Has anyone had Aquablation? Does ADT reduce prostate size enough to remove catheter?

[Back2future]

I am one of those unlucky ones after biopsy I was not a candidate for RP due to my high GS 10. As a result my uro didn't even want to recommend surgery since the PCa was already out of the prostate. As a result I am still wearing the foley catheter. But now am considering surgery to open the channel to allow me to void without catheter. Has anyone tried Aquablation?

[GP24]

Surgery to resolve obstruction of the urethra due to advanced prostate cancer is frequently done. So this would get you the RP you wanted in the first place. Look for a clinic which will do that for you.

[Tall_Allen]

Yes, hormone therapy will shrink your prostate over a few months. But sometimes the extra prostate tissue grows from the transition zone inward. There are several things you can do about it: prostatectomy, TURP, HoLEP, Rezum, Urolift, arterial embolization and aquablation. All of the whole-gland ablation techniques will work as well but are expensive and not covered by insurance. Within a year or two, I think the FDA will approve fexapotide triflutate injections for BPH:

prostatecancer.news/2020/04...

[Back2future in reply to Tall_Allen]

There are some insurances that cover it. Effective January 1, 2020 there is a new CPT for ultrasound guided transurethral ablation of prostate tissue for treating prostate cancer using thermotherapy with water vapor generated by high energy direct current.

[Patrick-Turner in reply to Tall_Allen]

The new fexapotide triflutate would be a good help to countless men whose main wish in life is to enjoy a good piss. And also to not be waken up 5 times a night to hobble out of bed to the WC in ensuite. Maybe a man falls asleep on the WC, wakes up cold, wishing life was better......Now talk about possible surgery just to make the prostatic urethra un-constricted is all very well, but only if the PG and its urethra within has not been given a pile of external beam RT.

I had a Gleason 9 with Nightmare diagnosis + prognosis in 2009, and had to wait 4 months before attempt at open RP. But Pca was well outside PG capsule, so uro would not remove PG and assigned me to immediate start of ADT which reduced swollen size of PG and allowed easier pee flow and less wake ups. 8 months after failed RP, I had 70grey EBRT, and ADT shrunk the size of PG so that target area for EBRT was much smaller so I suffered less side effects to rectum et all from the Xrays passing right through me. ADT held Psa down until 2016 when Psa went from nadir 0.08 in 2012 to about 6 in 2016.

I had 31grey salvation IMRT. 3 guidance beacons were inserted to PG to guide the Calypso IMRT machine. But the minor operation of injecting the beacons via 4mm dia needle through previously well radiated PG structure caused massive bleeding and a blot clot which blocked me up, so at 2am I had a catheter fitted, and docs were pissed off that this botch up had occurred, and my comment was that "Ya should have darn well known that making any type of surgical cut within radiation affected volume of flesh riddled with blood vessels was going to be a Big Problem"

I was first in Australia to have this type of salvation RT as described by a Dr Shultz in a 2011 AMCJ article. ( doctors magazine ) I have no idea if the Melbourne docs who did the job ever did the beacon procedure again. But over next 12 months, there was no evidence the extra 31Grey to PG worked any better than standard 70Grey EBRT I'd had in 2010 - which was not at all.

I also learnt by reading what else was said at hospital websites about EBRT / IMRT to PG and read that it had a 90% failure rate for Gleason scores 9 or above.

One man I met said he had same primary EBRT 70Grey + 2 years ADT, and he had nothing else, and he as fine after 10 years, so I would be too, but I just smiled, and said he just didn't know what a bastard my Pca was compared to his.

AFAIK, things that obviously antagonize but not kill Pca cells tend to stimulate Pca to mutate to become even more difficult to kill type of Pca.

But I digress. Fact to remember, beware any surgeon wanting to do some small little surgical procedure on any radiation affected areas; the blood vessels are permanently damaged, and small cuts which may stop bleeding within 2 minutes in normal non radiated tissue may take 10days to fully stop bleeding. This is what I found after my "install beacon procedure".

One other type of RT is BT, brachytherapy where perhaps 100 tiny radioactive gold pellets are deposited into a PG so that maybe 100Grey can be locally applied to PG without beam rays passing through bladder or bowel. Sometimes EBRT is also given to raise total RT to PG to a maximum of 160Grey, but total effect avoids more than small % of total being applied to rectum.

Usually 160Grey kills the Pca cells in PG, but it probably also kills more healthy cells and nerves, so years later a man is likely to be incontinent. I am fully continent despite 101Grey to PG and after 11 years. But if continence prosthetic devices cannot be fitted, a man may have a supra pubetic catheter fitted to bladder through a hole in pubic area skin below belly button, and a man can wear a bag to collect pee. This is prone to infection, but is far simpler than a much bigger op where bladder and PG and upper penile urethra is all removed, then both ureters from kidneys are joined and both terminated at a "stoma", ie a hole in left side lower abdomen flesh for plastic fitting and a bag. The outside skin joins to inside surface of ureters so there is a good seal to keep bacteria getting inside perineal volume. Internal surfaces of ureters are fairly sterile, soaked in a constant stream of pee.

I knew one man who had this. He didn't think EBRT, ADT, BT, or normal RP would work to prevent the Long Fight that so many men end up enduring with Pca. The big operation was a success, cost a lot, and he luckily did not have any met spread before having 1kg of his lower inner guts all removed.

Very few have the Big Op. Its like so few women get both breasts removed even with a "little bit" of Brca diagnosed in only one breast. From little things, big things grow, and one sister of mine didn't hesitate to be-breast herself at about 64. She also had anti estrogen therapy for 5 years, but at 76 she's OK now, but she most certainly is shy about anyone seeing her naked.

There are about 50,000 Australians who wear a pee bag, and quite a few also wear a poo bag, due to trauma to bowels or rectum. My friend to just has a 1 litre pee bag can have a long time between pees, and when he pees by opening a valve and squeezing bag with elbow, he pisses just like a horse, its all out in 10 seconds, so he gets a whole pile of lifetime not spent in toilets.

His wife loves him, both gave up having any kind of sex many years before they began having all this trouble with body plumbing.

It was another nice autumn Sunday here in Canberra Down Under.

All the best everyone!

Patrick Turner.

[Back2future in reply to Patrick-Turner]

Thank you for sharing. I just started ADT this month and did not have any EBRT / IMRT or RP to PG or anywhere else. I suspect you did not have a catheter before your biopsy. In my case fexapotide triflutate would not apply since I have APCa not BPH. However, the downside of aquablation seems to be bleeding for several days or weeks.

[RayF]

I hated the foley catheter. I asked if I could self-catheter, and have been doing so for over two years. I've never had an infection, it's mostly a non-issue for me. If you'd like more info, feel free to message me.

[Back2future in reply to RayF]

Thank you. I tried doing self cath with different sizes @ uros office and I just couldn't do it. I think the blockage was probably more than yours.

[RayF]

Edit: in regards to your first question, when I started treatment I could pass virtually nothing. After 6 months I could pass maybe 20-30% when my bladder is full, that is still the situation.

[Back2future in reply to RayF]

Thank you. This is what I expected. It just won't be enough so I will look at some type of surgery to remove the blockage. I don't mind if I use the catheter for a few weeks after. Seriously looking at aquablation. But there are only few places in US with lots experience.

[RonnyBaby]

TURP ! I had one and it worked quickly - I had a catheter for 4 months - so I should know.

They'll likely try radiation and some ADT combo - the prostate will shrink eventually, but not soon enough to give you the relief you seek.

The UTIs alone made my experience very infuriating - you'll pee like a racehorse again.

YEARS later, after my TURP, I still pee just fine thank you !

[Back2future in reply to RonnyBaby]

Thank you for sharing. I am getting close to 4 months. Why did you go with TURP? some risks include incontinence, retreatment, etc. How long did surgery last and how long did you wear catheter after surgery. When did the bleeding finally stop? What % of the PG did they remove? did your PSA drop after surgery? Any incontinence?

[RonnyBaby in reply to Back2future]

The risks are overrated IMO.

I stopped (minimal) bleeding in a matter of days.

The catheter was removed in two weeks OR less if I recall correctly.

To me it was the perfect solution and I had / have NO side effects other than the UTIs that used to plague me.

The UTIs stopped as well once the catheter was removed - we finally put the 'hell' out to pasture.

I would seriously pursue this solution ASAP. I have read about many others who had excellent results - the problematic ones are far fewer than the success stories. You'd think that 'cutting' a passage would seem surreal - but I barely bled at all.

I was aware that 'something' had happened down there and there was a bit of discomfort when I began the 'piss like a racehorse' but that went away relatively quickly.

I would do it again in a heartbeat!

Wishing you the best on your journey .....

[Back2future in reply to RonnyBaby]

Did you have BPH or PCa? With HOLEP, Aquablation, and others the carved tissue goes temporarly in the bladder then it gets flushed. I want no cancer cells sitting in my bladder.

[RonnyBaby in reply to Back2future]

I had BOTH - but Dx showed a G9 'enlarged' prostate with multiple lesions - it was about the size of a large lemon - I ended up with RT and ADT, but the TURP was very early in the treatment to relieve my 'agony'. I had the TURP before they started RT and there was NO issue with flushing cells into the bladder - I have no idea where you got that from - certainly NOT anything associated with a TURP as far as I know.

I stick to my guns - I don't understand why you think a TURP is so 'dangerous' and risky - where are getting your information from ? Makes NO sense to me .....

[monte1111]

I used to agonize trying to pee. I found an Ibuprofen a little before bedtime helped. Things were much better after the first chemo. Over four years, the hourly pee breaks are now down to about two a night. I'm sure j-o-h-n would be happy to piss on my grave.