By Tedler D. Depaynos, MD
It was over cups of unending black coffee when a young colleague related his experience regarding a patient who was initially diagnosed to have Prostatic Malignancy. Together in our small table was a curious lawyer friend with grayish hair obviously very interested to the medical tale he apparently once had a similar experience.
My colleague is the family MD of a 37 year old patient who had been urinating at least 3 – 4 times per night weeks before he sought consultation. It made him uncomfortable and it became irritating to his bedmate. It was the sudden bloody urine that made him “nervous” and his bedmate urged him to visit their family physician.
Initial impression was Urinary Tract Infection or UTI but he never experienced difficulty or painful urination or dysuria. Hence other considerations were entertained.
Because the frequency of urination was very prominent, an enlarged prostate was taken into consideration by the family MD.
The male prostate secretes fluid where the sperm swims. Without the fluid the semen would appear gel-like and will just be plastered. Hence, it contributes to fertilization. With enlarged prostate, our lawyer coffee mate argued that more fluid should be secreted which unfortunately does not happen.
It is located just at the bladder exit so that with enlargement, urine exit would be obstructed. Hence, signs of prostatic enlargement or prostatomegaly would be urination with effort, dribbling, frequency and nocturnal urination sometimes every 2 hrs and feeling of urinary retention. They may appear 1 or 2 at a time or all at the same time. Because of the difficulty of urination, lines of customers may form, awaiting for their turn and murmuring curses may sometimes be heard. Our lawyer coffee mate confessed that he sometimes had heard the murmured curses behind him.
A urinalysis confirmed the UTI of the patient and likewise a plain Ultrasound (UTZ) revealed a “moderately enlarged prostate gland”
There are various causes of an enlarged prostate. It could be due to plain infection causing “prostatitis” or enlargement usually due to ageing called Benign Prostatic Hypertrophy or BPH or tumors which may be benign or malignant. Experienced Urologists who have done hundreds of Digital Rectal Examination could sometimes be more reliable than plain UTZ. They could surmise the cause of the enlargement and they can even calculate the weight of the prostate which is normally 20 gms. just by their examining finger. They obviously have untiring fingers.
Because of the young age of the patient a possible malignant etiology was entertained especially with the bloody urine. This was buttressed by an elevated Prostatic Specific Antigen or PSA which may imply the possibility of Prostatic Cancer when elevated. His family MD then referred him to a young Urologist who trained at Veterans Hospital where most of the patients are elderlies.
This was meticulously explained to the patient which unfortunately made him more “nervous” if not for the calming embrace of his wife. Although the consulted Urologist had a dubious Digital Rectal Examination, he recommended a prostatic biopsy mainly because of the elevated PSA. A biopsy will rule out or confirm the impression so that if positive, an early surgery might be required. It was the wife that vocalized the patient’s confirmation.
The Prostatic Biopsy was done by the young Urologist under local anesthesia and as an out-patient procedure. Despite the obvious “nervousness” of the patient who felt a little dizzy after, he definitely underwent the procedure bravely even requested his wife to stay outside.
It was after a week of “nervousness” when the final result of the biopsy was released. Both the patient and his wife were with all smiles when they handed their copy to their family MD. Their smiles widened when the MD read again openly the result of the biopsy which read “negative for malignant cells”. They partly attributed the good results to the murmured prayers of their neighbor while they butchered native chickens with native wine. Obviously, their family MD just smiled.
As we parted our lawyer friend requested to be referred to the consulted Urologist which we gladly did.**
