Very large prostate

I'm 74 yrs old and have been on active surveillance for 13 yrs now after being diagnosed with pc t1c Gleason 6.
My prostate is currently 147ML in size according to my recent MRI (I've had 6 so far) and psa of 10.6 and 2 yrs ago if was 90ML and my psa was 11.4, the MRI shows no indication of changes within the capsule but plenty of BPH factor, its taken 13 yrs for my psa to double as well as a good prostate density calculation, my Urologist isn't very concerned and says to continue with AS but I'm wondering if I should just get it removed and avoid all the stress and anxiety, does anyone have any advice to give me please.

Hello tak. As Halbert says, there are certainly ways to deal with your overly large prostate w/o resorting to the major surgery of prostate removal. If your urologist is not discussing those alternatives with you perhaps you should seek a second opinion.

Beyond that you indicate that you have had several MRI's. How about biopsies? A formal AS program would include periodic biopsies to check on your cancer. What does your urologist say about that?

Jim

"...but I'm wondering if I should just get it removed..."

maybe irradiated but not removed

tak06,

I have almost the same issue as you. I am not planning on another biopsy. I have had 4. I am not concerned about the G6 and my PSA has seemed to stabilize. However, I am having the normal BPH symptoms and I don't like taking the normal medications.

For large prostates, based on my research, the best method to alleviate the BPH is the HOLEP procedure. I hope to meet with a highly regarded specialist in my area soon.

Unfortunately, unless there is a specific tumor involved, treatments like HOLEP, TURP or Greenlight don't lower you cancer concerns. I am not sure you should have any concerns with G6 and your age. Evidently, they don't remove enough cells near the outer boundary as that is where most cancer is formed.

Good luck and check out HOLEP for your BPH.

tak, with your history, you appear to be one of the men who is going to die with it, not of it. One of the procedures mentioned will dramatically improve your BPH situation, and it will give them some cells to look at to see if the PC is doing anything.

Your PSA is not extraordinary for your age and large prostate. You could push for a biopsy for peace of mind--your doctor may or may not agree.

A friend with a very large prostate and significant urinary issues recently had a PAE (prostate artery embolism) and he says he no longer needs medication and his urinary issues are gone. It’s a pretty simple noninvasive procedure where they shut down one of more blood vessels feeding the prostate causing it to shrink. It’s worth investigating. Best wishes…Terry

I have enlarged prostate, but don't know its size.
I have had to take Tamsulosin for years to aid urination.

2 years ago my kidney function (GFR) plunged and I had to have TURP surgery asap.
It removed the constricting of the urethra and raided the GFR. I think it saved my life.

That seems to be what I'd be most concerned about.

By the way, my PSA went down quite a bit. I have Gleason 6 from a test several years ago.