← Return to radical prostatectomy after partial HOLEP - is it possible?

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@heavyphil

Yes, but for different reasons. The HOLEP, to my understanding, does not remove the capsule which could be intact or broken, thereby releasing cancerous cells. You need to have that addressed.
Also, if you go the HOLEP route, the remaining prostate tissue is cancerous and must be removed by “morcellating” it, which is the grinding up and suctioning out of tissue - NOT a good idea! In fact, you do not mention when this G3+4 was discovered. If they analyzed ground up bits of gland from the procedure and found them to be cancerous that could be an issue. HOLEP guidelines say to tell your doctor if you have/had prostate cancer (not your job - they should know!).
Morcellation should only be used when no cancer is present. So please do not pursue this option!
First, you need a PSMA to see if there is any spread. Ben’s suggestion for MRIdian is excellent if the disease is still confined to the gland and capsule is intact; you may also consider surgical removal where lymph glands can be analyzed for spread.
Depending on what is found you may need radiation as well. G3+4 in itself is not super bad but if it got out of the gland due to your HOLEP it will need to be treated peripherally as well.
I tell you this because I had Green Light Laser - which uses no morellation - and never had a biopsy first. My PSA was not terribly high and my DRE was completely normal. However, a few years later when my Biopsy revealed G4+3 unfavorable my surgeon said I probably SHOULD have had a biopsy in lieu of the laser surgery (different doc) since the cancer was probably there already and only got worse even though my urination improved greatly after the procedure.
So please get as much info as you can and consult with different docs - surgeons, radiation oncologists - before you move forward. Best
Phil

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Replies to "Yes, but for different reasons. The HOLEP, to my understanding, does not remove the capsule which..."

I had the HOLEP in July, 2024 because I was unable to urinate after a hernia operation in May, 2024. The HOLEP removed the central core of my prostate which left 30 to 40 % of my prostate intact. I had an MRI in December with the following results:
Prostate has been assessed using ACR’s PI-RADS version 2.1.
PI-RADS category 4 suspicious mass, right posterior lateral basilar peripheral zone.
I will get a biopsy on March 12th.
I do not know if morellation was used during my HOLEP. After the operation, I had a catheter in for 9 days. I finally went to the emergency room to have it removed because it had gotten plugged up and I was urinating around the catheter. After the removal, I urinated and a cross section of my prostate came out. This is what was blocking the catheter. I asked my urologist if I this was a concern that a portion of my prostate which was cancerous was in my bladder for that period of time, and he said that it was not a concern. Do members here believe that I should be concerned about this and have an MRI done on my bladder?