Ask The Urologist Anything (Dr Michael Rotman)

[BryanW]

Dr. Rotman,

About how long after a prostate biopsy before PSA results would be considered meaningful (i.e., not affected by the biopsy)? Thank you for your help.

thanks,

Bryan

 

[DrRotman]

6 weeks is generally safe

 

[jsr0367]

Dr Rotman-
I am a distance cyclist that puts on 60-100 miles a week.

Have you heard of any evidence of a link between bicycling and prostate cancer?

 

[DrRotman]

No, I have not heard of any link.

 

[Nelson Vergel]

Hello Dr Rotman

Do you have any comments about this paper? Any insights for lay people? Thanks

Prostate Cancer: Can Biomarkers Make a Treatment Difference?

 

[Traderj]

Dr. Rotman,

I have a question about BPH. I am 57 very healthy and active, and I have been on Clomid for about a year. It has raised my testosterone and I have had no side effects. I see my Urologist regularly. But in the last year, I noticed a decrease in urine flow and more frequent urination.

I had a prostate exam last year and there were no mentions of any problems. I do not have any sexual or erection problems and I am on no other prescription meds.

I understand BPH is standard for someone my age but it is starting to become a problem. I am also afraid of some of the prescription solutions such as Flowmax, and they can have adverse side effects.

Nelson talked on here recently about a laser surgery that worked very well for him. However, he now has retrograde ejaculations. Evidently, the surgeon made a mistake. But he did say urination is not a problem anymore. But I would be concerned about someone making a mistake with me. Nelson, please jump in here if I got something wrong.

Could you please talk a little about what the options are to correct this problem? I noticed you mentioned several other options earlier in this thread.

Thanks

 

[jsr0367]

Recent blood work from yesterday has my PSA back to 3.59 which is where I have been for years..even on TRT. My Estradiol is 12. Off TRT for 4 weeks. My % FREE PSA is at 2.5 now....even lower.

 

[Nelson Vergel]

Dr. Rotman,

I have a question about BPH. I am 57 very healthy and active, and I have been on Clomid for about a year. It has raised my testosterone and I have had no side effects. I see my Urologist regularly. But in the last year, I noticed a decrease in urine flow and more frequent urination.

I had a prostate exam last year and there were no mentions of any problems. I do not have any sexual or erection problems and I am on no other prescription meds.

I understand BPH is standard for someone my age but it is starting to become a problem. I am also afraid of some of the prescription solutions such as Flowmax, and they can have adverse side effects.

Nelson talked on here recently about a laser surgery that worked very well for him. However, he now has retrograde ejaculations. Evidently, the surgeon made a mistake. But he did say urination is not a problem anymore. But I would be concerned about someone making a mistake with me. Nelson, please jump in here if I got something wrong.

Could you please talk a little about what the options are to correct this problem? I noticed you mentioned several other options earlier in this thread.

Thanks

Did you get an ultrasound test done of your urethra and prostate area?

 

[Nelson Vergel]

jsr0367

You could save people and the doctor time by giving us a background of your issue and treatment protocol so that we do not have to scroll back to find it. Thanks

 

[Traderj]

Did you get an ultrasound test done of your urethra and prostate area?

Nelson,

No I havent. I take it that is the next step?

 

[Nelson Vergel]

That is after I found out I can calcium deposits in my urethra. My prostate was smaller than normal and very low PSA.

 

[DrRotman]

Hi Traderj,

The treatment options do depend on the size of your prostate on transrectal ultrasound and what a flexible cystoscopy will show. If however you are a candidate, the new procedure called Rezum is a great option to avoid retrograde ejaculation and get off your bph medications.

 

[DrRotman]

Hi Nelson,

The PSA 4K test which is mentioned here does play a large role in my decision making process on when to recommend a prostate biopsy for a patient with an elevated PSA. It has been studied and validated. The GPS aka Oncotype DX test is used to better predict how a patients prostate cancer may behave in the future and guide the treatment choice. These are the two most used tests today.

 

[Traderj]

Thanks Doctor Rotman. I will make an appointment today. I checked out the stuff on the web. It looks very promising. Two questions. How long is the procedure been out and is it safe?

Also is the retrograde ejaculation a common problem with laser treatment?

Thanks,

 

[DrRotman]

It has been performed in US for over 2 years, very safe and effective. Any removal of prostate tissue at bladder neck predisposes one to retrograde ejaculation.

 

[Nelson Vergel]

Hi Nelson,

The PSA 4K test which is mentioned here does play a large role in my decision making process on when to recommend a prostate biopsy for a patient with an elevated PSA. It has been studied and validated. The GPS aka Oncotype DX test is used to better predict how a patients prostate cancer may behave in the future and guide the treatment choice. These are the two most used tests today.

I think I should offer them on DiscountedLabs.com. Thank you!

 

[CoastWatcher]

I think I should offer them on DiscountedLabs.com. Thank you!

If you can work out a reasonable price, that would be great.

 

[Nelson Vergel]

Hello Dr Rotman

I seem to have all the symptoms of Interstitial cystitis. Lower abdominal pain and referred pain down to my lower back and anus. Third occurrence. Previous two seemed to have responded to minocycline bid for 14 days.

I have retrograde ejaculation caused by a green laser procedure to remove calcium deposits from my urethra over 10 years ago. Can that be causing this issue?

I do not have urgency to urinate but I am now getting up once per night to pee. I void reasonably well. No pain while urinating or having an orgasm. No fever.

The main complaint is the abdominal (and lower back) pain that feels like my IBS has flared up (or at least what I used to think was IBS).

I am going for an urology work-up but wanted to pick your brain first. Thank you.

 

[DrRotman]

Hi Nelson, this is a situation I encounter quite frequently in my urban practice. I have sat in on many lectures dealing with chronic pelvic pain syndrome which encompasses much of what you are describing to me. The antibiotics frequently help the patients initially because they have anti-inflammatory properties and thus act like ibuprofen but symptoms return on stopping the meds.

The pain and situation you are describing to me, I treat with pelvic floor therapy. The pain isn’t originating from the prostate or bladder but is likely neurological in nature. I use a sports medicine specialist who utilizes trigger point therapy and pelvic floor therapy/exercise to analyze and treat the pain. This has been extremely successful and is the proper way to treat this situation after urological disorders such as BPH, urinary infection, etc have been ruled out by the urologist . My patients have been very grateful lately to find someone who is helping them. I personally used him as well after a snowmobile mishap which caused a C5-C6 radiculopathy which he was able to diagnose and treat. So in short, I would seek out a pelvic floor therapist, preferably an MD who can do a bit more than a non MD. Hope this helps

 

[Nelson Vergel]

Thanks a lot, Doc!

I will look for one in Houston today.

What have you heard about Pentosan and bladder distension as other options?