Prostate and Bladder Issues: What to do?

Hello I am new I just registered on this site. 66 years young. I have had prostate problems for about 10 years. I have managed up until now by frequent trips to the restroom or behind the barn, keeping empty plastic jugs in all my cars and shops for sudden urges. I have often been miserable especially when I was driving or on a a vacation tour, ect. and there is no bathroom. But it looks like it has caught up with me I am tired of this. I was OK this last summer it was manageable but my symptoms have suddenly gotten worse this fall as cold weather has set in. Last week I was unable to urinate and it scared me I had a prescription for Tamsolusin froma otor a year ago that I never went back to because he did seem to have anything else to offer me. I had not been taking the Tamsolisin luckey for me and after a couple of days of taking them it has helped relieve the symptoms plus I went to my family Doctor for a physical. But my sides and pelvis are hurting from the backup of urine and I am feeling somewhat better now. Preliminary tests by this Doctor showed no kidney problems but It has scared me. I have an appointment with a new Urologist in 2 weeks. The family doctor I saw yesterday wrote me a prescription for Dutasteride .5 mg Upon some investigation I found that it will cost me $100 a month for 30 pills and the big problem I have is all the web-site info I can find says that this class of drugs can actually lead to a more aggressive and incurable form of cancer. I have NEVER been told in the past that I have or am suspected of having Prostate cancer, just moderate BPH. I am not going to fill this prescription at this time. My thoughts on this are I am seeing a Urolugist/surgeon in 2 weeks and I would like to discuss all this with him and find out what he has to offer me in the form of treatment before I just waste money on pills that may not solve my problem. I want a game plan from him as to the best and most effective way to treat me.

MY QUESTION for all you men who have been where I am now is what would you do in my shoes ? My thoughts are I am very active I spend 3-4 days a week at the gym, I vacation, keep active working at home hobbies. I am in good heath except for this miserable prostate problem. I would rather have some kind of surgery and clear this up all at once. Rather than go on for years and thousands of dollars in pills and tests and end up having surgery anyway. What surgery would you say holds the greatest chance of reducing or eliminating the prostate and alleviating the symptoms for the longest time. Of course I will listen to the new doctor I am seeing but I need to know what I should be asking him and how to let him know firmly but respectfully that I am looking for a more permanent cure rather than pills and tests. The TURP looks promising can anyone tell me if has really worked for you. Thanks for any advise before I go to see this Doctor. SK Ohio

Hi @amgracing1. Welcome to Mayo Connect. Your story is very similar to mine, although about 10 years later. I had a bulging prostate that reached the point of forcing me behind a bush or rushing to a rest room. The prostate had filled a large share of the capacity of my bladder. For several years, I had taken medication -- first Propecia (Finasteride) and later Flomax (Tamsulosin), but alas they proved inconsequential. So my Urologist said, "It's time," and we scheduled surgery at the hospital for Transurethral Resection of the Prostate (TURP).

That was a good decision from two perspectives: First, pieces of my prostate were snipped off, removed through my urethra, and piled up to a little more than a golf ball. Second, removal of that tissue revealed a small papillary tumor on the lining of my bladder; it was also removed before a temporary tube was installed to collect my urine during a few days of healing.

When the tube was removed, the urologist examined the interior lining of the bladder thoroughly and found a dozen more of those little tumors, so we scheduled another Transurethral Resection procedure to be held at a walk-in surgery the following week. That also was a success. What followed was a series of five "BCG" bacterial treatments, which involved injecting a solution into the bladder; the solution was intended to kill any remaining tumor "seeds" in the bladder lining -- and it did. For the past 10 years, I have undergone regular cystoscope examinations of the bladder lining. No tumors -- not one -- has ever appeared since my second surgery.

From my experience, you may come up with questions. I'll be glad to respond to any that you have, and I know your urologist will also. One question I'd suggest for the doctor: What are chances that another TURP will be needed in the future? I hope that, if you choose a TURP, you will find it to be as vital and satisfying as I did. Martin

Thanks for the reply martin. You sold me ! I did not look forward to spending thousands on pills just to end up having the TURP anyway. The Tamsolusin (Flomax) 2 pills a day, I am taking now is relieving my symptoms but barely. I know a fellow 10 years younger than me mid 50's who had the TURP and he said it was the best thing he ever did. Like you he has had no additional problems. I see the Urologist is 2 weeks and I am going to tell him I would like to be evaluated for the TURP as soon as possible. I don't want to go through another winter having to stop the car every half hour. I'm sure the longer I wait I am stretching out my bladder and kidneys more. That's what worries me. I should have taken this more seriously but I'm stubborn and just didn't want to have to deal with it, all the appointments and tests. But I am really tired of living with this. My Medicare insurance should cover the surgery but they didn't want to pay for those pills. I will be sure to ask the doctor about how he would deal with complications or If he finds additional tumors like you mentioned on your bladder. Thanks again Martin if you don't mind I 'll post again after my Doctors appointment and give you an update. Steve Ohio

Any time, Steve (@amgracing1). I'm here almost every day, enjoying my control and wrestling with my other medical challenges. I'll look forward to your postings and/or your private messages under the envelope on the upper right of your screen! The best part of the future for you (and me) is the cystoscope examinations of the bladder lining that are common after a TURP. In that respect, be sure to check on the antibiotic that nurses like to supply before the cystoscope procedure. I don't allow fluorquinolones (like Ciprofloxacin or any of its relatives) because of issues raised by the FDA. Martin

Martin this is AMGracing1 in Ohio I contacted you a couple of weeks ago about my growing problems with prostate issues. I had my appointment last Thursday with a young but bright looking Doctor/surgeon at Ohio Health Urology Columbus Ohio. Upon the crude exam he said "Oh yea that's big", HA,'No Kiddin', he scheduled me for a cytology, a bladder exam and he is also going to drain a troublesome Hydocele this will be in 3 weeks, he is busy. I am on 2 Tamsulosin a day and it is OK but barely. We didn't discuss any treatments as of yet but when I mentioned a TURP I knew that a friend had he said there are a lot of possible options he has depending on what he finds in the upcoming exam. After reading your comment about HoLEP I like this idea. After looking at the article you attached. It looks like this is a lot better in the long run. Most effective at actually physically reducing the size of the prostate, in many case in half and less hospital stay and complications. I will ask him about it next visit and if he can't do it or won't do it. Do you know a Doctor you could recommend for me to get another opinion ? My opinion is some of these Doctors may appear to be too young and inexperienced BUT on the other hand they are well trained in the latest high tech surgery methods like HoLEP and there careers and skills are heading towards their peaks. should I ask to talk with satisfied customers of his or is this forbidden. I don't want to have to do this over again every few years. Thanks Martin have a Merry Christmas. SK Ohio

Hi @amgracing1. Glad to see you're on the move -- so much better than "hanging tough," going nowhere, and relying on hope. My main response now: Delay making any down-the-road decisions until after a good talk with your new urologist. Put a half-dozen strategic questions to him and see what develops from his answers. After that, you could think about things for a few days and -- if you are concerned about a firm plan for next steps -- ask him about helping you get a second opinion from a urologist that isn't on staff in his joint practice. Isn't that likely, given that Ohio State University's medical expertise is also located in Columbus? You could ask him about satisfied customers, but medical privacy laws and rules get in the way on that -- he may not have permission from former patients to reveal their medical information to you. It seems to me that you're more likely to get patient input from Mayo Connect where members control whether they "undress" their private information. One way to do that is to post a new, challenging appeal for input from Connect members on the issues that concern you most. As to doing it "again every few years," I understand your concern, but I am dealing with that as follows: My TURP and TURB ten years ago were readily tolerated, and I'm not very concerned about undergoing it again. That may be necessary in the days ahead. Like you, I'll be investigating whether HoLEP is a good alternative to a TURP. Incidentally, I dropped off of Tamsulosin (Flomax) several years ago because of its minimal impact and its potential for harm after several years of uninterrupted use.

Thanks again Martin for your support. I wasn't sure what to think when he told me he wanted to do the bladder exam. I have never had one but a friend of mine had one for kidney stones some years ago and said it was not that bad. The Draining of the Hydrocele sounded like fun but the Doctor said it is very quick and he numbs you up a bit down there. I am looking forward to my exam on Jan 7. just to see just what it shows and confirms there is no cancer just a very large prostate.. This young Doctor has assured me that I do not have cancer, Not sure how he can be so positive BUT all my lab tests were normal including all my kidney, liver and glucose levels and the big one my PSA was 1.01 with anything under 4.0 being OK. So maybe that's what he is basing it on. Looks like I have a chance to get this taken care of with a good outcome. I'll keep you posted. Steve Ohio

Cancer? Nope! That from my urologist after my last cystoscope exam last summer. While examining the inside of my bladder (which has given up some space to my bulging prostate), he obtained a sample of urine and sent that to the laboratory for microscopic examination. No cancer cells were detected with that exam. That's a major difference from 10 years ago, when I had a dozen papillary tumors of various malignancy sprouting on the internal bladder lining. In that case and at that time, the lab examined the tumors themselves after they were removed. After BCG treatment in the bladder to kill any cancer seeds remaining there, cystoscope exams were planned on a schedule of increasing duration, and that duration is now once a year. This year's was, once again, clear of any visible tumors, and -- in addition -- the newly applied test of urine reassured me that neither bladder nor kidney cancer were detected. Martin

What a lot of correspondence. I have suffered with bladder problems. Been on all these drugs I see mentioned here. I had prostate cancer some 5 years ago. Had high doses of Radiotherapy, too old for surgery. This was successful in dealing with cancer but problems still persisted. { then had TURPS with minor improvements. Learned how to do self catheritis?? . I am now waiting to have Botox. My doc says this will be successful.. I await in anticipation and will report in due course.AS an afterthought one of the results of my cancer treatment was that my balance went to hell, This has interfered with my walking not a happy man!!

Hello Martin this is Steve in Ohio. I have some new news in my journey to solving my prostate problems. Yesterday I had a bladder exam and it defensively confirmed I have an enlarged prostate by no signs of any cancer. Thank God. Here is what my young Doctor wants to do. He wants to do a fairly new procedure called a UroLift. If you look it up on the computer there is a website from the manufacturer that explains all about it. It is a surgical suture device that is used to permanently pull and hold the prostate tissue away from the urethra and bladder and thus opening up the plumbing like before your prostate closed it off. It has only been approved in the USA since 2013 but he says there have been thousands of them done and many happy customers. It is much less invasive and a shorter recovery, (same day home) than many other options as it does not use any heat or lasers and burning or cutting away of tissue. Here is my question all the testimonials on the web-site are all glowing and positive many happy men. But when I watched some other stuff on you-tube there seemed to be a lot of very unhappy men and some even telling of major problems and chronic pain and procedure did nothing for them. I know you can always find someone who is unhappy with any medical outcome. From what I understand this procedure is only recommended for men whose prostate is under a certain size and of the shape and anatomy that is best suited for a good outcome. My Doctor said he considered a lot of things for me including TURP, which he says is an older and more invasive procedure, lasers which he says are only for very large prostates where other things are less effective. He also considered a procedure called (Rezum) which uses a focused jet of steam to kill off prostate tissue close to the urethra and bladder which shrinks away and dies off opening up the plumbing again. There is a catheter and longer recovery with this steam procedure just like TURP. But he said he felt that the UroLift was the best all around for me. He said there are no sexual side effects and very short recovery time, NO catheter for most men, and with fast improvement in a few days to weeks and most men completely off medicine in a month or so. I wish there was more long range research about it but there doesn't seem to be much.

ATTENTION ALL MEN, could anyone who has actually had the UroLift procedure PLEASE tell me of your experience and how did the UroLift work for you, 3, 6 months a year later. Did you have problems , pain, no results are you still having to take medication. Thanks for any help or advise.
Thanks Martin hope your well. Steve Ohio