Navigating Prostate Health: My Experience

Following up on my suggestion to share health experiences (read here), I will, in this post, discuss prostate health and intertwine it with my experience.

The prostate, positioned under the male urinary bladder, secretes a fluid that enhances sperm’s viability and facilitates its movement.

The top part of the urethra, the tube that drains urine from the bladder, passes through the prostate. Given this fused structure, prostatic inflammation or enlargement impacts urinary health.

There are three notable prostate problems: prostatitis, benign prostatic hyperplasia (BPH), and prostate cancer. I have experienced the first two and am vigilant about the third.

Prostatitis

Prostatitis, characterized by prostate inflammation, can be bacterial or non-bacterial.

Non-bacterial prostatitis has no identifiable cause, much like essential hypertension, where high blood pressure is not directly related to a specific medical condition but to diet, stress, and the like.

Prostatitis can occur at any age in adulthood. I started experiencing pelvic floor discomfort in my early 30s.

After bladder and prostate function tests, including the digital (as in finger) rectal exam (DRE) and prostate-specific antigen (PSA) test, revealed no abnormalities, I was diagnosed with chronic non-bacterial prostatitis.

Rather than taking discomfort-relieving medicines, I became mindful of my sensitive prostate and adapted to living with it.

BPH

BPH, the enlargement, as opposed to inflammation, of the prostate, is caused by hormonal changes as men age. The onset and severity of BPH vary among individuals.

An enlarged prostate can compress the bladder and constrict the prostatic urethra, impairing urinary function. But not for everyone.

Some men with enlarged prostates do not experience urinary discomfort because of the specific pattern of their prostate enlargement (see notes). But most do, and they must address the problem.

Overlapping Symptoms:  I first experienced prostate-related urinary symptoms in my late 50s for which I consulted a urologist.

Prostatitis, BPH, and prostate cancer have overlapping symptoms. Accordingly, an initial prostatic evaluation is often open-ended and includes DRE and PSA.

DRE: Based on a DRE, my urologist did not suspect enlargement or cancer.

The DRE, however, has significant limitations because the examiner can feel only the back of the prostate that borders the rectum.

Gauging enlargement based on feeling a part of the prostate is imprecise and depends on the examiner’s tactile ability. Likewise, the examiner can potentially miss slow-growing cancers in other parts of the prostate (A non-cancerous prostate feels rubbery; a cancerous one feels hard/bumpy).

PSA: A blood test for PSA, a protein produced by prostate cells, is more informative than DRE and complements it.

Elevated PSA levels can indicate prostate enlargement, and potentially prostate cancer. However, PSA levels also temporarily spike with sexual activity, physical exercise, and prostate-related procedures.

While normal PSA levels vary by age, physicians commonly consider a blood PSA below 4.0 ng/ML normal.

My PSA level of 1.8, well within the normal range, contradicted my symptoms.

Cystoscopy: To resolve the contradiction, I underwent a cystoscopy, in which the urologist inserts a thin tube with a lens through the urethra to view the bladder and prostate.

Unlike the DRE and PSA, the cystoscopy showed a significantly enlarged prostate.

PSA Spike: Two months later, my PSA level doubled to 3.6 at a follow-up visit!

Not only the absolute PSA level but also its rate of change matters. An increase greater than 0.75 per year is worrisome. My spike of 1.8 was alarming!

However, a single PSA reading can be deceptive and requires follow-up.

MRI: The PSA spike prompted an MRI evaluation, which thankfully did not show cancerous growth and provided a baseline measure of my prostate size.

The follow-up PSA level dropped from 3.6 to 2.2.

PSA Spike Puzzle: I suspect the culprit was the cystoscopy. A cystoscopy affects PSA levels for at most six weeks. I had the PSA test more than eight weeks later. But because my prostate is sensitive, the six-week norm might not apply.

PSA Test Tips: To ensure a valid PSA reading, avoid sex and vigorous physical exercise, especially biking, for a couple of days prior. Get a PSA test before and not after a DRE.

To ensure consistency in tracking PSA levels, schedule testing during the same part (morning/afternoon) of the day with the same laboratory.

BPH Medications: Two types of BPH medications are available. One type eases urinary symptoms by relaxing the bladder and prostate muscles. This medication type has three subtypes with somewhat different side effects. Through trial and error, I have identified the one that works best for me.

The other type shrinks the prostate. There is some evidence that these drugs lower the risk of low-grade prostate cancer but increase the risk of high-grade cancer. Additionally, these drugs lower PSA levels, complicating early detection of cancer in some cases (see notes). So, I am somewhat wary.

A desirable side effect of the prostate-shrinking generic drug finasteride is that it prevents hair loss and promotes hair growth. The same drug at a lower strength is marketed as the hair growth drug Propecia (read my blog post about hair here).

Lifestyle Changes: I limit fluid intake in the evening, avoid diuretic foods, fluids, and bladder-aggravating medications, and make sure not to have an overfull bladder, which can cause bladder and kidney complications. Occasionally, I try to practice pelvic floor strengthening exercises

BPH Interventional Procedures: My urologist recommends these procedures only if medications fail to relieve symptoms. These procedures include surgically removing excess prostate tissue, shrinking the prostate with laser or steam, and inserting implants to open up the urethra.

Prostate Cancer

Prostate cancer, the most common cancer among men, is often asymptomatic in its early stages. Regular screening saves lives (see notes). It can detect prostate cancer early when effective and less invasive treatment options are viable.

While research, with some exceptions, suggests that chronic prostatitis and BPH don’t increase the risk of prostate cancer, I assume otherwise and remain proactive.

In conclusion, my prostate health experience has been insightful for me. By sharing my experience, I hope to benefit others.

If you are a middle-aged or older male, be prostate-smart. Stay informed. Stay vigilant. Stay healthy.

Disclaimer

I am not a medical professional and this post is not medical advice.

Notes

“Chronic” prostatitis refers to recurring prostatic inflammation.

The hormonal change causing BPH is the production of dihydrotestosterone, a derivative of testosterone.

Common BPH symptoms are what one would expect with a constricted urethra. It is difficult to start urinating, the urine stream is weak, it is hard to empty the bladder completely, and so on.

The prostate is donut-shaped with the urethra passing through the donut hole. If the prostate enlargement is such that the “hole” through which the prosthetic urethra passes also enlarges, the urethra does not constrict, and the individual is symptomless.

Midway, I ditched my urologist. He should have ordered an MRI instead of performing a cystoscopy. I was also concerned that he recommended an interventional procedure at the outset of my BPH diagnosis; my current nationally renowned urologist ordered an MRI and did not recommend any intervention.

An elevated PSA reading does not necessarily indicate cancer and a low level does not guarantee the absence of cancer. And because normal PSA levels vary with age, size of the enlarged prostate, race, and more, there are some interpretation hiccups.

According to an emerging perspective, regular prostate cancer screening, of which PSA testing is the main element, contributes to overdiagnosis and overtreatment.

Prostate-shrinking medications lower PSA levels. To compensate, doctors must scale the PSA level by a standard factor. Sometimes, there’s an oversight in recalibrating the PSA level.

Supplements to relieve BPH symptoms abound but with limited supporting evidence. While some people find relief, I have had no such luck.

Our knowledge of many aspects of prostate care is fluid and evolving. For instance, the current understanding of whether and how prostate-shrinking medications and procedures affect the risk of prostate cancer might be reinforced or refuted in the future.