Robotic Simple Prostateomy for BPH?

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Hello everyone,

I am new to this thread and have read many of your posts. I do need your advise for my problem. Thank you very much. Here's a quick summary of my BPH journey.

I am 67 and have had BPH for 20 years. I've had 3 biopsies over the years, the most recent was 2011. All were negative. I've been on an alpha blocker for 10 years and was on Proscar for 5 years and am now on Avodart since 2011. Last fall I had 2 "liquid biopsies", one was the MiPS urine test and the other was the Apifiny blood test that looks for autoantibodies to PCa. Both tests were extremely low for PCa risk so I can say that I am hopefully clear.

During the past 15 years my PSA has fluctuated between 4 and 15. Currently it is about 11. In 2011 my prostate size was measured at 150 gm. My urologist here in Ontario will only offer me Turp or an open prostatectomy.

My symptoms are the usual ones . A few weeks ago I travelled to another clinic to measure my prostate size (TRUS) and was surprised it had grown to 280gms. The bladder and kidneys still looked ok but showing the usual signs of stress. (My own uro here just yells at me when I suggest alternative solutions or diagnostics).

The uro who measured my prostate a few weeks ago said there was a large median lobe. He does robotic simple prostatectomies (SP) and offered me that. But last week I had the opportunity to see another local uro who also does robotic prostate procedures. He did a cystoscopy on me ( my first ) and said I had NO median lobe and would not benefit from a robotic SP. He said my prostate was very long and extended along the urethra in the transitional zone region. He said my bladder looked ok. It was interesting to watch it all.

So this urologist gave me a referral to another uro who does GLL. But this procedures worries me as I have read terrible accounts of its side effects on large prostates ( over 100gm ) due to extensive heating of the surrounding tissue due to the long procedure time.

I did contact Dr. Gat in Israel a few months ago about doing his procedure but he said the largest prostate he has done was 200gm. At the time I thought I had a large median lobe obstructing the bladder neck so he declined me. He also said it could take over a year for me to benefit from his procedure and I needed something sooner. I guess it saved me a lot of money but I have read his papers and the personal stories here and believe in it.

I also wonder about the PAE procedure. I have read some of the accounts here that seem promising. Maybe a 30% volume reduction for a very extended prostate would really help me? I don't know.

I've also looked into HoLEP but the potential for a dramatic reduction of quality of life is very scary for me. I also read about REZUM but it seems to be for smaller prostates. But maybe I could benefit from this procedure given the extended nature of my prostate? It seems that for a given prostate mass there are many different geometries and maybe some of these shapes are not disqualified while others are disqualified from certain procedures?

So now I don't know how to proceed and am very confused. The Holep surgeon I spoke to said it was "criminal" of my own uro to consider Turp on such a large prostate as I would be in surgery every 6 months. But another doctor told me that I am much too big for Holep as well and they would have to open up my abdomen to remove the enucleated tissue. And so on and so on.

This forum has so many smart people - can anyone offer any suggestions? I know I am sitting on a ticking time bomb and need to do something but don't want to jump at some procedure that could leave me with a worst problem for the rest of my life.

One last point: last summer I had an asthma attack and was given a 5 day supply of prednisone tablets (50mg). It was unbelievable! After 3 days I started peeing like I did in my 20s. I even set up a target 10 feet away and could hit it! All my BPH symptoms disappeared for a week - I never felt so good! I know steroids are very dangerous and are not the answer but it did demonstrate the inflammatory nature of this disease.

Thank you very much for reading this and any advise you offer me. I wish you all the best with all your own issues.

 

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  • Posted

    Hi Neil,

    Sorry to read of your troubles. I'm afraid I cannot offer much advice, other than to say I had the HoLEP procedure about 20 months ago. For me, the only 'side-effect' was retrograde ejectulation. My potency otherwise is OK. And my urine flow is much better.

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  • Posted

    I have not had a turp, but I have heard from many that it frequently causes retrograde ejaculation, and can cause impotence, and incontinence (uncontrolled peeing, or leakage ). There are several ways to do a turp using open surgery (cutting in from the outside ), inserting a probe up through your urethra (the tube in your penis that carries urine or semen), and then cutting or killing parts of your prostate either with a small roto rooter type cutter, burning it out with heat, a laser, or freezing it out with liquid nitrogen. All of those methods can cause any and all of the side effects mentioned above.

    A Urolift uses a small device which is inserted through the urethra, and then through one side or the other of your prostate. I leaves a piece inside your prostate connected through the wall of your prostate, to a piece outside your prostate, by a short string which are pulled tightly together, opening the urethra, and improving urine flow. These clips are installed in pairs. Other than some pain / bleeding for a few days or weeks after the procedure, there don't seem to be any side effects from the Urolift.

    All of the above procedures are done by urologists. The PAE is done by an interventional radiologist, so it will never be recommended by a urologist because they make no money from it.

    A PAE is done by threading a small tube through your arterys to your prostate, then releasing some small beads there which diminishes the blood supply to the prostate causing it to shrink with no side effects, and usually with improved urine flow. You can get a turp after a urolift or a PAE if you are not satisfied with the results. Look up PAE on the web.

    I hope this helps,

    ***

    As someone else reported, there are several. Your doctor can list. That's the good news.

    Bad news. They all have bad side effects, all have several from the following list: Impotence, incontinence, retrograde ejaculation (you ejaculate into your bladder instead of out the end of your penis, it also can become difficult or impossible for you to ejaculate, and, last but not least, they can make you grow breasts. I know his sounds awful, but I am not kidding. Look on the Web for each of these drugs before you take any of them!

    There other solutions. Your urologist will gladly recommend a TURP (tran Usurinary Prostectomy) in one of several possible flavors including surgery, microsurgery,lasers of different colors, freezing, microwaves, or heating. They also have many of the side effects listed above, in relatively high percentages. They also involve the joys of wearing a catheter for weeks. They will be the most miserable weeks of your life.

    So what's to do? There are two recent procedures. They none of the side effects listed above.

    The first is done by a urologist, who puts small clips between the inside and outside of the prostate, squeezing the sides slightly, and allowing urine to flow through the urethra. This may require a catheter for a few days, but the results are good, and the procedure is MUCH less invasive than the TURP procedures listed above.

    The other new procedure is called Prostate Artery Embolizm (PAE ). In this procedure, an interventional radiologist (NOT A UROLOGIST ) enters an artery in your wrist and threads a special kind of catheter down to your prostate. Once there, microbeads are released that block two of the arteries supplying blood to the prostate, causing it to shrink, improving urine flow dramatically, and many also report a better sex life. A urologist will NEVER recommend a PAE because they make no money on it.

    By coincidence, I just had a PAE today done by Dr. Ari Isaacson at UNC. I have a needle hole in my right arm, standard in any surgery, and a slightly larger hole in my left arm that I will have to keep dressed for a few days. NO CATHETER!

    I strongly recommend that you research these procedures on the Web extensively before you decide on any, and join and participate in a blog or two on the subject.

    Neal

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    • Posted

      Neal I thank you for putting everything out there for alot of the men to see what the procedures do.  There are some men jthat ust take there doctors word on what he thinks they need and don't look into any of the procedure side effect and when something happen they are shocked but once something is done there is no going back.  Most doctors tell you what procedure you need and tell you what they feel you need to hear and that everything will be the same and it no big deal.  I have also heard that some doctor will tell a patient that at your age sex should not matter.  At 60 I may not have it as offen but still enjoy it all and don't want to lose the feeling.  Information is the key to anything that you do.  There are so many new procedure out there that will do the same as the older ones and they have less side effects and less down time.  I thank you again.  Ken 
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    • Posted

      Thanks Neal for this info. How  are you doing today? Did you have to travel to UNC? I could travel  to UNC also. Do you think Dr. Isaacson would consider a 300gm prostate? There is no median lobe. The whole thing is stretched out along the urethra in the transitional zone. What was the size of your prostate and your symptoms? Are you taking drugs like Avodart/Flomax? I wish you all the best and thanks again for educating me.  
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    • Posted

      Hi Neil,

      I did travel to UNC for the procedure. It was done by Dr Isaacson. You will never find a better, more responsive doctor. For example, you asked whether he would consider doing your very large prostate, and how I am doing now. I am about 6 months post op. I have some complicating factors, including very small arteries on one side. I have had mixed results, but we expected that.

      People with large prostates generally do BETTER than those with small ones. Mine was 80. I was waking to urinate 8-10 times per night. Now I'm at 3-4 times per night. I'm seeing a radiologist next week to get an MRI so we can decide what's next. If you look Dr Isaacson at UNC up on the web, you will get his phone number. Call him and he will call you back in a VERY short time, and you can ask him about your prostate.

      I don't take any of those meds. They have awful side effects.

      Neal

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    • Posted

      Hi Kenneth

      You're very welcome. Sometime, I expect you will be able to help others with information that you can share. That's what these blogs are all about.

      Neal

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    • Posted

      I had no reaction to the contrast other than a warm sensation. It was not bad at all, and was over quickly. That said, some people do react to that dye, including my wife who, obviously had it for a different kind of MRI. The radiologists usually are prepared for the reaction, and this radiologist was. They gave her a medication, and she had to rest in the radiology department for a while. It was not too bad. Now she knows that she reacts too it, and can tell radiologists about it for future MRIs. There is medication to take before the procedure that helps a lot. Some people, of course, rarely do have serious reactions, so be sure that you have it at a reputable place.

      Neal

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    • Posted

      Hi Neal - guess what? I had a most outstanding phone conversation today with Dr. Isaacson after sending him all my medical records yesterday. He was everything you said times ten! So I am going to schedule the PAE procedure for mid August. After years of putting off operations, and seeing my rpostate grow to 300 gms I am finally pulling the trigger to do something while I still have time. Thank you my friend and to my new band of brothers on this forum.
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    • Posted

      Hi 

      Can you share how big your prostate was before surgery. I contacted Dr. Isaacson's office and their literature says 20-40% decrease in size. Also do you know if there is any regrowth after a period of time?

      thanks so much and good luck.

      I have a 191cc or 190 gram prostate and am considering robotic surgery in Dallas Texas as another option.

      spr

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    • Posted

      Hi Spr,

      Apparently, my prostate was 80 cc before the procedure. There can be some regrowth. That said, the procedure is so benign, with very few if any post op side effects, that you can easily get it again if you need it, and if that isn't thrilling enough for you, you can always get a Urolift, turp, laser, heat or freezing later if you really want it.

      Generally, people with larger prostates,like yours, have better results than those with smaller ones.

      Neal

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    • Posted

      Hello ..  How long ago did you have the procedure being that they only the center lobe and left the prostate alone did you experience retro.  ????   Ken 
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    • Posted

      I'm sorry they had to do that to you. With them taking the whole prostate I know you end up with retro.  I was just trying to find out with the simple prostateomy do you end up with retro being they only take the center lobe.  Have  good day  Ken

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    • Posted

      Hi Neal,

      Did your MRI show any evidence of necrosis yet or other changes to your prostate? I now have my procedure scheduled with Dr. Issacson for Aug. 9 and will fly in the night before from Toronto. The cost is $6500. up front cash since I am from outside the US. He said I can watch the whole thing so it depends if my curiosity exceeds my tolerance for pain/discomfort.

      One thing (among many) I really like about Dr. Isaacson is his good relationship with the urologists at UNC. I've asked him a few urology questions and he went and asked the urologists at UNC and got back to me. Thanks again.

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    • Posted

      I'm sorry, I was unclear.

      The PAE I had TREATED, and presumably shrunk my whole prostate. It doesn't remove the prostate.

      Sorry for the confusion.

      Neal

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    • Posted

      Please keep in touch and let me know how it goes. I was 99% asleep during mine, and felt nothing.

      Dr Isaacson is great! He is available and caring.

      Neal

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