September 1, 2022
By Dr. Jeffrey B. Walker
Asking your physician questions is a great way to stay on top of your urologic health, but knowing which questions to ask can be tough. I’ve selected a few of the most frequently asked questions I get asked as a urologist, with my responses, to help you be better prepared for your next appointment.
I’ve heard a lot about prostate cancer screening. Should I get screened?
In many cases, yes! Prostate cancer is the second most common cancer in American men (after skin cancer) and the second leading cause of cancer death in men. The decision whether to screen is best made through a conversation with your urologist. Your urologist will consider your goals and preferences, your age, risk factors, and other health problems.
Many years ago, prostate cancer was treated similarly for everyone. Over time, we have learned that some forms of prostate cancer can be monitored with active surveillance, allowing some men to avoid treatments such as surgery or radiation. The prostate specific antigen (PSA) blood test can help you learn whether you might have prostate cancer. It is used in conjunction with the rectal exam to decide whether a prostate biopsy is needed, which is the test that diagnoses prostate cancer. If prostate cancer is found, you and your urologist can then discuss what management options might be best for you.
I’m having problems with urination. How can I make this better?
Urinary symptoms are extremely common in men as we age. Going all the time, urgently, at night, a weak urine stream, hesitancy to start a urine stream, and leakage of urine can all be symptoms of prostate enlargement, which is different than prostate cancer. A large prostate can make it difficult to pass urine and can make your bladder have to squeeze extra hard and therefore frequently.
There is usually nothing you must to do for a large prostate, but there are many options for treating the bothersome symptoms from it. We usually start with medications that can help treat a variety of symptoms. There are many to choose from, so we can review them and determine the best course of treatment and avoid unwanted side effects. For men with persistent urinary symptoms despite taking medication, or for men who would like a more permanent treatment, there are a variety of minimally invasive procedures we can offer.
In my practice, I offer UroLift® (a quick scope-based technique with no cutting and a fast recovery), transurethral resection of prostate (TURP, for larger prostates or prostates with certain shapes), and robotic suprapubic prostatectomy (for extremely large prostates), as well as several others.
You and your urologist will decide together if undergoing a prostate procedure the best course of treatment given your symptoms.
Deciding whether to do a prostate procedure usually comes down to level of bother, but there is also an advantage to staying ahead of your symptoms to help protect your bladder health and avoid more significant problems down the road such as infections, bleeding, or not being able to urinate at all.
Should I get my testosterone level checked, and if it’s low, should I do something about it?
Testosterone plays a key role in development and contributes to our health and well-being throughout our lives. Testosterone levels naturally decrease as we age, and this drop can come with several downsides including lower sex drive, erectile dysfunction, depressed mood or decreased sense of well-being, fatigue, difficulties with concentration and memory, and loss of muscle mass. For some men, these symptoms can come at a younger age or at a more severe degree than in others.
If you are experiencing symptoms related to low testosterone, you may benefit from having your level checked. Checking your testosterone is done via a blood test in the morning. If low, your urologist can talk to you about testosterone replacement therapy and if it is right for you. Testosterone can be replaced via topical gels, injections, oral pills, and other ways. Your urologist will then monitor your levels and your symptoms to ensure you are on optimal treatment, as well as check to make sure you don’t develop any adverse effects from replacing your testosterone. There is a tremendous amount of advertising from companies selling alternative treatments for low testosterone. Most of these are not well regulated or tested for efficacy or patient safety. Testosterone replacement has many potential benefits but should be carefully managed by you and your urologist to ensure you are using an effective and safe product.
Sometimes it might be hard to know what questions to ask your urologist. Here are a few questions you might consider asking at your next visit:
I’ve had a kidney stone in the past. What can I do to prevent another one?
The rate of kidney stones formation is rapidly rising. About 1 in 10 Americans will have a kidney stone at some point in their life. When stones form in the kidney, they typically do not cause any symptoms. But anyone who has had a stone pass knows the pain it can cause when it gets stuck passing down the ureter from the kidney to the bladder. If you’ve passed a stone or had one removed, it’s easy to forget about it and go back to your normal routine when the symptoms are gone. However, urologists are taking a much more proactive approach to help patients prevent further stones from forming. We know that increasing hydration can help prevent all stone types, but a combination of urine and blood tests with periodic imaging can help us give you specific recommendations for what your individual risk factors are and what you can to with diet, minerals, medications, etc. to help you avoid another painful stone episode. Ask your doctor about a metabolic workup for kidney stone disease.
I am having a problem related to sex. What can I do about this?
Having a difficult time getting an erection is often a normal part of aging, but that does not mean older men must simply accept this if they desire to stay sexually active. Oral medications are safe for most men to help you achieve and maintain an erection. If you are still having trouble, there are a variety of other options.
When I bring up penile injections with my patients, most men have the same uneasy reaction. But those who try it often find that the needle is tiny and the success rate very high. Many men are shocked to discover how easy it can be to still get an erection with injection therapy. For some forms of erectile dysfunction there is also a new ultrasound-based treatment available called eWave®, which can treat the underlying vascular problem and help you achieve an erection on your own.
Some men may be reluctant to ask about other problems on their mind, such as penile curvature or ejaculatory disorder. If you have a concern about your sexual health, don’t be afraid to ask!
Is there a research study I should consider?
MidLantic Urology has more than 30 clinical trials underway providing cutting-edge therapies in prostate cancer, bladder cancer, kidney cancer, as well as many benign general urology conditions. While helping bring new treatments to all patients, these research trials give the individual patient to access to the latest advancements in urologic care before they are available to the general population.
Our dedicated clinical research team has decades of experience in supporting patients and keeping your well-being front and center. New studies are constantly becoming available; ask your urologist to check to see if there is one that may be right for you!
This article was written by Jeffrey B. Walker, MD. Dr. Walker specializes in minimally invasive robotic techniques for treating prostate cancer, kidney cancer, and benign upper tract pathology, as well as a variety of general urologic conditions. Dr. Walker practices out of MidLantic Urology’s Bala Cynwyd and East Norriton offices.