Interview: Enlarged prostate
"Then, after a while, I noticed that I was having more and more difficulties urinating. It just didn't really work properly anymore. It took longer to finish and I had to wait a bit before it would get going."
A few years ago I had a check-up and doctors discovered that I had high PSA levels. When the levels continued to increase, my family doctor referred me to a urologist.
The urologist did a biopsy but didn't find anything. So that was that, and they just carried on monitoring my PSA levels. The levels just kept on increasing, so in 2003 I went to the urologist again. He did a physical exam for abnormal developments and discovered that my prostate was very enlarged. But at that point I had not had any symptoms or noticed anything different. After the diagnosis, I read up about the prostate and enlarged prostates.
Then, after a while, I noticed that I was having more and more difficulties urinating. It just didn't really work properly anymore. It took longer to finish and I had to wait a bit before it would get going. The problems got worse over time. I had to get up to go to the toilet several times a night. Sometimes I felt like I had to go, but then nothing came out. It seemed like I was spending all of my time on the toilet. I would eke out three or four drops. But that went away again. I cycle a lot and started being aware of my enlarged prostate when I sat on my bike. I could feel a kind of pressure.
In spring this year, my PSA levels were very high again. My family doctor referred me the urologist again, and he referred me to the urological department of a hospital. They did another biopsy. This was an outpatient procedure and you could usually go home after two to three hours.
It took a little longer in my case. I could no longer pass water properly after the biopsy - I had urinary retention. There was a lot of pressure on my bladder and it was very painful. They kept me in hospital and gave me a catheter.
When things didn't get better and I couldn't pass water without the catheter, they recommended that I have an operation. I had the choice between that or a permanent catheter.
I'm not a big fan of operations and I won't let anyone use a scalpel on me if it isn't absolutely necessary. Besides, we had already planned a holiday. So I decided not to have an operation and I was given a catheter. That all went well and I went home the next day. The catheter had a small tap on it, so I could empty my bladder that way. And even though you have a catheter, you can still try to urinate the natural way too.
But after a while I realised that it wasn't a good solution in the long term. My urologist measured how much urine stayed behind in my bladder. He found that it was quite a lot and suggested trying medication. The package insert and information on the Internet said that you have to take the medication for a very long time. I didn't like the sound of that, so I decided to have surgery after all. I sort of suppressed any worries about the possible side effects associated with the operation. Although I had read about the risk of incontinence, I tried not to think about it and just took a "wait-and-see approach". I tend to be quite optimistic and trust that things will turn out for the best!
Part of my prostate was removed using TURP (transurethral resection of the prostate - Editor). The operation went very well. I was given a spinal anaesthetic and was able to follow the whole procedure on a screen.
When I was in hospital I met other patients with similar problems. We talked a lot and I learned quite a bit. One thing that bothered me was that they were all older than I was. It seems to have "got me" quite early.
I only realised how bad my problems urinating had been once my catheter was removed after the operation. There was such a great improvement from one day to the next that I could have sprayed the bark off a tree. It made a huge difference. At first I had hardly noticed that I had a problem, it had all happened so gradually. I thought it was just a normal part of growing older. And suddenly it was totally normal again, like it used to be - it took four seconds and I was done. Only then did I realise how much of a problem it had been.
Overall, I would say I have recovered quite well. The side effects of the surgery, like the dribbling after urinating, went away after a while. But I still can't quite trust the muscle to hold back my urine, particularly if I am doing something that is physically strenuous. I still leak a little sometimes. But I'm aware of it and it is getting better. Ejaculation is different now too - that's just the way it is. I can live with it. Other than that, I'm doing very well. I don't have any pain and have started doing sports again.
When I found out that my PSA levels were so high and getting higher, I was afraid that it might be cancer and wanted to have it checked out. Having the biopsy made me wonder what I would do if it was cancer. I read up about it and found out that it is easy to treat if it is discovered early, so I told myself that I should stay calm.
I probably could have done without the last biopsy, the one that ended in urinary retention. But the doctors wanted to do it, and you want to be sure of the diagnosis, so you let them do it.
My wife and I talked about everything. She gave me a lot of support and we both read up about enlarged prostates. When I decided that the operation was the best option for me, she agreed.
I really enjoy doing sports. For a few weeks after the operation, I wasn't allowed to. That did bother me a bit. But now everything is fine again. I even went to the gym when I had my catheter. When I got changed in the locker room other men approached me and told me that they had also had a catheter in the past. It became clear to me that it was no longer a taboo subject. I generally don't have any problems talking about it, and I even told people at work about it.
Doctors sometimes have different opinions. My urologist said that I was too young for an operation and should try medication first. The doctor in the hospital said that the operation was the best option for me because I was still so young. That's how different their views were. Having the operation was the right decision for me. It was bothering me and I wanted to have it out.
Everyone has to decide for themselves what is best in their personal case. It isn't easy, because everyone's symptoms are different. The tablets didn't work for me. Having urinary retention after the biopsy was a big problem for me. Some people say that it is easy to live with having to get up frequently at night to go to the toilet, or it taking a long time for you to urinate. I, personally, feel a lot better now. It was the best solution for me.
ACKNOWLEDGEMENT
These real-life stories were gathered during interviews with patients who generously shared their experiences with us. We are very grateful to these interview partners. All of them have given their permission for these stories to be published here.
The opinions and comments in these stories are the opinions of individuals. They are not necessarily shared by IQWiG and are not intended to serve as recommendations to help people make decisions.
A few years ago I had a check-up and doctors discovered that I had high PSA levels. When the levels continued to increase, my family doctor referred me to a urologist.
The urologist did a biopsy but didn't find anything. So that was that, and they just carried on monitoring my PSA levels. The levels just kept on increasing, so in 2003 I went to the urologist again. He did a physical exam for abnormal developments and discovered that my prostate was very enlarged. But at that point I had not had any symptoms or noticed anything different. After the diagnosis, I read up about the prostate and enlarged prostates.
Then, after a while, I noticed that I was having more and more difficulties urinating. It just didn't really work properly anymore. It took longer to finish and I had to wait a bit before it would get going. The problems got worse over time. I had to get up to go to the toilet several times a night. Sometimes I felt like I had to go, but then nothing came out. It seemed like I was spending all of my time on the toilet. I would eke out three or four drops. But that went away again. I cycle a lot and started being aware of my enlarged prostate when I sat on my bike. I could feel a kind of pressure.
In spring this year, my PSA levels were very high again. My family doctor referred me the urologist again, and he referred me to the urological department of a hospital. They did another biopsy. This was an outpatient procedure and you could usually go home after two to three hours.
It took a little longer in my case. I could no longer pass water properly after the biopsy - I had urinary retention. There was a lot of pressure on my bladder and it was very painful. They kept me in hospital and gave me a catheter.
When things didn't get better and I couldn't pass water without the catheter, they recommended that I have an operation. I had the choice between that or a permanent catheter.
I'm not a big fan of operations and I won't let anyone use a scalpel on me if it isn't absolutely necessary. Besides, we had already planned a holiday. So I decided not to have an operation and I was given a catheter. That all went well and I went home the next day. The catheter had a small tap on it, so I could empty my bladder that way. And even though you have a catheter, you can still try to urinate the natural way too.
But after a while I realised that it wasn't a good solution in the long term. My urologist measured how much urine stayed behind in my bladder. He found that it was quite a lot and suggested trying medication. The package insert and information on the Internet said that you have to take the medication for a very long time. I didn't like the sound of that, so I decided to have surgery after all. I sort of suppressed any worries about the possible side effects associated with the operation. Although I had read about the risk of incontinence, I tried not to think about it and just took a "wait-and-see approach". I tend to be quite optimistic and trust that things will turn out for the best!
Part of my prostate was removed using TURP (transurethral resection of the prostate - Editor). The operation went very well. I was given a spinal anaesthetic and was able to follow the whole procedure on a screen.
When I was in hospital I met other patients with similar problems. We talked a lot and I learned quite a bit. One thing that bothered me was that they were all older than I was. It seems to have "got me" quite early.
I only realised how bad my problems urinating had been once my catheter was removed after the operation. There was such a great improvement from one day to the next that I could have sprayed the bark off a tree. It made a huge difference. At first I had hardly noticed that I had a problem, it had all happened so gradually. I thought it was just a normal part of growing older. And suddenly it was totally normal again, like it used to be - it took four seconds and I was done. Only then did I realise how much of a problem it had been.
Overall, I would say I have recovered quite well. The side effects of the surgery, like the dribbling after urinating, went away after a while. But I still can't quite trust the muscle to hold back my urine, particularly if I am doing something that is physically strenuous. I still leak a little sometimes. But I'm aware of it and it is getting better. Ejaculation is different now too - that's just the way it is. I can live with it. Other than that, I'm doing very well. I don't have any pain and have started doing sports again.
When I found out that my PSA levels were so high and getting higher, I was afraid that it might be cancer and wanted to have it checked out. Having the biopsy made me wonder what I would do if it was cancer. I read up about it and found out that it is easy to treat if it is discovered early, so I told myself that I should stay calm.
I probably could have done without the last biopsy, the one that ended in urinary retention. But the doctors wanted to do it, and you want to be sure of the diagnosis, so you let them do it.
My wife and I talked about everything. She gave me a lot of support and we both read up about enlarged prostates. When I decided that the operation was the best option for me, she agreed.
I really enjoy doing sports. For a few weeks after the operation, I wasn't allowed to. That did bother me a bit. But now everything is fine again. I even went to the gym when I had my catheter. When I got changed in the locker room other men approached me and told me that they had also had a catheter in the past. It became clear to me that it was no longer a taboo subject. I generally don't have any problems talking about it, and I even told people at work about it.
Doctors sometimes have different opinions. My urologist said that I was too young for an operation and should try medication first. The doctor in the hospital said that the operation was the best option for me because I was still so young. That's how different their views were. Having the operation was the right decision for me. It was bothering me and I wanted to have it out.
Everyone has to decide for themselves what is best in their personal case. It isn't easy, because everyone's symptoms are different. The tablets didn't work for me. Having urinary retention after the biopsy was a big problem for me. Some people say that it is easy to live with having to get up frequently at night to go to the toilet, or it taking a long time for you to urinate. I, personally, feel a lot better now. It was the best solution for me.
ACKNOWLEDGEMENT
These real-life stories were gathered during interviews with patients who generously shared their experiences with us. We are very grateful to these interview partners. All of them have given their permission for these stories to be published here.
The opinions and comments in these stories are the opinions of individuals. They are not necessarily shared by IQWiG and are not intended to serve as recommendations to help people make decisions.
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