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BPH before radiation, and increased urinary issues after?

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Posted 9/21/2022 12:42 AM (GMT 0)
I am still trying to decide between surgery and radiation. Has anyone had BPH issues before radiation? My issues are weak stream and a little leakage after, if I'm not careful. If so, were your issues worse after radiation? The treatment options for BPH and urinary issues seem to be rather limited after radiation.
Posted 9/21/2022 1:42 AM (GMT 0)
Hey JRK,

You are on the right track by doing your due diligence.
I had an enlarged prostate (65cc) with a "nub" partially obstructing the urethra.(didn't know at the time) which caused urinary issues leading up to the time of treatment.I almost went to the ER just from the biopsy. So it seemed as if radiation would not be an option.
I was lucky to find a very experienced RO, whose specialized in prostate cancer only.
I was given medication before and during the external beam radiation(6 weeks) that shrunk the prostate prior to Brachy-Therapy from 65cc to 29cc. The small outgrowth or"nub" was still a issue so I needed a green light laser procedure just to shave down the offending growth, prior to seeding.

Obviously your case is much simpler, but the point is that the prostate size can be reduced with drugs prior to radiation and will weaken the cancer cells, making them more susceptible to the radiation.

So after all that, my urinary issues have improved compared to how I was but I did have that extra intervention in between. One RO wanted me to treat the urinary issues prior to starting treatment, the one I chose, knew how to manage it during the process. My older brother was treated years later with just 5 cyber knife treatments, so options have improved.
Posted 9/21/2022 1:59 AM (GMT 0)
Just re read my reply, probably doesn’t help you very much. Just aim for the treatment that will give you the best chance of a cure with the least chance side effects.
Posted 9/21/2022 3:24 AM (GMT 0)
My prostate is not overly large, so not sure what's causing my issues exactly. We are trying flomax currently to see if any improvement. Only been on it a few days and so far it's only given me a retrograde ejaculation. Didn't care for that.
Posted 9/21/2022 10:05 AM (GMT 0)
If, indeed, your symptoms are caused by BPH, symptom intensity is not always directly related to prostate size. It also depends on the direction of growth, which can favor growth outward from the urethra or inward, the latter obviously causing more problems.
Posted 9/21/2022 1:24 PM (GMT 0)
For many years before my dx., I had BPH. I was on Flomax for about 5 years. For the 12-18 months before dx. the drug's effectiveness was greatly diminishaing. Twice I had my jacket on ready to go to the ER due to an inability to urinate. Each time I gave it one more try and had success. But things were getting miserable. So that was one more reason I chose surgery (in addition to many other reasons). It certainly did cure my BPH!

Mel
Posted 9/21/2022 4:47 PM (GMT 0)
I had a color Doppler ultrasound to find that prostate protrusion then a urine flow test to determine how to fix it prior to the seed implant. My RO had his own on-site Doppler and ct scanner.I did however have external beam prior to that green light laser correction and made it through from the ADT Shrinkage during 6 weeks of external beam treatment.

An experienced RO should able to assess you for suitability for treatment. Maybe they can chemically shrink the prostate confirm there is no prostate tissue impinging into the urethra. The meds I took, casodex Avodart and a shot of Trelstar treats the cancer while you wait.

Or surgery which will eliminate all that.

I will say, don’t necessarily go with what’s easier up front. Make a list of pros and cons for each treatments. For me facing 2 primary treatments and being told they will be “cutting wide,” I was terrified of waking up from surgery with ED but permanent incontinence more so, while facing BCR
Posted 9/21/2022 5:43 PM (GMT 0)
JRK, Some guys address the urinary issues with HoLEP or Aquablation and follow with radiation. Might be worth investigating. I’m also glad to see you making a fully informed decision. Since your case is a little more complicated than others it’s even more important to seek out the very best treatment team you can. Terry



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Posted 9/21/2022 9:16 PM (GMT 0)

Terry's Cellar said...
JRK, Some guys address the urinary issues with HoLEP or Aquablation and follow with radiation. Might be worth investigating.
.


That’s my current tactic. I’m favorable intermediate G3+4 on AS, but had a 140cc prostate and urinary issues. Had the HoLEP to resolve the BPH and prep me for RT for when the day comes. It also provided a 94 gram sample of tissue for pathology. Dropped my PSA from 5.9 to 0.4. I’m comfortable with my path so far. Will continue on AS until things suggest otherwise.
Posted 9/22/2022 7:23 PM (GMT 0)
CPA Dude, you are in AS with Gleason 7? I didn't know they did that.


centralPAdude said...

Terry's Cellar said...
JRK, Some guys address the urinary issues with HoLEP or Aquablation and follow with radiation. Might be worth investigating.
.


That’s my current tactic. I’m favorable intermediate G3+4 on AS, but had a 140cc prostate and urinary issues. Had the HoLEP to resolve the BPH and prep me for RT for when the day comes. It also provided a 94 gram sample of tissue for pathology. Dropped my PSA from 5.9 to 0.4. I’m comfortable with my path so far. Will continue on AS until things suggest otherwise.

Posted 9/22/2022 10:36 PM (GMT 0)

JRK said...
CPA Dude, you are in AS with Gleason 7? I didn't know they did that.


I am, it is favorable intermediate, less than 5% 7. Current best practice is to consider AS for favorable intermediate, but it isn’t recommended like it is for G6.

My hospital actually called it a 6, but it was upgraded by Epstein at Hopkins when I sent it off for a second opinion. That led to some critical thinking of what course to take, and nudged me off the fence into getting the HoLEP.

Having the HoLEP and getting a full pathology of the prostate innards was a key part of my strategy. Biopsies sample minimal amounts of the prostate, really. With 2/3rds of my prostate looked at, and nothing found, I am much more comfortable with AS. I track emerging research on the AS for fav intermediate cohort closely.
Posted 9/23/2022 3:00 AM (GMT 0)
My 7 is right at 5% I believe. How old are you? I am 50, and I've already had sepsis from one biopsy, so I'm ready to treat it, IF I can make a decision!

centralPAdude said...

JRK said...
CPA Dude, you are in AS with Gleason 7? I didn't know they did that.


I am, it is favorable intermediate, less than 5% 7. Current best practice is to consider AS for favorable intermediate, but it isn’t recommended like it is for G6.

My hospital actually called it a 6, but it was upgraded by Epstein at Hopkins when I sent it off for a second opinion. That led to some critical thinking of what course to take, and nudged me off the fence into getting the HoLEP.

Having the HoLEP and getting a full pathology of the prostate innards was a key part of my strategy. Biopsies sample minimal amounts of the prostate, really. With 2/3rds of my prostate looked at, and nothing found, I am much more comfortable with AS. I track emerging research on the AS for fav intermediate cohort closely.

Posted 9/23/2022 3:07 AM (GMT 0)

JRK said...
My 7 is right at 5% I believe. How old are you? I am 50, and I've already had sepsis from one biopsy, so I'm ready to treat it, IF I can make a decision!


I am almost 62.

Sucks that you have to mess with this at 50, and that you had a bad biopsy experience. If you stay on AS, definitely go for the perineal biopsy next (my plan).
Posted 10/1/2022 12:29 AM (GMT 0)
Enlarged prostate so I had Greenlight laser surgery and that helped me through SBRT
Now 11 months post bph symptoms are back but not as bad

Glen
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