OK. Sorry. Guy health topic

[Bill in Oregon]

Here I go posting this just as Ms. Boots has returned to the forum. Please avert your eyes, ma'am.
OK, so the BPH has reached the point that I have to do something soon. I have been on doxazosin for nearly a decade but it "ain't workin' like it once did." I saw my urologist in Abilene a couple of months ago where, in my health plan, they do two procedures: the "Uro-Lift" and the old standby TURP (trans-urethral resection procedure for you poor young unsuspecting saps out there. Party while you can! )
The staff, all very nice ladies, did the cystoscopy and determined I was not a candidate for the Uro-Lift, so a TURP it shall be, and sooner than later. Old guys here will identify with jumping out of bed at 11, 2, 4 with an urgent need to void -- a couple of tablespoons.
Sooo, I have heard some guys say the first few days after a TURP are absolute Hades when you have to pee, and other guys say it wasn't bad at all and gave great relief.
Please share thoughts if you have been there, done that, and by PM if you don't want to be public about it.
One consistent side effect is "retrograde ejaculation." I have been divorced for several years now so do not know what this portends for a "love among the ruins" relationship late in life.
I apologize if I have offended. Just need to ask my homies that I trust about this.

[Rimfire McNutjob]

I .... am going to go curl up in a corner and never visit this thread again. Good luck.

[junkbug]

I have undergone the prostrate “seed treatment “ which is much less invasive than the turp, and now somewhat regret it. I would suggest exhaustive research before allowing yourself to be cut up like that.

[hfcable]

Bill, this is supposed to be the latest and greatest and least invasive

https://www.medscape.com/viewarticle/994249


if i needed it this is how i would go

[Ysabel Kid]

All of the sudden my medical challenges seem... less challenging.

Bill, I wish you luck and will say a prayer for you!

[TedH]

All of the sudden my medical challenges seem... less challenging.

Bill, I wish you luck and will say a prayer for you!

+1. Prayers Bill

[Lassiter]

A year or so ago, my son had a green light laser procedure. He says he is very happy with the results.
My understanding is that they remove a portion of the prostate around the urethra.

He is 48 years old and had to use a catheter often enough that he bought them in bulk.
Now he says he can pee over a 6 strand barb wire fence

[Sixgun]

I know people who have had the seeds and the “cut and reattach”. The first with the seeds is fine and continues with his visits to the “No Tell Motel”…the other guy has been wearing a diaper for the last year and a half………if it happens to me, I’ll load up on morphine and go out in style.

Oh, the 3-4 times visits to the bathroom…….thats what Gatorade bottle are for…..you stay warm under the covers and get right back to sleep.

[Nath]

Chit Bill

[Bill in Oregon]

Thanks for the sympathy, fellas. Harold, I really appreciate your mention of the Optilume procedure. I went to their Web site and requested more information.

[Old No7]

I wish you well Bill!

It's not a competition of course, but from all the replies -- I'd go with Lassiter's recommendation above. Check into that.

Maybe our resident Doc will chime in too? Or PM him?

Old No7

[AJMD429]

.
I deal with the pre-surgical phase, trying to prevent the situation from getting that bad, so don't have much help on the later stages, other than with retrograde ejaculation, the orgasm still happens, but the output takes the shorter path upstream instead, so no more side jobs doing ‘money shots’. The amount of semen is reduced to the extent there is less prostate gland after procedures, too. But old guys ALL eventually just shoot ‘dust’ anyway, and I don’t think their partners care (most wives say they appreciate the less mess).
You can try nasal oxytocin spray to see if it helps the ‘intensity’ of the orgasm, as it works for some women post-hysterectomy or other procedures (the prostate and uterus are embryologically similar in origin and both contract during orgasm; oxytocin enhances this sensation); both uterus and prostate respond to Cialis by relaxing, by the way, which is why that drug improves BPH symptoms AND helps menstrual cramps).

If you’re over 40, or over 30 and putting on weight, at your next physical (which should be YEARLY), be sure to get your testosterone (including the total, free/unbound, and DHT), your estrogens (at least the estradiol & estrone, there are many forms*), and maybe in the future, your progesterone, measured.

High estrogen MUST be addressed. Easy - usually with anastrozole a couple days a week). Low progesterone MAY be an issue; just now being explored. High DHT can be addressed by progesterone or more commonly by DIM (diondolylmethane).

Low testosterone in my opinion also should be addressed, even without ‘bedroom’ symptoms, due to a low testosterone being associated with weight gain, loss of muscle and bone mass, fatigue, earlier cognitive decline, depression, worse or earlier onset of diabetes, heart disease, stroke, AND an increased likelihood of delayed diagnosis of prostate cancer. Also if prostate cancer does develop, it tends to be more aggressive in Guy’s with low testosterone.

Complex stuff, and decisions must be individualized, and made with your personal physician, but I think that attending to these issues in your the 30-60 age range when there are no symptoms yet, can PREVENT needing the tamsulosin or finasteride or surgery later.

*this is the best test - https://dutchtest.com/product/dutch-sex ... tabolites/ - but I mostly use it for women, to differentiate between the many forms of estrogen, since some increase the risk of breast cancer and dome DECREASE the risk of breast cancer and we can easily alter which forms predominate.

[marlinman93]

Bill, I'll let you know after Feb. 12th. That's when they are going to roto rooter mine and we'll see how it is afterwards. My urologist did the scope a month ago and said I need the passage opened up, but also said my prostrate is growing into my bladder, so she'll also remove some of that at the same time.
I bled for a day after that scope, and that was the worst torture I've ever had inflicted on me! I wont ever let them do another scope while I'm awake!

[lonesome dave]

been the rotor rooter rout and frequent urinating beats the hell out of the catheter and i wore one for several months, the worst was the blood clots.

[mickbr]

great post doc, thanks. My only advice to all is never get a prostate massage. I had one on a whim in my early 30's. Woke up the next day feeling sort of weird internally swollen, a bit numb, also midlly incontinent later that week. My Doc prescribed anti-biotics and it settled down after a few weeks but sex was never the same, still functioned but sensation was reduced about 50%, to this day. No docs or specialists ever gave me a good explanation why, maybe continuing long term prostatis, maybe nerve damage. gave up trying to get answers after a few years and lived with it. Hope you find the best course of action Bill.

[Bill in Oregon]

Vall, bless your heart my friend. That cystoscopy was pretty uncomfortable all right -- certainly worse than a catheter upon removal. If I have to have the roto-rooter, thank gosh it's a general anesthetic and an overnight in the hospital. Wishing you well on the 12th.
Mick, not to pry, but is a prostate massage something you would get in, say, Saigon?

[AJMD429]

Mick, not to pry, but is a prostate massage something you would get in, say, Saigon?

The idea is to 'milk' out the stagnant seminal fluid (the sperm come from the testicles but most of the other ejaculate comes from the prostate). If it stagnates there is more inflammation and infection. Orgasms help and ideally should happen several times a week, but you know how that goes... Smooshing around on the gland (accessed rectally) can kind of do the same thing (and sometimes might even be pleasant, depending on the circumstances - perhaps in Saigon if you're really lonesome... - it is sort of how you get semen from large dangerous animals, using an electric 'prod' of sorts, because it might be a bit risky to do it using the external sensitive parts). It isn't done all that much medically any more, but probably does have some rationale in circumstances where the patient can't for whatever reason do it the conventional orgasmic way.

This is in contrast to a plain EXAM (or 'digital rectal exam' - sounds like a computer thing - ), which helps assess for tumors and/or infection. Not much fun for the patient - but having been on both ends of THAT exam, I feel no sympathy for the patient - if the glove breaks, they get finger-cooties in their bottom, but the physician gets a far worse experience...

[mickbr]

it wasnt saigon, nor was it pleasant and it changed my life for the worst , true story. Boy this thread got wierd fast

[Bill in Oregon]

Mick, Doc, sorry I asked -- but I am learning a lot!

[marlinman93]

Vall, bless your heart my friend. That cystoscopy was pretty uncomfortable all right -- certainly worse than a catheter upon removal. If I have to have the roto-rooter, thank gosh it's a general anesthetic and an overnight in the hospital. Wishing you well on the 12th.
Mick, not to pry, but is a prostate massage something you would get in, say, Saigon?

Yes, I'm told I'll be put under during the procedure, and will go home the next day.
The scope removal was a big relief once the doc took it out. She kept trying to stop and show me images, and I just wanted her to hurry up and finish! I bled all the rest of the day after the procedure, and for several days it set me back to where I was before she started me on Flomax. I was wishing she'd never done it, or at least given me something to take the edge off first!

[marlinman93]

Bringing this back up, simply because I'm sure there are others in their retirement years who might be having similar problems and considering a procedure in the future. I'll try not to be graphic in describing this.
I went in Monday morning at 5:30AM to have the TURP surgery done. Took maybe 90 minutes, and was back in my bed after recovery time. Eating lunch and a little uncomfortable from the catheter, but otherwise not bad. Tuesday morning the surgeon removed the catheter, and after several trips to the bathroom that morning, they finally sprung me just after lunch to go home.
Dr. told me it would take a week to fully heal and not pass blood, and it's better every day. They gave me a prescription for pain, and flow, but I've not needed either. Not enough pain to even take over the counter ibuprofen, and flow is better than I ever remember, even in my very younger years. I sleep all night now, with only one or none bathroom trips.
I have a final appointment for probably just a follow up in March, but can't see why I need it? I'll go see her just to thank her for a job well done.

[Bill in Oregon]

So pleased for you Vall. I am still not sure which route I will go but it is good to know the old TURP still works.

[marlinman93]

So pleased for you Vall. I am still not sure which route I will go but it is good to know the old TURP still works.

I talked with a friend who said he had the laser done and it was a total failure, and made things worse. He then opted for TURP and said things are great. My doctor told me she'd not do the laser, and said I'd need to go elsewhere if I wanted it done. I'm glad I listened to her!

[Old No7]

Wow, after reading all this (and recognizing that it will be helpful to many of us), all I can think of is this...

Man, these guys are using a Lewis Lead Remover on their wiener!!!!

OUCH!!!

Old No7

[piller]

Had a TURP in November. Glad I did. Tamsulosin and Proscar failed me.

[marlinman93]

Had a TURP in November. Glad I did. Tamsulosin and Proscar failed me.

My urologist prescribed Tamsulosin temporarily to help me get by until she could do the surgery. It helped, but I could never consider it a long term fix, or even good enough for short term. It saved me some discomfort, but not enough to rely on it for long.

[Bill in Oregon]

Brian, glad you have yours behind you as well. It seems the TURP and several other treatments I have looked at all have an asterisk: there is a very small risk of incontinence and or impotence. And I was never any good at poker ...
And Darryl can we please rephrase that as "getting Boresnaked" vs the Lewis Lead Remover imagery?

[marlinman93]

Brian, glad you have yours behind you as well. It seems the TURP and several other treatments I have looked at all have an asterisk: there is a very small risk of incontinence and or impotence. And I was never any good at poker ...
And Darryl can we please rephrase that as "getting Boresnaked" vs the Lewis Lead Remover imagery?

My urologist/surgeon told me the same Bill. But I have talked with several friends who've had TURP done, and none had any issues. One friend said his prostate was 3x-4x above normal size, and he was self catheterizing for over a year, and everything is great since surgery. He had the laser first and said it only made things worse.

[Ji in Hawaii]

Aloha Bill, When you said TURP first thing that popped into my mind was a procedure involving the use of turpentine.
I have been taking Tamsulosin for about 3 years now to help deal with an enlarged prostate, and frequent urination, though rarely more then once a night, though during the day it's every hour. I do drink a lot of water during my waking hours. If ya don't mind me askin' how was your PSA level on last check? I get mine checked every January. Last year it was 1.34. This past month it jumped up to 14.78. I went to see a specialist last week, and with a digital exam he found a growth in my prostate, so MRI is next. I am not looking forward to the biopsy.
Anyone else here gone through the whole prostate cancer deal including either radiation therapy, or prostatectomy? I had one doctor say remove your prostate if you can, and another doctor say do the radiation. I'm a tad confused. At least they both agreed that it was caught early, so the chance of full recovery is very high.

[AJMD429]

Wow, after reading all this (and recognizing that it will be helpful to many of us), all I can think of is this...

Man, these guys are using a Lewis Lead Remover on their wiener!!!!

LOL that's about right...

My part of the job is to try to prevent prostate cancer (a huge reduction with the right diet and with proper hormone replacement (being better than not replacing, which is better than replacing wrong way), and to find it early (the PSA test yearly after 45, and finger-butt exam yearly after 40).

So I'm not the one to advise regarding treatment options, but keep in mind that is highly dependent on details of type of cancer, stage, and even what part of the prostate it is in, plus the patient's overall health and age and comorbidities.

I've had some patients do EXCELLENTLY with just radiation pellets, just robotic surgery, and many have been able to delay surgery for several years since the cancers usually grow so slowly. I've also had men die of prostate cancer, but mostly due to not getting their ANNUAL preventative exams. Meanwhile their wives (women generally come in faithfully every year for physical/pap stuff, even when they feel fine) get all sorts of things found and fixed before they are bad enough to die from.

Moral of the story - biggest thing is get complete annual exams from a primary care doc who should check EVERYTHING.
Also - there seem to be legitimate things to prevent prostate cancer - a few are touched on here by Dr Peter Attia and Dr Rena Malik in various internet podcasts.

[Bill in Oregon]

Ji, I am very sorry to hear of your legitimate concern, and hope the imaging and further tests show a completely treatable cancer. My PSA levels -- checked regularly -- have been consistently low, as well, and the urologist saw nothing to concern her during the cystoscopy, thank gosh.
As usual, Doc is giving us gold-standard advice.
I have to wonder if our friend Rimfire is still curled up in the fetal position!

[marlinman93]

PSA levels are not the best way to know if a prostate is healthy. An enlarged prostate is pretty normal for guys in their older years, so high PSA can mean cancer, but also can just mean an enlarged prostate that's elevating the PSA level. My urologist sent me for a CT scan and said although my prostate is very large, the density is very low, and no signs of any more dense lumps.
I'm not sure why anyone would have a biopsy unless a CT scan showed lumps, and the biopsy was needed to identify if they're malignant or benign?

[Ji in Hawaii]

Neither my doctor or me were concerned about my enlarged prostate which I had for 3 years, that is until my PSA jumped from 1.34 to 14.78 between annual checkups. I think the ol' digital (as in finger up the exit) is a great initial exam to locate lumps, and if anything found, then followed by MRI to verify size and location of growths to aid in biopsy. Biopsy scares me because the hospital is only equipped to perform biopsy inside the colon, which can introduce E.coli to the bloodstream. Not sure how high the incidence is, but I read that men have died from infection introduced from performing biopsies. I'm very curious about what the MRI will find.

[Bill in Oregon]

Ji, you ARE going to a big hospital in Honolulu, right?

[AJMD429]

.
Every once in a while, the PSA is determined to not be a good test, and then they quit doing them for a few years and then they change their minds. What’s going on? Is that doctors just look at the sheet? The labs are printed on and if the PSA is less than four, they ignore, and if it’s over, for they freak out. The important thing is where the PSA is rising, and how fast, and then what’s called PSA density, which is, how much PSA is put out versus the prostate volume. Prostate volume is difficult to assess accurately but at least the concept is that the PSA should be somewhat proportional to the amount of prostate tissue. If it rises quickly, there’s something going on, whether it’s an infection or recent sexual activity or cancer. The other test is called a “free PSA” which is a way of working more intently at the substance in the blood, and at least, theoretically helps discern whether an elevated PSA is worrisome, in terms of malignancy or not.

The problem is the free PSA is only considered valid if the regular PSA is elevated, and the test gives a result in terms of the percent chance the patient will be diagnosed with prostate cancer during the next year. It is sometimes a depressing test because even under the best circumstances, most males with riding PSA have at least a 10% chance of that happening once they are over 60 or so, simply because the cancer is so common. Something like one out of eight men will develop it, usually between age 60 and 80. Fortunately, in most cases, it is slow growing enough that, the patient will outlive the cancer, in many cases, even if it’s not treated.

Currently, there is data to suggest that, ignoring a low testosterone level, which often happens if a patient isn’t having obvious symptoms, may not be a good thing, because low testosterone levels tend to mask, diagnosis and delay it, because they suppress the PSA level, artificially, and men with Low testosterone levels tend to get more aggressive, prostate cancer, stem in with normal levels, whether the normal level is natural or due to hormone replacement.

It may be useful to monitor dihydrotestosterone, versus testosterone, and monitoring estrone and estradiol are important. Some also think that progesterone may protect the prostate from cancer similarly to the way it protects the uterus (and possibly breasts) from cancer in women. That’s not for certain, and we’re not even sure what level of progesterone to consider normal in men, but clearly it mellows the mood in men similarly to the way it does in women, and appears to be a counter-balancing hormone to the testosterone in men and the estrogen in women, which are both mentally energizing, but can be too energizing, if not balanced with the right amount of progesterone. The most dramatic example of that is the women who suffer from PMS; simply giving them bioidentical (NOT ‘Provera’ and NOT ‘medroxyprogesterone’) progesterone cream in the morning or orally in the evening will help them sleep better and be in a much more mellow mood during the day. The guy to go from Melo to Road Reggie, when you normalize low testosterone appear to benefit from a balancing dose of progesterone as well.

[samsi]

Neither my doctor or me were concerned about my enlarged prostate which I had for 3 years, that is until my PSA jumped from 1.34 to 14.78 between annual checkups. I think the ol' digital (as in finger up the exit) is a great initial exam to locate lumps, and if anything found, then followed by MRI to verify size and location of growths to aid in biopsy. Biopsy scares me because the hospital is only equipped to perform biopsy inside the colon, which can introduce E.coli to the bloodstream. Not sure how high the incidence is, but I read that men have died from infection introduced from performing biopsies. I'm very curious about what the MRI will find.

The Doc should give you a script for an antibiotic that you start taking the morning of the procedure and continue for a number of days afterwards. I wasn't thrilled with the idea either, but had no serious issues afterwards.

[Ji in Hawaii]

Ji, you ARE going to a big hospital in Honolulu, right?

Yup, Kaiser Permanente Moanalua Medical Center. Been there many times, and have great confidence in the facility, and staff. My urologist has great credentials. Radiation therapy will be referred out to another facility (Saint Francis Medical Center) if we go that route after biopsy.

[Ji in Hawaii]

The Doc should give you a script for an antibiotic that you start taking the morning of the procedure and continue for a number of days afterwards. I wasn't thrilled with the idea either, but had no serious issues afterwards.

Thanks for the reply. He did mention that about taking anti-biotics, which is reassuring. Also, good to hear about your first hand experience. I also read that taking a Zanax pill before the procedure is not a bad idea, which I'll probably do. Thank you.

[Ji in Hawaii]

.
The important thing is where the PSA is rising, and how fast, and then what’s called PSA density, which is, how much PSA is put out versus the prostate volume. Prostate volume is difficult to assess accurately but at least the concept is that the PSA should be somewhat proportional to the amount of prostate tissue. If it rises quickly, there’s something going on, whether it’s an infection or recent sexual activity or cancer.

Would you consider a PSA jump from 1.34 to 14.78 in less than a year as fast? I've had an enlarged prostate for over 3 years but this is the first time my PSA went above 4. Urine test was clear, and I have not been sexually active for at least 5 years due to wife's condition. I'm very interested to find out what the MRI scan shows. Thank you for your input.

[Bill in Oregon]

Ji, please keep us in the loop if you are so inclined. You can count on lots of sincere prayers and good thoughts from the fine bunch here at Leverguns.

[Ji in Hawaii]

Ji, please keep us in the loop if you are so inclined. You can count on lots of sincere prayers and good thoughts from the fine bunch here at Leverguns.

Thanks Bill, Will do. Soonest the imaging department at hospital could schedule me was for the 14th of next month. Good to know it's a slow growing cancer.

[piller]

Xanax is not a good idea for me. That family of medications makes me angry for no reason. Took an hour to wake up after the procedure. The Anesthesiologist laughed when I said it would take.a while. He said 15 minutes MAX. Seeing your first medical Zebra is a bit of a surprise to most. He also dismissed the information when I told him I was missing genetics for liver function. They put the mask on me and instructed me to, well, something. I didn't hear what was said. I was out.

Now everything is working great.

[AJMD429]

.
Obviously it needs checked out but don't place too much on the exact amount of a jump because all sorts of other things affect it, including inflammation or infection or intimacy or even just the act of having had a prostate exam recently. Plus as others have said it's one of the more slow growing cancers even if it is a cancer, and it also an organ that has a capsule which means that cancer has a hard time getting outside of it.

[Ji in Hawaii]

.
Obviously it needs checked out but don't place too much on the exact amount of a jump because all sorts of other things affect it, including inflammation or infection or intimacy or even just the act of having had a prostate exam recently. Plus as others have said it's one of the more slow growing cancers even if it is a cancer, and it also an organ that has a capsule which means that cancer has a hard time getting outside of it.

I've had inflammation for 3 years, Urine test was clean, and no intimacy for 6 years. Prostate exam happened after my PSA blood test. My docs seem to be checking off all the right boxes. I am currently more curious than worried. Main thing it was caught early.