Many people take medication due to benign prostatic hyperplasia (BPH). As BPH progresses with aging, most individuals need to take medication throughout their lives. However, surgical treatment can allow for the discontinuation of medication. Therefore, if there is a high probability of needing surgery in the future, it might be better to consider surgery earlier. Of course, from the patient's perspective, there is often a strong desire to delay surgery by continuing medication, either because they perceive their symptoms as not severe or because they are afraid of surgery.
When benign prostatic hyperplasia worsens, significant pressure is exerted on the bladder to push urine through the enlarged prostate. Just as muscles develop with extensive exercise, the bladder also forms trabeculations when subjected to pressure. As more time passes, the bladder wall thickens further, and the bladder's storage capacity itself diminishes. In such cases, it is better to undergo surgery early, which is why medical professionals may suggest surgery to patients.
Even if symptoms are not severe, surgical treatment is considered if the PSA (Prostate-Specific Antigen) level is high. If PSA levels are high and increase annually, there is a possibility of prostate cancer, leading to MRI scans and tissue biopsies. However, since a high PSA level can also be caused by benign prostatic hyperplasia, PSA levels sometimes normalize after surgery.
As an example, we can discuss a case of a benign prostatic hyperplasia patient who claimed their urinary symptoms were not severe. This patient visited a urology department, and a prostate ultrasound examination revealed a prostate size of a remarkable 71g. For reference, the weight of a normal prostate is typically around 15-20g. This finding is an indicator that suggests functional impairment and a pathological condition.
What was even more noteworthy was this patient's PSA level. PSA is a key blood indicator that can help assess prostate cancer and other prostate diseases. In this patient's case, the levels were considerably high, and the variability was also significant. From a specialist's perspective, this constituted an undeniable warning sign.
Consequently, surgical treatment, specifically Holmium Laser Enucleation of the Prostate (HoLEP), was recommended. HoLEP is a representative minimally invasive surgical procedure for treating benign prostatic hyperplasia, involving the removal of the hypertrophied tissue that was compressing the urethra within the prostate using a holmium laser.
After the HoLEP surgery, the patient began to live a completely different life. The obstructed urethra was fully cleared, leading to a smooth flow of urine, and a clear improvement was observed in the uroflowmetry graph before and after the surgery. The previously concerning PSA level recovered to a normal range of 0.39 ng/mL, completely alleviating anxieties about prostate cancer.
Director Kim Tae-heon of Goldman Urology Seoul Station branch stated, “What a patient perceives as 'okay' and their actual health status can differ, and since prostate diseases often have minimal early symptoms or no subjective symptoms, objective measurements and imaging diagnostics are paramount.” He added, “Fortunately, various surgical methods with less pain burden and faster recovery have recently been developed, so do not be complacent if your symptoms are mild, and accurately check your body's condition through consultation and examination with medical professionals.”