radical prostatectomy after HOLEP - Is it possible?

spacer
spacer Member Posts: 14 Member
in Prostate Cancer #1

I had a partial HOLEP after I was not able to urinate, and they found cancer - Gleason 3+4. An MRI showed that there was still cancer in my prostate. Everyone wants me to have radiation, but I would rather have another HOLEP operation and remove the rest of my prostate. My radiologist says that no surgeon would do this do to scar tissue. Is he right?

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Comments

  • swl1956
    swl1956 Member Posts: 194 Member
    #2

    You might want to get CentraPA on here to opine. I believe he has a similar situation to yours. If it's low volume 3+4 you might be a candidate for Active Surveillance? Focal therapies like Cryo might be an option depending on the location of the cancer.

  • centralPA
    centralPA Member Posts: 379 Member
    #3

    Hi @spacer,

    There is no such thing as “another HoLEP” that removes additional tissue, only a full radical prostatectomy.

    You can absolutely have a RARP afterward, but you will want the most skilled surgeon. It’s trickier with a higher chance of incontinence initially, although long term rates are same as non-HoLEP. Here’s a paper on it…

    https://pubmed.ncbi.nlm.nih.gov/32962962/



    another

    https://pubmed.ncbi.nlm.nih.gov/31822128/



    Here’s a paper that talks about how after a HoLEP your PSA becomes a more accurate predictor of PCa progression.

    https://pubmed.ncbi.nlm.nih.gov/32997261/

    So what was your PSA before, and what is it now? Also, what percentage of your 3+4 is graded 4?

    I already knew I had PCa going into my HoLEP, and chose it to make me a better candidate for radiation. Spamming with another paper…

    https://pubmed.ncbi.nlm.nih.gov/36463424/

    Be patient and do your research. Keep asking questions.

  • Clevelandguy
    Clevelandguy Member Posts: 1,265 Member
    #4

    Hi,

    Consult with your Urologist and Oncologist to see which is the better option, surgery or radiation based on your specific set of circumstances. A second opinion with different doctors/hospital network due to your history so far.

    Dave 3+4

  • spacer
    spacer Member Posts: 14 Member
    #5

    I am going to see another urologist locally and also one at the Mayo clinic. I prefer to have another HOLEP. I do not want to expose myself to radiation because it may cause cancer itself. Are there any discussion here on radiation therapy causing cancer?

  • Clevelandguy
    Clevelandguy Member Posts: 1,265 Member
    #6

    Hi,

    Can they remove the whole Prostate with a HOLEP procedure?

    Dave 3+4

  • spacer
    spacer Member Posts: 14 Member
    #7

    Thank you centralPA for the articles. The HOLEP operation was so easy, I was hoping that they could do something similar to remove the rest of my prostate tissue and keep the outer cell intact, but you are saying that is not an option I believe. My PSA now is 0.35 before the HOLEP, it was 5.21, but the urologist did not believe that I had cancer at that time. I got the HOLEP because I was not able to urinate after a hernia operation. I had a cather in me for a month. The biopsy of my prostate after the HOLEP showed the following:

    prostatic acinar adenocarcinoma (PAA) Gleason Score:3+4 equal 7/10 (Grade group 2) PAA involves less than 5% of the total tissue submitted

    As I commented above, I would rather do something other than radiation. When I was discharged from the hospital after the HOLEP, I noticed that the hospital recommended that I see an oncologist, but there was no other indication that I had cancer. I bugged the urologist trying to see if I had cancer, but was not give an answer until the follow up appointment a month later. I then saw the urologist 4 months later and he said that with a PSA of 0.35 I should have it checked again in 6 months and have an MRI in one year and do nothing else until my PSA was over 1.0. I did also see a radiolgist at about the same time, and he had me do an MRI in 10 days which showed the following:

    1. Prostate has been assessed using ACR’s PI-RADS version 2.1.
    2. PI-RADS category 4 suspicious mass, right posterior lateral basilar peripheral zone.
      Recommend biopsy

    I will have a biopsy done March12th. The radiologist said that I would probably need radiation, and my oncologist also is leaning towards radiation, but I would like to find another option. I have always been told that I should reduce the amount of x-rays that I get so I do not believe that radiation therapy is 100% harmless. I may be wrong, but if there is another option with no great side effect then I will go that route. I would like to hear other people opinions whether I am a candidate for active surveillance or not. I get the feeling that my oncologist and radiologist do not consider that to be an option for me while my original urologist (who I will not see again) wants me to go that route. I will see another urologist since his recommendation to wait a year for an MRI is not a good idea, and also he would not tell me I had cancer until a month after my operation.

  • spacer
    spacer Member Posts: 14 Member
    #8

    I am trying to get an appointment with another urologist to see if it is possible to do another HOLEP operation, and I have an appointment with the MAYO clinic in Phoenix in April and I will ask them that question at that time. If any member can answer this question, please reply.

  • spacer
    spacer Member Posts: 14 Member
    #9

    Another question I have is this - after the operation, I had a catheter in me for about 9 days. I finally went to the emergency room to have it removed because it had gotten plugged up and I was urinating around the catheter. After the removal, I urinated and a cross section of my prostate came out. This is what was blocking the catheter. I asked my urologist if I this was a concern that a portion of my prostate which was cancerous was in my bladder for that period of time, and he said that it was not a concern. Do members here believe that I should be concerned about this and have an MRI done on my bladder?

  • spacer
    spacer Member Posts: 14 Member
    #10

    typo: I asked my urologist if I this was a concern

    should be - I asked my urologist if this was a concern

  • spacer
    spacer Member Posts: 14 Member
    #11

    I imagine that if another HOLEP can be done, then they will keep the outer shell of my prostate and remove the remaining tissue within. I thought that my entire prostate had been removed, but after the operation, the urologist told me that he had removed the central core which was 60 to 70% of my prostate. I wish he had removed it all, but he said that there would be a greater chance of urinary incontinence if it was all removed.

  • centralPA
    centralPA Member Posts: 379 Member
    #12

    Hi @spacer

    There is no way to do another HoLEP. Your procedure removed the central zone and transitional zone, and left the peripheral zone. Nothing else they can remove short of removing the whole prostate, and that is a RARP.

    After my HoLEP I blooped out a number of really big clots. What the HoLEP leaves behind is a cavern of raw tissue, like if you skinned your knee. Sounds like you had one clog your catheter, and you are not the first person to enjoy that effect. I can't imagine a problem with that clot in your bladder. It wasn't prostate tissue (I think).

    I was PIRADS 4 prior to my HoLEP, and I still am. My PSA before my HoLEP was like yours, about 5.5 or so, and droppped to 0.40 (like yours). Over two years it has crept up to 1.07 in my last check. That is way low for the size of what is left of my prostate. I am on Active Surveillance (AS), and just finished a round of diagnostics. Urologist continues to recommend AS and I agree.

    I think your biopsy will tell the tale. If it is all or mostly Grade 3 and only has a little bit of Grade 4, maybe you can consider just doing AS for a while. Your PSA has become a much better indicator of what is going on with the cancer. See where it is going over the next 6 - 12 months. That will give you lots of time to research and decide on your next step. The healing from the HoLEP can only help.

    If the biopsy comes back with more serious results, you should still be patient in deciding. You have time.

  • Steve1961
    Steve1961 Member Posts: 656 Member
    #13

    well I tell you what I’ve had radiation done with a breaytherapy booster and they say it’s very difficult to have surgery done after that nobody will do it blah blah blah. That’s a bull face lie had a appointment with Dr. Robert Reiter of UCLA he’s done over 30 of them after radiation. And ovef 4000 regularl ones He was willing to do the surgery for me he did in less than two hours only in the hospital overnight catheter one week. The only side effect I have is that I still leak a little urine. He did a wonderful job and I am cancer free and I’m very grateful. Look him up Dr. Robert Reiter UCLA .

  • spacer
    spacer Member Posts: 14 Member
    #14

    Thanks for the info Steve1961. I have not had radiation yet but am leaning towards surgery. What type of surgery did you have and what motivated you to have surgery?

  • spacer
    spacer Member Posts: 14 Member
    #15

    centralPA - thanks for the info. It sounds like I am in a situation very similar to yours. My oncologist and radiologist do not seem to believe in active surveillance. If there is any cancer in your body, they want to destroy it before it spreads. I will make a decision after the biopsy. There are so many different treatments for prostate cancer now. It seems like most doctors recommend radiation. When cancer is at the 3+4 level, it seems like they could do some alternative treatment like High-intensity focused ultrasound (HIFU) so that it does not get worse. I wonder if anyone here can provide info on alternative treatments.

  • spacer
    spacer Member Posts: 14 Member
    #16

    Here is another treatment option - laser ablation

    https://sperlingprostatecenter.com/focal-laser-ablation-new-york-city/?Idad={adid}&adposition=&campaignid={campid}&adcreative=174489303774&network=g&websiteplacement=&displaynetworkclick=&categoryplacement=&clickfromsearch=search&keyword=%2Bbest%20%2Bway%20%2Bto%20%2Btreat%20%2Bprostate%20%2Bcancer&gad_source=1&gclid=CjwKCAiA8Lu9BhA8EiwAag16b6SHhqoW7yoBfQG6Mm7PE5gY2nF7yExwAS0lLM6E2S62P6isX74LFBoC9yAQAvD_BwE

  • spacer
    spacer Member Posts: 14 Member
    #17

    Here is some info on HIFU

    https://www.mayoclinic.org/medical-professionals/urology/news/high-intensity-focused-ultrasound-for-the-treatment-of-prostate-cancer/mqc-20519431

  • spacer
    spacer Member Posts: 14 Member
    #18

    Here is another procedure:

    https://tulsaprocedure.com/

  • Wheel
    Wheel Member Posts: 194 Member
    #19

    you will get great recommendations from the Mayo Clinic. There is no specific Radiation preference over Surgery. These decisions are based on totality of the person’s cancer, age , health, concern of side effects. Alot goes into the decision. Even all the Radiation treatments are not open to all patients. Those treatments depend whether cancer has spread, whether its isolated identifiable lesion or lesions, whether its on both sides of the prostate.

  • spacer
    spacer Member Posts: 14 Member
    #20

    Here is a study on HIFU vs RARP:

    www.urologytimes.com/view/study-shows-hifu-noninferior-to-prostatectomy-for-localized-prostate-cancer

    I believe HIFU is my choice of treatment. If the tumor cannot be reached then I will do TULSA.

  • centralPA
    centralPA Member Posts: 379 Member
    #21
    https://csn.cancer.org/discussion/comment/1721010#Comment_1721010

    I think you are smart to look at focal therapies too, not just full removal of the prostate. I'll closely track what you figure out.

    Regarding AS, I feel like everyone here is on AS in a way since we all get our PSA regularly checked, etc., it's just a question of whether you are currently doing it before or after a treatment. 😕 You never stop monitoring.

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