Doctor Marawan El Tayeb, a urologist at Baylor Scott & White and the chief of urology at Baylor Scott & White in Temple, Texas, talks about HOLEP Treatment for Prostate Cancer.
Interview conducted by Ivanhoe Broadcast News in November 2021.
Can you talk about how serious of a problem it is that men battle with their prostate?
DR TAYEB: Yeah, sure. Prostate problems can be serious. It starts with mild symptoms in terms of hesitancy, difficulty urinating, having to push when you urinate, having to strain when you urinate, intermittency stopping and going. And it can progress into urine retention and complete inability to urinate. And after that, it can progress to renal failure if not treated appropriately.
Are the numbers of men being impacted by these issues with their prostate increasing? If so, why?
DR TAYEB: Yeah. So, we see it now more often because people live longer. From the data, 60% of men at 60 years of age will be having symptoms of enlarged prostate or benign prosthetic hyperplasia, and it can go up to 80% by the age of 80. And now with a medical treatment, the prostate continues to grow and when the prostate continues to grow, the symptoms gets worse with age.
How many men do you see on a day-to-day basis who come in for an enlarged prostate or it probably varies, but if you were to guess how many men a day you see who have issues with an enlarged prostate?
DR TAYEB: I see between 24 to 30 patients daily, and 70% of these patients has enlarged prostate, symptomatic, enlarged prostate in terms of the upcoming for the treatment.
What is an enlarged prostate and what causes it?
DR TAYEB: So, enlarged prostate is increasing the size of the prostate above normal. Normal size of prostate is between 15 to 25 cc, cubic centimeter, and any size above that is an enlarged prostate. Now, it is different from the pathology, which is benign prosthetic hyperplasia versus prostate cancer, because enlarged prostate can be due to just benign prostatic hyperplasia, which is a benign enlargement of the prostate, which is normal. And it can be due to prostate cancer, which affects 1 in 6 men in the United States.
Would you say it’s dangerous as the prostate gets larger, it can have an impact on the quality of life of men?
DR TAYEB: That’s correct.
Awesome. So, what is BPH?
DR TAYEB: BPH is benign enlargement of the prostate. And it can be detected as early as 30 years of age; however, it started being symptomatic or causing problems, usually by the age of 45 to 50 in some men, and it can be pretty significant at older age.
So, are all enlarged prostates due to BPH or no?
DR TAYEB: So, it can be due to BPH or it can be due to prostate cancer. So that’s why it is very important to get a PSA test and possible biopsy if the PSA is elevated.
What are some of the main symptoms of an enlarged prostate?
DR TAYEB: Main symptoms of enlarged prostate are difficulty urinating, having to push when urinating, stopping and going, so the stream stops middle stream, having to wake up at night, having to push when you urinate, slow stream, frequency, going very frequent to the bathroom, and urgency.
And this really can, I guess, impact a man’s life quality. It’s just an inconvenience.
DR TAYEB: Yes, it can impact the man’s quality of life first. But if left untreated, it can lead to urine retention and worsening of renal failure, acute renal failure.
What’s available to help treat enlarged prostate, whether BPH or prostate cancer?
DR TAYEB: So, for enlarged prostate due to BPH, there are multiple treatment modalities. If the symptoms are bad enough for the patient want to do something about it, we usually start with medical treatment in the form of tablets or capsules, and that usually helps with most of the patients. If the medical treatment is not working, then we progress to minimally invasive surgeries. And minimally invasive surgeries and procedures can vary from urolift, which is putting the stables inside the prostate, just push it out of the way or resume, which is injecting water vapor into prostate and steam it, or transect a section of the prostate, or one of the most advanced treatments is a HoLEP, which is Holmium Laser Enucleations of the prostate for bigger sized prostates or smaller sized prostate.
Walk us through what HoLEP is and how is the treatment utilized?
DR TAYEB: Holmium Laser Enucleation of the prostate or HoLEP is basically, if you can imagine the prostate like an orange with the peel outside and the fruit inside. Basically, we go around the fruit, taking it out of the peel and leave the patient with a very nice open channel for him to urinate through. It is an outpatient surgery, so 70% of the patients will leave the hospital same day. About 10% will have the catheter removed the same day, and about 95% will have the cancer to remove the following day.
So, who’s a good candidate for this, again? For this procedure?
DR TAYEB: Any man with enlarged prostate is a good candidate for a HoLEP if he elects to go for the minimally invasive surgery.
Does this particular form of treatment work for everyone who have an enlarged prostate?
DR TAYEB: It works for everyone. However, there are some indications that it will work less efficiently, like patients with a smaller size, very small sized prostate, however, they still have obstruction. Then there are other modalities that may work better for these patients.
What is the recovery time from this for the whole procedure?
DR TAYEB: Pretty quick. So, we advise the patients don’t lift anything more than 10 pounds for two weeks. However, they can resume their normal activities like, they can walk, they can walk fast, they can go back to the golf course as long as you are not going to lift anything more than 10 pounds. So, if I do the surgery on a Monday to Thursday, patient can play golf on a weekend.
How long does it take to get the benefits or feel the benefits, if you will, after the whole procedure?
DR TAYEB: Immediately. Patients will feel the benefit as soon as the catheter comes out. They will start feeling that they are urinating much better, the stream is much better, and they will feel immediate benefit.
Does this procedure need to be repeated at all or is this a one-time procedure that’s necessary for men?
DR TAYEB: Very rare. From the data, two in every thousand patients will have a recurrence, so the risk of repeating it or needing re-treatment is very, very rare.
What are the risks and complications?
DR TAYEB: Very low risk profile, if you would say. Three percent risk of bleeding and blood transfusion, about 2% of infection, about 1% of long-term incontinence, as it would be a transient incontinence, but 99% of the patients will recover from that based on their age group. The risk is a little bit higher in older folks, which reaches up to 3%, but the risk is very low overall.
Most of the patients that you deal with, are their symptoms generally the same in terms of what their experience in which they would need this procedure?
DR TAYEB: The symptoms vary quite a bit. Some patients present with mild symptoms, like a weak stream, interruption of the urine stream, going frequently at night. And some other patients present with more severe symptoms, like complete shutdown, urine retention, need to go to the emergency room. And worst-case scenario patient presents with urine retention that has been going on for a few days that led to an acute renal failure. After the surgery, patient will usually go home same day and then have the catheter removed either same day or the following day, based on how they are doing and their specific clinical condition. I don’t have anything else.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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