Before Your Pre-Op: What Every Prostate Procedure Really Costs You, and the 4 Numbers to Bring With You
A urologist's full guide for men who already have a TURP, HoLEP, Rezum or UroLift date. Keep the date. Use the weeks before it.
Every week I give a man a surgery date and about 90 seconds of information to go with it.
This page is the hour I never gave them. What each option actually costs you, what none of them touch, and exactly what to do between today and your pre-op.
I'm not going to tell you to cancel anything. Keep your date. But walk into that pre-op knowing more than I ever told my own patients.
Every option on the table, and what each one costs you
Read the last line of each one. That's the line nobody reads out to you in the exam room.
Flomax (tamsulosin)
- What it does
- Relaxes the muscle around the urethra so urine can get through.
- What it costs you
- Dizziness when you stand, and changes to ejaculation in a lot of men. Mayo Clinic's own drug page says it will not shrink the prostate, and that surgery may still be needed in the future.
- What it never touches
- The growth. The Cleveland Clinic says alpha-blockers do not change the size of the prostate or affect its growth in any way.
Finasteride
- What it does
- Shuts down DHT production all over the body. It works, and over months it can bring the gland down.
- What it costs you
- Drive, erections or ejaculation in some men. Plenty of men can't live with it and quietly stop taking it.
- What it touches
- DHT, by switching it off everywhere. That's the problem.
UroLift
- What it does
- Small implants hold the lobes of the prostate apart, like tiebacks on a curtain.
- What it costs you
- Ejaculation is usually kept. But in the main 5-year trial, 13.6% of men needed another procedure, and more went back on medication.
- What it never touches
- The growth that keeps pushing on the implants.
Rezum
- What it does
- Steam is injected into the gland to kill off some of the tissue.
- What it costs you
- A catheter for several days on average, a few weeks of burning and urgency, and 11.1% of men back on medication within 5 years in the manufacturer's own trial.
- What it never touches
- The hormone that grew the tissue in the first place.
TURP
- What it does
- The inside of the prostate is cut away through the urethra. It's been the standard for decades.
- What it costs you
- Between 2 in 3 and 3 in 4 men lose normal ejaculation for good. A catheter for a day to a week. 2 to 3 weeks at home before most men are ready for work. Between 1 in 10 and 1 in 50 lose some bladder control, for a while or for good.
- What it never touches
- DHT. About 1 in 10 men need the whole thing done again within 10 years, because what's left keeps growing.
HoLEP (laser)
- What it does
- A laser removes more of the inside of the gland than a TURP does. Fewer men need it redone.
- What it costs you
- Reviews put lost ejaculation at 74% to 78% of men.
- What it never touches
- DHT.
Go back and read only the last lines. Of everything on that list, exactly 1 goes after the hormone that makes the prostate grow, and it does it by shutting that hormone off across your whole body.
Surgery takes out what grew. Nothing in the operating room does anything about what grew it. Even the UK's surgical patient leaflet for TURP lists the possible need to repeat the treatment later because of regrowth.
How almost every man ends up with a date
I can usually tell where a man is on this road within a few minutes. It runs with a regularity that still bothers me.
- Up once a night. You blame the coffee, or the beer with dinner.
- Twice. You buy saw palmetto. When it doesn't help, you buy a stronger brand.
- The stream takes a while to start. Your doctor writes Flomax.
- Flomax works. Some mornings you're dizzy standing up, and something changed in the bedroom you don't mention to anyone.
- Back to twice a night, some nights 3. Some nights you run the shower just to get started.
- A scan shows urine still sitting in your bladder after you go. The word "procedure" gets said out loud.
- You're handed a pamphlet and a date.
Every step on that road is the same gland, growing, while each fix works on something else. The bottles in year 2 never moved it. The pill in year 3 was never meant to.
What I tell every man with a date now
The surgery talk ends differently in my office now. If you have a date, this is the whole plan.
- Keep your date. Don't cancel anything. Don't tell anyone you're "trying something instead."
- Get your 4 numbers now. Your flow rate. A bladder scan after you empty. Your symptom score. And how many times you're up at night, counted for a week. Write them down. They're your starting line.
- Take Saika every day. 2 capsules, 1 in the morning and 1 later in the day. Keep taking everything your doctor prescribed.
- Bring the bottle and your numbers to your pre-op. Let the same tests run again.
- Let your urologist decide. If the numbers moved, that's a conversation worth having. If they didn't, you've lost nothing and your date is still there.
When not to wait
If you're in a catheter right now, if you can't pass urine at all, if your kidneys are involved, or if you have blood in your urine or infection after infection, have the surgery your urologist recommends. Saika is not a replacement for it, and no supplement is.
What 4 numbers look like when they move
This is the chart from Robert's pre-op, the man who kept his March 7 date and took Saika in the 8 weeks before it.
| Test | January, surgery booked | March 1, pre-op |
|---|---|---|
| Flow rate | 6 ml a second | 11 ml a second |
| Left in bladder after emptying | 210 ml | 90 ml |
| Symptom score | 24 | 12 |
| Times up at night | 3 | 0 to 1 |
That's his ultrasound from before. 52 cc to 71 cc in 2 years, while he took his Flomax every single night. That's why I pushed his date back instead of signing off on it, and why his name came off the list in June.
See what Robert tookRobert wasn't the only one
Here are 4 more men from the last year. Not all of them cancelled. That's the point. The numbers decided, not me.
Ron, 63, an electrician, had a Rezum date in April. At his pre-op his flow had gone from 7 to 12. His urologist moved the date to the fall and told him to keep doing whatever he was doing.
Lyle, 72, a retired long-haul trucker, had a UroLift 4 years ago and was told TURP was next. After 9 weeks the urine left in his bladder dropped from 240 ml to 110. His urologist agreed to recheck in 3 months instead.
Ed, 69, kept his HoLEP date and had the surgery. He told me he walked in sleeping better than he had in 3 years, and his recovery nights were easier for it. Not every man's numbers move enough, and Ed's didn't. He has no regrets about the 8 weeks.
Marty, 66, a contractor, was up 4 times a night and on the list for a TURP consult. He's up once now, and he hasn't booked the consult.
Every one of them started where you are. Up in a dark bathroom at 3 in the morning, waiting, with a date on the calendar.
Why surgery leaves the real problem behind
Your prostate grows because of a hormone called DHT. It's 5 times stronger than testosterone, and as men age, the body makes more of it. DHT locks onto your prostate cells and tells them to grow.
A TURP or a laser takes out the tissue that's already grown. The DHT is still there the next morning, locking onto whatever's left. That's the regrowth in the surgical leaflet, and it's why about 1 in 10 men end up back on the table.
S-Equol works on the DHT itself. It binds to it, so the DHT can't lock onto your prostate cells. It doesn't shut anything off. Your testosterone stays where it is, and so does your drive.
Saika adds stinging nettle root, whose lignans block a protein called SHBG from docking onto prostate cells and pulling hormone signal into the tissue. 2 ingredients aimed at the same hormone from 2 directions. Most men can't make S-Equol in their own gut at all, which is why taking it directly matters.
Every dose is on the label: 12 mg of S-Equol and 50 mg of stinging nettle root per serving, with a small support blend of vitamins, minerals and green tea extract. No proprietary blend. I checked every number myself.
What to say at your pre-op
You don't have to convince your urologist of anything. You only have to ask for 2 tests he already runs. Say this:
No urologist will refuse that. If the numbers moved, he'll see it before you say a word about why. If they didn't, you're exactly where you were, with your date still on the calendar.
What to expect, and when
Weeks 1 and 2. Most men notice little. Some notice 1 fewer trip a night. That's normal.
Weeks 3 and 4. This is when most men in my practice notice a change. Fewer trips, an easier start, less standing and waiting.
Weeks 5 to 8. The window before a typical surgery date. Enough time for your own 4 numbers to move, or not, before anyone operates.
60 days. The guarantee window. If nothing has changed by then, you get your money back and your date is still there.
Why your urologist probably hasn't mentioned this
Not because he's hiding it. I didn't mention it either, for most of my 23 years.
We're trained to offer what's on the list: watch it, a pill, a bigger pill, a procedure. Nobody walks into a urology office to tell us about S-Equol, so most of us have simply never looked. That's why the plan ends with your numbers in front of him, not an argument.
You have 2 ways to spend the weeks before your date
Spend them the same way
Up at 1, 3 and 5. Reading recovery stories at 2 in the morning. Walk into the pre-op with the same numbers you have today, and sign the consent form.
Use them
Keep the date. Take Saika every day. Walk into the pre-op with your own before and after numbers, and let your urologist see what changed.
I don't get paid by Saika. Saika Prostate Intercept has a 60-day money-back guarantee. You email "this didn't work" and your money is back the same day.
Don't take my word for any of this. Ask for your hospital's own surgery leaflet and read the ejaculation numbers in it. Look up S-Equol and DHT. Read it the way I did, expecting to find nothing.
That's Robert on the Madison River this June. His son took it.
Saika Prostate Intercept
- 12 mg S-Equol and 50 mg stinging nettle root in every serving
- 2 capsules a day, 1 in the morning and 1 later in the day
- Every dose on the label, no proprietary blend
- Runs alongside what you already take
- 60-day money-back guarantee, refunded the same day you ask
What men wrote when they ordered
From Saika's post-purchase survey, September 2026. Written at the moment of ordering, before any results.
"my last chance before surgery, hoping for a miracle"
"fought this condition for years and it is getting worse"
"the outside chance this was not just another prostate scam"
What customers say
"I was running out of options"
"I'd been dealing with prostate trouble for almost 6 years. Tried saw palmetto, changed my diet, even gave up my evening coffee. When my doctor started discussing surgery, I got nervous about the possible side effects. I came across Saika while researching my options. I've been taking it for 9 weeks now. I'm still following up with my doctor, but I like knowing exactly what's in the capsules."
"I'd already wasted hundreds on supplements"
"After spending probably $400 on different prostate pills over the years, I wasn't exactly excited to buy another bottle. My wife actually found Saika and asked me to look into it. What caught my attention was the S-Equol ingredient. I've been using it for about 7 weeks. I can't say it's a miracle, but I appreciate that the company tells you the actual doses instead of hiding everything behind a fancy blend."
"My wife was more worried than I was"
"I'm 71, and after 43 years of marriage, my wife knows when something is bothering me. I'd been waking up several times a night and was getting frustrated. She encouraged me to speak to my doctor and look into my options. That's how we found Saika. I've been taking it for 2 months. It's easy to fit into my morning routine, and we're continuing to keep track of how I'm doing."
"The surgery conversation got my attention"
"My urologist brought up TURP last spring. I knew my prostate problems weren't getting any easier, but reading about the recovery and possible sexual side effects made me think seriously about my options. I spent a couple of weeks researching ingredients before ordering Saika. I've taken it consistently for 10 weeks. I'm glad I took the time to ask questions rather than rushing into a decision."
"I just wanted to enjoy retirement"
"I retired at 68 thinking I'd spend more time fishing and visiting the grandkids. Instead, I found myself planning drives around bathroom stops. My son helped me research prostate health, and Saika was one of the products we came across. I've been using it for nearly 3 months. I still take my doctor's advice seriously, but I appreciate having a straightforward supplement without a dozen mystery ingredients."
Questions men ask me
Can I take it with Flomax?
Saika is a dietary supplement meant to run alongside what you already take, not replace it. Keep taking everything your doctor prescribed, and show the label to your urologist or pharmacist.
What about finasteride?
Same answer. Don't stop or change any prescription on your own. Show the label to the doctor who prescribed it.
My date is only 3 or 4 weeks away.
Keep it. Most men notice a change by week 3 or 4, so you may see something before your pre-op. If you don't, the date is still there and the guarantee still covers you.
Will it shrink my prostate?
I won't promise that, and you should be wary of anyone who does. What S-Equol does is bind DHT so it can't tell your prostate cells to grow. What that means for your nights and your numbers is what the 60 days are for.
How is this different from saw palmetto?
Saw palmetto leans weakly on the enzyme that makes DHT, and in the 2 biggest US trials it did no better than a placebo. S-Equol doesn't try to stop DHT being made. It binds the DHT that's already there.
Where should I buy it?
Only at getsaika.com. Listings on Amazon and other marketplaces using the Saika name are not from Saika, and there's no way to know what's in them.
What if it doesn't work?
Email support@getsaika.com and write "this didn't work." Your money is back the same day. You have 60 days.
P.S. Get your 4 numbers this week, before your first capsule. Without a starting line, nobody can tell you what changed, not even you.
P.P.S. If your pre-op is less than 3 weeks away, keep the date and order anyway. The numbers still count on your recheck, and the 60-day guarantee covers you either way.
- British Association of Urological Surgeons. Transurethral resection of the prostate (TURP), patient information leaflet.
- Systematic review of reoperation rates after surgical treatment for benign prostatic hyperplasia (119 studies, 130,106 patients). Frontiers in Endocrinology, 2023.
- Marien T, et al. Holmium laser enucleation of the prostate outcomes. Research and Reports in Urology, 2016.
- Roehrborn CG, et al. Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Canadian Journal of Urology, 2017.
- McVary KT, et al. Final 5-year outcomes of the multicenter randomized sham-controlled trial of water vapor thermal therapy for benign prostatic hyperplasia. Journal of Urology, 2021.
- Barry MJ, et al. Effect of increasing doses of saw palmetto extract on lower urinary tract symptoms: a randomized trial. JAMA, 2011;306(12):1344-1351.
- McConnell JD, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. New England Journal of Medicine, 2003;349:2387-2398.
- Cleveland Clinic. Alpha-blockers. Health Library.
- Mayo Clinic. Tamsulosin (oral route), description and brand names.
- Lund TD, et al. Equol is a novel anti-androgen that inhibits prostate growth and hormone feedback. Biology of Reproduction, 2004;70(4):1188-1195.
- Schöttner M, Gansser D, Spiteller G. Lignans from the roots of Urtica dioica and their metabolites bind to human sex hormone binding globulin (SHBG). Planta Medica, 1997;63(6):529-532.