Background

NOTE: I am not a Doctor! This information is not intended as medical advice and should not be used as such. If you seek answers to your questions about prostate problems, consult your physician. Why this blog? This is a journal of my experiences with an enlarged prostate (BPH) and its medical consequences and remedies. The motivating factor in writing this blog was to help other men navigate the emotional and physical maze that is prostate disease. When I researched BPH and the various surgical procedures used to alleviate problems, I found web forums useful, but there was always something missing. Though they might be available, I couldn't find any support groups for BPH in my area. I needed something that spoke to me. I experienced a lot of anxiety, fear and a feeling of being alone with my problem. I think a lot of our identity as men is tied up with our sexuality. Some of the procedures to diagnose problems, such as a cystoscopy, are not especially painful but are invasive and can leave you feeling violated. I felt, in a strange way, that my manhood was being assaulted. I was reluctant to speak about my problems to my friends and acquaintances out of a misplaced sense of shame. I don't want someone to go through what I went through. I feel an obligation to publish this information so someone will have an easier time with their journey. So, I'm writing this to help a brother out. The more you know, the more comfortable you'll be. Early Warning Signs As I analyze my condition, I now realize that my problems were a long time in the making. One of the tell-tale signs was waking up at night to urinate. I probably have been getting up at least twice a night for over two decades. I'd hear 70-ish men complain that they have have to get up once a night to make a restroom visit. Pffft! That's nothing, I've been doing 2-3 times that since my early 40's. I had chalked it up to being a generally anxious person and having a stressful job. Gradually, as I approached my mid-50's, I started adapting to the disease in subtle, unconscious ways. In my head, I'd map the location of available restrooms if we were out and about anywhere, even if we were just in the local neighborhood. For longer road trips, my wife and I would stop about every hour or so to "stretch our legs" and "get gas" (uh-huh, yeah, right). I learned strategies for seeking out restrooms anywhere. Starbucks, grocery stores and hotels like Holiday Inn Express became my friends. First Indications In January 2007, I had a routine colonoscopy. I was 56 at the time. Ten days after the colonoscopy, I got up to use the restroom in the middle of the night. Surprise! Ow, ow, ow! What the hell is that?!? I was peeing glass. Well, that was special. Like many other men, I thought perhaps this was a one-time occurrence. If it the pain diminished or went away, I won't have to go to the doctor. Big mistake. I had a urinary tract infection (UTI) that was not "going away" by itself. When I continued to have symptoms of burning urination at the beginning of the stream, having to urinate more frequently, and having a more urgent need to urinate, I realized I had to see my doctor. I had an Enteroccocus infection. I was put on a 7-day course of Ciprofloxacin (Cipro) antibiotic which is considered the gold standard for treating UTI's. I'm allergic to Penicillin so that ruled out some other antibiotics. I was still experiencing symptoms after 7 days, so my doctor put me on a second course of Cipro. I took two doses of Cipro on the second course and suddenly started feeling what I would describe as flu-like symptoms: aching muscles (myalgia) much more than a workout would give you. This turned out to be a rare but known side effect of Cipro. I immediately stopped Cipro and about 3 days later the achiness resolved. Back to the doctor. He consulted with a specialist to find an antibiotic that would work for me. Doing this from memory now, but I believe that was Macrodantin (Nitrofurantoin). The symptoms went away after this course of meds. While I was dealing with the UTI, I had another issue to deal with: my PSA (Prostate-Specific Antigen) score was rising. It had always been in the normal range: about 2.3 for several years. Now, over about 6 weeks, it rose to 5.3. This can happen with UTI's, however it could also be an early indication of Prostate Cancer. My GP referred me to a urologist for further evaluation. First Urology Experience At the first office visit with the urologist, I was quite anxious. I normally have well-controlled high blood pressure, but the nurse measured my systolic BP as 160. I was unprepared for the first test the urologist routinely does - the Uroflowmetry, or urine flow test. As the name suggests, you urinate normally into a special urinal that has a device attached for measuring the flow rate. No big deal at all. The mistake I made, but was natural/routine for me now, was that I visited the restroom before seeing the doctor, so I didn't really have good volume. The urologist said my flow was weak. We moved to another room at the urologist's office and did a sonogram of the prostate. The urologist said the prostate didn't look all that large, but it had quite a few calcifications (AKA "stones"). These are actually quite common in middle-aged men. They are generally considered benign and have no correlation with prostate cancer. However, if you continue to read this blog, the stones will become significant later on in My TURP Story. The urologist said prostate cancer usually does not display such velocity (2.3 to 5.3 in 6 weeks or so) in the rise of PSA, but that we should do a biopsy to be sure. We scheduled one for six weeks out. I was anxious and fearful the whole six weeks. What if it IS cancer? Well, if it is, early detection and treatment is the best hope for a good outcome. Prostate Biopsy I arrived at the urologist's office again unprepared. They wanted to do the Uroflowmetry again. Would you people mind telling me what you expect of me for the next office visit? The actual biopsy was not scary at all. The urologist gave me a local anesthetic (Lidocaine) in the rectum which numbed the area where the biopsy was to take place. After that, I could feel pressure but no outright pain. The actual biopsy instrument is a kind of air-powered gun that is quite loud. The urologist warned me that the instrument makes a lot of noise, but not to be concerned about it. The procedure is also guided by sonogram. Samples are taken from two different locations in the prostate, 10 each location in my case. The entire prostate cannot be biopsied because there is a section facing away from the rectum. It's possible you could still have cancer in the section that isn't surveyed. After the first biopsy "pop" from the instrument, I started to relax. There was no pain, only pressure. I joked about it kind of like being at the dentist, only the other end is worked on. The whole procedure took about 20 minutes. I was left alone to dress when I noticed bright red blood seeping out of my penis and freaked out. I summoned a nurse and asked if this was normal and she said yes, it's expected. That's a channel for residual blood to flow. The urologist scheduled another office visit about 3 weeks out to go over the results of the biopsy. His nurse said to expect to see some sign of blood for about 2 weeks. In my case I was seeing blood in my urine for 3 weeks. When I returned to the urologist's, he gave me good news: the biopsy was negative, no cancer found. Prostate biopsies initiated by PSA scores are somewhat controversial. I have read estimates that about 80% are negative. Also, the biopsies can rarely register false positives. The CDC has recently clarified its position on the role of the PSA test in detecting prostate cancer. It follows guidelines "which state that there is insufficient evidence to recommend for or against routine screening for prostate cancer using PSA". See this page for more information. However, the urologist did put me on a medication to help my urinary symptoms. He prescribed Flomax (Tamsulosin), a popular medication in the alpha-blocker family. Flomax works by relaxing the veins of the prostate and the bladder neck, to allow better flow of urine. I took two doses and felt quite strange on the medication, hard to describe. Flomax may take up to 7 days for you to see noticeable improvement. In my case, I saw results from the first dose. Unfortunately, I felt so odd on it, I decided "I'm not taking this shit!". Look at this link for information on Flomax. On the next annual visit (2008) to the urologist, I said I had stopped taking Flomax. The urologist kind of responded, well, there are other medications that you can try. I didn't show any interest at the time, so no new prescriptions were offered. The last time I saw this urologist was 2009, no change in meds or prognosis. In 2009, I was still in the United Health Care (UHC) insurance system. In 2010, I changed to the Kaiser Permanente (KP) system due to the high cost of UHC. KP was roughly half the cost of UHC. Continue reading.... Skip to TURP Description....