Enlarged Prostate advice needed

[alwayslooking]

This is my first post, and I hope I am in the correct forum. I have a greatly enlarged prostate, over 170 g, and my urination is weak. I do take lots of herbal pills to help. Anyone know the least harmful method to increase urination? The TURP is to extreme for me, as I do not want to have permanent retrograde for life. My PSA is high, 19.1, but I refuse a biopsy as I think that will only agitate any cancer if I have cancer. Normal PSA for prostate my size is about 16, and my PSA is not risen very much in 3 years.

[alwayslooking]

I am taking the most advance blood test for prostate cancer called the 4kScore test. Much more accurate than PSA.

[CERICWIN]

Four years ago, I was taking the herbal pills, I had difficulty urinating and was in denial that it could be prostate cancer.       When finally I had to see a uro because I almost couldn't urinate at all, I had a biopsy, and scans.      Biopsy showed Gleason 8, 12 samples all positive and cancer had escaped the capsule.       Scans showed Stage IV advanced metastatic prostate cancer, with mets to spine, sacrum and "innumerable" pelvic lymph glands, with the prostate invading the bladder, partially blocking both ureters and bladder outlet.

I didn't learn immediately, though, that my beginning PSA was 744.     My uro didn't tell me at the time, and he was correct in doing so---I would have freaked out---the news was bad enough.

You should get tested for prostate cancer, even if it involves a biopsy, or try to get the less invasive 3TMRI.      Don't wait until it's too late like I did; I'm paying a terrible price for ignoring the symptoms.

CERICWIN

[Dr_WHO]

It is not a pleasant test, but please get a biopsy.  Do not wait and have what happened to me happen to you!

I am 58 years old. For the last four years a digital exam showed that my prostate was enlarged but my PSA was below 3.  The Dr. said that everything was normal for someone in their 50's, but that I should see an urologist if I was worried.  Of course I did not as it sounded like normal aging.  That changed last December when my digital exam indicated that there may be an area of concern and my PSA was 11.  A biopsy showed a Gleason score of 8 with 7 of 14 samples positive.  I am now two days in recovery from robotic surgery.  While I have to wait for the pathology report, the surgeon stated that it was at least T3N2 (i.e. all over the prostate and spread to nearby lymth nodes in a serious way).  When I have recovered I will start radiation and hormonal therapies.  I have to wonder what would of happened if I went in sooner.

[Flyfishingtony in reply to Dr_WHO]

Technically the stage of YOUR cancer is CURABLE otherwise they would not waste money on radiation . Forget your psa levels at this stage it is almost meaningless the biopsy is not . I have encountered psa levels of over 4ooo but the Gleason score/bone scan are very important . The psa level does become very relevant after treatment when it should drop to about 00.8 . This indicates a good result . I am 6 months into hormone treatment and just had 37 fractions of radiotherapy . You will take hormone tables initially to prevent " tumour flare" then an injection usually to last 3 months . The hormone treatment starves the cancer of testosterone and it shrinks wherever it is in the body it also weakens the cancer cells ready for radiotherapy . It is VERY important to get your water levels right before you have radiotherapy otherwise they will send you home untreated . I am happy to help you with achieving this . The reason is that the bowel must be empty and the bladder full otherwise the radiotherapy beam will damage your bowel/bladder and you could end up in a nappy for the rest of your life . There is a new silicone blocker that can be inserted to space these organs out and there is a new internal radiotherapy on trial at Christies in Manchester which sound very promising . Many cancers return , actually thhey appear to return this is because the scans do not pick up tiny cancers that are present in the body so it is not uncommon to go back for "salvage" treatment . They usually wait until your PSA goes up to 20 and then attack the cancer again . NB this can take a long time as prostate cancer is slow growing with a slow " doubling rate " as against other types of cancer .

[rickcricow]

<It is not a pleasant test, but please get a biopsy. >

I've had 2 biopsies, and it's really not bad at all.  Minor pricking feeling, less than a mosquito bite.  In and out in about 15 minutes. 

My second one I had pain about an hour later, lasting about 6 hours or so.  Googling and talking with my urologist, I'm told it's extremely rare, and likely because they hit a nerve.  Pain was only about a 3 or 4 on a 10 scale.

[van123]

I have had 2 biopsies, and it is not bad. I'm glad I did because in year I went to a PSA of 8. Ended up with a Gleason score of 8. The tumor had broken out of the sheath, but no cancer in bones, lymph glands, or bladder. Now after surgery, I am going through radiation and hormone therapy to kill any remaining cancer in the tissue that surrounded my prostate. The biopsies saved my life and help me avoid long treatments. Please have a biopsy.

[maack1]

11.2ng/ml is the PSA that can be attributed to your gland volume of 170gm/cc, thus the remaining 7.9ng/ml is suspect for prostate cancer.  Your likely best bet for now would be to move directly to androgen deprivation therapy with a combination of the antiandrogen bicalutamide (generic of casodex) usually prescribed at one 50mg tablet daily, the 5Alpha Reductase inhibitor dutasteride/Avodart usually prescribed at one 0.5mg capsule daily, then followed a week later by one of the LHRH agonists Lupron, Eligard, Trelstar, or Zoladex (that week later to allow absorption of the antiandrogen to thus prevent or at least ease the effect of a "flare" effect that can occur with initial injection of the LHRH agonist).  This triple medication will have the effect of shutting down production of testosterone (the fuel that stimulates prostate cancer cell growth/proliferation), blocking the multitude of androgen receptors on every cancer cell from testosterone access (the antiandrogen), and inhibit/prevent any testosterone that might access the cancer cell nucleus from converting to dihydrotestosterone, an up to five times more powerful stimulant to prostate cancer cell growth/proliferation.  Thus, this protocol will hopefully rein in continued prostate cancer cell growth while at the same time serve to reduce the advanced volume/size of your prostate gland.  Having the cancer cell growth blocked thus controlling/managing the prostate cancer, will at the same time reduce the gland volume with these medications so that any future treatment towards eradication of the cancer will be more effective because of the reduced size of the gland if either surgical removal of, or radiation to, the prostate gland is considered appropriate.  It is likely you DO have prostate cancer in development and certainly in your best interest to have a biopsy performed despite the large size of your prostate.  Though it may be a bit more difficult to accurately determine the extent of your cancer in view of the large prostate if tissues samples are taken from the 10 or 12 locations of the prostate usually performed in a biopsy, at least if should identify if prostate cancer is in development and hopefully an accurate assessment of the Gleason Grades/Score found in those samples.   My email address is [e-mail] if you have other questions.

[jimreilly]

so folks, who has wisdom about a biopsy "agitating" any cancer that might be there? I didn't know this was even an issue......

[DS_WAVL in reply to jimreilly]

It's being studied, but there is little evidence that this is a thing.  Besides, one's own immune system has ways of dealing with a handful of rogue cells even if they do get out- that's being studied also.

[Hidden in reply to jimreilly]

Jim,

I agree. I've only had one, and hope not to have another. But, how would it promote anything. Excluding pain, mind you. Mine hurt bad. 

Joe

[Hidden in reply to jimreilly]

Not a doctor but I believe this falls under the "urban myth" category. The benefit of finding where you stand cancer wise far outweighs an extremely unlikely risk.

[Hidden]

I also tried the herbal route with no success. As for the biopsy, I wouldn't let my worst enemy have it done. It was the most agonizing pain one can be put through. I also had problems urinating. I wound up having a blocked bladder, and it was annotated in my charts. You would think they would treat me for it. Not only was I not treated for it, no one ever told me about it. 

So when I went into the ER with radiation proctitis, I got a CT scan done, and that's when I found out about my bladder. Instead of putting me on Flomax, the last several months, my doc put me on Toviaz. Which blocks urine flow. What a joke. Now I have some kind of bladder disease along with my PCa. Just wonderful.

[DS_WAVL in reply to Hidden]

Joe,

I am sorry that you had a bad biopsy.  Were you offered a sedative and a local anesthetic?   From accounts I have read so far, your experience is atypical.  I want to reassure the OP that the procedure is pretty straight-forward, but do ask questions and ask for sedatives and a local.

[Hidden in reply to DS_WAVL]

Now thinking back, I remember that a newbie did the biopsy, with the doctor observing. He said I would feel a pinch when the numbing agent was injected. Not ten seconds later, he says, here we go. By the time twelve chunks were removed, I was soaked from sweat. Never had my eyeballs sweat. Each yank, I let out a gasp. 

So, there's my story. I just can't believe it, another supremely painful experience I shouldn't have had to deal with.

[dd92251]

I have been a bit suspicious about the Prostate Biopsy because my PSA was 3.1 before a biopsy and went to a 5.2 after the biopsy.  I too suspect that the biopsy punctured some cancer cells and caused it to spread.  So you are wise to be cautious.

I know of nothing other than Saw Palmetto to help with urination. Purchase a brand that has a standardized strength capsule to ensure you are getting the same dosage ever time.

[alwayslooking]

I have a report published in a urological medical journal that claims needle tracking, from a biopsy, could spread cancer cells. Though unlikely, it is possible

I am trying to get my 3rd intensive endo rectal MRI  performed but the insurance company is not permitting it. I just had the newest cancer prostate blood test performed, called 4K score, and waiting for results. I have seen statistics that show doing nothing has the same death rate as surgery or radiation. Not very encouraging 

I thank everyone for their comments 

[DS_WAVL]

Dear Friend,

Please RUN, don't walk, to a Urologist immediately.  They will examine you further and may very well recommend a biopsy.  If they do, please comply.

I was diagnosed last October, age 54, with Gleason 3+4, and a PSA of 17 that was detected during a routine physical.  I had a RARP on March 4th, 2016, and the post-surgery pathology report confirmed Gleason 3+4, with the cancer well-contained and negative margins, so that was good news for me.

The anticipative mental stress of the biopsy was far worse than the procedure itself.  My uro wisely prescribed an oral sedative before the procedure that was incredibly helpful.  The worst part of the procedure was the administration of the local anesthetic before the cores were taken, which only involved two shots with about 3 seconds of stinging and burning, each.  The rest of the procedure was over very quickly, somewhat uncomfortable, but completely painless.  I had some blood in my semen for about 3 weeks, and a little sensation of heaviness afterward, but that was it.

I understand the fear very well, but you must not delay.  For all of its imperfections, our medical system is still the best source of experienced treatment.  I wouldn't hire a painter to re-wire my house, so go with the experts who have made treating these kinds of issues their life's work.

You will be faced with many difficult decisions, but the important thing to remember is that absolutely nothing in life is 100% certain, but there are reams of  statistical data out there for the more established treatments that show 5 and 10 year outcomes.  Having reviewed many of them, I can't imagine how the chances of treatment could be no better than doing nothing.

I am at peace with the fact that I may experience biochemical failure in the future in spite of my favorable diagnosis, and I am also at peace with the fact that any number of other things could lead to my demise.  If you look at this forum, you will see countless stories of people who are being treated for advanced PCa in a way that has enabled them to add years to their life- with some side-effects to be sure, but still alive and able to experience much of what life has yet to offer.  Without treatment, they would have died a slow, horrible death years ago, as many others have.

This isn't easy, but we're here to help =.  Good luck, and do come back for support if you need it.  

Now please make that call.

 

[rudolph10021]

Flomax is a prescription med which relaxes the muscles in the area of the prostate, easing urination. Cialis 5mg can also be effective, relaxing slightly different muscles.  Flomax is cheap, Cialis is expensive @ +/- $130/mo. Generic Cialis 5mg can be purchased through Canadian pharmacies for a lot less. (Do a little research before using Canadian pharmacies, since the meds come from different places and the pharmacies vary. However, there are some good ones.) I never found saw palmetto or beta sitosterol did any good.

[DFZ4835]

Please get your head out of the sand and see what you are doing to yourself and those close to you. By denying you have a problem you could be killing yourself.  Get the test and find out what you are up against. If it is cancer the longer you wait and deny the more it spreads and the sooner you die.  Just do it.

[alwayslooking in reply to DFZ4835]

I don't think my head is in the sand as I have studied this subject intently for years. Many urologist feel the biopsy spreads the cancer or at the minimum agitates it. I don't know but this theory makes sense 

[DFZ4835 in reply to alwayslooking]

So if you just read about it and study it will just go away. What medical study says if you have a biopsy you will spread cancer. Doing nothing is sure to spread cancer. If you have cancer you need to start treatments to stop it or at least  slow it's progress. Find a good  oncologist and make a plan based on facts not speculation. 

[alwayslooking in reply to DFZ4835]

Here is just one urologist who wrote a book on this subject of needle tracking, meaning the spreading of cancer cells through a biopsy. What the video.

sunvitanutrition.com/Men-At...

[Hidden in reply to alwayslooking]

In my previous entry I stated that this notion that a biopsy spreads the cancer is an "urban myth". Science and statistics is on my side. It has been a while since your original post. I hope and pray that you took heed of the sincere warnings to take action and get the biopsy. I had TURP surgery 10 years ago and I had a wonderful outcome. I did develop prostate cancer a few months ago but my prostate size was only 34 cc -- yours is huge. The biopsy discomfort was very transient and the pain did not persist at all. Like getting bee stings that immediately recede to nothing. There are new procedures called "urolift" and "rezum" that are supposed to be less invasive alternatives to TURP. I think you are dealing with something far more dangerous than the risk of "retention" due to BPH. Get that biopsy if you haven't already done so. Don't let fear and denial mess up your future. PCa is treatable but outcomes are better if caught early.

[alwayslooking in reply to Hidden]

Thanks for your concern but I have had 3 prostate specific MRIs in lieu of a biopsy. If the MRI showed a questionable area I would do a biopsy. With a 210 gram prostate a blind biopsy is shooting in the dark

[alwayslooking]

The first report on cancer spreading through a prostate biopsy appeared in Journal of Urology, 145:1003-1007, May 1991, entitled "Needle Biopsy associated tumor tracking of Adenocarcinoma of the Prostate", by Dr. Sheldon Bastacky

[DFZ4835 in reply to alwayslooking]

The really big question is what are you doing about your problem? Have you had a doctor do a blood test for cancer in the blood or a PET scan to confirm you have cancer?  The point is if you have cancer you need to treat it and try to keep it from spreading. Weather you have a biopsy or not if you have cancer it needs to be treated. 

Dennis

[alwayslooking in reply to DFZ4835]

If you read my comments above, I just the newest blood test last week, called a 4K score test...no results yet. But I will look into a PET scan.

[DFZ4835 in reply to alwayslooking]

Thank you for your answer. I forgot about the blood test you wrote about before. I'm sorry if I'm a bit pushy. I don't want you to die from inaction.  I have met to many men who thought if they ignored the cancer signs they wouldn't really have it. I watched a friend die of metastasized cancer because he denied he had a problem. I would hate to hear that you died.

Dennis,

[alwayslooking]

Just received my tst results, and my 4K results were not good. I just heard I have a very high risk for PC. I plan to now do a MRI to isolate the suspicious area, followed by a biopsy. Not  good.

[alwayslooking]

I have been reading about mri guided biopsy...makes a lot more sense.

[GeoffNoLongerAS]

 A few things to consider in your situation:

There have not been any definitive studies that confirm the spread of cancer via biopsy.  At this time it remains a theoretical risk.

Cancer spreads on it's own. The number of men on this site that have had bone metastasis before any biopsy show that is true.

A biopsy does have risks that need to be balanced against the information to be obtained.  There is a measurable risk of a blood infection.  The risk depends on the site doing the biopsy as well as the prep used and how closely you follow the prep instructions.  I had followed them religiously and did end up in the hospital with a blood infection.  If you have prostate cancer, avoiding a biopsy will not stop cancer from spreading.

While supplements can play a part in a healthy life style, there is not any control over purity and strength.  There is a web site (disclaimer - it is a pay membership site.  I do not have any connection in any way with the site, I was turned on to it by the nutritionist at my urologists office), consumerlab.com.  It is similar to consumer reports but covers supplements.  They test the purity and strength if different supplements.  They do not recommend any particular brand or type of supplement but do advise if the supplement contains the amount of ingredient they claim as well as whether the supplement contains and dangerous contents.  They also report on the cost per dose.

The PSA doubling time and velocity can be more important than the absolute value.  Generally a doubling time of less than 2 years.  There are web sites that will estimate velocity and doubling time.  

I  hope all goes well for you and you investigate your various situation.  I have always believed that any decision about treatment is as much a personal and emotional decision as it is a medical decision.  It involves your personal evaluation of your situation, your situation, your views on life, and level of risk taking.

Good luck going forward.

[alwayslooking]

I just had prostate arterial embolism or pae. An outpatient procedure that blocks the blood supply to the prostate which causes it to shrink. More later as it takes 30-90 days for results