For years, I thought that chapter was behind me.
I had undergone HoLEP surgery for an enlarged prostate. The procedure worked. My urinary symptoms improved dramatically. The tissue that was removed was examined, and no cancer was found.
From my perspective as a patient, that felt reassuring.
Problem treated.
Move on.
And I did.
Eight years later, I was diagnosed with aggressive prostate cancer.
That experience has changed the way I think about prostate health, PSA testing, and what it really means when a treatment is successful.
HoLEP Did What It Was Supposed to Do
I want to make something very clear.
My message is not that HoLEP failed me.
HoLEP is a treatment for benign prostatic hyperplasia, or BPH. It removes the prostate tissue that is obstructing urinary flow. The tissue removed during the procedure can also be examined by pathology for conditions including prostate cancer.
In my case, the procedure accomplished its purpose.
My urinary problems improved.
The pathology from the tissue that was removed did not show cancer.
That was good news.
The mistake I made was in what I allowed that good news to mean in my own mind.
I interpreted:
“No cancer was found.”
as something much closer to:
“Prostate cancer is no longer something I need to worry about.”
Those are not the same statement.
HoLEP Is Not the Same as Removing the Entire Prostate
This is the distinction I wish I had understood more clearly.
A procedure for BPH removes obstructing prostate tissue. It is not the same operation as a radical prostatectomy performed to treat prostate cancer.
Prostate tissue remains after procedures used to treat an enlarged prostate, which means PSA does not necessarily disappear. Mayo Clinic notes that after partial prostate removal, PSA levels can later rise for several reasons, including remaining benign prostate tissue or prostate cancer.
That seems obvious to me today.
It did not seem obvious to me then.
And that is exactly why I am talking about it now.
A Negative Pathology Result Was Good News — But It Was a Snapshot
The tissue removed during my HoLEP showed no cancer.
I am grateful for that.
But I now think of that result differently.
It told me what was found in the tissue that was examined at that point in time.
It wasn’t a lifetime guarantee.
Research also shows that prostate cancer can be found incidentally in tissue removed during HoLEP, and PSA monitoring after HoLEP has specifically been studied as part of continued prostate-cancer surveillance.
Again, this does not mean HoLEP causes prostate cancer.
It does not mean a negative HoLEP pathology report is meaningless.
And it certainly does not mean men should avoid a procedure their doctors believe is appropriate for treating BPH.
My takeaway is much simpler:
A successful treatment for one prostate condition does not necessarily eliminate the need to continue paying attention to the prostate.
The Number Matters. The Trend Matters Too.
One of the biggest changes in how I look at PSA today is that I no longer see it as a simple pass/fail test.
I used to think of PSA almost like a smoke detector:
High number equals danger.
Normal number equals safety.
Simple.
My experience taught me that prostate cancer isn’t always that simple.
Today I want to know:
What was my PSA last time?
What was it before that?
Is it changing?
How quickly?
Does that change make sense given my history?
And if something doesn’t make sense:
Why?
That doesn’t mean diagnosing yourself from a laboratory report.
It means being an active participant in the conversation with your healthcare team.
The Question I Wish I Had Asked
Looking back, one question stands out:
“Now that I’ve had HoLEP, what should my long-term PSA follow-up look like?”
Maybe that conversation would have changed something.
Maybe it wouldn’t have.
I can’t rewrite that part of the story.
What I can do is make sure someone else thinks to ask the question.
That’s really what Jonesing for the Journey has become for me.
Not telling people what medical decisions they should make.
Not second-guessing doctors.
Not creating fear.
But encouraging patients to understand what happened, what it means, what happens next, and what questions still need answers.
Ask One More Question
If you’ve undergone HoLEP, TURP, or another procedure for an enlarged prostate, my story isn’t a reason to panic.
It’s a reason to have a conversation.
Ask your healthcare team what follow-up is appropriate for you.
Ask what your PSA should look like after your procedure.
Ask what changes they would want to investigate.
Keep your previous results.
Know the trend.
And when something doesn’t make sense, ask one more question.
Because sometimes the most important question isn’t:
“Is this number normal?”
It’s:
“Is this normal for me?”
That’s one of the biggest lessons cancer has taught me.
And it’s one I wish I had understood years earlier.
And So…The Adventure Continues.
This article reflects my personal experience as a prostate cancer patient and is not medical advice. Individual circumstances are different. Talk with your healthcare team about PSA testing, prostate cancer screening, and appropriate follow-up for you.
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I Thought I Was Done With Prostate Issues — I Was Wrong
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Five questions designed to help you take a more active role in your healthcare conversations.