Prostate Health (cont.)

This is a very common question and I think the fact that the writers of this question have gone and done their research tells us that they probably already know many of the answers.

First of all, a PSA in the high twos for a young man is a serious concern to me. We used to call 4.0 the cutoff of concern and for many experts now that's dropped down to 2.5. A young man in his 40s should have a PSA probably below one. So the fact that his PSA is 2.9 is of concern, and I do agree he needs a recheck of the PSA and evaluation by a urologist, most likely with prostate biopsies with transrectal ultrasound.

If there is not a urologist in the community that they feel comfortable with, then they should travel to the next significant city because there will be many urologists there. If they do have questions, then a good excellent resource is always the local medical school university training programs. They always have cutting-edge technology and usually well-read physicians who are able to provide state-of-the art medicine. But, just because the doctor is not at a medical school or medical center doesn't mean that he is bad.

I think the first thing would be just to talk to the local doctors and say, we need a referral and is there somebody in the nearest city who he can see and be evaluated?

I do think it's very important that he be evaluated with repeat PSAs and most likely with biopsies if the PSA is still above one and a half.

Ever since I had the cancer treatments, my prostate has dried up and I have no semen.

That is correct. Obviously if a man has the prostate removed, there will be nothing to come out because the majority of the fluid that does come out during ejaculation is from the prostate and adjacent glands called the seminal vesicles and during the surgery those are removed; so there should be nothing coming out after radiation.

The tissues are killed by the radiation. The goal is to kill the cancer cells and in so doing many of the adjacent normal prostate cells and seminal vesicles do whither up and atrophy. So after radiation, cryotherapy or many of the other conservative treatments, having no or minimal ejaculate is considered the norm.

"One thing to remember is that anything that happens from the base of the bladder all the way out to the tip of the penis is felt as urethral, penile pain."

I've heard that following a radical prostatectomy some men find masturbation more pleasurable than intercourse. Is this true and why?

My answer to this would be that it's very individual. I had not heard this before, but it may have to do with the fact that after surgery, there may be a compromise to some of the nerves and there may be a need for more physical stimulation to achieve the same level of satisfaction. So that is something that is totally individual and will depend on the person and their relationships and specifically the treatment and how effective it was and what injury may have occurred at the time.

I've been seeing my urologist for a couple of months now and he says I have prostatitis. He put me on Cipro XR 1,000 milligrams and I think it's finally working. But when I pinch my penis, the tube and back up to the head, I still feel some discomfort. Is there anything you can tell me? This is very depressing. Also, my semen is still a little clumpy, but not like it was.

Prostatitis is a name applied to a significant number of different problems. Prostatitis can be a bacterial infection of the prostate from any one of dozens of different bacteria, it can be viral and sometimes it's just an inflammatory irritation.

The nice thing about Cipro and other antibiotics in that category is not only do they kill most of the germs that live within the prostatic tissue and fluid, but there's also an anti-inflammatory component.

What we often do with men that have prostatitis is not only do we use a long course of antibiotics, such as Cipro, but we also usually add additional anti-inflammatory medications for the very reason he describes in that sometimes there's continued irritation of the urethra and prostate from the swelling that goes along with the infection. Whether the doctor uses over-the-counter anti- inflammatory medications such as ibuprofen or whether it is prescription medication such as Celebrex, the doctor will have to individualize the treatment for that particular person. Oftentimes these anti-inflammatory medications help significantly.

One thing to remember is that anything that happens from the base of the bladder all the way out to the tip of the penis is felt as urethral, penile pain. So pain in the prostatic urethra is felt out towards the tip. A bladder stone can be felt as pain in the tip, a kidney stone passing can even be felt as pain in the tip of the penis. The fact that he is feeling pain along the urethra suggests that there's probably still some inflammation going on and if he continues to have this he should talk to his doctor to follow up.

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