Turp or laser....MRI vs biopsy

Hi Lester,

That would be a dream come true for me.

How many times a day did you catheterize during that period?

Do you remember what your average PVR was?

Thanks.

You should consider getting a full workup - including bladder tests to see how much of your problem is due to problems there. If your bladder is functioning reasonably normally, Rezum may be an option for you. If not, there are cases where self cathng has gradually allowed bladders to function.

Find out what's causing your problem before arriving at a treatment is my suggestion.

Thank you for your advice. I am inclining to not do a biopsy and hearing the advice from other guys reinforces my thought. Doctors always want to do a biopsy to cover themselves from negligence.

Scaring the fact how many people suffer with this issue. I wonder what is the underlying cause that makes the BPH in our culture. Also, can it be reversed? If we continue this route, how will our children be affected in 30 years and beyond?

I don't think there is much evidence pointing to bph as culturally caused. It seems to be a part of the aging process - one they haven't been able to identify causes for. Nothing they've come up with reverses it, so they have focused on chopping the prostate down to size throgh various means and they get less barbaric over time.

I really don't know  the prevelance of BPH of our culture versus others, but we sit a lot, and are often too "busy" to take the time to go to the bathroom to the point where the capacity to "hold it in" has become a point of honor to some. I would say that a good proportion of what we term BPH has as much to do with prostate growth and more to do with bladder stretching due to bad habits from youth. 

Jim

By mentioning "culturally" I might have used a wrong word. According to internet information, men in Japan for example have a much lower incidence in BPH, hence I assume it has to do with diet and life style. I would actually want to know the underlying causes, so that the generation following us can be more proactive now.

Hi, Emil,

If you're interested, you may want to read up on Dr. Richard Ablin, the researcher who discovered PSA. He's done some writing on the what he calls the prostate hoax--and about how BPH has become a huge industry. After reading his work, I no longer put any stock in my PSA reading--and I've made that clear to my urologists. Others feel differently, and I understand that. I do listen to what my urologist has to say--but I research the heck out of recommended procedures and drugs.

I'm 62 years old, and up until this last year I was very active like you, running, hiking and snowshoeing. My AUR came on slowly--and I didn't feel any pain with it--and I was still urinating. When they figured out what was going on, they drained 7 liters out--that's right, 7 liters. It's important to know how well your bladder is working before choosing any course of treatment. Cleaning the pipe won't do any good, if the pump is weak.

If you are thinking about Prostate Artery Embolization (PAE) or Focused Laser Ablation (FLA), keep in mind those procedures are done by interventional radiologists--not urologists. Doctors tend to promote the procedures they were trained in--but it's up to you to decide what's best.

It sounds like you live a healthy lifestyle, regarding diet and exercise. I eat mostly paleo now and keep a food journal. There are foods that cause prostate inflamation for me, and I try to avoid them. I used to take antihistimines for seasonal allergies, and I think those played a part in my urinary retention--so now I avoid drugs, including the ones they use for BPH. Now I pretty much control my allergy symptoms through diet. I have hernia surgery coming up, and I will take some antibiotics and pain meds for it. But I'll get off those drugs asap.

Welcome to the forum. Best of luck as you research your treatment options.

Stebrunner

Hi Stebrunner,

​Happy to read your comment. I read that prescription drugs treating BPH are actually also potentially dangerous to develop PC. Hence I am trying to avoid them. Also will read up on Dr. Richard Ablin and find out about my hormonal balance which apparently also plays a role with inflammation. If you have further advice about your nutrition plans, please share. These things are so important and eventually the root of the problem we are facing.

Agreed re antihistamines.  I was taking them for hives and that is what sent me in to AUR.

Hi arlington, did you know the mechanism by which antihistamines caused your AUR ?

Also, did you try finasteride or dutasteride for your large median lobe ? Hank

Hi Steb, what foods cause your prostate inflammation ? Hank

..." I read that prescription drugs treating BPH are actually also potentially dangerous to develop PC..."

Where did you read this ? Hank

I don't think that's true (probably broscience) but I do believe that BPH increases your odds of ultimately getting prostate cancer.

My urologist showed me studies where finasteride/dutasteride were shown to increase the possibility of prostate cancer.  He also said it had been disproven - to some extent.  It dsidn't give me a lot of confidence in the drug.

Every doctor I have spoken to (and there have been many) have told me that there is no correlation between BPH and prostate cancer.

Over-the-counter cold and flu preparations that contain both antihistamines and decongestants can create a “perfect storm” for men with symptomatic benign prostatic hyperplasia (BPH). These products could substantially worsen symptoms of BPH, make it harder to urinate and may trigger complete urinary retention.Decongestants increase the resistance to urine flow through the prostate by causing the smooth muscle in the prostate to squeeze the urethra, and antihistamines weaken the bladder contractions. This lessens the bladder’s ability to expel the urine.

The ability to urinate normally depends upon having a forceful bladder muscle contraction to expel the urine and a low resistance to the flow of urine through the prostate gland and out the urethra. Anything that weakens the bladder’s ability to contract or increases the resistance to urine flow out of the bladder makes it more difficult—and sometimes impossible—to empty the bladder.

Re: finasteride/dutasteride: both for about 8 months (no improvement)

Abstract: Benign prostatic hyperplasia (BPH) has been suggested to be a risk factor for certain urologic cancers, but the current evidence is inconsistent.

The aim of this study was to investigate the association between BPH and urologic cancers.

MEDLINE, EMBASE, Cochrane Library, and Web of Science were searched for potential eligible studies.

We included case-control studies or cohort studies, which evaluated the association between BPH and urologic cancers (including prostate cancer, bladder cancer, kidney cancer, testicular cancer, or penile cancer).

Overall effect estimates were calculated using the DerSimonian–Laird method for a random-effects model. Summary effect-size was calculated as risk ratio (RR), together with the 95% confidence interval (CI).

This systematic review included 16 case-control studies and 10 cohort studies evaluating the association of BPH and prostate or bladder cancer; we did not identify any study about other urologic cancers. Meta-analyses demonstrated that BPH was associated with an increased incidence of prostate cancer (case-control study: RR?=?3.93, 95% CI?=?2.18–7.08; cohort-study: RR?=?1.41, 95% CI?=?1.00–1.99) and bladder cancer (case-control study: RR?=?2.50, 95% CI?=?1.63–3.84; cohort-study: RR?=?1.58, 95% CI?=?1.28–1.95). Subgroup analysis by ethnicity suggested that the association between BPH and prostate cancer was much stronger in Asians (RR?=?6.09, 95% CI?=?2.96–12.54) than in Caucasians (RR?=?1.54, 95% CI?=?1.19–2.01). Egger's tests indicated low risk of publication bias (prostate cancer: P?=?0.11; bladder cancer: P?=?0.95).

BPH is associated with an increased risk of prostate cancer and bladder cancer. The risk of prostate cancer is particularly high in Asian BPH patients. Given the limitations of included studies, additional prospective studies with strict design are needed to confirm our findings.

September 24, 2011 — The largest registry study so far has found a significant association between benign prostatic hyperplasia (BPH) and prostate cancer. The finding was reported here at the 2011 European Multidisciplinary Cancer Congress by Danish researchers, and comes from an analysis of data from more than 3 million men.

The results show that men who were hospitalized for BPH had double the risk of developing prostate cancer as those in the general population; those who underwent surgery for their BPH had treble their risk. In addition, the risk of dying from prostate cancer rose significantly — 2-fold among those hospitalized for BPH and up to 8-fold among those who underwent surgery, reported Stig Bojesen, MD, from Copenhagen University Hospital, Herlev, Denmark.

I suggest discontinuing finasteride/dutasteride if after 8 months you've seen no improvement - if they haven't helped by now they aren't going to.

Pretty much any drug that ends in "INE" can cause problems for someone with BPH - but they don't always. So anti nausea drugs like CompaZINE can also cause problems. I never found decongestants to be a problem, but I know that many do and I was warned about them by my urologist. 

So the idea is not to undergo surgery or be hospitalized for BPH ? Hank

Hi, Hank,

Some of the foods and food additives that cause me problems are red wine, citrus, spicey foods, MSG, fermented foods, aged cheeses and tomatoes. Keeping a food journal helped me pinpoint some of my triggers. Someplace I read that foods with tyramine can trigger BPH symptoms, which started my curiousity of a food connection. I don't believe diet will shrink my prostate at this point, but it seems to help lower my symptoms.

Stebrunner

Yeah - good ideas if if it didn't increase possibility of cancer. But in seriousness, most people with BPH are never hospitalized and only a small % of them get surgery (for this study, I'll bet the main if not only surgery was TURP) .

SO the true takeaway might be that the worst cases put people a greater risk, but the average guy who has some trouble peeing and gets up once or twice a night may not. I didn't read the whole thing

I"m assuming they took into account t the ages of the BPH group, which in general would be higher than a non BPH group. If not, then I'm totally unconvinced and really not convinced anyway, but then again haven't read the source study Also, could it be that the hospitalized patients were tested more for bph than the non-hospitalized group?

Jim

I don't really know either. In light of recent studies that say the PSA tests don't save lives, maybe anyone with BPH should get them anyway just to be safe. I could go on about over treatment for diagnosed prostate cancer, but I'll save that for another thread.

I left my last urolgoist because he was looking a little too hard for me. Had at least two scans done which turned out unecessary. Then he wanted to do a rigid cystoscopy to look for bladder cancer. I figured the only reason he wanted a rigid was so he could snip away at anything in site. I consulted with two other urologists who said a flexible cystoscopy was more than enough. I had one of them do a flex and they found nothing. You can argue what is the hard in looking too hard, well for me, the harm is a lot of needless anxiety which could lead to unecessary biopsies, etc. YMMV.

Jim

Oh oh ! Except for the red wine, I consume all your no-no foods on a regular basis. Maybe I should cut them down to see if that helps. Hank