physiological bladder outlet obstruction, then prostate growth

First time post, perhaps its not the appropriate forum, but I did not see a seperate urology forum, hence trying here.

Problem summary : Bladder outlet obstruction (probably physiological) for several years, with healthy prostate but now suddenly I have irregular prostate growth.

41 year old. Single male. Limited sexual experience.

Generally healthy. Blood pressure, lipid, sugar etc normal. Dont exercise but go for long walks. No smoking. Drink no more than 14 units per wk [But planning to quit] . 5 ft 10, 67 kg. No family history of prostate cancer. My dad has benign prostate enlargement but he got it only after the age of 75.

When I was 10 to 14 yrs old, on a few days I felt that bladder was not completely emptied. Dismissed it as psychological.

Always had back pain. Nowadays have chronic back pain. Back pain starts after 40 minutes of walking.

Since 2005, experiencing significant post void residue. First it was 35 ml, then 80 ml, then 110 ml. Flow rate very poor (single digit). Urodynamics finding was : bladder healthy but some type of physiological outlet obstruction. Cystoscopy was not done. Urologist suggested alpha blocker alfuzosin hydrochloride, it seemed to improve for a month (post void residue reduced to 20 ml), but after 3 months of use, post void went back to 85 ml.

Met top urologist in UK in Apr 2008, and he said just wait and watch, nothing to worry. I quit the alpha blocker (it was killing my sex drive).

UP UNTIL THIS point, I had no prostate problems. Prostate was normal size. Digital rectal exams all revealed normal prostate.

BUT, a few months ago UK GP asked me to do another post void residue test. Result : 50 ml. But prostate had now enlarged (42 mm traverse diameter). Per advice, I saw private urologist few days ago. This time, in his test, I had 125 ml residue. Also, he says there is a nodule in the prostate. It is hard on the right base. PSA is supposedly "normal" at 0.7. They took my urine sample and did the PCA3 (Genetic biomarker test). My score is 20.

But the scary thing is : This doctor says by doing ultrasound that he sees "irregular growth" of my prostate, growing into the bladder !!

I have always eaten healthy. No smoking. Balanced diet, lots of vegetables, wholegrain rice, some fish and chicken. Have wild canned Alaskan salmon, strawberries, tomatoes (lycopene), pumpkin seeds, sunflower seeds, brazil nuts (zinc and selinium) etc. Used to have flax seed oil in 2007 for health reason (omega 3) : 1 tea spoon daily. Could this have caused a problem ?

So, I basically have 2 problems :

1) Urinary obstruction. This was there even before the prostate issue. What is the reason ? Not sure whether it is a urethral stricture, or bladder neck problem or nerve problem. If my problem is physiological, why did it not happen before 36 years ?

2) Prostate growth problem : What is the reason ? Current plan is to wait few months, do another PSA / PCA3 test and then decide whether to do biopsy or not. I know BPH can start after age 40, but still think it is too early to get this much growth. Also, if it is BPH, why is it irregular ?

Are (1) and (2) connected ?

appreciate any thoughts. Thanks a million in advance and I wish everyone here the best health.

Purgatory : thanks for the immediate response. much appreciated. I am having a hard time communicating with my GP and specialist. Everyone seems to be in such a hurry, I cannot sit and talk patiently for say 15 to 20 minutes. They want to breeze thru the tests, recommend sophisticated machinery test / surgery / drugs / whatever in fast forward motion and buzz off to the next patient. He had no time to listen to my complete story. There is no human element anymore. And this is in supposedly one of the best private hospitals in the UK. I used to live in the U.S, and I recall the doctors would sit and talk to you patiently, and explain the problem, especially in the hospitals affiliated with a University.

Almost tempted to spend my own money and go to Johns Hopkins, Baltimore, USA. I wonder how much it would cost tho'.

Regarding the blockage problem, unless I do a cystoscopy, I wont know for sure. If it is a urethral stricture issue, you may be right in that it can be fixed rightaway, but if it is a bladder neck issue or nervous system issue, I understand that will require some kind of a semi-major surgery. Also, such a surgery would involve side effects, such as retrograde ejaculation. I still have a faint glimmer of a hope to find a partner and have a child, so its a tough one. I also told the doctor that I was on alpha blocker in 2008 and initially that seemed to improve my flow, but after 3 months of use, the post void residue went back up. The very fact that the alpha blocker improved the flow/postvoid residue implies that my problem was at the bladder neck, nor urethral stricture. So why go thru the extreme torture of cystoscopy just to arrive at the same conclusion ?

Regarding the second problem, prostate growth, even if we do a biopsy, suppose it comes negative. What next ? Should I have to keep doing biopsies every 6 months ? i.e once we rule out cancer, we would still need to find out the cause of the irregular growth. What are the possibilities here ? I really want to get the root cause of it tho'. I have no family history and have not done anything in excess such as drinking or red meat etc. So what did I do wrong ? Could sexual habits such as not ********** or excessive ********** could cause it ? There must be a reason isnt it ? I live in a fairly salubrious environment with more or less healthy habits, so what did I do wrong ?

Cant I control both problems by habit alone ? i.e cut out coffee, tea, alcohol, drink 8 to 10 glasses of water, empty the bladder regularly (never make the bladder very full which is when the hesitation / poor flow problem gets worse) ? Is there a danger of permanently harming the kidneys if I leave the first problem untreated ?

Lots of thoughts going thru my mind. I wish I could talk in detail with my specialist and/or GP.

Thanks logoslidat. This UK private urologist seems to be extremely busy, but his secretary is a very friendly helpful person. Obviously she is not a scientist or medic but she knows some of the literature probably from experience. So I expressed some of my concerns to her, she was sympathetic but obviously she did not have answers for everything.

Yes I do have private health insurance but only in the UK, but as I said I have a half mind to just pack up and go to Johns Hopkins. Isnt that the best urology dept in the world ? It wont be covered by my insurance but wondering what kind of numbers I am looking at. if it is less than 10 or 20 grand USD, I dont mind paying provided I get minimally invasive techniques (more advanced machines) and less pain, and great expertise.

Here is an interesting question : Coming back to purely problem (1), i.e urinary flow obstruction, my post-void residue hasnt changed at all since Apr 2008. In April 2008 when I saw a more experienced specialist in the same private UK hospital, he opined that we can just go for wait-n-watch and most likely I have "proximal bladder neck dyssynergia". But as long as I dont have any infection and residual urine stays below 150 ml, not much to worry. At the time my prostate was benign feeling and flat. But now even tho I have the same amount of post-void residual urine, this different urologist in the same hospital says he needs to really know the root cause of (1) and it has to be taken seriously. I wonder why. I wish I could meet the first urologist again but he is away for at least another month.

Anyone else, any thoughts on my follow up to Purgatory's response, or indeed anything else to say about my problems ? Particularly whether I can control the problem just by habit / diet alone ?

Thanks again.

Thanks English Alf.

My experience of NHS has been okay. Not too great. Not too bad. Two years ago, when I went to my NHS GP with the bladder outlet obstruction issue, he asked me if I had private insurance. I said yes. He then referred me to private and commented that waiting time on the NHS for this sort of problem would be way too long. By the way, the non-invasive PCA3 test that I got done in private would not have been available for me on the NHS. There are also some horror stories that BBC often highlights about some NHS hospitals but I guess (and hope) thats the exception rather than the norm. As somebody who lives alone and who doesnt have any family here in UK or any close friends who would visit me in hospital, I personally want the finest treatment I can get, even if it means I have to pay a lot for it.

I guess I am looking for the finest urologist in UK, not only in expertise and qualificaton but also in being kind and willing to switch off everything and just focus and listen to the patient for 15 minutes.

I have 2 main questions :
1) For the obstruction problem, what if I leave it untreated and just control by habit ? Is there a risk of serious kidney and bladder damage ?
2) the prostate growth : what is it ? My PSA(0.7) and PCA3(20) are favourable ...... If the biopsy comes back negative what next ? Do I keep taking biopsies every 6 months ? If the growth is not cancerous, will it go away on its own ? Does BPH cause such an irregular growth ?

I am finding some of the signatures here quite scary. They put a catheter into me for urodynamics. That hurt like hell. I cannot imagine being on catheter for months.

They said the right base of my prostate is hard (nodule). Today I am getting a slight dull pain there, also radiating toward my right leg.

Still waiting for replies for many of my technical questions on this thread. Look forward to people's responses.