My First Prostate Exam - Advice Please

[tomgreen]

I’m a 70 year old male recently retired to Thailand in good health and I exerciser daily , not over weight . I watch what I eat , and don’t drink much alcohol and I have never smoked. Since I arrived in Thailand I have started to notice that I have to get up may be two or three times every night to urinate and during the day time I have noticed that when I drink any liquids I seem to want to urinate quicker than in the past.

 

 

I have no other symptoms relating to bladder control.

 

I want to take a first ever test to see if there may be any indicators relating to having a possible prostate problem . I have looked through many comments here relating to prostate issues , but as this is going to be my first ever test , I’m still a bit confused . From what Ive seen reading other comments , the following may be the best way to proceed .

 

 

 

A. Get a blood test for PSA ( here I’m a bit confused between a Free PSA and a Total PSA ) and should I get two PSA blood tests from two different locations to compare the results ? .

 

B. Get a Digital Rectal Exam ( here I’m confused between Digital Rectal Exam / Manual prostate exam ).

 

C. Ultra sound scan .

 

 

Should I only proceed with a PSA blood test first or get all the tests done at one time ?

 

 

As this will be my first time taking any tests related to a possible prostate issue I am some what uneasy and stressed out , so any advice or suggestions as to the best way to proceed , would be very much appreciated

 

 

 

Thanks - Tom

 

[Sheryl]

You should get both a manual (digital) exam and a PSA. Digital and manual exam are the same thing. You need to see a good urologist as Dr experience is important. If you advise where in Thailand you are I will suggest where to go.

The doctor will order the blood test, perform the exam, and tevirw the test results. Based on all that he will do an ultrasound or order other tests if necessary, often they are not.

Virtually all men your age have some benign enlargement of the prostate (BPH) If the manual test finds and PSA are consistent with BPH you will be given medication.

Only if the manual exam findings and PSA level (the two things need to be reviewed in tandem) would other tests be needed.

Avoid ejaculation for at least 2 days before seeing the doctor, three if possible because ejaculation can slightly affect the result. The manual test should be done after the blood test, not before it, for same reason.



Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app

[Antonymous]

Around 70% of men your age have BPH, which is BENIGN and nothing to worry about as long as the symptoms you are experiencing do not impinge too much on your general wellbeing. There are drugs available to ease the symptoms, but be aware that they have side effects. There are alternatives that can ease the symptoms too. The most effective IMO is Beta Sitosterol. You can order this online from iHerb and one I recommend is 'Source Naturals, Mega Strength Beta Sitosterol 375mg'.

 

PSA testing is very controversial. It is also stressful. If your PSA is over 4.0 your urologist may recommend having a biopsy and that is even more stressful.

 

One thing to be aware of: an enlarged prostate will push up the PSA, but this does NOT automatically indicate cancer is present. A very large prostate (80cc plus) can push your PSA up above 6.0 for example with absolutely no malignancy present. So...if you have a PSA result over 4.0, I highly recommend that you ask for an ultrasound. Your urologist may not suggest it and is more likely to go straight to a biopsy. Ultrasound is cheap and easy and will show the size of your prostate and is far superior to a digital rectal exam for this purpose.

 

Another thing to be aware of is that IF your PSA is very high and the urologist insists on a biopsy, you can also elect for an MRI instead. An MRI is expensive, but the radiologists are experts at detecting if any cancer is present in the prostate from a single exam. Your urologist will be happier giving you endless repeat biopsies until he finds what he is looking for rather than sending you to another department for a single MRI, but remember, you are in control.

 

Good luck.

[Antonymous]

I recommend having a free-PSA along with the PSA. It is done from the same single blood sample and they must be done at the same time. You have to pay extra. The free-PSA level is another indication of whether the PSA result is benign or not. If the free-PSA figure is >25% of the total PSA figure, you are in the clear. this can be a great reassurance in cases where the total PSA is over 4.0.

[Lacessit]

I would recommend getting a PSA first. Then proceed further if necessary.

My urologist in Australia for the last 5 years has been saying I have a grossly enlarged prostate. My PSA is 1.9 on the most recent test. I have no urination problems, although alcohol consumption does increase my frequency.

Based on the experience of a couple of my friends, IMHO a biopsy should be a last resort, due to the damage risk.

[tomgreen]

54 minutes ago, Sheryl said:

You should get both a manual (digital) exam and a PSA. Digital and manual exam are the same thing. You need to see a good urologist as Dr experience is important. If you advise where in Thailand you are I will suggest where to go.

The doctor will order the blood test, perform the exam, and tevirw the test results. Based on all that he will do an ultrasound or order other tests if necessary, often they are not.

Virtually all men your age have some benign enlargement of the prostate (BPH) If the manual test finds and PSA are consistent with BPH you will be given medication.

Only if the manual exam findings and PSA level (the two things need to be reviewed in tandem) would other tests be needed.

Avoid ejaculation for at least 2 days before seeing the doctor, three if possible because ejaculation can slightly affect the result. The manual test should be done after the blood test, not before it, for same reason.



Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

 

 

Thank you , I am based in Pattaya City but in a few days I will be going to stay with an expat friend to assist with his new house building project . So then I will be staying in a village named Tha yiam yai which comes under the province of Nakhonratchasima . I should be there for around 2 – 3 months . So as I would like to get any tests as soon as possible a recommendation for that area would be most welcome. As a pensioner I know getting these test are of great importance but if possible I would prefer to stay away from establishments that may be overly expensive .

 

 

Tom

 

[tomgreen]

28 minutes ago, Antonymous said:

Around 70% of men your age have BPH, which is BENIGN and nothing to worry about as long as the symptoms you are experiencing do not impinge too much on your general wellbeing. There are drugs available to ease the symptoms, but be aware that they have side effects. There are alternatives that can ease the symptoms too. The most effective IMO is Beta Sitosterol. You can order this online from iHerb and one I recommend is 'Source Naturals, Mega Strength Beta Sitosterol 375mg'.

 

PSA testing is very controversial. It is also stressful. If your PSA is over 4.0 your urologist may recommend having a biopsy and that is even more stressful.

 

One thing to be aware of: an enlarged prostate will push up the PSA, but this does NOT automatically indicate cancer is present. A very large prostate (80cc plus) can push your PSA up above 6.0 for example with absolutely no malignancy present. So...if you have a PSA result over 4.0, I highly recommend that you ask for an ultrasound. Your urologist may not suggest it and is more likely to go straight to a biopsy. Ultrasound is cheap and easy and will show the size of your prostate and is far superior to a digital rectal exam for this purpose.

 

Another thing to be aware of is that IF your PSA is very high and the urologist insists on a biopsy, you can also elect for an MRI instead. An MRI is expensive, but the radiologists are experts at detecting if any cancer is present in the prostate from a single exam. Your urologist will be happier giving you endless repeat biopsies until he finds what he is looking for rather than sending you to another department for a single MRI, but remember, you are in control.

 

Good luck.

 

Thank you for your interesting comments and suggestions , it seems that this whole subject of male prostate problems can at times be a little overwhelming and daunting for some one like my self that is seeking their first ever test . Your second comment / recommendation about free-PSA along with the PSA done with the same blood test at the same time , is all so interesting and some thing to think about .

 

 

Tom

 

[tomgreen]

3 minutes ago, Lacessit said:

I would recommend getting a PSA first. Then proceed further if necessary.

My urologist in Australia for the last 5 years has been saying I have a grossly enlarged prostate. My PSA is 1.9 on the most recent test. I have no urination problems, although alcohol consumption does increase my frequency.

Based on the experience of a couple of my friends, IMHO a biopsy should be a last resort, due to the damage risk.

Thank you ,  I wondered about doing things step by step ,  you comment about your PSA blood test , did you have just a free-PSA or just the  PSA test ?

[Lacessit]

Just now, tomgreen said:

Thank you ,  I wondered about doing things step by step ,  you comment about your PSA blood test , did you have just a free-PSA or just the  PSA test ?

Total PSA. I don't take any medication for the BPH, don't think I need it.

[tomgreen]

Just now, Lacessit said:

Total PSA. I don't take any medication for the BPH, don't think I need it.

I was wondering if having 2 separate PSA tests at two different locations , so the results can be compared,  any thoughts on that ?

[Lacessit]

1 minute ago, tomgreen said:

I was wondering if having 2 separate PSA tests at two different locations , so the results can be compared,  any thoughts on that ?

There is a level of error in all tests. You may only end up confusing yourself.

The rate of increase is what doctors focus on. If the PSA is only increasing by 0.1 units per year ( as mine does ) there is no cause for concern.

[Antonymous]

5 minutes ago, tomgreen said:

I was wondering if having 2 separate PSA tests at two different locations , so the results can be compared,  any thoughts on that ?

Each lab will give slightly different results based on their equipment and methods.

 

What you should bear in mind is that PSA results have the most usefulness if you have a series of them over time. In which case you should choose a  lab that is convenient for you and use that every time.

 

By the way, you can usually get cheaper testing done at an independent lab than at a hospital. At the hospital you'll be charged not only more for the tests but also for a doctor visit. At a lab they will not usually be able to give you any advice on the result - this may or may not be important to you. Personally I avoid hospitals and always use a good lab for all my blood testing.

[jenny2017]

I was trying to ignore some similar symptoms that you've described in your OP but then went to see doctors, one of them a urologist, at the local hospital as it's free with the Thai Social security. But in addition to your problems, I had problems to urinate and finally decided to go for a check, fearing it was cancer. 

 

The first test was a urine and a blood test, done on the same day. Unfortunately, was medication given that had strange side effects. I stopped taking plenty of pills after two weeks. I couldn't get an erection anymore and after my online research, I decided that the medication was not indicated in my case. 

 

I had to come back after three weeks where the urine and blood test were repeated.

 

In the afternoon, I was told that the blood tests didn't show any cancer and a medication, called "Uroflow" was given for three months and I should see the urologist again after three months. 

 

Fortunately, I could stop taking the medicine as all went back to normal. The next check would be in one month. I had/have my niece and a good friend as "my online advisers", both are good doctors. 

 

  

 

[tomgreen]

1 hour ago, Antonymous said:

Each lab will give slightly different results based on their equipment and methods.

 

What you should bear in mind is that PSA results have the most usefulness if you have a series of them over time. In which case you should choose a  lab that is convenient for you and use that every time.

 

By the way, you can usually get cheaper testing done at an independent lab than at a hospital. At the hospital you'll be charged not only more for the tests but also for a doctor visit. At a lab they will not usually be able to give you any advice on the result - this may or may not be important to you. Personally I avoid hospitals and always use a good lab for all my blood testing.

The local lab for convenience is some thing to think about .

[tomgreen]

19 minutes ago, jenny2017 said:

I was trying to ignore some similar symptoms that you've described in your OP but then went to see doctors, one of them a urologist, at the local hospital as it's free with the Thai Social security. But in addition to your problems, I had problems to urinate and finally decided to go for a check, fearing it was cancer. 

 

The first test was a urine and a blood test, done on the same day. Unfortunately, was medication given that had strange side effects. I stopped taking plenty of pills after two weeks. I couldn't get an erection anymore and after my online research, I decided that the medication was not indicated in my case. 

 

I had to come back after three weeks where the urine and blood test were repeated.

 

In the afternoon, I was told that the blood tests didn't show any cancer and a medication, called "Uroflow" was given for three months and I should see the urologist again after three months. 

 

Fortunately, I could stop taking the medicine as all went back to normal. The next check would be in one month. I had/have my niece and a good friend as "my online advisers", both are good doctors. 

 

  

 

Thanks , the part where you say

 

‘’ In the afternoon, I was told that the blood tests didn't show any cancer ‘’

 

is interesting to note that a blood test can show signs of cancer .

 

The urine test part is all so interesting and some thing Ive not seen mentioned so far , so may be along with having a blood test for PSA , a urine test may be of benefit is some way ?

 

 

Tom

 

 

 

 

 

 

[jenny2017]

6 minutes ago, tomgreen said:

 

Thanks , the part where you say

 

‘’ In the afternoon, I was told that the blood tests didn't show any cancer ‘’

 

is interesting to note that a blood test can show signs of cancer .

 

The urine test part is all so interesting and some thing Ive not seen mentioned so far , so may be along with having a blood test for PSA , a urine test may be of benefit is some way ?

 

 

Tom

 

 

 

 

 

 

Hi Tom,

 

    I think it's important to mention that I feel okay again, all is fine and I've stopped taking the one tablet of "Uroflow" in the evening.

 

   I've got no idea how the urologist could come to his decision, here's a great article on the topic:

 

• Urine and blood tests may be done to check the function of your kidneys, to exclude a urine infection and to check there is no blood in the urine.
• https://patient.info/health/prostate-and-urethra-problems/prostate-gland-enlargement

 

 

[Antonymous]

9 minutes ago, tomgreen said:

 

Thanks , the part where you say

 

‘’ In the afternoon, I was told that the blood tests didn't show any cancer ‘’

 

is interesting to note that a blood test can show signs of cancer .

 

The urine test part is all so interesting and some thing Ive not seen mentioned so far , so may be along with having a blood test for PSA , a urine test may be of benefit is some way ?

 

 

Tom

 

 

 

 

 

 

If you are going to a lab to get a blood test, you can also ask for a urinalysis. It usually costs 100-200 baht and will tell you some useful things about your kidney function. No harm done.

 

Where urine tests are appropriate for peeing problems are if you have a UTI or prostatitis. A sign of UTI is that you would feel a stinging sensation (that can become really painful) when you pee. If you collect a sample in a clear glass you are likely to see it is cloudy with small white particles in it. In this case a urine culture is advised to determine the type of infection. Antibiotics for a few days usually clear that up promptly.

 

A UTI will definitely elevate your PSA considerably. To about 10.0 or higher is common. And that high number can remain for six months after the infection. I know, as this happened to me once.

 

Prostatitis can cause weak urine flow and also causes high PSA, but in some cases is non-specific and not as easy to detect. However a urine sample is usually the first test to see if it is present (such as trace blood in the urine would be an indication).

[tomgreen]

5 minutes ago, jenny2017 said:

Hi Tom,

 

    I think it's important to mention that I feel okay again, all is fine and I've stopped taking the one tablet of "Uroflow" in the evening.

 

   I've got no idea how the urologist could come to his decision, here's a great article on the topic:

 

• Urine and blood tests may be done to check the function of your kidneys, to exclude a urine infection and to check there is no blood in the urine.
• https://patient.info/health/prostate-and-urethra-problems/prostate-gland-enlargement

 

 

Hi and thanks for the article link ,  its good to hear that you are again feeling fine .  I will post back how things eventually go and I have my fingers firmly crossed .

 

I do try and take care to watch what I eat and drink , but the thought has now crossed my mind about trying to improve and lessen the possibilities of having a prostate problem by trying to eat certain foods or vitamins or leaving out certain foods ?

 

Tom

[jenny2017]

2 minutes ago, tomgreen said:

Hi and thanks for the article link ,  its good to hear that you are again feeling fine .  I will post back how things eventually go and I have my fingers firmly crossed .

 

I do try and take care to watch what I eat and drink , but the thought has now crossed my mind about trying to improve and lessen the possibilities of having a prostate problem by trying to eat certain foods or vitamins or leaving out certain foods ?

 

Tom

The Thais have an expression that "thinking too much", isn't really a good move. Of course is a good nutrition important, as well as some exercises. Sex is one of the most efficient ones. 

 

  When I look back, it seems that exactly this lack of exercises and perhaps my constantly dehydrated body could have easily been the cause of my problems.

 

Just don't see going to the toilet a few times at night as a problem. So more negative you think, so less happy you finally are.

 

Eat some healthy food, fruits, and veggies, drink enough fluids, have as much good sex as possible, and don't forget to laugh a lot. It helps a lot. Have a good one. 

[NanLaew]

15 hours ago, tomgreen said:

Since I arrived in Thailand I have started to notice that I have to get up may be two or three times every night to urinate and during the day time I have noticed that when I drink any liquids I seem to want to urinate quicker than in the past.

Maybe get a fasting blood glucose or blood sugar test? More frequent urination, day and night can indicate early onset diabetes and is totally unrelated to prostate health. AFAIK, early prostate problems are sometimes indicated by slow urination, feeling one hasn't finished pissing although nothing is coming out sometimes accompanied by leakage after finishing a midnight piss and getting back in bed or wetting yourself a little bit after a piss in the daytime.

[tomgreen]

9 minutes ago, Antonymous said:

If you are going to a lab to get a blood test, you can also ask for a urinalysis. It usually costs 100-200 baht and will tell you some useful things about your kidney function. No harm done.

 

Where urine tests are appropriate for peeing problems are if you have a UTI or prostatitis. A sign of UTI is that you would feel a stinging sensation (that can become really painful) when you pee. If you collect a sample in a clear glass you are likely to see it is cloudy with small white particles in it. In this case a urine culture is advised to determine the type of infection. Antibiotics for a few days usually clear that up promptly.

 

A UTI will definitely elevate your PSA considerably. To about 10.0 or higher is common. And that high number can remain for six months after the infection. I know, as this happened to me once.

 

Prostatitis can cause weak urine flow and also causes high PSA, but in some cases is non-specific and not as easy to detect. However a urine sample is usually the first test to see if it is present (such as trace blood in the urine would be an indication).

Thanks again , currently my only symptoms are having to get up more frequently during the night to urinate and in the day time when I drink any liquids , I seem to feel the need to urinate soon after which in the past I never felt the need to do  , I have no feeling of pain while urinating , or any weak flow problems. I think that for any new blood test I have done I may as well included other available tests .

[tomgreen]

4 minutes ago, jenny2017 said:

The Thais have an expression that "thinking too much", isn't really a good move. Of course is a good nutrition important, as well as some exercises. Sex is one of the most efficient ones. 

 

  When I look back, it seems that exactly this lack of exercises and perhaps my constantly dehydrated body could have easily been the cause of my problems.

 

Just don't see going to the toilet a few times at night as a problem. So more negative you think, so less happy you finally are.

 

Eat some healthy food, fruits, and veggies, drink enough fluids, have as much good sex as possible, and don't forget to laugh a lot. It helps a lot. Have a good one. 

Ive all ways been a continual worrier which seems to be taking more of a hold the older I become ,  having said that I'm not the sort to do nothing and then be told , I told you so .  Thanks for the sound advice , its some thing I really need to think about .

 

Tom 

[Jip99]

3 hours ago, Sheryl said:

You should get both a manual (digital) exam and a PSA. Digital and manual exam are the same thing. You need to see a good urologist as Dr experience is important. If you advise where in Thailand you are I will suggest where to go.

The doctor will order the blood test, perform the exam, and tevirw the test results. Based on all that he will do an ultrasound or order other tests if necessary, often they are not.

Virtually all men your age have some benign enlargement of the prostate (BPH) If the manual test finds and PSA are consistent with BPH you will be given medication.

Only if the manual exam findings and PSA level (the two things need to be reviewed in tandem) would other tests be needed.

Avoid ejaculation for at least 2 days before seeing the doctor, three if possible because ejaculation can slightly affect the result. The manual test should be done after the blood test, not before it, for same reason.



Sent from my SM-J701F using Thailand Forum - Thaivisa mobile app
 

 

 

This is also on my list of jobs to do.

 

 

Sheryl, I am Buriram based but Surin, Korat and Pattaya are all in striking distance. I would appreciate your suggestions. Thank you.

[tomgreen]

9 minutes ago, NanLaew said:

Maybe get a fasting blood glucose or blood sugar test? More frequent urination, day and night can indicate early onset diabetes and is totally unrelated to prostate health. AFAIK, early prostate problems are sometimes indicated by slow urination, feeling one hasn't finished pissing although nothing is coming out sometimes accompanied by leakage after finishing a midnight piss and getting back in bed or wetting yourself a little bit after a piss in the daytime.

Thats a valid point , and some thing that never crossed my mind , now I'm worrying about diabetes ,  sounds a blood test is urgently needed that includes more tests than just the PSA . 

[simple1]

OP have you checked to see if diabetes is a cause for your symptoms? A few years back I had a PSA blood test so have a good idea of what you're going through right now. Unless you have already done research via your home country Prostate Cancer advisory site, have a look at:

 

http://www.prostate.org.au/

 

.

Edited June 30, 2018 by simple1

[tomgreen]

2 minutes ago, Jip99 said:

 

 

This is also on my list of jobs to do.

 

 

Sheryl, I am Buriram based but Surin, Korat and Pattaya are all in striking distance. I would appreciate your suggestions. Thank you.

I would be interested to hear how you eventually get on  , thanks - Tom 

[tomgreen]

1 minute ago, simple1 said:

OP have you checked to see if diabetes is a cause for your symptoms? A few years back I had a PSA blood test so have a good idea of what you're going through right now. Unless you have already done research via your home country Prostate Cancer advisory site, have a look at:

 

http://www.prostate.org.au/

 

.

Many thanks for the info , I'm going to take a look right away .

 

Tom

[bkk6060]

I have BPH and get up to pee 5 times a night.  I took the medication and it caused erectile dysfunction so I threw it in the trash.  My PSA is under 2.

I would get all the tests you mentioned.

Edited June 30, 2018 by bkk6060

[JimmyJ]

"Routine PSA Tests No Longer Recommended - American Urological Association"

"https://www.medicalnewstoday.com/articles/260087.php"

 

"Guys: You Don't Want That PSA Test For Prostate Cancer"

https://www.forbes.com/sites/stevensalzberg/2017/04/03/guys-you-dont-want-that-psa-test-for-prostate-cancer/2/#7dcf5852308b

 

If you do get it, I've read an opinion that not having an orgasm for a few weeks prior will give a lower (and more accurate) reading.

In general from what I've read, the PSA count definitely can vary based on a variety of factors.

 

Also, as someone mentioned, if it does lead to a suggestion that you get a biopsy, the biopsy is stressful and has some danger.

 

 

[bkk6060]

1 minute ago, JimmyJ said:

"Routine PSA Tests No Longer Recommended - American Urological Association"

"https://www.medicalnewstoday.com/articles/260087.php"

 

"Guys: You Don't Want That PSA Test For Prostate Cancer"

https://www.forbes.com/sites/stevensalzberg/2017/04/03/guys-you-dont-want-that-psa-test-for-prostate-cancer/2/#7dcf5852308b

 

If you do get it, I've read an opinion that not having an orgasm for a few weeks prior will give a lower (and more accurate) reading.

In general from what I've read, the PSA count definitely can vary based on a variety of factors.

 

Also, as someone mentioned, if it does lead to a suggestion that you get a biopsy, the biopsy is stressful and has some danger.

 

 

Booze, sitting, dehydration, ejaculations, and probably stress can affect the test.