Not flowing freely!
Sorry RP your advice on PSA is very logical but not supported by the great and good in urology
PSA is very controversial because it has false positives and also because it doesn't differentiate between aggressive cancer that needs treatment and cancers that can just be monitored. Fortunately we are within a few years of getting tests that will differentiate
Until then the advice is just one PSA and no repeat for many years - as so often in medicine if you ask two doctors what many years means you get three opinions. But regular or frequent measurements following a normal result has a significant risk of false positives
If your occasional PSA is raised please see a urologist. This is a terribly difficult disease - we have lots of treatments but struggle to know which if any is applicable to a particular patient - and should not be left with a GP
PSA is very controversial because it has false positives and also because it doesn't differentiate between aggressive cancer that needs treatment and cancers that can just be monitored. Fortunately we are within a few years of getting tests that will differentiate
Until then the advice is just one PSA and no repeat for many years - as so often in medicine if you ask two doctors what many years means you get three opinions. But regular or frequent measurements following a normal result has a significant risk of false positives
If your occasional PSA is raised please see a urologist. This is a terribly difficult disease - we have lots of treatments but struggle to know which if any is applicable to a particular patient - and should not be left with a GP
Join Date: Sep 2007
Location: Esk QLD -Home of the Kransky Sisters
Posts: 6
Likes: 0
Received 0 Likes
on
0 Posts
Radgirl, you appear to be familiar with this area. RP says he had Holep. What is your view on this compared to the traditional TURP and other methods like the Green Light Laser?
Noosariver
I am not a urologist
I presume we are talking about benign prostatism
The treatment is simple - remove a core to stop the obstruction. The urololgists I know have not been impressed with green light because of high recurrence. They prefer to remove under direct vision. I know little about Holep but would be suspicious it may be similar
The best advice is to ask your GP who he would go to and then ask that urologist what he is happiest with. Far better to have the guy strutting his normal stuff than to be experimenting or struggling with something he is less familiar with
This is a routine operation. Go to the guy who does lots of them and you will be giving yourself the best chance of success
I am not a urologist
I presume we are talking about benign prostatism
The treatment is simple - remove a core to stop the obstruction. The urololgists I know have not been impressed with green light because of high recurrence. They prefer to remove under direct vision. I know little about Holep but would be suspicious it may be similar
The best advice is to ask your GP who he would go to and then ask that urologist what he is happiest with. Far better to have the guy strutting his normal stuff than to be experimenting or struggling with something he is less familiar with
This is a routine operation. Go to the guy who does lots of them and you will be giving yourself the best chance of success
Join Date: Dec 2006
Location: Belo Horizonte, Brazil
Age: 79
Posts: 50
Likes: 0
Received 0 Likes
on
0 Posts
Over the years I've had a few PSA tests and have come to the conclusion that I'm not going to take much notice of them any more. Over the last 15 years the level has varied between 3.3 and 6.0 ng/mL.
11 years ago when it was 6.0 I went for a biopsy. The result was negative thank goodness, so I'm not sure why the high reading. I remember mostly a difference of opinion with the doctor as to what his and my idea of pain was when he inserted the instrument up the the nether regions.
In June this year it was up to 5.4 again. Doc seemed to think everything felt ok with a DRE.
Normally, I take the bus down to the clinic, but last week decided to take the car for a repeat PSA test. The journey can be a bit bumpy on some of the roads here and so, having read that riding a bike should be avoided before the test, reasoned that maybe a more comfortable ride in the car might help. Result 4.0; the lowest its been since 2008. Doc still thinks that I should see a urologist, but quite honestly I can't see why since I'm almost 69. Yes the water has slowed a bit, but not too bad as far as I'm concerned.
11 years ago when it was 6.0 I went for a biopsy. The result was negative thank goodness, so I'm not sure why the high reading. I remember mostly a difference of opinion with the doctor as to what his and my idea of pain was when he inserted the instrument up the the nether regions.
In June this year it was up to 5.4 again. Doc seemed to think everything felt ok with a DRE.
Normally, I take the bus down to the clinic, but last week decided to take the car for a repeat PSA test. The journey can be a bit bumpy on some of the roads here and so, having read that riding a bike should be avoided before the test, reasoned that maybe a more comfortable ride in the car might help. Result 4.0; the lowest its been since 2008. Doc still thinks that I should see a urologist, but quite honestly I can't see why since I'm almost 69. Yes the water has slowed a bit, but not too bad as far as I'm concerned.
Avoid imitations
Join Date: Nov 2000
Location: Wandering the FIR and cyberspace often at highly unsociable times
Posts: 14,576
Received 425 Likes
on
224 Posts
Abstain from sexual activity and bicycle riding for seventy two hours prior to the test.
Psychophysiological entity
Radgirl. I'm given to understand you have a world authority on Brachytherapy down there.
I'm a retired pilot, not a doctor. While in Texas, we go to a wellness clinic for blood and ECG etc. Since I was getting a flow problem, wife pestered me to get the PSA included. It was 8.3
Went to a GP for digital. He said get yourself to a urologist.
Went to a urologist. He said he'd press on the prostate and cause some drips which would be analysed. The left side was squished, and then he went to the right.
"Oh, no need to do the test. You need a biopsy."
Wonderful doctor in San Antonio did the biopsy and the pain was less than the sting from an elastic band, which I'd been warned would be the level. When the results came back I had a Gleason of 7, BUT, it was a 4 + 3, the worst way round. (For some reason, the 3 + 4 is not as critical.)
He suggested getting a move on.
Back home I was offered Ordinary surgery. DaVinci machine surgery. Hormone treatment. External Beam radiation. Or Brachytherapy. Of all the treatments, the Hormone was the one I'd run a mile from. Did not like the sound of that. I was just inside the boundary for Brachytherapy, but was allowed that.
Southend under Mr Lodge. Volume studies. General anesthetic, but a non event otherwise. Go home.
They order the 'seeds' (radio iodine 125) and tell you to appear. General anesthetic, and they implant as many as 80 of these little rods. Have a nice rest, and go home. THAT'S IT - apart from sending in PSA results every 6 months.
This summer, 5 years after the procedure, I went to see Mr Lodge. He looked at my latest reading of a billionth of a PSA unit, and said go home, you're fine. He did in fact offer a MRI but another crisis meant I could not make the date.
Given my age, I'm extremely youthful, with a quite tedious preoccupation with sex. Sensitivity is fine. In most respects I'm very lucky - apart from the fact the extraordinarily young looking Rivetess has all but left me after 48 years.
Life has a way of being a pain in the arse whatever you do.
I'm a retired pilot, not a doctor. While in Texas, we go to a wellness clinic for blood and ECG etc. Since I was getting a flow problem, wife pestered me to get the PSA included. It was 8.3
Went to a GP for digital. He said get yourself to a urologist.
Went to a urologist. He said he'd press on the prostate and cause some drips which would be analysed. The left side was squished, and then he went to the right.
"Oh, no need to do the test. You need a biopsy."
Wonderful doctor in San Antonio did the biopsy and the pain was less than the sting from an elastic band, which I'd been warned would be the level. When the results came back I had a Gleason of 7, BUT, it was a 4 + 3, the worst way round. (For some reason, the 3 + 4 is not as critical.)
He suggested getting a move on.
Back home I was offered Ordinary surgery. DaVinci machine surgery. Hormone treatment. External Beam radiation. Or Brachytherapy. Of all the treatments, the Hormone was the one I'd run a mile from. Did not like the sound of that. I was just inside the boundary for Brachytherapy, but was allowed that.
Southend under Mr Lodge. Volume studies. General anesthetic, but a non event otherwise. Go home.
They order the 'seeds' (radio iodine 125) and tell you to appear. General anesthetic, and they implant as many as 80 of these little rods. Have a nice rest, and go home. THAT'S IT - apart from sending in PSA results every 6 months.
This summer, 5 years after the procedure, I went to see Mr Lodge. He looked at my latest reading of a billionth of a PSA unit, and said go home, you're fine. He did in fact offer a MRI but another crisis meant I could not make the date.
Given my age, I'm extremely youthful, with a quite tedious preoccupation with sex. Sensitivity is fine. In most respects I'm very lucky - apart from the fact the extraordinarily young looking Rivetess has all but left me after 48 years.
Life has a way of being a pain in the arse whatever you do.
Join Date: May 2013
Location: Antipodes
Posts: 31
Likes: 0
Received 0 Likes
on
0 Posts
Rad
Dont want to get into a pissing contest, but, having spent a fair bit of time with a urologist over the last few weeks leading to HoLEP last week, your advice and his are contradictory. I only repeated his explanation to me.
Noosa
Again, urologist told me that with TURP there is only a finite period of time that cutting take place and then surgeon must stop; thus the full procedure may not be completed. The advantage of HoLEP is less trauma, but with the same result. Here in NZ, his advice was to go private and undergo HoLEP, as there was no guarantee that Laser would be available on the day of surgery i the public hospital. A couple of links that I found useful, if you havent already searched:
Transurethral Resection of the Prostate (TURP) | Johns Hopkins Medicine Health Library
Holmium laser prostate surgery at Mayo Clinic
HoLEP vs. TURP for Benign Prostatic Enlargement: Johns Hopkins Health Alerts
Dont want to get into a pissing contest, but, having spent a fair bit of time with a urologist over the last few weeks leading to HoLEP last week, your advice and his are contradictory. I only repeated his explanation to me.
Noosa
Again, urologist told me that with TURP there is only a finite period of time that cutting take place and then surgeon must stop; thus the full procedure may not be completed. The advantage of HoLEP is less trauma, but with the same result. Here in NZ, his advice was to go private and undergo HoLEP, as there was no guarantee that Laser would be available on the day of surgery i the public hospital. A couple of links that I found useful, if you havent already searched:
Transurethral Resection of the Prostate (TURP) | Johns Hopkins Medicine Health Library
Holmium laser prostate surgery at Mayo Clinic
HoLEP vs. TURP for Benign Prostatic Enlargement: Johns Hopkins Health Alerts
Está servira para distraerle.
In the event of an early diagnosis of prostate cancer, which is not really what this thread is about, gender reassessment on the UK NHS would no doubt nicely fit the bill, thus enabling the patient, having vanquished the male sexual miasma, to prepare herself for the potential of the female mammary maelstrom.
Excellent brachytherapy may be had in Johannesburg for the price of a good meal for two in London if such a thing may be found at all.
Excellent brachytherapy may be had in Johannesburg for the price of a good meal for two in London if such a thing may be found at all.
Loose rivets
Great story. I think it underlies my gut feeling that there are many treatments and we really don't know which to offer many patients. Surgeons each have their own preference. You were given a choice and seem more happy as a result. Congratulations
RP
We must be careful as you are talking about two separate pathologies. You too underline the fact that different doctors give differing advice. On this thread I merely try to reflect that. Most of my comments are not my own so to speak as they are not from within my specialty but I attempt to reflect up to date opinions. That is why everyone is told not to rely on the thread but to get individual face to face advice.
I stick to what I said as that is the current view, but some doctors will disagree. Equally this new device you have been offered is just that - new - and if you look at the links you provided you will see that and need to consider evidence on that basis. Green light was thought to be fantastic and I can't count the number of hospitals that spent money putting in special sockets for the device. Where I am based most have been removed. Holep may be the bees knees or may be the same. Caveat emptor
Great story. I think it underlies my gut feeling that there are many treatments and we really don't know which to offer many patients. Surgeons each have their own preference. You were given a choice and seem more happy as a result. Congratulations
RP
We must be careful as you are talking about two separate pathologies. You too underline the fact that different doctors give differing advice. On this thread I merely try to reflect that. Most of my comments are not my own so to speak as they are not from within my specialty but I attempt to reflect up to date opinions. That is why everyone is told not to rely on the thread but to get individual face to face advice.
I stick to what I said as that is the current view, but some doctors will disagree. Equally this new device you have been offered is just that - new - and if you look at the links you provided you will see that and need to consider evidence on that basis. Green light was thought to be fantastic and I can't count the number of hospitals that spent money putting in special sockets for the device. Where I am based most have been removed. Holep may be the bees knees or may be the same. Caveat emptor
Join Date: Aug 2005
Location: E.Wash State
Posts: 0
Likes: 0
Received 0 Likes
on
0 Posts
I believe that Radgirl has pretty much summed up the state of things regarding prostate conditions, and the general consensus thereof. Nothing inconsistent in what she wrote.
In particular the very complex issue of PSA testing, which has not quite worked out to be all that it was promised. Rivets points out that an individual exam was what got him into the treatment protocol.
Now Pidgeon's experience is an example of what happens when a new technology comes along. Some very excellent results are obtained, and some of the "early adopters" decide that's it, that's the best treatment. And convince their patients of it. But the overall efficacy of the procedure must await further study, collections of outcomes, evaluation of risks and complications, and comparison to standardly available treatment.
Sometimes what starts out promising turns out to be less so when the bigger picture is evaluated. (And of course, sometimes not!)
In particular the very complex issue of PSA testing, which has not quite worked out to be all that it was promised. Rivets points out that an individual exam was what got him into the treatment protocol.
Now Pidgeon's experience is an example of what happens when a new technology comes along. Some very excellent results are obtained, and some of the "early adopters" decide that's it, that's the best treatment. And convince their patients of it. But the overall efficacy of the procedure must await further study, collections of outcomes, evaluation of risks and complications, and comparison to standardly available treatment.
Sometimes what starts out promising turns out to be less so when the bigger picture is evaluated. (And of course, sometimes not!)
Está servira para distraerle.
The resolution of ambiguity is helped along a tad with a prostatectomy procedure, perhaps performed by an experienced surgeon at the controls of a Da Vinci machine. Someone such as RK at the LPC, who recently put his own machine to the test on himself. This procedure was carried out by one of his team of course. Self help only extends so far. The subsequent pathology report on the quivering gland will inevitably reveal the degree and perhaps the extent of any cancer.
Surgery often presents choices and unfortunately sometimes collateral damage. A British composer of renown underwent a Da Vinci procedure a year or two ago. Apparently scar tissue from an old appendectomy procedure created a problem which led to the surgeon having to remove rather more tissue than had been envisaged by the musical maestro. The best laid plans sometimes do go wrong in the theatre and the only stick waving around in this maestro's right hand from now on is likely to be his conductor's baton.
The above tale is well documented and in the public domain. The man in question was generous enough to make his private information public in the interests of helping fellow prostate cancer sufferers.
Surgery often presents choices and unfortunately sometimes collateral damage. A British composer of renown underwent a Da Vinci procedure a year or two ago. Apparently scar tissue from an old appendectomy procedure created a problem which led to the surgeon having to remove rather more tissue than had been envisaged by the musical maestro. The best laid plans sometimes do go wrong in the theatre and the only stick waving around in this maestro's right hand from now on is likely to be his conductor's baton.
The above tale is well documented and in the public domain. The man in question was generous enough to make his private information public in the interests of helping fellow prostate cancer sufferers.
And your point CC is?????
I do hope this RK has also given you his permission to discuss his personal medical history.
Sorry but I do not think we should discuss other people without their permission. I do try to amuse by mentioning cases from the past but I would never identify anyone
I do hope this RK has also given you his permission to discuss his personal medical history.
Sorry but I do not think we should discuss other people without their permission. I do try to amuse by mentioning cases from the past but I would never identify anyone
Join Date: May 2013
Location: Antipodes
Posts: 31
Likes: 0
Received 0 Likes
on
0 Posts
A couple of links, if anyone is interested.
The procedure, as developed in NZ. Note the video is dated 2009, so at least three years of experience and improvement since this was taken.
WARNING: If you are about to go in for surgery, you may not want to watch the procedure, but some interesting data within the video, as well as in the comment under the video (if viewed in YouTube - sorry about the pun 
).
Interesting to note that urologists from around the world are coming to NZ (and staying!) to learn the procedure, as shown here:
Christophe Chemasle - New Zealand | LinkedIn
I could not find a lot of information on Green Laser Surgery and whether it is the same as HoLEP. But from my limited reading, I think green laser uses an ablation process (vapourisation), rather than enucleation (resection?).
Prostate laser surgery - MayoClinic.com
Green Light Laser Surgery for Prostate Enlargement
I hope this helps? But, as Rad states, the best advice comes from your urologist who will know what techniques are available in your location and more importantly, your condition.
The procedure, as developed in NZ. Note the video is dated 2009, so at least three years of experience and improvement since this was taken.
).Interesting to note that urologists from around the world are coming to NZ (and staying!) to learn the procedure, as shown here:
Christophe Chemasle - New Zealand | LinkedIn
I could not find a lot of information on Green Laser Surgery and whether it is the same as HoLEP. But from my limited reading, I think green laser uses an ablation process (vapourisation), rather than enucleation (resection?).
Prostate laser surgery - MayoClinic.com
Green Light Laser Surgery for Prostate Enlargement
I hope this helps? But, as Rad states, the best advice comes from your urologist who will know what techniques are available in your location and more importantly, your condition.
Está servira para distraerle.
Relatively easy as were the points of my previous post to diagnose, I suppose they could be enumerated thus:
1. Prostate cancer diagnosis can be ambiguous and the real state of affairs downstairs may only be determined after prostate removal and subsequent histology.
2. The Da Vinci machine is a pretty keen piece of kit.
3. There are some good operators out there.
4. Even they are not immune from prostate cancer.
5. There are often choices to be made in surgery and not all of them turn out as either the patient or the surgeon would wish,
6. Collateral damage in cancer care surgery is often a consequence.
7. There's a musician with soul out there in the wild shores of Britain.
I think that covers it Radgirl except perhaps to say that research is usually of benefit before expostulative conclusion.
1. Prostate cancer diagnosis can be ambiguous and the real state of affairs downstairs may only be determined after prostate removal and subsequent histology.
2. The Da Vinci machine is a pretty keen piece of kit.
3. There are some good operators out there.
4. Even they are not immune from prostate cancer.
5. There are often choices to be made in surgery and not all of them turn out as either the patient or the surgeon would wish,
6. Collateral damage in cancer care surgery is often a consequence.
7. There's a musician with soul out there in the wild shores of Britain.
I think that covers it Radgirl except perhaps to say that research is usually of benefit before expostulative conclusion.
Last edited by cavortingcheetah; 25th Nov 2013 at 03:28.
Join Date: May 2013
Location: Antipodes
Posts: 31
Likes: 0
Received 0 Likes
on
0 Posts
As for me?
Day 4 at home, no pain relief required.
The rosé is now a sav blanc.
Re-learning to aim straight.
Uncomfortable but not painful during the sitting and standing evolutions, but getting better all the time.
Discomfort 'à la pointe'
while passing but also getting better quickly.
An uninterrupted 8 hours sleep, as opposed to 1.5 hours max, pre-op.
Finally, in spite only recent introduction of HoLEP, my pre and post operative reading and advice convinced me that I had made the correct decision. Independent advice, backed by data in the John Hopkins link in #27 above were enough to help me choose this course of action for the op.
Day 4 at home, no pain relief required.
The rosé is now a sav blanc.
Re-learning to aim straight.
Uncomfortable but not painful during the sitting and standing evolutions, but getting better all the time.
Discomfort 'à la pointe'
while passing but also getting better quickly.An uninterrupted 8 hours sleep, as opposed to 1.5 hours max, pre-op.
Finally, in spite only recent introduction of HoLEP, my pre and post operative reading and advice convinced me that I had made the correct decision. Independent advice, backed by data in the John Hopkins link in #27 above were enough to help me choose this course of action for the op.
Psychophysiological entity
Radgirl - see your PMs
Is Dr Fraundorfer's first name Mark?
Part I
Free PSA. Had to laugh. I questioned the urology folk down here about this test. The numbers are reversed for this by the way.
"No, we charge for that."
"no, I mean the Free PSA test, it's different to . . ."
"No, we charge for PSA tests."
Is Dr Fraundorfer's first name Mark?
Part I
Free PSA. Had to laugh. I questioned the urology folk down here about this test. The numbers are reversed for this by the way.
"No, we charge for that."
"no, I mean the Free PSA test, it's different to . . ."
"No, we charge for PSA tests."
Join Date: Aug 2005
Location: E.Wash State
Posts: 0
Likes: 0
Received 0 Likes
on
0 Posts
Her's another point, alluded to above but very important:
Never try to push your surgeon into using some technique other than the one(s) he prefers to use. He might well say "fine, I've always wanted to try that", and you do NOT want to be in the first few cases he ever did. The more hi-tech the procedure, the more important this is.
If you've decided on a certain technique, change docs if you must, but find a surgeon who has a lot of experience with that technique.
Never try to push your surgeon into using some technique other than the one(s) he prefers to use. He might well say "fine, I've always wanted to try that", and you do NOT want to be in the first few cases he ever did. The more hi-tech the procedure, the more important this is.
If you've decided on a certain technique, change docs if you must, but find a surgeon who has a lot of experience with that technique.