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Reduction In Prostate Size

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Posted 2/5/2015 12:57 AM (GMT 0)
At first biopsy my prostate was measured at 137, that was in December, 2013. Had my second biopsy today and it was measured at 40. I have been taking proscar for a year and had a turp in October that removed 28 grams of material so that accounts for the reduction.

Now, of course, I have the wait for the results of the biopsy. If I am still a Gleason 6 I may elect to continue AS. If not I will need to choose a therapy. Would like brachytherapy but understand some results have indicated a higher incontinence rate for those who have had a turp, depending on length of time since the turp and how much was removed.

Surgery has been ruled out so I may end up with the longer treatment regimen of radiation therapy.

Regardless of the biopsy result I believe I will meet with radiation people about my options. To that end can anybody recommend a stellar Brachytherapy dr in the Southeast. I could travel for that since it is only a day or two in the hospital. I live in Pensacola, FL so Atlanta, Birmingham, New Orleans, Jacksonville, and even Houston would not be a stretch for travel for the best.
Posted 2/5/2015 5:01 PM (GMT 0)
You asked:  To that end can anybody recommend a stellar Brachytherapy dr in the Southeast.

Yes.  Dattoli Cancer Center & Brachytherapy Research Institute in Sarasota is very highly regarded. 

http://www.dattoli.com/

Posted 2/5/2015 9:40 PM (GMT 0)
I think LDR brachy may be a problem after the TURP. HDR brachy might be a better choice. SBRT could be OK as well. MY SBRT RO says he sees about 5% rate of urinary strictures with it. As you say, the time since TURP can make a big difference, so the longer you can wait, the better.

I'd recommend you talk to Debra Freeman in Tampa. She was one of the pioneers and has been doing it for over 10 years. She treated 2 guys I know with great results.

BTW- you don't double PSA - a common mistake, perpetuated by doctors.
Posted 2/6/2015 3:11 AM (GMT 0)
TA, could you explain a little more about the effect of Proscar on PSA? I did a Google search and found a couple resources that said for men over 60 the PSA often drops by 50%.

But it was my doctor who said for a direct comparison to pre Proscar PSA's you need to double the post Proscar scores.
Posted 2/6/2015 3:36 AM (GMT 0)
You have to double it because the proscar reduces the psa but not the cancer emitting it, I believe.
Posted 2/6/2015 5:41 AM (GMT 0)
Many people, doctors included, are ill-informed about this. It is true that Proscar (or Avodart), on the average, cuts PSA in half. Two points:

• That is just an average and it varies widely from man to man. "Doubling it" has no rational basis.

• Proscar cuts the PSA due to BPH, but not so much the PSA due to PC. What this means is that PSA after taking Proscar becomes a much better tool for tracking PC progression. What you lose thereby is your past history of PSA, which was pretty useless anyway because you don't know what part of it was due to PC and what part was due to BPH.

The way to handle PSA after Proscar is to use it "as is," but to ignore previous readings. We call this "re-setting your baseline." With the new baseline, PSA becomes a lot more useful -- any increase suggests progression, and even the rate of increase may become more meaningful.

Here's a reference you can share with your doctor:
Effect of Finasteride on the Sensitivity of PSA for Detecting Prostate Cancer

You would no more artificially inflate your PSA after taking Proscar than you would after taking an antibiotic to reduce the PSA effects of prostatitis.

- Allen
Posted 2/6/2015 6:12 AM (GMT 0)
Thank you!
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