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A urologist is a doctor who has had extensive training in the physiology and pathology of the genitourinary tract. This training usually lasts for five or six years after medical school. The doctor then must pass a day-long written examination given by the Board of Urology. After a year and a half, if the doctor's practice of urology is considered competent, he or she must then demonstrate satisfactory expertise before a committee in an orals examination before becoming board-certified and receiving the tide of Diplomate of the American Board of Urology—a prestigious and highly coveted designation. The considerable training and experience of a board-certified urologist should give you a high level of confidence.

Men are typically apprehensive about a urological exam; there is a special fear about having a doctor examine what's between their legs. But—to put it literally—you are in the hands of an expert. The exam is usually without pain, and the results will often give you peace of mind. The urologist will most likely begin by feeling the patient's lower abdomen to see if the bladder is full. One of the common developments associated with BP! 1 is residual urine, which can build up to such a volume that the bladder becomes distended.

A urine sample will be taken once more; again, this is basically a screening test to provide pertinent information about a patient and his genitourinary tract at a bargain cost. The urologist will look for red blood cells in the urine, which suggest disease in the urinary tract, BPH, bladder infection, bladder cancer, bladder or kidney stones, kidney cancer, or prostate cancer. If red blood cells are present, an X-ray of the urethra and bladder may be recommended. White blood cells (pus cells) in the urine could also alert the doctor to an infection. Although examining the urine sample does not directly contribute to the diagnosis of BPH or prostate cancer, the analysis is a basic and valuable tool for the urologist and well worth the cost.

The patient may also undergo a urodynamic study—a test with a flow meter to determine the flow rate of the urine. This will help the doctor determine whether the patient's symptoms are the result of an obstruction or a different problem, such as bladder abnormalities. In some cases, the doctor will elect to use a catheter to measure the urine left in the bladder after urinating (alternatively, this can now be done more comfortably using a small ultrasound machine).

The PSA test and the DRE will most likely be given again. The urologist may very well detect a problem that was overlooked by a family physician not experienced in giving a DRE. If the patient was referred to the urologist, he or she will certainly want to establish whether or not a problem may exist. The urologist will also want another PSA test, as often a result will vary, and they will want to ascertain a reliable level for future testing.

A variety of sophisticated equipment is available for diagnosing prostate problems. The urologist will order the tests necessary to make an accurate diagnosis. You should discuss these options at length with your urologist; you will feel more relaxed about subjecting yourself to these procedures if you understand why they are ordered. Following are some of the available options.

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THE FOOD-PROSTATE CONNECTION: HAVE YOU CHEWED ON YOUR PLANT ESTROGENS TODAY?

Over the past 20 to 30 years, scientists have not only determined the content of many chemicals within plants, but have also evaluated the role of some of these chemicals in health and disease. One group of plant chemicals studied very closely includes the phytoestrogens, or plant estrogens. It has been proposed that the high intake of fat, meats, and sugar in Western diets, along with a lower intake of plant products, could well contribute to the higher rate of cancers in Western Europe and the USA .

The interaction of the thousands of plant chemicals daily consumed with the various tissue systems in the body is extremely complicated. However, it is known that these chemicals not only influence the metabolism of sex hormones, but also influence protein synthesis, cell growth, the health of blood vessels, and have some role to play with practically every organ, tissue, and cell.

Soy products have been very well studied as a source of phytoestrogens. The two best known phytoestrogens within soy are genistein and daidzein. Other plant estrogens include coumestrol, which is found in the highest concentration in mung bean sprouts. Flaxseed (linseed) oil is an abundant source of lignans such as secoisolariciresinol and matairesinol. The examples are indicative of the variety of plant chemicals available in food. Hence, it would be simplistic to recommend one particular plant or vegetable as a "miracle food." They all have important compounds within them that should be consumed. For practical purposes, it's not necessarily important to remember which plant has which type of chemical composition. Men are likely to be on safe ground if they ingest a wide variety of grains, beans, and legumes.

The plant estrogens, when consumed, undergo a number of metabolic conversions in the gut resulting in the formation of hormone-like compounds. These compounds are then absorbed into the bloodstream, enter the tissues, including the prostate gland, and have the ability to bind to estrogen receptors. They can also perform a number of other functions unrelated to their estrogenic effects. For instance, a chemical known as enterolactone (metabolized in the gut from compounds found in flaxseed oil) inhibits the enzyme 5-alpha-reductase. This enzyme converts testosterone to dihydrotestosterone, a hormone partly responsible in stimulating the growth of the prostate gland. Genistein could possibly interfere with some of the growth factors that stimulate the proliferation of prostatic tissue.

The types of foods eaten have more of an influence on the biochemistry of the body than previously imagined.

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