having to urinate frequently and experiencing other symptoms of urinary incontinence aren’t trivial consequences of childbirth or a natural part of aging. Not all doctors routinely ask about urinary function during an exam. It’s up to you to take the first step. If you have bladder control problems, tell your doctor about them and ask for help.
Why to seek help
Bladder control problems require medical attention for several reasons. Reduced bladder control may, for instance:
When to seek help
A few isolated incidents of urinary incontinence don’t necessarily require medical attention. But if the problem continues or affects your quality of life, consider getting these symptoms evaluated.
Make an appointment with your primary care provider if:
In most circumstances, symptoms can be improved.
When to seek a specialist
Many health care providers can treat bladder control problems without referring you to a specialist but not all have the necessary training or experience. In spite of better understanding and the treatment of urinary incontinence, some medical health providers consider it an inevitable consequence of childbearing, menopause or normal aging — a belief that makes them unlikely to consider you for evaluation or treatment.
If your doctor dismisses significant symptoms or seems uninformed about the many possible treatments, ask for a referral to see a specialist. Doctors who specialise in urinary disorders include:
BLADDER PROBLEMS IN MEN
Bladder problems are common in men as they age. Benign prostatic hyperplasia usually begins in men who are in their 40s and 50s. Problems associated with benign prostatic hypotrophy are common in men 60 and older. Many problems are closely associated and may be the result of an underlying issue. However, each problem may develop independently of other pathologies.
Bladder stones are the crystallisation of minerals in the urine. This is the result of concentrated urine that may result from urinary tract infections, prostatic hyperplasia or nerve damage. The development of bladder stones may be asymptomatic; however, they can affect the emptying of urine from the bladder. This can result in pelvic pain, frequent and painful urination, incontinence, difficulty urinating, hematuria and penile pain.
BLADDER OUTLET OBSTRUCTION
Bladder outlet obstruction is the blockage of the flow of urine from the bladder. This has several aetiologies, including benign prostatic hyperplasia, bladder tumours, bladder cysts and bladder stones. Bladder outlet obstruction may be a sign of more serious problems, like the presence of renal calculi, and can be associated with renal failure.
Benign prostatic hyperplasia or prostatic cancer may cause bladder problems in men because the prostate obstructs the urethra in both conditions. Nocturia is frequent, night-time urination (ie. more than 2 times per night). . Overactive bladder is the urgent need to frequently urinate and can occur during the night. Urinary tract infections, interstitial cystitis and diabetes may also cause nocturia.
Bladder cancer may be diagnosed by ruling out other causes of bladder symptoms. Visible blood in the urine without accompanying pain can be a sign of bladder cancer, although bladder cancer may be asymptomatic. The location of the tumour may lead to other bladder problems such as urinary incontinence and bladder outlet obstruction. Symptoms may evolve to the inability of the bladder to retain an adequate amount of urine and pain.
Urinary incontinence is the leakage of urine from the bladder. While it is common, it is not a normal condition. It is also treatable. There are several causes of urinary incontinence in men. The nerves controlling the bladder may become damaged. Nerve damage may result as a diabetes complication, stroke, neurological disease or injury to the spinal cord. Urinary incontinence may also result from an enlarged prostate, prostate surgery or radiation as a treatment for prostate cancer.
Prostate cancer treatment depends on the patient age, health, extent and aggressiveness of the cancer. In certain cases active surveillance where the cancer is closely watched under guidance of your urologist is the optimal initial therapy. In other cases surgery, radiation therapy, hormonal therapy or chemotherapy is required to treat the cancer.KIDNEY CANCER
The main form of curative treatment for kidney cancer is surgery in the form of a nephrectomy where the kidney is removed, or a partial nephrectomy where part of the kidney is removed. Chemotherapy is used in advanced cases to palliate symptoms and prolong survival. Radiation therapy is used in selected cases to reduce pain or bleeding.BLADDER CANCER
Bladder cancer arises from the lining of the bladder and its treatment depends on how deeply the cancer has involved the bladder wall. Superficial bladder cancers can be treated by removal via a cystoscope (a telescope that is passed through the urethra) with the addition of BCG or local chemotherapy in more aggressive cases. When the bladder cancer invades the muscle a different form of treatment is required. In such cases a radical cystectomy can be carried out, a major abdominal operation where the bladder is removed and a urine bag or artificial bladder created. The other treatment is curative radiotherapy (sometimes with added chemotherapy). This treatment has the same cure rates as surgery and allows the patients natural bladder to remain intact as well as the natural way of urinating to continue as normal.
Testicular tumours often present as a lump in a testicle. Initial management is a radical orchidectomy, an operation to remove the affected testicle. Further treatment depends on what type of cancer is seen by the pathologist in the affected testicle, as well as the extent of the cancer.
The subspecialty of female urology is concerned with the diagnosis and treatment of those urinary tract disorders most prevalent in females. These include urinary incontinence and pelvic floor prolapse, voiding dysfunction, recurrent urinary tract infection, urethral syndrome and interstitial cystitis. Expert evaluation of these conditions includes a complete history and physical exam. Urodynamics (bladder function test) and imaging studies may be required to fully evaluate the urinary tracts. Additional bladder studies such as cystoscopy may be necessary.WHAT IS INCONTINENCE?
Incontinence is an involuntary loss of urine. It is further defined by type as either stress (leakage with straining, coughing or sneezing), urge, mixed, overflow, functional or reflex incontinence. Treatment is dependent on the type of incontinence. Current therapies include dietary changes, scheduled voiding, bladder retraining, pelvic muscle exercises, biofeedback, electrical stimulation therapy, medication, collagen implants and minimally invasive surgery.WHAT IS VOIDING DYSFUNCTION?
Voiding dysfunction can take many forms. The main symptoms are urinary frequency, urgency, painful urination and/or incomplete bladder emptying. Treatment is aimed at decreasing or eliminating symptoms. Treatment may involve medications or pelvic floor relaxation exercises.
WHAT IS A RECURRENT URINARY TRACT INFECTION?
A recurrent urinary tract infection (UTI) may be generally defined as three or more infections within one year. This may be idiopathic (no obvious cause or related to a urologic disorder such as stones, tumour, reflux (urine flows backwards toward the kidney) or ineffective bladder emptying. Treatment is aimed at identifying the cause and/or proper antibiotic therapy to break the cycle of recurrent infection.
WHAT IS URETHRAL SYNDROME?
Urethral syndrome is a condition involving pain at the urethra that can occur during urination or without regard to urination. Treatment may consist of oral medication or local oestrogen replacement therapy. Urethral syndrome may exist as a component of interstitial cystitis.
WHAT IS INTERSTITIAL CYSTITIS?
Interstitial cystitis (IC) is a urologic syndrome characterised by excessive urinary urgency, frequency, nocturia (night time urination) and pain in the lower abdomen and/or perineum. It can occur at any age; however, the median age at diagnosis is between 42 and 46 years. The cause of IC is unclear. It is believed to be related to irregularities in the bladder lining and/or an allergic/immune response. IC can severely affect an individual’s quality of life. Other drugs with calming effects on the bladder may also be helpful. Bladder instillations with dimethyl sulfoxide (DMSO) have achieved variable success. Hydrodistention of the bladder under anaesthesia is a common therapeutic and diagnostic procedure. In the most severe cases, surgery including denervation (resection of nerves of the bladder), urinary diversion (removing the bladder) and augmentation cytoplasty (Bladder enlargement) may be performed.
Pediatric urology is a surgical subspecialty of medicine dealing with the disorders of children’s genitourinary systems. Pediatric urologists provide care for both boys and girls ranging from birth to early adult age. The most common problems are those involving disorders of urination and testes.
PSA is a protein circulating in the blood of normal prostate cells as well as prostate cancer cells. Blood tests are often used as a screening test to look for men who may have prostate cancer. Interpretation of results has to include assessing the patient age; gland size and a variety of other factors. PSA is a good but not perfect test for prostate cancer screening because other prostate conditions can also have an abnormal elevated blood level PSA; such as inflammation, infection and enlargement. Doctor’s don’t usually look at only one PSA reading, they review and watch and see how the numbers progress. There is no known ideal PSA level, but the higher the levels are, the greater the need for follow up tests.
THE PSA TEST
What is the PSA test?
Prostate-specific antigen, or PSA, is a glyco-protein produced by cells of the prostate gland. The PSA test measures the level of PSA in a man’s blood. For this test, a blood sample is sent to a laboratory for analysis. The results are usually reported as nanograms of PSA per millilitre (ng/mL) of blood.
The blood level of PSA is often elevated in men with prostate cancer, and the PSA test was originally approved by the FDA in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease.
In addition to prostate cancer, a number of benign (not cancerous) conditions can cause a man’s PSA level to rise. The most frequent benign prostate conditions that cause an elevation in PSA level are prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH) (enlargement of the prostate). There is no evidence that prostatitis or BPH leads to prostate cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.
Is the PSA test recommended for prostate cancer screening?
Screening is for the whole population not only for individuals needing a professional opinion.
What is a normal PSA test result?
There is no specific normal or abnormal level of PSA in the blood. In the past, most doctors considered PSA levels of 4.0 ng/mL and lower as normal. Therefore, if a man had a PSA level above 4.0 ng/mL, doctors would often recommend a prostate biopsy to determine whether prostate cancer was present.
However, more recent studies have shown that some men with PSA levels below 4.0 ng/mL have prostate cancer and that many men with higher levels do not have prostate cancer. In addition, various factors can cause a man’s PSA level to fluctuate. For example, a man’s PSA level often rises if he has prostatitis or a urinary tract infection. Prostate biopsies and prostate surgery also increase PSA level. Conversely, some drugs—including finasteride and dutasteride, which are used to treat BPH—lower a man’s PSA level. PSA level may also vary somewhat across testing laboratories.
In general, however, the higher a man’s PSA level, the more likely it is that he has prostate cancer. Moreover, continuous rise in a man’s PSA level over time may also be a sign of prostate cancer.
What if a screening test shows an elevated PSA level?
If a man who has no symptoms of prostate cancer chooses to undergo prostate cancer screening and is found to have an elevated PSA level, the doctor may recommend another PSA test to confirm the original finding. If the PSA level is still high, the doctor may recommend that the man continue with PSA tests and DREs (finger tests) at regular intervals to watch for any changes over time.
If a man’s PSA level continues to rise or if a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. A urine test may be recommended to check for a urinary tract infection. The doctor may also recommend imaging tests, such as a trans rectal ultrasound, x-rays, or cystoscopy.
If prostate cancer is suspected, the doctor will recommend a prostate biopsy. During this procedure, multiple samples of prostate tissue are collected by inserting hollow needles into the prostate and then withdrawing them. Most often, the needles are inserted through the wall of the rectum (trans rectal biopsy); however, the needles may also be inserted through the skin between the scrotum and the anus (trans perennial biopsy). A pathologist then examines the collected tissue under a microscope. The doctor may use ultrasound to view the prostate during the biopsy, but ultrasound cannot be used alone to diagnose prostate cancer.
What are some of the limitations and potential harms of the PSA test for prostate cancer screening?
Detecting prostate cancer early may not reduce the chance of dying from prostate cancer. When used in screening, the PSA test can help detect small tumours that do not cause symptoms. Finding a small tumour, however, may not necessarily reduce a man’s chance of dying from prostate cancer. Some tumours found through PSA testing grow so slowly that they are unlikely to threaten a man’s life. Detecting tumours that are not life threatening is called “over diagnosis,” and treating these tumours is called “overtreatment.”
Overtreatment exposes men unnecessarily to the potential complications and harmful side effects of treatments for early prostate cancer, including surgery and radiation therapy. The side effects of these treatments include urinary incontinence (inability to control urine flow), problems with bowel function, erectile dysfunction (loss of erections, or having erections that are inadequate for sexual intercourse), and infection.
In addition, finding cancer early may not help a man who has a fast-growing or aggressive tumour that may have spread to other parts of the body before being detected.
The PSA test may give false-positive or false-negative results. A false-positive test result occurs when a man’s PSA level is elevated but no cancer is actually present. A false-positive test result may create anxiety for a man and his family and lead to additional medical procedures, such as a prostate biopsy, that can be harmful. Possible side effects of biopsies include serious infections, pain, and bleeding.
Most men with an elevated PSA level turn out not to have prostate cancer; only about 25 percent of men who have a prostate biopsy due to an elevated PSA level actually have prostate cancer.
A false-negative test result occurs when a man’s PSA level is low even though he actually has prostate cancer. False-negative test results may give a man, his family, and his doctor false assurance that he does not have cancer, when he may in fact have a cancer that requires treatment.
A urine test checks different components of urine, a waste product made by the kidneys. A regular urine test may be done to help find the cause of symptoms. The test can give information about your health and problems you may have.
The kidneys take out waste material, minerals, fluids, and other substances from the blood to be passed in the urine. Urine has hundreds of different body wastes. What you eat, drink, how much you exercise, and how well your kidneys work can affect what is in your urine. More than 100 different tests can be done on urine.
A regular urinalysis often includes the following tests.
The organisms that cause sexually transmitted diseases may pass from person to person in blood, semen, or vaginal and other bodily fluids. Some such infections can also be transmitted non-sexually, such as from mother to infant during pregnancy or childbirth, or through blood transfusions or shared needles. It’s possible to contract sexually transmitted diseases from people who seem perfectly healthy — people who, in fact, aren’t even aware of being infected. Many STDs cause no symptoms in some people, which is one of the reasons experts prefer the term “sexually transmitted infections” to “sexually transmitted diseases.”
Sexually transmitted infections (STIs) have a range of signs and symptoms. That’s why they may go unnoticed until complications occur or a partner is diagnosed. Signs and symptoms that might indicate an STI include:
Signs and symptoms may appear a few days to years after exposure, depending on the organism. They may resolve in a few weeks, even without treatment, but progression with later complications or recurrence sometimes occurs.
WHEN TO SEE A DOCTOR
See a doctor immediately if:
Make an appointment with a doctor for STI counselling and, if appropriate, screening tests
A kidney stone is a hard, crystalline mineral material formed within the kidney or urinary tract. Kidney stones are a common cause of blood in the urine (haematuria) and often severe pain in the abdomen, flank, or groin. Kidney stones are sometimes called renal calculi.A kidney stone may not cause symptoms until it moves around within your kidney or passes into your ureter — the tube connecting the kidney and bladder. At that point, these signs and symptoms may occur:
Pain caused by a kidney stone may change — for instance, shifting to a different location or increasing in intensity — as the stone moves through your urinary tract.
WHEN TO SEE A DOCTOR
Make an appointment with your doctor if you have any signs and symptoms that worry you. Seek immediate medical attention if you experience:
It is not contagious and cannot spread from one person to another. This form of Cancer is relatively rare when compared with other types of cancer. Testicular cancer accounts for approximately 1 percent of all cancers in men. However, it is the most common male cancer in men between the ages of 15 and 39
The symptoms of testicular cancer include:
Typically, testicular cancer develops in one or both testicles in young men, but it can occur in older men as well. It is a highly treatable and usually curable type of cancer.
One of the first signs of testicular cancer is often a lump or swelling in the testes.
It is not very common for testicular cancer to spread to other organs, apart from the lungs. However, if it has, the following symptoms may be present: