Prostate

My prostate weighs 167 grams. I have a bevy of symptoms, including severe pain in my abdomen, left testicle, back and left leg. A catscan shows no other problems. My urologist feels that the only treatment that will reduce the prostate's size enough to relieve my symptoms is to have a surgery where he will open the prostate and "scoop" out a significant amount of the gland. I have found little information on this procedure. Does anyone have any information?

Thanks,
Greg

This message has been edited. Last edited by: ProstateSupport,

Response from Dr. Jay Motola, HealthCentral's Urology Consultant
A prostate that actually weighs 167 grams is indeed a very large gland, providing that the measurement had been done accurately with a transrectal sonogram. Just because a prostate is enlarged, does not mean that it needs to be removed. Most important in this decision making process is how the symptoms that are attributable to urinary obstruction due to this enlarged prostate are effecting you. Many patients have very large prostates that do no cause a plethora of symptoms.

The traditional treatment of such a large prostate is with an open surgical procedure known as either a suprapubic or retropubic prostatectomy. These procedures refer to a surgical incision that is made in the lower abdomen and via an entry into the bladder (suprapubic) and directly onto the capsule of the prostate (retropubic), the prostate adenoma (the portion of the prostate that is causing the obstruction) is removed. Post-operative recovery is usually on the order of about 7 days. After the surgery, a catheter will be placed in the urethra that will drain the urine away from the bladder while healing occurs.

Due to the vast size of the prostate, you are not a good candidate for a transurethral resection of the prostate (TURP), and the minimally invasive alternatives such as laser prostatectomy, transurethral microwave therapy (TARGIS), transurethral needle ablation of the prostate (TUNA), or Indigo Laser are not ideal choices.

Depending on how problematic your symptoms are one other alternative may exist. Several medications in the category of 5 alpha reductase inhibitors (Avodart, Proscar) are available that help shrink the prostate volume. These medications can be effective but take up to 6 months to see an effect. If the symptoms that you have are not terribly bothersome, a trial of these drugs may be in order to try to shrink the prostate. Depending on your response to such drugs, you may be able to avoid the open surgery, and potentially become a candidate for one of the minimally invasive alternatives.

Thank you, doctor, for your kind response. Yes the size of my prostate was determined by a sonogram that was performed in connection with a prostate biopsy. It is consistant with a sonogram (a previous biopsy) done about 18 months earlier.

I have been on Proscar for about six months. I've taken Flomax for about two years. My urinary symptoms are under control. My problem is the sometimes excruciating pain in my left testicle. Two different urologists find no disease, just a large prostate.

I appreciate your opinion about the value of transurethral procedures, due to the size of my prostate.

Have you heard of symptoms like mine from an enlarged prostate? (Aching pain in left testicle,groin, growing down my left leg and into my lower back and lower left abdomen)?

Thanks for your help.

Since you are now getting pain in your testicles, I'd also ask your physician about "epididymitis," the diagnosis I got before they discovered I had prostate cancer.

Despite the fact they're not connected in terms of cause and effect, I'm aware that some men get epididymitis at the same time they have prostate cancer.

You might want to read my introductory essay on my blog on the main prostate site.

C. lukas