So, what are your thoughts on the effectiveness or UroLift versus a TURP to improve urinary
flow?
This is a fascinating area that is difficult to sort out. UroLift is where they pin the
prostate open to help men urinate better. It is a convenient outpatient procedure; that
makes it very attractive. It's not as effective in men with really large prostates, and so,
a TURP is going to work better in those individuals. Transurethral resection or TURP is an operation
with all the negative things associated with operations, and, you know, there's complications—bleeding
and whatnot. But transurethral resection has been around for years; it's an established
mainstream way to try and help men with slow urination and urinary problems. So, UroLift
— attractive because of its convenience, outpatient, and if the prostate is not too
big, it might be a good first step.
So, for this patient, he has UroLift and I'm guessing he may have had a big prostate because
he says the UroLift didn't work, so now he's saying "should I get a TURP procedure, or
is there anything else he should do?"
Well, we usually start men off—and I'm assuming he's been through this process—of various
medications to try and relax the prostate or shrink the prostate, and once those pharmaceutical
approaches have become demonstrated to be ineffective, then you start thinking about
TURPs, aqua-ablation, HI-FU, there's another treatment called Rezum, and these are all
different interventions that can be quite effective. You want to find a doctor has done
that particular procedure a lot. It would be nice if one doctor could do all of them
and say, "Well, for your particular situation, you'll be better with Rezum or UroLift," but
usually what you encounter is these doctors develop skills in doing one thing, and so
then it's left up to you to decide "do we want to go get a TURP" if so, maybe I'll go
to this doctor, and if I want to get a Rezum, I'll go to this doctor, and so it's hard to
find an unbiased source as to which procedure is best, and then of course, once you've made
that decision, kind of like for any kind of prostate treatment, then you've got to find
a maven, a really talented person that has done a lot of that.
So, you know, we've talked about in different types of treatment, finding the person who
has done maybe a thousand — read a thousand MRIs or done a thousand treatments. Would
you say, how many procedures would you say for something like HI-FU or Rezum or any of
these, you know? Should they call the office and ask how many the doctor has done?
Yeah, I think so. 50-100 would be nice. What kind of training did they get? And what type
of online reviews do they have? What do they support groups say about them and the types
of results that they're getting. If there's a primary care physician involved who has
referred that doctor a lot of patients — what kind of outcomes is he seeing in the patients
that he has referred? So there's different ways to do homework; none of them are perfect,
but you definitely want to be thorough because when you enter into a procedure sometimes
it has irreversible consequences.
No, I really appreciate you mentioning all of that because I think, you know, we always
talk about patient empowerment, but I don't think patients know they can call and ask
those questions because a lot of times it's, "They're the doctor; they're the expert; who
am I to call?" But you're the one it's being done to, and so I think that's an incredible
concept and it needs to be applied in many cases.
You know, talking about unbiased opinion — we hear Rezum is steam; UroLift is obviously
pinning back the prostate — if you had to put those in a certain order, what would you
do?
UroLift stands apart because it's an outpatient procedure and they're not cutting any tissue
out, so if it's feasible in the judgement of the doctor doing the procedure, then that
would probably be the most attractive first step. I always like to take baby steps before,
you know, committing to a bigger procedure where it may have a more durable effect, but
it may also have permanent side effects if things don't go well.
You mentioned a series of pills they can take in order to shrink the prostate. Can you list
those for the audience?
Well, there are many of them. The alpha-blocker categories like Flomax, Uroxatral, Rapaflo,
and then you have the Cialis (tadalafil) which is effective; you have the antispasmodic like
Myrbetriq and Toviaz, and then the prostate shrinking drugs like Proscar, which is called
finasteride or Avodart. So, they all have their pros and cons and side effects and different
roles, and they can be used in combination.
Do you have one that you use more than the others in the office?
Well, people have different needs. Some people have bladder irritability. Some people have,
you know, blockage from the prostate. Those are different medications to help with those
situations, but I'd say a very popular product is the Flomax or tamsulosin is the generic
name. It's generally well-tolerated and if it works, it works very quickly.
Hi everyone! It's Alex and Hunter. Hunter is our official PCRI mascot. If you'd like
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