Ask a Doc: Three Questions Men Over 70 Should Ask

One of the biggest mistakes men can make as they get older is assuming that a new symptom is simply part of aging. Some changes are expected, but others deserve a closer look.

I’m up three times a night to urinate. Is that just aging?

It can be. The prostate continues to grow throughout your life. Because it surrounds the tube that empties the bladder, that growth is likely to cause some difficulty with urination at some point.

The real question is whether it’s affecting your life. If you’re up so often that it’s disrupting your sleep, you can’t empty your bladder completely because your stream is weak, or daytime frequency is interfering with your routine, it’s time to visit your primary care doctor.

Should men over 75 still get PSA tests?

The U.S. Preventive Services Task Force recommends against routine PSA screening beginning at age 70. That recommendation is based partly on actuarial tables, which use average life expectancy, and the fact that many prostate cancers grow slowly. The reasoning is that an older man may not live long enough to benefit from finding a cancer that might not become dangerous for five to 10 years.

But that age-based recommendation doesn’t necessarily fit a healthy, active man who may live another 10 or 20 years, as many of our patients do.

Look, I’d rather know at 80 that you have a slow-growing prostate cancer we can keep an eye on than simply decide not to look. Finding it doesn’t mean we have to treat it aggressively. It means you’re informed and can make that choice.

That’s why our preference at the Clinic is to check PSA annually. We also watch PSA “velocity,” or how much the number changes from one year to the next. A sudden jump can be concerning even when the PSA is still within the normal range.

For anyone interested in learning more, this thorough overview from the National Library of Medicine explains how prostate cancer screening and management have evolved, including the history of PSA testing and how it is used today.

There’s so much talk about low testosterone. When is it real, and when is it marketing?

The marketing has helped in one way: It’s gotten men thinking about testosterone and asking questions. But fatigue, low sex drive, low energy and difficulty building muscle don’t automatically mean your testosterone is low.

I may see someone whose level is perfectly appropriate for his age, but he’s gained 20 pounds, stopped exercising regularly and isn’t sleeping well. In that case, testosterone probably isn’t the answer.

Start with your primary care doctor and get tested. We’ll consider your level, your symptoms and the whole picture, including sleep, weight, diet and exercise. As we age, maintaining muscle also takes exercise that really stimulates the muscles and enough protein throughout the day.

If your testosterone is low or low-normal and your symptoms fit, a short, medically supervised trial may be worthwhile. Some men feel a difference; others don’t. That’s why the decision should be made together, not based on an advertisement.

About the Author

Raymond A. James, D.O.

Dr. James joined the Clinic in March 2018 . A graduate of Des Moines University College of Osteopathic Medicine, he completed his residency at Metropolitan Hospital in Grand Rapids, Michigan. He is board certified in emergency medicine and has been awarded fellowship status by the American College of Emergency Physicians. Throughout his medical career, Dr. […]