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Large prostate considerations for RRP

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Posted 4/27/2022 9:21 PM (GMT 0)
For the benefit of the group- My urologist and surgeon both said I was not a good candidate for radiation due to the 180cc monster prostate i have. The rationale was potential for damage to rectum and bladder due to "crowding" could cause radiation damage. I elected surgery based on that but in case others are confronted with the same dialog, what are the pros and cons of this situation? They were so adamant I never even got a second opinion from a radiation guy. They other consideration was that they said surgery wasn't an option after radiation. I've seen that on this board before.
Posted 4/27/2022 10:35 PM (GMT 0)
given that last comment -- a misleading scare tactic -- i would definitely consider getting a second opinion. good luck to you!
Posted 4/27/2022 10:56 PM (GMT 0)
Rich,
First, thanks for reaching out!

Radiation to large prostates can cause issues, especially if you already have BPH and urinary issues. The radiation treatment can cause swelling to the point that urinary problems can get really bad. Also, with a large prostate, some of the radiation treatments are hard because it's hard to get the aim exactly right.

That being said, that last line is so, so irritating. Consider this:

It's assumng that primary radiation treatment will not successfully treat the cancer. Yes, surgery after radiation is complicated because of the tissue damage. However, if you have a treatment failure, it's not the end of the line--there are other options.

What is your gleason score? What was your biopsy results?
Posted 4/27/2022 11:08 PM (GMT 0)
At a minimum get a second opinion, it’s your life we’re talking about.
The prostate can be drastically reduced in size, mine was. Around 64 cc down to high 20’s.
180cc might be too large but I would want to hear it from the RO to confirm it.
Posted 4/27/2022 11:27 PM (GMT 0)
"Yes, surgery after radiation is complicated because of the tissue damage. However, if you have a treatment failure, it's not the end of the line--there are other options."

since radiation treats a larger area, i prefer the answer: if radiation fails the cancer was most likely systemic. i.e., surgery and SRT would have failed too
Posted 4/28/2022 1:45 AM (GMT 0)
Rich,

I'm confused: You're posting about a large prostate and treatment options, suggesting you haven't been treated yet...and a few days ago you posted about penile pump problems--which usually comes up after treatment. Am I missing something?

Also, please do post your biopsy results (I assume you've had one), your gleason score and history, your age, location, etc.

Oh, don't let a surgeon tell you about radiation therapy.
Posted 4/28/2022 2:47 AM (GMT 0)
Rich,

You're posting a great question, rarely discussed for the benefit of the group. I had a 150cc prostate and was diagnosed with G3+4 in 2018. I had appointments with two RO's, one MO and a half dozen uros/surgeons. The RO's wanted me on six months of Lupron to try to shrink the prostate prior to treating with radiation. They thought surgery was a better option for me, as did the MO. I can't say I did a deep, deep dive but I was convinced any type of radiation therapy would make my already troublesome urinary symptoms worse. My surgery went very well, everything is good and my urinary symptoms are gigantically improved. But it takes some time. I did my kegels and my penile rehab. very regularly the first year and I still try to do a good set of kegels every day. BTW, you and I are both lightweights. A guy in my support group had a 230cc prostate!
Posted 4/28/2022 10:54 AM (GMT 0)
Just to clarify, Rich DID have surgery a few months back as described in a post in another thread. Rich, it would be helpful to all if you would create a signature which you can do in your HW profile. That way other members won't have any confusion about your treatment or status.

Now to the subject at hand. Certainly surgery was a reasonable choice for you with a monster sized prostate. But, as most of us typically recommend, it's always a good idea to get opinions on treatment options from experts in their fields. Never take radiation advice from a surgeon nor surgical advice from a RO. It's beyond choice for you now but some radiation options (like HDR Brachy) may not have been off the table.

As to your last sentence it is unfortunately one of the perpetuated myths that help convince men to have surgery but is totally misleading. As Hal (a surgical patient) pointed out, there are equally good options after failed radiation as there are after failed surgery. To imply otherwise is not the case.

Good luck in your continued recovery.

Jim
Posted 4/28/2022 1:03 PM (GMT 0)
I’m in the BPH and PCa crowd, but also in the Active Surveillance cohort. Prostate is 140cc.

Well, it used to be, but I had a HoLEP procedure on Monday, and I expect the total mass to be *way* below that now. If the day comes I need to treat, I’ll target radiation.

Up to 10% of HoLEPs find incidental PCa on the pathology review, so it seems to be common to debulk the prostate prior to some kind of treatment, even if that wasn’t the plan going in.

This is an ongoing trial to knowingly incorporate HoLEP into the PCa treatment plan, that I am kind of mirroring. Will be curious to see their final result.

https://clinicaltrials.gov/ct2/show/NCT03802851

“The investigators hypothesize that pre-radiation HoLEP may decrease their overall LUTS and may decrease their need for subsequent radiation therapy. The goal with this study is to better understand the overlap between prostate cancer and LUTS, as well as determine if primary surgical treatment for the LUTS with HoLEP can also serve as a possible treatment modality for concurrent prostate cancer. “
Posted 4/28/2022 2:46 PM (GMT 0)
@Dude…I cannot offer any personal experience; however, your logic seems sound. On the surface it seems RRP is like getting ‘two for one’ for those suffering from both BPH and PCa; but, removing a very large prostate presents greater risk of side effects. The HoLEP has the potential of removing the cancer as well as treating the LUTS. Certainly another option that guys suffering from both conditions should consider. Terry
Posted 4/28/2022 3:01 PM (GMT 0)

F8 said...
given that last comment -- a misleading scare tactic -- i would definitely consider getting a second opinion. good luck to you!

There certainly nothing wrong with getting a second opinion, but there is something very wrong with a layman telling someone that statements from both a surgeon and Uro were misleading.

Large prostates cause treatment challenges for both the surgeon and the RO..

Post Edited (Duck2) : 4/28/2022 9:06:21 AM (GMT-6)

Posted 4/28/2022 3:08 PM (GMT 0)

Duck2 said...

F8 said...
given that last comment -- a misleading scare tactic -- i would definitely consider getting a second opinion. good luck to you!

There certainly nothing wrong with getting a second opinion, but there is something very wrong with a layman telling someone that statements from both a surgeon and Uro were misleading.

"Large prostates cause treatment challenges for both the surgeon and the RO..

"

no argument from me. apparently you missed my point
Posted 4/28/2022 3:27 PM (GMT 0)
No, I didn’t miss you point your point. Since you are not his treating physician and know nothing about this patient’s condition, accusations of their treatment recommendation being a misleading scare tactic is beyond your knowledge on many levels.
Posted 4/28/2022 4:07 PM (GMT 0)

Duck2 said...
No, I didn’t miss you point your point. Since you are not his treating physician and know nothing about this patient’s condition, accusations of their treatment recommendation being a misleading scare tactic is beyond your knowledge on many levels.

then you are projecting. if it quacks like a duck...
Posted 4/28/2022 4:30 PM (GMT 0)
Most of us have experienced the Urologist who repeats the "you can have radiation after surgery but not surgery after radiation". And we have discussed this many, many times in here. It's true, to a point, but it is truly a misleading sales tactic to promote surgery as "better", by surgeons.

I really wish they would stop using it..especially without explaining the context.
Posted 4/28/2022 6:13 PM (GMT 0)

halbert said...
Most of us have experienced the Urologist who repeats the "you can have radiation after surgery but not surgery after radiation". And we have discussed this many, many times in here. It's true, to a point, but it is truly a misleading sales tactic to promote surgery as "better", by surgeons.

I really wish they would stop using it..especially without explaining the context.

it's a true statement used deceptively and effectively by a professional who will profit from your fear
Posted 4/29/2022 4:02 AM (GMT 0)

F8 said...

halbert said...
Most of us have experienced the Urologist who repeats the "you can have radiation after surgery but not surgery after radiation". And we have discussed this many, many times in here. It's true, to a point, but it is truly a misleading sales tactic to promote surgery as "better", by surgeons.

I really wish they would stop using it..especially without explaining the context.

it's a true statement used deceptively and effectively by a professional who will profit from your fear


That point applies to both surgeons and ROs.
Posted 4/30/2022 3:22 AM (GMT 0)
3+4 . 5 cores positive of 14 on MRI guided biopsy, 14 years of PSA above 7, 3 biopsy's and one MRI. All negative until my PSA spiked from 11 to 16 in 6 months so I guess I was on watchful waiting with my uro in Fairfax, Va. The high PSA was tolerated by the URO due to the psa density calculation and the fact my high PSA was constant for many years. Surgery confirmed 3+4 and negative margin and lymphs. I did have some EPE that gave me a final diagnosis of 3 but they said it did not spread and they got it all. S
Thanks for everyone who has weighed in on my large prostate dilemma LOL. This forum is a godsend. I did have surgery on 2/ 22, 2022(cool date) but that was the only cool thing about that day. Both my uro and Johns Hopkins consult recommended surgery based on the size. At Johns Hopkins, I was lucky enough to do my consult with Dr. Partin, the head of JH Urology by zoom. He did mention prostate size reduction using Proscar or whatever, but it would delay treatment by at least 6 months, which worried me. I don't think at a place like Johns Hopkins that the profit motive overcomes sound medical advice so those that keep insinuating that are wrong. I am now enrolled in their research program and I have called them with concerns post surgery and they are incredibly helpful cheerfully. I bring the large prostate issue to the group because it does seem to be an influencing factor in the course of treatmen options available. Those that have gone the radiation route have I am sure gotten good advice. This darn PCa is still not a perfect science. I am at peace with my approach and I urge everyone to follow their instincts, supplemented by their research and education from medical professionals as there will be a lot of time to dwell on and second guess your decision later on and you don't want to have regrets.

Post Edited (Richp6) : 4/29/2022 9:33:09 PM (GMT-6)

Posted 4/30/2022 9:30 AM (GMT 0)
Rich,

Thanks for the update and further information. There is a lot of clarity there. I suspect a lot of the comments came because you were asking about PC with an extra-large prostate, and treatment options--so the assumption may have been that you were still exploring options (I know that's how it worked for me).

You've checked all the boxes we suggest here--go to a top location, consult with the true experts, make a decision and get it done. You did all that. Now you're in recuperation and recovery mode. Let us know when you get your 3 month PSA after surgery, we'll be pulling for you to get a "<" in front of your reading. Keep going with your rehab. How's your continence and ED?
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