Medication Vs Surgical intervention.
Posted , 22 users are following.
Hi all,
Just wondering how many of you, if any, have chosen to avoid surgical intervention of any sort and remain, long term, on medication for your BPH.
By long term I mean four years or more.
In particular I would be interested to hear from anyone who has been taking Finasteride alone or in combination with Tamsulosin.
With regards to Finasteride which, supposedly, shrinks the prostate have you noticed a gradual improvement in your flow rate over the years and, in particular, in the fourth or fifth year?
I have been taking Tamsulosin for around seven years and Finasteride for almost five. Over the past six or so months I have perceived a better flow rate, variable, and less frequency along with some nights only having to get up to the loo two or three times, which is an improvement.
I was advised to have a TURP almost two years ago now, after a urodynamic test, but opted for Urolift, for which I am still waiting, but am wondering whether I still need it or should I just carry on with the meds.
Best wishes to all who read this forum.
Steve.
0 likes, 61 replies
lester90053 stephen54687
Posted
The consensus of opinion on this and other forums is that nothing yet invented is a cure-all.
stephen54687 lester90053
Posted
Hi Lester,
Indeed! If only one could be found!
oldbuzzard stephen54687
Posted
The meds help some people, but not most. The side effects can be bad and in some cases not reversible.
The less invasive procedures that don't preclude a surgery later (Rezum, PAE, FLA) make sense as a first option. They work for most people (PAE not good with and enlarged median lobe) with no anesthesia, quick recovery and very low side effect profiles.
The only drug I would take is Alfusozin. The others all had too many side effects for me.
kenneth_42676 stephen54687
Posted
i had a TURP last june and the urologist still has me on flomax ,i was told id always be in it now .
doesnt make sense to me .
id advise against a TURP, its as barbaric of a procedure as you can ever imagine .
derek76 kenneth_42676
Posted
Did he give you a reason for that ?
After my second laser procure my surgeon suggested that I take Avodart to stop it from growing again. I was not at all in favour and asked him if at my age he thought that it had time to grow to need a third procedure. He glanced at my age on his screen (79 at that time ) and said perhaps not. Six years later no problems.
tom86211 kenneth_42676
Posted
Kenneth,
id advise against a TURP, its as barbaric of a procedure as you can ever imagine .**
What??
I had a bipolar TURP 4/5th of this year. My BPH symptoms are slowly improving. I had a general anesthesia and was completely unaware of the operation. The only negative was the Foley catheter I had to use for three days after. Was out of the hospital four hours after the operation. I had a PAE a year and a half prior and it was only slightly helpful for a year only due to median lobe.
I am completely happy I had my bipolar TURP which is NOT the same as the older style monopolar TURP. After getting off the Foley I have had no blood in my urine, no pain, just going through a slow improvement process.
Tom
kenneth_42676 tom86211
Posted
you had a different TURP than i did, glad it worked for you .....
tom86211 kenneth_42676
Posted
Ken,
The bipolar TURP uses a loop to cut the tissue and a plasma button to cauterize. The irrigation fluid is saline. While wearing the Foley my urine was pink and there were a few blood clots, but once the Foley was out the urine color went back to light yellow and no more clots. Improvement from pre-op has been slow and gradual.
Since this post is about medication to improve BPH symptoms, I have recently added Azo Bladder Control capsules, taking two per day. I stopped my trospium (for overactive bladder) because it wasn't doing anything, but the Azo seems to be working and I noticed the improvement almost immediately. It appears to calm the bladder and improve the flow.
Tom
jagdeesh stephen54687
Posted
Dear Stephen ,
I have been on Alfusozin - 10 mg for over two years ; ( One at Bedtime ); No side effects ;
I am taking oneURIMAX - D Tabletin the morning ( which contains 0.4 mg Tamsulosin and Dutasteride 0.5 mg ) ;since Last One month -- recently prescribed by the URO ; ( so far no Side Effects ) ;
I get up one to two times at Night to pee ,My Prostrate size is 72 Gms ;PSA is 1.36
No I have not undergone any Surgery for enlarged Prostrate ;
After perusal of thefeedback from other Members posted by them on thisForum ,I have Learntthat even after undergoing Surgery , Uros are still prescribing Tamsulosin to patientson long -- term basis ;
I plan to continue with the above Medication ;
I realize that there is no One Cure all --- whethersurgery or Medication ;
Controlling / monitoring intake of Water /Fluids during the dayis Very Necessary ;
Thks / Rgds -- Jagdeesh
nick67069 stephen54687
Posted
I am taking Tamsulosin for maybe 7 years or so. The dose is 0.2mg and lately it seems to be less effective. I have tried some other medication, for a short time, but side effects ( dry ejaculation) was a reason that I stopped. When I tried 0.4mg dose, it helped with BPH, but had also sometimes dry ejaculation or at least drastically reduced quantity.
My last "discovery" was a combination of 0.2mg of Tamsulosin and 2.5mg of Cialis ( I split 5mg pill) and it seems to work. My night visits to bathroom are reduced to max 3, usually 1-2 times and occasionally I sleep thru the night. My prostate is about 70 gr, and PSA is relatively high ~11, but stable.
What I like about the Tamsulosin and Cialis combo is that it seems that CIalis reverses some of the negative side effects of Tamsulosin, does not introduce negative side effects and provides overall better QOL .
Note: Initially I was using 5mg Cialis daily, and it worked great on BPH, but after a month or so I suspect it started to cause some muscle pain in my legs and back. Reducing the dose to 2.5 mg avoided muscle pain.
stephen54687 nick67069
Posted
Hi Nick,
Good to hear you have found the right combination. Was it 'trial and error' on your part or were you prescribed the drugs by a doctor?
I agree with you regarding the reduction in ejaculate with Tamsulosin but, what I found, the addition of Finasteride really put paid to it completely.
Would you consider any sort of surgical intervention, if your symptoms remain the same, or are you quite happy to continue with the meds indefinitely?
Take care,
Steve.
nick67069 stephen54687
Posted
I have tried Cialis by itself and was not happy with results. Combo that is currently working for me is a result of experimentation. When I told my doctor about Tamsulosin and CIalis combo... his comment was " it is a good idea".
I thought about surgical option and to be honest, as long as my symptoms stay as they are, I will just take meds.
MichaelVM7 nick67069
Posted
Nick
Cialis improves your flow? I am up to 0.4 mg Flomax 2x/day
Flomax (Tamsulosin) decreases libido but w/o it my stream is weak, especially at night
I haven't tried Cialis. Since it doesn't shrink prostate like Finasteride I thought it was a substitute for Tamsulosin
Do you take them together or at opposite ends of the day?
At 70 cc, your prostate isn't huge but definitely enlarged
My prostate is 130 cc. My PSA was 11 last year, down to around 5 now. I must have had prostatitis along w BPH last summer
Any idea why your PSA is so high?
Michael
derek76 MichaelVM7
Posted
Big prostate equals his PSA. Mine was about 9.8 with 130 grm prostate and down to 0.74 after laser procedure.
nick67069 MichaelVM7
Posted
I take Tamsulosin 0.2mg at night , 9:30PM and Cialis 2.5mg after breakfast ~9AM or so. Although they have similar function ( muscle relaxing ), combo has less of side effects for me, thus why.
My prostate has been about the same size for last several years, measured with MRI 3Tesla scans, so it seems that it has not changed. I always had elevated PSA readings, and when I developed another unrelated autoimmune condition ( PMR ) my PSA went thru the roof, It was as high as 24 + and my prostate did not change the size. It seems that PSA number is relative measure and , the way my uro explained to me, only trend, not the number itself is important. I had to take steroids ( prednisone) to control PMR and over time PSA slowly drifted back to 10-11 range. Size of the prostate was constant during this period. The reason I had MRI scans was to check if there is any trace of cancer and none was found.
nick67069 derek76
Posted
Not necessarily - see my response to MichaelVM7 ...
TKM nick67069
Posted
Nick,
I was told by a urologist that Medicare and most insurance would not pay for a 3T MRI, so I would have to pay for it myself, if I wanted it.
Can I ask how your 3T MRI was paid for ?
Thomas
nick67069 TKM
Posted
Sorry I can't really help you with advice on how to get coverage from insurance for 3T MRI. Although I lived in US for most of my working life and have medicare, after retirement I moved to Japan. Here, with socialized medical coverage everyone is insured and there was no question by insurance after urologist ordered 3T MRI. The cost was reasonable even if you were to pay without insurance; my co-pay at 30% was only $60-$70.
MichaelVM7 nick67069
Posted
Nick,
Glad to read you had a 3T MRI. I was a little concerned because your PSA density is around 0.16.
But the 3T MRIs are good at seeing suspect lesions.
With a PSA of 24 you may have had prostatitis at the time.
I'd like to take less Tamsulosin (Flomax). I take 4x what you do daily but w/o Cialis.
Michael
MichaelVM7 TKM
Posted
Thomas,
Do you have an elevated PSA or a PSA that is trending upward? If so, how can Medicare deny an MRI?
Ballpark est. for a 3T MRI w/o contrast is $3000. That is a big chunk of change out of pocket.
Let me guess....Medicare would cover a blind 12-core TRUS guided biopsy, huh?
I'm against single payer (Govt-controlled) health care in the US, but our system does have flaws. Not covering an MRI if your PCP or Uro identifies ICD and diagnostic codes supporting the need for imaging to screen for cancer is terribly wrong.
Michael