Prostate Restored
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Should a 75 year old man get a PSA test?

The U.S. Preventive Services Task Force recommends against screening for men over 75. "There's no question that there has been overtreatment of prostate cancer," says Tosoian.

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We are living longer, and 75 is not the ripe old age it used to be. But it's a cutoff age for PSA screening — and this is missing cancer in men who really need to be treated, say Brady investigators. "There is increasing evidence that this age-based approach is significantly flawed," says Patrick C. Walsh, M.D., University Distinguished Service Professor of Urology. Walsh is the senior author of a recent Brady study that looked at high-risk prostate cancer in older men. The study's interdisciplinary group of investigators also includes first authors Jeffrey Tosoian and Ridwan Alam, and Carol Gergis; Amol Narang, Noura Radwan, Scott Robertson, Todd McNutt, Ashley Ross, Danny Song, Theodore Deweese, and Phuoc Tran. The U.S. Preventive Services Task Force recommends against screening for men over 75. "There's no question that there has been overtreatment of prostate cancer," says Tosoian. "However, that is getting better; more men are taking part in active surveillance programs, and we are much better at interpreting PSA and other biomarkers to rule out aggressive disease." But PSA can't be interpreted if a man doesn't get his PSA tested. Population studies have shown that "men diagnosed at 75 years or older account for 48 percent of metastatic cancers and 53 percent of prostate cancer deaths, despite representing only 26 percent of the overall population," says Tran, Clinical Director of Radiation Oncology and Molecular Radiation Sciences. Why are older men more likely to die from prostate cancer? To find out, the team studied 274 men over age 75 who underwent radiation therapy for prostate cancer. "We found that men who underwent PSA testing were significantly less likely to be diagnosed with high-risk prostate cancer, and that men with either no PSA testing or incomplete testing (either a change in PSA was not followed up, or a biopsy was not performed when it was indicated) had more than a three-fold higher risk of having high-risk disease at diagnosis, when adjusted for other clinical risk factors," says Tran. Although this was a small study and more research is needed, Walsh says, "we believe that PSA screening should be considered in very healthy older men."

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How long does it take to pee normally after TURP?

It often takes up to 6 weeks for this to get better. After you have healed, you may have less trouble urinating. You may have better control over starting and stopping your urine stream.

Your Recovery

Transurethral resection of the prostate (TURP) is surgery to remove prostate tissue. It is done when an overgrown prostate gland is pressing on the urethra and making it hard to urinate. You may need a urinary catheter for a short time. It is a flexible plastic tube used to drain urine from your bladder when you can't urinate on your own. If it's still in place when you go home, your doctor will give you instructions on how to care for your catheter. For several days after surgery, you may feel burning when you urinate. Your urine may be pink for 1 to 3 weeks after surgery. You also may have bladder cramps, or spasms. Your doctor may give you medicine to help control the spasms. You may still feel like you need to urinate often in the weeks after your surgery. It often takes up to 6 weeks for this to get better. After you have healed, you may have less trouble urinating. You may have better control over starting and stopping your urine stream. And you may feel like you get more relief when you urinate. Most people can return to work or many of their usual tasks in 1 to 3 weeks. But for about 6 weeks, try to avoid heavy lifting and strenuous activities that might put extra pressure on your bladder. Most people still can have erections after surgery (if they were able to have them before surgery). But they may not ejaculate when they have an orgasm. Semen may go into the bladder instead of out through the penis. This is called retrograde ejaculation. It does not hurt and is not harmful to your health.

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