da Vinci Simple Prostatectomy for severe BPH feedback (no cancer)?

Wow! That's the biggest one I've ever heard of.

If TURPs are out, none of your alternatives are symptom free, but radical prostatectomy is extreme, invasive, and difficult on prostates that large. (I'm surprised it can be done laparoscopically at all. I suppose the surgeon will morcellate it.)

I was wondering if you could shrink it with 6 months of Casodex (bicalutamide). It has side effects - it will extinguish your libido while you're on it, and you may grow breast tissue (10 mg daily tamoxifen will prevent that). You may also experience hot flashes, and some loss of lean muscle too. But the upside is the side effects are not permanent, it's inexpensive, non-invasive, and taken for only 6 months or so, you will probably be spared the side effects that increase with time. Maybe it's worth a try before resorting to prostatectomy.

This kind of hormone therapy is sometimes used to shrink large prostates before brachytherapy.

- Allen

Thank you Allen for your reply. I know this is a prostate cancer topic so I apologize for my BPH questions. My prostate got so large because my uro told me year after year that everything was ok and when I went into acute retention he would do turp on me. So I trusted him. Then last year I heard about these new liquid biopsies for PCa (MiPS;Apifiny) and when he wouldn't do them I drove to a clinic in Detroit ( I live in Canada ) and paid for them myself. Thankfully the results were good even thought my psa had risen to 8 then. ( It is now 11 ). A month ago on my annual visit I begged him to do an u/s to check my prostate/bladder/kidneys but he refused and just asked me if I was ready for turp. So I drove back to that clinic and had a trus and retropertineal u/s and was really shocked to learn it had grown to 285 gm and was impinging on the bladder neck. Also my kidneys were showing signs of stress.
Until now I have been looking into a lot of new procedures including the PAE you mentioned (thanks). But it only reduces the prostate about 30% and seems to be ineffective after a few years because the arterial blood finds other ways to the gland. Then there is the problem of necrosis.
The hormone therapy you mention is new to me and I will study it (thanks again). I have been on dutasteride (Avodart) for nearly 10 years (including Proscar) which act by blocking the enzyme receptors on the prostate that convert testosterone to DHT. I am on the max dose and have all the side effects you mentioned.
I am in real danger but am very scared of surgery. I am 67 and my only one was for an appendix when I was 8. I will have to travel to another city for the robotic surgery. I guess they use da Vinci to enter above my prostate and open it and scoop out the tissue and then close it leaving the rigid capsule behind. So the surgeon says I should not be incontinent or suffer ED and all that. But I don't believe doctors. I only believe real people who have been through this procedure which is why I am so anxious to hear from men who have gone through it for bph.
My uro here told me not believe the liquid biopsy reports because it is almost certain I have cancer in a prostate this size (that was when it was 185gm five years ago). So maybe they will test the tissue they remove. It is so confusing.
Thanks again for helping. I wish you and everyone else here the best of outcomes.
Neil

Thanks again Allen for your help and encouraging comments. I sure wish I could speak with men who had this robotic procedure for very large prostates. The uro in Detroit told me it is very uncommon because most doctors follow their patients every year and never let their prostates get so large. I trusted my uro all these years and now I'm in trouble when this could have been dealt with years ago. It shows that we all must be proactive and not passive patients.
Good luck to you. Thanks

I'd have lots of questions. I always bring my questions in writing and write down the answers as you get them. Bring someone with you if you can. Here are a few off the top of my head:

• Does it make sense to explore the cause? Is there an endocrinal explanation for my peculiar situation (i.e., accumulation of androgens in the prostate)? Should we do a blood draw from my transition zone for an endocrinological assay?
• Are my adrenals churning out excess androgens? Should we do an MRI of my adrenals to search for tumors there? What are my ACTH and cortisol levels?
• Is it worth a try shrinking it with Casodex rather than surgically?
• Would it make sense to do both - shrink it as much as possible with Casodex, and then do surgery?
• Will the bladder neck be spared?
• Are neurovascular bundles completely spared? Is there a risk of shock to the nerves?
• What about damage to the penile artery?
• What are the odds of:
- erectile or orgasmic dysfunction?
- bladder neck contracture?
- incontinence?
- stress incontinence?
- climacturia?
- loss of ejaculation or retrograde ejaculation?
• Is it possible that I will regrow tissue or develop so much scar tissue that a second procedure will be required?
• Will there be a pathologist standing by to examine the tissue for prostate cancer?
• If cancer is found and it is high grade, will the whole prostate be removed? What if it is low grade?
• How will this procedure affect my ability to have prostate surgery or radiation in the future?
• What other acute side effects should I expect? blood/blood clots in urine and semen? painful urination? pain in my penis or perineum? hematoma? lymphocele? epididymitis? hernia? UTI? sepsis? bladder spasms? urinary blockage/retention?
• What side effects, even rare ones, should I be aware of because they will require an immediate visit to the ER?
• How will we monitor my recovery?

- Allen

Post Edited (Tall Allen) : 5/14/2016 10:06:22 PM (GMT-6)

I have never had a surgery in my life so I am quite frightened at the prospect of a 5 hour robotic prostatectomy this summer. Is there any danger that being under anesthesia that long could cause some brain damage? Are there steps to take before the surgery, like vitamins or other natural supplements that would reduce the adverse effects of such a long surgery?
Also I am having a cystoscopy next week which sounds very scary. Is there a danger of an infection/UTI from this procedure? Will it cause urination problems afterwards? And again can I do something before the procedure to reduce side effects? Then I am having a 3T fusion MRI but they will sedate me as I am claustrophobic.
Thanks for sharing experiences with me. All the best to everyone.
Neil

Thank you island time ( I like your handle ). Your info helps a lot and I will follow up. I'm sorry to be posting questions not related to PCa on this thread but you have all gone through this and know so much. Thanks for helping me.