What HoLEP Fixed — and What It Didn’t

The Procedure Worked

Eight years before I was diagnosed with aggressive prostate cancer, I had surgery on my prostate.

And it worked.

I was dealing with benign prostatic hyperplasia—BPH—an enlarged prostate that had begun interfering with everyday life.

Urinating had become difficult.

I was getting up multiple times during the night.

My prostate had simply become too large, and the symptoms were affecting both my sleep and my quality of life.

The procedure was called HoLEP: holmium laser enucleation of the prostate.

In my case, it made an enormous difference.

I could urinate better.

I could sleep better.

The symptoms that had been interfering with my life improved dramatically.

From my perspective, HoLEP was a success.

That part of this story is important.

Because what happened years later does not change the fact that the procedure successfully treated the problem I had at the time.

Somewhere Along the Way, I Started Believing Something Else

The procedure worked so well that eventually I stopped thinking very much about my prostate.

That seems perfectly reasonable when I look back on it.

You have a problem.

You undergo treatment.

The treatment works.

You move on.

That is what we are supposed to do.

I wasn’t waking up every morning wondering whether something else might eventually happen inside my prostate.

My urinary symptoms were dramatically better.

The chapter felt finished.

Somewhere along the way, however, I think I quietly translated:

My prostate problem was fixed.

into:

I’m done worrying about my prostate.

Those are not the same statement.

Eight Years Later, the Story Changed

Eight years after that successful procedure, I was diagnosed with aggressive prostate cancer.

Gleason 9.

Grade Group 5.

Ultimately, Stage 4A prostate cancer.

That was not remotely the prostate story I thought I was going to have.

I had spent years thinking of the earlier surgery as the end of my prostate problems.

Instead, my prostate would eventually become part of one of the defining stories of my life.

But I want to make something very clear:

HoLEP did not cause my prostate cancer.

And this is not a story about a procedure that failed.

HoLEP treated my enlarged prostate.

Prostate cancer was a different disease and a different conversation.

HoLEP and Radical Prostatectomy Are Not the Same Thing

I think this distinction is worth explaining because the word prostate surgery can make things confusing.

When I underwent HoLEP, the goal was to relieve the urinary obstruction caused by BPH.

Tissue causing that obstruction was removed.

But HoLEP is not the same operation as a radical prostatectomy performed for prostate cancer.

Years later, when I was diagnosed with cancer, my prostate would ultimately be removed through radical prostatectomy.

Those procedures happened for two entirely different reasons.

That sounds obvious to me today.

I’m not sure I appreciated the distinction nearly as much after my HoLEP.

The Part I Wish I Had Understood Better Was PSA

PSA eventually became one of the most important lessons of my cancer story.

For years, I tended to think about PSA almost like a smoke detector.

High number?

Alarm.

Number that doesn’t look especially high?

Everything must be okay.

Simple.

Except my experience taught me that PSA wasn’t that simple.

Especially after I had already undergone a procedure that removed a significant amount of prostate tissue.

What I eventually wished I had focused on more was not simply:

What is my PSA today?

I wish I had also been asking:

What is my PSA doing?

One Dot Didn’t Tell the Story

Think about a graph.

If I show you one dot, there isn’t much of a story.

It is simply a point.

Now add another.

And another.

And another.

Suddenly you no longer have isolated dots.

You have a line.

A direction.

A trend.

That became incredibly important in my journey because my PSA wasn’t necessarily screaming at us with one enormous number.

It was more subtle.

It was moving.

And numbers that move gradually can be psychologically reassuring because each individual result may not look particularly frightening when viewed alone.

The Number Was Below 4.0

One of the results that bothered me was a PSA of 3.706.

Someone looking only at a commonly recognized cutoff might have seen that number and felt reassured.

But I had something else available to me:

my history.

Compared with where my PSA had previously been, the number did not feel normal to me.

The direction bothered me.

I was told the next PSA could wait until April.

I asked for another one sooner.

I wanted it repeated in November.

That decision is one of the moments I return to often when I talk about being an active participant in your own care.

I wasn’t diagnosing myself.

I wasn’t declaring that my doctor was wrong.

I had a question.

The number looked different from my history.

I wanted more information.

So I asked for it.

This Is What “Ask One More Question” Looks Like in Real Life

Sometimes patient advocacy sounds complicated.

It doesn’t always have to be.

Sometimes it is simply saying:

Can you help me understand why we’re comfortable waiting?

Or:

How does this PSA compare with my previous results?

Or:

Does my previous HoLEP change the way you interpret this number?

Those are not accusations.

They are questions.

And questions belong in healthcare.

I Am Not Anti-Doctor. I Am Pro You.

I say this often because I don’t want the message behind my story misunderstood.

I am not suggesting that patients replace medical expertise with internet research or their own assumptions.

I am not saying every medical recommendation should be challenged.

And I am certainly not saying my experience should become somebody else’s treatment plan.

Doctors treated the problem that was in front of us when I had HoLEP.

That problem was BPH.

The procedure worked.

What I have learned since is that my voice still belonged in the conversation.

Medical expertise and patient participation do not have to compete with one another.

They should work together.

Eventually, We Needed More Answers

At some point, watching and questioning led to needing more information.

That eventually led to a prostate biopsy.

And the biopsy changed everything.

Gleason 9.

Grade Group 5.

Aggressive prostate cancer.

Later, surgery gave us even more information.

The final pathology showed that the disease had extended beyond the prostate.

There was seminal vesicle involvement.

There were positive surgical margins.

Cancer was also found in a lymph node.

The picture we had after surgery was much more serious than the prostate story I thought had ended eight years earlier.

Of Course I Have Asked Myself the “What If” Questions

Could we have found it sooner?

What if I had understood PSA after HoLEP differently?

What if I had looked harder at the trend?

What if I had asked another question earlier?

What if I had sought another opinion?

Those questions are easy to ask after you already know the ending.

I could spend the rest of my life living inside them.

But I cannot go backward.

And endlessly trying to rewrite the past does not help me.

More importantly, it doesn’t help the person reading this.

What I can do is take what I learned and hand it to the next person.

Three Things I Wish I Had Understood Better

1. Track the Trend, Not Just the Number

I still care about an individual PSA result.

But now I want context.

What was it last time?

What was it a year ago?

What does the pattern look like?

Has something changed?

And given my own medical history, what does my healthcare team think that change means?

A number without context tells me much less than a number with history.

2. A Successful BPH Procedure Is Not a Cancer-Free Pass

This is especially important to me because I don’t want someone reading this to misunderstand my story.

HoLEP worked extremely well for me.

Having HoLEP does not mean somebody is destined to develop prostate cancer.

My story is my story.

But I also would not personally treat a successful BPH procedure as a reason to stop having conversations about prostate health.

If I were having that conversation today, one of my questions would be:

I’ve previously had HoLEP. How should that history affect the way we interpret my PSA and monitor me going forward?

3. Ask One More Question

If you’ve spent much time around Jonesing For The Journey, you knew this one was coming.

Ask one more question.

What does the number mean?

How has it changed?

Why are we comfortable with it?

What would make us concerned?

Is there any other information that would help?

When should we check it again?

What don’t I understand yet?

Your voice does not replace your physician’s expertise.

Your voice belongs in the conversation alongside it.

Fear and Vigilance Are Not the Same Thing

There is another side of this story that matters.

I do not want someone who had HoLEP several years ago to read this article and immediately assume prostate cancer must now be growing inside them.

That is not the message.

I do not want men afraid of every PSA result.

I want them informed enough to have a useful conversation with their healthcare team.

Fear says:

Something terrible must be happening.

Vigilance says:

I’m going to pay attention.

After everything I have been through, I will choose paying attention.

Questions I Would Ask After HoLEP Today

If I could sit down with the version of myself who had just completed HoLEP, these are some of the questions I would want him to ask:

1. What should I expect my PSA to do after this procedure?

2. Once things settle after surgery, what will we consider my new baseline?

3. How often should my PSA be checked based on my age, history, and individual risk?

4. What type of change in my PSA would make you want to look more closely?

5. Should we evaluate the trend rather than relying on one result?

6. How does having had HoLEP affect the way you interpret future PSA results?

7. Are there other parts of my personal or family history that change how I should be followed?

8. If the number starts changing, what would the next step be?

9. What question am I not asking that you think I should understand?

The Lesson Wasn’t That HoLEP Failed

I want to return to this because it is the most important distinction in the article.

HoLEP did not fail me.

It treated the problem it was intended to treat.

My urinary symptoms improved dramatically.

My quality of life improved.

Years later, a different prostate problem entered the story.

The lesson isn’t:

Don’t have HoLEP.

The lesson is:

Understand what a treatment fixed—and understand what still deserves to be followed afterward.

The Bigger Lesson Was About Information

Cancer taught me how dangerous it can be to look at information in isolation.

One PSA result.

One scan.

One pathology finding.

One symptom.

One doctor’s opinion.

Each one may be important.

None necessarily tells the entire story by itself.

I want the history.

I want the trend.

I want the context.

And when something doesn’t make sense to me, I want to ask about it.

What I Hope You Take From This Mile Marker

If you have had HoLEP—or another procedure for an enlarged prostate— my story is not a prediction of yours.

It is one patient’s experience.

What I hope you take from it is much simpler.

Know what your procedure was intended to fix.

Know what follow-up your healthcare team recommends.

Keep your test results.

Know your history.

Pay attention to the trend.

And when something looks different from what is normal for you, ask about it.

Not out of panic.

Not because every change means cancer.

Because paying attention gives you the opportunity to ask an informed question.

Eight years ago, I thought my prostate chapter was finished.

Today I understand it differently.

HoLEP fixed what it was supposed to fix.

What it didn’t fix was my responsibility to keep paying attention.

Watch My HoLEP Story

I tell this story in more detail in the video below, including how my thinking about PSA changed and the three things I wish I had understood better after HoLEP.

I Thought I Was Done With Prostate Issues — I Was Wrong
Watch on YouTube

And So…The Adventure Continues.