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PaperclipPerfector  1mo ago (text post)   2253 thread views

Small-Scale Question Sunday for March 3, 2024

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

This is your opportunity to ask questions. No question too simple or too silly.

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What is the best evidence on prostate cancer screening? Should it be done? Is it worth getting a biopsy or treating prostate cancer?

I am not a medical doctor.

Prostate screening isn't a bad idea, especially if it will assuage worries or if one is experiencing pain or things like hematuria (blood in urine.. notably hematospermia is less of a concern) but there is debate, as you must know because you've asked this question.

The real issue is what to do if cancer is found, and not just the usual benign dys/hyperplasia that nearly all men will have eventually. If cancer is found, the annoying and counterintuitive best practice is currently watch and wait for most men. Watch for changes, wait for development. This depends on age, severity of symptoms, and the size of the tumor, and so on, of course. Prostate cancer in a man under 50 is more of a concern. Medical information online is almost always generalized to populations, not individuals. Young men shouldn't be getting prostate cancer.

Prostate cancer screening is typically done via DRE and, if abnormalities are detected, ultrasound (There is something called transurethral ultrasound where a tube is inserted) and ultimately biopsy if needed, . meaning part of the suspected tumor is lasered or otherwise cut out and examined for malignancy. But the first step is bending over and singing Moon River.

Treatment can include partial or complete 3 prostatectomy, which obviously isn't ideal and has several rather dramatic effects on the plumbing, up to and including ED and urinary incontinence. This is in addition to chemo and whatever else.

Having written this, I personally am for screening, which is really minimally invasive apart from the embarrassment and discomfort. The reason there's even discussion about it as far as I can tell is that for older men surgery and chemo may seriously hinder quality of life and not ultimately really buy much time. But concurrent with this, catching it early in younger men is better than finding out after it has metastasized.

Edit: Measuring urine PSA is actually step 1 and is no more painful than peeing in a cup.

Why is blood in the ejaculate less of a concern? Just curious.

If it's happening a lot, it's a concern. I wouldn't ignore it. Otherwise it's usually infection or some inflammation and doesn't recur (hematospermia I mean). Particularly if one has no other symptoms. It's apparently not uncommon.

Hematuria is more a predictor of larger or more systemic urinary tract issues or cancer. You'd think there would be a much more robust answer to bloody sperm than "Yeah don't worry about it." I suppose there is, but generally that's the line.

Again though, not a doctor. Part of my job is translating and explaining medical concepts from Japanese into English (and rarely vice versa) so I do more reading on medical issues than any sane non-doctor would.

I see. How does someone even notice hematuria, btw? Is it obvious?

You wouldn't unless you are aware of your usual urine color. Gross (visible) hematuria would be considerably different--brownish, cola colored, or reddish. But what's called occult hematuria or microscopic hematuria is probably more common and your urologist only detects that via microscope (3/4 red blood cells per High powered field is the standard).

Hematospermia is much more noticeable and is characterized by either bright red, brown, or even almost black ejaculate.

Thanks for the info!

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