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Radiation Therapy If Enlarged Prostate

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Posted 6/21/2019 9:54 PM (GMT 0)
My brother was recently diagnosed as a GL7 (3+4) at age 62. I don't have the full stats but there were two non adjacent cores found. And his prostate is enlarged. He is planning on being treated.

I'm very satisfied with the results from my HDR Brachytherapy treatment. But this or other RT may not be appropriate with his enlarged prostate, and think he was leaning towards surgery, anyway. My brother is primarily getting advice from a prominent urologist who is recommending surgery. Who would also do the surgery. Though the radiologist the uro referred him to is agreeing.

Can anyone who had an enlarged prostate and did have RT, either with or without hormone therapy, describe their experiences.
Posted 6/21/2019 11:01 PM (GMT 0)
HDR, what you and I had, is one radiation therapy that works very well with enlarged prostates. As does traditional IMRT and SBRT. The only radiation therapy that is limited by prostate size is permanent seeds.

Also, robotic surgery is often challenged by large prostates and he may be looking at open surgery. Just how larges is the prostate?

Why isn’t he seeking out radiation oncologists in the different specialities like HDR and SBRT? He may be eligible for mono-therapy and would be just as good as surgery for cancer control with generally less significant and severs treatment side effects.
Posted 6/22/2019 2:00 AM (GMT 0)
Having your urologist (a surgeon) recommend radiation oncologists to consult is a bit like being a woman invited to a dance. Your date may encourage you to dance with his friends because he knows they will understand the expectation that you will leave with the guy who brought you.

If your brother wants to pursue radiation therapy his enlarged prostate can be worked around. He might ask about a short course of androgen deprivation prior to the treatments. For higher-risk disease ADT improves the effectiveness of some external-beam radiation but that's probably not needed for his Gleason 7(3+4) disease. Still, it would shrink his prostate, giving less tissue to irradiate, and it wouldn't hurt his chances of a cure.

Having your prostate removed can have bothersome side effects and it's kind of a big hammer to use to deal with an over-large prostate that can usually be treated with drugs.
Posted 6/22/2019 3:39 AM (GMT 0)
My advice for your brother is simple:

Read JNF’s post. Then, read it again and again until you have made an appointment with a radiation oncologist.
Posted 6/22/2019 11:12 AM (GMT 0)
Radiation oncologists are no less biased than urologists. Saying that, I'd get an 'independent' oncologist's opinion too. But if both say 'my way's the best', then all you can do is weigh up the advice and personal preference.
Posted 6/22/2019 11:17 AM (GMT 0)
Works, I totally agree with the previous posts. I had LDR Brachy and it was clear that would have been problematical with an enlarged prostate. HDR Brachy or SBRT should work fine. He should seek out specialists in those areas so he can make an educated decision. Please tell him what he may be facing with surgery whether or not the surgeon is "prominent".

BTW, I hope he is getting his biopsy slide reviewed by Dr. Epstein. With 2 cores and a 3 + 4 there is certainly a chance that Dr. E. might change that to a 3 + 3. Think how that might change bro's decisions....

Jim
Posted 6/22/2019 2:26 PM (GMT 0)
Thanks, all.

Have forwarded info on to my brother.

Regards,
Posted 6/22/2019 3:24 PM (GMT 0)
While it is true that each practitioner will usually tell you that "My way is the best" it is also true that some treatments are "more better" than others -- depending upon the patient's particular pathology and their personal preferences.

With G3+4=7, ADT is usually not within the Standard of Care, unless the patient has a very high PSA. You didn't state what his PSA is, so we don't know how that could impact things.

Absent any need for ADT, most of the modern methods of external beam radiation can accommodate enlarged prostates with little to no issue. My prostate was mildly enlarged, and my SBRT RO had no issue developing a treatment plan for me.

With low-risk and favorable intermediate-risk PCa (as your brother seems to present), many forms of treatment can be appropriate - both surgical and radiological. My own advice to your brother would be to identify which treatment modes are medically appropriate and research the efficacy AND SIDE EFFECTS of each, preferably on this site and other similar sites rather than at the doctor's office. The folks who have had each treatment will certainly remember their side effects, while the doc may not. I think he will find that most of the common monotherapies have very similar success rates for G3+4, thus the real decision factors will become which mode's side effects he can more readily accept. At his age, we assume that he will have a good many years over which to experience side effects, so it is important that he becomes comfortable with what his life will likely be like after treatment.
Posted 6/22/2019 11:32 PM (GMT 0)
Had SBRT 15 months ago with 63ml prostate. All is well.
Posted 6/23/2019 6:06 PM (GMT 0)
My brother is placing a lot of trust in the URO, and I just found out the SBRT practitioner the URO referred him to is concurring that surgery is the best course.

I don't know the prostate size or whether the surgery would be open or robotic or what assurances the URO has given my brother on nerve sparing. Doubt my brother will investigate other alternatives and I expect he will have surgery.

If you are thinking that there has not been much communication between the older brother who became reasonably knowledgeable in this matter, and the younger brother who is faced with decision making, you are not the only one.
Posted 6/25/2019 3:31 AM (GMT 0)

Works Out said...
My brother is placing a lot of trust in the URO, and I just found out the SBRT practitioner the URO referred him to is concurring that surgery is the best course.

I don't know the prostate size or whether the surgery would be open or robotic or what assurances the URO has given my brother on nerve sparing. Doubt my brother will investigate other alternatives and I expect he will have surgery.

If you are thinking that there has not been much communication between the older brother who became reasonably knowledgeable in this matter, and the younger brother who is faced with decision making, you are not the only one.

It sounds like your brother is getting good advice from his doctors and you. I'd leave it at that and not risk pushing or questioning. It's a very personal decision to make.
Posted 6/25/2019 3:19 PM (GMT 0)
You're absolutely right. Time for me to butt out. Not offering any more advice unless he requests it. I don't think he has investigated this sufficiently but it's his choice to make.


jasperx10 said...

Works Out said...
My brother is placing a lot of trust in the URO, and I just found out the SBRT practitioner the URO referred him to is concurring that surgery is the best course.

I don't know the prostate size or whether the surgery would be open or robotic or what assurances the URO has given my brother on nerve sparing. Doubt my brother will investigate other alternatives and I expect he will have surgery.

If you are thinking that there has not been much communication between the older brother who became reasonably knowledgeable in this matter, and the younger brother who is faced with decision making, you are not the only one.

It sounds like your brother is getting good advice from his doctors and you. I'd leave it at that and not risk pushing or questioning. It's a very personal decision to make.

Posted 6/25/2019 3:26 PM (GMT 0)
Works..."butt out"...I dunno. I don't know the relationship between you and your brother but if it was my brother at this point, here is probably what I would say:

"Bro, I think you are making a mistake by not getting your biopsy slides re-read by Dr. Epstein and by not seriously looking at alternatives to surgery. However, I understand that it's your body and your decision and will butt out if you want me to. So, shall I butt out?"

Jim
Posted 6/25/2019 7:02 PM (GMT 0)
Works Out...I faced the exact same situation with my brother when he was diagnosed as a G6. I was disappointed since I wanted him to take advantage of all the knowledge I had gained over the years. I counseled him to investigate AS and told him he should talk to some some ROs. But he and his wife pretty much had their mind up that he was going to have surgery.

I never asked him if I should butt out...if I asked him, I'm sure he would have said "no" since he's a really nice guy and we have a good relationship. At the same time, it was clear that he had a path set so anything else I added would be awkward (at best). At the end of the day, it was their decision to make and I accepted that.
Posted 6/25/2019 8:42 PM (GMT 0)
Works Out. Your brother only gets one chance at a treatment decision. My advice in this situation would be to do as I did. I was assessed by three different urologists. I was assessed by two different radiation oncologists, one that used permanent seed brachytherapy and one that performed High Dose Rate brachytherapy. I did not get a second opinion on my biopsy slides as my urologist used Bostwick Labs and they, with Epstein, are the best. All this took about three weeks.

I learned a lot and was able to make a well informed decision that I have never looked back on. I didnt have the luxury of time due to my high risk diagnosis. Your brother has all the time on his side given his very low risk diagnosis. He owes it to himself and his family to do much more investigative work before making a treatment decision.

If you didn’t care about him, you wouldn’t be so concerned and he may need to hear this from you. And if he tells you to “butt out” it probably wont be the first time, nor the last time, and it sure should not have any negative effect on your relationship. In my opinion, he is a bit cavalier and placing too much faith in the one urologist. Typically on this forum when men are asked about their regrets regarding treatment choices, the universal one from most is that they did not do enough initial research and get multiple assessments.
Posted 6/25/2019 8:54 PM (GMT 0)
It is possible, just depends. Pubic arch and other factors need to be considered
I had an enlarged prostate at the start of treatment. Had it shrunk through short term ADT prior to LDR Brachy
Posted 6/25/2019 10:08 PM (GMT 0)
Agree. Don't think he is well enough informed.

My brother is Mensa smart, but I think not handling wisely.

I am not Mensa smart, but was wise enough to consider my Uro's advice as one data point, and to continue my research here and elsewhere, and consulted with several practitioners. And decided on the therapy I felt made the most sense, which wasn't what my Uro had recommended. And maybe I would be in the same place today if I had chosen other therapy, but I feel good that I did my research and went with what I thought made sense.

He is apparently not open to more input. It is what it is.

My brother lives in England and I wonder if the attitude there towards health care there is less questioning and, even if you are a smart guy, you are more likely to go along with what your Dr. says, especially if you are seeing someone you think is a rock star.



JNF said...
Works Out. Your brother only gets one chance at a treatment decision. My advice in this situation would be to do as I did. I was assessed by three different urologists. I was assessed by two different radiation oncologists, one that used permanent seed brachytherapy and one that performed High Dose Rate brachytherapy. I did not get a second opinion on my biopsy slides as my urologist used Bostwick Labs and they, with Epstein, are the best. All this took about three weeks.

I learned a lot and was able to make a well informed decision that I have never looked back on. I didnt have the luxury of time due to my high risk diagnosis. Your brother has all the time on his side given his very low risk diagnosis. He owes it to himself and his family to do much more investigative work before making a treatment decision.

If you didn’t care about him, you wouldn’t be so concerned and he may need to hear this from you. And if he tells you to “butt out” it probably wont be the first time, nor the last time, and it sure should not have any negative effect on your relationship. In my opinion, he is a bit cavalier and placing too much faith in the one urologist. Typically on this forum when men are asked about their regrets regarding treatment choices, the universal one from most is that they did not do enough initial research and get multiple assessments.

Posted 6/26/2019 12:28 AM (GMT 0)
If he is Mensa Smart and very worldly he certainly knows that the UK PCa actual experience woefully trails the USA PCa experience. The UK statistics really suck (a MENSA term) compared to the USA. So why would a genius accept what the NHS provides? To me that is not very smart, certainly not MENSA smart.

If he were older brother WISE, he would hop on a plane to the USA and pursue assessments at MSK, Mayo, MD Anderson, etc. All institutions that are superior to what he may have available in the UK.

Many MENSA members that were in the public eye were so smart they smoked themselves to death. I have never been impressed by the MENSA designation as I have known several that behaved very stupidly.
Posted 6/26/2019 12:54 AM (GMT 0)
JNF,

Can you link to any US vs UK stats? Maybe that would get his attention. Or he may just attribute it to lack of routine screening in the UK.

Tks,



JNF said...
If he is Mensa Smart and very worldly he certainly knows that the UK PCa actual experience woefully trails the USA PCa experience. The UK statistics really suck (a MENSA term) compared to the USA. So why would a genius accept what the NHS provides? To me that is not very smart, certainly not MENSA smart.

If he were older brother WISE, he would hop on a plane to the USA and pursue assessments at MSK, Mayo, MD Anderson, etc. All institutions that are superior to what he may have available in the UK.

Many MENSA members that were in the public eye were so smart they smoked themselves to death. I have never been impressed by the MENSA designation as I have known several that behaved very stupidly.

Posted 6/26/2019 3:35 AM (GMT 0)
So, the SBRT doctor that his surgeon referred him to recommended surgery?

Wonder if the surgeon recommends radiation for patients referred from the RO?

My advice would be for him to consult with a medical oncologist, who could then refer him to a different, unaffiliated RO.
Posted 1/30/2020 10:33 PM (GMT 0)
Has he tried nascent iodide? It worked wonders for me!
I had prostate issues for 27 years and about 7 months ago I started taking nascent iodide.... Two months ago I went in for a 6 month check up and it was completely normal. Urination is back to mornal... From what I've heard, In some cases it works some take a little longer, but totally worth it.


Works Out said...
My brother was recently diagnosed as a GL7 (3+4) at age 62. I don't have the full stats but there were two non adjacent cores found. And his prostate is enlarged. He is planning on being treated.

I'm very satisfied with the results from my HDR Brachytherapy treatment. But this or other RT may not be appropriate with his enlarged prostate, and think he was leaning towards surgery, anyway. My brother is primarily getting advice from a prominent urologist who is recommending surgery. Who would also do the surgery. Though the radiologist the uro referred him to is agreeing.

Can anyone who had an enlarged prostate and did have RT, either with or without hormone therapy, describe their experiences.

Posted 1/30/2020 11:10 PM (GMT 0)
A large prostate is not a problem for surgery. Mine was 90 g and prostates much larger are removed. A related question is, how do various RT modalities affect BPH? I have yet to come across a study on BPH outcomes with RT.

Djin
Posted 1/31/2020 1:01 PM (GMT 0)
I agree. Surgery is specially adequate for enlarged prostates. It was the main reason of my choice. No prostate, no problems derived from a large prostate that may be many and greatly affecting the QOL. Of course, nobody is sure if the primary treatment will be the only one he may needs. But radiation with an enlarged prostate means that you have to deal with two problems that require two different treatments and you have to do it conveniently soon.
Posted 1/31/2020 3:47 PM (GMT 0)
That's nuts! No pun intended.. GUYS! You don't need surgery!! Get yourselves on nascent Iodine! It will solve the darned problem! By the way, I am not a sales person. I literally am seeking out men to tell them of the success I've had nascent iodine! 27 years of struggling with an inlarged prostate and within 6 months of being on iodide, my last check up was 2 months ago, I now have a normal prostate! All symptoms are gone!
We all are iodide deficient!
X2 Nasent Iodine worked for me.
Posted 1/31/2020 4:19 PM (GMT 0)
@T.S. Eliot or anyone with radiation treatment as a monotherapy and a large prostate; what was your urinary function prior to and following treatment. In my case my prostate was a typical size and I thought my urinary function was very good prior to treatment. Following SBRT I find my urinary function may actually be better. Prior to treatment I rarely got up at night and now never do. Prior to treatment I had occasional urgency now none. I’m only a data point of one; however, my treatment selection was based on minimizing treatment side effects. I did not expect to see an side effect benefits even small ones. Just wondering about the guys with larger prostates and possibly below normal urinary function however defined.
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