Prostate surgery, full removal, partial core removal, Holep and Cancer of both prostate and colon

[al007]

I am currently helping three people re prostate advice

 

I received this email today

 

I hope this email finds you well.  

I have found your information online in the ThaiVisa Nation forum.  I currently live in Seoul but my fiancee lives in Bangkok.  I have concerns on an elevated PSA score and some BPH symptoms and would like to rule out possible prostate cancer via the 3T prostate MRI.  I am wondering if you could give be basic guidance on this matter....I believe Chulalongkorn Hospital does have the 3T Multi Prostate MRI?  Do you have any recommendations on any doctors/best radiologists to assist me in getting this test scheduled/interpreted?  I have read conflicting guidance on how to get the test prescribed, i.e. must have doctor's order first, multiple month wait thereafter, etc.  

 

Or do you know if there is any other facilities in BKK that do the 3T MRI?  I am asking as I have to have as much information as possible and appointments scheduled prior to traveling from Seoul.

 

Thank you in advance for any information you can give me, I hope I am not disturbing your privacy by asking these questions.  My fiancee is Thai and can help me with language/scheduling, etc.

Best D

 

I replied

Ok you found me

note this is a better email address axxxxxxxx.com

I am not a doctor, but know too much about prostate 

Please feel free to call me xxxxxxxxxxxxx

Can I cut and paste you email to me to open forum as there are others who can also help you

I am very delighted to assist

Al

consent to post

Please feel free to cut and paste the email.  I am assuming to Thai Visa forum?

 

I am sorry but I don't think my cell phone provider in Korea allows for international calling so calling you doesn't seem to be an option...

 

Thank you for your help.

 

D

 

There has been a lot written on this topic but it is spread across several threads, I want to try and sumarise my own experiences in one place for the benefit of others, I am not a doctor

 

I first became aware of prostate problems some 3 yrs ago my PSA levels were rising above the norm of 4.5

 

I started needing to pee in the night 2/3 times despite being told by some why worry I did and wanted to change things

 

I had had regular medicals here in Thailand for the previous seven yrs, including ultrasounds and PSA tests, I was always told not to worry, I was also loosing blood through my bowels and again told not to worry, I accepted what I was told as it came from doctors and was an answer I rather liked

 

Well time went on I saw a urologist, I had an MRI at an independent facility, then a month later a CAT scan at a private hospital and a colonoscopy, on all these by various unconnected professionals I was assured there was no problem, I continued to see my urologist, and the meetings normally went along the lines what did I think, and being told up to you, today I know even that first MRI was not interpreted accurately, and I have a written opinion to that effect

 

As time went on I learnt and researched a lot more I became more certain I had BPH symptons, my current consultant urologist whilst a nice guy was not upto the task

 

I was 72 with no medical insurance but could drop back on the UK NHS in event of emergency

 

I wanted upto date technology at affordable prices, and for prostate surgery Thailand is well down the scale of choices and expensive

 

India was becoming the place of my choice, I found a USA accredited and trained surgeon, I looked at Calcutta, Dehli Bombay  Madras,Bangalore Goa , I also explored some of the medical intermediaries, I found a great diversity of price, on hospitals of equal accreditation

 

I choose Dr Ashi of Blue Ribbon in Dehli with hindsight an excellent choice, for my holep surgery

 

I was only in hospital for three days, the hospital arranged the airport transfers gave my wife accomodation and food in the same room as myself

 

As I was undergoing surgery I also at the same time asked for colonoscopy, as a double check on my thailand hospitals

 

With everything I know today India for the prostate surgery was the very best choice on every front and considerably cheaper than the other options (excluding free on UK NHS)

 

I was lucky two different cancers were discovered in India at early stages, however for cancer and the longer timescales to fix I chose not to use India and found some very wonderful caring state of the Art treatment at Chulalongkorn in Bangkok

 

 

Dr Ashi told me many patients went to him clear of cancer despite 12 or 24 section biopsies, and in 60 % of cases the biopsies from the holep showed cancer

 

My latest friend believes  MRI  3 T which Chulalongkorn can do, can give a definate answer yes or no to prostate cancer, I am not so sure and ask for guidance from those who know better than I and if the case were yes then a second opinion on that MRI is easy to get, I have had too many incorrect interpretations of medical data to rely on only one

 

I have become very accustomed to sending large files like MRI s via the google drive  drop box, works well

 

My advice to my friend is find a good Urologist and be guided by him, but also go to one who can do the surgery if necessary

 

Dr Ashi my Urologist arranged within 12 hrs a CAT scan, which was under half the cost of thailand, another friend has had surgery with Dr Ashi and another at this moment is exploring possibilities, other scans and procedures in Dehli are easily available, at a fraction of Thailand costs

 

My advice to my friend would be bypass thailand go direct to India, see the urologist and have all the tests done there and if necessary either holep nor robotic removal of the Prostate, at the same time, prices and appointments can all be done prior to booking the ticket

 

I choose Thailand for my cancer treatment since I live here

 

My chemo and radiation treatment has so far been excellent very targeted and avoided surgery, and in the next two weeks I have more MRIs more colonoscopies and four consultants, if my cancer were to return I would still check out the India option on surgery, and this would necessitate a colostomy  bag either short or long term

 

I look to friends on this forum for guidance for myself and my friend

 

I consider I am a fortunate and lucky man, and do say thank you God as well

 

 

[al007]

Some more from our man D

 

On Aug 21, 2017, at 13:11, R. D****** wrote:

Al

 

Thank you for your reply.  I will respond in order to your questions:

 

1.  My PSA is approx 2.6 and has remained about that over several tests for the last year. My free PSA is 19%.

2.  I am 54 years

3.  I am a pilot and simulator instructor pilot.

4.  Not a member of TV....yet

 

My fiancee is inquiring today about the availability of 3T MRI in all the Bangkok hospitals.  I told her about the possible 3 plus month wait at Chulalongkorn, So she is checking all hospitals for availability and scheduling possibilities. 

 

I will let you know of any information I get from her.  I am checking on the availability of the 3T MRI prostate here in Seoul too.  But believe it or not I don't think the medical care is as good here as Thailand.  

 

If any anomaly is found on the MRI, I plan to go back to the US to get the new 4kscore blood test, which will give you the percentage possibility of having the more aggressive forms of prostate cancer.  

 

Thanks again! for your response.

 

Best,  D

 

Young man, interesting job, does your employer not pay medical 

2.8 is lowish for PSA

Not sure what the 19% free is

Generally Prostate cancer is less invasive than most but not always

Sounds to me maybe no rush, but do not put off too long you never know

Do you get cheap air fares, if so a visit to DR Ashi just for consultation in India maybe best route

Probably in any case you get a top salary so to visit india very affordable

Regardless of everything we are not qualified as doctors you need that expert Urologist, you do not let an amateur play with the wires in your simulator !!

 

 

Edited August 21, 2017 by al007

[al007]

More information this gentleman has scheduled MRI 3T at Bangkok Hospital Bangkok next week ie short notice at Bhatt 20,000, interestingly he also foud Chulalongkorn wait list until end Dec 2017 for 3T MRI

[al007]

I asked my urologist who did my holep in india if MRI would positively rule out cancer and got the following reply from him

 

 

Dr Ashi when I asked about MRI being safe way of ruling out cancer replied to me as follows

 

On Aug 23, 2017, at 17:10, Dr Ashish Sabharwal  wrote:

MULTI PARAMETRIC MRI PROSTATE WITH CHOLINE SPECTROSCOPY CAN RULE OUT PROSTATE CANCER IN MORE THAN 95% CASES.

 

[Sheryl]

A baiting post and flaming replies to it have been removed as has a post on Moderation.

 

Both parties to this flamefest will find themselves suspended if this continues.

 

I would prefer to leave this thread open as it has useful information  but if this keeps up that will not be possible.

[al007]

Colorectal surgery

 

I sent to my urologist in india who I trust highly, and originally identified both my cancers the following email

 

I have some questions at the moment I am a little nervous I got blood tests today Psa was 0.180 suggests prostate Ok

 

However CEA has increased to 3.36 , norm (0 to 2.5) suggests the colorectal cancer may not be ok

 

I have MRI and colonoscopy next week 

 

I am worried they may want to do surgery

 

I am further worried I may have to make a fast decision

 

I feel the best option if this is the case maybe Laparoscopic Colon Surgery in India, I believe your techniques above Thailand where laparascopic options may be limited, I am also not a rich man and need sensible costs 

 

I am just thinking ahead and would appreciate any input 

 

When I have more facts I will come back to you

Al

 

Input from TV members very much appreciated, I am not in any way panicking just need to be prepared

[Sheryl]

I would not address that question to a urologist. for starters. Secondly bear in mind that doctors at a private hospital in India will have a financial interest in urging you to come there.

 

You have an excellent colorectal surgeon here in Thailand, trained at one of the best facilities in the US and specializing in laparoscopic techniciques... which are not, in fact, limited in Thailand.

 

I suggest you wait until you have his recommendation as to what type of surgery is indicated, and get cost estimate, before thinking of going to India. You can discuss frankly with him whether there are more advanced techniques available on other countries, he will know.

 

It is possible depending in the exact location and size of the tumor than 2 separate procedures might be needed, with a temporary colostomy in between and cehmo might  also be advised. Doing all that in India would entail a lot of trips there and prolonged stays, are you really up for that? Costs are not likely to be that high at Chula.

[al007]

1 hour ago, Sheryl said:

I would not address that question to a urologist. for starters. Secondly bear in mind that doctors at a private hospital in India will have a financial interest in urging you to come there.

 

You have an excellent colorectal surgeon here in Thailand, trained at one of the best facilities in the US and specializing in laparoscopic techniciques... which are not, in fact, limited in Thailand.

 

I suggest you wait until you have his recommendation as to what type of surgery is indicated, and get cost estimate, before thinking of going to India. You can discuss frankly with him whether there are more advanced techniques available on other countries, he will know.

 

It is possible depending in the exact location and size of the tumor than 2 separate procedures might be needed, with a temporary colostomy in between and cehmo might  also be advised. Doing all that in India would entail a lot of trips there and prolonged stays, are you really up for that? Costs are not likely to be that high at Chula.

I agree principally with what you say, all being good sound advice, I am  exploring options only, and might need to be in position to make fast decisions, there is no downside for me going this route

 

Surgery depends on the man hence as I have a trustworthy man who has already operated on me, albeit with the wrong speciality, in India I start my search there, I still have prostate problems he suggested last night my PSA reading he says is not ideal, where else Sheryl might I ask would you have started, go to the agencies and they take a big cut, he is also a leader in keyhole surgery, albeit the wrong hole !!!

 

India should not just be ruled out and yes under the table money does move around but with care it can be kept in sensible sums, starting with the agencies increases that money substantially, I still believe my prostate surgery costs were eminently reasonable, and was very satisfied with the result and cost

 

I generally say if you make a negative statement give me a positive alternative, I did not see one, smile !

 

On Thai Visa there are many wide ranging opinions,on India for surgery, I am very much in the middle with a preference in favor of Thailand, however for prostate problems India is in my humble opinion a clear leader

 

I do in this series of appointments at Chula next week, have an appointment with a urologist recommended by my colorectal surgeon Dr Chuckcheep for who I have the very highest regard, that in itself will be interesting, and I will later share that for the benefit of others

 

A man who I am trying to assist who is now having 3TMRI at Bangkok Hospital BKK next week is seeing a urologist named Dr. Damrongpan Watanachote, he has a wealth of experience and may be approaching 70 yrs old, however I personally look for Doctors and surgeons in their mid forties, I want doctors who saw the modern equipment when they were being trained, and not learnt it later. I have already agreed with this friend once he has the copy MRI in his hands he will get a second opinion

 

I hope to meet with this man from Seoul in BKK next week and will share later on his experience, and mine on Urologists, I personally am looking for one in mid forties, not who will be retiring soon, I also want specialists who will out live me, and know my case, and of course be in Bangkok

 

20 yrs ago, they found a heart murmer, on a routine medical,  in the UK caused some panic and more bills, my specialist about 62 nice old guy , but we agreed we switch to a younger man, I was monitored for several yrs and eventually my specialist told me there had been no deterioration, and said go enjoy life (and continue cruising the world in my yacht,)  forget about it unless you have chest pains or breaything problems, so far no problems, interestingly despite many medicals and lots of doctors appointments over the last eight years in Thailand no one has observed or commented on this murmer, if I am advised to have surgery I will eventually mention it, but lets see if they find it first, I some how doubt it I have had several heart tests, first to prove to my wife I really do have one

 

Sometimes the advice if it is not broke  do not fix it is the correct solution but not always

 

As a business man and Chartered Accountant I am not the best to ask about computers, they are high technology,  they came after me, you again need a man in mid forties, yes us older ones have experience, hopefully know where to go for advice, but are seldom at the leading edge of technology in our field and are also not as greedy to learn as the man in his early forties

 

I continue to learn, and lets not forget my medical knowledge is exceedingly limited, you, Sheryl,  also help me by advising me laparoscopic is available here in Thailand, I did not know that,  I am prepared to research as well as I can

 

I do not just say to a doctor please do what you need and tell me when you are finished, that is not my style

 

I do research on both Google and You Tube and it was not until this week I was aware of the great knowledge base of medical information on U Tube

 

My understanding is maybe the recovery form laparoscopic surgery is quicker and easier

 

I am also severely dyslectic, something I did not find out until I was 50, and explained a lot of my learning and comprehension difficulties, this also means to work some things out I need to do more work than many, and can slow down my comprehension but also has the advantage I think outside the box

 

Many brilliant people are dyslectic

 

I see my surgeon after eight days with many tests and appointments, I instinctively believe him to be first class, I was not aware he was US trained you help me again there

 

Cost is not the major consideration but still important, it is not inconceivable that I could run out of funds, but hopefully unlikely although self insured I think I can deal with it, but have on several occasions asked about cost but never got a definitive answer, I have said to Chuckcheep at Chula 300,000 Bhatt  for surgery , and  he smiled, and I interpret that he agrees I am in the right ballpark 

 

I do NOT want to have to go to India but being a sensible and successful business man must not rule out that option, hence my initial start with my trusted urologist, and others have been to this urologist and agree with my summation of him

 

When I meet with DR Chuckcheep my appointment will be brief, he is a busy man and often talks to his students more than me, I will have a list of questions, I will be at that meeting alone with my wife, I will not have Sheryl with her experience also there, so it is very important I am properly prepared, unfortunately my surgeon does not respond to emails, so it is primarily a one meeting discussion, rest assured before I leave I will have booked a follow up meeting

 

I also for the record believe the two best colorectal surgeons in Thailand are DR Chuckcheep in Bangkok ( my personal favorite) and Dr/ Professor  Hiranyakas from Bangkok Hospital in Phuket, who I have also consulted with, they are both good friends and qualified around the same time, I believe one would be in good hands in both cases, they both know I have seen the other one as well

 

 

 

 

 

 

 

[al007]

RISK ASSESMENT

 

I am thinking a lot about what the hospital appoinments will bring next week, it also helps me clarify matters by putting my thoughts in writing and there may be some snipets that help others, I am also watching the hurricane develop, and is sad many do not prepare for a hurricane before it is announced

 

I have all my life been a risk taker,  and opportunist, reference Thailand we need to asses the risk before coming, again concerning insurance that is another risk, we have to make decisions based on facts others can not do that for us, I have made the decision to remain in Thailand, too many run with no life plan, very dangerous may i suggest

 

I want to look at some of the risk scenarios I have been through, when I was 21 yrs old working full time and training to be a Chartered Accountant, I passed the first exam, and then wanted to do the second six months later rather than the normal eighteen months, everyone said mad, I replied if I fail I tell no one, what is the downside, I passed, which put me on fast track career progression

 

I bought my first house and borrowed 120%, my bank manager called and said I had borrowed 120%, I replied did I tell you anything incorrect and he relied No, I mentioned as a side issue prices had been going up at 2% per month or 24% per annum for the last two years

 

In my life I have always had a plan and it has stood me in good stead

 

My children were educated in the state system because my career went up and down and I could not guarantee to be able to keep them in the private system

 

At one stage in my career when FD of a public company controlled by Asians, I refused to lie on oath I was of course fired

 

I wound up working for Italians for no money three days a week, many said madness, I replied I have no downside, I am already down, well I put my house on the line borrowed money and within two years had sold my stake for 50 times what I paid

 

Around 49 yrs of age I bought a beautiful yacht the needed refit, I was told US$600,000, I thought no say 1.2M just in case and add contingency of another 600,000, well we spent the 1.8M but the vessel was not repossessed, most of what I had was invested in this boat, I bumped all my credit card limits to $300,000, did not use them but just in case. I had a wonderful life cruising the world for 12 Yrs plus

 

I am not the conventional boring Chartered Accountant

 

I cruised the world with only a wife, many told me insanity but we survived it, i had double back up for all systems, carried spares for the spares, generally food for two years and everything for the hurricane I survive two and on another occasion a lightning strike that crippled the boat, and many other catastrophes that would have seen many dead

 

I have always dabbled and done well on stock markets

 

Today I am not a wealthy man, yes still have more than many, three divorces do not add to financial security

 

I have never committed any crimes but have seen the insides of jails in the Uk, Israel, Cuba and Honduras and survived beatings by police and prison guards, I always found a way out, In Israel I had been held for 12 days no embassy no lawyer, well I got a razor blade, and was admitted to the local hospital with so much blood coming from my wrists and I have the scars to prove it, but I got to a lawyer, a Russian Israeli witch with her mafia Israel friends  was trying to take all my money

 

I can not afford medical insurance

 

I have a pension fund that remains fully invested and generally I can achieve 18% per annum, many say this is stupidity, it works for me and I can cash out immediately with reasonably proximity to normal hours, I monitor 3/4 times a day, normal staid investments do not give me enough money

 

I wind up with these cancers 

 

So i look to my experience of life, do not panic, asses the risk and costs to remedy the situation, and get a plan with a back up plan together

 

I was short of money, I had a QROPS pension in Gibraltar, there is no flexible drawdown in Gibraltar, many experts said it is impossible to free money, I went to ministers in Gibraltar, and MP in the UK all were sympathetic but said impossible, I read and read the Trust deed many times I became an expert and eventually with the help of lawyers to overcome difficult people, came to agreement to get my money out, legally in two tranches,( and ill health does not qualify), one I already have and the second in the forthcoming months, taxed at 5%

 

I had credit cards and bank facilities in the Uk these I maxed   out on hospitals, my costs were escalating, with the help of professionals in the Uk at no cost to me these substantial loans, are both frozen for the foreseeable future, no interest and payments of £1.00 per month, I have experienced nothing but understanding from the UK lenders, and say thank you

Yes I had to put a strong case some 18 doctors many MRIs, colonoscopies etc from both Thailand and India, I also only told the truth, properly documented

 

I am on a separate thread researching palliative care, Sheryl states it is not possible to get intravenous opiads in the home, I respect her view, but am still and will continue to find a way to do it legally, or an alternative solution

 

My father a sour man from Scotland and highly respected in the medical field, used to say there is no such thing as can't, when both my mother and then my sister were threatened with life crippling illnesses  he continued to fight  in London 200 miles from home, he would never give in my mother lived another 40 yrs and my sister similar

 

My moral there is always help, use your ingenuity, do not accept no as the answer, and keep asking questions

 

I note on the Hurricane reporting people are asking God to help, well I do that every day and also  more importantly say thank you God

 

I need positive people negativity spreads and destroys

 

I am always happy to help people if I have the necessary expertise, and give my phone number out too freely

 

Sometimes legal is not the only way note Yingluck a lady I admire and like, for the record I would never recommend something illegal, I also stay away from the Immigration thread and not ask did she have a valid exit permit !!

 

Keep smiling, and let others know by your smile, I am bad on this one

[al007]

 

 

A rather interesting video on Utube explains a lot about prostate BHP, also suggests the norm TURPS in Thailand is rather outdated, this procedure is FDA approved

 

Having had holep surgery I know a reasonable amount I learnt more from this video

 

I believe it very informative

 

I have another  TVF friend considering Holep in India

[djinn]

New procedure now called Prostate embolization for enlarged prostate.They insert via catheters plastic microballs in the arteries around the prostate.Prostate immediatly shrinking.ambulatory surgery.But I only found it at Lisboa Portugal and in Paris (St Louis Hospital).Google could help

If I needed a procedure for enlarged prostate,I would be happy to go to Paris

Hope this help

[al007]

I wish to add a brief post ( which is today my norm as it keeps me away from those who I upset)

 

This morning I was called by another TVF member who has just returned from prostate surgery with my surgeon in Dehli, ( he also visited Chulalongkorn on my suggestion) he was very positive and happy about the experience

 

This brings us to four, who have had this option and Holep surgery in Dehli, ( cost US$3,000 to 4,000) and there is another  gentleman on his way in the new year

 

I have substantial experience of hospitals here and in India, which in many cases can be a far better option, (see also my threads on Chulalongkorn)

 

Anyone wanting more information please PM me, and that way I do not get accused of breaking the forum rules and guidelines

 

I am a mere retired Chartered Accountant who has by experience the hard way a certain amount of experience on Thai and Indian hospitals

 

Be careful what advice you follow, and check their credentials, so far I have yet to find one doctor on TVF giving advice

[huawei]

Keep going, you bring reality, practically and common sense .

 

i will vote for you as poster of the year.

 

 

[xylophone]

2 hours ago, al007 said:

I wish to add a brief post ( which is today my norm as it keeps me away from those who I upset)

 

This morning I was called by another TVF member who has just returned from prostate surgery with my surgeon in Dehli, ( he also visited Chulalongkorn on my suggestion) he was very positive and happy about the experience

 

This brings us to four, who have had this option and Holep surgery in Dehli, ( cost US$3,000 to 4,000) and there is another  gentleman on his way in the new year

 

I have substantial experience of hospitals here and in India, which in many cases can be a far better option, (see also my threads on Chulalongkorn)

 

Anyone wanting more information please PM me, and that way I do not get accused of breaking the forum rules and guidelines

 

I am a mere retired Chartered Accountant who has by experience the hard way a certain amount of experience on Thai and Indian hospitals

 

Be careful what advice you follow, and check their credentials, so far I have yet to find one doctor on TVF giving advice

Hi again al007,  we have communicated in the past and I have just noticed you are back on this thread.

 

I couldn't make out how you are progressing from what you've posted, so I hope there is nothing untoward which has "come out of the woodwork" to hinder any positive progress you have been making.

 

Personally, I can't understand why there should be posters who would want to post inflammatory or derogatory posts, this especially when you are trying your best to help others who may find themselves in a similar position.

 

My very best wishes to you, and as Sheryl has said, keep posting because this is a subject which will affect so many of us as we age.

 

[huawei]

5 minutes ago, xylophone said:

Hi again al007,  we have communicated in the past and I have just noticed you are back on this thread.

 

I couldn't make out how you are progressing from what you've posted, so I hope there is nothing untoward which has "come out of the woodwork" to hinder any positive progress you have been making.

 

Personally, I can't understand why there should be posters who would want to post inflammatory or derogatory posts, this especially when you are trying your best to help others who may find themselves in a similar position.

 

My very best wishes to you, and as Sheryl has said, keep posting because this is a subject which will affect so many of us as we age.

 

I don't use thaivisa much, it either full of anti this or anti that..all coming from points of either complete ignorance or a failure to acknowledge reality.

 

criticism( counter argument)  is fair based on experience and knowledge. That isn't the case here.

 

he is a poster with extensive experience of a matter and some want to criticise.

 

thailand can be a nightmare country to be old and ill in...and here is a poster stating the risks involved..does everyone who comes here think it's paradise and that to live a quality life which includes availing yourself of decent health care is not relevant or cheap..or best ignored..the mind boggles at such stupidity..

[JLCrab]

In Post #1 it is mentioned that the surgeon doctors in India performing HoLEP were trained in the USA.

OK I am not a candidate any time soon for HoLEP surgery but, as one who regularly has prostate screenings, I took interest in this topic. So what about HoLEP in the USA?

 

I have gathered from non-official Medicare websites that HoLEP is covered by Medicare and one writer in the past 2 years noted that the Mayo Clinic -- whose reference pages are often linked here -- did the surgery at its Phoenix AZ clinic. Medicare covered 80% and the co-pay was $1500. Others have listed HoLEP non-Medicare co-pays and total out-of-pocket costs of up to $5000.

 

[Jai Dee]

An off-topic troll post designed to provoke other members into responding has been removed from this thread.

[nontabury]

Can only confirm what others have already stated, that if you what to go to a 5 star hotel/hospital with good looking well turned out nurses, then Thailand is for you. However if your first priority is the actual treatment and nursing care, then perhaps it’s better to look further afield. One such destination is India, where I’ve just returned from. I would further add that the actual cost of medical treatment in India is far less, and this includes airfares, than here in Thailand. A country that is trying to promote itself as the medical hub of S.E. Asia. Personally I think that is wishful thinking, as I’m of the opinion that the majority of the medical industry in Thailand Is superficial. That is not to say that all doctors here are not up to standard, but certainly many do not seem to be able to think out of the box,when it comes to diagnosing, and as for expecting them to make suggestion regarding treatment, forget it.

Regarding  a1007 I have found him to be very knowledgeable for a non medical person, and even though he has concerns regarding his own well-being, he is always willing to offer advice and support, an inspiration to us all.

[KiChakayan]

Could someone be factual and tell us which BPH treatment options are available in Thailand?

And the same for prostate cancer?

 

Thanks.

 

P.S: I spell "prostate" because I am a not a royalist...

[xylophone]

39 minutes ago, KiChakayan said:

Could someone be factual and tell us which BPH treatment options are available in Thailand?

And the same for prostate cancer?

 

Thanks.

 

P.S: I spell "prostate" because I am a not a royalist...

For BPH Thailand has all of the normal options available, from medicines to the old fashioned TURP or the newer Laser surgery.

 

I have seen some "newer" options on the internet but usually these procedures have not been tested over time (steam, tying the prostate tissue back etc).

 

For cancer, the option I like is Brachytherapy where small beads inserted inside the prostate deliver radiation to the site and can remain in place without discomfort. Other than that normal radiation methods and the robotic removal by the Da Vinci machine.

 

Try to contact al007 by PM as he has much knowledge on this subject.

[Sheryl]

In Thailand,  as elsewhere, treatment starts with medications and for many people this will suffice.

 

For those for whom maximal medical therapy is inadequate, both conventional (nerve-sparing) surgery and robotic surgery is available.

 

Holmium Laser Enucleation of the prostate (HoLEP) is not yet widely available and if you did manage to find someone doing it, I would have concerns about level of experience. It is available in India.

 

I have not come across anyplace doing transurethral needle ablation  (TUNA) here.

 

Brachytherapy is used in treatment of prostate cancer. It is nto mormally doen for BPH.

[KiChakayan]

1 hour ago, Sheryl said:

 

Brachytherapy is used in treatment of prostate cancer. It is nto mormally doen for BPH.

My guess would be that HDR Brachytherapy is out of the question.

 

As far as BPH medication is concerned I have refused to take Finasteride (Proscar). Was quite surprise they give it to younger men; I am only 65, and no ambition to apply for a job in a cabaret.

[xylophone]

1 minute ago, KiChakayan said:

My guess would be that HDR Brachytherapy is out of the question.

 

As far as BPH medication is concerned I have refused to take Finasteride (Proscar). Was quite surprise they give it to younger men; I am only 65, and no ambition to apply for a job in a cabaret.

As both Sheryl and I said, it is for treatment of prostate cancer....treatments for which you did enquire about.

 

Many/most men do not experience side effects from Proscar and even the supposed effect on libido is in doubt. You won't know until you try it and recent drug combining Tamsulosin and Dutasteride has proven to give good results.

 

Anyway if libido was a problem, then Cialis and the like are available.

 

If you wanted to try the natural way then in my book Beta- Sitosterol tablets/capsules are worth a try.

 

To be clear before entering into numerous replies..........what are your symptoms??

 

[KiChakayan]

29 minutes ago, xylophone said:

As both Sheryl and I said, it is for treatment of prostate cancer....treatments for which you did enquire about.

 

Many/most men do not experience side effects from Proscar and even the supposed effect on libido is in doubt. You won't know until you try it and recent drug combining Tamsulosin and Dutasteride has proven to give good results.

 

Anyway if libido was a problem, then Cialis and the like are available.

 

If you wanted to try the natural way then in my book Beta- Sitosterol tablets/capsules are worth a try.

 

To be clear before entering into numerous replies..........what are your symptoms??

 

Volume 100cc, revealed through MRI Coil at Bumrungrad

PSA fluctuation between 6 and 13 over 8 years,

Urinary symptoms consistent with BPH come and go,

Previous MRI and Biopsy did not confirm cancer,

Lovely wife, sex about 3 times a week, some rare extras....

 

Cialis will not compensate loss of libido, only help you to achieve erection when you are in the mood and can't for various other reasons...

 

Finasteride side effects occur in a larger proportion of patients, I remember seeing figures as high as 25%, and worse, sometimes irreversible. Propecia a scaled down version for hair regrowth destroyed the lives of many young men.

 

I suggested that HDR (High Dose Rate) Brachytherapy, which is an advanced technology would not be available in Thailand, please see this as an indirect question. This treatment is fundamentally different from "normal" Brachytherapy as the seeds stay on a few seconds each inside the gland. It is quite uncomfortable but achieves much better results. And has other advantages for someone who has young children.

 

Edited December 12, 2017 by KiChakayan

[Sheryl]

There is a lot of unreliable info on the web and you need to look carefully at the source before accepting what you read. In particular look at the qualifications and vested interests of the entitities posting.

 

Propecia has defininitely not "destroyed the lives of many young men".   The incidence of adverse sexual affects from finasteride is nothing remotely near 25%. More like 1-5%, These effects  also are not permanent, and there is no plausible physiological mechanism I can think of that would render them permanant.

" A number of studies have looked at the problem of side effects caused by finasteride.[6–11] These studies which are discussed below reveal that sexual adverse effects occur at the rates of 2.1% to 3.8%, erectile dysfunction (ED) being the commonest followed by ejaculatory dysfunction and loss of libido. These effects occurred early in the therapy and returned to normal on stopping or over a time on continuous use of the drug. "

....“To date, there is no evidence-based data substantiating the link between finasteride and persistent sexual side effects in the numerous double blinded, placebo controlled studies using finasteride 1 mg for hairloss. Reports of persistent sexual side effects have come from a variety of sources with some internet sites attracting individuals claiming to have sexual and psychological issues related to finasteride. While continued difficulty having erections after discontinuing finasteride has been reported in post-marketing surveillance the incidence of this problem remains unknown.This rare side effect is included in Merck's patient product information in the United States, and in Public Assessment Reports of the Medicines and Health Regulatory Agency of the United Kingdom and the Medical Products Agency of Sweden. The persistence of sexual side effects appears to be a rare event, and it has yet to be determined whether these recent reports represent a true causal relationship, or if they are simply coincidental and related to other factors such as the high incidence of sexual dysfunction in the general population, and/or the placebo effect. Also, little data is available concerning the medical and psychological work-up of these patients to exclude other potential causative factors."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481923/

 

 

 

 

[nontabury]

4 hours ago, xylophone said:

For BPH Thailand has all of the normal options available, from medicines to the old fashioned TURP or the newer Laser surgery.

 

I have seen some "newer" options on the internet but usually these procedures have not been tested over time (steam, tying the prostate tissue back etc).

 

For cancer, the option I like is Brachytherapy where small beads inserted inside the prostate deliver radiation to the site and can remain in place without discomfort. Other than that normal radiation methods and the robotic removal by the Da Vinci machine.

 

Try to contact al007 by PM as he has much knowledge on this subject.

Where do they carry out the newer laser surgery in Thailand?

I enquired earlier this year,came up blank. What you also have to take into consideration, is not only the price of the proceedure, but very importantly the expertise and experience of the Doctor.

 Regarding Rezume (steam). This procedure is O.K for the smaller prostrates, anything Below 80cc. At the moment it seems to only be available in the USA, though they are carrying out trials in the U.K.

 Regarding cancer of the prostrate, proton therapy is now one of the best treatments available, unfortunately though, it’s quite expensive, £20,000-£30,000.

Available in many countries,but not at the moment in the U.K. That’s why many Brits travel to Prague.

 

[KiChakayan]

12 hours ago, Sheryl said:

There is a lot of unreliable info on the web and you need to look carefully at the source before accepting what you read. In particular look at the qualifications and vested interests of the entitities posting.

Sheryl, don't you think that, for any medication, the strongest vested interests would be those of the labs producing the drugs. Especially in countries where vast amounts of money are spent on lobbying.

 

Thanks for your caution however, it may lead to some further research.

[xylophone]

2 hours ago, KiChakayan said:

Sheryl, don't you think that, for any medication, the strongest vested interests would be those of the labs producing the drugs. Especially in countries where vast amounts of money are spent on lobbying.

 

Thanks for your caution however, it may lead to some further research.

That which Sheryl quoted suports my findings when doing some research over the years........and I was on the drug for 6 months and more and it did not adversely affect me.

 

The only reason I came off that was because I was getting some blood in my semen, so had a urologist look around and he suggested a TURP to take pressure off the urethra and "tidy up" the prostate, as many years of prostatitis had affected it, hence the bleeding.

 

And as for Cialis and the like, well libido or sexual urge/desire is something that I have found I can "turn on" as and when I wish and Cialis helps the end result, so to speak!

 

Your PSA score is higher that I would wish, but I was told by a urologist that to get the most accurate measure it is best to abstain from sex for a few days prior to having the test as it can be affected by sexual activity? And the volume of 100cc......is that residual urine or that which is expelled?

[xylophone]

Nontabury said: What you also have to take into consideration, is not only the price of the proceedure, but very importantly the expertise and experience of the Doctor

 

VERY true with the laser treatment.........my surgeon said exactly that; seek out the specialist who has done the most treatments as it is a procedure which at the "touch of a button" instantly vaporises that which it touches and that bit has gone forever! Whereas with the old fashioned TURP procedure it is a cutting motion which is done through movement of the "cutting" wire so more control and no "bits vaporised".......that is why it is still considered the Gold Standard. 

 

Laser surgery is carried out in Thailand, but as you say.........how experienced is the surgeon?

 

 

[nontabury]

11 minutes ago, xylophone said:

Nontabury said: What you also have to take into consideration, is not only the price of the proceedure, but very importantly the expertise and experience of the Doctor

 

VERY true with the laser treatment.........my surgeon said exactly that; seek out the specialist who has done the most treatments as it is a procedure which at the "touch of a button" instantly vaporises that which it touches and that bit has gone forever! Whereas with the old fashioned TURP procedure it is a cutting motion which is done through movement of the "cutting" wire so more control and no "bits vaporised".......that is why it is still considered the Gold Standard. 

 

Laser surgery is carried out in Thailand, but as you say.........how experienced is the surgeon?

 

 

Your correct in stating that Turps is the old fashioned proceedure, there are now many other options that are available, and it is these that are Now considered the Gold Standard.

I looked into Turps a few years back, the potential side effects scared me to death. So why are some Dr still recommending this proceedure? Well the answers fairly simple. It requires special training, that is why I am under the impression, that this is the reason laser surgery is not available in Thailand.

 I don’t wish to get into an argument with you, but please for the second time of asking,WHERE in Thailand is the newer laser procedures performed.