Q: I am 60 years old with an enlarged prostate measuring 67.97 g. Residual urine is 43.6 cc. My blood sugar (fasting) is 113 and 201 (PP) and blood pressure is normal. Should I go for prostate surgery or can I take tomcontin 0.4 mg for another six months (using it for the last four months)? The USG-KUB study impression is prostatomegaly with mildly significant post void residue. My urine flow is not that bad as it was before. Only there is some residue, which may cause infection or lead to cancer of prostate or damage kidneys. I am afraid of the pain after prostate surgery and want to avoid if I can by using medicines.

A:The need for prostate surgery is not dependent on the size of prostate, or the residual urine. Residual urine does not predispose to infection or cancer. There are some direct indicators to detect the need for surgical intervention, like acute retention of urine (and failed voiding trial after removal of catheter), association of bladder stones, secondary back-pressure changes like dilatation of kidneys with deranged renal functions, and recurrent infections associated with obstructive symptoms. Fortunately, you do not seem to have any of them. In absence of the above, the need for surgery is derived by the degree of obstructive symptoms (assessed by International Prostate Symptom Score, or IPSS), and the degree of response to alpha blockers (drugs like tamsulosin that you are having). You are the best judge of whether or not you need a surgery. If you are comfortable with your symptoms while taking alpha blockers, you have every right to continue taking them and not going for surgery for as long as you desire. In case symptoms do not improve despite medications, deteriorate while taking them, or you have troublesome side effects with medicines, you may have to opt for the surgical treatment for prostate. You certainly need a uroflometry and a PSA estimation as the baseline to ensure that the flows at present are adequate, and that there is no risk of cancer in the prostate gland.