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1 21st December 07:24
derek f
External User
Posts: 1
Default No PVP or Avodart in Edinburgh. (enlarged prostate)

I had an appointment with an NHS urologist in Edinburgh on Friday. My GP had
referred me as I had twice asked him for Avodart after it was approved for
use in the UK earlier this year and he was dubious about prescribing it for
me. The uro looked through my notes as I had first attended that hospital in
1995 after my GP found my enlarged prostate after doing a DRE. The PSA
result prior to that first appointment was 5.7. The uro at that time
estimated my prostate at 35 grams and after an ultrasound scan and flow test
said that my obstruction was causing the 400 ml retention that was
measured. He did another PSA test and it was down to 5.0 and after a
negative biopsy he recommended a TURP as a matter of urgency but after
researching the subject I turned down his offer and started on Saw Palmetto.
I had annual and later six monthly PSA tests after that with results as high
as 9.0 which resulted in two more negative biopsies in 1998 and 1999. My
most recent PSA reading in July was 6.7.
At the time I turned down the TURP in 1995 no medications were suggested by
the uro for my condition. When I asked my GP about Finasteride and Flowmax
he went through their side effects with me and we agreed that they were
rather dangerous. Recently as my urgency increased and my output reduced in
volume I waited anxiously for PVP to reach Scotland.
Fridays consultant said that Avodart is no better that Finasteride and
Flowmax used together and does not have less in the way of side effects. He
said that it is not going to be included the British National Formulae (BNF)
the prescribing manual for British doctors. He asked about my aversion to
having a TURP and agreed that it gets a bad press but he had been doing it
for ten years and in that time has only had one patient who suffered from
incontinence after it. The results all depended on the surgeons hands he
smiled:-) He said that TURP is the gold standard and will remain so and
really regards PVP as a TURP with a different instrument and that he would
be happy to use it. Strangely the BUPA hospital in Edinburgh where he is
also one of the consultants is not taking the PVP route either.
When I asked about the business plan that the uro's had put forward to bring
PVP to the hospital he said that it had been turned down by the hospital
management board (accountants) I put the case of the cost savings to the NHS
for what is basically Day Surgery, reduced waiting lists and freed beds and
less time off work for the patients. He agreed with all that but said that
the only savings that management wanted to make were getting rid of staff
and closing wards. He said that if he put forward a plan for something like
an "Ethnic Awareness Group" management would fall over themselves and he
would get the money for it the next day. Life is great in Blair's New
He told me that a NHS consultant at Ninewells Hospital in Dundee is now
doing PVP and that he could ask the consultant there to do him a favour by
taking me as a patient (NHS costs are borne by the Health Authority of the
area the hospital is in) apart from a TURP my other option was
Finasteride/Flowmax for a trial period to see if it helped me. It seems
really strange that one area will approve a treatment or medication and
another deny it, here it is called Post Code prescribing.
He did not do a DRE and was quite satisfied that another biopsy would be
negative, (my GP had done a DRE recently and thought that though enlarged my
prostate felt normal) on arrival the nurse had wanted me to do a flow test
but as the appointment letter had not warned me of it I had been to the
toilet on arrival at the hospital. On the spur of the moment I agreed to
the drug option and to have a flowtest in four months time before deciding
on a referral to Dundee. After 3 or 4 trips to the toilet during the night
and reading Derry's excellent tribute to PVP this morning I changed my mind

that would sway any rational accountant?? Finally he said that prostates
grow again after TURP or PVP and that in ten years most patients will
require another one. He would not give me the medication from the hospital
pharmacy as the cost would come off his budget, instead he gave me a note to
get a prescription for it from my GP, that's how accountants work:-)
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2 27th January 07:42
derek f
External User
Posts: 1
Default No PVP or Avodart in Edinburgh.

While told by the urologist that Avodart was not going to be approved for
use in the UK it seems that statement was just the usual preference for the
old drugs.


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3 27th January 23:04
External User
Posts: 1
Default No PVP or Avodart in Edinburgh.


I have been taking Avodart for many months now and it is continued to be
supplied and my GP was quite willing to try me on it even though he new it
was a new medication.

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4 27th January 23:04
derek f
External User
Posts: 1
Default No PVP or Avodart in Edinburgh. (proscar)

Did you take Proscar prior to Avodart and if so have you noticed a greater
Price could not have been a prescribing factor as Avodart cost 26.68 for 30
and Proscar 24.90 for 28.
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5 28th January 13:44
External User
Posts: 1
Default No PVP or Avodart in Edinburgh.


No, I have been on Hytrin for years and the GP gave me Avodart this year
when it first became available.

No difference to me in the past year.

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