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Have you consulted your urologist? What is the urologist opinion? I would consult urologist if not already. The lobulating indention into the bladder may be cause for concern. It might be watched by depending on the details of the appearance it may be a consideration for prostate biopsy... the PSA is below 4.0 but just barely.. usually with that we would recheck in 6 months. I think that details of the appearance on the ultrasound would probably sway your urologist to perhaps proceed with prostate biopsy or follow with recheck in 6 months another possible way to follow that. The symptoms and general picture fits with BPH ( benign prostatic hypertrophy) That would account for the getting up to urinate at night and hesitancy. Medical treatment for BPH may help you with hesitancy symptoms...
I suspect more that your urologist would favor checking a prostate biopsy due to the seeming asymmetry of prostate.
Combination of Avodart plus Flomax may be helpful for BPH aspect which is I think most of the issue as far of the symptoms that you have....(Adding Avodart would drop the PSA reading and that would need to be accounted for though..If ibuprofen seems to help with discomfort then I see no problem with that...
I hope that this is helpful for you. Let me know if you have further questions. I will be happy to get back with you! If my answers have been helpful and to your satisfaction then please remember to leave positive feedback. Thank You and Best Regards,
Anthony Bray MD
You are very welcome.Let me know if I may be of further help.Best wishes going forward!