Prostate Cancer after Biopsy-want to do HoLep

Papalewder
Papalewder CSN Member Posts: 5 *
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: 187 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: 187 Member
    #3
  • Old Salt
    Old Salt CSN Member Posts: 1,686 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: 428 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.

  • Papalewder
    Papalewder CSN Member Posts: 5 *
    #6

    Ok, I wasn't clear, my fault. I believe my cancer is 3+3 as it's a 6 on the scale. That was almost a year ago. Just had an MRI and it showed a lesion, but not defined. The goal of the new Biopsy is to see if the cancer has spread or just sitting. If it has spread, the urologist is suggesting removing the prostate for 1. relief peeing and 2. remove the cancer. He suggested Radiation is not an option as it could make the pain I have sometimes peeing (not all the time, but sometimes) worse and be permanent pain. However, if the Biopsy shows no new growth, then he's recommending that HoLep to create relief, but then Active Survelience. I'm doing the biopsy in a few days, so we'll have the answer. But, I fought over the biopsy as It was a difficult recovery…painful, but no catheter needed afterwards so I'm hopeful none will be needed this time either. We'll see. Size of prostate 63, CC and the lesion is in the transitional zone with a 3/5 assessment, whatever that means.

  • Old Salt
    Old Salt CSN Member Posts: 1,686 Member
    edited August 20 #7

    Thanks; that clears up several questions we had. The proposed approach makes some sense to me, although the side effects of the prostate removal should not be underestimated. On the positive side, your age (57) may help with a speedier recovery.

    With respect to surgery, we always recommend to have this done by a specialist with significant experience. Also note that there is a newer way of doing this. Wheel has posted on this several times; you may want to read those posts carefully and inquire whether that method can be used advantageously for your case. Be aware though that you don't want to be a guinea pig.

  • Papalewder
    Papalewder CSN Member Posts: 5 *
    #8

    Thank you! I started reading about prostate removal. Maybe why my Dr. suggested it. It removes the cancer AND fixes the BHP at the same time and does it with one surgery, not 2(HoLep). But, without the Biopsy after the MRI, we won't know what we're dealing with. I'm a little worried about the recovery of the Biopsy, but feel it's the right way to do this. Better to have more info than less. Biopsy is tomorrow morning. Should have results back and then meet with the urologist. I just need to remember to breathe. Breathing is good. :)

  • Clevelandguy
    Clevelandguy CSN Member Posts: 1,351 Member
    #9

    Hi,

    As Oldsalt has stated I would look into the new technique of one incision to remove the Prostate. You need to find an experienced doctor who has done this one incision technique many times. Your Prostate is a little on the large size(BPH) which could explain your difficulty in urinating, the Holep should help.

    Dave 3+4

  • Papalewder
    Papalewder CSN Member Posts: 5 *
    #10

    Thanks Clevelandguy! My guy is very experienced. They are one of 2 providers in Maryland that even do HoLep, so I believe they are the right people for this. Having said that, I always like the less is more approach and if I could do the HoLep and my body cooperates to where I might need the entire prostate removed, but in like 10 years, I'd prefer to do that. If he thinks now is the best due to my age and other factors, I'll cross that bridge when I get to it. Many decisions to make and advice to find and understand. I very much appreciate all the help I've been given here so far! :)

  • centralPA
    centralPA CSN Member Posts: 428 Member
    #11

    It sounds like you had a biopsy first then an MRI. Frankly, that is not standard of care any more. The standard is you get an MRI first and then use it to help guide a biopsy. For that reason alone, I would find another urologist from the first one. Sounds like you did.

    The biopsy probably won’t say much about the spread unless it really spread. It will say whether the lesion in the prostate is where the cancer was (they will target it) and more importantly give you a Gleason score. Key is if you have any grade 4 or 5 in there.

    You had a single positive sample out of 12 on your last biopsy, just 5%, all G6. Your MRI sounds like it saw minimal stuff. Your case strongly suggests active surveillance.

    You said the lesion is in the transitional zone. That gets entirely removed in a HoLEP procedure, where it is all available to a pathologist to look at. If that is where the cancer is, then it will likely mostly be removed by a HoLEP.

    Good luck on the biopsy!

  • Papalewder
    Papalewder CSN Member Posts: 5 *
    #12

    huge thank you! Yea, the Biopsy was done last year. This one is being done in conjunction with the MRI from last week. I would love to do just the HoLep and have him get the crud out. I'd like to keep Mr. Happy. Assuming he remains happy. Seriously, I'm not making lite of my condition of anyone else's. Just trying to keep my chin up. Appreciate it!

  • Old Salt
    Old Salt CSN Member Posts: 1,686 Member
    #13

    Let's hope the MRI + biopsy won't reveal anything new to worry about.

  • Steve1961
    Steve1961 CSN Member Posts: 703 Member
    #14

    I have advice for you at 57 years old you’re overthinking it like I did overthink it as well at 57 like you ..first of all. Did you send the biopsy out for decipher testing? You need to do this to find out if it is aggressive or not to find out if it is a cribbiform or not the cancer I had ended up being crib form and I did radiation and I totally regret it later because it didn’t work So if it is contained to the a prostate and you expect to live 10 years or more look this up what gold standard is it is surgery Yiu have cancer in your body. It doesn’t belong in there. Take it out if you’re thinking about doing anything else why thinking about doing radiation? Radiation is putting a poison in your body to kill a poison that might not even work that could cause cancer down the line. Find yourself a good surgeon removed and don’t look back you have radiation in your pocket as a back up that’s my opinion take it as you wish. Good luck.

  • centralPA
    centralPA CSN Member Posts: 428 Member
    #15

    @Papalewder , did you get the results of your biopsy?

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