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Prostate Screening

What Patients Should Know About Prostate Screening

Prostate cancer is the most common non-skin cancer in men in the United States, and the second leading cause of cancer death in men. One in six men will be diagnosed with prostate cancer during his lifetime. African-American men face a one in three chance of being diagnosed. Over 30,000 men will die each year from prostate cancer; however ,early detection may save lives. 

The American Urological Association Foundation (AUA Foundation) is concerned that recent studies about prostate specific antigen (PSA) testing may present conflicting information to patients about the value of this critical prostate-cancer screening test. The benefits of regular screening and early detection should not be discounted in the overall population. The AUA Foundation believes that the decision to screen is one that a man should make with his doctor following a careful discussion of the benefits and risks of screening. In men who wish to be screened, the AUA recommends getting a baseline PSA, along with a physical exam of the prostate known as a digital rectal exam (DRE) at age 40.

What is a PSA? 

Prostate-specific antigen (PSA) is a substance produced by the prostate gland. The PSA level in a man’s blood is an important marker of many prostate diseases, including prostate cancer.

Men who wish to be screened for prostate cancer should have both a PSA test and a DRE.

Evidence from research suggests that combining both tests improves the overall rate of prostate cancer detection. 

A variety of factors can affect PSA levels and should be considered in the interpretation of results. 

The three most common prostate diseases: prostatitis, benign prostatic hyperplasia (BPH), and prostate cancer-may cause elevated PSA levels in the blood. Other medications, trauma or treatments (which can include a prostate biopsy or cystoscopy) to the prostate can affect PSA test results. 

Men choosing to undergo PSA testing should know that some important factors may influence results.

  • Change in PSA levels over time known as PSA velocity is used to assess both cancer risk and aggressiveness 
  • Blood PSA levels tend to increase with age
  • Larger prostates produce larger amounts of PSA

A prostate biopsy confirms the presence of prostate cancer.

The decision to proceed with a prostate biopsy should be based primarily on PSA and DRE results. It should also take into account other factors including a man’s family history of prostate cancer, his race, any prior biopsy history and other significant health issues he may have.

PSA level in a man’s blood is generally a good predictor of the risk of prostate cancer and the extent of the cancer.

Men whose PSA levels rise sharply over a short period are more likely to have prostate cancer than those who do not see significant changes in their PSA velocity.

The decision to use PSA for the early detection of prostate cancer should be individualized.

Men should be informed of the known risks and the potential benefits of early screening. To learn more about prostate cancer, visit KnowYourStats.org and click on the resources link. UrologyHealth.org also includes valuable patient education information about prostate cancer, as well as many urologic health resources and research information. 

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Stress Incontinence

Condition Basics

What is stress incontinence?

Stress incontinence means that you leak a small amount of urine when you do something that puts stress, strain, or pressure on your bladder. It can happen when you cough, laugh, strain, lift something, or change position.

What causes it?

Stress incontinence is caused by conditions that stretch, weaken, or damage the pelvic floor muscles. When these muscles can't support the urethra and bladder, you can leak urine. Stress incontinence can be caused by childbirth or weight gain. And it can happen when the prostate is removed or after radiation treatment for prostate cancer.

What are the symptoms?

The main symptom of stress incontinence is the leaking of urine when you sneeze, cough, laugh, lift something, change position, or do something that puts stress or strain on your bladder. With this type of bladder control problem, you may leak a small to moderate amount of urine.

How is it diagnosed?

Your doctor will ask you about your health history. You'll be asked how often and how much you urinate and leak urine. Your doctor will also do a physical exam and check a sample of your urine. Other tests may be needed to make sure your incontinence isn't caused by another condition.

How is stress incontinence treated?

Stress incontinence can be treated with:

  • Pelvic floor muscle exercises (Kegels). These help strengthen the muscles that control the flow of urine.
  • Diet and lifestyle changes. For example, limit caffeine, carbonated drinks, and alcohol. They make you urinate more.
  • Medicines. An antidepressant medicine may help with bladder control. Estrogen cream may be used in the vagina. This may help with bladder control.
  • Medical devices. These include:
    • Urinary catheter. This includes condom catheters.
    • Penile clamp. This may work for short-term use.
    • Incontinence pessary. This fits into the vagina and compresses the urethra.
  • Injections of material around the urethra (urethral bulking). This can help prevent leaking.
  • Surgery. This is done to put in a perineal or urethral sling to support, lift, or compress the urethra. This makes you less likely to leak urine when you sneeze, cough, or laugh. Surgery can be very effective, but it has risks. When deciding whether to have surgery, talk about the risks and benefits with your doctor.

There are products, like pads and disposable underwear, that absorb urine.

How is surgery used to treat it?

Surgery may be used if other treatments, such as pelvic floor exercises (Kegels) and medications, aren't helping enough. There are different kinds of surgeries to help with stress incontinence. They include:

  • Urethral bulking. Material is injected around the urethra, the tube that carries urine from your bladder to the outside of your body. This is done to build up the thickness of the wall of the urethra so it seals tightly when you hold back urine.
  • Perineal or urethral sling. A sling is placed beneath the urethra. The sling may be used to lift, support, or compress the urethra.
  • Artificial urinary sphincter. A silicone cuff is fitted around the urethra. The device also includes a balloon reservoir and a pump. You can inflate or deflate the device to control urination.

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Current as of: November 15, 2023

Author: Healthwise Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.