Prostate Enlargement: When Surgery Becomes Necessary - Urology

More Info

---

When it comes to prostate enlargement, also known as benign prostatic hyperplasia (BPH), the decision to proceed with surgery is often influenced by several factors, including the size of the prostate, the levels of prostate-specific antigen (PSA), and the impact on the patient's quality of life. In your father's case, with a prostate weight of 57 grams and elevated PSA levels, it is understandable to have concerns regarding the necessity of surgical intervention.

1. Is Surgery Absolutely Necessary?
While your father's prostate size and PSA levels suggest that he is at a threshold where surgery may be considered, it is not an absolute requirement if his current condition is not significantly affecting his quality of life. The decision to undergo surgery should be based on a comprehensive evaluation that includes not only the size of the prostate and PSA levels but also the presence of symptoms such as urinary obstruction, frequency, urgency, or nocturia. If these symptoms are mild and manageable, a conservative approach may be appropriate.

2. Can Medication Be Used First?
Yes, medication can be an effective first-line treatment for BPH. Alpha-blockers (like tamsulosin) can help relax the muscles of the prostate and bladder neck, improving urine flow. 5-alpha-reductase inhibitors (like finasteride or dutasteride) can help shrink the prostate over time by blocking the hormone responsible for prostate growth. However, it is important to note that while medications can alleviate symptoms and improve quality of life, they may not significantly reduce the size of a very enlarged prostate. In some cases, the effectiveness of medication may diminish over time, leading to the consideration of surgical options.

3. When is Surgery Inevitable?
Surgery becomes necessary when the patient experiences severe symptoms that significantly impair quality of life or when complications arise. These complications can include acute urinary retention (the inability to urinate), recurrent urinary tract infections, bladder stones, or kidney damage due to prolonged obstruction. If your father begins to experience any of these issues, it would warrant a discussion about surgical options.

4. Can Medication Reduce Prostate Size?
While medications can help manage symptoms, they are not always effective in significantly reducing the size of an already enlarged prostate, especially if it is considerably large. 5-alpha-reductase inhibitors may lead to a gradual reduction in prostate size over time, but this process can take several months to years, and not all patients will experience a significant decrease. If the prostate is very large, surgical options such as transurethral resection of the prostate (TURP) or laser prostatectomy may be more effective in providing immediate relief and reducing the size of the prostate.

In conclusion, the decision regarding surgery should be made collaboratively between your father and his healthcare provider, considering his symptoms, overall health, and personal preferences. It may be beneficial to seek a second opinion or discuss the potential benefits and risks of both medical and surgical treatments. Regular monitoring of PSA levels and prostate size, along with symptom management, can also help guide the decision-making process.