TURP Alternatives

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

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.

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.

Hi, oldoz. Your concern about TURP is understandable, but I hope my experience will ease your mind. I had prostate interference with urinating 15 years ago, and my urologist convinced me to endure a TURP. I'm glad I agreed. The procedure in the hospital caused no pain or regrets. In fact, removing the prostate instrusion of my bladder exposed a small tumor on the bladder lining; it was removed and diagnosed as moderately malignant. However, it was discovered at an early stage and had not grown roots deeper than the epithelial (lining) cells, so its removal was complete. To be sure, we scheduled another cystoscopy two weeks later, and that viewing showed several more small tumors on the bladder lining. Another TURP removed them and led to another diagnosis of malignancy, but again they were superficial in place, easily removed, and left no bad tissue behind. Still cautious, we turned next to what is known as a Bacillus Calmette-Guerin (BCG) treatment that injects a solution into the bladder in up to six weekly applications. The solution contains immune system cells designed to neutralize any seeds of malignancy without causing any significant discomfort or extended symptoms. Like you, I had been on medications that fell short of opening my urinary system to free flowing, but after the TURP and followup treatment, my problems were a greatly relieved, medications were stopped, urination remains dependable, my last cystoscopy (after 15 years) led to no further bladder treatments. I'm now proud to acknowledge being a cancer survivor. Martin

How long do out of area people have to stay in town to get this done. I could motel it for a week or two, not if I have to come back once a week for months. Thanks for the explanation.

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!