^{Disclaimer: This is a personal account with BPH and is not intended as medical advice. If you suspect you may need treatment for BPH, please consult a medical practitioner for proper guidance.}

After several years of living with an Enlarged Prostate (Benign Prostatic Hyperplasia or BPH), my husband made the decision to seek treatment. He underwent a procedure known as HoLEP (Holmium Laser Enucleation of the Prostate) on 7 Oct 2024 and is now recuperating at home.

With Prostate Cancer being one of the most common cancers among men, and BPH potentially serving as an early indicator, we felt it was important to share his experience. By doing so, we hope to raise awareness and encourage others to seek timely treatments if they face similar concerns.

Here is David’s journey:

“Surely I’m not THAT old?” I asked my Urologist in shock. At which he calmly answered that, at some point in life, most, if not all men, will have Enlarged Prostate. It’s just a question of whether it affects the urethra or becomes something more sinister.

Early Symptoms: High Frequency, Low Flow

My symptoms started six years ago, around the same time Angie was receiving treatment for her Endometrial Cancer. I began experiencing sudden, frequent urges to urinate, often coming with little warning. It was so disruptive that I couldn’t even complete a 30-minute car ride without urgently needing to find a bathroom! Initially, I attributed this to my high water intake—a habit instilled in me by my Mother. However, even after trying to reduce the amount of water I drink, the urgency didn’t go away. That’s when I began to worry, as it was clearly starting to affect my daily routine.

In addition to the frequent urges, I noticed that my urine flow had become somewhat weak and irregular. Despite trying to “push” harder, the stream would still be weak. At first, I attributed it to sign of ‘old age’, but as it worsened and combined with the frequent need to urinate, I knew something wasn’t right. Not only was I making more trips to the bathroom, but I was spending longer time in it.

These symptoms—high frequency and low flow—impacted my sleep quality and severely disrupted my lifestyle. Angie and kids began to comment on how often I had to excuse myself and how long I’d be gone. But with Angie already undergoing cancer treatment, I decided to keep the concerns to myself, focusing on supporting her and not wanting to worry the kids about both parents dealing with health issues.

Seeking Answers and Undergoing Procedures

Thankfully, after Angie was healed (she’s now in her sixth year of cancer remission—thank God), I finally decided to seek medical help for my prostate condition. The constant discomfort and disruptions to my daily life made it clear that something has to be done.

To properly diagnose my symptoms, my urologist, Dr. James Tan, performed several tests:

• Digital Rectal Examination (DRE): The doctor used a gloved hand and lubricant to insert a finger into my rectum to feel the prostate for any abnormalities.
• Transrectal Ultrasound: A probe was inserted into the rectum to scan the prostate and measure its size from the inside.
• Urine Flow Test: I had to urinate into a funnel that measured the speed and strength of my urine flow, which was noticeably weak.
• PSA (Prostate-Specific Antigen) Blood Test: This test checked the level of PSA, a protein that can indicate an Enlarged Prostate or, in some cases, prostate cancer if the count is above a certain threshold.

From these tests, the diagnosis was confirmed as BPH (Benign Prostatic Hyperplasia or Enlarged Prostate in short) However, Dr. Tan was concerned about an irregularity in my PSA levels and ordered a CT scan. Based on the scan results, a biopsy was then performed.

Thankfully, the biopsy revealed that it wasn’t cancer, but rather an infection, which was promptly treated with a course of antibiotics. While the infection was resolved, BPH cannot be cured without surgery—the symptoms could only be managed through medication.

^{With the effects of an enlarged prostate, long trips like the ones we took to New Zealand, Vietnam and Egypt was quite a challenge!}

Living with BPH (Enlarged Prostate)

Once the prostate becomes enlarged, it cannot shrink on its own without surgery. Complete removal of the prostate is a major surgery which is usually done as a last resort—usually in cases where cancer is present, or when other complications arise. At the time of my diagnosis, I chose not to opt for surgery because the available treatments for shrinking the prostate had a high recurrence rate (meaning the enlargement could return within 10 to 15 years).

On the advice of my urologist Dr Tan, I managed the BPH symptoms for the past few years through medication. The plan was to monitor the condition closely until surgery became a necessity.

With regular medication and biannual check-ups, I’ve been able to keep tab of my BPH. Occasionally, my PSA levels would fluctuate, and I’ve had to undergone CT scans to rule out abnormalities.

On my own, I also did extensive research online about maintaining prostate health. Almost every source, along with my urologist, emphasised the same thing: adopting a healthy, active lifestyle and following a “Mediterranean Diet”. This diet is rich in protein and greens while avoiding high-carb and high-sugar foods.

It struck me that our lifestyle choices have such direct impact on our health, and eventually, we’ll have to “pay back” any unhealthy habits we’ve accumulated over the years. I became more conscious of my lifestyle, embarking on the ‘Mediterranean Diet’ (switching white/brown rice to cauliflower rice, and taking more proteins and fish instead of red meat, omitting alcohol and sugary drinks). I also started incorporating more intensive physical workouts into my daily routine.

Six years on, with lots of perseverance, I’ve shed 27kg and managed to maintain that weight loss for the past 2.5 years.

^{Me just minutes before my first ever surgery. Thankful for my wife who is constantly by my side.}

Why the Surgery Now?

Since my diagnosis years ago, I always knew it was just a matter of time before I would need surgery. In the back of my mind, I had lived with the constant concern that my BPH might progress to something more sinister.

Two years ago, I started noticing the familiar symptoms returning. The medication that had been managing my BPH seemed to be losing its effectiveness, as I started experiencing frequent urges to urinate along with weak urine flow. These symptoms brought about the same inconveniences I had encountered before—disruptions to my daily life and a sense of ‘déjà vu’ that returned much earlier than I expected. When we resumed travel after COVID-19, I found myself abstaining from water intake totally during long drives, bus tours, and boat rides, which made holidays very uncomfortable and inconvenient.

During a recent check-up, things took a worrying turn. My PSA levels had unexpectedly spiked, and scans revealed that my prostate had grown nearly four times its original size! This was alarming, as the Enlarged Prostate now posed a risk of causing permanent damage to my bladder. While I could manage without my prostate (now that family planning was out of the way), the thought of living with a damaged bladder was worrying as the damage is irreversible.

Thankfully, Dr. Tan informed me of a relatively new procedure called HoLEP (Holmium Laser Enucleation of the Prostate). This minimally invasive surgery has an extremely low recurrence rate (only 1% of men experience regrowth over the next 10–15 years). Plus, it comes with fewer complications compared to traditional surgical options.

^{Me just before I got discharged and the items the family prepared for me to fuel me with love and encouragement.}

With much prayers and the full support of Angie and the kids, I decided it was time to take action. I underwent the 3.5 hrs. successful surgery at Mount Alvernia. Despite suffering from nasty post-surgery reactions to the anesthesia, I am recuperating at home now. I am relieved that I am leaving my problematic BPH behind, and look forward to making a full recovery and stepping into a healthier chapter of my life.

^{Hope to continue leading a healthy lifestyle, not be a burden to the family and to go on more pleasant family adventures together.}

Coda:

My experience with BPH, along with Angie’s Cancer journey, has been sobering reminders for us to take our health seriously. These challenges have pushed us to make better lifestyle choices, ensuring we can enjoy the years ahead with a renewed focus on well-being. Through it all, we’ve learned that prioritizing health is not just about managing illness, but about living fully and purposefully each day.