BPH - natural treatments vs TURP, open surgery

Good advice, thank you.

Have seen two uro's.  One recommended TURP last year, the other is more conservative and says to hold out on any  procedure as long as I can.  I did read that for very big prostates, TURP is a little riskier...and at 120 cc, mine is very large.

Flomax helps me urinate (normal flow) but I have zero libido.  I can't use Proscar because of strong family cancer incidence, and Proscar can cause aggressive cancer type is some men. 

I think I've taken over the last 6 months more saw palmetto than most men take in 20 years.  Same for maca, curcumin, pumpkin seed oil, zinc, sitosterols, and on and on it goes....

I've tried every "natural" supplement in the known universe.

I'll check out PAE.  And HoLEP.  I dread having to do an open prostatectomy for BPH.  I can see something that drastic for a high grade, local cancer, but for BPH?  But if it means 20 years of misery or major surgery, that becomes a difficult decision.

 

Wait you have a family history of prostate cancer? So the urologist just told you to do a TURP? Strange

Yes, Mark. I've seen two uros. They both have good reputations. One was a little aggressive and suggested TURP and not to wait. Yes, strong history of prostate cancer. Probably why I can't use Proscar to shrink it.

I'd almost prefer open prostatectomy to TURP. I hope for a way to avoid both.

Michael

Have you investigated some of the other procedures available to treat BPH? Many are far less  radical than TURP, and many have been reported as effective. Some men seem happy with their TURP, while others advise to avoid it at all costs. Good luck with whatever you decide. 

Mark  Just because you have a family history of prostate cancer does not mean you would get it.  That was wrong for him to tell you that  Ken

Michael do you have prostate cancer.  If you do There are other ways to take care of it.  And most of the cancers are slow growing.  You could have 10 to 15 years.  Why cause a problem.  There are other meds and procedure to shrink the prostate  Don't let them push you into anything.  Remember you are the one that will have to deal with the side effects.  Not them  Ken

Ken,

Based on 2015 biopsy and recent MP-MRI that showed nothing suspicious, it's not likely I have cancer.

MP-MRI 3T is more accurate than biopsy when both show negative results.

I have family history of PCa. That's probably why I can't use Proscar to shrink the prostate. That would relieve some symptoms. But some guys run the risk of Gleason 8 and higher cancer from Proscar.

Seems like everything with the prostate is a percentage game.

Michael

Yes it is.  So take one step at a time  Ken

wow, thanks James.  Will definitely research HoLEP further.

I literally cringe when thinking about TURP and the thought of a week in the hospital and a week or longer with a catheter following open surgery is equally distressful.

Seems like decisions for BPH are harder than for cancer. If a man has a localized cancer, even aggressive like Gleason 9 or 10, then open prostatectomy sounds like an absolute lifesaver.  But for BPH?  Maybe too drastic.  I wonder though if a surgeon can cut out 40-60 cc and leave me with a smaller prostate, it might be worth it.

Going to research HoLEP.  Is that the same as "GreenLight"?

 

Not the same and believe from posts here Greenlight not near as pleasant an experience. The major thing to look for with HoLEP is a surgeon with pleanty of experience in performing this procedure as it requires this and that is why not many Urologists offer it. Best that he/she has done it hundreds of times so ask and this is a question you should ask always for any procedure.

Remember only failures tend to post of their experiences. I had GL in 2004 and would sooner have another than have a tooth out,,, and less bleeding from the GL!  The hospital who did my GL switched on a split decision to HoLep in 2013

The later Thulium/Holmium laser procedure I had when my prostate regrew was also no great problem but more blood as I am on Warfarin that I stopped for two days.

 

I think if the symptoms are bad and the surgical outcome promises to be positive enough it makes sense to undergo whatever procedure seems appropriate to the situation. I think doctors  sometimes get it wrong, however. That's why so many men have urged caution before agreeing to surgery and after making the decision, then selecting a competent doctor. Remember, 50% of the physicians out there finished in the bottom half of their class.

Our NHS urologists seem better than your ones. However the hospital where mine was done was doing GL as a trial with four Uro's doing it. I was patient no 38 but only the eighth of the one doing it and I was confident of his ability. The same applied to two friends who had theirs done just before me under similar circumstances at two other hospitals.

I'm the only one who has needed a rebore.

We all had to travel to get it done as our local uro's were still only doing TURP. 

I met one of the two original Uros doing it in the UK years later and he said that initially they thought it was an easy procedure but later realised that more care was needed.

The latest version of GL (XPS)  is now the preferred option from The National Institute for Health and Care Excellence (NICE) to hospitals.  

I met with one uro surgeon - I won't mention his name but he is recognizable as one of the best in the US - and he was very conservative, advising me to hold off surgery (open prostatectomy) for as long as I could. He did mention HoLEP but is still very conservative, which I appreciate. I know he is a top surgeon and if my biopsy showed a Gleason 9 tumor confined to the prostate, I would not hesitate at all to have him take out the prostate. Of course, w/ BPH there is no such urgency - well, unless the kidneys are affected. This forum has introduced me to things I had never heard of before (PAE) and I have read far and wide w.r.t. prostate cancer and BPH treatments. I appreciate the caution offered by the men here.  There's a lot of wisdom and life experience a guy can glean on this forum.

Michael

Does GL mean Green Light?  Are you aware of any studies that report how long it takes for the prostate to regrow?  For example, does TURP have to be redone in 5, 10, 15 years, HoLEP in 5, Green Light in ____ years, etc., etc.?  

Wouldn't the time a given procedure can buy you factor into the decision process (along w/ complications such as ED, incontinence risks)?  A man in his late 50s might make a different choice than a man in his late 70s.

Also, are there certain procedures that if done and fail rule out other options down the road?

Thanks,

Michael

It depends on the individual prostate as some grow like a weed.

I had my Green Light PVP in June 2004 on my 75 gram prostate. When I had the Thulium/Holmium laser one in 2013 my prostate was 135 grams.

Two friends who also had the procedure  in 2004 have not needed a second one.. yet. 

Total surgical removal is the only way not to need it done again but what life would tou have after that?

If Icould turn the clock back the best option now seems to be PAE.