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Archived 3-4-2008 Q: I am a 47 year old male. When should I start having my prostate checked? -  J.L. Dr. Kranc: If you are Caucasian and over 50, you need to have an annual prostate exam. If you have a family history of prostate cancer in a direct relative such as a father, brother or uncle, you should be checked when you are 40. For African American males, an annual prostate exam should be done beginning at age 40. If there is a family history of prostate cancer, those individuals should begin having exams at age 30. Q: What is a PSA? -  S.S. Dr. Kranc: PSA stands for Prostate Specific Antigen, a simple blood test. It is a screening tool used to help diagnose prostate cancer. The PSA test has been used as a screening tool for over 20 years. Unfortunately, it is not specific for prostate cancer as it is made by both normal and cancerous prostate cells. Because it is not specific, physicians have tried to interpret the PSA value in different ways to help them diagnose prostate cancer. It seems one of the best ways to use the PSA data is to measure the velocity, how rapidly the PSA level rises over a set amount of time. If the PSA level rises too rapidly, those individuals should have a prostate biopsy. Q: I leak urine when I sneeze or cough. Why? -  J.W. Dr. Kranc: There are two types of incontinence - stress and urge. Stress incontinence is the loss of urine with laughing, coughing, sneezing or exercise. It occurs from the aging process, childbirth or pelvic surgery. The bladder "falls" because of pressure in the abdomen, causing the urine to leak out. Urge incontinence is an overwhelming urge to urinate. Sometimes there is an uncontrollable leak of urine. This is caused from either infection or inflammation of the bladder. Stress incontinence may be treated with a surgical procedure to lift the bladder back up into it's normal position. Urge incontinence is treated with medication. Some people have only one type of incontinence, others may have both.

Q:   After 4 children, my wife is insisting that I have a vasectomy. I heard that a vasectomy could cause prostate problems later on in life. Is this so? Are there any health issues that could arise from having a vasectomy at the age of 36? Dr. Kranc: There is no cause for concern about having a vasectomy at your age. There were several articles published about 15 years ago which stated that men, especially those under 40, had a greater chance of developing prostate cancer after having a vasectomy later in life. The most current published data show no correlation between having a vasectomy and developing prostate cancer. Q:    I am a 23 year old male who is pretty healthy. 3 weeks ago I noticed an occasional pulsating sensation in what seems to be my right testicle. Recently I've also felt it on the left at times. About 4 days ago, I began feeling a slight burning in the tip of my penis. Could I possibly have prostatitis? How do I find out if it is an infection or just inflammation? Do any of my symptoms or activities point to one more than the other? Is it okay to begin taking antibiotics without being sure I have an infection? Dr. Kranc: Prostatitis is irritation of the prostate gland due to either an infection or inflammation. The chance of your having prostatitis is low unless you either jog or bike on a regular basis. Both of these activities can cause inflammation of the prostate. Treatment typically involves drinking plenty of water, urinating regularly and taking over the counter pain relievers if needed. A prostate infection is diagnosed by having a urinalysis and urine culture performed at your doctor’s office. Please note - No one should take antibiotics without having a documented infection. Taking antibiotics without having a confirmed infection may cause any number of problems from incorrect or incomplete treatment to fostering drug resistant bacteria. The burning sensation you are experiencing may be an inflammatory response to something in your diet. Food items that could produce such symptoms include alcohol, spicy foods or carbonated beverages. Q:  What is a neurogenic bladder? Dr. Kranc: A neurogenic bladder may be classified in 2 ways: hypotonic, also called minimally functioning or hypertonic, also called an irritated bladder. An irritated bladder is a result of either an infection, inflammation or other process that makes the bladder want to empty with minimal or no urine in it. This occurs in individuals with Parkinson ’s disease, a stroke, Multiple Sclerosis and certain other neurologic conditions. The person feels that he always has to go to the bathroom. Once any infectious or cancerous conditions are ruled out, the patient is started on anticholinergic medications. These medications relax the bladder and relieve the symptoms of urgency and frequency. A hypotonic bladder is a bladder that does not respond to the natural stimulus to empty. This occurs in diabetics and/or individuals with spinal cord tumors, spinal trauma and long term outlet obstruction from the prostate. These patients usually have no sensation that their bladder is full and are unable to completely empty their bladders. Both men and women may take medications such as alpha blockers to treat their symptoms. These medications open the bladder neck in both men and women and also open the prostate in men, thus allowing them to empty better. However, if a person can not empty well and the residual volume of urine remaining in the bladder is high, these individuals must learn to catheterize themselves several times per day to completely empty the bladder and avoid any long term complications. There is no specific medication that helps a personwith a hypotonic neurogenic bladder empty completely. In our area patients who have uncontrolled or poorly controlled diabetes frequently have problems with a hypotonic bladder. Diabetes interferes with the nerve function to the bladder which would give one the “full bladder” sensation. It eventually interferes with the nerves that tell the bladder to empty fully. The best way to prevent this complication is to properly manage one’s diabetes.