{"id":431,"date":"2026-09-09T16:15:38","date_gmt":"2026-09-09T16:15:38","guid":{"rendered":"https:\/\/jonesingforthejourney.com\/journal\/?p=431"},"modified":"2026-09-09T16:07:10","modified_gmt":"2026-09-09T16:07:10","slug":"what-holep-fixed-and-what-it-didnt","status":"publish","type":"post","link":"https:\/\/jonesingforthejourney.com\/journal\/what-holep-fixed-and-what-it-didnt\/","title":{"rendered":"What HoLEP Fixed \u2014 and What It Didn\u2019t"},"content":{"rendered":"
\n\n

The Procedure Worked<\/h2>\n\n

\n Eight years before I was diagnosed with aggressive prostate cancer,\n I had surgery on my prostate.\n <\/p>\n\n

\n And it worked.\n <\/p>\n\n

\n I was dealing with benign prostatic hyperplasia\u2014BPH\u2014an enlarged prostate\n that had begun interfering with everyday life.\n <\/p>\n\n

\n Urinating had become difficult.\n <\/p>\n\n

\n I was getting up multiple times during the night.\n <\/p>\n\n

\n My prostate had simply become too large, and the symptoms were affecting\n both my sleep and my quality of life.\n <\/p>\n\n

\n The procedure was called HoLEP:\n holmium laser enucleation of the prostate.\n <\/p>\n\n

\n In my case, it made an enormous difference.\n <\/p>\n\n

\n I could urinate better.\n <\/p>\n\n

\n I could sleep better.\n <\/p>\n\n

\n The symptoms that had been interfering with my life improved dramatically.\n <\/p>\n\n

\n From my perspective, HoLEP was a success.\n <\/p>\n\n

\n That part of this story is important.\n <\/p>\n\n

\n Because what happened years later does not change the fact that the procedure\n successfully treated the problem I had at the time.\n <\/p>\n\n\n

Somewhere Along the Way, I Started Believing Something Else<\/h2>\n\n

\n The procedure worked so well that eventually I stopped thinking very much\n about my prostate.\n <\/p>\n\n

\n That seems perfectly reasonable when I look back on it.\n <\/p>\n\n

\n You have a problem.\n <\/p>\n\n

\n You undergo treatment.\n <\/p>\n\n

\n The treatment works.\n <\/p>\n\n

\n You move on.\n <\/p>\n\n

\n That is what we are supposed to do.\n <\/p>\n\n

\n I wasn’t waking up every morning wondering whether something else might\n eventually happen inside my prostate.\n <\/p>\n\n

\n My urinary symptoms were dramatically better.\n <\/p>\n\n

\n The chapter felt finished.\n <\/p>\n\n

\n Somewhere along the way, however, I think I quietly translated:\n <\/p>\n\n

\n

My prostate problem was fixed.<\/strong><\/p>\n <\/blockquote>\n\n

\n into:\n <\/p>\n\n

\n

I’m done worrying about my prostate.<\/strong><\/p>\n <\/blockquote>\n\n

\n Those are not the same statement.\n <\/p>\n\n\n

\n\n

\n The Distinction I Wish I Had Understood Better\n <\/h3>\n\n

\n \n HoLEP fixed the prostate problem I had then.\n It was never a guarantee against the prostate problem I would face later.\n <\/strong>\n <\/p>\n\n <\/div>\n\n\n

Eight Years Later, the Story Changed<\/h2>\n\n

\n Eight years after that successful procedure, I was diagnosed with\n aggressive prostate cancer.\n <\/p>\n\n

\n Gleason 9.\n <\/p>\n\n

\n Grade Group 5.\n <\/p>\n\n

\n Ultimately, Stage 4A prostate cancer.\n <\/p>\n\n

\n That was not remotely the prostate story I thought I was going to have.\n <\/p>\n\n

\n I had spent years thinking of the earlier surgery as the end of my\n prostate problems.\n <\/p>\n\n

\n Instead, my prostate would eventually become part of one of the defining\n stories of my life.\n <\/p>\n\n

\n But I want to make something very clear:\n <\/p>\n\n

\n HoLEP did not cause my prostate cancer.<\/strong>\n <\/p>\n\n

\n And this is not a story about a procedure that failed.\n <\/p>\n\n

\n HoLEP treated my enlarged prostate.\n <\/p>\n\n

\n Prostate cancer was a different disease and a different conversation.\n <\/p>\n\n\n

HoLEP and Radical Prostatectomy Are Not the Same Thing<\/h2>\n\n

\n I think this distinction is worth explaining because the word\n prostate surgery<\/em> can make things confusing.\n <\/p>\n\n

\n When I underwent HoLEP, the goal was to relieve the urinary obstruction\n caused by BPH.\n <\/p>\n\n

\n Tissue causing that obstruction was removed.\n <\/p>\n\n

\n But HoLEP is not the same operation as a radical prostatectomy performed\n for prostate cancer.\n <\/p>\n\n

\n Years later, when I was diagnosed with cancer, my prostate would ultimately\n be removed through radical prostatectomy.\n <\/p>\n\n

\n Those procedures happened for two entirely different reasons.\n <\/p>\n\n

\n That sounds obvious to me today.\n <\/p>\n\n

\n I’m not sure I appreciated the distinction nearly as much after my HoLEP.\n <\/p>\n\n\n

The Part I Wish I Had Understood Better Was PSA<\/h2>\n\n

\n PSA eventually became one of the most important lessons of my cancer story.\n <\/p>\n\n

\n For years, I tended to think about PSA almost like a smoke detector.\n <\/p>\n\n

\n High number?\n <\/p>\n\n

\n Alarm.\n <\/p>\n\n

\n Number that doesn’t look especially high?\n <\/p>\n\n

\n Everything must be okay.\n <\/p>\n\n

\n Simple.\n <\/p>\n\n

\n Except my experience taught me that PSA wasn’t that simple.\n <\/p>\n\n

\n Especially after I had already undergone a procedure that removed\n a significant amount of prostate tissue.\n <\/p>\n\n

\n What I eventually wished I had focused on more was not simply:\n <\/p>\n\n

\n

What is my PSA today?<\/strong><\/p>\n <\/blockquote>\n\n

\n I wish I had also been asking:\n <\/p>\n\n

\n

What is my PSA doing?<\/strong><\/p>\n <\/blockquote>\n\n\n

One Dot Didn’t Tell the Story<\/h2>\n\n

\n Think about a graph.\n <\/p>\n\n

\n If I show you one dot, there isn’t much of a story.\n <\/p>\n\n

\n It is simply a point.\n <\/p>\n\n

\n Now add another.\n <\/p>\n\n

\n And another.\n <\/p>\n\n

\n And another.\n <\/p>\n\n

\n Suddenly you no longer have isolated dots.\n <\/p>\n\n

\n You have a line.\n <\/p>\n\n

\n A direction.\n <\/p>\n\n

\n A trend.\n <\/p>\n\n

\n That became incredibly important in my journey because my PSA wasn’t necessarily\n screaming at us with one enormous number.\n <\/p>\n\n

\n It was more subtle.\n <\/p>\n\n

\n It was moving.\n <\/p>\n\n

\n And numbers that move gradually can be psychologically reassuring because\n each individual result may not look particularly frightening when viewed alone.\n <\/p>\n\n\n

\n\n

\n One of My Biggest Lessons\n <\/p>\n\n

\n \n Don’t just know the number. Know the trend.\n <\/strong>\n <\/p>\n\n <\/div>\n\n\n

The Number Was Below 4.0<\/h2>\n\n

\n One of the results that bothered me was a PSA of 3.706.\n <\/p>\n\n

\n Someone looking only at a commonly recognized cutoff might have seen that\n number and felt reassured.\n <\/p>\n\n

\n But I had something else available to me:\n <\/p>\n\n

\n my history.<\/strong>\n <\/p>\n\n

\n Compared with where my PSA had previously been, the number did not feel\n normal to me.\n <\/p>\n\n

\n The direction bothered me.\n <\/p>\n\n

\n I was told the next PSA could wait until April.\n <\/p>\n\n

\n I asked for another one sooner.\n <\/p>\n\n

\n I wanted it repeated in November.\n <\/p>\n\n

\n That decision is one of the moments I return to often when I talk about\n being an active participant in your own care.\n <\/p>\n\n

\n I wasn’t diagnosing myself.\n <\/p>\n\n

\n I wasn’t declaring that my doctor was wrong.\n <\/p>\n\n

\n I had a question.\n <\/p>\n\n

\n The number looked different from my history.\n <\/p>\n\n

\n I wanted more information.\n <\/p>\n\n

\n So I asked for it.\n <\/p>\n\n\n

This Is What \u201cAsk One More Question\u201d Looks Like in Real Life<\/h2>\n\n

\n Sometimes patient advocacy sounds complicated.\n <\/p>\n\n

\n It doesn’t always have to be.\n <\/p>\n\n

\n Sometimes it is simply saying:\n <\/p>\n\n

\n

\n \n Can you help me understand why we’re comfortable waiting?\n <\/strong>\n <\/p>\n <\/blockquote>\n\n

\n Or:\n <\/p>\n\n

\n

\n \n How does this PSA compare with my previous results?\n <\/strong>\n <\/p>\n <\/blockquote>\n\n

\n Or:\n <\/p>\n\n

\n

\n \n Does my previous HoLEP change the way you interpret this number?\n <\/strong>\n <\/p>\n <\/blockquote>\n\n

\n Those are not accusations.\n <\/p>\n\n

\n They are questions.\n <\/p>\n\n

\n And questions belong in healthcare.\n <\/p>\n\n\n

I Am Not Anti-Doctor. I Am Pro You.<\/h2>\n\n

\n I say this often because I don’t want the message behind my story misunderstood.\n <\/p>\n\n

\n I am not suggesting that patients replace medical expertise with internet\n research or their own assumptions.\n <\/p>\n\n

\n I am not saying every medical recommendation should be challenged.\n <\/p>\n\n

\n And I am certainly not saying my experience should become somebody else’s\n treatment plan.\n <\/p>\n\n

\n Doctors treated the problem that was in front of us when I had HoLEP.\n <\/p>\n\n

\n That problem was BPH.\n <\/p>\n\n

\n The procedure worked.\n <\/p>\n\n

\n What I have learned since is that my voice still belonged in the conversation.\n <\/p>\n\n

\n Medical expertise and patient participation do not have to compete with one another.\n <\/p>\n\n

\n They should work together.\n <\/p>\n\n\n

Eventually, We Needed More Answers<\/h2>\n\n

\n At some point, watching and questioning led to needing more information.\n <\/p>\n\n

\n That eventually led to a prostate biopsy.\n <\/p>\n\n

\n And the biopsy changed everything.\n <\/p>\n\n

\n Gleason 9.\n <\/p>\n\n

\n Grade Group 5.\n <\/p>\n\n

\n Aggressive prostate cancer.\n <\/p>\n\n

\n Later, surgery gave us even more information.\n <\/p>\n\n

\n The final pathology showed that the disease had extended beyond the prostate.\n <\/p>\n\n

\n There was seminal vesicle involvement.\n <\/p>\n\n

\n There were positive surgical margins.\n <\/p>\n\n

\n Cancer was also found in a lymph node.\n <\/p>\n\n

\n The picture we had after surgery was much more serious than the prostate story\n I thought had ended eight years earlier.\n <\/p>\n\n\n

Of Course I Have Asked Myself the \u201cWhat If\u201d Questions<\/h2>\n\n

\n Could we have found it sooner?\n <\/p>\n\n

\n What if I had understood PSA after HoLEP differently?\n <\/p>\n\n

\n What if I had looked harder at the trend?\n <\/p>\n\n

\n What if I had asked another question earlier?\n <\/p>\n\n

\n What if I had sought another opinion?\n <\/p>\n\n

\n Those questions are easy to ask after you already know the ending.\n <\/p>\n\n

\n I could spend the rest of my life living inside them.\n <\/p>\n\n

\n But I cannot go backward.\n <\/p>\n\n

\n And endlessly trying to rewrite the past does not help me.\n <\/p>\n\n

\n More importantly, it doesn’t help the person reading this.\n <\/p>\n\n

\n What I can do is take what I learned and hand it to the next person.\n <\/p>\n\n\n

Three Things I Wish I Had Understood Better<\/h2>\n\n

1. Track the Trend, Not Just the Number<\/h3>\n\n

\n I still care about an individual PSA result.\n <\/p>\n\n

\n But now I want context.\n <\/p>\n\n

\n What was it last time?\n <\/p>\n\n

\n What was it a year ago?\n <\/p>\n\n

\n What does the pattern look like?\n <\/p>\n\n

\n Has something changed?\n <\/p>\n\n

\n And given my own medical history, what does my healthcare team think\n that change means?\n <\/p>\n\n

\n A number without context tells me much less than a number with history.\n <\/p>\n\n\n

2. A Successful BPH Procedure Is Not a Cancer-Free Pass<\/h3>\n\n

\n This is especially important to me because I don’t want someone reading this\n to misunderstand my story.\n <\/p>\n\n

\n HoLEP worked extremely well for me.\n <\/p>\n\n

\n Having HoLEP does not mean somebody is destined to develop prostate cancer.\n <\/p>\n\n

\n My story is my story.\n <\/p>\n\n

\n But I also would not personally treat a successful BPH procedure as a reason\n to stop having conversations about prostate health.\n <\/p>\n\n

\n If I were having that conversation today, one of my questions would be:\n <\/p>\n\n

\n

\n \n I’ve previously had HoLEP. How should that history affect the way\n we interpret my PSA and monitor me going forward?\n <\/strong>\n <\/p>\n <\/blockquote>\n\n\n

3. Ask One More Question<\/h3>\n\n

\n If you’ve spent much time around Jonesing For The Journey, you knew this one\n was coming.\n <\/p>\n\n

\n Ask one more question.\n <\/p>\n\n

\n What does the number mean?\n <\/p>\n\n

\n How has it changed?\n <\/p>\n\n

\n Why are we comfortable with it?\n <\/p>\n\n

\n What would make us concerned?\n <\/p>\n\n

\n Is there any other information that would help?\n <\/p>\n\n

\n When should we check it again?\n <\/p>\n\n

\n What don’t I understand yet?\n <\/p>\n\n

\n Your voice does not replace your physician’s expertise.\n <\/p>\n\n

\n Your voice belongs in the conversation alongside it.<\/strong>\n <\/p>\n\n\n

Fear and Vigilance Are Not the Same Thing<\/h2>\n\n

\n There is another side of this story that matters.\n <\/p>\n\n

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

\n That is not the message.\n <\/p>\n\n

\n I do not want men afraid of every PSA result.\n <\/p>\n\n

\n I want them informed enough to have a useful conversation with their healthcare team.\n <\/p>\n\n

\n Fear says:\n <\/p>\n\n

\n

Something terrible must be happening.<\/strong><\/p>\n <\/blockquote>\n\n

\n Vigilance says:\n <\/p>\n\n

\n

I’m going to pay attention.<\/strong><\/p>\n <\/blockquote>\n\n

\n After everything I have been through, I will choose paying attention.\n <\/p>\n\n\n

Questions I Would Ask After HoLEP Today<\/h2>\n\n

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

    \n
  1. \n

    \n What should I expect my PSA to do after this procedure?<\/strong>\n <\/p>\n <\/li>\n\n

  2. \n

    \n Once things settle after surgery, what will we consider my new baseline?<\/strong>\n <\/p>\n <\/li>\n\n

  3. \n

    \n How often should my PSA be checked based on my age, history, and individual risk?<\/strong>\n <\/p>\n <\/li>\n\n

  4. \n

    \n What type of change in my PSA would make you want to look more closely?<\/strong>\n <\/p>\n <\/li>\n\n

  5. \n

    \n Should we evaluate the trend rather than relying on one result?<\/strong>\n <\/p>\n <\/li>\n\n

  6. \n

    \n How does having had HoLEP affect the way you interpret future PSA results?<\/strong>\n <\/p>\n <\/li>\n\n

  7. \n

    \n Are there other parts of my personal or family history that change how I should be followed?<\/strong>\n <\/p>\n <\/li>\n\n

  8. \n

    \n If the number starts changing, what would the next step be?<\/strong>\n <\/p>\n <\/li>\n\n

  9. \n

    \n What question am I not asking that you think I should understand?<\/strong>\n <\/p>\n <\/li>\n <\/ol>\n\n\n

    The Lesson Wasn’t That HoLEP Failed<\/h2>\n\n

    \n I want to return to this because it is the most important distinction in the article.\n <\/p>\n\n

    \n HoLEP did not fail me.\n <\/p>\n\n

    \n It treated the problem it was intended to treat.\n <\/p>\n\n

    \n My urinary symptoms improved dramatically.\n <\/p>\n\n

    \n My quality of life improved.\n <\/p>\n\n

    \n Years later, a different prostate problem entered the story.\n <\/p>\n\n

    \n The lesson isn’t:\n <\/p>\n\n

    \n

    Don’t have HoLEP.<\/strong><\/p>\n <\/blockquote>\n\n

    \n The lesson is:\n <\/p>\n\n

    \n

    \n \n Understand what a treatment fixed\u2014and understand what still deserves\n to be followed afterward.\n <\/strong>\n <\/p>\n <\/blockquote>\n\n\n

    The Bigger Lesson Was About Information<\/h2>\n\n

    \n Cancer taught me how dangerous it can be to look at information in isolation.\n <\/p>\n\n

    \n One PSA result.\n <\/p>\n\n

    \n One scan.\n <\/p>\n\n

    \n One pathology finding.\n <\/p>\n\n

    \n One symptom.\n <\/p>\n\n

    \n One doctor’s opinion.\n <\/p>\n\n

    \n Each one may be important.\n <\/p>\n\n

    \n None necessarily tells the entire story by itself.\n <\/p>\n\n

    \n I want the history.\n <\/p>\n\n

    \n I want the trend.\n <\/p>\n\n

    \n I want the context.\n <\/p>\n\n

    \n And when something doesn’t make sense to me, I want to ask about it.\n <\/p>\n\n\n

    \n\n

    \n The HoLEP Lesson\n <\/h3>\n\n

    \n \n A successful treatment for one problem does not mean you stop\n paying attention to everything else.\n <\/strong>\n <\/p>\n\n <\/div>\n\n\n

    What I Hope You Take From This Mile Marker<\/h2>\n\n

    \n If you have had HoLEP\u2014or another procedure for an enlarged prostate\u2014\n my story is not a prediction of yours.\n <\/p>\n\n

    \n It is one patient’s experience.\n <\/p>\n\n

    \n What I hope you take from it is much simpler.\n <\/p>\n\n

    \n Know what your procedure was intended to fix.\n <\/p>\n\n

    \n Know what follow-up your healthcare team recommends.\n <\/p>\n\n

    \n Keep your test results.\n <\/p>\n\n

    \n Know your history.\n <\/p>\n\n

    \n Pay attention to the trend.\n <\/p>\n\n

    \n And when something looks different from what is normal for you,\n ask about it.\n <\/p>\n\n

    \n Not out of panic.\n <\/p>\n\n

    \n Not because every change means cancer.\n <\/p>\n\n

    \n Because paying attention gives you the opportunity to ask an informed question.\n <\/p>\n\n

    \n Eight years ago, I thought my prostate chapter was finished.\n <\/p>\n\n

    \n Today I understand it differently.\n <\/p>\n\n

    \n HoLEP fixed what it was supposed to fix.\n <\/p>\n\n

    \n What it didn’t fix was my responsibility to keep paying attention.\n <\/p>\n\n\n

    Watch My HoLEP Story<\/h2>\n\n

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

    \n I Thought I Was Done With Prostate Issues \u2014 I Was Wrong<\/strong>
    \n \n Watch on YouTube\n <\/a>\n <\/p>\n\n\n

    \n\n

    \n Continue the Journey\n <\/p>\n\n

    \n What to Read Next\n <\/h2>\n\n

    \n \n \n What Was Already in the Room\n <\/a>\n <\/strong>
    \n Step back and look at the earlier clues and history that were already\n part of the story before diagnosis.\n <\/p>\n\n

    \n \n \n The Diagnosis\n <\/a>\n <\/strong>
    \n Read how continued attention to my PSA eventually led to the biopsy\n and diagnosis that changed everything.\n <\/p>\n\n

    \n \n \n Where Do I Start?\n <\/a>\n <\/strong>
    \n If prostate cancer has just entered your life, this is a practical\n starting point for the questions I wish I had known to ask sooner.\n <\/p>\n\n <\/div>\n\n\n

    \n\n

    \n About Mike Jones\n <\/h3>\n\n

    \n Mike Jones is the creator of Jonesing For The Journey<\/em>,\n where he shares his first-hand experience navigating prostate cancer,\n surgery, treatment, recovery, and patient advocacy.\n <\/p>\n\n

    \n His goal is not to tell other patients what medical decision to make.\n It is to share the questions, lessons, and experiences that may help\n someone have a better-informed conversation with their own healthcare team.\n <\/p>\n\n

    \n Medical Disclaimer:<\/strong>\n This Mile Marker reflects my personal experience with HoLEP,\n PSA monitoring, BPH, and prostate cancer. I am not a physician,\n and this content is provided for informational and educational purposes only.\n HoLEP outcomes, PSA levels, prostate-cancer risk, screening recommendations,\n and appropriate follow-up vary from one person to another. Always discuss\n your own medical history, PSA results, symptoms, and appropriate monitoring\n with your physician or qualified healthcare team.\n <\/p>\n\n <\/div>\n\n\n

    \n And So\u2026The Adventure Continues.<\/strong>\n <\/p>\n\n<\/article>","protected":false},"excerpt":{"rendered":"

    I thought my prostate problem had been fixed. My HoLEP procedure worked, the tissue removed showed no cancer, and my urinary symptoms improved. Eight years later, I was diagnosed with aggressive prostate cancer. The lesson wasn\u2019t that HoLEP failed. It was that treating BPH didn\u2019t mean I could stop paying attention to my prostate.<\/p>\n","protected":false},"author":1,"featured_media":432,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_wp_convertkit_post_meta":{"form":"-1","landing_page":"0","tag":"0","restrict_content":"0"},"footnotes":""},"categories":[2],"tags":[29,23,41,15,16],"class_list":["post-431","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-mile-marker-journal","tag-cancer-journey","tag-cancer-treatment","tag-holep","tag-prostate-cancer","tag-radical-prostatectomy"],"_links":{"self":[{"href":"https:\/\/jonesingforthejourney.com\/journal\/wp-json\/wp\/v2\/posts\/431","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jonesingforthejourney.com\/journal\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jonesingforthejourney.com\/journal\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jonesingforthejourney.com\/journal\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jonesingforthejourney.com\/journal\/wp-json\/wp\/v2\/comments?post=431"}],"version-history":[{"count":5,"href":"https:\/\/jonesingforthejourney.com\/journal\/wp-json\/wp\/v2\/posts\/431\/revisions"}],"predecessor-version":[{"id":576,"href":"https:\/\/jonesingforthejourney.com\/journal\/wp-json\/wp\/v2\/posts\/431\/revisions\/576"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/jonesingforthejourney.com\/journal\/wp-json\/wp\/v2\/media\/432"}],"wp:attachment":[{"href":"https:\/\/jonesingforthejourney.com\/journal\/wp-json\/wp\/v2\/media?parent=431"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jonesingforthejourney.com\/journal\/wp-json\/wp\/v2\/categories?post=431"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jonesingforthejourney.com\/journal\/wp-json\/wp\/v2\/tags?post=431"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}