Enlarged Prostate Gland - Reports to request in 2nd opinion before surgery

Men's health
1

Hello,

What are the reports that a Urologist should request to check for enlarged prostate gland issues? This is for a 66 year old male patient (my father) and his Ultrasound shows that his Prostate is severely enlarged with a volume of 74cc.

The opinion of the lab based on the ultrasound was:

"Severe prostatomegaly is noted with significant post void residue"

The PSA came at 3.95

The current Urologist has suggested surgery but I would like to get a 2nd opinion and also generate more tests and reports before taking the drastic steps.

Any other things I should consider at this stage? Is cancer also something we should potentially check for and if so, how is that detected?

Thanks in advance

2

Cancer is suspected where there is a high PSA, 3.95 is within the normal range for somebody his age, I think your dads problem is more to do with not being able to completely empty his Bladder more than anything else (which, if there is an infection, can raise the PSA as well). I don't think the Urologist is talking about plucking the whole Prostate out (but of course you'd need to ask them)...

See the Patient UK Leaflet patient.info/health/prostate-gland-enlargement

Hope I've helped smile

3

I think as your father's prostate problem is quite critical you should not experiment too much about it.Please do the surgery as the doc suggested.

Thanks

4

Johnm,

You didn't mention what surgery the urologist is recommending, but I imagine it is some sort of a turp.

You didn't mention what symptoms your Dad is having. If he is restricted and can't urinate, then he has to either take a drug like tamsulosin to allow him to urinate or have a procedure. 74cc is not a terribly large prostate. Mine was over 120cc when I had a greenlight laser ablation to remove about 70cc of it. You also didn't mention the number off cc your dad is retaining as showed on the ultrasound. "Significant" doesn't define it at all. If it's over 250cc, that is significant. If it is 100cc or even 150cc that's is much less significant.My own experience is that prostate procedures like a greenlight laser or turp can help if you are restricted, urinating painfully or with small amounts very frequently, and/or retaining over 250cc after voiding. The condition can be helped with tamsulosin or similar drugs which generally allow a person with an enlarged prostate to urinate freely within a couple of days. They have their side effects, and may stop working after a few months, but are often a first thing to try before surgery. What surgery often doesn't help is frequency or urgency once the stream has improved and the bladder is emptying. Although better than it was before, I am still going every 2-3 hours around the clock.

5

Johnm,

Regarding cancer, a PSA of 3.95 is pretty good. I wouldn't worry unless the PSA jumped several pointsover a couple of readings. A single test can also be an outlier. I had one reading of 8.7, the next was 6.5. which was back in line with what I was expecting. I'm 67 and my PSA is 6.5 and has jumped about 0.5 points or less a year for several years. I haven't had or wanted a biopsy. If it got to 10.0 I probably would consider investigating it. Most men have Prostate Cancer in their bodies as they age. If it is slow moving it generally doesn't effect them in any way.A fast moving cancer is serious and ought to show up with a doubling of the PSA in a short time. Not doing anything is called Watchful Waiting. In many cases aggressively seeking out a diagnosis and treatment causes more problems than leaving it alone.

6

I know all of these posts are at least 2 months old and the problems have probably been solved by now one way or another but there is another solution, an alternative to Green Light laser and TURP that has come on the scene with great promise. It's called Urolift and there's a wealth of information about it on the web but not many reviews from actual post-procedure patients. So far I have heard from three patients who recently had the procedure done and all three relate very positve results in just a few days with no side effects at all.

I'm convinced that the procedure is in my near future if my prostate upon examination is less than either 80 grams or 100 grams, depending and if I have no medial lobe of the prostate which apparently is rare. I'm tending strongly toward the procedure but I surely would like to hear a few more reviews, pro or con. Any more Urolift patients out there? Thousands of BPH sufferers need to know how you are faring. 

7

Hi Ron,

From what I have read about the urolift I would not have been a candidate. My prostate was too large and I do have a large median lobe that still protrudes into the bladder. The reason why it was not recommended for larger prostates is that additional staples would have to be used and more than 6 staples (three per side) can work against each other. I haven't heard of any reports from anyone having had this procedure. I personally wouldn't want to be an early adopter. Several years back the innovation of the prostatic stent was hailed as a good procedure for bph. It sounded good, (a stent to keep the urethra open within the prostate area) but it had disasterous results as the stent became impacted into the tissue and had to be surgically removed. I could see something similar happening with the urolift staples that are used to pin back the prostate to make a wider path for the urine to pass through.

8

Hi Bob,

I, too, have been diagnosed with BPH (at age 71) and advised to have TURP, but do not like the risks of death/complications associated with it. It had already occurred to me that a stent should solve the problem since my urinary tract is currently being kept open by a catheter, but yours was the first mention of its existence that I came accross. Could you please tell me more about the prostatic stent to which your submission refers? Did the impaction occur in all the procedures,or just some, and how long after insertion did it take before causing a problem?  What problem did the impaction cause? Where was the innovation made and by whom?

9

I think the originators and suppliers of prostatic stents is Urolome. They are part of American Medical Systems who also make the Greenlight Laser systems. Stents can be temporary or permanent. The temporary ones can be biodegradable. If you look up Prostatic Stents on Wiki they have a good article on them. I have read of the permanent stents becoming impacted in the prostate and needing to be surgically removed. I think a major risk is that with a permanent stent in place a person needing to have an emergency procedure with a cystoscope

like I did, wouldn't be able to have it until the stent were removed. I have heard of stents moving and causing complete retention until they were rmoved. I imagine you couldn't be cathed if this happened until the stent were removed.

10

Hi Bob,

Thankyou for your prompt and complete reply to my query. I am new to this, having been diagnosed only last week and having only started with symptoms at the end of March 2014 - which were originally diagnosed as UTI for which I was given two courses of antibiotics (the first did not solve the problem). I then had about 3 weeks without symptoms followed by a return of frequent desire to urinate accompanied by need to pass bowel movement or wind. Generally micturation was sparse but I was managing a reasonable flow once or twice a day.  I went back to GP who prescribed a further dose of antibiotics but felt my abdomen and sent me to A&E hospital for intervention for acute retention. I was catheterised and immediately drained of about 900ml. The doctor thought I was somewhat dehydrated so I agreed to drink a litre of water before going home, and have since tried to increase my daily fluid intake.

.

This retention did not worry me since I have always been able to have a (nowadays occasional) 4 hour drinking session whilst only needing to urinate once or twice during the evening. Furthermore, since giving up smoking about 15 years ago, I regularly had no fluid (or food) intake between breakfast and 5pm and did not need to urinate during that time.

On return to the hospital to see the urologist (intern?) I was advised to keep the catheter until after a scan and appointment with a specialist because otherwise there was a danger that my kidneys might be damaged by urine retention of which I was unaware. I was told my prostate, BP and blood test results had all been within normal limits (including kidney function) and that there had been no sign of infection on first admission to A&E. The scan showed healthy kidneys but stones embedded in the bladder wall and some (old) scarring. My only concern was to get rid of the catheter which initially made even walking difficult and is preventing me from wearing my shorts when running and sunbathing. I have now got to the stage where it no longer seriously interferes with my running and vigorous excercise/dance sessions (but sex is out of the question although, surprisingly,.ejaculation is normal!).

The specialist examined my prostate and anounced that it was enlarged - which was normal for someone of my age. He was going to prescribe alpha blockers until he examined the scan and announced that the stones indicated that the problem had been going on for some time. ( If that were so, why had it not already affected my kidneys?). He recommended TURP and simultaneous removal of stones through endoscopy.

I have been fit and healthy all my life and have seen what invasive surgical procedures can do to other people. I immediately began investigating the alternatives: lithotripsy can break up the stones with ultrasound - without an endoscope I understand - I now needed a  non invasive solution to the enlarged prostate. The temporary biodegradable stents that you describe would appear to be the best solution (in the event of complete retention, emergency catheterisation could be performed by entering the bladder from between the navel and the pubic bone - and cytoscopy could surely be performed the same way). My only reservation is your description (elsewhere) of the flap of tissue above the confluence of the vas deferens and the urethra which  prevents reverse ejaculation into the bladder.  Could this be compromised by an inexpertly fitted stent or its subsequent movement?

I think I will start initally on the Saw Palmetto and other medical alternatives before demanding a trial without catheter. Again, many thanks for your help.

Mike

 

11

Mike, there is new and minimally-invasive procedure that may be the best solution for you called UROLIFT. Don't be surprised if your urologist has not heard of it. Mine had not either but he was very intrigued and is now preparing to do the procedure himself.

I've taken all the bph meds for at least ten years. The Docs don't tell you but they will destroy your sex life completely. I used Saw Palmetto and other non-prescripition herbs and concoctions but they had no effect at all that I could tell.  

The prescription meds for bph do work to relieve your symptoms so it's really easy to just accept that solution. It's not so easy when the side effects kick in. The meds are really just a very slow but very certain castration. The first effect is retrograge (dry) ejaculation. That is not reversible. The next effect is to reduce your libido and finally erectile disfunction. There was never a word from my urologist that this would be the inevitable result. I refused to do the turp procedure because of the possible very negative and very possible results and if you read these posts you'll see that it my not work anyway. 

When I read about urolift this March I researched it thoroughly, found that it was approved by the FDA only in Sept 2013, and only a handful of Urologists are doing it.  I contacted one of these Docs, had the cystoscope examination to determine if the prostate had a third lobe which disqualifies the urolift procedure and an ultrasound to measure the size of the prostate.  I was very depressed to find that not only does my prostate have a third (central) lobe but is larger than the 100mg limit. Either of these conditions will disqualify a patient for urolift.  Very depressing as only turp will work for me and I may be in dire straits for the rest of my life as a result.

I urge you to look on youtube at several demonstrations of urolift. It's a wonder solution that will last at least for years and you get to keep your sexual desire and ability.  The uroloft procedure is being done in a number of European locations, mainly England and in the US as well. Chances are excellent that you will find a urolift Doc in most large cities. In Texas it is being done in Dallas, San Antonio, Houston and probably other places as well.

Do yourself a big favor and at least see if your prostate is a candidate for urolift and let us know here what you find. These posts and other internet sites such as Youtube are an excellent source of real world experiences. Good luck and welcome to the BPH sufferers community!       

  

12

Mike, here's a link: Good luck!  

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Patient Moderator Note: I have removed an URL (a link) from this reply as it was unsuitable for inclusion within these forums. If any user is interested in this removed information they should contact the author via the Private Messaging system requesting such. Thank you for your cooperation.

13

Hi Mike,

I only got temporary results from Saw Palmetto and over the counter prostate supplements. Like you said, I experienced good and bad voids. The only thing that actually allowed me to go when I was quite restricted was Jack Daniels Whiskey. If I woke up in the middle of the night feeling like I needed to go and couldn't, I'd drink a whiskey and walk around the kitchen for 10 minutes and then I'd be able to go.

900ml is a lot to retain. I'm surprised you didn't feel it. That can be a problem as you can damage your kidneys. A relative of mine has no sensation of needing to urinate and caths every 6 hours around the clock. He had a turp but it only lasted a few years, then was told his bladder had lost elasticity and could no longer contract, so he chose to cath on schedule.

When I went to the emergency in full retention in the middle of the night they removed 1400 ml and I was begging for a cath. After that I bought some hydrophilic (packed in sterile water and pre-lubricated) caths and learned to cath myself. 

Having been down this road for more than three years now, I found flomax (or the generic tamsulosin) to give good relief. For me though it stopped working after a few months.  It's very difficult in these cases to pinpoint the actual problem.

If I were you I'd have the stones removed with a cystoscope in surgery and start taking the flomax or tamsulosin and see if that works.

In three years I've had the TUMT (microwave procedure to open the prostate), a Greenlight XPS laser to remove 70g. of a 120 g. prostate, a cystoscope procedure to remove a membrane blocking the urethra, 

tried self cathing every 2 eeks to "keep the channel open", and emergency cysto surgery to cauterize three bleederrs causing a hematuria, remove bladder stones, and resection (widen) the bladder neck. When I had the Greenlight Laser my uro said he uncover a lot of of pus in my prostate that were never seen or diagnosed with tests as chronic prostatitis. So all contributed to my symptoms, and just widening the prostate alone with the laser turp only lasted 6 months for me.

Regarding the retro, my uro preserved a flap of tissue above the valve that releases semen into the prostate to direct the semen down and out instead of back into the bladder. Most uros don't practice this. Even though he did the laser turp and then the cysto resection and cauterization and bladder stone removal, he said he would try to spare me from retro, and he did, but he said he couldn't guarantee it. Whether the stent would interfere ewith ejaculation is something i don't know. Certainly if it got impacted and had to be removed surgically, it's a possibility the surgeon wouldn't be looking to spare you from retro.

 

14

Two things I forgot to mention is that flomax or tamsulosin has helped some people pass stones within a few days. It's been 6 months since my cysto surgery (the cystoscpe passes through the urethra and I think is less invasive than an endoscope which passes through the belly and would perforate the bladder) and I take tamsulosin on Monday and Tuesday night to increase my flow for two days as a way to possibly prevent stones from accumulating in my bladder.

My flow is decent now, but the tamsulosin turns it into a stronger flow for two days. I do this on my own, thinking if I am forming stones, this may wash them out rather than allow them to take root and grow. The tamsulosin does have side effects but just taking it two nights a week is quite tolerable for me.

15

Hi Ron,

I had read your posts and fully intend to investgate urolift as you suggest. The Moderator has removed your link and suggests a 'private messaging system' (which he does not explain how to use), but I am sure I shall be able to find the nformation. In case you were in any doubt, I live in Greater London, England, so your locations in US may not be cost effective for me.  Thankyou for your kind concern and information, anyway.

Mike

16

One last thing (this discussion has really jogged my memory banks). I have a tendency to gout and I found several years ago that drinking Guiness stout would precipitate gout wihin a few hours. My big toe would blow up like a walnut and the stabbing pain would last a few hours. I hated to give up the Guiness but switched from beer to wine and whiskey.

I use the 10 parameter test strips to check my urine periodically and it is always quite acidic (ph5 to6). Bladder stones may be formed from uric acid, same the crystals that bring on a gout attack.

During the year following my GL, I was taking a thiazide diuretic for blood pressure. I later found out that thiazide increases uric acid. So having a propensity for acidic urine and previous episodes of gout, I reasoned the thiazide may have contributed to the bladder stones, and I stopped taking it after the stones were removed. Just another piece of this puzzle.

17

Hi Bob,

Thankyou for your further detailed advice. Do you know if the Hydrophyllic Catheter lubrication includes lidocaine or similar anaesthetic and if they are available in UK or by mail order?  I am still at the stage of investigation and 'watch and wait' and may yet get a second opinion from another urologist before committing to anything drastic. any input and advice is welcome, however, and gratefully received.

Kind regards, Mike

18

I have not actually tested my urine, but I am pretty certain that, at least before the onset of symptoms, it was alkaline: I have read that a vegetaian diet tends to have this result, and I had been eating meat only about twice a week for some months - although I have milk and yoghurt with my breakfst cereal. Prior to that, it may well have been acidic since I ate a lot of fillet steak, and had been carnivorous since childhood, father having been a butcher. 

I, too, noticed, before catheterisation, that, after a pint or two of beer, any retention or limited flow was relieved. I must close because apx. every other keystroke fails to register - I don't know if it is the site or my keyboard - this note has taken me over half an hour!

19

I believe that the procedure has been performed in London longer than in the US or anywhere else as your medical system approved it quicker than ours. It was invented in California about ten years or so ago and is making its way around Europe, Australia and the Far East so that sounds true to form for us. I don't know why the moderator has a problem with a link to you tube but you'll find a wealth of information. You'll notice that a lot of the posts are from me. I really pushed it hard trying to get input from urolift patients and thinking wrongly that it would work for me  I did get some replies. Every single reference and post is favorable. It will replace TURP, currently the gold standard,  for those who qualify, because it is hardly invasive at all, very little pain and almost no blood, no effect on your sexual desire or abilty, they just staple the lobes of the prostate one side to the other compressing the center of the lobes away from the urethra into a narower profile allowing urine to flow and the bladder to empty. What could be simpler than that? Almost all patients go home the same day or next in some cases and have no symptoms from the procedure, after a week or so. It has proven to be effective for several years which TURP may not be.    

I knew you were a Limy as you cannot conceal the accent no matter how hard you try. lol My forbears immigrated from County York before the Revolution so I feel an affinity to Merry Ole England.

Best of luck in your endeavor and stay away from those damn meds if there is any way possible. 

20

Hi Patient Moderator. I used a link to youtube to provide information about the urolift procedure. I am a bph patient who doesn't qualify for urolift but if I did I would have had the procedure two months ago and I would be free of bph symptoms now instead of in a state of foreboding and dread as I am faced with TURP as my only solution and I will be faced with whatever outcome it provides for the rest of my life. I am sincerely doing my best to make BPH sufferers aware of a revolutionary new non-invasive procedure. Nothing like this has ever been seen before. This site's reason for being, as I understand it, is to do exactly what I am trying to do, get out the word to other patients to provide real-world experiences from those who are not as inflicted by BPH as i am. Where did I go wrong, just no links allowed? Ron