To pee or not to pee

I was standing in the ensuite talking to my ol’ fella the other night.
No, wait; it’s not what you think. I had got up for a pee in the middle of the night and, not unusually, nothing much was happening.
“Jeez, mate,” I grumbled, sotto voce in the ensuite. “Bloody get on with it, will you?”
Once it starts, depending how long I’ve been holding on, it can take forever. The worst possible thing I can do is sit in a car for hours and not pull over for a pee when I first feel the need. Leave it too long and you could watch a whole episode of Better Homes and Gardens while I’m still in the loo.
So yeah, things can be a little slow in the waterworks department. Life is generally better if I go at the first hint that I need a pee. Now when you are on the road a lot, as we have been, this is not as easy as it sounds. True, blokes can just pull off the road, get out of the car and fertilise a tree. But we don’t like to be a burden.
“What, again? Didn’t you just do that?”
The other thing about travelling is you are sitting on your bum for two to three hours at a time. In the sitting position, you are putting pressure on all of the bits that adversely affect the prostate, which for those who did not know or don’t even want to think about it, is in an inaccessible place between a man’s testicles and his bottom.

Ah, I sense all of my male readers over 60 wincing and empathising about the myriad bladder problems that affect men of that age or older. The usual problem is an enlarged prostate gland, which restricts the flow of urine to one degree or another. It is a complex problem and one cannot immediately assume the prostate is the culprit. Sometimes the bladder or other organs are at fault. The key issue with prostate problems is that urine can be retained in the bladder and that, my friends, is when you go to see an urologist.
There is only one way a GP can assess whether or not your prostate is enlarged and that involves a rather invasive procedure where the doctor takes the only available route to digitally examine the prostate. The problem most doctors have is convincing men to have a routine examination – once a year is not a big ask, but you ought to do it from the age of 45, especially if there is a family history of cancer.

The women who read this column will know that what I’m going to say is truer than their men would care to admit. While the women of the house have their annual mammograms and pap smears diarised from one year to the next, their husbands could go on covertly carrying a bladder problems for years before it might occur to them that it’s a problem.
Having a digital examination to diagnose an enlarged prostate is not what most blokes would volunteer for, especially when forewarned. It does not hurt, as such; but it’s darned uncomfortable.
Not all enlarged prostates become cancerous, but it is fairly prevalent. According to the Cancer Council, and they should know, one in 5 men will get prostate cancer before they turn 85. Generally speaking, it is one of the slower growing cancers and as doctors are fond of telling their 76 year old patients, “You’ll die of something else before this gets you”. This is not always the case, so anyone diagnosed with the disease ought to keep close tabs on its progress.

Prostate cancer can be detected by a simple blood test (prostate-specific antigen (PSA) screening). This blood test alone has increased prostate cancer awareness since it was first used as a screening tool almost 28 years ago.
Advances in Urology 2012 carried a scholarly article that discussed the problem of over-diagnosis and over-treatment. Here’s a link so you can print it out and read while having a sit-down pee. http://www.hindawi.com/journals/au/2012/862639/
The authors of this article say that due to the largely indolent course of the disease and the unspecific nature of the PSA test, increased incidence has largely been associated with cancers that would not go on to cause death. This leads to over-diagnosis and over-treatment, which is exacerbated by the high risk of side effects that put patients’ quality of life at risk, with little or no survival benefit.
“PSA testing, while it helps to discover mortal cancers, can also often lead to the discovery of non-mortal cancers, or those which would never have been noticed without screening. Given that 20–50% of asymptomatic men are found to harbor prostate cancer upon autopsy, it follows that the PSA test leads to a much greater detection of cancers, both mortal and non-mortal.”
The National Cancer Institute says the rising incidence of prostate cancer is in contrast to the relatively unchanged mortality rate from 1975 to 2007. The number of newly-discovered prostate cancers is over seven times greater than the number of prostate cancer related deaths.

The low mortality thing is some comfort, but no-one can guarantee that the cancer won’t misbehave in between check-ups. In 2010, 19,821 new cases of prostate cancer were diagnosed in Australia. This represents 30% of all cancers diagnosed in Australian men. Being an occasional betting man, it seems to me that the odds are in favour of getting things checked out. The first GP I consulted about this issue examined me and after some discussion counselled against chemical solutions. In other words, you can take pills to improve the flow of urine, but, ahem, sometimes it improves too much.
According to the World Health Organisation, 200 million people have some degree of bladder control problem. About a quarter of the world’s older people develop incontinence, but it is both preventable and treatable. You just have to front up and talk to a medico about it first.

Medical clinics today often have annual health checks where a nurse takes a medical history before you see the GP. Nurse will take your blood pressure, look in your ears, listen to your lungs and then ask all kinds of questions about your life like, “Are you still active?” Yeh, I mow the lawns and trim the hedge. “No, I mean in the bedroom, mate.”
So, it’s that time of year again – a full blood screen, a lung function test, a flu shot and then playing 20 questions with the nurse. Just so you know – Medicare pays!
Some of the questions Nurse asked last year were about this very subject, like how many times I have to go and pee, do I ever feel like I’m not finished, and, do I “leak”. I could tell you, but a man is entitled to some dignity, don’t you think?

So there you go; another weekly episode of what my songwriter friend Fred Smith calls “stuff you didn’t know that you need to know”. Thanks for giving the column a plug at the house concert, mate – I’d love to keep chatting, but more importantly, I gotta go pee.