Going for Tulsa Pro
I've posted here a few times over the last year and have read most of the posts from others. I was diagnosed in January 2024 through an ultrasound biopsy (it should have been MRI guided), followed by a PSA test CT scan, MRI, and Decipher test. My cancer is not aggressive, but there are three growths in my prostate. My doctors recommended a full ablation, and I’ve decided to go with the Tulsa Procedure at UCLA with Dr. Steven Raman.
I’ve waited until now because I believe Medicare will begin covering the procedure on the 1st. of 2025. Earlier this year, I switched from a Medicare HMO plan (Blue Shield) to Original Medicare with a supplemental plan, where Medicare covers 80% and the supplemental plan pays the remaining 20%. It’s been incredibly difficult to determine whether Medicare will actually cover the procedure, as I’ve received conflicting information. However, I think they will.
I considered going back to an HMO with United Health Plans, which includes UCLA physicians as in-network, but no one could guarantee that they’d cover the procedure either.
Anyway, I thought I’d document this journey. It begins on January 5th, when I’ll check into an Airbnb hotel near the procedure location. This is two days before the procedure. I’ll have to fast those 2 days and completely empty my stomach (I’ll spare you the details). In the best-case scenario, I’ll wake up with a catheter and a “burned out” prostate. I’ll need to wear the catheter for at least two weeks. Hopefully, they'll get it all 🙂
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Question for the guys who have already had the procedure. On Tuesday I'll be 4 weeks post procedure and 3 weeks post catheter removal. I'm wondering if my recovery to this point is typical. My urine stream is better than right after catheter removal but not as good as pre-procedure. I'm still getting a splash of blood when I first start my stream, but it clears up with a second or two. The last bit of voiding slows to a dribble/drips. I'm taking .4mg flowmax and 1mg Terazosin twice a day. I experimented with 2 does of Flomax a day but it didn't seem to make much of a difference. I feel like I've reached a plateaue. If it is getting better, it's so slow that it's not noticeable. I'm a little paranoid given the fact that they used a malfunctioning Tulsa probe at first then removed it and inserted a functioning one. I'm worried that either they may have ablated an area of my prostate that they didn't intend to ablate and/or caused extra trauma due to having to insert 2 probes. Anyway, very interested in hearing about your recoveries. I realize we are all different but still would like to hear from you. I haven't found much online.
It's been 2 weeks today post procedure and 1 week post catheter removal. No observable tissue and little to no blood in urine. Flow has greatly increased but still less than pre-procedure. My fear was that I would be fully obstructed and end up in the emergency room, but thankfully that never happened. I hope our posts here help alleviate apprehension and fear of future Tulsa Procedure patients. If I had seen these posts before my procedure, I would have been better prepared to anticipate the stages of recovery. The good news is, that less than two weeks out, I was feeling much better, and now I'm 90% back to normal. No pain, 80% flow.
My apologies, I just saw your post. I have been approved now for the procedure and met with the doctor Ram Pathak, M.D. I asked if I wanted to schedule how soon they could do the procedure, he said like 3 weeks. They may have more scheduled now that it is a covered procedure. I had to do a ct pelvis scan to rule out calcium deposits, he said if there is any that he cannot do the Tulsa, I just finished the scan and it is clear. I am on a diet, I am overweight, so losing some weight before the procedure so that recovery will be easier, I will be scheduling soon. I really love mayo, there has been no other hospital better. They value you, and value your time, they spend all the time with you that you need and answer all questions so that I understand. Let me know if I can answer any more questions, please contact me.
I had Tulsa at Mayo in July. PSA every 3 months & MRI every 6 months for a 2 year period. Biopsy at 18 months or 2 years. I have not asked what the protocol is after that. I am happy with that schedule as I know if anything crops up they will be on top of it. No side effects and procedure was a breeze.
I am the 80 year old that had this procedure done in April '24 and a follow up MRI in December at Mayo in JAX. The above post appears to have had similar experience with the cath and lack of many side effects or pain. My priorities might have been different due to being older than most here, but I am very pleased with the results so far. The bedroom and bathroom issues have been minimal and I return this weekend for a follow up next week and will report the results.
Note that Tulsa has the ability to do a full ablation of the prostate. We talked about full ablation or just the tumors. I thought we had decided to just do the tumors but we went back and forth, ultimately I think I told the Doctor to do whatever he thought was in my best interest just before going under. I chose Tulsa because of the good odds of not having major life changing side effects. Everyone has to decide on their own, but I'm glad I went with the Tulsa Procedure. All bodily functions I've been able to test are working so far. Still have one to try out but have to wait a few weeks on that. Glad that I don't have urinary or fecal inconvenience issues which is a huge relief. They are very uncommon with Tulsa but not so uncommon with some other procedures. AI answered a lot of my questions along with my own research. Oh, and I just set an appointment for a follow up MRI in 6 weeks.
Thank you for the detailed updates and congrats on getting through what I hope is the worst of it for you. Passing ablated prostate tissue sounds ghastly.
I am trying to evaluate treatments that may be appropriate for me down the road, and one thing that I want to factor into the equation is the fact that any treatment that leaves prostate tissue behind will most likely necessitate the need for ongoing biopsies. Obviously tolerable, but still a consideration in the evaluation process. Good luck as you recuperate and know that you are providing a real and valuable service to others.
I'm sure others will chime in, and I really don't know the full answer to your questions. I just had my procedure done less than 2 weeks ago. If you read my posts, you'll know that my procedure didn't go exactly as planned because of a malfunction of the Tulsa probe. Luck of the draw I guess. They did have a backup probe and it worked fine, so they were able to complete the procedure. One thing that doesn't get discussed much is the recovery after the procedure. The catheter isn't a lot of fun, more of a nuisance than anything and a little painful especially at the tip. Consider purchasing a pair of pants made for holding a catheter bag, and wearing them for the day of your procedure. I wore jeans and that was a big mistake. You'll wear the pants if you go out of the house. While I was inside, I just wore a pair of PJ bottoms. I cut a slit in the side of the leg a little above the knee. The bag had a hook on it for hanging, so I hung it on the outside of the PJs at the bottom of the slit. This worked great, but I live alone and no one else had to see it. One good thing is, I got to sleep through the night with the catheter since I didn't have to get up to pee, I'm normally up at least 2 times and often more. One week after the procedure to the day, I drove myself 2 hours to see the Urologist's nurse who pulled out the catheter. Prior to that though, they do a little test. She said, "we're going to fill your bladder, then make sure you can pee it out". I'm thinking, ok, I have to drink a bunch of water, Nope. She takes these BIG syringes, fills them with water, disconnects the bag from the catheter while leaving the rest of the catheter in place. Then she squirts the water through the catheter directly into your bladder. Not bad at all, until it's really full, which is the goal. I think she must have put 20 gallons into me (slight exaggeration ;-).
Then she asks if I'm ready to remove the catheter, I say yep. On 3, 1,2,THREE! It's out in a flash, and it hurts, but the pain subsides back close to zero in a couple seconds. Then she says for me to pee in a container while she leaves. I did, and it was NOT easy. Only got a little out, but she must have taken some out too, because she said it was perfect. Then she did an ultra sound of my bladder to see how much liquid was left, there was none, I passed. The next 4 days were the worst. I didn't have any incontinence but urinating was next to impossible. It hurt like hell and literally just a very small trickle at first turning to drips after. It took an eternity to empty my bladder (ok 3 to 5 mins, but it felt like forever). You'll be prescribed AZO for bladder and urinary tract pain, take it. Turns your pee yellow. Take your Flomax (Tamsulosin). In my case, my flow started with pain and a spurt of blood and sometimes tissue fragments. Sometimes I thought I wasn't going to be able to void, but I did and I still am. The first 3 days after removal were rough, but it's been better since. It has not been linear improvement, there have been minor setbacks. I really don't know what's going on in there but I suspect that what's left of my prostate is swollen and impinging on my urethra, add to that the small pieces of ablated tissue that found it's way out of my prostate into my urethra AND the blood that is probably trying clot and you end up with almost (but not entirely) a complete blockage. The body is trying to sort it all out. Today is day 12 post procedure and day 5 post catheter removal. Pain while urinating has dropped from an 8 to a 2 to 3. Flow has increased from a dribble to a stream that is about 1/4 of what I had before the procedure, AND I'm happy about it because it's improved a lot and I could live with it the way it is, but still hopeful that it will continue to improve.
Now, to answer your question. My next appointment with the Urologist is in 3 months for a follow up. I don't know what's in store for me. I had two Doctors, the one who did the procedure and the Urologist who does the follow up. The procedure doctor said that there will regular PSA level tests, MRI'S AND biopsies. Not looking forward to the latter 🙁
I'm glad you're finding these posts helpful. I'm posting these details because I could find specifics online. Would I do it again? I hope I won't have to, but for me, the alternatives are scary. If you have any questions, post here and I'll try to answer. Best of luck 🙂
Really appreciate you guys reporting on your procedures. It is super helpful! When you get a chance, I'd be interested in what your long-term follow-up protocols are? Will you be having scheduled biopsies regardless of PSA readings? How frequent will your follow-up visits be...if you know?
It's a little better today, and I think you're right. I haven't had any tissue large enough that it had to be pulled out, but there is always a little spurt of blood followed by small pieces of tissue.