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  • TURP, Green Light Laser, or another method

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    Old 01-25-2020, 01:00 PM   #1
    Susej
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    TURP, Green Light Laser, or another method

    I tried REZUM a year ago and it failed to relieve BPH. I now need to try another method. My URO is recommending TURP but I still have an active sex life and don't want to risk problems there. It's why I chose REZUM initially. A friend recommends Green Light Laser. My chief concern is to minimize the risk of ED and incontinence. Any suggestions as to which methods I should consider to relieve BPH?

    BTW, my prostate is not overly large and I am in active surveillance for PC.

     
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    Old 01-25-2020, 01:13 PM   #2
    DjinTonic
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    Re: TURP, Green Light Laser, or another method

    Quote:
    Originally Posted by Susej View Post
    I tried REZUM a year ago and it failed to relieve BPH. I now need to try another method. My URO is recommending TURP but I still have an active sex life and don't want to risk problems there. It's why I chose REZUM initially. A friend recommends Green Light Laser. My chief concern is to minimize the risk of ED and incontinence. Any suggestions as to which methods I should consider to relieve BPH?

    BTW, my prostate is not overly large and I am in active surveillance for PC.
    By AS do you mean you have had a biopsy that was positive for cancer or that your doc is suspicious and you are being monitored as to whether a biopsy may become advisable? The latter is not active surveillance.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)…0.015 (1 yr. 6 mo.)…0.015 (2 yr. 4 mo.)

     
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    Old 01-25-2020, 02:57 PM   #3
    IADT3since2000
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    Re: TURP, Green Light Laser, or another method

    Hi Susej, and welcome to the Board!

    You could try one of the two drugs in the 5-alpha reductase inhibitor class, either finasteride/Proscar or dutasteride/Avodart. Both are approved for BPH. Neither affects continence, but both, in a minority of men, can affect ED and/or interest in sex while on the drug; if these side effects are experienced, they go away when the drug is stopped. That means you can try the drug, and if you have that side effect, you can stop it and recover. I have been on both (and am still on Avodart). I was definitely not affected by Proscar, but while on Avodart, age (entering 70s), radiation, many years of intermittent hormonal blockade, or a combination may have led to substantially reduced interest and capability. I suspect the ED/libido side effects may be more common with Avodart but haven't checked studies.

    Both drugs will lower PSA, setting a new baseline from which to check for increases. They will also make DREs and biopsies more efficient. They reduce the blood supply to the prostate in a good way and reduce the size of the prostate. They seem to be able to stop or get rid of some less aggressive prostate cancer (GS-2 - 6).

    Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.

     
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    Old 01-25-2020, 04:52 PM   #4
    Susej
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    Re: TURP, Green Light Laser, or another method

    A year ago I had a biopsy (G 3+4) and after much testing, including low risk Decipher, I went on AS. I'll get another biopsy next month as followup. I'm being monitored at UCSF in San Francisco. They seem cutting edge on this stuff, but my Uro wants me to do TURP after failing REZUM and I'm hesitant because of the ED issue. Not sure what my best option is at this point.

     
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    Old 01-25-2020, 06:48 PM   #5
    DjinTonic
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    Re: TURP, Green Light Laser, or another method

    If only my cancer diagnosis had come before my TURP. I would have jumped at the chance to take care of both my PCa and BPH with a RP!

    My TURP was a complete success, reducing my prostate from 90 to 30 g. A few years later, when my prostate was examined after my RP, it had grown back to 64 g. My uro had warned me that some men need additional BPH procedures in time! That's where I was likely headed.

    While most cancers form in the periphery of the gland, and a TURP scoops out tissue in the core that are pressing on the urethra, it is possible you have a TURP, more serious lesions are found, and you need to treat for PCa.

    A TURP is a major procedure, but the recovery is very short, and, while other procedures are available as you well know, TURP is the gold standard.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)…0.015 (1 yr. 6 mo.)…0.015 (2 yr. 4 mo.)

     
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    Old 01-25-2020, 09:37 PM   #6
    guitarhillbilly
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    Re: TURP, Green Light Laser, or another method

    My UR does this procedure and it makes a lot of sense to me. In fact a MD that I know chose this method to reduce the size of his prostate. In fact it is cauterizing the prostate at the same time it is reducing the size of the prostate.

    https://my.clevelandclinic.org/health/treatments/17917-holmium-laser-enucleation-of-the-prostate-holep

    "What are the advantages of holmium laser enucleation of the prostate (HoLEP)?
    Use of HoLEP in many different parts of the world has shown it to be a safe and effective procedure. Although there are many types of BPH surgeries available, HoLEP offers a unique advantage in being able to remove a large amount of tissue without any incisions on the body, even in very large prostates, while decreasing the risk of bleeding and providing tissue for pathology (to look for cancer). This decreases the need for blood transfusions during surgery, minimizes the time of stay in the hospital to one or two days, and reduces the risk of needing repeat treatment."

    From Mayo Clinic website:
    "TURP is generally considered an option for men who have moderate to severe urinary problems that haven't responded to medication. While TURP has been considered the most effective treatment for an enlarged prostate, a number of other, minimally invasive procedures are becoming more effective. These procedures generally cause fewer complications and have a quicker recovery period than TURP."


    These folks call the HoLEP procedure the "gold standard",

    "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4446381/"

    "Introduction: For many years, transurethral resection of the prostate (TURP) has been accepted as the gold standard to surgically alleviate obstructive voiding dysfunction in men with benign prostatic hyperplasia (BPH). This historical standard has been challenged repeatedly over the last decade by consistent data demonstrating the superiority of Holmium enucleation of the prostate (HoLEP). This review summarizes the literature comparing HoLEP and traditional therapies for BPH that are widely used and have long term efficacy data, primarily TURP, open prostatectomy (OP), and alternative laser therapies (PVP, ThuLEP, etc). Results: Patients undergoing HoLEP have greater improvements in post-operative Qmax, greater reduction in post-operative subjective symptom scores, and lower rates of repeat endoscopic procedures for recurrent symptoms at 5-10 year follow up compared with TURP, OP, and other laser therapies. Furthermore, patients undergoing HoLEP benefit from significantly shortened catheterization times, decreased length of hospital stay (LOS), and fewer serious post-operative complications."

    "In summary, HoLEP is at least as effective as other surgical therapies, including TURP, OP and other laser modalities, with fewer complications, shorter hospital stays, and decreased catheter time. These benefits make HoLEP the procedure of choice for men seeking surgical relief for BPH related LUTS and the gold standard for the 21st Century."

    Sounds like HoLEP is a better procedure than TURP.

     
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    Old 01-26-2020, 04:22 AM   #7
    Prostatefree
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    Re: TURP, Green Light Laser, or another method

    Treat the cancer and you treat the BPH. Treat the BPH and you don't treat the cancer.

    You got your eye on the wrong ball. Treat the cancer.

    Your chief concern is the cancer. You have a positive biopsy and a green light to treat the cancer.

    Treating the BPH with a positive cancer diagnosis is fiddling while Rome burns, or whistling past the grave yard, or tilting at windmills, or borrowing your head in the sand, or ... treat the cancer.

    Early diagnosis early treatment. You can't finesse cancer. You have one certain fact. You have G3+4 prostate cancer, or more. All the other tests you want to rely on are fallible. Treat the cancer.

     
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    Old 01-26-2020, 05:53 AM   #8
    guitarhillbilly
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    Re: TURP, Green Light Laser, or another method

    In my case the PCa came before BPH so my choice was already made for me. In fact with T2a / Gleason Score= 8 my prostate is well within the "normal" size range.I'm presently on Lupron Therapy and waiting for my 2 months to be completed so I can start IMRT. Next step is the SpaceOAR Gel injection and fuducial markers put into the prostate.

    The question is how long one is willing to wait to treat the PCa once they have a diagnosis?
    Different people have different levels of risk tolerance. Some folks choose surgery- some choose EBRT and/or Hormone Therapy- and some choose to do nothing. Every choice has consequences and varies with each individual.

    As my radiologist stated in my initial visit" There are MD's out there that will tell you can do nothing but looking at your lab report if you make that choice the PCa will Kill You."

    In my case it was 4 years from the initial spike in my PSA until my biopsy and diagnosis but that was MY Choice. My UR wanted to do a biopsy sooner but I made the decision to delay [one reason is possible infection due to the biopsy]. Any result of the outcome is all on me and me only.

    Some folks have to see the airplane going down before they are ready to jump out with a parachute. Some folks jump out of airplanes with parachutes for sport. Both decisions involve risks and are up to the individual.

    I would never tell anyone what choice to make because it is their life.
    It is very good that people on this forum are sharing their individual experiences for others dealing with the same disease.

     
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    Old 01-26-2020, 07:08 PM   #9
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    Re: TURP, Green Light Laser, or another method

    If you are looking at BPH solutions, I suggest that you research prostate artery embolization (PAE).

    There were clinical trials in the Washington DC area several years ago, and two local hospitals offer it. I met a Los Angeles area radiologist year last year, and he said that PAE was very popular at his practice. He also said that they were seeing 85 percent reductions in prostate size.

    I’m not sure how often BPH treatments are used for diagnosed PCa men. I share some of Prostatefree’s concerns.

     
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