11-18-2022, 10:56 PM
Dredging up this thread because it's top of mind for me. I'm a relative youngster in this group (58) but have had an enlarged prostate for several years. Folks with enlarged prostates typically have higher than "normal" PSA readings, so as mentioned above, it's as much a change in PSA as it is the raw number that triggers things. In my case, regular bloodwork and MRI guided biopsies were the settled-on course of action. After a few years of this, the biopsy comes up positive in small and localized regions. Tests on the samples reveals that I'm likely in the "die with it" instead of "die of it" category, so more watching and waiting. After a couple more years, additional MRIs/biopsies didn't find any cancer and PSA is stable (this doesn't mean that the cancer went away, just that it's small enough that it's hard to find and that it isn't spreading.)
If it weren't for symptoms associated with an enlarged prostate, I'd have been happy to just keep on the monitoring / waiting plan. Everybody needs to do their own research, and there are now a couple of decades worth of data to look at when making a decision. In my case, with the specific genetic markers and the localization and the PSA, the expected survival rate associated with doing nothing is virtually identical to if I had a radical prostatectomy. While I'm no spring chicken, I'm young enough that some of the potential side effects still matter to me. But the symptoms of the enlarged prostate are significant enough now that something needs to be done. Medication alone isn't cutting it. In my case, after looking at the myriad of options, I'm going with minimally invasive laser therapy where they clear out a channel in the prostate. Not entirely without risks and side effects, but all-in-all, looks to be a good option for me.
My reason for bringing all of this up is that while I have found the urologists that I've dealt with very capable, competent and professional, there is far from a consensus in terms of recommended courses of action. Every situation is different, and the risk / reward calculus is unique to the individual. Also, different urologists have their different specialty procedures that they perform, and they tend to be biased towards using the hammer that happens to be in their toolbox. The understandable reaction of "I have cancer, get it out" might not be the best course in all cases.
If it weren't for symptoms associated with an enlarged prostate, I'd have been happy to just keep on the monitoring / waiting plan. Everybody needs to do their own research, and there are now a couple of decades worth of data to look at when making a decision. In my case, with the specific genetic markers and the localization and the PSA, the expected survival rate associated with doing nothing is virtually identical to if I had a radical prostatectomy. While I'm no spring chicken, I'm young enough that some of the potential side effects still matter to me. But the symptoms of the enlarged prostate are significant enough now that something needs to be done. Medication alone isn't cutting it. In my case, after looking at the myriad of options, I'm going with minimally invasive laser therapy where they clear out a channel in the prostate. Not entirely without risks and side effects, but all-in-all, looks to be a good option for me.
My reason for bringing all of this up is that while I have found the urologists that I've dealt with very capable, competent and professional, there is far from a consensus in terms of recommended courses of action. Every situation is different, and the risk / reward calculus is unique to the individual. Also, different urologists have their different specialty procedures that they perform, and they tend to be biased towards using the hammer that happens to be in their toolbox. The understandable reaction of "I have cancer, get it out" might not be the best course in all cases.