prostate reduction

[cheeryble]

Went for medical yesterday.

Age 64.

My prostate has been a bit oversized (like many) and slowly growing for some years, first doc some years ago said it was growing in my bladder direction.

Don't have particularly sensitive bladder don't really get caught short and don't wake up every night....though sometimes.....or avoid drink in the evening. Had my last digital about a year ago which i guess was OK.

Well the last year it's been like I go for my first pee (flow reasonable if not horselike) and five minutes later need another one. This is regular now.

I have read the USPSTF advisory document when they recommended no more PSAs for symptomless patients, and this was a great source of facts which tended to suggest less treatment rather than more, and means I'll have to think twice rather than follow advice robotically for biopsies, -ectomies, indeed anything.

Anyway went for medical and looking at screen asked is that the bladder and the prostate and she said yes.......it's quite big.

So will see the doc for the results tomorrow, but it seems like whether it's this year or after a year or two, crossing fingers it's BPH not worse, I'm gonna need reduction of the prostate.

My elderly friend knows about the Bumrungrad, and surprised me by saying they have stopped doing the microwave treatment. He had it explained (rightly or wrongly) that Thais don't opt for something which only lasts two or three years, they prefer a one-off solution. That said, friend says they did have laser treatment.

In any case, starting to take an interest and would like to get an idea what options are available and where (I live in CM but would certainly travel to BKK if nec) and the rough cost.

Thanks!

Edited June 12, 2013 by cheeryble

[Thanyaburi Mac]

Here's an earlier thread on the subject:

http://www.thaivisa.com/forum/topic/606243-prostate-green-laser-surgery/

Never heard of this outfit, and no map, bares checking out:

http://www.pvpthailand.com/en/pvp/20051106174637.html

Bumrungrad's take on the laser option:

http://www.bumrungrad.com/en/urology-prostate-bladder/pvp-photoselective-vaporization-prostate

And, not related, it seems, to laser treatment:

http://www.thaiprostate.com/Surgical_procedure_for_prostate_enlargement_turp_tuip/enlarged_prostate_surgery/info_enlarged_prostate.html

Mac

[oxymoron]

I had the operation for BPH in 2003 in Perth Australia. When done the urologist gave a 10 year warranty.

Recently had all the tests, Flexible Cystocosphy ( spelling) CT scan, Digital as a result of passing some blood. Well as I knew postrate BPH has grown back and is vascular.

Urologist prescribed DUO DART, a new medication only available in Australia since around 2011-12, actually I asked for AVODART which had been given to my brother and a mate, but the urologist said the DuoDart is better.

It has two drugs, one for relaxing the muscles and improving the "flow rate" the other for "shrinking" the postrate by inhibiting the enzime that causes it to grow.

Have been taking it for 2 weeks now, the flow rate is certainly up and get up once only at night if that. Urologist says it will be a least 6 months before will see any reduction in postrate size.

Amazing the improvements in medicine in the last 10 years, hopefully I wont have to have another rebore as was predicted when I had the first opration in 2003

[Tolley]

Lots of natural therapies out there to assist with enlarged prostate.

Many have proven quite successful.

I would try and research those first before I went down the road of any surgical procedures or pharmaceutical therapies.

Many people end up with even more problems after surgery or a quck recurrence of the original problem and most of the pharmaceuticals have undersired side effects.

[oxymoron]

I did and in fact used most of them between 1996 and 2003, the result was me ending up with 10 hours of pain like you could not imagine, until in an "emergency" hospital they punched a cathetre through to allow the urine to flow and relieve the pressure.

Sorry to burst your bubble but if you have BPH home remedies are not the way to go. Professional help is what you need.

Beside you do not know you have BPH without it, it may be the "big C"

For guys, High PSA see a urologist, pee blood see a urologist, both can be the firt signs of either postrate or bladder cancer.

Women are so much smarter than us macho men they regularly check those areas of their bodies that have the highest potential for cancer to begin.

[jrtmedic]

Retention of urine caused by an enlarged prostate is indeed very painful.

In many instances , as your case, the problem can be "cured" by trans-urethral catheterisation.

In more challenging cases it is necessary to decompress the bladder by transabdominal catheterisation of the bladder.

Once the urgent need to decompress the bladder has been achieved further investigation will be needed before a definitive treatment plan can formulated.

I would urge anyone suffering problems/difficulty with urination to seek medical advise.

Dr Google is not always your best friend and self medication can be a very bad idea !

Edited June 13, 2013 by jrtmedic

[Tolley]

Retention of urine caused by an enlarged prostate is indeed very painful.

In many instances , as your case, the problem can be "cured" by trans-urethral catheterisation.

In more challenging cases it is necessary to decompress the bladder by transabdominal catheterisation of the bladder.

Once the urgent need to decompress the bladder has been achieved further investigation will be needed before a definitive treatment plan can formulated.

I would urge anyone suffering problems/difficulty with urination to seek medical advise.

Dr Google is not always your best friend and self medication can be a very bad idea !

Sure go and seek medical advice and then research the medical advice that you have been given along with the potential side effects of medications and the success/failure of suggested interventions and then look at what other methods or treatments are available that might also help with your problem and then make an informed decision.

Rushing into any sort of surgery or unecessary medications may be even worse for your health than the orginal problem.

[cheeryble]

Thankyou for all your advice

I may indeed be jumping the gun but I wold like to be prepared with knowledge for the day I'm told i need a biopsy or a this or a that.

The mere fact that the American College of Urologists had a fit when the overseeing body the USPSTF said no more PSAs for symptomless patients, then the urologists reversing 180 degrees over the next year perhaps on realising they were urologists not experts at assessing evidence......suggests caution for advice in Thailand.

BTW about food i was once told eating bacon and so on will give me prostate cancer and kill me.

Luckily I believe in evidence.

It took a quarter hour to learn this was nonsense and the nitrites and nitrates blamed are mostly produced in your own body.

Still......all comments very gratefully received.

Edited June 13, 2013 by cheeryble

[Tolley]

I did and in fact used most of them between 1996 and 2003, the result was me ending up with 10 hours of pain like you could not imagine, until in an "emergency" hospital they punched a cathetre through to allow the urine to flow and relieve the pressure.

Sorry to burst your bubble but if you have BPH home remedies are not the way to go. Professional help is what you need.

Beside you do not know you have BPH without it, it may be the "big C"

For guys, High PSA see a urologist, pee blood see a urologist, both can be the firt signs of either postrate or bladder cancer.

Women are so much smarter than us macho men they regularly check those areas of their bodies that have the highest potential for cancer to begin.

I did and in fact used most of them between 1996 and 2003, the result was me ending up with 10 hours of pain like you could not imagine, until in an "emergency" hospital they punched a cathetre through to allow the urine to flow and relieve the pressure.

Sorry to burst your bubble but if you have BPH home remedies are not the way to go. Professional help is what you need.

Beside you do not know you have BPH without it, it may be the "big C"

For guys, High PSA see a urologist, pee blood see a urologist, both can be the firt signs of either postrate or bladder cancer.

Women are so much smarter than us macho men they regularly check those areas of their bodies that have the highest potential for cancer to begin.

BPH is and has been treated successfully for many men by taking herbal supplements, diet, losing weight etc.

In fact in Europe it is the preferred method of treatment for many men.

It doesnt work in all cases but for many it does unfortunately not in your situation.

As I understand you can have BPH and not have elevated PSA scores anyway?

[ESDinBKK]

I had the same problem, waking up every hour to go to the bathroom. Went to a urologist and found I had a large prostate. He gave me flow max and that worked for about three years. My PSA was always around 0.3 or lower. Still had the problem of peeing in morse code, so the doc did a TERP. A roter rooter of the urinary track into the prostrate.removed a lot of stuff from the prostate. Had the lab test and came back with the diagnosis of prostrate cancer. Was worried, but the doc who was the best prostate man in western US, said that I'd die of natural causes before the prostate cancer became a problem. He said every man will be diagnosed with prostrate cancer of some form in his later years. No real problem unless the PSA rises rapidly to over 5.0-6.0. If it does, the best solution is prostate removal utilizing the DaVinci machine robotic surgery. A one inch cut and blood loss is less than a teaspoon of blood, and you're up and around in a few days. The knife method of operation requires 2 liters of blood, a eight inch cut, and 6 months or more of full recovery. Check Dr. Jay Yew website as he's one of the top guys in the US on this. I think there are 2 hospitals here in Thailand that bought this DaVinci machine. It really expensive, somewhere over 2million $ US. The hospital where the King is and one other one.

After my TERP 5 years ago, I've havent had any problems, and sleep most of the night.

[jrtmedic]

Anyone considering the use of "herbal" or other "remedies" should be aware that in many instances there is no substantive body of evidence as to effectiveness !

For example http://www.supplementspot.com/maximum-prostate-60-caps.html?gclid=CLaJnZ7K4LcCFQYl4god2TkADA makes a number of claims about "prostate health" and follows up with a disclaimer

"* These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease."

Under "Cautions" this company say ------

"As always, consult a health care practitioner before taking supplements, especially if you have a medical or psychiatric condition.

These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease."

These disclaimers would perhaps lead one to conclude that a quack product was being offered !

Caveat Emptor !

Edited June 13, 2013 by jrtmedic

[Sheryl]

The normal management of BPH (after, of course, making sure that it is BPH and not Cancer) is medical i.e. use of medications. Only when this fails is surgery considered. So yes, you are jumping the gun a bit. A good urologist will start you one medication and see how that does.

[jrtmedic]

+1

[cheeryble]

Well came back with a PSA of 5.47 (very much hoping previous post saying prostatectomy for 5 to 6 is incorrect......I am not an expert but doubt a full excision would ever be recommended without a biopsy and high grade of cancer.)

I'm 5.47 puts me in a grey area where they might well want to biopsy, and not sure what I think about that. For example, if 99% of cancers can be seen on ultrasound I'd be willing to take my chances with no biopsy.

So we know hard masses show up ultrasound.....how good is it at detecting prostate cancers?

Again, I'm not in any great state of concern here.......just learning.

Whatever happens I'll get the digit!

Edited June 13, 2013 by cheeryble

[jrtmedic]

The Mayo clinic provide a good overview -----

go here

http://www.mayoclinic.com/health/prostate-gland-enlargement/DS00027/DSECTION=symptoms

[Tolley]

Anyone considering the use of "herbal" or other "remedies" should be aware that in many instances there is no substantive body of evidence as to effectiveness !

For example http://www.supplementspot.com/maximum-prostate-60-caps.html?gclid=CLaJnZ7K4LcCFQYl4god2TkADA makes a number of claims about "prostate health" and follows up with a disclaimer

"* These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease."

Under "Cautions" this company say ------

"As always, consult a health care practitioner before taking supplements, especially if you have a medical or psychiatric condition.

These statements have not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease."

These disclaimers would perhaps lead one to conclude that a quack product was being offered !

Caveat Emptor !

Quite correct there are many products herbal or otherwise that are not useful and a waste of money that is why you need to do your own research.

But many people have also been treated successfully for BPH with herbal supplements and lifestyle changes.

Many people have also suffered very undesirable side effects as a result of undergoing medical interventions for BPH when they might not have had to undergo them.

Caveat Emptor

[Sheryl]

Well came back with a PSA of 5.47 (very much hoping previous post saying prostatectomy for 5 to 6 is incorrect......I am not an expert but doubt a full excision would ever be recommended without a biopsy and high grade of cancer.) I'm 5.47 puts me in a grey area where they might well want to biopsy, and not sure what I think about that. For example, if 99% of cancers can be seen on ultrasound I'd be willing to take my chances with no biopsy. So we know hard masses show up ultrasound.....how good is it at detecting prostate cancers? Again, I'm not in any great state of concern here.......just learning. Whatever happens I'll get the digit!

The decision for prostatectomy is never made based on a PSA score per se and in any event, getting way ahead of yourself. Odds favor it being benign in which case you will be treated with medication. Even if it is malignant there are many different treatment approaches of which prostatectomy (itself having several different forms) is but one.

The digital exam will be indicative of the likelihood of malignancy though to 100% exclude it you would need a biopsy. However some doctors would hold off on biopsy if the digital exam is not in any way suspicious for malignancy and just follow the PSA and do periodic digitals (if it's BPH, the pace of growth will be small, and the enlarged prostate will feel smooth and even).

[Sceptict11]

How does one undertake research into the prostate problem and know what treatment is good/bad/indifferent/dangerous?

Edited June 13, 2013 by Sceptict11

[cheeryble]

How does one undertake research into the prostate problem and know what treatment is good/bad/indifferent/dangerous?

I found the below document from the USPSTF which makes health recommendations in the US useful.

It is the evidence base on which they recommended a halt to PSA testing for asymptomatic patients.

http://www.uspreventiveservicestaskforce.org/prostatecancerscreening/prostateart.pdf

If you are the type who can enjoy a document like this (I love disciplined analysis, some won't) it has a lot of background like PSA efficacy (or not), false positives, biopsy infection rates, age-relationship to benefits from various treatments, efficacy of prostatectomy vs alternatives, etc, and it links to further documents. It gave me a much better idea of the general dangers than i for one had before (it generally suggests dangers are much less than I was previously led to expect).

Edited June 14, 2013 by cheeryble

[Sceptict11]

cheeryble

Thank you very much for that link.

The paper is of course academic and would prove to be a "difficult" read for those without a scientific background.

I am now looking for papers of equivalent stature which examine the risks/benefits of herbal and other "natural" products.

I suspect I am on a hopeless quest !

[cheeryble]

I am now looking for papers of equivalent stature which examine the risks/benefits of herbal and other "natural" products.

I suspect I am on a hopeless quest !

You won't find anything with an equivalent stature I'm afraid that the analysis the USPSTF did was the gold standard and as it incorporates metastudies whilst natural medicine has a dearth of any type of high quality (sample size/double blind/etc etc) studies I don't believe anything like it exists in the natural medicine field and that compounded with most people's inability to see poorly presented evidence is not a good basis for confidence.

Anecdotes and references to historical use are regular fare but unacceptable.

When you start examining evidence you need to know about how to do so.

IMO statistics is the most undertaught subject and knowledge of fallacies the next.

Happily the BBC has a marvellous podcast on assessing and debunking evidence called More or Less which some will like.

ps: You will notice in the study i linked that the USPSTF constantly points out to readers the incompleteness of their used data but nevertheless comes to the most rational conclusion. These reminders are the way it should be.

Edited June 14, 2013 by cheeryble

[jrtmedic]

Agree 100% !

[cheeryble]

This sent by a friend may be of general interest.

It is about a new high focus ultrasound procedure developed at University College Hospital London which shows remarkable results.

http://www.telegraph.co.uk/health/healthnews/9206425/New-treatment-for-prostate-cancer-gives-perfect-results-for-nine-in-ten-men-research.html#disqus_thread

[Tolley]

Pretty easy to do your own research if you have time and are prepared to dig around a bit.

There is some research that highly recommends pomegranate juice for prostate problems.

You could also look at saw palmetto, beta sisterol, zinc supplementation etc

[JDGRUEN]

I have had BPH - enlarged prostate for 30 years ... much more of a problem for the last 15 years - were it not for taking Saw Palmetto in mega doses for all this time then my life would be VERY uncomfortable ... I take 6 - 160 mg Gel Caps of Saw Palmetto EXTRACT (concentrated) in the morning and again at bed time ... I am symptom free... as long as I take this natural medication... If for some reason I do not take it then after a few days my prostate will enlarge again and symptoms return ... The SP extract is not expensive and available in many places in the States.

Not only am I experience in this - but I have a Science and Medical / Health Education - plus i have many years of hands on medical / health experience - so I know what I am talking about... My remedy does not preclude the possibility of prostate cancer. But IMO - I believe that a chronic enlarged prostate contributes to the development of prostate cancer.

[cheeryble]

Thankyou JDGruen

....you echo others about saw palmetto.

May I ask how you know your prostate enlarges without it....which presumably means it shrinks with it?

Is it about the "need to go" sensation or the flow or both?

1. Do you know if this has ever been studied properly?

2. Do you notice any other effects from the SP?

Edited June 15, 2013 by cheeryble

[Sceptict11]

The latest Cochrane Database review (2012) concludes that Serenoa repens was not more effective than placebo for treatment of urinary symptoms consistent with BPH

ref http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001423.pub3/abstract

PLAIN LANGUAGE SUMMARY

Serenoa repens for benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is the nonmalignant enlargement of the prostate gland that is caused by an increase in volume of epithelial (top layer of tissue that line cavities and surfaces of the body) and stromal (connective tissue) cells. This increase in cells can, over time, create fairly large, discrete nodules in the periurethral region of the prostate, and in turn can restrict the urethral canal

causing partial or complete blockage.

The use of plants and herbs (phytotherapy) for the treatment of lower urinary tract symptoms associated with BPH is common and has been growing steadily in most Western countries. The extract of the berry of the American saw palmetto, or dwarf palm plant, Serenoa repens (SR), which is also known by its botanical name of Sabal serrulatum, is one of several phytotherapeutic agents available for the

treatment of BPH.

The update of this review included 32 randomized controlled trials involving 5666 men.

Compared with placebo, Serenoa repens, at double and triple the usual dose, provides no improvement for nocturia, peak urine flow,and symptom scores for men with benign prostatic hyperplasia.

Edited June 15, 2013 by Sceptict11

[CBR250]

There are still no hard and fast answers about the prostate and need for / preferred treatment. This is the result of the paucity of research over many years. In Australia the NHMRC spent about 10% on prostate research compared to breast cancer research. This was justified by the catch cry "men die with prostate cancer, not from prostate cancer". However, this is false. Prostate cancer is the second most common cause of cancer mortality after lung cancer in men. Sure, the men dying from prostate cancer are older than the women who die from breast cancer, so maybe the men were expendable given their age. Now as there are masses of longer living baby boomers with assets, interest in the prostate has accelerated. Let's hope that the interest leads to better diagnostic and treatment options in the short term!

[moe666]

Well came back with a PSA of 5.47 (very much hoping previous post saying prostatectomy for 5 to 6 is incorrect......I am not an expert but doubt a full excision would ever be recommended without a biopsy and high grade of cancer.) I'm 5.47 puts me in a grey area where they might well want to biopsy, and not sure what I think about that. For example, if 99% of cancers can be seen on ultrasound I'd be willing to take my chances with no biopsy. So we know hard masses show up ultrasound.....how good is it at detecting prostate cancers? Again, I'm not in any great state of concern here.......just learning. Whatever happens I'll get the digit!

Last year had some blood work done PSA 10 hehehe did a bit of research and found out that over 10 50 percent chance of cancer. Took a deep breath and contacted a friend who is very knowledgeable about this stuff and after talking to him started on 1mg o0f finesteride every other day also got back on my hormone therapy. Liquid zinc to stop production of estrogen, dim. which balances out estrogen that you do have, testosterone gel and a prostate support supplement containing saw palmetto, stinging nettle and lycopene.

Went back to the states for a visit a few months later and sch. an appointment with a Dr. I know well the PSA down below 3 estrogen levels down and T levels up never felt better and the Dr. said keep up the good work the cancer screening test was negative. Good luck on what you decide but do your on research no matter what some say here most Drs. do not keep up with the latest and the greatest

Edited June 15, 2013 by moe666

[Sheryl]

re saw plametto there have been conflicting findings with some studies suggesting efficacy and the more recently published not. I don't think there is any harm in taking it as far as anyone knows, and taking it need not preclude other therapy.

OP needs as a priority to see a good urologist, have manual digital exam and then get the doctor's advice as to whether or not, based on manual findings and the PSA level, immediate biopsy is indicated. If it is not, he will be advised to start medication, with finasteride usually being the first drug of choice. From the described severity of symptoms, I'd suggest complying, but if you want to also take saw palmetto -- or try it alone first -- go ahead.

There are risks to delaying treatment. Even with BPH, serious urinary obstruction can occur leading to infections etc. And of course, with an elevated PSA and not yet even having had a digital exam, there is some risk that you may actually have cancer. You need to exclude that ASAP. The manual exam is a MUST, and should be done by a well qualified and very experienced urologist, I would suggest either Dr. Viroj at Bumrungrad or Dr. Thanoo at Samitivej. While any doctor can palpate an enlarged prostate, doctors specializing in prostate cancer with many years experience are best able to determine whether the enlargement is suggestive of malignancy or not.

If what is deterring you is fear of the biopsy procedure, it is not necessarily going to be required. IF a very experienced, competent urologist , after digital examination, assesses the likelihood of malignancy as low, you can discuss with them deferring biopsy in favor of periodic repeat exams and repeat PSAs while treating for BPH. Of course if they find that their are irregular masses that they assess as suspicious then a biopsy is a must, but odds favor BPH. So please go ahead and have this seen to, I think you have reached the limits of what you can get through online research at this stage.

You are much better off attending a planned appointment with a carefully selected specialist than having to go to an ER with acute urinary obstruction (painful as hell) or a severe infection or even sepsis, all of which can occur in the absence of treatment.