Turp or laser....MRI vs biopsy

I've been doing CIC since I went in to AUR in July 2014.  I tried the PAE, which I thought was the best option, in 2015.  I also have enlarged mid lobe and, at the time, they thought the PAE would still work, but it turns out that it didn't.  I've only seen 1 of hundreds of cases where the PAE helped for those w/ enlarged mid lobes.  At present, I don't see anything out there that seems better to me than CIC'ing. I'm watching FLA and HIFU, but it is very early days and they have mixed results.  I would like to do something because I'm having to catheterize a bit more often thatn before.

Good luck!

First - hopefully you don't end up with cancer. If you do, they can score its aggressiveness and you can make decisions from there. Most prostate cancers (95%) will never cause a problem, so statistically, you have about a 3% chance of getting a prostate cancer that could hurt you.

I would suggest avoiding laser and TURP. Probably the best option for you right now is Rezum. THey spray your prostate with steam, it kills the tissue and your body absorbs the dead tissue over time. This can be done in a docs office, does not require anesthesia and they can direct the spray where your prostate is obstructing things such as a median lobe. Almost no chance of incontinence or impotence from it, while both are possible with TURP/Laser. THey claim about 3% chance of retro ejaculation with Rezum - based on anectodatal eveidnce on this blog it could be as much as 10%, but still lower than the 100% with TURP and 50% with Greenlight. TURP is outdated and should almost never be performed - if your urololgist suggests it, find another doctor. Too many risks, complications, too long a recovery, ect. Greenlight can cause real problems too - use it as a last resort IMO.

If Rezum doesn't work, it doesn't preclude doing anything more extensive and for most men, it does work. You could also look into FLA (Focused Laser Ablation) which has been a cancer treatment where people kept reporting it helped their BPH, so they are now experimenting with it for BPH. ITs done by interventional radiologists (like PAE is) and doesn't have the track record Rezum and Urolift do, but might be worth looking into.

Meanwhile, stop using that powder mix and get set up to self cath (cic) so if you go into rentention again, you can deal with it without a trip to the ER or foley catheter. Until you make a decision about treatment (assuming that retention wasn't a one-off due to the powder mix) it will buy you as much time as you need and let you live pretty normally.

You should do what you feel is right. If the MRI was clean, I would think that PC isn't an issue and if it is, then it is small, so small in fact that it is unlikely the cause of the enlargement. Probably BPH. I am 48 years old and I have trouble urinating, so bad in fact I am having kidney pain at times and I nearly needed to go to the hospital to be cathed. Eventhough my PSA is still very low at .32. I doubt I have PC, but my dad has BPH, with no suprise, a low PSA. Seems to be a patern here, at least in my family. I may need PAE, but I am not sure where my prostate is enlarged. In your case I would ask my doctor what they thought would be the best action and if you are not ok with Biopsy or even if you are, please get a second opinion. That could change everything. Some times a fresh perspective is what is needed and if both doctors say Biopsy, then maybe it should be done. For me, I would say no to a biopsy, but I have other health conditions that make a biopsy more risky for me. Good luck to ya.

This is my considered advice based on my own experiences.  As your MRI has come ouu clean as you say then a biopsy even a template biopsy is highly likely not going to find anything.

Given that the 4K test gives you a 60% risk of developing PCa, then I would suggest a 6 monthly PSA testing regime and if and when you get into double figures have another MRI and if a lesion is detected I would then recommend another MRI.

In the meantime and if you are not already doing so, radically change your lifestyle.  Exercise regularly, loose weight if you are obese, change your diet to no read meats, no processed meats and no dairy products plus more veg and fruit.

I started all of the above over ten years ago and I'm still on an active surveillance routine.

TURP or Laser?  Laser everytime!  HoLEP is by far and away the best and being one who has experienced it I would recommend it.  Out the same day without a catheter can't be bad or following day if you are operated on late in the day.

Good luck.

Outside of the marathon, was this your only incidence of acute urinary retention (AUR)? I assume they catherized you right after. Do you know how much fluid came out? Have you had your post void residual (PVR) measured under normal conditions. It should be part of any urologist's visit with someone with BPH, especially given an episode of AUR. Have you had a bladder/kidney ultrasound study? This is important, not only to examine the bladder but to see if there is any kidney issues from retention such as hydronephrsis. What are your other symptons besides the case of AUR? Do you know your IPSS score (you can google it and take the 5 minute test).

Unfortunately, urologist's often short course the route from symptons to surgery, especially when presented with a case of AUR. I say, unfortunately, because the right course of action only becomes clear after thorough testing and analysis. You may not need a procedure at all now, or if you do, it's important that the intergrity of your bladder is tested first. That test is called urodynamics, the best being video urodynamics? Have they mentioned that to you. Also, I would think cystoscopy should be done prior to any surgery.

Jim