Picking the best Treatment prior TURP with bladder neck scarring

Hi everyone. I am 68 a runner in great health. I lasted on AS for 3 month and now I am heading to MD Anderson for a Proton Consult. I am still debating this treatment or Photon. I was recommended not to have surgery due to bladder neck scarring from TURP in 2003 and intermittent catheterization since 2000 due to neurogenic bladder (disk disease). Another recent leaning experience was that because I have been on finasteride since my TURP my PSA of 14.9 should be doubled. My PSA has gone up since Jan from 13.78. Although I have a 3+4 =7 Gleason and a small right-side tumor 1.8 cm confined to the prostate capsule <20 cm. This was confirmed with 3TMRI and genetic tests Polaris and a high risk screening placing me in the intermediate range. The increased risk of radiation treatment is 15% to 25% for related UI problems verse 5% to 8% for those without a prior TURP. Incontinence is my main concern on my treatment selection. Of course getting rid of the Cancer too. If anyone has experience with Proton and Photon treatments outcomes and side effect please advise. Thank you!

The scarring from TURP will increase your risk of urinary side effects from any kind of radiation. Whether your PSA should be doubled or not is debatable, but the moderately sized GS 3+4 and the genomic test are causes for concern - did the biopsy report say what % of it is pattern 4? If not, you can get a second opinion from Epstein that will tell you that. If it's 5% pattern 4, you might decide to wait; if it's 45%, maybe not.

Anecdotally, I know 2 men who had SBRT with a prior TURP - one did very well, the other had problems with incontinence and needed catheterization. I don't know if proton is any better.

That means that less than 15% of the core was GS 3+4. The other question is, what % of that GS 3+4 core was pattern 4. If it's low, you might consider AS. But with the intermediate genomic score, it certainly makes sense to pursue treatment. Since surgery, brachytherapy, and ablation are ruled out. That only leaves SBRT, IMRT, or protons. There's a great therapy called carbon ion beam that is unfortunately not available in the western hemisphere.

Well here is an update. Just back from MD Anderson. The had done their own pathology report on my previous biopsy slides and came up with a 4+3=7 rather than a 3+4=7. My intermediate diagnosis was already on the high side with the PSA at 14.9 so I let them start me on leuprolide (3 month) (LUPRON DEPOT). I picked up some Bicalutamide 50 mg today. In 30 days I will find out if it worked on the PSA. I should start Proton Treatment in two to three months unless I switch to IMRT at UNM Cancer or at the local hospital in town. The Proton treatment will be a long one with reduced dosage to protect the bladder neck. I believe 48 treatments in all 5 days a week. Interestingly they are using a epoxy between the prostate and rectum to protect it. I will also need to have a colonoscopy prior to the treatment. This was due for a couple of years but that is their protocol. It seems like a good team and my prognosis is good. But there could be stuff floating around. I will be doing a lot of exercise and working on keeping the sexual function going. Thanks for everyone's input. It helps.