Median Lobe Problem - Rezum and Fexapotide

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After 20 years with increasing BPH symptoms I had 4 pairs of Urolift clips placed 8 months ago. As a result I have had some relief. But the surgeon mentioned that I have a “long” prostate which later I learned he meant a long median lobe. The clips do not help much with the restriction of the median lobe on the bladder neck so I still have occasional bouts when it acts as a “ball valve” that infuriatingly blocks my flow, especially at night or if I have had to “hold back” too long.

The Uro now is talking about a TURP, but to me that is a barbaric procedure and I even doubt they can cut close enough to the problem area of the bladder neck without harming the sphincter. On the other hand I have read that the Rezum procedure can be quite specific and guided into the median lobe, successfully reducing the bladder neck blockage.

What do you guys think of going in the direction of a limited Rezum since the Urolift seems to have done the job with the other parts of the prostate?

Secondly, I am enthusiastic about Fexapotide or Topsalysis. As I understand it these proteins target only prostate cells and cause the gland to shrink with apoptosis. I wonder if a targeted injection into the top of the median lobe would reduce the “ball valve” effect without harming the bladder neck’s sphincter cells???

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  • Posted

    call dr mcvary and ask him its possible and see what he recommends. he is the god of rezum. he also had been an early urolift tester.

    he will tell you what he recommends and if he can do it and your insurance pays for it go to him in chicago.

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  • Posted

    I wish I had done more research before agreeing to a TURP. I would never had done it and would have looked at other options. That being said, I had a great surgeon and it does relieve your BPH symptoms. But I waited too long to do and the retention messed up my bladder. The TURP also destroyed my sex life. Everyone is different so you may do fine with a TURP. I would try less evasive options because you can always do a TURP later in life. Good luck with your decision.

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  • Posted

    Look into MedLift also, it's Urolift for median lobe. A urologist that does Urolift needs to be trained for it. Had it done 5 months ago, sometimes pee pretty good, other times so-so, but I'm off the meds and only do CIC once every 3-4 days so for now I'm satisfied with the results. No ED or RE. Things would probably be better if my bladder wasn't stretched out from BPH.

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  • Posted

    Was interested in your reference to Topsalysin and did a little bit of digging. It is currently in Phase 3 trials principally for the treatment of prostate cancer but they are also looking at possible benefits for those suffering from BPH.

    It is described as a pro-drug that is turned into a potent anti-cancer agent by the action of an enzyme (in this case PSA - prostate specific antigen which would be expected in high levels in patients with prostate cancer)

    However for those suffering BPH symptoms it is often the case that their PSA levels are relatively low due to the benign nature of the prostate enlargement. In my mind that raises the question of whether this type of pro-drug therapy would be effective in cases where PSA levels are and remain relatively low.

    Will do a bit more investigation

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    • Posted

      Arlowood, thanks for picking up on that. My thought is to be killing two birds with one stone. My PSA is quite high which worries every Uro I have dealt with. At 15.1 they all assume I have CA and have put me through 3 biopsies, DREs, and an MRI without discovering anything. (I do have a large gland so the PSA density is not very high.) That said I am not fully convinced that there does NOT lurk CA somewhere that they can not find. So... if this "magic bullet" can both reduce my gland size AND stifle any occult CA this would be awesome.

      I have tried to attach a graph of my PSA over a 10 year period. Hopefully you can see by the trendline that it is essentially a linear progression which is indicative of BPH and not CA.

      image

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  • Posted

    To my knowledge Topsalysis is only experimental right now. Am I wrong?

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    • Posted

      You are correct. But I am sure something like it is going to be the eventual answer because most of the procedures that involve removing tissue are barbaric in my eyes and everyone I have spoken to who have been TURPed or zapped have had sexual degradation (although they shrug and say "at least I can pee better now". ) Plus recovery is not easy.

      I was very disappointed when my urolift surgeon started talking about doing a TURP. I thought he understood my repulsion for it. Sigh. I have Medicare Senior Advantage with Kaiser San Diego which does not have the Rezum equipment. I am thinking I may have to quit Kaiser and join a different group that does Rezum since the injections are not yet available. I will ask him about the Medi-lift. Thanks everyone.

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    • Posted

      DrDavidB,

      .

      So Kaiser does not do Rezum in California yet? I was told by NxThera over a year ago, that Kaiser was evaluating Rezum in California. In Washington State, Kaiser decided not to do Rezum. I ended up on having a Rezum done in Colorado outside of Kaiser and paid out-of-pocket as Kaiser does not do Rezum here either. They only do TURP here. There is a good chance that I will be leaving Kaiser too...

      .

      Steve

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  • Posted

    The median lobe is a cone-shaped portion of the gland situated between the two ejaculatory ducts and the urethra.Large prostate size, median lobes, and prior benign prostatic hyperplasia surgery may pose technical challenges.so contact the doctor and ask the possible way.

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  • Posted

    I had a TURP in February and am 100% satisfied with the results. I also had a large median lobe and experienced the same "ball valve" issue if I waited too long to void. That issue has been totally eliminated and I no longer panic if I feel the urge and am not near a bathroom. YMMV.

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  • Posted

    I had rezum 6 weeks ago for what was diagnosed as an enlarged prostate with a large median lobe by my regular urologist. I was told it was one of the few minimally invasive procedures that deal with a large median lobe, and has virtually no sexual side-effects. Not sure how it works in conjunction with Urolift, but I can't see why it wouldn't. They'd just inject steam into the medium lobe and in time the tissue dies and is absorbed by the body.. Turns out I didn't have a large median lobe, but after 6 weeks I'm off all BPH Meds and doing great. I'd look into it if you can find an experienced doctor.. I was Dr Levin's 199th procedure..

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