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How I Solved My Great Big Prostate Problem

Most men will endure an enlarged prostate at some point in life. One man shares his journey to finding relief


spinner image leaking garden hose with a large knot tied in it as a symbol for a prostate problem
Nick Ferrari Photography

I was 61 years old, and I was being held hostage. By my prostate.

I couldn’t travel anywhere unless I knew where the nearest restroom was. Must-go-now emergencies came out of nowhere, and my nights were a series of strolls between bedroom and bathroom. I talked with a urologist who said that, at my age, I was probably dealing with an enlarged prostate — in medical terms, benign prostatic hyper­plasia, or BPH.

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The prostate is the walnut-sized gland in men that produces semen. As we age, it often increases in size and, because it surrounds the urethra (the tube that carries urine out of the body), it can obstruct its flow. BPH can leave a man feeling as though his bladder is always full, even after he’s just gone, and make it difficult for him to get the flow of urine started.

My urologist offered me a prescription drug to address my symptoms. But I wasn’t eager to add another medication to my growing daily regimen, so I opted first to experiment with herbal supplements long used in traditional cultures for men’s urinary health — plant extracts such as saw palmetto and milk thistle. I experienced fewer symptoms after a couple of weeks, but the problem slowly worsened until it was clear I needed a different solution.

“We don’t have good data to support supplements,” says Naren Nimmagadda, M.D., assistant professor of urology at Johns Hopkins University School of Medicine in Baltimore. He adds, though, “If people are on them and they tell me they have benefit, I don’t tell them to stop them.”

There’s a lot that science doesn’t understand about BPH — including what causes it, why it’s more common in the West than in Asian countries such as China and Japan, and why it may be more common among Black men. “Genetics, lifestyle and environmental factors may play a role,” says Thomas Chi, M.D., a urology professor at the University of California San Francisco.

What is known is that a man’s decade of life corresponds almost exactly with the likelihood that he’ll suffer an enlarged prostate. “Fifty percent of 50-year-olds, 60 percent of 60-year-olds, 70 percent of 70-year-olds and so on will have prostatic enlargement,” says Mayo Clinic urologist Tobias S. Kohler, M.D. But Kohler notes that only about half of those men will experience symptoms, because it’s not just the prostate’s size that causes obstruction but also its architecture (that is, how it’s configured around the urethra).

I sought out another urologist, who ran tests to confirm BPH and determine how much my prostate was interfering with my urinary function. First was a questionnaire. Next was a flow test, in which I peed into a funnel to measure my stream’s strength. After that, they put me through an ultrasound scanner to see how much urine was still left in my bladder.

Finally came the cystoscopy. My doctor explained that he’d insert specialized implements through my ­penis into my urethra to reach my prostate and bladder. It can be done under light sedation, but no thanks: I chose full sedation as I was frankly freaked out by the thought of anything going in “there.”

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The cystoscopy is essential to ruling out prostate cancer. BPH commonly causes blood to show up in the urine or the level of PSA (prostate-specific antigen) in your body to increase. Turns out both are symptoms of prostate cancer as well. And BPH can complicate prostate cancer treatment, says Adam S. Feldman, M.D., director of urologic research at Massachusetts General Hospital in Boston. A prostate MRI is often used to accurately size the prostate, important information in deciding your best course of action.

Once BPH was confirmed, my medical treatment began with the erectile dysfunction drug tadalafil (Cialis), which is also FDA-approved to treat enlarged prostates by relaxing prostate and bladder muscles, reducing pressure on the urethra. Next up was tamsulosin (Flomax), which also relaxes prostate muscles and loosens the gland’s grip on the urethra. A downside of this and similar alpha-blocker drugs is that their side effects can include retrograde ejaculation. Chi says it’s “not typically harmful and doesn’t require treatment,” but so-called dry orgasm can be unsettling and put the kibosh on a man’s fertility.

When these medications failed to control my symptoms, it was time to explore other options, meaning surgery.

“While procedures can be a big jump for some men, the efficacy is much greater than medications,” says R. Charles Welliver Jr., M.D., associate professor of urology and director of men’s health at Albany Medical College, in Albany, New York.

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There are essentially two surgery options:

  • TURP (transurethral resection of the prostate), in which prostate tissue is cut away by a device that’s inserted into the urethra. The pros: It’s effective at relieving symptoms quickly, and most men experience a much stronger urine flow within days. But its impact on sex can be significant: It can result in retrograde ejaculation, and erectile dysfunction is a rare but potential result.
  • MIST (minimally invasive surgical therapy), which encompasses a number of different outpatient procedures, including surgeries, laser and even steam treatments. Though MISTs are much less likely to cause sexual dysfunction, they’re not considered permanent fixes, because prostates continue to grow after a procedure. “We’re definitely preserving ejaculatory function,” says urologist Amy E. Krambeck, M.D., at Northwestern Medicine in Chicago. “But the retreatment rates are exceptionally high.”

Deciding on a procedure essentially comes down to one question, Krambeck says: “Do I want to risk having another surgery and preserve my ejaculation, or do I want to get rid of my ejaculation and not have to worry about another surgery?” Because preserving sexual function was a priority for me, I chose a MIST procedure that involves pinning back the lobes of the prostate to open the urethra. It doesn’t tend to open the urethra as fully as TURP, but it has an excellent record for preserving erection and ejaculation.

One year since my procedure, I am happy to report that my urinary symptoms have greatly improved and my sexual functions remain intact. If I am not quite peeing like a fire hose, I’m also not having emergencies. All six urologists I interviewed say it’s normal for men (and women) over 60 to awaken at least once or twice a night to urinate. But some nights I don’t have to get up at all.

Will I need another procedure one day? Maybe. For now, I’m just happy not to be a hostage to my prostate anymore.

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