I am a healthy 49 year-old male. For the past 4 years, I have had

Health Professional

I am a healthy 49 year-old male. For the past 4 years, I have had had chronic problems with the following:

  • I get up 1-2 times a night to urinate (if I take 4 Advil, I sleep almost the whole night, 6-7 hours). I do not have urgency just a dull discomfort that I have to go. When I go it relieves the problem and the sensation goes away.
  • I have the same issue during the day. I do not get any urgency just a discomfort. No pain, but my urine flow is slower than I remember it. I take between 8-15 seconds to start and there is a mild discomfort initially.
  • I also have soreness around the base of my testicles and anus that is worse when sitting. This seems to be worse than before. I feel the need to urinate every 2-4 hours in order to relieve the pressure feeling.
  • I run 3-4 miles and swim 3 times a week. I sometimes have a pain around the tip of my penis after I exercise hard; this occurs a few hours later.

I have been diagnosed with a mild enlargement of the prostate. I had a CT scan and it measured 50mm. My PSA ranges from 1-1.5. I had fairly normal residual urine on ultrasound. My urologist started me on Uroxatral, but it made me feel strange. My question is: Are my symptoms from BPH or something else? Is 50mm considered really large? My symptoms are starting to get more annoying what should I do?
**It sounds like some of your symptoms may be attributable to prostatitis, and conservative therapies for this are available. This is apparent by some of the symptoms that you are describing, which include soreness around the base of the testicles and anus (perineum) when sitting. The pain at the tip of your penis after exercise may just be as the result of irritation from clothing that you are wearing while exercising. It would pay to think this part of the discomfort through a little more thoroughly. Eliminating caffeine, alcohol, and spice are usually a good place to start with regards to initiating conservative treatments.

50cc is certainly a large prostate. The use of various drugs such as Finasteride or Dutasteride (drug category is 5-alpha reductase inhibitors) or preparations of Saw Palmetto may be helpful in relieving the size of your prostate. Uroxatral is in a different category of drug (alpha blocker) that works by relieving the muscle tension around the prostate. This too may be helpful in alleviating your symptoms, and it is commonly used in patients with prostatitis and BPH. Patients can often use drugs in both categories simultaneously. A trial of a different alpha blocker may also prove to be helpful.

There can often be an overlap of symptoms in patients with BPH and prostatitis. Patients oftentimes get frustrated since the source of their symptoms may not always be clear, and many times empirical trials of various categories of drugs may be required to sort things out.**

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