physiological bladder outlet obstruction, then prostate growth

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moonraker
New Member


Date Joined Jul 2010
Total Posts : 9
   Posted 7/19/2010 1:34 PM (GMT -6)   
First time post, perhaps its not the appropriate forum, but I did not see a seperate urology forum, hence trying here.

Problem summary : Bladder outlet obstruction (probably physiological) for several years, with healthy prostate but now suddenly I have irregular prostate growth.

41 year old. Single male. Limited sexual experience.

Generally healthy. Blood pressure, lipid, sugar etc normal. Dont exercise but go for long walks. No smoking. Drink no more than 14 units per wk [But planning to quit] . 5 ft 10, 67 kg. No family history of prostate cancer. My dad has benign prostate enlargement but he got it only after the age of 75.

When I was 10 to 14 yrs old, on a few days I felt that bladder was not completely emptied. Dismissed it as psychological.

Always had back pain. Nowadays have chronic back pain. Back pain starts after 40 minutes of walking.

Since 2005, experiencing significant post void residue. First it was 35 ml, then 80 ml, then 110 ml. Flow rate very poor (single digit). Urodynamics finding was : bladder healthy but some type of physiological outlet obstruction. Cystoscopy was not done. Urologist suggested alpha blocker alfuzosin hydrochloride, it seemed to improve for a month (post void residue reduced to 20 ml), but after 3 months of use, post void went back to 85 ml.

Met top urologist in UK in Apr 2008, and he said just wait and watch, nothing to worry. I quit the alpha blocker (it was killing my sex drive).

UP UNTIL THIS point, I had no prostate problems. Prostate was normal size. Digital rectal exams all revealed normal prostate.

BUT, a few months ago UK GP asked me to do another post void residue test. Result : 50 ml. But prostate had now enlarged (42 mm traverse diameter). Per advice, I saw private urologist few days ago. This time, in his test, I had 125 ml residue. Also, he says there is a nodule in the prostate. It is hard on the right base. PSA is supposedly "normal" at 0.7. They took my urine sample and did the PCA3 (Genetic biomarker test). My score is 20.

But the scary thing is : This doctor says by doing ultrasound that he sees "irregular growth" of my prostate, growing into the bladder !!

I have always eaten healthy. No smoking. Balanced diet, lots of vegetables, wholegrain rice, some fish and chicken. Have wild canned Alaskan salmon, strawberries, tomatoes (lycopene), pumpkin seeds, sunflower seeds, brazil nuts (zinc and selinium) etc. Used to have flax seed oil in 2007 for health reason (omega 3) : 1 tea spoon daily. Could this have caused a problem ?

So, I basically have 2 problems :

1) Urinary obstruction. This was there even before the prostate issue. What is the reason ? Not sure whether it is a urethral stricture, or bladder neck problem or nerve problem. If my problem is physiological, why did it not happen before 36 years ?

2) Prostate growth problem : What is the reason ? Current plan is to wait few months, do another PSA / PCA3 test and then decide whether to do biopsy or not. I know BPH can start after age 40, but still think it is too early to get this much growth. Also, if it is BPH, why is it irregular ?

Are (1) and (2) connected ?

appreciate any thoughts. Thanks a million in advance and I wish everyone here the best health.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 23873
   Posted 7/19/2010 1:42 PM (GMT -6)   
A good scoping with an experienced urologist should get to the obstruction/stricture issue real fast. There can any number of non-cancerous reasons for that problem, and with many men, a small procedure can be done sometimes right in the doctor's office to "open" things back up, or at worse, a minor day surgery.

As far as the rest of your issue goes, if there really is a noticable growth on your prostate as your doctor indicates, if it were me, I wouldn't sleep right until I had a full prostate biopsy peformed, just to be on the safe side. There are plenty of men with prostate cancer with low PSA numbers and no other symptons. It might give you some peace of mind.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one: Aug 3
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19


moonraker
New Member


Date Joined Jul 2010
Total Posts : 9
   Posted 7/19/2010 6:34 PM (GMT -6)   
Purgatory : thanks for the immediate response. much appreciated. I am having a hard time communicating with my GP and specialist. Everyone seems to be in such a hurry, I cannot sit and talk patiently for say 15 to 20 minutes. They want to breeze thru the tests, recommend sophisticated machinery test / surgery / drugs / whatever in fast forward motion and buzz off to the next patient. He had no time to listen to my complete story. There is no human element anymore. And this is in supposedly one of the best private hospitals in the UK. I used to live in the U.S, and I recall the doctors would sit and talk to you patiently, and explain the problem, especially in the hospitals affiliated with a University.

Almost tempted to spend my own money and go to Johns Hopkins, Baltimore, USA. I wonder how much it would cost tho'.

Regarding the blockage problem, unless I do a cystoscopy, I wont know for sure. If it is a urethral stricture issue, you may be right in that it can be fixed rightaway, but if it is a bladder neck issue or nervous system issue, I understand that will require some kind of a semi-major surgery. Also, such a surgery would involve side effects, such as retrograde ejaculation. I still have a faint glimmer of a hope to find a partner and have a child, so its a tough one. I also told the doctor that I was on alpha blocker in 2008 and initially that seemed to improve my flow, but after 3 months of use, the post void residue went back up. The very fact that the alpha blocker improved the flow/postvoid residue implies that my problem was at the bladder neck, nor urethral stricture. So why go thru the extreme torture of cystoscopy just to arrive at the same conclusion ?

Regarding the second problem, prostate growth, even if we do a biopsy, suppose it comes negative. What next ? Should I have to keep doing biopsies every 6 months ? i.e once we rule out cancer, we would still need to find out the cause of the irregular growth. What are the possibilities here ? I really want to get the root cause of it tho'. I have no family history and have not done anything in excess such as drinking or red meat etc. So what did I do wrong ? Could sexual habits such as not ********** or excessive ********** could cause it ? There must be a reason isnt it ? I live in a fairly salubrious environment with more or less healthy habits, so what did I do wrong ?

Cant I control both problems by habit alone ? i.e cut out coffee, tea, alcohol, drink 8 to 10 glasses of water, empty the bladder regularly (never make the bladder very full which is when the hesitation / poor flow problem gets worse) ? Is there a danger of permanently harming the kidneys if I leave the first problem untreated ?

Lots of thoughts going thru my mind. I wish I could talk in detail with my specialist and/or GP.

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 2676
   Posted 7/19/2010 7:06 PM (GMT -6)   
Unless insurance is an issue, find a specialist and/or GP. And if it is an issue get in the face of these people and demand the answers you are paying for. There is a whole different paradigm going on in the healthcare industry, maybe even the world. They've changed the rules, so I have no problem changing my rules for dealing with their's. Wadda ya gonna do!!!!!
age 67 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of Washington Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci, extensive PNI, That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
Dec 14,2009 psa 0.0 May 10 2010, psa 0.0

" Hypocrisy is vice's homage to Virtue " read it in Bartlet's book of quotation years ago stuck with me, can't remember who said it.


moonraker
New Member


Date Joined Jul 2010
Total Posts : 9
   Posted 7/20/2010 12:06 PM (GMT -6)   
Thanks logoslidat. This UK private urologist seems to be extremely busy, but his secretary is a very friendly helpful person. Obviously she is not a scientist or medic but she knows some of the literature probably from experience. So I expressed some of my concerns to her, she was sympathetic but obviously she did not have answers for everything.

Yes I do have private health insurance but only in the UK, but as I said I have a half mind to just pack up and go to Johns Hopkins. Isnt that the best urology dept in the world ? It wont be covered by my insurance but wondering what kind of numbers I am looking at. if it is less than 10 or 20 grand USD, I dont mind paying provided I get minimally invasive techniques (more advanced machines) and less pain, and great expertise.

Here is an interesting question : Coming back to purely problem (1), i.e urinary flow obstruction, my post-void residue hasnt changed at all since Apr 2008. In April 2008 when I saw a more experienced specialist in the same private UK hospital, he opined that we can just go for wait-n-watch and most likely I have "proximal bladder neck dyssynergia". But as long as I dont have any infection and residual urine stays below 150 ml, not much to worry. At the time my prostate was benign feeling and flat. But now even tho I have the same amount of post-void residual urine, this different urologist in the same hospital says he needs to really know the root cause of (1) and it has to be taken seriously. I wonder why. I wish I could meet the first urologist again but he is away for at least another month.

Anyone else, any thoughts on my follow up to Purgatory's response, or indeed anything else to say about my problems ? Particularly whether I can control the problem just by habit / diet alone ?

Thanks again.

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2062
   Posted 7/20/2010 1:02 PM (GMT -6)   
Welcome to the Forum,

I think you are right to avoid people who are in a hurry. But you do need to know what's going on.

I'm a Brit, but I haven't lived in the UK for over 25 years (I live in Holland) so I don't really know enough about the way the NHS would handle this type of thing, but I tend to think that the bulk of the expertise is likely to be in the NHS. There are UK folk here who have had good experiences with their prostates at places like Guys and UCH in London, plus Addenbrookes in Cambridge and a friend was sorted at John Radcliffe in Oxford. So where are you based? What has been your experience with NHS as opposed to private?

Alfred
Age at Dx 48 No Family history of Prostate Cancer
Married 25 years, and I cannot thank my wife enough for her support.
April 2009: PSA 8.6 DRE: negative. Tumour in 2 out of 12 cores. Gleason 3+3.
RALP (nerve-sparing) at AVL-NKI Hospital Amsterdam on 29th July 2009. Stay 1 night.
Partial erections on while catheter still in. Catheter out on 6th Aug 2009.
Dry at night after catheter came out
Post-op Gleason 3+4. Tumour mainly in left near neck of bladder.
Left Seminal Vesicle invaded, (=T3b!)
no perineraul invasion, no vascular invasion. clear margins,
Erection 100% on 15th Aug 2009, but lots of leaking of urine
Stopped wearing pads on 21st Sept 2009
Pre-op style intercourse on 24th Oct 2009 !! No use of tablets, jabs, VED etc. but...
Nov 17th 2009 PSA = 0.1
Can still get erections okay, and almost no leaking of urine, but since December 2009 I don't have orgasms, instead I just have intense pain in place where prostate used to be.
Mar 17th 2010 PSA = 0.4!!! referred to radiation therapist
April 13th 2010 CT scan.
April 28th 2010 Started Radiation Therapy (66Gy - 33 sessions)
June 11th 2010 finished RT - main side effect tiredness, but also the occasional small leak
June 27th My 50th Birthday - feeling better but still not 100% okay


moonraker
New Member


Date Joined Jul 2010
Total Posts : 9
   Posted 7/20/2010 4:45 PM (GMT -6)   
Thanks English Alf.

My experience of NHS has been okay. Not too great. Not too bad. Two years ago, when I went to my NHS GP with the bladder outlet obstruction issue, he asked me if I had private insurance. I said yes. He then referred me to private and commented that waiting time on the NHS for this sort of problem would be way too long. By the way, the non-invasive PCA3 test that I got done in private would not have been available for me on the NHS. There are also some horror stories that BBC often highlights about some NHS hospitals but I guess (and hope) thats the exception rather than the norm. As somebody who lives alone and who doesnt have any family here in UK or any close friends who would visit me in hospital, I personally want the finest treatment I can get, even if it means I have to pay a lot for it.

I guess I am looking for the finest urologist in UK, not only in expertise and qualificaton but also in being kind and willing to switch off everything and just focus and listen to the patient for 15 minutes.

I have 2 main questions :
1) For the obstruction problem, what if I leave it untreated and just control by habit ? Is there a risk of serious kidney and bladder damage ?
2) the prostate growth : what is it ? My PSA(0.7) and PCA3(20) are favourable ...... If the biopsy comes back negative what next ? Do I keep taking biopsies every 6 months ? If the growth is not cancerous, will it go away on its own ? Does BPH cause such an irregular growth ?

I am finding some of the signatures here quite scary. They put a catheter into me for urodynamics. That hurt like hell. I cannot imagine being on catheter for months.

They said the right base of my prostate is hard (nodule). Today I am getting a slight dull pain there, also radiating toward my right leg.

Still waiting for replies for many of my technical questions on this thread. Look forward to people's responses.

moonraker
New Member


Date Joined Jul 2010
Total Posts : 9
   Posted 7/20/2010 5:20 PM (GMT -6)   
forgot to add that I am in the South East, which apparently has the best urologists according to my GP
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