Prostate Health (cont.)
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.
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.
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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