Valentine’s Gift…A Prostate Exam? What ever happened to flowers and candy?

Did you know that a woman’s favorite color rose is not red? Hmmmmmmmm?

Prostate Diaries

This will probably be TMI  (too much information) but I think  it will make a point nicely. When I was a urology resident in 1983, my wife was pregnant with our second child Bess. As a medical student, I had done a rotation in Savannah, Ga in obstetrics. I must have delivered about twenty babies and checked hundreds of women at various stages of pregnancy. One of the things you are taught is to determine how close a women is to delivery after the patient’s water breaks. What you do is a mini-pelvic exam to see how  far apart the cervix has spread. No spreading means that the birth is not imminent. If the cervix is 10 centimeters and thin, then birth is very close. You place two finger in the vagina, find the cervix, spread your fingers to the width of the opening then estimate the distance. I had done it hundreds…

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Masturbation and tomatoes

I have even canned tomatoes !

Prostate Diaries

Masturbation ‘cuts cancer risk’
Men could reduce their risk of developing prostate cancer through regular masturbation, researchers suggest. They say cancer-causing chemicals could build up in the prostate if men do not ejaculate regularly.

And they say sexual intercourse may not have the same protective effect because of the possibility of contracting a sexually transmitted infection, which could increase men’s cancer risk.

Australian researchers questioned over 1,000 men who had developed prostate cancer and 1,250 who had not about their sexual habits.

This is a plausible theory
Dr Chris Hiley, Prostate Cancer Charity
They found those who had ejaculated the most between the ages of 20 and 50 were the least likely to develop the cancer.The protective effect was greatest while the men were in their 20s.

Men who ejaculated more than five times a week were a third less likely to develop prostate cancer later in life.



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watch out dr oz and live rectal exams…live prostate biopsies on patients doing impersonations. Which do you like the best? Please comment.

Talk about a calm biopsy!

Prostate Diaries

A couple of days ago, on a most interesting patient, I performed a prostate biopsy. As we got started it came up that he enjoyed doing impersonations, ” I particularly like doing Australians,” he said. As I was performing the prostate block and with the patient now on his left side I say,” Do some if you don’t mind.” He had taken a pain pill and a sedative I had given him before the procedure and with the addition of the prostate block he was having very little discomfort. At this point he does Russians, Australians, Roger Moore, and all sorts of neat snippets of movie and cartoon characters. ” I think the favorite of the girls I work with is a baby crying,” he said and then proceeds to do that to perfection. It was perfect and the pitch so high it was hard to imagine how he did…

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Prostate cancer question: Describe significant PSA pre and post prostatectomy,nanoknife,proton beam,HIFU,radiation therapy.

True friends you can count on one hand.

Prostate Diaries

This was a comment/question a few days ago….this issue is confusing  but I think I can simplify it-here goes.

  • The ongoing debate about the PSA has to do with pretreatment decision-making. The PSA is often times elevated before the diagnosis of prostate cancer is made for many reasons other than prostate cancer. So some want to “throw the baby out with the bath water.” If you come into my office and you are referred to me for an elevated PSA (anything higher than 4) a couple of things could happen. I might repeat it, I might give an antibiotic and repeat the PSA several weeks later, or if on rectal exam there is an abnormality-I would recommend a biopsy then without repeating the PSA (the rectal exam trumps the PSA if the prostate feels abnormal.)
  • If the PSA is elevated pre diagnosis (by this I mean at this point we don’t…

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For humor to be effective there must be an element of truth. That the family guy “prostate” episodes are funny shows that men in general would rather not have the prostate exam. This “rectal refusal syndrom” plays a role in delaying the diagnosis of prostate cancer.

A physician must have a ready wit. A dour attitude is offensive to the well and sick alike!

Prostate Diaries

Family guy sues doctor for rectal exam. Violated! 

The reason the above resonates as funny is that many men really feel  this way about a doctor doing  the prostate exam. This in turn leads to attempts at early detection being thwarted. 

You hear about a famous person being ” stricken” with terminal prostate cancer almost weekly. What has happened here is a male that , for whatever reason, had not had a prostate exam or a PSA. They were most probably in good health otherwise, no voiding symptoms and life was perking along just fine. The prostate cancer slowly grows, not causing any voiding symptoms and that is the kicker, and spreads to the bones which does cause symptoms and then and only then does this class of patient goes to the doctor. He then finds that he has “terminal” prostate cancer. 

To me it seems there is a…

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risk calculator for prostate cancer….would my numbers have changed anything? is this a circle and we end up where we were i.e. a certain percentage chance of prostate cancer? at what percentage does one “pull da trigger?”

At what percentage chance of something… Would you act? How about breast cancer and your daughter? Huhhhhhhhhhh?

Prostate Diaries

“And the universe is a lot like the earth, if you go straight around you end up where you were, and the universe is a lot like the earth….”
Modest Mouse
So I put my numbers in the risk calculator and come up with a 41% chance of prostate cancer. The only abnormality or risk  was a slightly elevated PSA. So…we are back to doing a biopsy on an elevated PSA…what did this do for us?
For years I have been offering the Free PSA to patients who felt they needed more evidence to proceed to biopsy or were “biopsy reluctant”. It almost always comes back somewhere in the middle…i.e. “You have a 18% chance of a positive biopsy.” It doesn’t help that much…so it’s 18%…what would you do? You still don’t know what percentage of 100 “you” are.
Now about me…I had the elevated PSA and was…

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