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Medical Forum / Diseases and Disorders / Prostate BPH / September 2004gold standard vs new kid on block
TURP is called the "gold standard" for 50 years. If you have a really skilled expert doing it, is the TURP better than the "green light" laser, PVP? As far as I can tell, PVP burns away tissue instead of scraping it away, but it is the final result that is meaningful. In the old days, people would make a canoe from a tree in two ways: chipping out the center, or burning it out with fire. >TURP is called the "gold standard" for 50 years. >If you have a really skilled expert doing it, [quoted text clipped - 6 lines] >tree in two ways: chipping out the center, or burning >it out with fire. All are TURPs - nominally Transurethral Resection of the Prostate T Trans U Urethral R Resection P Prostate Altough factually, the process is primarily intended to open up the passage from the bladder to the outside world. The differences between the burning and cutting involves several differences. 1. The burning process is inherently self-sealing and so is a touch less traumatic > TURP is called the "gold standard" for 50 years. > If you have a really skilled expert doing it, [quoted text clipped - 8 lines] > > I refused point blank to have a TURP especially because of the stiff catheter and 4 days in hospital ......had PVP and walked out of the hospital 4 hours later and enjoyed the afternoon in the garden that was 13months ago no regrets >> TURP is called the "gold standard" for 50 years. >> If you have a really skilled expert doing it, [quoted text clipped - 8 lines] >> >> I refused point blank to have a TURP SNIP >.had PVP SNIP How does one get through to you guys ?? YOU HAD A TURP YOU HAD A TURP YOU HAD A TURP >that was 13months ago no regrets > >> TURP is called the "gold standard" for 50 years. > >> If you have a really skilled expert doing it, [quoted text clipped - 19 lines] > > YOU HAD A TURP Calm down. To avoid confusion, in this newsgroup, we are using the term PVP to describe a TURP performed with the GreenLight laser. It's easier to remember and is only 3 letters to type. While the PVP procedure may be a TURP from a surgical definition standpoint, it is very different from a traditional TURP in terms of recovery period. >>>>TURP is called the "gold standard" for 50 years. >>>>If you have a really skilled expert doing it, [quoted text clipped - 28 lines] > TURP from a surgical definition standpoint, it is very different from a > traditional TURP in terms of recovery period. My urologist told me before my PVP that he did TURP as well as PVP, and considered them about equal in effectiveness. He apparently makes the same "mistake" (thinking that the two are different) as a lot of us do. I've had both, and there's a real difference. <snip> > > Calm down. To avoid confusion, in this newsgroup, we are using the term PVP > > to describe a TURP performed with the GreenLight laser. It's easier to [quoted text clipped - 6 lines] > same "mistake" (thinking that the two are different) as a lot of us do. > I've had both, and there's a real difference. So which one was better? > <snip> > [quoted text clipped - 16 lines] > > So which one was better? The PVP (done March 2004) was much, much easier. Essentially no pain involved, only about six hours in the hospital, less than 24 hours catheterized, and quick recovery. The improvement after PVP took a couple of weeks to become obvious, but has so far been quite satisfactory. I do find that occasionally the symptoms (slow stream, frequency getting up at night) return; usually accompanied by upset digestion, so probably related to "something I ate." The TURP (done in 1989, 3 days in hospital, catheterized most of that time) involved a fair amount of pain, some (lower back) probably due to the spinal injection. Recovery took weeks, and much of the improvement I had experienced disappeared when the clot dissolved. I would never have the traditional TURP again, and had been putting up with the symptoms until I found out about PVP. The only way in which TURP could be considered better was that it didn't cause retrograde ejaculation, and PVP did. Not a concern for me, but maybe for some. > > <snip> > > [quoted text clipped - 33 lines] > be considered better was that it didn't cause retrograde ejaculation, > and PVP did. Not a concern for me, but maybe for some. Thanks for your info. My doc says 1 night in hosp. for conventional TURP, he does not do PVP -- my guess is that his success with conventional TURP is so good he doesn't see the reason to change to or add PVP to his toolkit. Anyway, for me his is recommending either Indium Laser or Microwave treatment instead. My feeling is that Indium or Microwave is much less risk and it keeps my options open. Look at it this way. Ten years ago there were about 200,000 TURP done per year in the US. In 2004, about 40,000 PVPs done and about 40,000 TURPs will been done. By 2007 there will be about 80,000 PVPs done annually in the US and 0 TURPs. The new technology will take over the old in roughly 5 years. Patrick > > > <snip> > > > [quoted text clipped - 42 lines] > instead. My feeling is that Indium or Microwave is much less risk and it > keeps my options open. > Look at it this way. > [quoted text clipped - 7 lines] > > Patrick Ya, my doc said that the young doctors are not getting experience with the traditional TURP and expects that it won't be very long before you have to seek out an older doctor if you want one. > > > > <snip> > > > > [quoted text clipped - 48 lines] > > instead. My feeling is that Indium or Microwave is much less risk and it > > keeps my options open. Why anyone would chose a traditional TURP over PVP today is beyond comprehension. > > Look at it this way. > > [quoted text clipped - 74 lines] > > > instead. My feeling is that Indium or Microwave is much less risk and it > > > keeps my options open. > Why anyone would chose a traditional TURP over PVP today is beyond > comprehension. Doesn't it depend on the skill of the doc? If the doc has more experience with traditional TURP than PVP I should think that s/he would do a better job with what they know best. Of course there is more blood with traditional, but so what? Another lame analogy: When you sit down at the kitchen table with the kids to make a jack-o-lantern on haloween, you clean out the pumpkin with a spoon -- or do you use a blowtorch. > > > Look at it this way. > > > [quoted text clipped - 83 lines] > it > > > > keeps my options open. Yes the skill of the surgueon matters in both TURP and PVP. But put a PVP laserscope in the hands of a good surgueon and he will create a channel through the prostate with a far less trauma that with the electro cutting loop of a TURP. Fact are that traditional TURPs are no longer taught in medical schools in this country. Fewer and fewer are done each year. Medications and alternative therapies like TUNAs and TUMTs and now PVP have resulted in the number of TURPs in recent years to be drastically reduced. And rightfully so. TURPs are far too trauma to the patient and have considerable risks that are not there with alternative therapies available today. PVP vs. TURP is no longer subject to debate. In 2005, in the US, the number of PVPs will exceed the number of TURPs. Now that Medicare is on the bandwagon, a surgueon will have to justify why he is doing a TURP instead of the far less invasive and less costly PVP. The question that remains in the treatment of BPH is what to do next after medications are no longer effective. Some would say try a TUMT first then go on to PVP, others would just go to PVP directly and as soon as necessary. But the debate is over. At the end of this year PVP will be the "gold standard". I am glad that my large median-lobe BPH was removed with one of the first PVPs instead of one of the last TURPs. Patrick > > Why anyone would chose a traditional TURP over PVP today is beyond > > comprehension. [quoted text clipped - 105 lines] > > it > > > > > keeps my options open. >Why anyone would chose a traditional TURP over PVP today is beyond >comprehension. SNIP Could it be that it is because your comprehension is very limited ? Please tell me a reason why today in United States, a person with BPH would chose to have a traditional TURP over a PVP? > >Why anyone would chose a traditional TURP over PVP today is beyond > >comprehension. > SNIP > > Could it be that it is because your comprehension is very limited ? >Please tell me a reason why today in United States, a person with BPH would >chose to have a traditional TURP over a PVP? One reason only ? OK, let me explain the main, overiding reason . I qualify this reason because there are some situations other reasons can become significant. In my opinion, the main reason for a patient to choose to have a traditional TURP rather than any other procedure, whether that be an alternative form of TURP or some other procedure, is because he has been advised by his urologist to do so. In my opinion, the advice of somebody who has been selected for ability and aptitude, coupled with a minimum of 8 - 10 years of experience and training, coupled with a familiarity with the condition of that individual patient far outweighs the advice from the typical contributor to this NG who is likely to be either a shill or some bewildered old man who's only argument, however enthusiasticly expressed, is that "it worked for me therefore it will work for you". Regards Okay, I agree with you that if today in the US, half of the men needing surgury to treat BPH are getting TURPs (about 40,000 in 2004) and the other half are getting PVPs (the other 40,000), being in the TURP group is probably because they trust an "old" urologist's tried and true method. But in two to three years, there will be few if any TURPs being done in this country (as I believe Medicare and Insurance companies will stop paying for it because of the costs involved). Would you still want to chose to be in that small group that holds on to the old techniques? > >Please tell me a reason why today in United States, a person with BPH would > >chose to have a traditional TURP over a PVP? [quoted text clipped - 21 lines] > > Regards Patrick, where are you getting this 40,000 figure for PVPs in 2004? It doesn't seem to jive with the number of doctors performing PVP according to the website. If I put in my zipcode, the 10 listings that come up cover a radius with a population that probably exceeds 20,000,000 people. If we call that 6.5% of the US population, that means those 10 doctors have to average 260 PVPs each per year. That sounds like an awful lot. Lee > Okay, I agree with you that if today in the US, half of the men needing > surgury to treat BPH are getting TURPs (about 40,000 in 2004) and the [quoted text clipped - 35 lines] >> >> Regards Lee, I got the 40,000 figure for PVPs in 2004 from the last quarter Laserscope Quarterly report. In it they say that they expect to sell 40,000 disposable fiber in 2004. They sold about 9000 last quarter. As for the number of PVPs done, doctors like Dr. Te are doing five or six a day several days a week. Plus there are now 100s of doctors doing PVP in the US and 100s of Laserscope Systems out there working every day. Pretty big jump from 2002. Lee, how have you been doing? fine I hope. Regards, Patrick > Patrick, where are you getting this 40,000 figure for PVPs in 2004? It > doesn't seem to jive with the number of doctors performing PVP according to [quoted text clipped - 44 lines] > >> > >> Regards Patrick, Thanks for asking. After a thorough exam which revealed a rather small gland (21cc per the TRUS, he had estimated 30-35 from the DRE), 0 retention but a small median lobe, my uro said he didn't think a PVP would help. He put me on Detrol which didn't help. Now I'm on Ditropan which is helping a little but not dramatically. Daytime frequency is still more than I'd like though I only get up once per night. Not where I'd like to be but I've adjusted to the inconvenience and I can live with it. I see the doc again in December. Lee > Lee, > I got the 40,000 figure for PVPs in 2004 from the last quarter Laserscope [quoted text clipped - 24 lines] >> >> Lee > Okay, I agree with you that if today in the US, half of the men needing > surgury to treat BPH are getting TURPs (about 40,000 in 2004) and the other [quoted text clipped - 5 lines] > it because of the costs involved). Would you still want to chose to be in > that small group that holds on to the old techniques? Your reason is that it is cheaper????? There is an incentive to use cheaper methods, but I would hope the surgeon has the best interest of the patient in mind rather than what is cheaper. > > >Please tell me a reason why today in United States, a person with BPH > would [quoted text clipped - 22 lines] > > > > Regards It turns out that PVP is a more expensive procedure to perform due to the cost of the disposable fiber but when you add in the lower cost of post precedure hospital stay and less post procedure costs due to less side effects, the overall cost is significantly less with PVP over TURP (for Medicare and the insurance company). That is why Medicare approved higher reimbursements to doctors because the overall costs were lower. Hospitals and insurance companies have now gotten on the bandwagon so they are tracking patients to PVPs and away from TURPs. For once, the hospitals and insurance companies are pushing for something that is more benefical to the patient, i.e. the PVP procedure with less trauma to the patient. Patrick > > Okay, I agree with you that if today in the US, half of the men needing > > surgury to treat BPH are getting TURPs (about 40,000 in 2004) and the [quoted text clipped - 39 lines] > > > > > > Regards I had a traditional TURP and didn't spend any four days in the hospital. I was in overnight and sent home with a catheter which was removed the following day. That was six years ago, no regrets. Now having said that, PVP was not available then and if it was, I would certainly have considered it over the traditional TURP. Don in Tracy, Calif. > > I refused point blank to have a TURP especially because of the stiff > catheter and 4 days in hospital ......had PVP and walked out of the hospital > 4 hours later and enjoyed the afternoon in the garden > > that was 13months ago no regrets > I had a traditional TURP and didn't spend any four days in the hospital. I > was in overnight and sent home with a catheter which was removed the > following day. That was six years ago, no regrets. Now having said that, > PVP was not available then and if it was, I would certainly have considered > it over the traditional TURP. My doc says 1 overnight in hosp also. So other than less bleeding, what makes people think PVP has a better outcome than traditional TURP. > Don in Tracy, Calif. > [quoted text clipped - 4 lines] > > > > that was 13months ago no regrets >> I had a traditional TURP and didn't spend any four days in the hospital. >I >> was in overnight and sent home with a catheter which was removed the >> following day. That was six years ago, no regrets. SNP >My doc says 1 overnight in hosp also. So other than less bleeding, what >makes people think PVP has a better outcome than traditional TURP. > >> Don in Tracy, Calif. Those people who believe that PVP has a better outcome than a traditional TURP are in a minority - a very small minority who dwell within the limits of this NG and/or are have commercial interests. Outside of this small group, the medically informed opinion is that the traditional TURP has overall, a superior outcome, albeit only a small one. On the other hand, informed opinion is that the PVP procedure has a less traumatic effect on the patient - but again - only by a small margin. Choice between these, and other surgical procedures, would be very difficult except that the traditional TURP provides an important additional benefit which is totally absent from PVP. This is the provision of tissue which can be used to check for the presence of prostate cancer. This alone saves thousands of men from suffering a very unpleasant end . Regards Having a TURP to check for prostate cancer is just plain dumb. If prostate cancer is suspected a biopsy should be performed BEFORE a PVP or a TURP. I would be very upset with my doctor if he told me AFTER a TURP that I had prostate cancer. Prostate cancer is something that should be checked for BEFORE going for prostate surgury. Patrick > >> I had a traditional TURP and didn't spend any four days in the hospital. > >I [quoted text clipped - 27 lines] > > Regards >Having a TURP to check for prostate cancer is just plain dumb. SNIP Agreed. Have you found somebody who does recommend this, if so do please tell who and where. >t the traditional TURP provides an important >> additional benefit which is totally absent from PVP. This is the >> provision of tissue which can be used to check for the presence of >> prostate cancer. This alone saves thousands of men from suffering a >> very unpleasant end . Unfortunately, medical diagnosis and detection is not an exact science and some prostate problems are wrongly diagnosed as being benign. I suggest that if you find this difficult to comprehend then read a book on the subject - if you have one. If you haven't one then ask a friend - if you have one. Regards you said: "the traditional TURP provides an important additional benefit which is totally absent from PVP. This is the provision of tissue which can be used to check for the presence of prostate cancer. This alone saves thousands of men from suffering a very unpleasant end" You are absolutely incorrect to say the detecting prostate cancer is an additional benefit of a TURP. It is not an additional benefit but a sign of a doctor's malpractice. A prostate biopsy BEFORE a TURP is the proper way of diagnosing prostate cancer. In 2004, to have a TURP without eliminating the possibility of Prostate Cancer beforehand using PSA test, free/total PSA test and a eight octant (24 sample) biopsy is irresponsible by both the person going for the TURP and the surgueon. And to say the finding prostate cancer AFTER a TURP "saves thousands of men from suffering a very unpleasant end" is completely false. It is PSA testing and biopsies that has detected prostate cancer early enough to "save thousands of men from suffering a very unpleasant end." not post-TURP pathology reports. Patrick > >Having a TURP to check for prostate cancer is just plain dumb. > SNIP [quoted text clipped - 17 lines] > > Regards Patrick: In my situation, with decent PSA results and normal DRE results, doctors have made no mention of a biopsy. I assume many have PVP WITHOUT having a biopsy first. Am I wrong? Mel > you said: "the traditional TURP provides an important > additional benefit which is totally absent from PVP. This is the provision [quoted text clipped - 38 lines] > > > > Regards If the doctors have no reason to suspect prostate cancer, i.e. your PSA is sable and not higher than the new age adjusted values, it is safe to preceed with a PVP. My point in the previous post was that examining for prostate cancer AFTER a TURP is not an advantage of TURP over PVP. It is a sign of neglect and malpractice. Checking for prostate cancer should be done BEFORE a TURP or PVP. Patrick > Patrick: > [quoted text clipped - 53 lines] > > > > > > Regards > If the doctors have no reason to suspect prostate cancer, i.e. your PSA is > sable and not higher than the new age adjusted values, it is safe to preceed [quoted text clipped - 5 lines] > > Checking for prostate cancer should be done BEFORE a TURP or PVP. If I have a mole removed, the doc always sends it out for testing to see if it is cancerous. > Patrick > [quoted text clipped - 58 lines] > > > > > > > > Regards Of course, but he is not just going to zap away at it if beforehand he suspects it to be cancerous. > > If the doctors have no reason to suspect prostate cancer, i.e. your PSA is > > sable and not higher than the new age adjusted values, it is safe to [quoted text clipped - 84 lines] > > > > > > > > > > Regards And your point??? Mel > > If the doctors have no reason to suspect prostate cancer, i.e. your PSA is > > sable and not higher than the new age adjusted values, it is safe to [quoted text clipped - 84 lines] > > > > > > > > > > Regards > If the doctors have no reason to suspect prostate cancer, i.e. your PSA is > sable and not higher than the new age adjusted values, it is safe to preceed [quoted text clipped - 7 lines] > > Patrick Not nescessarily "safe to proceed" with low PSA without a biopsy. Article from New England Journal of Medicine: "PREVALENCE OF PROSTATE CANCER IN MEN WITH PSA <4.0" Background The optimal upper limit of the normal range for prostate-specific antigen (PSA) is unknown. We investigated the prevalence of prostate cancer among men in the Prostate Cancer Prevention Trial who had a PSA level of 4.0 ng per milliliter or less. Methods Of 18,882 men enrolled in the prevention trial, 9459 were randomly assigned to receive placebo and had an annual measurement of PSA and a digital rectal examination. Among these 9459 men, 2950 men never had a PSA level of more than 4.0 ng per milliliter or an abnormal digital rectal examination, had a final PSA determination, and underwent a prostate biopsy after being in the study for seven years. Results Among the 2950 men (age range, 62 to 91 years), prostate cancer was diagnosed in 449 (15.2 percent); 67 of these 449 cancers (14.9 percent) had a Gleason score of 7 or higher. The prevalence of prostate cancer was 6.6 percent among men with a PSA level of up to 0.5 ng per milliliter, 10.1 percent among those with values of 0.6 to 1.0 ng per milliliter, 17.0 percent among those with values of 1.1 to 2.0 ng per milliliter, 23.9 percent among those with values of 2.1 to 3.0 ng per milliliter, and 26.9 percent among those with values of 3.1 to 4.0 ng per milliliter. The prevalence of high-grade cancers increased from 12.5 percent of cancers associated with a PSA level of 0.5 ng per milliliter or less to 25.0 percent of cancers associated with a PSA level of 3.1 to 4.0 ng per milliliter. Conclusions Biopsy-detected prostate cancer, including high-grade cancers, is not rare among men with PSA levels of 4.0 ng per milliliter or less levels generally thought to be in the normal range. So, are they now recommending that we just biopsy everyone??? I don't think so. Mel > > If the doctors have no reason to suspect prostate cancer, i.e. your PSA is > > sable and not higher than the new age adjusted values, it is safe to preceed [quoted text clipped - 43 lines] > milliliter or less - levels generally thought to be in the normal > range. > You are absolutely incorrect to say the detecting prostate cancer is an > additional benefit of a TURP. It is not an additional benefit but a sign of [quoted text clipped - 3 lines] > test and a eight octant (24 sample) biopsy is irresponsible by both the > person going for the TURP and the surgueon. Are you saying that you should have a biopsy even though the result of your PSA test is normal or only if higher than normal? Don What I am saying is that your doctor BEFORE doing a PVP or a TURP should do whatever is necessary to assure you and him that prostate cancer is not present in the prostate that will be operated on. Today this can be done with PSA testing (both regular and free/total) and/or a biopsy. Just going with a single PSA result is tricky and saying any result under 4.0 is good and over 4.0 is bad doesn't work. Such factors as age, race, and annual change in PSA level are very important. For example, Dr. Te insisted that I have a biopsy BEFORE my PVP. My PSA was 3.0 But he said at my age and race (43 caucasion) it should have been below 2.5 Also the year before my PSA it was 2.5 so he felt that it increased to much in one year (high PSA velocity) I had a 24 sample biopsy in all 8 octants of the prostate and the pathology report showed no evidence of prostate cancer so the PVP was done. The primary point in all this, is that all of this should be done beforehand, not waiting for a post-TURP pathology report as one poster said was an advantage of TURP over PVP. Patrick > > You are absolutely incorrect to say the detecting prostate cancer is an > > additional benefit of a TURP. It is not an additional benefit but a sign [quoted text clipped - 11 lines] > > Don > What I am saying is that your doctor BEFORE doing a PVP or a TURP should do > whatever is necessary to assure you and him that prostate cancer is not [quoted text clipped - 11 lines] > below 2.5 Also the year before my PSA it was 2.5 so he felt that it > increased to much in one year (high PSA velocity) Isn't it true that BPH symptomology can increase PSA just as Flowmax can decrease PSA? Also, what would you do if cancer was found? Not have the PVP? > I had a 24 sample biopsy in all 8 octants of the prostate and the pathology > report showed no evidence of prostate cancer so the PVP was done. [quoted text clipped - 22 lines] > > > > Don Liz: I assume if cancer was found, you would first and foremost have to stage it and then investigate the multitude of treatment options. I doubt if PVP would be done at that point mel > > What I am saying is that your doctor BEFORE doing a PVP or a TURP should > do [quoted text clipped - 51 lines] > > > > > > Don If cancer is found, all efforts shift to treating the cancer not the BPH. > > What I am saying is that your doctor BEFORE doing a PVP or a TURP should > do [quoted text clipped - 51 lines] > > > > > > Don > Isn't it true that BPH symptomology can increase PSA just as Flowmax can > decrease PSA? It was in my case. Prior to having a traditional TURP several years ago my PSA got as high as 17. It dropped back to 4 after TURP, which is where it was before the surgery. It continues to remain at 4. My doc said this was quite common. Don Nam: You have probably written 500 posts saying the same thing. I am real pleased for you that everything worked out. I have to say, however, that after perusing the totality of posts over a few years, none of the procedures in general are a walk in the park (except for a very few lucky ones like you and Patrick). All that being said, I have personally sought out a PVP doctor. When the time comes (hopefully "if," but most likely "when") I would absolutely choose the PVP over any other procedure. But my point is that your results were exceptional, not typical. Incidentally, I have been on flomax for MANY years now. While I psychologically HATE taking medicine, I have to say that I am one of the lucky few: it has worked VERY well with no side effects. Mel > > TURP is called the "gold standard" for 50 years. > > If you have a really skilled expert doing it, [quoted text clipped - 12 lines] > > that was 13months ago no regrets Mine was a walk in the park - and the results are miraculous. > Nam: > [quoted text clipped - 36 lines] >> >>that was 13months ago no regrets >TURP is called the "gold standard" for 50 years. >If you have a really skilled expert doing it, [quoted text clipped - 6 lines] >tree in two ways: chipping out the center, or burning >it out with fire. The "new kid on the block" is also described by many as being not a competitor for the title "Gold Standard" but a "Busted Flush". A "busted flush" is not treating bph and drowning on the river. PVP is the nut flush on the flop. > >TURP is called the "gold standard" for 50 years. > >If you have a really skilled expert doing it, [quoted text clipped - 9 lines] > The "new kid on the block" is also described by many as being not a > competitor for the title "Gold Standard" but a "Busted Flush". Are you guys using poker talk? > A "busted flush" is not treating bph and drowning on the river. PVP is the > nut flush on the flop. [quoted text clipped - 12 lines] > > The "new kid on the block" is also described by many as being not a > > competitor for the title "Gold Standard" but a "Busted Flush". |
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