Prostate and Bladder Issues: What to do?

Such an informative and helpful post, Kayak. Good luck with the surgery tomorrow.

Virginia Urology just did a prostate check and said my PSA was 5.67 (I'm 66 years old) ... they set me up for a prostate biopsy early next month ... I agreed to this "recommendation" ... my question is what is the percentage of men that all of a sudden have to get this expensive procedure ??? ... is it EVER , "hey , Bob , you're fine , see you in another year " ??? ... they said it's not necessarily hereditary but I believe otherwise !!! ... do men of my age just get "railroaded" into this procedure ??? ... robert j. walters

Robert, I started having higher PSA's when I was about 55, cannot remember how much higher than 4 it was at the time, but I think 7-10. I also had an enlarged prostrate which was the most likely cause of the high PSA. At that time I did have two rounds of biopsys, as they were trying to make sure I did not have cancer. (I was put on a drug that caused my prostrate to shrink and my PSA to go down, but eventually went off of it due to other effects I did not like. My prostrate grew again and my PSA went back up.). My biopsys were negative, though, keeping in mind that each round was 12 small pieces from 12 small areas of a large prostrate, so the chance of hitting a spot with cancer cells is pretty small, but that is what they do. My impression is this is pretty common with higher PSA's in otherwise healthy men. If you are otherwise not very healthy, I got the impression that it might not be deemed so critical. But no one wants to miss a cancer and have a healthy person end up with prostrate cancer. On the other hand, most otherwise healthy men end up having a benign form of prostrate cancer when they die, or so I am told. There are other tests they do now to help find cancer if a high PSA persists and none is otherwise found. One is a prostrate MRI, which identifies areas where prostrate cancer MIGHT exist so a followup round of biopsys can target that area. There is also something called a 4K test that is a blood test like the PSA but uses added factors to possibly indicate risk of prostrate cancer. My brother was found to have a form of prostrate cancer through the biopsy process, but it was deemed not a dangerous type, so he has now been monitored for years with no problem and without any kind of surgery. I also saw a recent article where some doctors feel this mild form should not really be deemed cancer at all unless it gets more serious. Bottom line--biopsys are probably a good tool but even if you end up with a bad result, that does not mean prostrate removal is necessary. Lastly, all of this is just from my own reading up on the issue given my prostrate issues, and is not definitive at all. I should probably add that after many years keeping watch for cancer, none has ever been found but my enlarged prostrate eventually caused my bladder to retain urine to the extent that it backed up into my kidneys causing acute renal failure, which led me to have HoLEP prostrate surgery to remove the inner core of my prostrate to relieve pressure on my uretha. That went extremely well allowing me to be able to urinate freely for the first time in years. But I ended up with chronic kidney disease--stage 3b which hopefully will not be too bad as long as I follow my kidney doctors recommendations. So if you have an enlarged prostrate and have trouble urinating make sure and ask your doctor to monitor you for urine retention on a regular basis. Mine did not do this, nor ever told me of this danger, which contributed to that problem for me.

Hope all went well Kayak, All the best.

You don't mention it here but from my experience an increase of .75 year over year may give urologist some concern, especially like yours being outside the accepted range for your age, although probably not by much. Having peace of mind after my biopsy was a comfort to me, although my prostate didn't like it.

I’m traveling home today and once there I’ll write about my experience. It’s over, I’m happy and glad! All went well!

May 3rd was the big day for me, I had HOLEP Surgery at the JAX Mayo Hospital. I was there because my enlarged prostate was growing up and into my bladder which would have eventually caused problems as urine could back-up into the kidneys. I learned at 6:00 PM on May 2nd when to report to the Hospital. I reported 30 minutes prior to the scheduled time, I was called for surgery prep just before 12:30. As usual, the staff here is wonderful, I don’t think you can find a better place to have specialized treatment for many reasons. The prep nurse reviewed everything with me, double checking history, condition, tests. Dr. Dora came by to discuss things and make sure I had answers to any questions. The Anesthesiologist came and explained things and answered questions. Mayo has the process down! Efficient but never rushed. I was wheeled into surgery, an epidural was administered, and I have no memory beyond them preparing to administer the epidural. The procedure lasted 61 minutes, at least 53 grams of Prostate was removed. I woke up in recovery, and it took me 4 hours to become stable enough to be discharged. The Mayo Clinic Campus has a Courtyard Marriott Hotel within a few hundred yards of the Mayo Hospital, and because I was not local, I utilized a service called the Care Hotel. This means that I was transported to the hotel, taken to a room that was private, a nurse on staff until 11:00PM, and three ways of getting help if I needed it. So my wife and I stayed there in that room overnight. If I needed help, an I-Pad linked to the nursing staff for video link was by my bed. A special phone was available so that one button would call the nursing staff if I needed help or if something went wrong. I didn’t sleep very well that night primarily due to the Foley Catheter in place. You pee allot of bloody urine the first night which is completely normal, it can continue for a few weeks. I disliked the Foley catheter a great deal and was eager to have it removed. The following morning, I went back to Urology for my appointment where the Foley was removed. I felt liberated! Later that day, and after drinking about 80 oz of water, urinating several times, I went back to urology where they checked my urine retention status….mine was good and therefore I was effectively released! The timeline….I reported to surgery at 12:30 on Tuesday, and 26 hours later I was good to go. The Doctor asks that we stay Wednesday night in the area before driving 3 hours to our home. I’m home now, following the Doctors plan for recovery. I will go back to see him in 3 months. I am already urinating so much better, emptying my bladder, and the outlook for the future looks bright! I’m taking a stool softener to minimize any strain to the area while healing. The blood in the urine is looking much better! I’m still tender and sore, but I am improving everyday. While driving home I received the notice that my Pathology report was available. Of the 53 grams of prostate removed and submitted, all tissue was found to be free of any malignancy. I can’t say enough good things about the Mayo Clinic. It’s fabulous! You are in a good place when you’re at the Mayo!

@kayak461 Thanks for the detailed report kayak, so happy it all went well and you are firmly on the road to recovery. Hearing about your experience with Mayo is as good a review they can ever get and will give comfort to others considering this procedure there. The Marriott setup is quite amazing, kudos to them too.

I’m up in the Boston area and I know a procedure is in my future. I am seriously considering the Aquablation performed by only a few surgeons as it is fairly new. With a prostate of 125g I have been buying some time being on a plant based diet for nearly a year. PSA dropped to 2.4 from 2.6 in a year and hoping to see more of a drop in November when I see the urologist. My symptoms are marked better but I have no idea if that will continue, only time will tell.

Happy for you kayak, wishing you continued good progress.

Bill

Wishing you the best in your treatment Bill! When you decide to proceed, please report back to the group as your experiences will help others as they make decisions about treatment options. This Connect group has been so helpful to me in my journey, I’m sure you will help and inspire others!

Well. after a PSA test of 10.4, Digital rectal exam, a Urinary flow test, a Postvoid residual volume test, a Cystoscopy, and a Prostate biopsy, the urologist gave me a choice of Rezum or Urolift. I thought I would ask the Mayo Connect community for advice. Rezum? Urolift? Something else?