As men age, we commonly find that our urinary habits change slowly over time. In fact, the change is usually insidious because it occurs very slowly, and we then accommodate accordingly.

We go to the doctor and the standard question is asked – “do you have any problems urinating”? Well, most men will say, “no, I do not”. The problem is that men overlook the fact that urinating more frequently during the day and night and having less time to get to the rest room are in fact “problems” urinating. These are also among the most common complaints middle aged and older men will discuss with their family physicians.

So why do men get these problems?
Though it is not completely understood, we have learned through research that benign enlargement (BPE) of a man’s prostate creates bladder changes and responses, resulting in the obstruction of urinary flow, given that men urinate through the prostate. Many men will have concerns that this may indicate cancer when the fact it does not. Again, the vast majority of men have these symptoms due to BPE.

So how do we know that there is no cancer underlying the symptoms? Two commonly used tools are available. The first is the age-old physical exam – in this case, the digital rectal exam. This is akin to what can be thought of as a male ‘Pap Smear,’ an annual test with the family physician or urologist to feel the backside of the prostate using the physician’s gloved index finger in the rectum. Although not pleasant – for either patient or physician – the exam is quick, relatively risk free, and of great utility in establishing whether that the part of the prostate that harbors the most prostate cancers and the most aggressive cancers feels normal.

A little more than 25 years ago, another tool was adopted into medical practice – that of a simple blood test that measures the amount of prostatic specific antigen (PSA) in the blood stream. Since PSA has been used in clinical practice, the number of annual deaths from prostate cancer have decreased significantly. Fewer men now go on to develop prostate cancer in the bones with associated pain and deterioration leading to death.

That said, many men have undergone treatment for prostate cancer over these same years, many of whom likely did not need treatment. We have learned that most men do not need treatment. It is not an exact science to determine who does and who does not need treatment. We do know one thing for sure: urologists and other doctors today are better educated and have more knowledge in determining who needs treatment. Many substantive advances in both the understanding and treatment for all prostate conditions have been introduced in the last two decades. Further, even the tried and tested treatments of old have undergone important evolutions improving both safety and effectiveness.

Talking to your doctor about any complaints or changes provides the opportunity to help you with troubling symptoms as well as avoid surprises down the road.

Mark Plante, MD, FRCS(C), FACS, is division chief of Urology at the University of Vermont Medical Center. 

Mark Plante, is division chief of Urology at the University of Vermont Medical Center.

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