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This is my first post here and I want to thank everyone for everything I have learned by reading so many posts.I also want to ask for input and advice on my situation.  

I am 66 years old and, other than BPH, in great shape.  I work out 6 days each week, probably 15 pounds overweight, eat well, etc.  I have had BPH for at least 15 years and the symptoms have very gradually been getting worse.I have been on Flo-Max for the last couple of years.  Several months ago a couple of times per week I would barely be able to get a flow going at night.  I had been getting up 3 to 5 times per night.  I find it scary when I can't get it started.  Would be on the toilet for 15 minutes or so....maybe get a tiny amount out....try going back to sleep and 15 minutes later have to get up again at which time I might be able to get a tiny stream going.Told my urologist who put me on Finesteride (Proscar) as well as the Flo-Max.  The combination of the two has improved all my symptoms.....although they are all still there.I have discussed these drugs and surgeries and HoLep with my urologist.  His opinion is that if the drugs are working, and if I am not experiencing any side effects (which I do not think I am) that I can stay on those until the symptoms get worse, if indeed they do.  Otherwise, he suggests a Bi-Lateral TURP (which he considers the Gold Standard) unless my prostate is more than 100 ccs, in which case he suggests an open prostectetomy. I am scheduled for a trans rectal ultrasound next month to determine its size (5 years ago it was 80 to 90 ccs).

My questions:

1.  What are your opinions re: staying on these drugs indefinitely if they appear to be working??  Or, will my symptoms inevitably get worse and should I just accept the inevitable and get surgery sooner rather than later??

2.  Is there anyone reading this who thinks a Bi-Lateral TURP is a good idea vs HoLep??

3.  Is there any consensus on where to have HoLep done??   I live in Northern California and would have preferred the Mayo Clinic in AZ; but when I called they said they would not accept me under any circumstance (even if I paid 100% on my own) because I am on Medicare and because of the nature of my Kaiser Advantage Plus insurance.  So, I am thinking the Mayo Clinic in Minnesota (where they will accept my Medicare...go figure).

Thanks for your input.



I have been doing lots of research, as I think you have, and my conclusion is that HoLEP is far superior to the so called gold standard TURP. I heard second hand about about a guy who had HoLEP at the first-in-the-US location to do HoLEP (Univ of Indiana / Methodist Hosp), and he said the advice to go there and get that procedure was the best health care advice he had ever received. The traditional TURP is just an old established technology that lots of surgeons know how to do. Perhaps the gold in gold standard has to do with doctor's profit, or low overhead. As far as I can tell, it is not the least bit competitive with HoLEP or green light laser. I have Medicare only, and I am trying to determine if it will pay for HoLEP. Last I heard it will not, but it sounds as if I should contact Mayo in Minnesota.


For me, the best route was Dr. Lingeman in Indiana--I am also from N. Cal.
The trip to Indiana: flying and a hotel room was inconvenient- but well worth it. I am totally pleased with Holep. The local Urologists here perform Greenlight, turp, etc and my research is that they are far less effective, involve more blood, longer recovery times, etc. I read the studies -they are online-like the McGill University study-and they really do support the Holep as the way to go.
Bill in CA