Experiences with Holmium Laser Enucleation of the Prostate, HoLEP, Laser Surgery

This is a reduction of 88.38% which is better than the anticipated 86% post HOLEP.

I would not too readily discount the possibility of PSA testing flagging up possible PCa. PSA velocity is important to consider, particularly after a radical prostatectomy for example.

It may not provide a high degree of predictability on its own, but taken in conjunction with other parameters, and for specific results beyond the norm, it can certainly prompt further investigation.

I know there are results at both ends of the spectrum that are false positives and false negatives, but I still believe that PSA testing remains a good general tool in appropriate circumstances.

I plotted my twice yearly PSA results quite methodically over 15 years. This was something the medical profession did not do. When I provided them with the data, they were reasonably confident looking at the velocity over time and taken in conjunction with other parameters, that my prostate problems were in fact due to BPH. There are also certain nomograms that when you plug in the data give you the probabilities of PCa.

It has been published in a number of research papers that your new base line PSA level should remain fairly static for 5 to 10 years post HOLEP. I now have my new base line PSA. If it was to present as a consistent upward gradient within the next few years, it would alert me to have matters investigated further.

I was just using it for the benefit of others. I place little credence in PSA tests since my research has turned up men with PSA scores of 16-20 and no cancer and no need for invasive treatments, while at the same time some men with very low PSA scores turn up with prostate cancer. The doctor who developed the test has recommended against relying upon its results.

I did mention that there are false positives and false negatives at either end of the spectrum. The false positives can be simply due to prostatitis for example. I also emphasised that PSA screening tests should be used in conjunction with other parameters, and that an elevated PSA can be used as a measure for deciding on further possibly more invasive investigation. I know the whole system is fraught with problems, even subsequent often repeat biopsies are inconclusive. Prostate screening is a bit of a political issue in various countries due to scarce resources and subsequent cost benefit analysis. Recently there has been an international reappraisal of breast screening in the same context, which in some countries came down in favour of no breast screening.

There is, however, a differentiation between screening and post operative PSA testing. While I still believe there is a place for screening particularly when PSA velocity over time is taken into account, my focus was on post operative PSA testing where there is much less equivocation as to PCa predictability. Following a radical prostatectomy for example: the most widely accepted definition of a cancer recurrence is a PSA > 0.2 ng/mL that has risen on at least two separate occasions at least two weeks apart and measured by the same lab. Please see Prostate Cancer Foundation info here http://www.pcf.org/site/c.leJRIROrEpH/b.5838551/k.6D69/PSA_Rising_PostTreatment.htm

On a personal level I am more focused on post HOLEP PSA levels. HOLEP like the conventional TURP removes the central core of the prostate and moves towards the periphery of the capsule. A margin of the tissue on the periphery of the prostate remains untouched. It is in this peripheral area of the prostate where a majority of PCa originates. For medium to longer term monitoring of my prostate health, it is of significant interest for me (and other HOLEP patients) to determine the new PSA base line result. In my case it is a PSA level of 0.8. formerly it was 6.8. I will monitor any rise in this level, and particularly the velocity. Should I perceive a rise and particularly increasing velocity I would move to further investigation. The fact that my urination problems have been resolved through HOLEP and that the 50 gms of tissue removed was benign, does not mean that I do not have PCa or indeed will not develop PCa.

There has been research done into PSA levels pre and post HOLEP which were quite predictive of those patients who went on to be subsequently diagnosed with PCa. See http://www.ncbi.nlm.nih.gov/pubmed/19773035 , which is just one example of post HOLEP PSA predictability.

jonal,

  I have another appt in April with Dr Lingeman . I dont know if they will do  another PSA test or not. I was amazed about my test post Holep as well.  I was told by my urologist they like to wait about 6 weeks for the prostate to settle down after a catheter is taken out or DRE. An ejaculation will skew the numbers even .  It is my belief your numbers will come down since you were dealing with pus cells just prior to your test.  Any info I get from the Dr will be passed on to you. 

Steve, 

  The kegals have helped me but it has taken some time. Keep doing them it will pay off.  Ive had dramatic improvement in the last 3 weeks . I had stress incontinence especially at work ,that is almost a thing of the past. The urge incontinence quit suddenly ,a most welcome relief.  I am almost back to normal , if there is such a thing!

Hi just me,

I believe of all the HOLEP contributors to this site your progress has been absolutely excellent, and top notch.

From a large prostate of 110 gms with a necessity for repeat and ongoing catheterisation pe op and a subsequent urethotomy during HOLEP to the stage you are now is quite amazing.

Add to that your post op PSA of 0.3 from a peak of 17 pre op is also fantastic. This is a 98.23% reduction in PSA! I thought I was doing really well with an 88.23% reduction in PSA. The norm is usually around 86%. Even if my reduction does not improve from 88.23% I am still delighted because it is well above the expected norm.

I hope you get a further PSA test so that we can continue to compare notes.

You have never mentioned continued RE. If you no longer have this, I will fall off my seat!!

Dr Lingeman should use you as a case study and for publicity.

Hi jonal,

 Ive trie to respond several times 

just me

Hi jonal ,

I have been trying to respond to you  but for some reason I cant get through .  

I have an appointment with Dr Lingeman in mid April. If there is a PSA test I will keep you informed . I honestly would not be

surprised if your next test did not come down,due to the fact you were so recently dealing with pus cells .I would think that is an

indication your prostate could still be stirred up a little.  I was told even an ejaculation to soon to a test could bring up the level

some.

Stress incontinence is still an issue for me at work or when lifting ,but, it is getting much better in these last few weeks.  

I am amazed at some of these guys who come out of surgery with no leaking and no need to wear any protection at all! 

I do experience Retrograde ejaculation ,however I have had a few normal ejaculations with about 50% of the semen I had before

Flomax and surgery.  RE does not bother me as I find very little difference in the sensation between normal and RE.  In fact I

consider it a trade off . My erections are much better now than before.  Ar 59 years old I am not looking to father any more children 

besides ,Ive also had a vasectomy!

 I had a similar experience to you last week . A friend at work was standing at the the urinal in that all to familiar pose as I walked

in and stood next to him .  I finished ,washed my hands and walked out while he was still there.

   I am so glad that is in the past for me!

 I agree with you jonal, I have done very well as you have with your surgery.  We are

blessed to have had good care with experienced Drs.

Roman
133-cc of removal! Wow, how big was your prostate before? Did it cause a fold in your bladder?

Who did your procedure?

Thanks
JD

Hi all! Well good news for me. Went to see the Nurse at Dr. Das' today for second biofeedback session to see if I'm doing the Kegels correctly. And - apparantly - I am! I can see it on the screen. While there they did an ultra sound of my bladder. I know you guys talk about ML and such so I asked for the #. After I emptied my bladder I had only 21 ML left which she said was less than an ounce! Just as - or even more - important is that I think we found the "cure" for my IBS. A new daily pill I started 10 days ago and have had no "gut" issues. So I'm a "happy camper". Made my next followup with Dr. Das for June 5th (3 months from last one).
Steve

My husband had HOLEP at Vanderbilt with Dr. Miller on December 17. He is now about 4 months since the surgery which was successful as far as increasing urine flow and alleviating difficulty in urinating. There was no bleeding, pain, or incontinence after the surgery. His prostate was 90cc and she removed about 75cc.

What has been a disappointment is that he still has frequency of urination. He has to pee about every 2 hours or less, approximately 15-17 times a day and still urinates 2-3 times at night. He can not seem to hold it for more than 7-9 oz or approximately 225ml. He does drink coffee in morning and afternoon which I am trying to get him to cut down and drinks small amount of wine or beer 3-4 times a week. I read that many of you are getting 500ml or more of urine after the surgery and can hold it to sleep thru the night.

When he had his initial exam with Dr. Miller, it showed that he had ridges/scars on his bladder from at least 2 decades of difficult urination. But she said the scarring was not that bad. But now she thinks it is contributing to his frequency. So I would like to know if any of you have still had frequent urination after 4 months, and what you are doing for it.  He is trying to "retrain" his bladder to hold it longer, and is doing Kegels. Someone mentioned rolling over at night but he can't get back to sleep as it is too uncomfortable to hold it---he doesn't drink anything after 7pm, but that still doesn't help.

 

The Dr. recommended that he go on Vesicare, but when we looked it up, it does not get good reviews, and the side effects look bad.  Has anyone here been on Vesicare for frequency problems, and if so, what has been you experience?

Has anyone been able to "stretch" their bladder to hold more?

Thanks so much for the help and info!

Glad to hear Your doing so well Steve.  I have been dealing with another health issue besides BPH also. It is tough when you dont feel good .  Holep took care of one of them !

Lafcadio,

I am dealing with stress incontinence and it has been 6 months .  My bladder would only hold 110 ml for quite some time.  in time I was able to increase the amount up to 500 ml. during the night. I am not sure of your husbands age as that could be a factor . Progress does take time .

I have a Dr appt this week for 6 month check . will post  results

Hoping all the best for everyone

just me

Hi Lafcadio: I can only speak for me - and I may be repeating myself (if you read my earlier posts) - but after almost 4 month (next week) I am having very few urges and only up once a night. I wasn't sure how to do nthe Kegels correctly and having a nurse use biofeedback to show me on a graph did help. Also I tried a new medicine to stop urges - Myrbetriq(Mirabegron)- that I got a month of SAMPLES from my surgeon (Dr. Das). Seems to help at first and then I stopped and it didn't get worse. I had no side effects. So your husband may want to see if he can get samples of it. Worth a shot.

Hope this helps a bit. I still use pads when I leave home but no "accidents" yet.

Steve

More great news. It's now over a week since I've stopped wearing a pad to leave home. And no problems! Still doing the Kegels in AM when I get up and before I go to sleep. And most nights I'm either not up and need to go or get up ONCE about 5am. Sure beats the old schedule!

Jonal and steve,

I had my 6 month check up recently.  My score on the  BPH survey went from a 26 pre surgery to 2 post surgery !!

I did not have a DRE or PSA  test,Only a urine sample which came back CRYSTAL CLEAR !!

Yearly follow ups from now on.

Dr Lingeman told me my PSA score was low enough , the likelyhood of developing cancer would be very low!  Hey guys , we still

have a prostate so we still have to get them checked .

Still have Retrograde ejaculation ,but a normal ejaculation does happen once in a while. No big deal to me. Stress incontinence is

getting much better, so I still wear a pad for security. I change it every 24 hrs just to be clean .  I am so grateful to the Drs and

nurses that cared for me and brought me to this much better life .

Hoping the best for all of you ,

just me