Recently Diagnosed 6 Weeks after

Because of my diagnosis, unlikely to have a clean margins, surgery not on my list. I am opting for IMRT/Brachy and maybe short term hormone.

My problem(well, the current one)

First, the Uro told me my prostate was unusually small. After his biopsy, came back at 64cc. Next, pelvic MRI w/contrast simply stated, enlarged prostate indenting the bladder.

Next up, an ultra sound ordered by my RO. Prostate at 40cc, however, only sightly enlarged, but at the median lobe, impinging the bladder neck, causing my urinary problems. I'm thinking a turp would be beneficial prior to the treatment, to reduce the risk of problems during treatment.
After reading of possible side effects from a TURP, it looks worse than the treatment. I would prefer to shrink the sucker some other way
Just found this site the other day, seems like a great place to get informed prior to making a life altering decision
Any advice is appreciated.

Welcome to our little corner of the world. Glad you found us and joined in so quickly.

I have positive margins but so far, I am in the Zero Club with my first 2 PSA test and I had surgery.

I agree some what with Andrew. Robotic surgery would allow the surgeon to see everything better than shooting in the dark, so to speak. Dealing that close to the bladder could have long term SE. Besides, radiation could follow later. If you have radiation first, you usually don't follow that up with surgery.

Thanks for posting. Keep us informed.

Bill

Hi there, Fauntleroy,

We may have "met" in another PC forum, so we may already have had an exchange of comments.

I share the opinion of the others here who suggest that you look into a surgical approach. From what I can see, your PC, while perhaps not completely confined to the prostate, is likely to be no further than the other glands that would usually be removed along with the prostate.

Your situation also sounds similar to mine in that I had a huge prostate. My doctor at Mayo Clinic did a cystocopy on me the day before my DaVinci procedure. He told me that "you have a whopper of a prostate."

He went on to explain that very large prostates, such as mine, often tend to deform and also begin to encroach into the bladder, etc. He then assured that my choice of surgery was my only logical option -- an opinion that was shared by the Mayo radiation oncologist that I had also consulted with.

With the surgery, you get rid of the cancer (hopefully!) and the infringement on the bladder, have normal urinary function restored, etc.

Also, as another poster mentioned, you CANNOT do surgery if external beam radiation fails because of all the scar tissue built up around the prostate from the radiation.

You might consider meeting with a urologist who specializes in prostate cancer surgery and see what s/he has to say about the pros and cons regarding surgery in your case. Then you will be able to consider all the different treatment options available in your case, possibly including surgery.

Good luck my friend!
Chuck

7/11 PSA 6.41 (4.1 2009) DRE-BPH,no lumps PCa Dx 8/11 age 62 adenocarcinoma 3/20 cores,T2C Glea 3+3 DaVinci prostatectomy 11/1/11 Mayo Clinic, nerve sparing Dr. Matthew Tollefson-highly recommend! Pathology-tumor confined to prostate 5 lymph nodes, seminal vesicules, extraprostatic soft tissue negative 1x.6x.6 cm mass involving R post inferior, R post apex, L mid post prostate R post apex margin involved by tumor over .2 cm length
Catheter out 7 days, no incontinence
Post-op exams 2/13/12, 9/10/12, PSA <0.1

I was placed on avodart for several weeks prior to my brachytherapy to shrink my prostate. After approximately 6 weeks my gland size was reduced from 41 to 20 CC. This can also be administered in conjunction with the IMRT treatments.

Turns out, the comment about the prostate being small, was from two separate DRE's from the same uro (I guess it's fairly subjective, the second at 64cc was determined during the biopsy, I found out today that the tech assisting during the biopsy takes measurements and he, not the uro , estimates the size. The uro is focused on getting a good biopsy.

So, from the ultra sound by the RO this week, 39cc, with what he called a "knuckle" slightly indenting into the bladder neck. My urinary symptoms are really not that severe.

Is it possible a biopsy core sample just happened to be near that slight indent resulting in the urinary retention, could be right?

The take away from today was, 2 weeks, casodex follow by 6 months of lupron, 5 weeks of IMRT followed by Brachy. Might be overkill but, 8 of 12 cores, both sides involved, apex and base, perineural invasion, family history of PC, at least G7

Whatever route you go, it's scary knowing you may never be the same again