What should I consider for BPH?

Hi Ken,

Have you had any systematic biopsies? Usually one is advised in biopsy-naive men who have a negative MRI when PCa is suspected. Are you still looking for a BPH treatment other than a TURP? Your prostate is getting large and I've seen less-than-optimal outcomes in Forum brothers with some BPH treatments.

I had great symptomatic improvement for my BPH for years with tamulosin and finasteride, but eventually my BPH won the battle and I was getting close to total blockage. My TURP was very successful, reducing my prostate from 90 to about 30 cc and restoring a very strong stream. Four years later, when my PCa was diagnosed, my prostate had grown back to 60 cc. My uro/surgeon did both my TURP and my very successful RP at Duke Regional.

What I would have given for a crystal ball back when I had BPH to have known PCa was in my future and I would need a RP. I think you want to rule out PCa as best as you can before you have any procedure for BPH. Of course I'm hoping your are cancer-free, but if not, surgery could solve both issues definitively.

Djin

A systematic biopsy is the same as a non-targeted one.

Most of the time a "targeted biopsy" is a combination of a targeted-only biopsy--where cores are taken only aiming at the MRI-identified targets--plus a "systematic biopsy"--where cores (usually 12) are taken more or less randomly in six prostate zones on each side. I had many biopsies over the years, all of them systematic. Evidently not all of your docs thought one was necessary; but they may not have needed much convincing if you were leaning in favor.

"At the time, my PSA was elevated and my local uro suggested a nine or twelve core non-targeted biopsy."

What happened? Did you say no?

Since I had a TURP, I can't speak about other procedures for BPH. Let's see what other Forum brothers have to say.

"Significant prostate cancer" excludes Gleason 6 (3+3). This is indolent PCa, and many men with it can go on Active Surveillance where it is monitored and treatment is advised only if the cancer progresses or the amount of G6 cancer increases. However, with moderate to severe BPH, knowing you have G6 cancer could change the picture if you reach the point where a procedure is needed for the BPH. You want to weigh all your options, including a prostatectomy.

Djin

Ken said...
I have delayed treatment for some years hoping for better methods than TURP.

HoLEP

See my signature for details of PCa, but my HoLEP was done at Hershey MC by Dr. Knoedler, and it’s worked out fine. You get the contents for a biopsy too, which you don’t get with other procedures like Green Light Laser, Rezum, etc.

It’s real surgery, so there’s that. But it completely fixed BPH symptoms, and my PSA dropped from above 5 to 0.4. That will make future PSAs a better predictor of PCa evolution.