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Have prostate gland enlargement and PSA of .04. Recommended surgery but is heart patient. Advise?

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My dad is 65 years old, with prostate gland enlargement to 30cc. He has a PSA of .04. The doctors recommend surgery but he is a heart patient with EF 30%. Do you think in his case, surgery is the only option?
Posted Wed, 31 Jul 2013 in Hypertension and Heart Disease
 
 
Answered by Dr. Jorge Brenes-Salazar 2 hours later
Dear patient,

Thanks for your health concerns; not doing surgery is always an option, a prostate biopsy with a needle could be entertained before embarking in radical surgery. From a cardiac standpoint, he would be at mild-moderate increased risk of cardiac events with surgery, but if there are no active cardiac conditions, he can climb 4 or more flights of stairs at a time and no other concerning cardiac issues, he may pass a preoperative cardiovascular evaluation by a competent provider. An EF of 30% does not necesarily preclude surgery.

Yours truly,

Dr Brenes-Salazar MD
Cardiology
Mayo Clinic MN
Above answer was peer-reviewed by
 
Follow-up: Have prostate gland enlargement and PSA of .04. Recommended surgery but is heart patient. Advise? 29 hours later
My dad never took any medicine for his prostate and the surgeon says the surgery is required. In his case di you think prescribing a medicine should be the first option?Also what are his options to maintain his EF.he has always passes his stress test with normal reports. He was able to do achieve the heart rate of 170 in 8 mins without complications. He takes e xcellent care of him self by fast walking if 5-7km everyday and eats extremely healthy diet. He has been doing ever since he had his first attack 23 years ago . He lives a normal and healthy life , the only concern at this point of time if the EF 30. Also is it ok for him to travel as my parents are planning to visit us but because of all this , we are concerned.
 
 
Answered by Dr. Jorge Brenes-Salazar 18 hours later
Hi,

Thanks for writing back.

Sorry for the delay in answering.

Yes, I believe medications like finestride and alfa adrenergic drugs could be employed first before opting for surgery.

Based on your description of your father's health, I consider even with EF 30 he is a moderate risk candidate for surgery and he can go for surgery without fear.

Hope, I answered your query.

Wish you good health.

Regards,
Above answer was peer-reviewed by
 
Follow-up: Have prostate gland enlargement and PSA of .04. Recommended surgery but is heart patient. Advise? 28 hours later
Doctors prescribed him alfuzosin for prostrate which is dropping his blood pressure. The cardiologist has prescribed him medicine for marinating his EF which also drops the BP. The doctor says all medications for prostrate will drop the BP and says you have to decide what you want to take care of ( EF of Prostrate). Could you please tell the best scenario for him? What steps should be taken for the best results. Are there any medications for prostrate which will suit him?
 
 
Answered by Dr. Jorge Brenes-Salazar 1 hour later
dear XXXXXXX

thanks for the follow up question. As a matter of fact, there is one medication for enlarged prostate that works well and does not lower blood pressure; the name is finasteride, I encourage you to discuss this option with his provider.

yours truly

Dr Brenes Salazar
Above answer was peer-reviewed by
 
Follow-up: Have prostate gland enlargement and PSA of .04. Recommended surgery but is heart patient. Advise? 22 hours later
Thanks .. Is this medicine available in India? If yes,what is the name ?
 
 
Answered by Dr. Jorge Brenes-Salazar 1 hour later
It is indeed available in India with several names: Finara, Finast, Proscar

truly yours
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Follow-up: Have prostate gland enlargement and PSA of .04. Recommended surgery but is heart patient. Advise? 45 hours later
Does this medicine elevate uric acid? Are there any significant side effects?
 
 
Answered by Dr. Jorge Brenes-Salazar 1 hour later
Finasteride does not increase uric acid levels; a benign common side effect is increased hair growth but it is a very well tolerated medication
Above answer was peer-reviewed by
 
Follow-up: Have prostate gland enlargement and PSA of .04. Recommended surgery but is heart patient. Advise? 2 days later
Is there any medication to increase the ejection fraction?
 
 
Answered by Dr. Jorge Brenes-Salazar 1 hour later
Thanks for the follow up

These groups of medications have all showed to increase ejection fraction:
1. Beta blockers: eg. metoprolol, carvedilol, bisoprolol
2. Angiotensin converting enzyme inhibitors: eg. lisinopril, captopril, enalapril
3. Angiotensin receptor blockers: losartan, valsartan, irbersartan

Truly yours

Dr Brenes Salazar
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