My uncle - diagnosed with prostate cancer approximately five years ago - developed a urinary blockage shortly after a recent surgery for double hernias. I am inquiring about the laser procedure that is being proposed to clear this blockage and about alternate laser treatments.
As background, my uncle - who is elderly - chose to treat the initial occurence of cancer with testicular removal. During prepatory blood work for his recent hernia surgery, his PSA was detected in elevated condition at around 34. Based on this the doctors think he has a recurrence of the prostate cancer. A bone scan did not show any spread of the cancer to the bone. The urologist who was brought in after he developed a urinary blockage is proposing to do a laser procedure to clear away a path to the bladder. The proposed procedures were:
- laser vaporization of the prostate
- placement of a super-public catheter
My first question is would it be a common practice to vaporize part of the prostate before there is even a confirmation about what is the cause of the blockage? The doctor seems to be taking a "blast away first, ask questions later or during procedure" approach. Is there any sense here in doing just the cystoscopy and possible biopsy to better characterize the blockage, then do the laser procedure later? I'm interested in knowing both what is common practice, and also what is a reasonable request for the patient to be making.
Second, if the blockage is in fact being caused by a recurrence of cancer in the prostate, and the laser procedure is the appropriate treatment, then my question is are there any urology centers on the West Coast of the U.S. who are using the new Holmium Laser Ablation of the Prostate (HoLAP) procedure? Is this procedure approved by the FDA in the U.S.?
My understanding is that there are three different laser procedures in common use:
a) VLAP technique that uses the Nd:YAG laser
b) Photoselective Vaporization of the Prostate (PVP) with the GreenLight (KTP) laser
c) HoLAP procedure.
The supposed advantage of the newer HoLAP procedure is that it has a lower penetration depth of <0.5mm and thus avoids complications of dead tissue caused by the other procedures that reach down about 2.0mm.
My uncle will probably want a second opinion, but I'm hoping to get some technical enlightment here about what issues we should be caring about and what questions we should be asking, both of which might help us to identify the right urologist for the second opinion.