1. < Prostate Cancer

HoLEP procedure experiences?

Posted by southgeorgia @southgeorgia, Aug 6, 2023

Background: 62 yo in good health, no meds or other conditions other than 3,3 Gleason and 4.8 PSA. Had my first visit to Mayo (Jacksonville) and was blown away by their efficiency, courtesy, and knowledge. Had blood test, MRI, and Uriflow exams. I am currently on active surveillance with an enlarged prostate causing retention and flow issues, risking damage to my bladder which shows some distention. I have a tele-health appointment this week to discuss having a HoLEP procedure (Holmium Laser Enucleation of the Prostate) and would love to hear from you if you have had this done in regard to your experience, what to expect, what to ask the surgeon, etc. Thank you!

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

jeffmarc | @jeffmarc | Aug 26 2:33pm
In reply to @docandy111 "I was diagnosed with Prostate CA. 6 months ago. Have had all testing done, including MRI..." + (show)
@docandy111

I was diagnosed with Prostate CA. 6 months ago. Have had all testing done, including MRI directed biopsy ,Decipher, PSMA etc. I’m 71 and in good physical shape. I have BPH (100cc.), PSA is 7 with Flowmax, and Proscar, so true reading is 14. PSMA scan was negative for metastasis. I fall into Unfavorable/Intermediate Risk category, with Decipher score of 94.Gleason mostly 3+3, with 3 scores of 4+3. I’m in the Philadelphia area, so have had 2 sets of opinions with multiple oncologists from Jefferson University Hospital Dr’s and Fox Chase/Temple Health Dr’s. I’ve spoken to multiple friends and others re: their experience with surgery and decided the side effects were not for me,and that includes effects from radiation. My Dr’s think I could be a candidate for HELOP, TURP, and maybe radiation follow up. Has anyone had any experience with the same type of treatment .

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Since you have at least one 4+3 your Gleason score is considered a seven. That is not something to just let go. That means you have cancer in your prostate and you really should treat it, it almost always spreads.

My brother had a 4+3 and at 76 he had 5 sessions of SBRT radiation to the prostate. That was done last January and he has been undetectable since then.

The effects of radiation are a lot less than the effects of surgery. I’ve had both and radiation didn’t affect me in any way and it didn’t affect my brother either.

If you speak to a urologist, they usually recommend surgery since they do surgery. You wanna speak to a variety of medical professionals including a genito urinary oncologist, the ones that specialize in prostate cancer.

If you don’t treat it soon, you should get ADT so that it stops it from growing, that works for almost everyone and allows you to think about it for a few months.

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russ777 | @russ777 | Aug 26 9:37pm
In reply to @docandy111 "I was diagnosed with Prostate CA. 6 months ago. Have had all testing done, including MRI..." + (show)
@docandy111

I was diagnosed with Prostate CA. 6 months ago. Have had all testing done, including MRI directed biopsy ,Decipher, PSMA etc. I’m 71 and in good physical shape. I have BPH (100cc.), PSA is 7 with Flowmax, and Proscar, so true reading is 14. PSMA scan was negative for metastasis. I fall into Unfavorable/Intermediate Risk category, with Decipher score of 94.Gleason mostly 3+3, with 3 scores of 4+3. I’m in the Philadelphia area, so have had 2 sets of opinions with multiple oncologists from Jefferson University Hospital Dr’s and Fox Chase/Temple Health Dr’s. I’ve spoken to multiple friends and others re: their experience with surgery and decided the side effects were not for me,and that includes effects from radiation. My Dr’s think I could be a candidate for HELOP, TURP, and maybe radiation follow up. Has anyone had any experience with the same type of treatment .

Jump to this post

I think you meant HoLEP, right? Holmium Laser Enucleation of the Prostate.

Neither of those procedures removes the peripheral zone which is where most PCas occur, not in the transition zone, which is where most BPH occurs. I would not consider those options unless you have an unusually focal tumor in your prostate AND it is entirely located within the area of the prostate normally resected in BPH surgeries. 3 cores of 4+3 is nothing to mess around with IMO.

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bens1 | @bens1 | Aug 27 5:56am
In reply to @docandy111 "I was diagnosed with Prostate CA. 6 months ago. Have had all testing done, including MRI..." + (show)
@docandy111

I was diagnosed with Prostate CA. 6 months ago. Have had all testing done, including MRI directed biopsy ,Decipher, PSMA etc. I’m 71 and in good physical shape. I have BPH (100cc.), PSA is 7 with Flowmax, and Proscar, so true reading is 14. PSMA scan was negative for metastasis. I fall into Unfavorable/Intermediate Risk category, with Decipher score of 94.Gleason mostly 3+3, with 3 scores of 4+3. I’m in the Philadelphia area, so have had 2 sets of opinions with multiple oncologists from Jefferson University Hospital Dr’s and Fox Chase/Temple Health Dr’s. I’ve spoken to multiple friends and others re: their experience with surgery and decided the side effects were not for me,and that includes effects from radiation. My Dr’s think I could be a candidate for HELOP, TURP, and maybe radiation follow up. Has anyone had any experience with the same type of treatment .

Jump to this post

@docandy111 NOT ALL radiation and the machines are alike. The margins used have an impact on how much healthy tissue is exposed and your side effects. You might want to Google the Mirage randomized trial which compares radiation machines, like the Mridian or Elekta, that have a built in MRI vs radiation machines that use fused images and are forced to use larger margins. Healthy tissue exposure matters and one can have significantly different results depending on the machine you choose with your doctors (I spoke with 5 radiation oncologists).

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heavyphil | @heavyphil | Aug 27 2:33pm
In reply to @docandy111 "I was diagnosed with Prostate CA. 6 months ago. Have had all testing done, including MRI..." + (show)
@docandy111

I was diagnosed with Prostate CA. 6 months ago. Have had all testing done, including MRI directed biopsy ,Decipher, PSMA etc. I’m 71 and in good physical shape. I have BPH (100cc.), PSA is 7 with Flowmax, and Proscar, so true reading is 14. PSMA scan was negative for metastasis. I fall into Unfavorable/Intermediate Risk category, with Decipher score of 94.Gleason mostly 3+3, with 3 scores of 4+3. I’m in the Philadelphia area, so have had 2 sets of opinions with multiple oncologists from Jefferson University Hospital Dr’s and Fox Chase/Temple Health Dr’s. I’ve spoken to multiple friends and others re: their experience with surgery and decided the side effects were not for me,and that includes effects from radiation. My Dr’s think I could be a candidate for HELOP, TURP, and maybe radiation follow up. Has anyone had any experience with the same type of treatment .

Jump to this post

Docandy, you seem like a young 71. So I agree with every post before mine in terms of killing the cancer one way or the other and not screwing around with these different methods that just skirt the issue.
SBRT - whether MRI or CAT guided is an excellent choice if you want to avoid surgery and have fewer side effects. My buddy just had Cyber knife at Sloan: No ADT even though he had two 4+3 cores since his Decipher test was low probability of metastasis. ZERO side effects 3 months out, PSA went from 8 to .8 and it’s not done coming down.
Best of Luck to you!

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Moderator
Colleen Young, Connect Director | @colleenyoung | Sep 9 5:18pm
In reply to @docandy111 "I was diagnosed with Prostate CA. 6 months ago. Have had all testing done, including MRI..." + (show)
@docandy111

I was diagnosed with Prostate CA. 6 months ago. Have had all testing done, including MRI directed biopsy ,Decipher, PSMA etc. I’m 71 and in good physical shape. I have BPH (100cc.), PSA is 7 with Flowmax, and Proscar, so true reading is 14. PSMA scan was negative for metastasis. I fall into Unfavorable/Intermediate Risk category, with Decipher score of 94.Gleason mostly 3+3, with 3 scores of 4+3. I’m in the Philadelphia area, so have had 2 sets of opinions with multiple oncologists from Jefferson University Hospital Dr’s and Fox Chase/Temple Health Dr’s. I’ve spoken to multiple friends and others re: their experience with surgery and decided the side effects were not for me,and that includes effects from radiation. My Dr’s think I could be a candidate for HELOP, TURP, and maybe radiation follow up. Has anyone had any experience with the same type of treatment .

Jump to this post

@docandy111, you might be interested in reading the experiences of others who have had HoLEP for prostate cancer here:
- HoLEP procedure experiences?
https://connect.mayoclinic.org/discussion/holep-procedure-experiences/
How are you doing?

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kran0910 | @kran0910 | Oct 12 1:14pm

Had my HoLep procedure done on September 10, 2024. I have been doing well. I just started about 2 weeks ago having a sensation in my rectum through my urethra when urinating. My steam is extremely strong and that drives that sensation. I think this is common? My Prostste was over 170 grams.

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1 reply
southgeorgia | @southgeorgia | Oct 14 4:55pm

I know for me, it definitely is a different sensation when urinating. I think, over time, it goes back to filling more “normal” (or I have just gotten used to a different sensation). There are times when I really have a strong urge to urinate that it feels a little different. But what a relief to be able to go like a teenager again!

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jc105776 | @jc105776 | Oct 22 1:21am

I am 77-years old with BPH living in the Los Angeles area. By reading this thread, I gathered a few great surgeon names like Drs. Krambeck, Lingeman,, and Dora with great skills in HoLEP. However I am wondering if anybody here has knowledge on any highly experienced surgeons who are also practicing HoLEP in my area. It would be wonderful if I don't have to fly far away to get this treatment unless necessary. I would rather get treated by a highly experienced doctor who has done this procedure at least several hundred times if not thousands. Thanks in advance.

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kswf62 | @kswf62 | Oct 27 11:44am
In reply to @kran0910 "Had my HoLep procedure done on September 10, 2024. I have been doing well. I just..." + (show)
@kran0910

Had my HoLep procedure done on September 10, 2024. I have been doing well. I just started about 2 weeks ago having a sensation in my rectum through my urethra when urinating. My steam is extremely strong and that drives that sensation. I think this is common? My Prostste was over 170 grams.

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My HoLEP was Sep 25th. I am having an experience like that as well. I can feel something from time to time even when not urinating. Did you find anything out about that sensation? Is it normal or concerning?

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1 reply
kran0910 | @kran0910 | Oct 27 12:14pm
In reply to @kswf62 "My HoLEP was Sep 25th. I am having an experience like that as well. I can..." + (show)
@kswf62

My HoLEP was Sep 25th. I am having an experience like that as well. I can feel something from time to time even when not urinating. Did you find anything out about that sensation? Is it normal or concerning?

Jump to this post

I am still having it. It feels like when I am urinating I have a rushing sensation in my rectal area. I am going to try to get more information. I have also noticed a little bit of pink blood when I am defacating in the morning only coming from urethra But never when I am urinating during the day or night
Strange feeling

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