Turp or laser....MRI vs biopsy

hmm...every single mention of Urolift I've seen says that it doesn't work w/ enlarged median lobe. 

Geoff,

Did you get back to normal with medication? Are you taking anything now? How many times you need to get up at night? Have you changed lifestyle since the AUR? What is your plan of surveillance? What is your cc value of the prostate?

I did the MRI on a 3T machine in Houston at a very reasonable price and i am glad i did!

Emil, I had 8 weeks of cipro to kill the infection. I am on no medication now as I have no issues that warrant any treatment. I have never had an issue with getting up in the night(that I have not caused). When my head hits the pillow, I blink, and its daytime again. I have never had a AUR, I had a UTI. Almost $%^ killed me. Never been so sick in my life...As for surveillance, I will get a PSA test every 6 months and as long as it is still returning to my previous 2.4, all is sweet. My 54 year old Brother had the same as me and his PSA took almost 2.5 years to get back close to original PSA. Uro suggested my PSA may never get back to original level, but close. My prostate is enlarged at 43cc, but gives me no bother at all. Other than the UTI I had, my prostate has never been an issue for me. At 68, looking on this forum, I am lucky.

If you have had a mpMRI and got a 1 or 2 PIRAD score, then you will most probably be ok, with little if any serious PCa.

Geoff   

Geoff,

thanks, yes, you are a lucky man. My prostate is at 55cc, I get on good days 5, 6 hours of sleep, then I need to get up. Did you find out what triggered to get a UTI?

Thanks for all your comments!

Emil

Geoff.  Glad your doing so well.  You have to watch because some doctor like to push for alot of test and sometimes the test is what causes the problem.  Just be carefull.  Take care  Ken

Emil, I was born with a urethral stricture, which is one cause. Had a couple of goes at fixing it, but uro said the only way was major surgery, and the gains were not worth it considering my flow rate is within range for age. The second cause, and most probably the reason, I do not drink enough water a day. This tends to make UTI infection matters much worse. So,  now I try and drink at least a litre of water a day.

Geoff 

Hi kenneth. My uro and general doctor do not like a lot of tests and rely more on common sense. When I had the mpMRI done(at my own request) and it came back clear of meaningful PCa,  both doctors backed off the PCa bandwagon and said prostatitus. Both said to simply wait for the PSA to settle.

Geoff

 

That makes sence Never rush into anything  Take care 

Emil, What Geoff just wrote in his last paragraph about the mpMRI (multi-parametric MRI) is THE kind of MRI you need.  It has over a 95% negative prediction accuracy for PCa (prostate cancer).  It finds suspicious areas or no suspicious areas, and that determines the so-called PIRAD score that Geoff mentioned.  If it finds no suspicious areas, then it's bettern than 95% that you do not have an aggressive PCa, although you might have an indolent cancer.  If there are suspicious areas, then a biopsy is required to diagnosis the cancer.  And the most accurate biopsy that targets the suspicious area is one taken in the same machine on which the mpMRI is performed, while looking at the same image.  Unfortunately, there are not many locations where that's performed, to other, less accurate methods are used to direct the biopsy needle to the suspicious area in the prostate.

I don't kinow what a 4k biopsy is.

I had the mpMRI when my PSA leaped from 8.2 to 14 within about 4 months.  I had a PIRAD score of 2, which meant I was unlikely to have anything but an indolent PCa.  A month later, my PSA dropped back down to 8.3 or something.  It has gradually increased from 6.2 in 1999.

Performing a biopsy without first performing an mpMRI should be considered obsolete.

I also agree that no medication, physical activity and healthful diet are the way to go, which is my style.  My prostate is about 60cc and really gives me no problems.  I wake up every 2-4 hours, which usually means once or twice/night to pee, although a few times I've had hard starting at night (never during the day), so I purchased, with JimJames's advice a couple CIC catheters, just in case.

One last thing about the recent unrecommendation to have screening PSAs.  It may be true that the large studies proved that overall, the mortality rate is unchanged; however, that result is only useful for insurance companies, and is inapropriate applied to an individual.  That statistic considers the harms done from various procedures by incompetent or uncaring urologists, hospital-acquired infections, or patients who insist on useless procedures.  The overall result that PSA screening does not change the overall mortality rate means that some people who did not get screened will die from PCa because it went untreated until it was too late, and others who died because they had a procedure gone wrong.  Information should always be a benefit, and information with education is even better.  So, get the PSA test and be informed.  Some people without PCa who find out they have a high PSA might leap off a bridge and distort the statistics; but, it's unlikely to be anone who participates on this site.

Harvey (in Southern California)