TURP Alternatives

I'm 70 and had a bilateral NS RALP at Mayo Phoenix in late 06/2024. I was real happy with the care I received at Mayo Phoenix and the results from the surgery so far. My urine flow is really great now (much better than before surgery), but I still get up 2 or 3 times a night during an 8 hour sleep. In my case, part of the problem is I consume a lot of liquids during the evening so I kind of expect to need to get rid of it during the night and I don't worry about it. My point though is that while I urinate much easier now, I personally didn't see any improvement from before surgery to after surgery regarding how many times I get up during sleep. In fact, I think I get up a bit more now as I'm less confident I won't have an accident if I wait too long. I haven't discussed it with my doctor because it's not a big deal for me, but thought I'd share that while getting rid of the prostate greatly improved flow, it didn't improve my frequency. Also, even though I've been continent since the catheter came out (except for a few minor accidents as I'm figuring a few things out), I'm certainly less confident of my ability to resist urine leakage in stressful situations. I'm am gaining more confidence as the weeks go by, but I don't know if I'll ever be fully as confident as before surgery. Since this is one of the factors affecting your decision to have surgery, I'd suggest discussing this with the Mayo urologist so you understand whether it's likely you'll get the result you're seeking regarding less trips to the toilet while sleeping. While I didn't, I have no idea if other men do see a benefit from the surgery in this regard. I'm interested in seeing how others respond to your post and I think I'll ask about this at my next urology visit. Best wishes.

I had mine removed LARP with bladder flow issues prior. I still have those issues. I am also incontinent for the most part and lack erections. Those are new since the surgery. However, I am 5 years out from surgery. No other treatments. Zero PSA. I cant say whether the surgery would stop your prostate issues. I didnt wait for mine to get any worse.

@oldoz doctors have a natural bias towards doing procedures that they have had success with and are used to doing. They are dedicated but not infallible. You are clearly considering Mayo in Arizona which is great but being in a small town does not limit you from sending any blood work, imaging, biopsy report and any genomic testing, i.e. Decipher test, to a center of excellence and have a zoom consultation. It is done all the time.

I had a 3+4 Gleason with a PSA of 10.2. I did not want to wait for it to grow and potentially cause more severe treatment and side effect problems. I had 5 hypo-fractional treatments with the mridian linac radiation machine with has a built in mri so its all real time treatment. What the radiation oncologist sees is what they treat vs other forms of radiation machines that use fused images. Secondly, many of the radiation treatments involve treating the entire prostate PLUS extra space, called margins. The margins with the mridian were 2mm instead of 3-5 mm with other types of radiation machines. This meant potentially greater side effects. Google the Mirage randomized trial.

There are many choices that people have made successfully on this web site, including removal and partial removal, which is comforting to know. My decisions were made on my definition of cure, side effects and quality of life in the short, medium and long term. Good luck.

All good advice above. Especially using a Center of Excellence and your consideration of Mayo Phoenix would be well worth it IMneverHO.
I had the same Gleason score 3+4 at age 75 but with the caveat of the worst area being near the margin (possible escape of PC) so I went right for the RALP (done 1/2022). However, the pathology of the tumor sadly but in a very valuable way showed "positive" margins; the PC had escaped. To me, this clear info was the advantage of prostatectomy. I/we knew what the situation was and I did 2-years of ADT (Lupron). Now my PSA is negligible for which I'm most thankful.
You might strongly consider Dr Patrick Walsh's book, "Surviving Prostrate Cancer" (available at Amazon & etc). For sure get the latest edition as the older versions don't contain the extensive improvements in PC diagnoses and treatment of the last 5-years. It will also address your concerns of continence and frequency post treatment.
And don't forget the "active" part of Active Surveillance. I"m sure that term intends to encourage research such as: quiz multiple doctors/specialissts, read, study, computer search, and dig into all the info you can.
God Speed to you on this life changing and, most hopefully, reaffirming journey!

Personally, I would seek a 2d opinion and focus on my PCa treatment.
Best wishes.

Not much recovery time for turbt
But if CA comes back I would have it removed as I did 10 years ago
Close to Los Angeles ?
Have You had a Psma pet ct?!!
Radiation prior to surgery makes surgery less viable
Also having surgery alleviates the anxiety of wondering if CA returned

Best to you

Thanks - My biggest concern is getting rid of the cancer, and being able to urinate without having to but in a catheter every time I get the urge to go. I accept that I will have side effects, and I'm unfortunately already use to poor sleep.

Thanks for the response. I spent the morning reading the replies and then looking up the terms and abbreviations that I wasn't familiar with. Located in Southern Utah, 6 hours from everything except Vegas it seems like. Mayo is a short non-stop flight from my location, but a long drive because you have to get around that pesky Grand Canyon. I not only did not have a Psma pet ct scan, I had not even heard of it before.

Hey grandpun, Glad you are doing well. Curious as to why no radiation following surgery. I realize that once the cells break out, they’re out. But I would have thought some kind of radiation might have been done due to lymph gland involvement? Prostate Bed?
Just curious as a layman since radiation combined with ADT seems to be the norm these days…thanks!

Waiting 18 months with a 3+4 may not have been advisable. There’s a good chance of spread. You should get another biopsy and see what’s going on, more likely the cancer has spread in your prostate and your Gleason score may be higher.

You definitely should be seeing a different doctor. Active Surveillance is more for 3+3 than 3+4. Get to the Mayo Clinic ASAP.

A prostatectomy would completely replace a TURP. You might be in a situation where you get the TURP and then need a prostatectomy, so all the pain and time wasted on the TURP is totally wasted.