What is the best treatment for prostrate enlargement bph of 140gm & psa 6.73? catheter insertion for one month & chronic sob, no hypertension. 72years

Prostatectomy: Your prostate is too large to respond to medical treatment, so you need surgery. Presumeably you were in urinary retention and hence required a catheter, but, long term catheterization always results in infection. You need to in a center with reliable anesthesia, and with a urologist experienced in "open" surgery. The specimen will be reviewed by a pathologist, especially in view of the psa.

Probably surgery: Your prostate is very big, and that might explain the high psa. Urinary retention and catheter insertion also can rise psa . I agree that the best treatment will be surgical either open or robotic prostatectomy . Your prostate is too big for trans-urethral resection ( turp). If your psa remains high, a prostate biopsy is needed to rule out prostate cancer.

Simple Prostatectomy: Given your psa, a biopsy should be considered, though not imperative. Your only choices are to continue with a catheter indefinitely to see if medications eventually help, or proceed with removal of the obstructing portion of the prostate (a simple prostatectomy). This operation carries a fair amount of morbidity, but it can be done with spinal anesthesia. This would be helpful in light of sob.

Open prostatectomy: With a prostate that large, an open prostatectomy is probably your best choice but it depends on your surgeon.

Simple prostatectomy: I agree with the first answer, but advocate a robotic simple prostatectomy to decrease blood loss and improve the urethra to bladder reconstruction.