Sandeep Mehta, MD

An elevated PSA does not automatically mean prostate cancer. We use a step-by-step approach to understand your risk before deciding whether a biopsy is needed.

• What PSA means: PSA reflects prostate activity — not a cancer test by itself. It can rise from an enlarged prostate (BPH), infection or inflammation, recent ejaculation, or urinary irritation, as well as cancer.
• MRI & risk review: For most patients the next step is a prostate MRI, which gives a PI-RADS score and prostate size (used to calculate PSA density). We also weigh age, family history, and prior biopsies.
• Biopsy vs. monitoring: Not every elevated PSA needs a biopsy. Options may include repeat PSA, continued monitoring, or biopsy. The goal is to avoid unnecessary biopsies while still catching cancers that matter.
• If a biopsy is recommended: Dr. Mehta performs a transperineal prostate biopsy (through the skin), sampling 10 standard sectors plus 2–3 targeted samples from any MRI region of interest.

A prostate cancer diagnosis doesn't mean everyone needs the same treatment right away. For most localized cancers there is time to review your options carefully. Your risk comes from your PSA, MRI, biopsy (Gleason / Grade Group), stage, and sometimes genetics — and the choice balances cancer control against urinary control, erections, bowel effects, and recovery time.

• Active surveillance: close monitoring with PSA, MRI, and repeat biopsy for many low-risk and select favorable intermediate-risk cancers. This is careful monitoring, not ignoring the cancer.
• Robotic surgery: removes the prostate (checking lymph nodes when needed) and provides final pathology; PSA is expected to become undetectable afterward. Main tradeoffs are catheter recovery, urinary leakage, and erection changes.
• Radiation ± hormone therapy: whole-gland treatment without surgery. If you choose radiation, Dr. Mehta typically places a SpaceOAR spacer and gold markers beforehand; hormone therapy depends on your risk category.
• Focal therapy (HIFU): treats a single targeted cancer area in carefully selected cases, with less long-term data than surgery or radiation.

BPH (benign prostatic hyperplasia) means the prostate has enlarged and is squeezing the urine channel. It is common with age and is not cancer. It can cause a weak stream, straining, starting and stopping, frequency, urgency, getting up at night, or a feeling that the bladder doesn't empty — and in some men, urinary retention, recurrent infections, bladder stones, or blood in the urine.

Why see a urologist? Many men start treatment with their primary doctor. Urology gets involved when symptoms persist, medicines aren't tolerated, or there may be a fixable “plumbing” problem. Our job isn't to pressure you toward surgery — it's to understand your symptoms, check how well your bladder empties, and explain every option.

Medications are usually the first step.

• Alpha-blockers (tamsulosin/Flomax and similar) relax the prostate and bladder neck to improve flow, often within days.
• 5-alpha-reductase inhibitors (finasteride, dutasteride) shrink larger prostates over months; we usually check a PSA first, because these medicines change how PSA is read.
• Other options can include daily tadalafil (Cialis) and bladder-calming medicines (beta-3 agonists or antimuscarinics) when urgency is a major problem.

Procedures become reasonable if medicines don't work, cause side effects, or you prefer a more lasting fix. The goal is to open the prostate channel and, when possible, reduce or stop BPH medicines. Options I offer at Baytown include:

• GreenLight PVP (laser vaporization): a side-firing laser vaporizes the blocking tissue. A good fit for smaller and moderate prostates (in our practice, generally up to about 60 grams). No incisions, and many patients go home the same day.
• HoLEP (laser enucleation): a laser “peels out” the entire inner blocking tissue — like removing the fruit and leaving the peel. It works for any prostate size, including very large glands, and has the lowest chance of needing another prostate procedure later.
• TURP: the long-established standard, trimming the blocking tissue through the scope; well suited to moderate-sized prostates.
• UroLift: tiny implants hold the prostate lobes open without removing tissue — best for smaller prostates, and the option most likely to preserve ejaculation.
• Aquablation: a heat-free, image-guided water jet removes blocking tissue, used for selected prostates.

Many kidney findings are discovered by accident on a scan done for another reason. A kidney finding does not automatically mean cancer — many are simple cysts, and some are small, slow-growing tumors found early.

• Get the right scan: Most patients need a dedicated renal mass protocol CT or MRI (imaging before and after contrast) to see whether an area truly enhances.
• Sort the finding: Scans help separate simple cysts, complex cysts (graded Bosniak 1–4), and solid masses.
• Choose a plan together: Depending on size, location, kidney function, and your health, options may include active surveillance, biopsy, ablation, focused radiation (SBRT), robotic partial nephrectomy, or radical nephrectomy.

Contrast questions: A CT contrast (iodine) allergy does not automatically rule out MRI contrast (gadolinium). Many patients with kidney disease can still be imaged safely with radiology's help.

Stone referrals often arrive with incomplete information. At your first visit we're answering three questions: is there truly a stone causing the problem, where is it and is it blocking the kidney, and is treatment needed now or is watchful waiting reasonable? A non-contrast CT stone protocol is usually the most useful test — please bring any outside images on a disc or USB, not just the report.

• Treatment depends on the stone: options range from observation (small, non-blocking stones) and a medication-assisted trial of passage, to shock-wave therapy (ESWL), ureteroscopy with a laser and a temporary stent, or — for large or complex stones — a procedure through the back (PCNL).
• Preventing the next stone: most stones are calcium-based, and the biggest drivers are usually dehydration and too much salt. Drink enough to keep your urine pale yellow (about 2–2.5 liters a day), cut back on sodium, keep normal dietary calcium with meals, add citrus such as lemon water, and limit sugary drinks.

Urinary symptoms — burning, urgency, frequency, or bladder pressure — are a common reason to see urology, whether it's a single infection or ones that keep coming back. Your symptoms are real, but not every episode of burning or urgency is actually an infection, so our job is to confirm what's really going on and treat the right cause.

• One clue alone doesn't prove a UTI. A dipstick, white cells, or cloudy urine can suggest inflammation but don't always prove infection — and a CT that mentions “bladder wall thickening” isn't proof either. The clearest answer combines your symptoms, urine inflammation, and a urine culture, ideally collected during symptoms and before antibiotics (prior antibiotics can make a culture falsely negative).
• Symptoms can overlap with other things — overactive bladder or pelvic-floor spasm, vaginal dryness or irritation, kidney stones, incomplete emptying, or non-urologic pelvic and back pain. Treating these as infections with repeated antibiotics doesn't help and can cause resistance, yeast infections, and side effects.

Recurrent UTIs usually means 2 or more infections in 6 months, or 3 or more in a year. We look at the whole pattern — your symptoms, urine inflammation, culture history, prior antibiotics, and any kidney, bladder, or prostate factors.

• PCR / molecular urine testing can help in select tricky cases — for example, when cultures keep coming back negative or antibiotics were already started. But more sensitive isn't always better: a positive PCR can pick up harmless, leftover, or contaminating bacteria, so we read it together with your symptoms and history. A positive test by itself is not automatically an infection.
• We usually don't test or treat when you feel well. Bacteria can live in the urine without causing symptoms (called asymptomatic bacteriuria), and treating that tends to do more harm than good — with a few exceptions, like pregnancy or before certain procedures.

The “plumbing” check. Beyond choosing an antibiotic, urology looks for a fixable cause — incomplete bladder emptying, kidney swelling (hydronephrosis), stones, bladder-outlet or urethral narrowing, and, in men, the prostate. A bladder scan, selective imaging, or cystoscopy may be used when there are warning signs (such as blood in the urine, a smoking history, stones, or unusual symptoms), but these are not routine for every straightforward case.

• Women and men differ. In women, recurrent infections are common and menopause-related tissue changes often play a role — vaginal estrogen is one of the most useful non-antibiotic options. In men, recurrent infections more often point to the prostate or incomplete emptying from an enlarged prostate, which may need a different plan.
• Prevention is individualized. Depending on the cause, options include better hydration, vaginal estrogen after menopause, cranberry or methenamine, and carefully chosen preventive antibiotics. (Evidence for D-mannose is weaker after a 2024 trial.)

To your visit, please bring prior urine cultures or PCR results, imaging reports or discs, a list of antibiotics you've taken, and a timeline of your symptoms.

Finding blood in the urine — called hematuria — can be stressful, but most people who are evaluated do not turn out to have cancer. It comes in two forms: microscopic hematuria (seen only under the microscope on a urine test — you can't see it yourself) and visible (gross) hematuria (urine that looks pink, red, tea-colored, brown, or bloody). Visible blood usually needs a more complete evaluation.

Common causes include urinary infections or inflammation, kidney or bladder stones, an enlarged prostate, a recent catheter or procedure, vigorous exercise, benign kidney cysts, or medical kidney disease — and, less often, bladder, kidney, or upper-tract cancers. Sometimes no cause is found.

The testing is matched to your risk — based on your age, sex, smoking history, how much blood is present, whether it's microscopic or visible, and whether it keeps coming back. Not everyone needs the same tests. The workup may include:

• A repeat urine test to see whether microscopic blood clears or persists — often all that's needed for low-risk cases.
• Cystoscopy: a brief office camera look at the bladder and (in men) the prostate channel, done with numbing jelly; most patients drive themselves home. Imaging alone can't reliably rule out a bladder problem, which is why this matters.
• Kidney/bladder ultrasound: a no-radiation look at the kidneys and bladder, often used for intermediate-risk cases.
• CT urogram: a detailed CT scan with contrast of the kidneys, ureters, and bladder, used for higher-risk cases or visible blood when appropriate.
• Urine culture or cytology in selected cases (a culture checks for infection; cytology looks for abnormal cells).

Hearing “bladder mass” or “possible bladder cancer” is frightening — but the evaluation is very stepwise, and we don't decide treatment from a scan or a single look. A bladder mass is simply an abnormal area inside the bladder, usually found on cystoscopy or imaging (CT or ultrasound), most often because of blood in the urine. It isn't truly diagnosed until a sample is removed and reviewed by a pathologist.

The reassuring part: many bladder tumors are caught early, before they reach the bladder muscle (“non-muscle-invasive”), and many can be treated and followed entirely through the urinary channel — no abdominal cuts or major surgery.

TURBT — the key first procedure. TURBT (transurethral resection of bladder tumor) uses a scope passed through the urinary channel to remove or biopsy the visible tumor — there are no abdominal incisions. For many early tumors, this is also the first treatment. The tissue goes to pathology, and most patients go home the same day (sometimes with a temporary catheter; some mild bleeding, burning, and frequent urination afterward are normal).

The pathology report is the turning point. It tells the grade (how aggressive the cells look — low vs. high grade) and the stage (how deep it goes). The most important split is:

• Non-muscle-invasive (Ta, T1, or CIS): on or just under the bladder lining, not into the muscle — often managed with local urology care.
• Muscle-invasive (T2): the cancer has reached the bladder muscle — a different category that usually involves a larger treatment team.

Sometimes a second (repeat) TURBT is recommended soon after — for example if the tumor was high-grade, large, or T1, or if muscle wasn't in the first sample — to confirm the stage and clear any remaining tumor.

Treatment is guided by your risk group. For non-muscle-invasive cancer, low-risk disease is often TURBT plus surveillance; intermediate- and high-risk disease often add medicine placed directly into the bladder (“intravesical therapy” — through a small catheter, not IV chemotherapy) such as gemcitabine, mitomycin, or BCG. Muscle-invasive cancer is managed by a larger team and may involve chemotherapy, immunotherapy, radiation, bladder removal, or bladder-preserving approaches.

Follow-up is part of treatment. Bladder cancer (especially non-muscle-invasive) can come back, so surveillance cystoscopy is routine, on a schedule matched to your risk group.

The first question with urinary leakage is what type it is, because the treatment is different:

• Urgency leakage (overactive bladder): a sudden "I have to go right now" feeling, frequent trips, waking at night, or leaking before you reach the toilet.
• Stress leakage: leaking with coughing, laughing, sneezing, lifting, or exercise — usually related to pelvic floor support.

Many women have both (mixed leakage); we'll decide together which is most bothersome. Workup may include a symptom review, urine testing, a look inside the bladder (cystoscopy), and a cough stress test.

A vasectomy is considered permanent birth control. Only choose it if you're comfortable with permanent sterilization — if you're unsure, it's better to wait.

• What changes: Sperm is blocked from the semen. Testosterone, sex drive, erections, orgasm, and ejaculation should not change; semen looks essentially the same.
• Where it's done: About 90–95% of vasectomies are done in clinic with local numbing only. Many patients drive themselves home; bring a driver if you're nervous, prone to fainting, or take sedating medicine.
• Recovery: Plan for light duty 3–7 days, use scrotal support and ice, and avoid heavy lifting and strenuous activity until improving.
• It doesn't work right away. Keep using birth control until a semen test (usually 8–16 weeks later) confirms success. A vasectomy does not protect against STIs.

ED means difficulty getting or keeping an erection firm enough for satisfactory sex. It's very common, especially with age, and is often treatable. Because penile blood vessels are small, ED can sometimes be an early sign of cardiovascular disease — so it isn't just a "penis problem."

• Why a broader check-up helps: We often review diabetes (A1c), cholesterol, blood pressure, medications, cardiovascular risk, and testosterone when symptoms suggest it.
• First-line treatment is usually pills: PDE-5 inhibitors such as sildenafil (Viagra) or tadalafil (Cialis) improve blood flow — sexual stimulation is still needed.
• Important safety warning: Do not combine ED pills with nitrates (nitroglycerin, isosorbide) or "poppers" — the combination can cause a dangerous drop in blood pressure. Tell us about any chest pain or heart disease.
• If pills aren't enough: options include a vacuum erection device, penile injection therapy, intraurethral medication, or an inflatable penile prosthesis (surgery).