Living with BPH/Enlarged Prostate

I am 65. I have had an enlarged prostate for at least 15 years. My symptoms of increased frequency and urgency increased in the last year. My PSA crossed the 4.0,threshold to 4.7, five months ago. This led to a visit to a local urologist who wanted to do a biopsy immediately. However, knowing the high level of unnecessary biopsies, I suggested a course of antibiotics to rule out an infection as the cause of the elevated PSA.

Also, importantly, the urologist failed to ask about sex the night before the PSA test (which I had). As you probably know, sex shortly before the PSA test will elevate the results.

Whether from the antibiotics or abstaining from sex for a few days before the follow-up PSA, the next PSA, about a month later, went down to 3.1.

So far so good. But the symptoms persisted, so I went to another urologist who was highly recommended. This urologist prescribed Flomax, then Deterol. Both were expensive and neither made a meaningful improvement.

So I decided to try prostate reduction surgery. The second urologist was very experience with the laser (Green Light) procedure, a transurethral technique.

The laser surgery went well, and all was fine for about 10 days. Then I experienced a sharp pain in my chest, which I realized could be a pulmonary embolism. I had experienced a blood clot in my leg following knee surgery 10 years earlier, and had informed the doctors.

A visit to the ER, and a CT scan, revealed a sub-massive pulmonary embolism. I was treated with the usual blood thinners (anti-coagulants) and I thought I was out of the woods. Unfortunately, the worst was yet to come. The most common blood thinner is Cummodin (Warfarin). This drug is cheap and very widely used. Unfortunately it does not have consistent results. In my case I “overreacted”, with my blood getting “too thin” (INR of 10) so my primary care physician prescribed vitamin K, a coagulant, to lower the INR. However, the result was that the cogulant caused blood clots from the surgery to form. These were passed in my urine until one did not pass; I now had a urinary blockage. So back to the ER.

The blockage was opened using an irrigation catheter. The experience of the blockage and its clearing involved a great deal of pain.

S0: the take-away: If you are considering any form of surgery to reduce the size of your prostate, I recommend that you FIRST visit a hemotologist to determine if you have a blood clotting tendency that will expose you to clotting (thrombosis or pulmonary embolism PE). Based on that determination you may want to defer the surgery or to have the hemotologist prescribe blood thinners that will have a protective effect against clotting triggered by the surgery.

There is no such think as “minor surgery”. I recommend taking any surgery very seriously.

My PE may have retarded my recovery, as I am now about 10 weeks post procedure and the urinary symptoms have not improved. My urologist says it could take up to 9 months for full recovery.