Prostate size, BPH & the decision: RALP or RT?

My prostate - 74ml. I have all the common BPH symptoms - weaker urine stream, frequent or urgent need to urinate, increased frequency of urination at night, inability to completely empty the bladder, along with 75-80% reduced semen.

If I'm cured I may have another 20 years to go in this world and I'd like to think my Genitourinary (GU) issues are not going to be a continuing issue.

I'd like to hear short and long term experiences from others who have had brachy or other RT in the past 10 years, who also had BPH symptoms and enlarged prostates. It would be helpful to know what size was your prostate was before and after, and notwithstanding the cancer cure, how did the RT affect your BPH symptoms.

LDR brachy is not recommended for "large"prostates 60ml and over. This has been ruled out. I have not been able to talk to a HDR Brachy RT yet but understand that a "large" prostate does not rule out this treatment.

RT in general can cause urinary symptoms both short term and long. However, SBRT RO Dr King UCLA told me that, following RT, over time, the prostate size shrinks which often leads to reduced BPH symptoms.

Following IMRT or HDR Brachy, reported Genitourinary complication rates are small - in the 1-4% range, however, do not distinguish between those patients that had larger prostates or BPH symptoms.

I've been trying hard to narrow down the treatment decision for my PCa. Since my overall cardio health is excellent there is no increased risk with surgery. The potential RT side effects on the prostate (swelling and irritation and BPH symptoms) have me thinking that a RALP is a better choice because of my large prostate and current BPH symptoms. Also, if treated with RT, the chance that these symptoms will continue as is or get worse and possibly require medical treatment is unattractive.

I am well aware of the ED stats for both RT and RALP and it appears life will be different either way I go. Another "side effect" of the RALP is a shorter penis. The literature I've read so far is vague on this subject and I haven't yet addressed this with my URO. If the size (length) of my large prostate correlates to this, I would like to know up front what I can expect. And what about this potential side effect following RT?

You can significantly shrink the prostate by taking Avodart. This is a common treatment for BPH and can help you prepare for brachytherapy. Reduction of 35-50% is common in a few months. As you mention, HDR brachytherapy can be used in larger prostates than LDR. I had HDR and IMRT and after nine years have no negative treatment side effects. A common radiation treatment side effect is reduced ejaculate, but not a problem.

My advice is to get a HDR brachytherapy assessment to conclusively determine that possibility. Where are you located?

RE: penis shortening. That seems to be a sometimes true sometimes not thing. It can happen...particularly in situations where the ED is immediate and permanent--this is atrophy of the tissues. Shortening (mr turtle effect) when flaccid seems pretty common--particularly in cold weather. Shortening (or not) when erect is a different thing. Some seem to have it, some not so much.

Like a lot of PC treatment things, it's variable, and much seems to depend on the individuals (both patient and surgeon) involved.

For the rest, this decision is important. Some RO's won't do radiation at all on a large prostate, because of the risk of what increased prostate swelling can do. Some will do HDR, some will do SBRT and/or EBRT. Many times they will use Avodart for a period of weeks or months before starting treatment. On the other hand, some surgeons will tell you that doing RALP on a very large prostate can be tricky too--the prostate is "squishy" which makes identifying the edges difficult, and there is a greater chance of the prostate being attached in weird ways to other tissues.

In the end, you're the only one who can decide what is right for you, based on how you weigh all the factors. keep coming with questions and ruminations. We'll listen, and share our own experience.

Before I was John Holmes. Through much counseling, I’ve finally come to terms with average.


Keep asking all the right questions.

Great information. Often the concerns over prostate size and brachytherapy are expressed by non-experts, also known as urologists.

You must always get the proper assessment from the specific provider that specializes in the actual treatment. Do not let non-specialists speak for the specialist.

My wife has been treated twice for breast cancer. The first included a lumpectomy and whole breast radiation. Fourteen years later another cancer in that breast resulted in a mastectomy and the surgeon wanted some radiation due to a margin concern. Many docs said no that she had already been radiated citing generalities regarding maximum dose. Fortunately we found a true specialist that studied what had been done and determined that a small area could be radiated again and provided effective and successful treatment. He basically used very tight IMRT over 45 fractions.

Again, find the best specialist for the specific work to be done. And then let them work their magic.

You can also use proscar. It predates Avodart and is available in a generic form. Could be less expensive.

What's this ejaculation thing you speak of?

Retrograde ejaculation (into the bladder) can also be caused by some BP meds and some antidepressants - SSRIs.

Not ejaculating is not that big a deal. Less mess. Not having any function at all? THAT is a big deal.

I'll add my two cents on the subject of retrograde ejaculation since this is something I suffer from as a result of medication I am taking for my enlarged prostate(67 cc). While I'm sure everyone is different, for me it was a bit emasculating. I am still able to to perform but the finish is just not the same. I guess the best way to describe it is everything feels normal until the end. Things build normally but there is just no big bang at the end, it just ends. To be honest it is a bit of a let down. Like I said, I'm sure everyone is different. Maybe my problem is something else. I talked to the Uro about it once but he just kind of shrugged it off and said that is one of the possible side effects.

I hope everyone in the States had a Happy Thanksgiving!

Gemson

Post Edited (Gemson) : 11/28/2019 6:43:20 PM (GMT-7)