Many patients with benign prostatic hyperplasia (BPH) take medication to manage their symptoms. Because BPH tends to progress with age, most patients need to continue taking medication for the rest of their lives. However, when surgical treatment is performed, medication can often be discontinued. For this reason, if surgery is likely to be needed in the future, it may sometimes be better to consider it earlier. From the patient’s perspective, however, symptoms may not feel severe, or there may be fear of surgery, leading many people to prefer delaying treatment while continuing medication.
As BPH progresses, the bladder must generate strong pressure to push urine through the narrowed passage created by the enlarged prostate. Similar to how muscles grow stronger with repeated exercise, the bladder wall can develop thickened folds known as trabeculation due to this constant pressure. Over time, the bladder wall may become thicker and the bladder’s storage capacity may decrease. In such cases, physicians may recommend earlier surgical treatment to prevent further deterioration of bladder function.
Even when symptoms are not severe, surgery may be considered if the prostate-specific antigen (PSA) level is elevated. When PSA levels are high and continue to increase each year, doctors may perform MRI scans and biopsy tests to rule out the possibility of prostate cancer. However, PSA levels can also rise due to BPH. In such cases, PSA levels may return to normal after surgical treatment of the enlarged prostate.
One example involves a patient who insisted that his urinary symptoms were not severe. When he visited a urology clinic and underwent prostate ultrasound, his prostate was measured at 71 grams. For reference, a normal prostate typically weighs around 15 to 20 grams. This finding suggested possible functional impairment and a pathological condition.
Another notable finding in this case was the patient’s PSA level. PSA is an important blood marker used to evaluate prostate cancer and other prostate-related conditions. In this patient, the PSA level was significantly elevated and showed considerable fluctuation, which was a concerning sign from a clinical perspective.
As a result, surgical treatment—specifically holmium laser enucleation of the prostate (HoLEP)—was recommended. HoLEP is a widely used minimally invasive procedure for treating BPH. The surgery removes the enlarged prostate tissue compressing the urethra using a holmium laser.
After undergoing HoLEP surgery, the patient experienced a dramatic improvement in quality of life. The previously obstructed urethra was cleared, allowing urine to flow normally again. Postoperative urinary flow tests also showed clear improvement compared with the preoperative results. The patient’s PSA level, which had been a major concern, dropped to 0.39 ng/mL and returned to a normal range, effectively relieving anxiety about possible prostate cancer.
Dr. Kim Tae-heon of Goldman Urology Clinic’s Seoul Station branch explained that a patient’s subjective feeling of being “fine” may differ from their actual medical condition. Prostate diseases often present with mild or even unnoticed symptoms in the early stages, making objective measurements and imaging tests extremely important. He added that many modern surgical techniques now involve less pain and faster recovery. Therefore, even if symptoms appear mild, patients should not ignore them and should consult with a specialist and undergo appropriate examinations to accurately assess their health.