1. < Prostate Cancer

TURP Alternatives

Posted by oldoz @oldoz, Aug 31 8:38pm

TURP alternatives question?
72 year old. Been on Tamsulosin and Finasteride for years, later on the Doctor added Myrbetriq which was like the magic pill relating to no more getting up multiple times a night. After a couple of years that gradually quit working at about the same time that I had my annual physical/wellness exam, and my doctor told me I was in excellent health, except my PSA which had been gradually climbing had shot up from 3.6 to 8.1 in one year. He sent me to a local Urologist that did multiple tests, then did a conventional biopsy giving me a (3+4)7 score 18 months ago. He had some other test (genomic???) that indicated it didn’t appear to be real aggressive. He recommended we do Active Surveillance. PSA tests have stayed high. He did decide to do a bone scan 6 months ago which didn’t reveal any likely spread. Last month he had an MRI done. He told me it showed a couple of hot spots (?). Then said I will need to at some point get Radiation or a Prostatectomy because it would likely spread in the next ten years. But, what he wants to do now is a TURP, because he said on my last three visits the Ultrasound showed I was unable to fully empty my bladder, which is why I’m back to getting up 3 times at night again. He said besides the loss of good sleep that I was injuring my bladder and he needed to do a TURP procedure at the local hospital. I asked about alternatives and he said there were some, but he does the TURP, and had one of his Assistants schedule it for next month. I looked to get a 2nd opinion but this being a fairly small town there are not a lot of advanced options.
I am now wondering if I just go to the Arizona Mayo Clinic and have the prostate removed and if that would solve both the bladder flow and prostate problems, without having to go through 2 recoveries? Apologize for the length. Appreciate any thoughts.

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oldoz | @oldoz | Sep 1 12:22pm
In reply to @retireditguy "@oldoz -- Yeah, I agree. I'm actually very happy with my surgical outcome at Mayo Phoenix...." + (show)
@retireditguy

@oldoz -- Yeah, I agree. I'm actually very happy with my surgical outcome at Mayo Phoenix. Dr. Paul Andrews was my surgeon at Mayo and I think he did excellent work on me. That said, I agree with @jeffmarc's comment that your data is pretty old and you'll probably need some new tests to determine the most effective treatment for you. But Mayo Phoenix is a cancer center of excellence and I believe they'll give you excellent advice on additional testing and treatment options. As someone already mentioned, I'd also recommend getting Dr. Patrick Walsh's Guide to Surviving Prostate Cancer Paperback – October 3, 2023. It's on Amazon and it's the best $20 I ever spent. It really helped educate me on some key points in my decision making. Best wishes to you and yours.

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Thanks for the comment, I ordered the book. How long does the procedure usually last?

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1 reply
Martin Jensen, Volunteer Mentor | @predictable | Sep 1 1:10pm
In reply to @oldoz "Thanks - Was your treatment at Mayo? My Dad died a 83 from cancer of the..." + (show)
@oldoz

Thanks - Was your treatment at Mayo?
My Dad died a 83 from cancer of the bladder and kidney. He waited to long for treatment and as I understand it the radiation just slowed it down until it spread everywhere. I mentioned that to my urologist as a family history and he discounted it because dad was a smoker, and I wasn't.

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My treatment was in Northern Virginia -- a hospital in Arlington for the first TURP, a walk-in surgery center nearby for the second TURP and the BCG treatments. The medical team is from Kaiser-Permanente Atlantic Region around Washington DC. Sorry about your father's plight from cancer. Last year, I developed two tumors in my colon that were removed surgically in a Mayo-collaborated hospital in Arlington along with most of my colon. This year my recovery and rehabilitation has been gradual but persistent, and I'm planning to bowl in a league that begins competition next week. Martin

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retireditguy | @retireditguy | Sep 1 1:13pm
In reply to @oldoz "Thanks for the comment, I ordered the book. How long does the procedure usually last?" + (show)
@oldoz

Thanks for the comment, I ordered the book. How long does the procedure usually last?

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@oldoz -- I'm not a medical professional, but I assume the NS RALP procedure duration depends on what they find during the surgery. I checked in early at Mayo (like 6:30am) and was discharged by mid-afternoon. I think the procedure itself was about 3 or 4 hours.

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grandpun | @grandpun | Sep 1 4:22pm
In reply to @heavyphil "Hey grandpun, Glad you are doing well. Curious as to why no radiation following surgery. I..." + (show)
@heavyphil

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!

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That seems to always be a good question - what's the next treatment once the PC is out?
And I didn't mention that besides the positive margins a spot of PC was found on one of my ribs. Therefore, the ADT had the body-wide action that arrested the PC with one treatment system.
And so far it has worked well.
Thanks for asking.

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heavyphil | @heavyphil | Sep 2 7:15am
In reply to @oldoz "Thanks for the response. I spent the morning reading the replies and then looking up the..." + (show)
@oldoz

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.

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If you never heard of a PSMA Pet scan, get outta Dodge and rent a room for a week near a GOOD medical center. Get tested and re-evaluated so you know what is REALLY going on - this is your LIFE here you’re talking about and ‘convenience’ cannot be a factor.
I drive over an hour in heavy traffic to get treatment - when I could have walked to the place near my home. True, you are a much greater distance than I am but you will not regret it.
However, you WILL regret not receiving the best care possible.

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1 reply
dbee | @dbee | Sep 2 7:59am

I hope the poster sees this comment. I have/had BPH and Gleason 6 (3+3) prostate cancer. My treatments have been handled by Mayo Clinic Rochester and my local urologist working together. I struggled with the decision of treating the BPH first, given that I might have to treat the prostate cancer later (50/50 chance). The Mayo Clinic made the decision crystal clear. They told me that they treat the BPH before the prostate surgery anyway as part of their best practices. So, I needed to get the BPH treated first.

I just finished TURP with my local urologist. Why TURP? In my case, a cystoscopy revealed that the median lobe of the prostate was causing the blockage, not the general narrowing of the prostate area. So, the urologist felt that a median lobe TURP would be the least invasive procedure. Given what he's seen with patients on complications from various prostate treatments, he felt pursuing the least invasive option was very important to preserve all future prostate cancer treatment options. Mayo felt this was a reasonable approach. Mayo felt Holep would still be okay as a treatment instead of TURP, but felt TURP was fine too.

HoLep takes more prostate material than TURP. My urologist felt taking that much material was overkill for my issue. He also performs aquablation, but didn't want to do aquablation because he said the water jets leave a rough surface and he would have to smooth it out with the same tool that is used in TURP. So, he felt TURP was the best option. I'm about 8 weeks from surgery and so far I'm fine. I researched the heck out of every BPH treatment. If I had to treat the whole prostate instead of just the median lobe, I probably would have done aquablation or HoLep. But for my situation, TURP seemed to be a very good choice. The urologist I chose had done thousands of TURP procedures as well. So, I felt that would reduce the odds of complications. The day I had my surgery done, he had 6 TURP procedures scheduled. I was the first.

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2 replies
oldoz | @oldoz | Sep 2 10:35am
In reply to @heavyphil "If you never heard of a PSMA Pet scan, get outta Dodge and rent a room..." + (show)
@heavyphil

If you never heard of a PSMA Pet scan, get outta Dodge and rent a room for a week near a GOOD medical center. Get tested and re-evaluated so you know what is REALLY going on - this is your LIFE here you’re talking about and ‘convenience’ cannot be a factor.
I drive over an hour in heavy traffic to get treatment - when I could have walked to the place near my home. True, you are a much greater distance than I am but you will not regret it.
However, you WILL regret not receiving the best care possible.

Jump to this post

I filled out a form to see someone at the Arizona Mayo Clinic and am waiting to hear back if I can get an appointment. You are correct, I asked my doctor about other tests and scans and he didn't explain, possibly the local hospital doesn't do some of this stuff. I am ready to travel.
Thanks.

REPLY
oldoz | @oldoz | Sep 2 10:51am
In reply to @dbee "I hope the poster sees this comment. I have/had BPH and Gleason 6 (3+3) prostate cancer...." + (show)
@dbee

I hope the poster sees this comment. I have/had BPH and Gleason 6 (3+3) prostate cancer. My treatments have been handled by Mayo Clinic Rochester and my local urologist working together. I struggled with the decision of treating the BPH first, given that I might have to treat the prostate cancer later (50/50 chance). The Mayo Clinic made the decision crystal clear. They told me that they treat the BPH before the prostate surgery anyway as part of their best practices. So, I needed to get the BPH treated first.

I just finished TURP with my local urologist. Why TURP? In my case, a cystoscopy revealed that the median lobe of the prostate was causing the blockage, not the general narrowing of the prostate area. So, the urologist felt that a median lobe TURP would be the least invasive procedure. Given what he's seen with patients on complications from various prostate treatments, he felt pursuing the least invasive option was very important to preserve all future prostate cancer treatment options. Mayo felt this was a reasonable approach. Mayo felt Holep would still be okay as a treatment instead of TURP, but felt TURP was fine too.

HoLep takes more prostate material than TURP. My urologist felt taking that much material was overkill for my issue. He also performs aquablation, but didn't want to do aquablation because he said the water jets leave a rough surface and he would have to smooth it out with the same tool that is used in TURP. So, he felt TURP was the best option. I'm about 8 weeks from surgery and so far I'm fine. I researched the heck out of every BPH treatment. If I had to treat the whole prostate instead of just the median lobe, I probably would have done aquablation or HoLep. But for my situation, TURP seemed to be a very good choice. The urologist I chose had done thousands of TURP procedures as well. So, I felt that would reduce the odds of complications. The day I had my surgery done, he had 6 TURP procedures scheduled. I was the first.

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Thanks. I'm trying to get an appointment at the Mayo Clinic. I appreciate what you are explaining to me about 'best practices'. It sounds like I may end up with the TURP anyway.
Although I would like to at least have confidence that it is being done by someone that has explained all options, done a lot of these, and has the latest equipment. I guess some of my concerns in addition to the cancer is getting caught in the repeat cycle of procedures, complications, scarring, more procedures, etc. I get there are no guarantees. Thanks again, I am getting great information on this site from all of the contributors!

REPLY
heavyphil | @heavyphil | Sep 2 12:59pm
In reply to @dbee "I hope the poster sees this comment. I have/had BPH and Gleason 6 (3+3) prostate cancer...." + (show)
@dbee

I hope the poster sees this comment. I have/had BPH and Gleason 6 (3+3) prostate cancer. My treatments have been handled by Mayo Clinic Rochester and my local urologist working together. I struggled with the decision of treating the BPH first, given that I might have to treat the prostate cancer later (50/50 chance). The Mayo Clinic made the decision crystal clear. They told me that they treat the BPH before the prostate surgery anyway as part of their best practices. So, I needed to get the BPH treated first.

I just finished TURP with my local urologist. Why TURP? In my case, a cystoscopy revealed that the median lobe of the prostate was causing the blockage, not the general narrowing of the prostate area. So, the urologist felt that a median lobe TURP would be the least invasive procedure. Given what he's seen with patients on complications from various prostate treatments, he felt pursuing the least invasive option was very important to preserve all future prostate cancer treatment options. Mayo felt this was a reasonable approach. Mayo felt Holep would still be okay as a treatment instead of TURP, but felt TURP was fine too.

HoLep takes more prostate material than TURP. My urologist felt taking that much material was overkill for my issue. He also performs aquablation, but didn't want to do aquablation because he said the water jets leave a rough surface and he would have to smooth it out with the same tool that is used in TURP. So, he felt TURP was the best option. I'm about 8 weeks from surgery and so far I'm fine. I researched the heck out of every BPH treatment. If I had to treat the whole prostate instead of just the median lobe, I probably would have done aquablation or HoLep. But for my situation, TURP seemed to be a very good choice. The urologist I chose had done thousands of TURP procedures as well. So, I felt that would reduce the odds of complications. The day I had my surgery done, he had 6 TURP procedures scheduled. I was the first.

Jump to this post

I too had a medial lobe issue about 10 yrs ago but mine was treated with a Green Light laser - the precursor to the Holmium which is far better.
There were two problems with this option: first, you can’t biopsy ablated/lasered tissue - it’s vaporized.
Also, when I was diagnosed with Gleason 4+3 about 5 yrs after this and asked the RO about brachytherapy, he said he couldn’t do it because I had a big hole in the middle of the gland and there was nowhere to put the seeds.
TURP definitely the way to go.

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southgeorgia | @southgeorgia | Sep 10 9:09pm

I would recommend asking about the HoLEP procedure. I had a similar issue of not being able to empty my bladder to the point it was getting extended and could have led to kidney issues. I went the HoLEP route and recovery was easy and I can go relieve myself like I was a teenager again!

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