I have bowel movement problems as well as slow stream from time to time when urinating. Could this be a prostate problem?

Sometimes GI constipation can contribute to men (and even women) to have difficulty voiding (urinating). In men, constipation can even more so affect urination because of the prostate. Slow stream is one sign of men having an enlarged prostate–it’s called BPH for benign prostatic hyperplasia. If you have having chronic GI problems such as chronic constipation, it is important for you to see your doctor and get referred to have a colonoscopy to check for any important problems that could be contributing to this. Often increasing your fiber intake will be of benefit.

“Every Man Needs A Urologist”, so if you are having voiding difficulty, such as a slow stream or getting up many times a night to urinate, you should be evaluated by a urologist who will also screen you for possible prostate cancer. Benign conditions of the prostate such as BPH can be easily treated by medications but sometimes require surgery.

Any suggestions on a pill that works like the big blue $40 pill for men who makes less..????

The oral medications used to treat erectile dysfunction are effective for many men but yes, they are expensive and most insurance plans do not pay for such medications. Recently, a generic version of PDE5 inhibitors like Viagra and Cialis has been made available which is less costly–called Revatio. You can go to goodrx.com to look at and compare costs of medications.

Does garlic pills help kidney health?

There is no absolute definitive proof regarding the effects of garlic on kidney health. The best way to protect your kidneys is to prevent the onset of or control any high blood pressure of diabetes you may have and by controlling your weight. Early screenings for kidney health are also recommended.

Doc how accurate are PSA tests? I heard that bike riding and exercise can skew the test results.

The PSA blood test to screen for prostate cancer is not specific for prostate cancer but for prostate activity.  Having an elevated psa can result from having an enlarged prostate and does not mean there is prostate cancer.  However, an elevated psa should be evaluated by a urologist. Bike riding and sexual activity close to having the psa blood test drawn can indeed elevate the test result. Avoid heavy sexual activity and bike riding for a least week prior to getting the psa test drawn.

You are a urologist who is embarrassed to talk about men’s sexual function and female organs, but has no problem saying digital rectal exam!?!

Thank you for your observation; but you are incorrect. I brought up the subject of men’s sexual health.Please listen more carefully next time. I am not at all embarrassed to talk about men’s sexual function.  If you listened carefully to my comments, I am the one who brought up the topic of erectile dysfunction. So no, I am not embarrassed.

I simply wanted to be respectful to the listening audience who consists of all segments of society including children, who are listening to the radio with their parents on their way to school, for example. I wanted to choose my words very carefully; but brought the topic up because it is an important topic to discuss.

When as a physician and urologist, I also raise the option with the patient in the privacy of the exam room to engage with me in a candid discussion regarding men’s sexual function. The most important thing to me was for no one in the listening audience to change the radio channel because I did not want anyone to miss out on the important life-saving medical content to be discussed.

What if your man is in his late forties and diabetic? How does that impact erectile dysfunction?

Thank you for your question. Men in their late 40’s and even earlier often start to develop some element of erectile dysfunction for a variety of reasons, some of which include the onset of diabetes, hyperlipidemia (high cholesterol or triglycerides), heart disease, and hypertension. These medical conditions contribute to the onset of erectile dysfunction by reducing the blood flow to the penis.

Doctor, do things like super beta prostate pills actually work?

Medications like this have not been scientifically proven to improve voiding (urination) patterns. Many medications may have a placebo effect. The most effective medications to improve voiding dysfunction are the alpha blockers, examples of which include Flomax, Uroxatral, Hytrin and others….

Good morning doctor! As far as natural vitamins that men could use to help minimize prostate cancer, there have been inclusive studies regarding the benefits of vitamin E and selenium with respect to preventing prostate cancer. Eating a heart healthy diet and exercise is considered to be of benefit in the prevention of prostate cancer as prostate cancer incidence is associated with obesity.

I had my annual prostate exam a couple months ago, but my new doctor only did the PSA, not the digital rectal exam. He said that everything looked okay based on that test alone. I’m worried, is this okay?

The sensitivity of detecting prostate cancer is increased by doing both a digital rectal examination; however the digital rectal examination does not need to be performed on every encounter with the physician. The PSA blood test is the most sensitive test to suggest the presence of prostate cancer. Most cases of prostate cancer now days are found in men with elevated PSA blood tests in the setting of normal prostate exams.

Doctor, I’m a 49-year-old black male whose brother had colon issues. He’s 54 yrs old and my dad, who’s 78 years old, beat prostate cancer last year. I always heard 50 yrs old is when you should start getting tested. Is that true?

The recommendations for screening for colorectal cancer is to begin at the age of 50 years old; however, if you have someone in your immediate family such as a sibling or parent or uncle/aunt with colorectal cancer, it is recommended that you’ve been screening for colorectal cancer 5 years earlier than when your first-degree relative was diagnosed with colorectal cancer.

Many insurance companies may try to or may deny payment for screening prior to the age of 50. However, your physician and you can get pre-authorization to have this performed even before age 50 if you provide your insurance company with the fact that colorectal cancer is prevalent in your family.

My doctor recently found 2 small renal cysts after CT scan. What causes this? How long should I watch them?

70-80 % of adults are found to have benign renal cysts in their kidneys. What is significant depends upon the size, location, number of cysts and whether or not the cysts are considered to be “simple” cysts as determined by well-defined radiographical terminology.

There are some cysts in the kidneys that are considered to be “simple” cysts and others complex–according to the Bosniak criteria. Your physician needs to interpret the characteristics of the cysts with the radiologist.  The necessary follow up the cysts is determined by the type of cysts – simple versus complex. Also, the reason for you getting the CT scan and whether or not you have hematuria (blood in the urine) will impact the recommendation as to when and if you need a follow-up with either a CT scan, ultrasound or MRI.

So the day of two fingers used in a prostate exam is gone with use of digital?

I am not aware of any physicians or urologists who use two fingers to perform the prostate examination.  I strongly recommend and suggest that “Every Man Needs a Urologist.” In other words, it is important that every man get a urologist, in addition to having a primary care doctor, because urologists are expert in helping men maintain their health.

Urologists are also expertly trained in performing the digital rectal prostate exam which is important because it is important that this test be performed as comfortably as possible so that men will not refuse to undergo the examination. In fact, the DRE (digital rectal examination) is no where near a uncomfortable as many men claim. There are many misconceptions and claims about the DRE that are exaggerated.  Please don’t put your life at risk out of fear of getting a DRE which in the correct hands is relatively painless and only takes a few seconds to perform.

I am a 55-year-old male and my mother was a breast cancer survivor. Does that put me at risk for any cancer? 

Great question. Breast cancer and prostate cancer have genetically been linked. In other words, if a woman in your family has had a history of breast cancer, the risk of a man in the family developing prostate cancer in turn is elevated. By the way, men also can get breast cancer. If you feel a lump in your breast or have nipple discharge or breast pain and you are a man, you too should get evaluated for breast cancer by a physician.

I heard the doctor say that every man should have a urologist. What can the urologist do that my regular internal medicine doctor can’t do?

“Every man should have urologist” in addition to a primary care doctor. The urologist is expertly trained in addressing men’s health concerns such as prostate health, prostate cancer and men’s reproductive and sexual health. The urologist is also uniquely trained in interpretation of the PSA Prostate Specific Antigen test results and can augment the care your primary care doctor can provide.

Many physicians may not be aware of the fact that men can have prostate cancer despite having normal PSA blood test results. The urologist focuses also not only on the absolute level of the PSA blood test but also on how quickly over a period of time the PSA level is changing, which may be an early indicator of the presence of prostate cancer.

The urologist is also aware that what is considered to be a normal PSA varies according to the age range of the patient and the race/ethnicity of the patient in general. The urologist is also trained in the diagnosis and treatment of erectile dysfunction–the treatments of which include not only medications but also the penile vacuum erection device, penile injection therapy and implantable penile prosthetic devices.

What can I do about shrinking foreskin where it seems like I can’t pull back until it gets moist?

This is a condition called phimosis, which can be very painful and also a very serious condition. It often occurs in diabetics and can lead to significant infection life-threatening infection and morbidity. It is also very important that a man be able to retract the foreskin to examine the head of the penis (glans penis) routinely to make sure there is no penis cancer developing.

Is it expected that every man will experience erectile dysfunction? I’m dating a 57-year-old man that doesn’t have it yet, so what are the chances he will develop it?

As men age the incidence/ likelihood of erectile dysfunction increases, often the result of hypertension, diabetes, heart disease and/or obesity and is sometimes caused by medications the patient is taking–such as anti-hypertensive medications, antidepressants or alcohol or tobacco consumption. However, not every man develops ED and men at no point should simply discontinue prescription medications to treat hypertension or other conditions until consulting with their physician.

Control of hypertension and diabetes will help prevent ED. Also it is extremely important to note that the occurrence of ED is often associated also with the onset or existence of often undiagnosed heart disease, in particular coronary heart disease. ED onset often occurs about 3 years prior to the diagnosis of coronary heart disease, so recommendations are that any man experiencing erectile dysfunction should also be screened for undiagnosed unrecognized heart disease.

Doctor! What does Tamulson do to help enlarged prostate?

Tamsulosin, also known as Flomax, is an alpha-blocker. The mechanism of action is that this medication, which is a prescription medication, helps alleviate urination symptoms not by reducing the size of the prostate, but by relaxing the smooth muscles located in and around the prostate.

It thereby helps open up the bladder neck and urethra which makes it easier for men to urinate–reducing the amount of straining to urinate and increasing the strength of the stream which helps reduce the number of times men have to get up at night to urinate. The medication generally may take a few weeks to improve symptoms of the enlarged prostate after you begin taking it.

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