Prostate Cancer after Biopsy-want to do HoLep

Papalewder
Papalewder CSN Member Posts: 1 *
in Prostate Cancer #1

Hi. So last year I got diagnosed with Prostate Cancer 11 cores negative, 1 with 5%. My PSA has held steady at 4.9 for several months. My new urologist is suggesting a HoLep to shrink prostate so I can pee easier. However, I had an MRI and he'd like to do an MRI first. If the cancer as grown, his idea is to remove it and solve the cancer/peeing issue at the same time. I'm debating the second Biopsy as it took me months to recover from the first one. That was a Rectal, this new one would be a Transperinial(?). Not sure if there is really any difference, but I don't want it because of the recovery. He's not saying not to do the Biopsy now, he's saying if we find the cancer advancing in the future, we'll have to remove it anyway as Radiation is out due to the pain from the first biopsy(I prefer no radiation anyway). Would anyone have any advice for me? I'm 57. My father had it, his brother and his nephew. So it runs in our family. Thanks!

Comments

  • Marlon
    Marlon CSN Member Posts: 185 Member
    #2

    So you're saying there was no cancer found with first biopsy? I assume nothing identified by digital exam. So your main issue is peeing with an enlarged prostate. Did you try Flowmax and that doesnt help? Remember that PSA is not a measure just of cancer, it's a measure of overall prostate tissue, so an enlarged prostate would cause a higher than normal PSA by itself (mine did).

    I would think any doctor (and insurance company) would require a biopsy before any surgery or radiation. They have to know what they are targeting. So I'm sympathetic to your concerns, but I'm not sure there's any other option. A wait and see option doesn't sound like a good idea either.

    I had a trans-rectal and it seems to me the trans-perineal is just the same (bunch of needles into the prostate), just with a less potential for infection. Maybe someone else will comment.

  • Marlon
    Marlon CSN Member Posts: 185 Member
    #3
  • Old Salt
    Old Salt CSN Member Posts: 1,673 Member
    #4

    To me, there seem to be inconsistencies in the above post.

    Your urologist is suggesting a HOLEP to remove part of your prostate so you can urinate better. I don't think another biopsy is part of the procedure, but you will end up with a catheter for a day or so. Also, why a second MRI? You wrote you had one, or is that a mistake?

    More in general, a peritoneal biopsy is considered to be superior over a transrectal one because the chance of infection is lower.

    It would be good to know if the HOLEP would remove the bit of cancer that was found earlier.

    Finally, the step from a HOLEP to complete removal is a big one that should not be underestimated with respect to the recovery and longer-term side effects.

  • centralPA
    centralPA CSN Member Posts: 422 Member
    #5
    https://csn.cancer.org/discussion/329614/prostate-cancer-after-biopsy-want-to-do-holep

    Hey, questions…

    1. How big is your prostate? That info is on the MRI report.
    2. Did you actually have an MRI?
    3. Where was the cancer? In the peripheral zone? Transitional? If transitional, a HoLEP will remove it. Not the case if in the PZ.
    4. Your 5% of cancer was what flavor? G3+3? 3+4?
    5. Why is radiation out? Your statement that you don't want radiation due to pain from your biopsy doesn't make sense.

    I was diagnosed with PCa, G3+4 (wee bit of 4) and had a large prostate. Had a HoLEP procedure and I am now on active surveillance. Had the removed tissue looked at for cancer, it was clean.

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