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Dr Basu
Dr Basu, Experienced Specialist
Category: Medical
Satisfied Customers: 28290
Experience:  MD
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I have a daily pain from my prostrate area up through my urethra.

Resolved Question:

I have a daily pain from my prostrate area up through my urethra. My doctor tried some relax tablets and some anti inflammatory tablets as he thought it could be a muscle problem. That did not work so he gave me antibiotics as he said it could be prostatitis. I have been on them for a month but still have the daily pains. Urine and blood tests have not revealed anything except blood test for prostrate was level 5. I am due to see a urologist but am concerned about the wait.
Submitted: 2 years ago.
Category: Medical
Expert:  Dr Basu replied 2 years ago.
Dr Basu :

Hi there, This is Dr Basu, Experienced Specialist. I am here to address your concerns and provide great service.

Dr Basu :

Your PSA level is high.

Dr Basu :

Now constant pain can be due to the prostate cancer.

Dr Basu :

This can only be diagnosed by the prostate ultrasound and then a biopsy.

Dr Basu :

THis risk is small but still there.

Dr Basu :

I will also suggest a CT scan of the pelvis with contrast if psosible or at least an ultrasound of the pelvis to take a close look at the prostate and also the lower spine bones.

Dr Basu :

This can be ordered by your GP.

Dr Basu :

Most usual problem is the benign enlargeement of the prostate or BPH.

Dr Basu :

The constant pain can be due to the influence of testosterone on the prostate gland.

Dr Basu :

YOur symptoms can be treated effectively with following medications:

Dr Basu :

1. Tamsulosin ( Flomax) 0.4 mg cap daily.

Dr Basu :

2. Finasteride 5 to 10 mg daily

Dr Basu :

These two medications help to relax the prostate gland, muscles, as well as shrink it by reducing testosterone effect.

Dr Basu :

Please discuss these options with your doctor.

Dr Basu :

Best wishes,

Dr Basu :

It was my pleasure to help you today.
I am Dr Basu experienced in Urological Diseases.
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Expert:  Dr Basu replied 2 years ago.
Dr Basu : Hi there, This is Dr Basu, Experienced Specialist. I am here to address your concerns and provide great service.
Dr Basu : Your PSA level is high.
Dr Basu : Now constant pain can be due to the prostate cancer.
Dr Basu : This can only be diagnosed by the prostate ultrasound and then a biopsy.
Dr Basu : THis risk is small but still there.
Dr Basu : I will also suggest a CT scan of the pelvis with contrast if psosible or at least an ultrasound of the pelvis to take a close look at the prostate and also the lower spine bones.
Dr Basu : This can be ordered by your GP.
Dr Basu : Most usual problem is the benign enlargeement of the prostate or BPH.
Dr Basu : The constant pain can be due to the influence of testosterone on the prostate gland.
Dr Basu : YOur symptoms can be treated effectively with following medications:
Dr Basu : 1. Tamsulosin ( Flomax) 0.4 mg cap daily.
Dr Basu : 2. Finasteride 5 to 10 mg daily
Dr Basu : These two medications help to relax the prostate gland, muscles, as well as shrink it by reducing testosterone effect.
Dr Basu : Please discuss these options with your doctor.
Dr Basu : Best wishes,
Dr Basu : It was my pleasure to help you today.
I am Dr Basu experienced in Urological Diseases.
If I have answered all your questions, Please rate my response Excellent (click on the smiley faces) under this chat box only.
Please bookmark my profile for asking further questions!
This is the link to my profile:
http://www.justanswer.com/medical/expert-mysticdoc/
Customer: replied 2 years ago.

Thank you for your answer. Not really told me a lot that I already knew. A bit scary starting off with prostrate cancer. Do not think this was worth £24. Additionally I have sharp pains through my penis which led me to believe it was prostatitis as did my doctor. (I also get aches and pains in my penis when I turn over in bed or sometimes when bending over i.e. gravity seems to have an effect) There is also some pain relief when my bladder is full.He said this condition affects all genitals. I also understand acute prostatitis can be from bacterial problems or not and other treatments may be necessary other than antibiotics. The doctor also said level 5 on the blood prostrate is only just over acceptable level 4.

I feel you have just told me to see a urologist which I will be so have not gained anything here. I also am now quite worried about prostrate cancer. Comments would be appreciated.

Expert:  Dr Basu replied 2 years ago.
Thanks for replying back with additional questions.
I will elaborate on each point.
Your current symptoms are not related to acute prostatitis as it would have responded well to antibiotic and anti inflammatory --you did not see improvement --so it is not acute prostatitis.
The prostate related symptoms can affect your genital area as a whole --that is correct.
I specifically mentioned about a Pelvic scan to look for any spread of prostate cancer.
Sometimes, PSA level is not a good estimate of prostate cancer.
The level can be falsely low.
And your test measured total PSA level.
THis is not a accurate test.
We also want to check free PSA level ( PSA not bound to the proteins). Total level does not give that information.
Free PSA level if high, that is more suggestive of prostate cancer.
Still, you will need a biopsy for confirmation.
Lastly, The medications I mentioned are commonly used to treat any chronic prostate related symptoms.
Your current medications are not at all related to these ones:
Tamsulosin relaxes the smooth muscles and the bladder sphincter--so your urine flow will improve and pelvic pain will improve.
Finasteride blocks the testosterone action on prostate gland --so prostate will not grow any further.
Finasteride also blunts the pain receptors to some extent.
These medications will give you relief while still waiting for Urologist appointment.
Best wishes,
Please reply with further questions.
It was my pleasure to help you today.
I am Dr Basu experienced in Urological Diseases.
If I have answered all your questions, Please rate my response Excellent (click on the smiley faces) under this chat box only.
Please bookmark my profile for asking further questions!
This is the link to my profile:
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Dr Basu, Experienced Specialist
Category: Medical
Satisfied Customers: 28290
Experience: MD
Dr Basu and other Medical Specialists are ready to help you
Customer: replied 2 years ago.

Thank you for your reply.

How is free psa tested?

I understand that prostatitis can be of an unknown cause - not bacterial and possibly diet controls this?

Where do I get the medicines you quoted?

My doctor did not indicate to me it could be prostrate cancer from his assessment. I am now very anxious!

Not really what I was expecting.

Expert:  Dr Basu replied 2 years ago.
Free PSA is also a blood test --can be ordered by your GP.
Most commonly this is not cancerous.
But we get concerned when you have persistent symptoms with elevated PSA.
Yes diet does play a role --you will need to avoid alcohol, caffeine, red meat.
You should eat more fruits and vegetables.
You can take saw Palmetto supplement --a natural supplement which improve prostate functioning.
The medications I mentioned above can be prescribed by your GP.
Best wishes,
Customer: replied 2 years ago.

I think maybe starting off with it may be a benign prostrate may have been a more tactful. Talk of spreading cancer is also quite scary.My wife and I are now very anxious. Perhaps I should have waited to see the urologist. I will consult my doctor again.

I am not very happy with how this issue has been answered!

Expert:  Dr Basu replied 2 years ago.
I apologize for causing anxiety.
I provided possibilities associated with your presenting symptoms.
I never said you got the cancer --but i will need to mention that.
Since your GP already addressed the infection part, I needed to mentioned the other causes --and of course I will need to mention 'C' word.
I did not want to provide with false reassurance to downplay your symptoms.
Unfortunately your workup is not complete--the tests I mentioned are commonly ordered for better evaluation while waiting to see the specialist.
I wanted to make you aware of these tests which should be done during your wait period.
There are limitations in online interaction --in email formats as we are not discussing the issue face to face.
Hopefully, you will be able to get these tests done and that will calm your nerves once they come back normal ( in most cases they do).
As long as I have been able to deliver the message ( since you understood the importance of these tests hence the anxiety part came in), I have done my part in providing right direction to the problem.
Best wishes and get well soon,
Expert:  DrHelen replied 2 years ago.

Good evening, I am Dr Helen, a UK doctor. I work in both GP and cancer care.

Firstly I would like to offer you some reassurance as you are clearly now very worried.

As your own GP said a PSA level of 5 is only very slightly raised as the normal range is up to 4.The so called "free PSA" test is not routinely carried out here in the UK. (The previous expert on this thread is based in the US where things may be done differently.)

Your symptoms, particularly the pain you describe, sound consistent with a condition called chronic prostatitis. This condition can also cause a rise in PSA.

This is a link to a UK website which tells you more about it: http://www.patient.co.uk/health/chronic-prostatitis

The type of pain you are describing is not usually associated with prostate cancer. In fact it is very rare for men to present with penile pain as an initial symptom of prostate cancer.

The urologist will obviously be able to examine you and give you a definitive answer as to your diagnosis. He (and not the GP) will organise any further tests he wants you to have. This may include analysis of fluid from the prostate and perhaps a scan of the prostate. CT scans with contrast and scanning of the bones would only be carried out if there was a clinical need and are not part of a routine "work up" here in the UK. The urologist will go down this route only if necessary and it is too soon to say you have to have these tests done as well.

I hope this goes some way to reassuring you. It is always wise to consider prostate cancer in ANY man with prostate symptoms but there are many other benign causes too. Your GP has quite rightly asked a urologist to see you but that is standard practice given your symptoms.

I wish you well and hope this is soon all resolved for you.

Best wishes.

Customer: replied 2 years ago.

Thank you for coming back to me. I feel much better now as what you have said corresponds to my doctor's assessment. I have obviously contemplated the problem could be more serious but needed some overview such as you have given. I came online to get that overview and also because I have had the pain for some time and it has been a struggle to get to see a urologist. It seems the resources are not in place in the NHS to see patients in good time which in my case has resulted in quite a lot of daily pain which also leads to anxiety and uncertainty.

Your colleague suggested I use other medications to ease the pain but am not sure whether to ask my doctor as he has organised a urologist appointment. I have tried anti inflammatory, paracetamol and codeine as recommended by my doctor but to no avail. What do you think? I will be seeing the urologist in about 10 daytime. I told my doctor but he said just keep taking the antibiotics until I see the urologist.

Thank you once again for your measured response.

p.s. The statement above this reply states you agree with This Expert - I do get the impression you have not quite agreed with his USA perspective.

p.p.s thank you for the link to chronic prostatitis

HAS DR HELEN RECEIVED MY REPLY ABOVE?

Expert:  DrHelen replied 2 years ago.
Hello, my apologies for not replying sooner, I have been off line until now.
Another expert (not Dr Basu) agreed with my reply to you.

There is no getting away from the fact that there are major differences between the US and UK healthcare systems. I think a lot of non UK doctors don't understand the role of the GP as "gatekeeper" to secondary care from specialists and how the referral process to specialists work. Likewise access to investigations such as CT scans is very different here. GPs generally cannot organise them (although this can vary around the country), only the hospital specialist.


In terms of medications I do think it would be wise to wait for the advice of the urologist. Whilst there are other medications that may help you until you have a definitive diagnosis it is difficult to know which to suggest. I would agree with your GP that you continue the antibiotics. Taking painkillers regularly, not just when the pain is at its worst, may help so that you have a steady level of analgesia in your body all the time.

Wishing you well.

Customer: replied 2 years ago.

Thank you for that.


 


I tried to give you a rating but a message came up to say I had already given a rating (Dr Basu) and if I gave another one I would have to pay some more.

Expert:  DrHelen replied 2 years ago.
You can contact customer services to sort this for you and I will do likewise. I don't want you to be charged again.

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