"Prostate problems treatment"

Enlarged prostate diagnosis, testing (biopsy), MRI (2 so far), consultations, low level prostate cancer found (to-date still within prostate thankfully).

For the first 65 years of my life, I had no medical problems that involved hospitals. Even visits to a GP were rare. Sure, as my wife and I had two growing children, we all had the occasional coughs and colds during the winter seasons. But thankfully, for both of us, that was about it. The 'kids' are all grown up now with one side having their own two children. So my wife and I became grandparents.

When I reached just over age 65, I noticed some of what I thought were 'minor changes'. Being a typical man, I ignored them and 'soldiered on' so to speak. I am self-employed, so if I didn't work, then I didn't earn -- so that was another factor that would affect things going forward. Health issues get in the way of work.

As time went on, originally, I progressively found problems not being able to urinate normally. I even laughed about this myself at times. However, I was to learn that what might be funny in the short term, could if left 'untreated' soon become uncomfortable, then annoying, then painful, then extremely painful, and if not dealt with relatively quickly at that stage, would become life threatening. Normal healthy human kidneys keep producing urine non-stop, which of course has to be let go regularly, or we die.

In due course, one of the GPs at Portree Medical Centre confirmed my prostate was indeed larger than it should be. So I was also booked in for various follow-up tests at Raigmore Hospital. A prostate biopsy (not a fun day for that one), plus a little later, an MRI scan. So these were done. In addition to having an enlarged prostate, some low-level prostate cancer was also found thankfully still contained inside the prostate.

I learned that a large prostate did not automatically mean prostate cancer and that having a small or normal-sized prostate did not mean there was no prostate cancer. So if we didn't already know, prostate woes are not straightforward. Nevertheless, the wonderful Urology team at Raigmore Hospital know their stuff.

In relation to the prostate cancer detected I was advised to take a 'watch and wait' approach. So this meant leaving a blood sample every 3 months and having an MRI once a year. Portree Medical Centre is so good at reminding me to keep these appointments for which I am grateful.

Not being able to urinate sufficiently was attributed to an enlarged prostate pinching the urethra. My troublesome large prostate meant I wasn't urinating sufficiently, which of course causes other problems too. During the coming months on multiple occasions, I would need a catheter valve fitted when the problem became too much to cope with. I was prescribed Tamsulosin pills to help with the urethra narrowing. These can help over time but can take many months to even start to work.

Over time, the problem did indeed gradually get worse. It seemed my prostate just kept growing. Several times, several visits to Portree Medical Centre, and the first emergency visit to Broadford Hospital, meant that I had to have a catheter valve fitted yet again. Before the catheter valve was fitted, driving to Broadford Hospital 30 miles away when suffering extreme pain (my own fault for leaving things too long and sticking my head in the sand so to speak) was an additional trial: I had to 'pull the car in' several times on route in an attempt to relieve the pressure. To be honest, I probably shouldn't have been driving but I was in such pain I felt I could do it okay -- eventually. Thankfully, I arrived okay - but in ever increasing waves of pain due to not being able to urinate properly.

Unfortunately, at that time, Broadford Hospital was short-staffed, and a local car accident seemed to have occurred at about the same time, so naturally took greater priority. As a result, I was not seen for about 3 hours: I was close to passing out. I had to keep visiting the toilet close by -- with not much luck every time. So seconds or minutes later the pain would return and I would need to repeat the process. But of course, it didn't work. I thought the doctor on duty had forgotten I was there and no one seemed to be aware of my obvious distress or checking if I was okay. I didn't like to make a fuss as I didn't know how the car accident situation was developing, but things seemed pretty relaxed further down the ward. Eventually, I think I was reaching my limit: feeling dizzy and nauseous, I had to ask for help or I would simply have to lie down on the ward floor (being horizontal seemed to help a little). A nurse eventually fitted a catheter valve: the relief was ... memorable.

While I found catheter valves uncomfortable and strange, the relief from the pain of not being able to urinate overshadowed the drawbacks. This time, I only had the catheter valve in place for a few weeks. The idea was to test whether I could cope without it. So the catheter valve was removed again and I returned home. At around that time, I also thought I had pulled a muscle in my back which got really painful over a few days. I then noticed an extensive rash on my lower back right side. So I imagined I must have somehow torn a ligament or something. A visit to our local GP confirmed it was Shingles, not a torn ligament. Later I guessed that the Shingles outbreak might have been brought on by the extreme stress (that I seemed to deny was a problem) of multiple urination problems. Up to that point, I had never had Shingles before so it was another new unwelcome experience for me to discover and learn about.

Continual urination problems combined with me ignoring or denying to myself that there was a problem I couldn't cope with, meant yet another emergency hospital visit to Broadford Hospital to have a catheter valve reinserted (fourth time I think). On this visit, there were two simply outstanding young ladies who helped enormously: one was a doctor and one a nurse. They were so professional, helpful, kind, considerate. This time, the catheter would be in place for about 3 months. Along with a high strength antibiotic injection and a course of antibiotic pills -- I imagine this was to resolve the effects of UTI, the Shingles, and ongoing urination problems. A few weeks later, the Shingles gradually lessened and got better.

Though only after taking a couple of these new pills, one of the pain killer medicines reacted with another one I was taking, so I had to stop taking that. This meant essentially putting up with the Shingles pain. A few nights the pain was so bad I had to sleep on the sofa leaning at a strange angle. My wife tells me due to the constant Shingles pain I was moaning most nights but I don't recall that (maybe I blanked it out).

Earlier, my GP suggested trying an additional drug called Finasteride -- to help shrink the prostate. While I didn't like the sound of it, at this stage, I simply didn't care: anything to shrink my prostate monster would get my vote. Like Tamsulosin, Finasteride takes time to work. So I took one Tamsulosin pill and one Finasteride pill every day while the catheter valve was in place. I was careful to make sure to follow all the guidelines and change the valve myself every week, from the supply our Portree District Nurses kindly provided.

My GP also told me that later once the Finasteride had time to reduce the prostate a little, I would probably need an operation later to widen the urethra. There were various options for this -- I wasn't looking forward to any of them but accepted that if it was needed, then I would just have to choose one option and keep my fingers crossed.

Unfortunately, while having the catheter valve in place, I seemed to pick up multiple urinary tract infections regularly which are no fun. A burning sensation while urinating doesn't help, but drinking more water seems counterintuitive as you have to urinate more -- so initially, you get more burning sensations. However, for me, I knew that if I stuck to it, the problem would ease sooner. The quicker I could do that, the better. So I just got on with it. I chose to simply drink more water to help flush these UTIs out. Usually, within a few days, that would indeed work. I must have had 5 or 6 of these 'UTI infections' over the 3-month period. I also found that some foods caused more problems: so I soon found out when I had too much coffee or any food with spices in it were definite no-nos.

About three months later, it was agreed that we should remove the catheter valve to test whether I could manage without it. So that was done. At this stage, while I was keeping my fingers crossed, I could imagine having to go back in within days to have the catheter re-fitted. However, much to my relief (a word I grew to use a lot), I found that I could urinate normally again. I almost couldn't believe it! In addition, since the prostate appeared to have shrunk, it seems I could eat normally again. I could drink more than a single cup of coffee per day again and tolerate some foods with spices in with no effects whatsoever. Which was nice -- and another relief. It's been months now without any further problems urinating.

When it was time to have an online 'catch-up consultation', the consultant suggested that the combination of Tamsulosin and Finasteride tends to only work in a small number of cases. Plus, some people can have intolerable side effects from either one or both drugs. Thankfully, I hadn't noticed any real side effects from either drug or their combination. So the consultant surgeon told me 'I was lucky'. So while being somewhat grateful for that reality, I hadn't quite worked out yet what that meant. As a result, it seemed I wouldn't need to have a 'urethra-widening' operation after all. At least for now. So he asked if I wanted to be taken off the list. Once I realised that I wouldn't need to have a laser blasting a wider gap inside my penis in the near future, it was a good day.

It seems that both Tamsulosin and Finasteride are 'cheap to manufacture' drugs and can be taken long term. So that's where we are right now. No urination problems any more (touch-wood), no catheter valve, and two drugs that seemed to have fixed my problem -- for now at least. So yes, grateful, relieved (there it is again).

Once a year, I've been advised to have an MRI to keep an eye on the 'low-level prostate cancer'. So I just had another one of those and am awaiting results. Usually, if there's nothing of significance to report, I may not get any automatic feedback. However, if I don't, I might just phone up and ask anyway. Otherwise, my imagination may start running with wild nightmares.

So an appropriate ending for now is, phew!