Q: I was recently diagnosed with an enlarged prostrate gland. The gland is weighing 32.3 g and the gland measures 4.1/3.8/3.9 cm. Calcific foci are seen in the prostrate. The PSA test reveals 0.43 mg/ml. My urologist prescribed Tom Dura 0.4 mg for one month and stated that these tablets will prevent further enlargement of the gland and also reduce its size. The urinary bladder is normal but shows retention of urine 65 cc. What are these calcific foci? Will the tablets help in reducing the size of the gland and arrest further growth and remove the calcific foci? Is there a need for operating the gland? If so, at what stage and after how much time should it be done? Will the operation cure the problem once for all? Are there any side effects of the operation?

A:Decision to treat for prostate is not done for the size, or the residual urine, but is entirely based on the symptoms and the effect on the quality of life it is creating. Treatment is possible either with medications or surgically. Medical treatment in presence of enlarged gland is usually done using a combination of two kinds of drugs, alphablockers to give immediate relief and 5-alpha reductase inhibitors to prevent further enlargement. The medication prescribed to you is one such combination. The current literature suggests that the use of 5-alpha reductase inhibitors does reduce the risk of complications in future, though may not entirely prevent it. Calcific foci in prostate indicate past infections in this gland and are neither producing any symptoms, nor removed by any drugs. Surgery for prostate is usually advised for severe symptoms, history of retention of urine, in presence of renal failure, evidence of upper tract dilatation, and in presence of prostate enlargement along with bladder stones. Medications are usually ineffective in later situations and surgery would be a better choice.