Everyone has their own situation to assess, and I am definitely in favor of starting with least invasive option(s). In my case, however, I have had two laser PVP procedures, one Rezum procedure, and tissue has grown back after each one. I am now getting ready to have my fourth BPH surgery. I recognize my case is probably rather unusual, and for this reason I am seeking my further care/surgery at Mayo. The good news is that there is an increasing array of less invasive options available now for BPH treatment. This can make it challenging in selecting the best one for any given person. I feel the key here is to have a skilled urologist who is able to help evaluate the full range of options (including pros/cons, risks/benefits) to select the one that best fits the individual's condition. If I had not been through what I already have I would definitely consider the MIST procedure.