EP 595: Prostate Problems? When To Worry About Prostatitis and Bladder/Prostate Cancer

In this episode, Dr. Mistry and Donna Lee answer questions about bladder and prostate cancer as well as acute prostatitis. Irritating symptoms like urinary urgency or frequency, pain with ejaculation, or blood in your urine or semen could portend prostate problems. From cancer warning signs and treatment options to the causes of acute prostatitis, Dr. Mistry shares secrets that can make your bladder gladder! 

Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Phone: (512) 238-0762

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Transcript

Speaker 1: 0:07

Welcome to the armor men's health show with Dr. Mystery and Donna Lee.

Speaker 2: 0:12

Hello and welcome to the armor men's health show. I'm Dr. Mystery, your host joined always with my co-host Donna Lee. That's

Speaker 3: 0:19

Right. Welcome everybody to the armor men's health show, we recently changed it. Yes. And our website is armor men's health.com.

Speaker 2: 0:27

Okay, well, thank you so much for that. Uh, important piece of information. I'm a board certified urologist. Mm-hmm<affirmative>. This is a men's health show. Donna Lee is certifiable and uh, always joins us. She's a professional comedian and

Speaker 3: 0:39

Board certified in the area of comedy, a comedy in the laughter

Speaker 2: 0:43

Comedy mm-hmm<affirmative> she's from Lockhart. If you can't tell<laugh>

Speaker 3: 0:47

It's all that barbecue. Yeah, I'm exhausted.

Speaker 2: 0:51

Uh, I'm a board certified urologist. This is a show that's brought to you by the practice that I started in 2007 N AU urology specialist that makes this our 15th anniversary.

Speaker 3: 1:01

It's a long time.

Speaker 2: 1:02

I feel like an old man. Now

Speaker 3: 1:03

You can't tell though,

Speaker 2: 1:04

I still feel like I'm

Speaker 3: 1:05

There you look spry with all that gray hair.

Speaker 2: 1:06

Yes. That's not funny.<laugh> Donna, how do people get ahold of us? How do people see us as patients?

Speaker 3: 1:12

That's right. You can, first of all, listen to our amazing podcasts. Um, their award-winning for best men's sexual health, um, best pro prostate cancer awareness podcast, and men's health all around by feed spot.com. So you can verify it. It's an actual thing. Uh, you can check us out on our website, armor men's health.com. You can also submit questions to our cute little new website, and we're in round rock, north Austin, south Austin, and dripping Springs, Texas. If you're in the air, they love dripping. They love dripping, and we're gonna fix all of that nasty dripping. Um, and then you just reach out to us 5 1 2 2 3 8 0 7 6 2. And we have so many wonderful questions, but I thought we'd start talking about some man stuff. Today's let's do, um, you want me, you want me to hit you up with a question? Yeah, go ahead. All right. This was, this is, I thought a good one. Uh, Dr. Mystery and Donna question mark. He included me.<laugh> that's good. Cause I am, you know, Dr. Donna had bladder cancer in, oh, in 16, maybe at 16 after a couple of TURPs. So I want you to explain what TURPs are. Of course. And BCG follow up all has been good. Doc warned me about my dry orgasms as a side effect. And I was okay with that. Oh, that's nice. I'm glad he was okay with that, cuz I'm okay with that. I've been getting pain sometimes at orgasm, regardless lately, if I'm masturbating or with my girlfriend, I'd like to talk to you about why sometimes I, it seems to be fine. May I talk with someone about this or will you please address this PS? I'm a 69 year old, otherwise in great health,

Speaker 2: 2:35

69. Hey, so, um, it sounds like, um, this patient had a couple of different things or this listener had a couple different things. The first one is that he probably had an enlarged prostate and then needed that obstructing prostate tissue kind of opened up. And that's what the TURP is or trans uretal resection of the prostate. That's right. We also call it the rotor roter. I don't like that. No likes the rotor roter.

Speaker 3: 2:58

I don't like the, it makes me feel weird in my booty hole. When you say that<laugh>

Speaker 2: 3:02

Thank

Speaker 3: 3:03

You so much. And I have, you had this visual of somebody doing this with their hand.

Speaker 2: 3:07

Okay. It, it, it looks like that oftentimes when you, yeah, the

Speaker 3: 3:10

Handing

Speaker 2: 3:10

Motion, the hand piece that you use is very much just kind of like, you know, like a, like, like a little digging motion that you do so

Speaker 3: 3:17

19 prostate, 67 kind of procedure.

Speaker 2: 3:19

But anyway, once you do that procedure, you, you are often and very likely to have a dry or retrograde. Why? Because, um, the way that, uh, we as men, you know, from a reproductive standpoint, the prostate makes semen, the semen gets deposited in the urethra mm-hmm<affirmative> and then it gets pushed out by muscles that kind of squeeze the urethra. But in order for that to happen, the neck of the bladder has to close. So the, you know, the, the, the, the, the part that goes back up into the bladder has to close mm-hmm<affirmative>. And that way the fluid only comes out in one direction. But when you do the TURP procedure, you actually destroy that bladder, neck, uh, mechanism. And so the, all the semen, anything that gets produced goes back into the bladder, but moreover, a lot of the tissue that makes semen is, gets taken away in the surgery, in the TURP surgery. Oh, so a lot of, a lot of times you're just not making any semen. So why is this patient hurting? Yeah, so pain with orgasm is almost always a muscular issue. Almost always a, a pelvic floor issue. And that's why it happens sometimes and doesn't happen other times. So, okay. He may notice that if he goes, you know, on a long trip or sits in a plane for a long period of time, then he is in more likely to have this kind of painful orgasm or if he has, um, maybe he golfs that day and has some lower back pain that then he'll have pain mm-hmm<affirmative>, uh, with orgasm, but when he's more relaxed and that pelvic floor is more relaxed than he may not have pain. So we have in our office, a wonderful pelvic floor, physical therapist, her name is Colette

Speaker 3: 4:53

Mm-hmm.<affirmative> Dr. Rodin,

Speaker 2: 4:54

Dr. Rodin. She's amazing. And, uh, she's, she's, uh, her services are covered under insurance mm-hmm<affirmative> and almost everyone that we have in our clinic that has painful orgasm, it'll get fixed with, uh, pelvic floor physical therapy. Right. In addition, this patient also had bladder cancer. And for those of you that don't know, uh, bladder cancer is, um, you know, uh, a fairly common urologic disease. It, um, is

Speaker 3: 5:21

What causes bladder cancer.

Speaker 2: 5:22

Well, uh, it's, there's a genetic condition mm-hmm<affirmative>, uh, predisposition, uh, and smoking, uh, is a, is a big predisposing factor as well as, uh, exposure to dyes. Uh Anine and, and, and benzene dies really

Speaker 3: 5:35

Mm-hmm<affirmative> I didn't know that.

Speaker 2: 5:37

So, uh, oh, no. Especially in, um, the Austin area, uh, where a lot of people used to work in smelting plants and things like that. Mm-hmm<affirmative>, um, those patients we see with bladder cancer, you know, years later, oh, my, uh, interestingly, this patient had a treatment for his bladder cancer called BCG treatment. And this is just an, an example of how medicine can be so mysterious.<laugh> sometimes it's a, it's the, it's the tuberculosis virus. Mm-hmm,<affirmative>, that's been attenuated, meaning it's no longer alive and it, you put it into the bladder. Right. And there's an immunologic response that occurs that makes bladder cancer go away. Oh my. So how tuberculosis and bladder cancer are related is just, is a mystery<laugh>, but

Speaker 3: 6:22

It, it kinda like your name.

Speaker 2: 6:23

Yeah. It's a real name by the way.<laugh> and, uh, so this patient had, um, removal of the tumors and then probably had to have BCG afterwards. And luckily it works about 70% of the time, but 30% of the time the cancers do come back. So if you are diagnosed with bladder cancer, you're gonna have to come back and get scoped every year. Uh, and that's what this, this patient needs. Now, the fact that he's 69 healthy, still sexually active. That makes him one of my favorite patients. Right. I

Speaker 3: 6:50

Know you love that guy.

Speaker 2: 6:50

We love that guy<laugh> because, because we wanna make sure that, um, as far

Speaker 3: 6:55

Sex till he's 80,

Speaker 2: 6:56

Until he is 80, right. Or, and beyond, right.

Speaker 3: 6:58

Oh, there's beyond that's

Speaker 2: 6:59

Right. Yeah. That's right.<laugh> not for you.

Speaker 3: 7:01

<laugh> no, I'm struggling.

Speaker 2: 7:03

Can I stop 50 50? And so, um, there's not gonna be any cure for the retrograde of the dry yet. This patient has a lot of times patients will come to us after surgery and want me to fix it somehow. And unfortunately there's no way to fix it. Um, so, uh,

Speaker 3: 7:24

We did you ask their wife if they wanna be, if they want

Speaker 2: 7:26

It fixed, they want the girlfriend may like it. I

Speaker 3: 7:28

Don't know.

Speaker 2: 7:29

You'd be surprised at how I

Speaker 3: 7:30

Took a poll.

Speaker 2: 7:31

You'd be,

Speaker 3: 7:32

I took an unofficial poll of my girlfriends. Yes. And we all agreed. It would be great if y'all could just make it all, go away, just have your orgasm and just make it less messy.

Speaker 2: 7:41

You know, I, you say that, but,

Speaker 3: 7:43

Well, I only have two friends. So there was two friends on that pool. Yes.

Speaker 2: 7:46

<laugh> we, we often will. Well, like men, men come to us telling us that their wives are wondering if they're really orgasming or not. Like they're faking it.

Speaker 3: 7:58

That's funny.

Speaker 2: 7:59

Now you don't care. I don't care. You just want him to go to sleep. I do, but<laugh> just get off

Speaker 3: 8:04

With Michael. That is correct. Just get off with Michael. I'm tired.

Speaker 2: 8:07

I'm

Speaker 3: 8:07

Tired. I did all the dishes

Speaker 2: 8:08

I've been talking all

Speaker 3: 8:09

Day, leave me alone.

Speaker 2: 8:11

So, um, I've been

Speaker 3: 8:12

Talking<laugh>

Speaker 2: 8:13

So

Speaker 3: 8:14

That's, you have five TikTok accounts.

Speaker 2: 8:16

So, um, but, uh, but, but you know, there are, there are couples in which, oh,

Speaker 3: 8:21

Are there

Speaker 2: 8:22

In which having an anti integrated is important to them and, uh, maybe, maybe a sign of true love or something. I don't know. Our previous topic had to do with bladder cancer and bladder symptoms. And we have another question similar to that. Go ahead. A

Speaker 3: 8:34

Donna. Yep. We have one a really interesting, intriguing one about this patient's bladder issue issues, as they say in more sophisticated lens, Dr. Mystery, good afternoon. I've been diagnosed with prostatitis three times in the last 12 months. It originally presented itself as blood in my semen, which freaked me out. I was on Leva Leva Floxin for two weeks and ended up having to take, take it for a total of eight weeks. Last year, exam of my prostate exhibited node nodules, but it was inflamed. I also had cystoscope through my penis, into my bladder while traveling into my bladder. The urologist looked at my prostate, but he said, prostate, that's always confusing being, you have to go into it through the bladder started stated it looked good, but irritated. My PSA is 1.2 December of this year, I began to urinate. Blood went to I'm sorry. Last year went to the ER, it was a weekend. The ER doctor said it was the flare up of my Prostitis again and treated me again with Levo Floxin in March of this year, I had blood levels checked for my hormones and my PSA had jumped to 8.3. Wow. That's high from 1.2 in may of, of, of last year. Obviously the startled me, I went to my urologist and was examined again. No nodules in my prostate. It was, I was told it was spongy, but felt normal placed on another round of antibiotics for two weeks. I'm going, uh, again, to see the doctor soon to have my PSA checked. Am I missing anything or is this somewhat normal from Prostitis I'm 48 years old. My father had prostate cancer when he was 59 years old and had it removed. I just wanna make sure I'm not missing anything. Dr. Mystery.

Speaker 2: 9:55

Well, one of the things that's fascinated me, Donna mm-hmm<affirmative> after practicing medicine for so long mm-hmm<affirmative> is how much of the things that we just learned when we were residents that is just complete crap.

Speaker 3: 10:05

<laugh> like what numbers

Speaker 2: 10:06

I'll I'll give you a couple. Okay. One piece of crap is that you can tell how big the prostate is from a prostate exam, because it's just,

Speaker 3: 10:11

It's a few seconds long, right?

Speaker 2: 10:13

It's not, it's not the time. Or we'd spend a lot more time in there. Yay. Good. It reminds me, I was talking to a patient of mine who was African American, great, good friend of mine and a, and a patient of ours. And I was like, men, black men do not like the prostate exam. And they get so freaked out about it. And they, they, and I said, but I want to attract more into the practice. How do I do that? He goes, just put the size of the person's hand on your website.

Speaker 3: 10:35

<laugh> well, that takes you outta the

Speaker 2: 10:37

That's right. That's right. So, so I thought that for the, for the next go around for those little bios that we have in our, in our office, Uhhuh there're pictures there, but also the size of their hands.

Speaker 3: 10:45

Oh boy. We'll Dr. Dr. OGs, little tiny hands, little tiny

Speaker 2: 10:48

Hands. I'll

Speaker 3: 10:49

See her. What about that little fake hand that you can buy little plastic? Can

Speaker 2: 10:52

You can't feel nothing? Yeah. When you do the prostate exam, you're just looking for prostate nodules and you really can't tell the size. So people are always like, well, my previous person told me they had a big, big prostate. I said, and I, and I, I have to say to myself, I'm sorry for that. Person's like the words they use, but you really can't tell the size of the prostate.

Speaker 3: 11:09

How many seconds long does

Speaker 2: 11:10

This? It does not matter how long it is.

Speaker 3: 11:12

It does because guys freak out. If they, if they hear you say it's only two seconds long, they might go to the doctor more. If it's like 27 minutes long, then they're gonna be like, mm I'm not into that. What

Speaker 2: 11:20

If they pay extra?

Speaker 3: 11:21

Then they can have

Speaker 2: 11:22

27 minutes, 27 minutes.<laugh> it's$500 an hour in case you're wondering, oh, it it's like trying to size an entire apple where you don't know the shape of the apple by only feeling one part of the apple. Right? You can't, you can make some kind of educated guess, but you're wrong. 50% of the time. That's why the size, the second thing that that people do is they talk about boggy or soggy, spongy or spongy prostates. Is that the thing? And I'll tell you, if you have, Prostitis like you have an infection of your prostate Uhhuh. Nobody should be pushing on your prostate because the infection can go into your bloodstream. Oh, so you shouldn't do it. You should, nobody should be doing a prostate exam on somebody who they think has Prostitis and two, they all feel weird. So, or, or the, or different. So you

Speaker 3: 12:00

Can't, I guess an organ would feel

Speaker 2: 12:01

Weird. You just can't always say that something feels boggy or spongy. And then third, when you're looking past the prostate with a cystoscopy mm-hmm,<affirmative>, you're looking past it. You really can't tell it's inflamed or not in this particular.

Speaker 3: 12:10

So, so many things are wrong in this email.<laugh> no

Speaker 2: 12:12

Nothing nothing's wrong. It's more about this idea of conventional wisdom. And so, right. You know, I'm 47 years old. Mm-hmm<affirmative> and I meet my 60, 65 year old urology counterparts all the time. And they still do the same thing. You have a big pro on physical exam, your feels boggy. And I look at them and I'm like, you know that, what you're saying is complete crap. Right?

Speaker 3: 12:32

Clearly they don't it's

Speaker 2: 12:33

There's nothing saying it. No, if you push on the prostitute and the guy jumps off the table, because it's hurting so much now, that's Prostitis, you know what I mean? Like that's, that's not spy. That's painful.

Speaker 3: 12:40

What causes Prostitis.

Speaker 2: 12:42

So usually it's a bacteria mm-hmm<affirmative> but there are in our practice, we deal with two different kinds of Prostitis acute prostitute is, which is not that cute

Speaker 3: 12:49

Prostitute or Prostitis

Speaker 2: 12:51

Prostitis,<laugh>,

Speaker 3: 12:52

It's a whole different

Speaker 2: 12:53

Discussion. It's a different clinic. It's a different

Speaker 3: 12:55

Podcast.

Speaker 2: 12:55

<laugh> different podcast. And then we have chronic Prostitis chronic Prostitis is not the topic of what we're gonna talk about today. That usually causes a chronic low grade discomfort. Usually it's not really organ related. It's more pelvic floor related. We have 10 podcasts that talk about chronic Prostitis. We have fewer that talk about acute Prostitis. Acute Prostitis was gonna present with pain, usually back pain or lower flank pain. Mm-hmm<affirmative> sometimes urinary complaints like urgency, frequency, nighttime peeing blood in the urine and blood in the semen. As if matter of fact, blood in the semen. Most of the time it is from Prostitis. Although it freaks people out, it's not usually something completely dangerous. If somebody thinks that they have had an episode of Prostitis, then feel a shirt, 10% of all your male counterparts have had that at least one time in their life. Hmm. Antibiotics for a couple weeks makes a lot of sense. Sometimes leave Aquin,

Speaker 3: 13:44

But he was on a lot.

Speaker 2: 13:45

I know we talked about that before this guy had three episodes and was on eight weeks of leave Aquin, and that's just too much antibiotics, right? It's gonna screw up your gut health cause bloating, other things it's gonna predispose you to other infections.

Speaker 3: 13:58

If they try a different antibiotic is always LeVox and levoquin is the, the one, if

Speaker 2: 14:03

Two or three weeks of antibiotics did not fix the problem. Mm-hmm<affirmative> then you have to think that maybe the problem is something different. Right? And so that's what I would do. I would look for kidney stones that can mimic Prostitis. I would look for a number of other things like, okay. None of my patients, if you come see Dr. Mystery as a patient, there is no way you're gonna be on eight weeks antibiotic. Yeah. It just doesn't. It would never happen. Right? I would, I would, I would go back to the drawing board and try to figure out where I screwed up your evaluation. Right. And so with that in mind, um, if you've had one episode of Prostitis mm-hmm<affirmative> you gained 10% of your friends, you know, you join 10% of your male friends, right. Two in a year is very uncommon. Hmm. So either the first one didn't get fixed or you have some kind of problem that's causing you to get more Prostitis episodes like the, and this guy got a third one.

Speaker 3: 14:49

Yeah. He's a little, he needs to go by the lottery

Speaker 2: 14:51

Three in a first, in, in one year means that something is wrong with you. That has nothing to do that may have something else to do than the prostate mm-hmm<affirmative>. So you could be not emptying your bladder. You could have some type of foreign body in there. You could have some type of infection or cyst or something of your prostate. That's not being drained. Mm-hmm<affirmative> you need to be more deeply evaluated. So, so my, my deeper point to this patient is that absolutely need to make sure there's something they're gonna get missed. Right? Three in one ear is absolutely abnormal. Right? And so what we do in our office, we do a cat scan of your prostate, maybe an MRI of your prostate. We do a cat scan of your kidneys, um, and your abdomen. Uh, I would do an ultrasound of your prostate gland for sure. I would for sure. Put you on a medicine to relax your prostate. Something like ayin or tain or SIL doin mm-hmm<affirmative> and then we'd, then we'd watch you. And if you got another one, then in our practice, three episodes of Prostitis in one year mm-hmm<affirmative> usually has us do something to your prostate surgically to, to lower your risk of getting another, another infection. Mm-hmm<affirmative> because eventually one of these is gonna make you sick. Yeah. This patient didn't get sick. He got, he had, he got lucky. He got, he, he got, he got blood in his urine. He got blood in his semen. Right. But you can get sick, sick, like it can put you in the hospital. I have, you know, we have, we have a patient now that we're contending with that has had Prostitis that's giving him fevers for almost eight days now. Oh my gosh, you can get sick. So you don't want, Prostitis now this 48 year old man, he's gonna be just fine. He's young, he's robust. He has a lot of reserve, but if you're a 68 or 78 year old man, right? Like you can get sick and be in the hospital and get a heart attack and get a blood clot just like that.

Speaker 3: 16:22

Well, he brought up his dad's prostate cancer. So how, how, I mean, shouldn't he be a little more concerned? Like,

Speaker 2: 16:29

I think that's a great question. There's usually no strong relationship between Prostitis oh. And prostate cancer. Okay. But if you forget about his Prostitis, which I've now discussed in beat to death,

Speaker 3: 16:39

<laugh> just like his prosti prostate, just, just like his beat death to death.

Speaker 2: 16:43

Just, just like his poor prostate has been beat to death, poor death. Uh, is that, what is your risk or how should you be more like, um, effective in, in monitoring yourself for prostate cancer? If you have a strong family history mm-hmm<affirmative> and the answer is that when you're under 50, we have a lower threshold for your PSA. Usually two or lower is normal, not four as it is when you're older. Right. If you're very concerned, you can have your father checked for a genetic test. And if he's interested, we can order the test, uh, or tell the doctor that he sees, you know, what to test test for mm-hmm<affirmative>, it's offered by a company called myriad. It's covered by insurance. Right. And it tells you if he has the gene for prostate cancer. Oh. Because if he has it, then you got a 50% chance that you have it. Oh. And now you might be a little bit more aggressive in looking for your cancer MRIs at the prostate. When you're younger, we have other tests that can look for, um, the likelihood of you developing cancer. Mm-hmm<affirmative>. And so, especially for those of you that have, uh, parents or fathers who under 60 had to have their prostate removed or bad prostate cancer, you should be a lot more aggressive. Donna. How do people get ahold of us? Ask us

Speaker 3: 17:51

More question. That's right. Send your questions to armor men's health.com. That's our cute little website, just for the show. And just for this podcast, you can check out our podcast, wherever you listen to free podcasts. We are award-winning in a, the arena of men's wellness, prostate cancer and sexual health. Our phone number's(512) 238-0762. And again, our website armor men's health.com.

Speaker 1: 18:11

The armor men's health hour is brought to you by urology specialist for questions, or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at armor men's health.com.