I just had my second biopsy yesterday. I’m 50; I have no symptoms but a couple of years ago my PSA came back a bit high (4.9). An MRI followed by an initial biopsy revealed I have a small cancer so far, and we’re doing active surveillance for the moment. I had a second MRI earlier this year as well; my PSA is currently 6.6, but the doctor didn’t seem too particularly worried given my MRI results. Whatever I have so far is small and contained. I suspect a prostatectomy is somewhere in my future, but I’ve elected to keep an eye out on it so far. My doctor does not recommend any of the radiation options at my young-ish age.
So other than the tests, I would never have known I have prostate cancer. I don’t have any symptoms at the moment.
DISCLAIMER: I am not a doctor, but I am a doctor’s son (FWIW).
In 2007 at the age of 60, in the course of about two weeks, I went from normal urination to a big problem. Like other posters, I had to urinate frequently. By the time I felt the need to urinate, the situation was urgent. I did have a few incidents of “leakage.”
The OP and others mentioned complete prostate removal. Obviously that is the most drastic possible action. There are other less extreme options.
My urologist performed an outpatient procedure which removes a tiny portion of the prostate. IIRC the name is **Green Laser TURP**. I highly recommend it, despite some side effects which apparently vary widely. Like they say on all those TV drug commercials, “Ask your doctor if Green Laser TURP is right for you.”
Since then, I am back to a reasonable approximation of normal. I do not have the “fire hose” I had in my 20s, but I do have a “garden hose” which is perfectly adequate. I have a continuous flow, not the off-&-on some guys joke about.
I try to urinate every 2 hours, but can usually wait 4 hours and occasionally even longer. At night I typically get up once or twice. I always produce a solid stream and sufficient quantity, not just a little squirt.
TURP is the common treatment and is supposed to be a one and done. It basically reduces the size of the prostate.
I looked at Green Laser but was told it often needed a repeat after 5-10 years and since I have long life genes I opted for the surgical TURP.
I’m 77 and waited too long to get it dealt with even tho symptoms were clear. Most men do wait too long.
The TURP procedure is quite easy and for most will be a permanent fix tho you do lose ability for wet ejaculation.
Now the situation was brewing for years and I ignored it and initially the TURP worked well.
Due to specific condition of my anatomy and a late in life motorcycle accident ( I’m still riding ) I was not able to pee normally and needed a catheter.
After the TURP and then the accident I did not recover the ability to pee normally and got used to a catheter. My issue is my bladder has effectively failed so will not void properly so I use an i/o catheter to drain it once a day. It’s actually straight forward and no more hassle or time than brushing teeth.
I would have been content if that had continued indefinitely - many people have an i/o catheter.
However my second TURP also failed and I’m just transitioning to a supra-pubic catheter that avoids the penis entirely and sits above the penis.
My PSA went up to 6 from 4 point something two years ago, so I’ll be making a urologist appointment soon. I had a biopsy in 2021 that turned up nothing. I rarely have to get up to pee at night, although I go during the day a little more than I used to.
Was there an MRI first, or was the biopsy based only on the raised PSA score? Did they re-test the PSA at least once before the biopsy?
I ask because there are other factors that can raise your PSA score besides cancer, which your doctor should have discussed with you. One is simply age, and doctors should not be too surprised if one’s score goes up over time, especially when you are in your 60s and 70s. Another is sexual activity; for anyone who doesn’t already know, it is best to refrain from sex for 72 hours before your PSA blood draw.
My PSA started rising in late 2008, and my PCP put me through two rounds of antibiotics to rule out other causes (I was 61, and sexual activity wasn’t a factor). Only when it kept climbing was I referred to a urologist. I don’t recall an MRI before biopsy, which confirmed cancer. The only options at the time were chemo, radiation and surgery; after doing my research I opted for the last.
As I’ve mentioned before, based on post-surgical pathology I wouldn’t have been in the “with it but not of it” demographic. And it would have been extremely unpleasant.
Apparently the condition is called retrograde ejaculation, where you have an orgasm but no semen comes out. I have had this since I had a comprehensive prostate biopsy more than 10 years ago. I am informed by folks on this board that any actual semen produced by the prostate, instead of traveling out through the urethra, goes into the bladder and is later passed out with the urine. I’m not sure what happens to any sperm, which are made in the testicles rather than the prostate, but I suspect from my own experience that they are ejaculated but that the amount is so small as to be easy to miss.
A side-effect of either the Tamsulosin or the Finasteride is dry ejaculation. It’s kind of a god-send. Seriously. From where I sit/stand/lay, the orgasm intensity is the same as always. Just no fluid at all most of the time. Sometimes a tiny bit compared to a lifetime of average to larger volume ejaculations ( I have to take my sexual partners’ word for this. ) But– that tiny bit has zero taste and zero scent. Weird as hell, but there you have it.
Your back-seat mileage may, of course, vary.
This thread is enormously helpful. Keep ‘em coming. ( frisky pun intended ). I’ve got drug names and treatments to discuss when I call my Urologist on Monday.
Immediately after my procedure and for several years my orgasms were much milder. I still figured it was better than needing adult diapers. Slowly but irregularly they returned to normal and now are as good as ever. YMMV.
For those who don’t know I will decipher the acronym: Trans-Urethral Resection of the Prostate. Either version is like a “Roto-Rooter.”
My urologist did not discuss the surgical version that some posters mentioned. I infer that the Green Laser version is suitable for milder cases.
I don’t recall what my urologist said at the time (almost 20 years ago) about repeats, but like I mentioned he told me this year I should be good for life.
You are correct that the semen goes “up” the urethra to the bladder rather than “down” and out. I couldn’t care less. After the original consultation I asked Mrs Maven if she minded. She smiled and said, “No muss, no fuss.”
I would assume that ALL sperm is carried with the semen no matter which direction. In my particular case the point is moot. I had a vasectomy in 1989.
That tiny bit that sometimes escapes (at least according to my urologist) also carries sperm. He cautioned me that the side effect is not to be considered a method of birth control.
I’m 57. Never seen a doctor about it*, but the need to urinate can come upon me suddenly, strongly and unexpectedly. Especially when I’ve had a few beers, but not only then.
“No Public Restrooms” signs on every single damn store and restaurant, and the fact that even some supermarkets have started locking their bathrooms, really does not help.
I’ve had to urinate against a tree or wall more often than I like to think about.
*I haven’t had a checkup since 2019, because it’s just such a pain in the ass dealing with the medical bureaucracy. Last time, they wanted to do some kind of bowel test, but I’d have to go without breakfast and take at least the morning off work, because they’re not open on weekends at all. To hell with that. (I have no SO or kids who’d miss me if I were gone anyway).
Almost five years ago I had an open repair of an Abdominal Aorta Aneurysm. During that procedure a nerve that is close to the aorta was cut, resulting in retrograde ejaculation.
I’m curious about the Green Laser TURP. Starting to read into this a bit, will read more and from different sites offering it, etc.
The idea of a laser being aimed against the ( mightymighty thin ) wall of my Urethra to affect the Prostate pressing in hard at all angles is, well, fascinating. I wonder what the negative side-effects are? If the Surgeon is watching YouTube videos of Neil Young Unplugged while doing my work he could….laser a bit too much in one area? Making a thin and small hole in the Urethra and causing massive problems? Only partially kidding here. I’d want to find NYC’s Green Laser TURP Prince of Accuracy.
And yet- I can live without firehose and would find garden hose Sooooooooo satisfying. God is very slowly clenching down on things and I fear where this is going.
