I have three male patients that are over 50 coming in for consultations today.  At that age, all men need to have their prostate checked regularly.  The first two patients are here for a general checkup.  My third patient is in for a follow up related to an existing condition.

For each of them, I'll do a digital rectal exam to discern whether there are any obvious abnormal growths on the prostate.  I will tell you that there is no man that wants to have this kind of invasive check done, but I think everyone understands that it is important.

The second thing I always do is order a PSA test.  PSA stands for Prostate-Specific Antigen, and is a blood test that will check the level of PSA in the blood.  One thing to note about this test is that sometimes a condition other than cancer can cause the PSA count to be elevated.  So, if one of my patients came back with a high PSA test result, we'd look into doing more testing to see what might be the cause.

Each of these three patients have complained about a common problem with men in their age range.  All of them have a decreased flow of urine, and often get up at night to urinate.  This condition is called Benign Prostatic Hyperplasia, more commonly known as an enlarged prostate.  This condition can be relieved to a degree with medication, which I normally prescribe.  But in the end it is part of growing older, and it is hard to completely avoid its impact, despite the effective medication that is available.  

My sessions with the first two patients were fairly straightforward.  But the conversation I had to have with my third patient, however, was clearly awkward for both of us.

Dr. Tanaka: Good to see you again Mr. Scheefer. 

Mr. Scheefer nervously nods and smiles.  Dr. Tanaka looked at his online notes from Mr. Scheefer's previous examination.

Dr. Tanaka: OK, the last time we talked you said that you were having some pain in your groin area and painful urination.  Have your symptoms changed in any way?

Mr. Scheefer: Not really.  It's pretty much the same as before.

Dr. Tanaka: Ok.  I am looking at the results from the blood tests and urinalysis we did.  You have a bacterial infection in your prostate that is called prostatitis.  

Mr. Scheefer: Really?  What do you think caused that?

Dr. Tanaka:  Well, the lab results also include the type of bacteria that was found. Sorry to have to tell you this, but the infection is a result of an STD called Chlamydia.  Perhaps you have heard of it.

Mr. Scheefer:  Yes.  Oh my God.

Poor Mr. Scheefer.  I could see how embarrassed he was.  It was pretty awkward for me too.

Dr. Tanaka: Don't worry.  We have antibiotics that can take care of it.  You'll have to take them for 4 weeks.  I'll prescribe it now, and you can pick it up at the pharmacy today.  One other thing.  You should contact whoever you had sexual relations with recently and let them know that you contracted Chlamydia.  They should go for an exam too.

Mr. Scheefer: Of course, of course.  Will do.  

As Mr. Scheefer got up, he sighed heavily, and left with his head down.  I am really glad that those kind of cases are rare.