Problems with Urinating

[sunnny]

Hi Doc,
Thankyou in advance for your time and help, it is most appreciated.

I'm a Male 41, please note Father died from advanced prostate cancer at 54.
I have been diagnosed with Hashimoto's Hypothyroid disease.

My issues, over the last 6+ months Ive noticed very gradual changes in my urinating habits.

I now go more often, but less comes out.
Ive more of an urge to go during the night..just making it through the night now.
I get the urge to go when it is really cold or I hear water flowing/dripping.

The stream is slightly weaker and also has a seconds hesitation before it starts.
Last but not least I'm dripping for a while after I stop...I now have to milk the urethra quite a few times until no more drops come out.

My Doc examined me (DRE) in July ..said prostate was smooth
PSA was 0.44
Had a Bladder Ultrasound:
"Bladder 530cc's lower ureters appear normal"
"No significant post void residual urine" (though I had milked the urethra)
"Prostate 21cc's at upper limit of normal for size."
"No pelvic pathology identified."

Doctor put me on Cranberry tablets, so far after 2 weeks no improvement.

Please could you advise and perhaps suggest tests I should ask for from now. I believe the symptoms are worsening noticeably each week.

Thanks Again
RJ

[Ash Tewari, MD, M.Ch.]

Hello Sir,

Thank you for providing some pertinent history, this is difficult as it is, and usually patients omit these important findings. Your family history is concerning, but if your PSA is normal (it is) and with a normal DRE, it is unlikely that you have any malignant process going on. It sounds like you might have BPH (benign prostatic hypertrophy - enlargement) without any cancer. Although I'm not sure about the efficacy of cranberry tablets at this time, you might need an alpha blocker, or flomax in order to "push" the urine past your enlarged prostate. I know your bladder ultrasound said your prostate is only 21 grams, but a transrectal ultrasound is a better tool, and if that is equivocal, a cystoscopy (direct visualization of prostatic urethra and bladder) will be able to show the exact diameter of the urethra and if it is obstructed. Some have proposed endorectal MRI in order to visualize the prostate, however I do not think that would provide any additional benefit for you. So ask your doctor and find out what they think of this possible analysis.

Thanks!

[sunnny]

Thanks for your fast reply, it is very much appreciated.

Seeing Urologist on 25th September.
From what Ive found  he is into using endorectal MRI for diagnosis, so I might open the discussion with him to have the tests you have advised.

Thanks again for your time
RJ