First Urologist visit coming up

36 year old male here.

I had my annual physical at my regular doctors office recently. I shared with them about some urinary changes I've had where my urine stream often splits into two streams and when my bladder is full I tend to strain more and have a bit of a weaker stream.

They didn't examine my prostate, instead they had me do a PSA blood test. To my surprise, the levels came back high. They then referred me to go to a urologist, which I'm scheduled to see in a few weeks with a female PA.

I'm never been to a urologist and never had my prostate examined before. What can I expect for my first visit and how likely is it they would do a DRE for someone like me?

It’s interesting that your PCP didn’t reevaluate you after the increase in PSA. I was referred to the urologist after I complained of voiding symptoms. My primary ordered an ultrasound of my bladder that showed I was retaining urine after voiding. My doc had me come back after getting the results and did an exam (genital and prostate). He also started me on an antibiotic. When I saw the urologist I had to do the standard voiding questionnaire then he examined me. He gave me a pretty thorough examine of my heart, lungs and neurological function. Then he had me remove my pants and underwear. He examined my penis and testicles while I was laying back on the exam table and then had me roll onto my side to check my prostate. I rolled over and he lifted my right butt cheek and in went his finger. He said prostate was small and smooth and then felt the walls of my rectum. He then said this might be a little uncomfortable and started massaging the prostate, he did this for about 20-30 secs. Once finished he removed his finger and quickly wiped the lube from my anus. He then had me roll onto my back and milk my penis onto a slide. He left to check the slide and let me get dressed. It wasn’t bad a little embarrassing but overall fine. Funny thing was when the doc came in he had the slide in his hand and made a statement that if you ever see a doc come in with a slide to run like hell because they want to express something. That will give you an idea of what to expect. I would expect to have your prostate examined.

I think they probably will. If they don't you can definitely ask. Tell them that the primary hasnt checked. Prostate cancer isn't common in men in their 30s, but it can occur and tends to be more aggressive. If it was me, I would ask them if they could check it during the interview.

They didn't examine my prostate, instead they had me do a PSA blood test. To my surprise, the levels came back high. They then referred me to go to a urologist, which I'm scheduled to see in a few weeks with a female PA.

@Obvakhi By chance did you ejaculate or do some strenuous activity or exercise within 48 hours before the PSA blood draw? My urologist instructed me not to, since any of those can elevate the PSA. I've had several other providers order a PSA and never tell me that.

@Obvakhi By chance did you ejaculate or do some strenuous activity or exercise within 48 hours before the PSA blood draw? My urologist instructed me not to, since any of those can elevate the PSA. I've had several other providers order a PSA and never tell me that.

I did have sex the previous day, no strenuous exercise. Funny that they didn't ask me that at my PCP.

I wonder if I tell them that at the urologist that they'll just have me do another PSA test and send me on my way. Or will they actually be thorough with an examination?

The first visit I had with one was about a year ago -- my pcp had put me on flomax for symptoms of bph about a year before that, and I still had increasing symptoms so they referred me to that urologist, and he put me on more meds, as well as gave me a short genital (but no rectal) exam. In the initial consultation call when I started on the meds they discussed doing a cytoscopy but that never happened.

Fast forward now this past week I had my year follow up on starting these meds, but now with a new urologist, and told him I'm not super pleased with a lot of the side effects of the meds right now, so he suggested doing a rezum procedure, but first I have to get a cytoscope, and also get my prostate measured, so I get to have both done at the same time at the end of the year.

@Obvakhi What can raise the PSA is prostatitis. To have a correct diagnosis, you must do a digital rectal exam to have a diagnosis of prostatitis with the PSA test.