Men, let's talk Prostate Glands

Miscellaneous and Personal Stuff I Must Share
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** Usual Disclaimer– I am aware that the SDMB is not a medical advice site and opinions are just that-opinions. **

Okay then. I’m 63. Got a pretty advanced case of Benign Prostate Hyperplasia. In laymen’s terms, an enlarged prostate.

Cystoscopy revealed nothing of note. Similarly Sonogram.

My PSA is normal.

The urine stream strength/ duration tests run 18 months apart show a serious decline in flow.

Been on 0.8 Flomax and Finasteride daily for the last few years. It is slowing the decline but clearly not managing it.

Like plenty of us in our 60s, I have friends who have Prostate Cancer. More than 2 have died of it, one just a few months ago.

I want this thing out. Yet again this past weekend, we visited with friends and made a few new ones. ( always nice ! ) One woman whose husband couldn’t make the trip for the reason I am about to share explained that he really cannot be more than 15-20 minutes from a bathroom. His life is utterly dominated by urine control and prostate issues.

My future includes reeking of dried urine 24/7 AND carrying around disposable adult diapers so I can swap out when I’m drenched.

In addition to some preliminary discussions with my Urologist, I’ve input from a few friends who have had various surgeries to try to manage the compression caused by the Hyperplasia.

I am opening this thread in the hopes that DoperMenz will share their situation and management techniques. It would be quite useful to learn how many others have dealt with this or are dealing with it. Has anyone had their prostate gland removed prophylactically?

Is Cancer of the Prostate worse than what I am now managing? No doubt. My dear pal Jeff who died a few months ago had Prostate Cancer. They removed his prostate. He lived quite a few years until the cancer came back, marching around his body like Sherman through Atlanta. He reported some unnerving but manageable side-effects. Many drugs to replace what his prostate provided. He was tired a LOT of the time. ( Turns out, this was the cancer leeching back in to a large degree. )

Sexual function is not a concern. It’s just not. I trade that for not being trapped in a life where I am constantly in discomfort, constantly mapping the next urinal, constantly stressed. Suffice to say that my wife is in agreement here. The intrusion already is rough on us both. It will only get worse until I’m catheterizing incessantly.

So. Why do I want to remove it or why do I NOT want to remove it?

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I’m only 48 now, so it’s not too bad yet… but it was the cause of death for both my father and my mother’s father, and I’m very healthy otherwise, so I think that if I don’t eventually have it out, it’s my most likely cause of death, too. So far, though, all I have is difficulty completely emptying my bladder sometimes.

One thing that I’ve found, anecdotally, but haven’t confirmed yet, is that when I eat a lot of salt, it seems to make my bladder difficulties worse. Might be worth a try.

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I’m 70 and was diagnosed with BPH five years ago because I was urinating frequently. My urologist prescribed Tamsulosin, which helped me a lot. I still have to pee multiple times during the night, but I can live with that. Like you, my PSA is normal, which means no signs of prostate cancer, at least for now. Prostate cancer doesn’t seem to run in my family. I don’t know the pluses and minuses of prostate surgery, but it might make sense given your situation.

I consciously moderate my fluid intake, especially if I plan to be away from home for hours. I drink mainly bottled water, but not habitually, only when I’m thirsty. No soda or fruit juices of any kind. I have a cup of tea in the morning and a cup of coffee with dinner, and I don’t have issues with either.

If I were you, I would research current BPH treatments and talk to your urologist. If you’re lucky, there may be a therapeutic trial going on in your area that you can enroll in, which could improve your life with BPH.

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I am taking Tamsulosin- it’s trade name is Flomax™.

My bad, I should have used both names.

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No problem. I should know that. Does it help?

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Here are two relevant threads:
Jun 2025:

This 2017 thread sort of turned into an omnibus PC thread with many folks posting about many experiences over years and years. It was last usefully updated a few months ago.

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As to the OP specifically …
66yo w mild BPH. Been on tamsulosin (Flomax) 0.4/day for about 7 years now. It was working OK to keep me with decent stream, no urgency during the day and one overnight wakeup most nights; never two.

For reasons unrelated to BPH I added tadalafil (Cialis) 10mg/day about four years ago. Which worked great for the usual purposes :grin: but also greatly improved the BPH. I now do not wake up at night to urinate. I now have the large capacity bladder I did at 40 and plenty of stream flow. No worries at all about being away from a bathroom for hours.

Getting medical insurance to pay for daily tadalafil for BPH is kinda difficult. Because the brand name pills are stupid expensive, like $20 each. And they assume the BPH diagnosis is BS and you’re just looking for ED pills; which is not a covered diagnosis.

There are legit e-commerce pharmacies in the USA that are much more affordable, albeit they don’t work at all with insurance. I use GoGoMeds and pay $16 for a 90 day supply of generic tadalafil. $60/year out of pocket is well worth it.

Another decent choice is Mark Cuban - Cost Plus Drugs.

I can’t speak to the severity of your case and whether prostate removal is a smart option for where you are. But before I went too far down much more intrusive rabbit holes I’d sure get my urologist to write a scrip for a bottle of max strength tadalafil (20mg) and take 1x/day for a month & see what changes. When I started on the stuff the effects on sexual function were obvious the next day and stabilized after about 3 days. The improved urinary capacity & stream flow took a week to become noticeable, and settled in at “very, very nice” after about 2 weeks. For me. YMMV, but I hope this helps you.

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I’ve had BPH for 25 years now, and it’s been managed with finasteride (Proscar) and doxazosin (Cardura). My urologist is amazed that the combo has kept my symptoms managed for this long. But I don’t drink alcohol and don’t have any caffeine after dinner, which are the two big things he told me to do.

I know that there have been new treatments developed that are less invasive and have fewer side effects than surgery. I don’t know how their long-term effectiveness is, but it’s certainly worth asking your urologist.

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It and the other drug seem to be slowing the progress but definitely have not stopped it. (No less reversing it)

Hence this thread !

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25 years !! Wow. I’m not familiar with Doxazosin. Will ask my Urologist, well, now- by Online Patient portal.

I drink very little alcohol per month. I could got a month and not touch a glass of wine or a shot of tequila. Been away at 2 different lakes this past weekend. Sipped maybe a glass of red per night, that’s all. If that was a hard stop to help this, I’d get good and drunk one more time and give it up.

And yes, he’s hinted at other treatments but they all seem to include surgical intervention.

Surgeons== LOVE to cut into people. :face_with_raised_eyebrow:

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They sure do. I had a surgeon once tell me I should try to refrain from asking ANY surgeon if I should have a surgery. He suggested that my PCP could probably provide me with much more balanced advice.

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That’s chilling.

I’m clicking the quotation marks in my reply here, but your post is NOT quoted. No clue why. Have to get into ATMB and ask…

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OK, I’ll share, although our situations don’t seem all that similar. I’m 75. My waking urination frequency and amount seems normal to me, certainly doesn’t cause me any problems. I occasionally have urgency, but if I can’t go just then the urgency usually subsides within a few minutes. Sleeping is a different story, but I think it is made worse by having sleep apnea – even though I use CPAP, my personal opinion is that my sleep is not as deep as it would be without the apnea. Most nights I get up about 4 times, and this has been going on for I don’t know how many years. I think it has increased from 3 times to 4 times over the past 5 years or so. It seems very stable, and it doesn’t bother me – I am roughly half awake when I’m urinating at night, I have a night light in the bathroom so I don’t need to turn on a light, and most of the time I don’t have any problem going back to sleep. Occasionally my urine smells sweet, like maple syrup, which I think is a symptom of not emptying my bladder. This only caused me a noticeable problem once when I got a UTI maybe 4 years ago, and my PCP asked me (in hushed tones) if I was, OMG, sexually active (the answer was, regrettably, no, at least not the way he meant it ). I see a urologist a couple times a year, because we are keeping an eye on my somewhat elevated PSA score. I don’t take any medications for BPH and I don’t want to unless the situation becomes unbearable. I don’t want to have my prostate removed unless it is necessary, more likely in my case I think for potential cancer than for BPH. I have read about the potential side effects of removal and even though they are only potential they seem dire, because I guess there is no way to know beforehand how severe the side effects will be.

tl:dr version of above: I have BPH, pee 4x per night, no drugs, no treatment, it has been steady for probably 20 years, I have no plans to do anything about it unless it gets severely worse.

My father told me late in life that he had suffered from BPH for 10 years, even going so far as to catheterize himself sometimes, before he finally had surgery. He did not specify, and I did not ask, how much of it he had taken out, nor what side effects he may have had after the surgery. I assumed he waited that long because he did not want to lose sexual function, which seemed very important to him. I thought that was pretty ridiculous to go that long for that reason, but now that I am almost as old as he was, I sort of see the point. Losing sexual function, to me, would be another long if symbolic step towards dying, of which I’ve had too many lately. These are, of course, purely personal views, and may not be of much relevance to the OP.

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I get Tadalifil from Costco pharmacy at the cash price of roughly $10/month. No coupon.

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I’m 78 and have mild issues. I usually have to get up a few times at night, but have no urgency issues during the day. Last Tuesday, I drove us an hour and a half from here and then ate lunch before taking a pee break prior to heading back. And even that was just preemptory in case of traffic issues. I don’t take any meds (for this), but do have the usual enlarged prostate. I’ve found that if I take an Aleve prior to going to bed that I don’t have the same urinary frequency during the night; perhaps it has a calming effect on the bladder? But I don’t like taking a lot of NSAIDs, for obvious reasons. I consider myself to be lucky so far, as I see a lot of old people in this building who clearly have problems. My turn may be coming, but that remains to be seen.

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On the “possible side effects from the surgery” front, with the note that this is not the usual experience:
My father had his prostate removed as part of his prostate cancer treatment, and has several issues from it. He was a particularly difficult case due to being very overweight, and lots of scar tissue from previous surgeries in the area.
In his case, he ended up with noticeable nerve damage and no longer can tell when his bladder is full and he needs to urinate, and was also incontinent. He had to have an artificial sphincter installed. Now when he wants to pee, he basically has a button he has to press near his testicles. He keeps a timer to remind him to pee every few hours.

This was a fairly extreme side effect due to his circumstances, but when considering surgical options, it can be good to know what can, in theory, go wrong.

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I mentioned this in one of the other related threads. I am in my late fifties and my PSA has been gradually rising over the past ten or so years (I am screened for high cholesterol regularly and my Dr evidently has been checking my PSA as well). This year he referred me to a urologist for a consult, and he said something that really struck me - a study was done on hundreds of cadavers to see how many men had prostate cancer at various ages: 60s, 70s, 80s, etc. 90% had prostate cancer, and many did not even know it, and may not have had any symptoms and were thus not treated for it. 90% His point is that it’s not a matter of IF men will get it, only a matter of when.

I am going in for my very first MRI in a few weeks. I am understanding that in many countries rising PSA is not really tracked to more procedures until people are more symptomatic. I know the MRI will not be conclusive, but the more invasive biopsy does not seem warranted at this point. I do get up 1 or 2 times a night to pee, but many other nights I don’t get up for that at all. Infrequent alcohol use, but daily morning caffeine, frequent bicycle riding (urologist said this can be a cause of rising PSA). I have no trouble urinating at any other time, but I do use available restrooms when out and about because I am at that age where “never pass-up a bathroom” has some meaning.

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When is the last time you had your blood sugar tested? Sweet-smelling urine could be a symptom of several things.

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A couple of weeks ago. My various doctors are keeping their eyes on my A1c as well as my PSA.

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Gosh do I appreciate the honesty and detail in your post. In ALL of the posts, but for some reason, yours really struck me just now.