If and when to have the HoLEP procedure?

I take Myrbetriq For urgency and don’t get up most nights at all anymore. I used to wake up two or three times at night and feel like I had to go when I knew I didn’t, Still end up getting up.

Gemtesa Also works similarly.

You could ask your doctor which one you could try out. Have your doctor mentioned these drugs to you?

What does your RO say about your prostate size and radiation? After radiation your prostate will shrink more but I doubt either HoLEP or the ADT/Radiation will reduce 4 to 0 (immediately after radiation it will be worse for a few weeks or months). The medications mentioned by Jeff work.

@jeffmarc I will certainly bring up these pharmaceuticals that you mentioned with my medical oncologist. I have a zoom meeting with him Tuesday. Thank you so much for your input.

@jim18 Excellent point…radiation can make your urinary issues worse during treatment - and even after.
HoLep is usually done to avoid those complications, such as urinary retention (and trips to the ER).
The Orgovyx will shrink the prostate ‘in total volume’ but may not shrink the hyperplastic cells causing the pressure on the urethra and your inability to void fully.
Phil

I'm 80 yo, 114cc prostate, 4+3 in two biopsy locations, benign in others in February 2026. Past MRIs have not identified any lesions.Did several (!) second opinion consults, watched too many videos, read several studies and decided to do PSAs in August and December and biopsy in January 2027 rather than pick a treatment option. My care team was supportive. Just had the August PSA and it was 4.67. Lowest since 2025 when it was also 4.6. I had a 5.0 and a 7.67 in between. I'm considering ho-lep at some point to reduce the size of my prostate which would make radiation therapies more of an option. Some I'm in the "If-and-When" Club as well. For now, watching and waiting. But mostly watching.

@tdgillett
Had a friend whose PSA was always around 50 but he had a huge prostate and no biopsy ever found anything. You may not have anything to worry about. An occasional biopsy would confirm there’s nothing going on. If you have pride, having problems with urination, then HoLEP can help.

@tdgillett many thanks for your thoughtful words.

I finished my SBRT about 6 weeks ago. I started on Orgovyx in Feb. with my prostate at 77 ml. I had a PAE at Mayo ,Mn on 3/27. When I started my SBRT on 6/18 my prostate had shrunk to 37 ml. Prior to SBRT my Urinary issues disappeared and I was totally impressed with my pee stream. Since SBRT my pee stream has weakened some and I am taking a flowmax every other day . My DR says I'm still healing and he expects it will normalize .
Not everyone does the PAE's but I believe its interchangeable with a HoLep. It was an easy recovery . Check it out as you weigh your options. Best of luck

Right about this time last year at age 75, I finally got where I could not pee at all. After a trip to the ER I was taught how to self catheter. I continued that until I could finally get HoLEP surgery scheduled on November 24th. The surgery successfully got my flow back, but the biopsy from the surgery showed aggressive prostate cancer. I’ve been treating that with orgovyx and Abiraterone since the first of the year and just completed 6 chemotherapy treatments with Docetaxel, As a result my PSA has gone down drastically. Back to the HoLEP, my flow has continued just fine but my pee frequency has held at about 3 times a night. I guess that’s because I still have an enlarged prostate. I know all of this doesn’t apply to your question but felt like you needed to get the big picture.

@rwells50 thank you for your summary!4