Medical, surgical or no treatment. Please help me decide.
Posted , 12 users are following.
I have written before and had helpful advise but am no further on in spite of seeing another urologist.
I suffer from difficulty starting to urinate and poor flow/stream. I never need to go during the night and usually go 6 hours or so between visits to the toilet. I feel fairly confident that I do not have any urine retained.
1st Urologist did ultrasound scan of my prostate, DRE and flow test. After a very brief discussion told me I would have to have TURPS. Booked me in for cystoscopy to be followed by the operation. I was unhappy about the operation and managed to speak to him a couple of days before and he agreed to cancel and told me to seek drug advise from my GP about suitable treatment to be followed by another appointment with him to have further stream test.
After several letters and telephone calls to the urologist my GP could get no report of my condition or results of the cystoscopy.
He finally referred me to another (also private) urologist. This one just did a DRE, told me I had a medium sized prostate and that the only options were Tamsulosin, Finesteride or TURPS. He discounted GL treatment saying that TURPS was the only sure treatment. I mentioned to him that my stream was not consistently poor and varied, especially with improvement after sex and is very poor when sitting on the toilet. He said this would not happen and that it would be consistently poor. He offered no explanation for the variation and said it could not be anything other than enlarged prostate causing my problems. He prescibed Tamsulosin and booked me in for a consultation in 4 weeks. (I was a bit bothered that he took 3 phone calls during my consultation which I thought unprofessional).
Neither consultant gave me a measurement for my prostate or suggested that retained urine should be measured.
Having read about Tamsulosin, I am concerned about the side effects. Specifically I do not want to stop running as it keeps my weight down and fitness up but there are warnings about vigorous excercise and sweating. I also have a slow heart rate (40bpm) at rest but normal blood pressure. Do people think that I ought to try the drug or is there a serious health risk with my running, especially in warm weather? Also, do the side effects or RE and reduced sex drive stop when I stop the drug? It is very difficult to find information about these things and the urologist didn't mention the serious side effects and only commented (after me asking him) that I shouldn't have eye surgery whilst taking it and should stop just for the surgery. I don't need surgery at the moment but fully expect to as eye problems run in my family.
Finally the second urologist said that I shouldn't have regular PSA tests or DRE as they lead to false positives. When I asked if he thought it could be cancerous he just said he couldn't be sure but didn't think so.
I would be very grateful for any comments from anyone out there.
Sorry for the lengthy post.
Thank you for taking time to read it.
Richard.
0 likes, 23 replies
harveybronx richardeblack
Posted
First, it seems like you should find still another urologist. It seems life threatening to not have regular PSA (and free-PSA) tests and also DRE. It’s a ridiculous argument that there may be false positives. Are you supposed to wait until you have symptoms of metastatic prostate cancer before you take action? More information is always better than less information. You just need to do some research to know what to do with the information. Or find a urologist who doesn’t treat you like an idiot who needs someone else to make your decisions for you. And an answer like: "couldn't be sure but didn't think so" is useless and unprofessional.
There is a great article regarding TURP and all other forms of “reaming” the prostate on the PubMed website. Just search for the article’s title and it should come up: “HoLEP: the gold standard for the surgical management of BPH in the 12st Century”, by John Michalak, et al., pub. April 30, 2015
I’m 74 y.o. and my prostate is 70cc, about twice the normal volume. During the day I have no problem urinating if I urinate when the urge strikes, although the rate of flow is widely variable. If I have a strong urge and hold it in because, say, I’m driving, building up pressure, the stream typically begins with a low flow rate and gradually increases in flow rate.
At night, I do awaken about every 3 hours while asleep to urinate, and have a similar problem when beginning to urinate; but, none of this bothers me.
I would not want to take any medication unless absolutely essential. The side effects are often worse than what's being fixed. It does not bother me that sometimes my urine stream is slow or very slow, or it’s sometimes difficult to begin urinating. That’s hardly life threatening. It’s not a problem that demands fixing unless you can’t urinate at all. And that’s something I sometimes think is happening when it takes a particularly long time to begin urinating. So, if that should happen, I know where the nearest emergency room is. No big deal.
j12080 richardeblack
Posted
Rick, my advice, get a 3T (tesla) MRI using a pelvic coil or if you can't find a pelvic coil a transrectal coil. The pelvic lays across the pelvic area. The rectal coil is inserted in the rectum for the MRI. With this test, you will detrimine several facts that you need to know. This is quick and painless and much more informative than a DRE and a biopsy. 1) you will finally know you volume (size of prostate) 2) you will know if you have cancer lesions. 3) you will know your mass density of you prostate. A radiologist is who does this. Not a urologist. That is why even though I is better and painless, they will not tell you about this. If you have cancer then, focal laser abalation is the way to go as it targets the specific tumor and has not side effects. If you only have BPH, then PAE is the best choice in my opinion. Also, to be full informed abou your situation, I would recommend a PSA and a Free PSA blood test as baseline number to use to watch. Then you will know where you are and can proceed with a active surveillance program while watching you symptoms. Lots of things are coming down the road soon in this area. Good luck.
richardeblack
Posted
Thank you for all the detailed comments and the message. A lot of food for thought. I will read them all thoroughly and will make a decision then.
I am so grateful for this forum where so many people take the time to be so supportive. It is so difficult when you just have to rely on doctors and consultants who don't seem to want to explain anything, just follow their own agenda (at least that is how it seems sometimes).
I will keep you posted about how I proceed.
Thank you very much,
Richard.
zdzislaw richardeblack
Posted
I would be most concerned about your heartbeat. 40bpm is bradycardia. Are you sure? Either you are a confirmed athlete than maybe, ok, but still it is low.
The use of betablockers doesn't do anything to your sex life, although I found some of thenm (alfuzosin) more inocuous than others. All side effects are temporary. It will lower your blood pressure, but nothing dramatic. Only this bradycardia????
dai12345 richardeblack
Posted
HI. I had a greatly enlarged prostate and my excellent urologist suggested HoLep as the best treatment for me as HoLep is ideal for a really large prostate. I am totally satisfied by the procedure much more than expected. Recovery was very quick and the only negative is retro ejaculation but as mine was small anyway and I'm 70 it doesn't matter. Urination is great and sex life unchanged. There was no pain after the first day and never any leaks. My excellent HoLep urologist in Cambridge implied GL was more suited to smaller prostates. HoLep requires great skill, training experience and I'm sure GL does as well so a good surgeon is important. Laser treatment must be better than TURP where no cancer is suspected. Retained urine is a big and silent problem. My urologist found my bladder was twice normal size and thought it might be 'dead' but tests showed it was fine; don't leave it 'til the bladder is 'dead'. BTW my brother who also has an enlarged prostate is taking Tamsulosin with no problems as well as Finasteride
bruce00991 richardeblack
Posted
Hi,Richard. You do not give your whereabouts so I have assumed it is in the UK. Regarding PSA test, some 15 years ago I had an excellent GP, who, when I asked for a PSA test said that one on its own is meaningless, you need to have a PSA test at least once a year and record the results. Several house moves and GPs later, I have a 15year data base of my PSA and can report that it is fairly constant. The GP said slight rises year on year would point to a slow growing cancer; a steep rise, an aggresive one needing prompt attention.
Next, regarding BPH, my symptoms were similar to yours, but I really didnt want to be on drugs for the rest of my life, I'M 70 BTW, so being in good health I opted for a Bi polar TURP this proceedure was approved by NICE only last year.. My uro was very good, talked me through the proceedure and the risks. My op was at the end of July. I am happy to say that I had no pain, no bladder spasms and no incontinence, only stinging at start and end of urinating and no drugs e.g tamulosin. I still pass a very little blood but it is getting less each day, in fact today I passed no blood on two occasions. My hospital stay was for two nights, the op late afternoon day 1, catheter and irrigation on day 2, catheter removed and home, day 3. If my experience is anything to go by, if you have no other health issues get it done soon.