A child on his fathers shoulders outdoors

Let’s talk about the Big Four. And we’re not referencing the number of major American pro sports leagues, gentlemen. Instead, we’re alluding to medical conditions of the prostate. They might seem embarrassing, but they’re worth discussing with your doctor.

“Symptoms may be due to an easily treated urinary infection – or something serious, such as prostate cancer,” says Andrew Selzman, MD, a urologist affiliated with Memorial Hermann Memorial City Medical Center.

It takes speaking up for your doctor to rule out – or diagnose – if you have an enlarged prostate, prostate cancer, erectile dysfunction or low testosterone. Many have similar symptoms.

“Should I worry that I drip urine or need to use the restroom during the night?”

Why Fess Up: While the most likely culprit is an enlarged prostate gland, you need to rule out prostate cancer, which shares symptoms. Plus, addressing the problem will improve your (and your partner’s) quality of sleep and life. Untreated symptoms only rise with age.

Signs: The prostate gland gets larger with age, starting in your 40s. This can block normal flow from your bladder or urethra (urinary tract). That leads to a slower, delayed or intermittent urine stream, incomplete emptying and dribbling. An infection of the prostate, bladder, urinary tract and kidney also may be to blame. Its signals include urgent, frequent and nocturnal need to pee.

How Common: One-third of men are bothered by symptoms by age 60 and half by age 80.

Diagnosis: Your doctor can rule out cancer with a PSA (prostate specific antigen) blood test, digital rectal exam or a study of your urine for residuals.

Treatment: Medications, minimally invasive therapy or surgery can relieve symptoms.

“Could I have prostate cancer?”

Why Fess Up: Urinary problems also may signal prostate cancer.

Signs: Symptoms are similar to those for an enlarged prostate. See above.

How Common: 10% of men will be diagnosed, though African- Americans and those with a family history of the disease are at greater risk. The likelihood of prostate cancer increases with age.

Diagnosis: Men’s blood levels of prostate-specific antigen, or PSA, should be checked yearly. Any PSA over 4 is a concern for men, and a PSA above 2.5 in men in their 50s and younger is also concerning. So is a rise of 1 point or more from one year to the next. As with an enlarged prostate, digital exams or urine residuals can show cancer. Your urologist also may do a biopsy to screen for cancer cells.

Treatment: Prostate cancer grows slowly, so doctors may check you more regularly to see if further treatment is needed. Radioactive pellets (called brachytherapy) can be planted in the penis to kill cancerous cells. General radiation or removal of the prostate (prostatectomy) may be necessary.

“Why has my sex drive or energy dropped?”

Why Fess Up: You may suffer low levels of the male hormone testosterone, which can be improved.

Signs: You may have less energy, sex drive and erections. You might also be sad, angry or less focused, or be gaining weight.

How Common: Testosterone fuels puberty, hairiness, lower voice and other signs of manhood. Levels dwindle gradually in all men, starting at age 30.

Diagnosis: Blood tests reveal low hormone levels (hypogonadism), but a physical exam and X-rays also may be suggested to determine if your symptoms stem from diabetes, heart disease or a thyroid imbalance.

Treatment: Testosterone can be restored via creams, serums, injections or long-lasting pellets inserted beneath the skin of the lower back. But first, “you have to rule out prostate cancer,” Dr. Selzman says. “Otherwise, testosterone is like putting gasoline on the fire.”

“Why can't I get or keep an erection?”

Why Fess Up: You don’t have to suffer. “If there’s a will, there’s a way. Don’t be embarrassed to ask somebody for help,” says Dr. Selzman. Also, hypertension, blocked arteries and other conditions may be to blame.

Signs: Erections may become less firm or frequent.

How Common: All men have the occasional bout of impotence, but incidence rises 10% per decade after age 40. Thus, 50% of men in their 50s and 60% of men in their 60s have some erectile dysfunction.

Diagnosis: Blood tests and X-rays can screen for blocked blood vessels or other causes.

Treatment: Pills, injections, vacuum erection devices and penile prosthesis can restore function.

For more information on men's health, click here.

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