BPH (enlarged prostate) Diagnosis

[frayne]

Update, I saw my urologist yesterday for the cystoscopy procedure which confirmed an enlarged prostate, everything else look pretty good. The procedure itself was not painful or uncomfortable and I got to watch on the live video feed as Steven Speilberg and George Lucas took their entire films crew up my urethra looking for the lost ark. The doctor explained everything we were looking at along the way. Due to the size of my prostate 150 grams she has recommended the HoLep procedure and can get me scheduled in about a month or so, if I decide to proceed. In the meantime I am researching everything I can about the procedure (there is a wealth of information on YouTube) and will a make decision in the next week or so. Currently I'm self cathing as needed (3-4 times a day) and other than that being a minor inconvenience it really isn't a problem with quality of life issues, like working out, going out for dinner, visiting friends or playing golf. I'm starting a list of questions to ask her i.e., how many of these procedures has she done, complication rates, issues with incontinence and retrograde ejaculation. For the most part most everything I have read and seen, the HoLep procedure looks like a pretty promising path to travel. Thanks again to everyone who has commented here, (and especially Marko). If anyone else here who has had the HoLep procedure cares to comment good or bad, I'd love to hear your thoughts. Again, thanks guys.

 

[jgman]

I have a cystoscopy next week for BPH symptoms. My prostate was only measured at 32cc. I've done a lot of research and would like to do the HOLEP also, but not sure if my prostate is to small for the procedure. Started Alfuzosin 3 weeks ago with limited success.

 

[Midpack]

Following this thread. My husband has his MRI tomorrow because his PSA numbers are moving up. Urologist is in 2 weeks.

My dad did very well with the TURP. 10 yearsater he got prostate cancer, and had radiation, which effectively treated his prostate cancer.

We’re on the same track. Had my MRI last week, radiologist says PI-RADS 4, peripheral lesion 6x6x9 mm, prostate 45 cc. I meet with the urologist tomorrow to discuss next steps. I’m not having problems of any kind other than low flow, a PSA of 4.76 led to all this (I turn 70 yo in May). PSA velocity unchanged, slow progression over 15+ years. No family history of prostate cancer at all and Dad lived to 96. Fingers crossed.

 

[Car-Guy]

We’re on the same track. Had my MRI last week, radiologist says PI-RADS 4, peripheral lesion 6x6x9 mm, prostate 45 cc. I meet with the urologist tomorrow to discuss next steps. I’m not having problems of any kind other than low flow, a PSA of 4.76 led to all this (I turn 70 yo in May). PSA velocity unchanged, slow progression over 15+ years. No family history of prostate cancer at all and Dad lived to 96. Fingers crossed.

I'm not a doctor (so I really don't know) and this is the Internet (full of good and bad info) but it sounds to me like a prostate biopsy is in your future. FYI, a normal needle prostate biopsy is not such a big deal that so many claim. The actual traditional biopsy preformed by a skilled urologist in his office can be quick (5 to 10 mins) and "almost" painless. YMMV...

 

[Midpack]

I'm not a doctor (so I really don't know) and this is the Internet (full of good and bad info) but it sounds to me like a prostate biopsy is in your future. FYI, a normal needle prostate biopsy is not such a big deal that so many claim. The actual traditional biopsy preformed by a skilled urologist in his office can be quick (5 to 10 mins) and "almost" painless. YMMV...

I am expecting a biopsy, outside chance at a second MRI. From what I read the MRI should allow them to target the biopsy to where the lesion is, instead of needling all over the prostate. I assume the risks are lower with a targeted approach. Thanks.

I am unclear on whether BPH is still on the table for me, given a lesion on the MRI, versus outright prostate cancer (aggressive or otherwise)?

 

[grasshopper]

Back in 2021 I had my first MRI after 10 years of Active Surveillance for PC. My report was PI-RADS 5, had a MRI-Ultrasound Prostate Fusion Biopsy. Results weren't scary at all and stayed on AS

Now it appears that my HoLEP may have zapped the PC that the biopsy caught.

 

[RetMD21]

I was on Flomax for some years, then it slowly stopped working and had negative side effects. I switched to Tadalfil years ago, and it works very well. FWIW.

That's interesting. I was sort of surprised to see it being used for BPH symptoms. I understand it works very well for some people.

Everybody has their favorite procedure. For most patients it seems to be the one they had. For the urologist it is sometimes the one he (she) has a machine for.

 

[jgman]

Went to a top BPH surgeon on the East Coast- Dr Bandi Georgetown University. Said my prostate was too small for HOLEP. Recommended Aquablation. It will be outpatient with Catheter out the next day. He scheduled me for May 1, so I can enjoy my summer!

 

[Qs Laptop]

Went to a top BPH surgeon on the East Coast- Dr Bandi Georgetown University. Said my prostate was too small for HOLEP. Recommended Aquablation. It will be outpatient with Catheter out the next day. He scheduled me for May 1, so I can enjoy my summer!

jgman, would you please come back to this thread after your procedure and post your experience? My urologist is recommending aquablation as a possible treatment for me and any information would be appreciated.

 

[jgman]

jgman, would you please come back to this thread after your procedure and post your experience? My urologist is recommending aquablation as a possible treatment for me and any information would be appreciated.

Absolutely QsLaptop. Will post my feedback after the surgery.

A little more info about me....my main problem is retention...I am retaining over 300 ml hence there need for surgery. Been on Alfuzosin for 6 weeks with limited success. Saw 3 Urologists and all recommended Aquablation. Was told that I will probably have retro ejaculation from Dr Bandi but that I will have better results than I would if I chose to preserve ejaculation. Also one of the Urologists wanted me to stay a night in the hospital and then 4 days with the Catheter - no thanks.

 

[wanaberetiree]

Went to a top BPH surgeon on the East Coast- Dr Bandi Georgetown University. Said my prostate was too small for HOLEP. Recommended Aquablation. It will be outpatient with Catheter out the next day. He scheduled me for May 1, so I can enjoy my summer!

I am scheduled for May 7th but will have to stay overnight.
Interesting

 

[frayne]

Everybody has their favorite procedure. For most patients it seems to be the one they had. For the urologist it is sometimes the one he (she) has a machine for.

Probably more truth to that statement than most would admit. I wish someone would come up with a matrix, listing all the types of prostrate procedures along with pros, cons, and cost of each.

 

[jgman]

I am scheduled for May 7th but will have to stay overnight.
Interesting

Two of the three Urologists I went to do the procedure as Outpatient with Catheter out the next day. In fact, my surgeon said I can remove the Catheter on my own so no need to return to the hospital the following day.

 

[Time2]

Did anyone get prescribed Finasteride and find that to be effective?

Or not. Meantime going with the flo...

I was prescribed both at the same time. I'd don't remember the exact date but it was over 2 years ago. This was after the second mention to my doc, I told him it's time to do something, "I'm to the point when I get up at night, I know it will be a while so I just sit down"
After two years I am now to the point where I can sleep all night without getting up about 90% of the time. My thinking is, the Finasteride has shrink my prostate, and solves the problem, but it took a long time, My doc suggested at 6 months I might be able to stop the Tamulosin, but I haven't. I have cut back the finasteride to about 3 days a week, (personal experiment, after I saw a doc in an Attia interview suggest he didn't know why finasteride is a taken daily when it has such a long half life)
I may try skipping Tamulosin which I'm already not as compliant as when I started. But, I haven't tried to tie lack of Tamulosin use to having to get up in the night. (another experiment)

 

[rodi]

I am expecting a biopsy, outside chance at a second MRI. From what I read the MRI should allow them to target the biopsy to where the lesion is, instead of needling all over the prostate. I assume the risks are lower with a targeted approach. Thanks.

I am unclear on whether BPH is still on the table for me, given a lesion on the MRI, versus outright prostate cancer (aggressive or otherwise)?

DHs biopsy is in 2 weeks. In the meantime he got a second opinion and that urologist ordered an IsoPSA test, which is similar to the PSA but more predictive of cancer likeliness. Unfortunately his numbers were high, so he very likely has cancer. We are just waiting on the biopsy (which is guided by the MRI) to determine which flavor of cancer it is. He was told that it's best to wait 4-6 weeks after the biopsy before prostatectomy. So this is what he's looking forward for this summer.

 

[AllDone]

My husband had prostatic artery embolization. It's a fairly new procedure although a similar procedure has been done for several decades for women with uterine bleeding from fibroids. He's been satisfied with the results.

 

[Time2]

My husband had prostatic artery embolization. It's a fairly new procedure although a similar procedure has been done for several decades for women with uterine bleeding from fibroids. He's been satisfied with the results.

This is also what I keep coming back to. I'm doing well on meds, but if I ever need it, I'll see if this fits my situation.

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[tulak]

So sorry to hear this Rodi. I wish your husband all the best and my thoughts are with him and your family.

 

[Midpack]

DHs biopsy is in 2 weeks. In the meantime he got a second opinion and that urologist ordered an IsoPSA test, which is similar to the PSA but more predictive of cancer likeliness. Unfortunately his numbers were high, so he very likely has cancer. We are just waiting on the biopsy (which is guided by the MRI) to determine which flavor of cancer it is. He was told that it's best to wait 4-6 weeks after the biopsy before prostatectomy. So this is what he's looking forward for this summer.

My fusion biopsy is 6/12. With no family history I am not happy about this path but I’d rather just know for sure.

 

[Dtail]

DHs biopsy is in 2 weeks. In the meantime he got a second opinion and that urologist ordered an IsoPSA test, which is similar to the PSA but more predictive of cancer likeliness. Unfortunately his numbers were high, so he very likely has cancer. We are just waiting on the biopsy (which is guided by the MRI) to determine which flavor of cancer it is. He was told that it's best to wait 4-6 weeks after the biopsy before prostatectomy. So this is what he's looking forward for this summer.

My numbers were high too and the likelihood of cancer was 80% on the biopsy but turned out negative. You never know.
I get checked every 6 months now and the numbers are up and down.

 

[marko]

My numbers were high too and the likelihood of cancer was 80% on the biopsy but turned out negative. You never know.
I get checked every 6 months now and the numbers are up and down+1

+1. My PSA was in the 14 to 18 range for 20 years. Prostatectomy biopsy revealed zero cancer. This is why PSA is so controversial.
Now even post-prostatectomy my PSA is at 8!

Prayers for all going through this now.

 

[rodi]

My numbers were high too and the likelihood of cancer was 80% on the biopsy but turned out negative. You never know.
I get checked every 6 months now and the numbers are up and down.

That's why he did the IsoPSA... It is a different blood test than the PSA, and looks at whether a biopsy is needed... if one of the bad cancers is likely. It's pretty new. We found out about it because his brother has elevated PSA and his doctor ordered this test. BILs IsoPSA numbers were low so he was able to avoid the biopsy. Unfortunately hubby's IsoPSA was a 12... Above 6 is considered highly likely to be one of the bad strains cancer.

(My reading says there are a lot of prostate cancers that are slow and 'watch and wait' is appropriate)

IsoPSA® TESTING | Cleveland Diagnostics — Cleveland Diagnostics

 

[Dtail]

That's why he did the IsoPSA... It is a different blood test than the PSA, and looks at whether a biopsy is needed... if one of the bad cancers is likely. It's pretty new. We found out about it because his brother has elevated PSA and his doctor ordered this test. BILs IsoPSA numbers were low so he was able to avoid the biopsy. Unfortunately hubby's IsoPSA was a 12... Above 6 is considered highly likely to be one of the bad strains cancer.

(My reading says there are a lot of prostate cancers that are slow and 'watch and wait' is appropriate)

IsoPSA® TESTING | Cleveland Diagnostics — Cleveland Diagnostics

Okay sorry to hear that. Yes many of the prostate cancers are slow developing and if first showing up at certain advanced ages, it might not even be treated.

 

[ChrisC]

That's why he did the IsoPSA... It is a different blood test than the PSA, and looks at whether a biopsy is needed... if one of the bad cancers is likely. It's pretty new. We found out about it because his brother has elevated PSA and his doctor ordered this test. BILs IsoPSA numbers were low so he was able to avoid the biopsy. Unfortunately hubby's IsoPSA was a 12... Above 6 is considered highly likely to be one of the bad strains cancer.

(My reading says there are a lot of prostate cancers that are slow and 'watch and wait' is appropriate)

IsoPSA® TESTING | Cleveland Diagnostics — Cleveland Diagnostics

I've gone through several diagnostic protocols before treatment for my prostate cancer: PSA, Exosome Test, MRI, Fusion Biopsy, and PetSCan. The game changer for me was the Genomic Testing (there are two prevalent types, Decipher and Oncotype DX) -- this resulted in more aggressive treatment for me -- hormonal therapy (Androgen Deprivation Therapy) and External Beam Radiation Treatment. I hope to ring the bell this Thursday with hopefully a cancer cure from 28 sessions of radiation treatment. One thing you should do is get multiple opinions about potential treatment.

These prior threads here in this forum might be helpful: Getting a prostate PSA test directly

My TULSA prostate cancer adventure

As promised, here is the after action report on my TULSA PRO procedure. I decided to leave out the most graphic details. If you are seriously considering TULSA and want the full report send me a PM. It is now almost exactly 72 hours since I hit the recovery room. So there will be more to say...

www.early-retirement.org