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Pending Decision - Urethra Tube Length / Incontinence

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Posted 6/21/2021 7:24 PM (GMT 0)
Hello everyone,
I have posted prior and explained I have a pending decision on my treatment path. I was given some information recently with respect to my risk for incontinence based on uretha tube length thru the prostate and wanted to know if anyone heard of this prior. To refresh, below was my diagnosis.
Positive cores 4 out of 12, highest Gleason grade 3+4=7 (ISUP Group 2) ,
PSA 5.74 ng/ml, DRE: normal T1c.
According to NCCN guideline this tumor would be considered intermediate risk.
Speculated TNM stage= T1c N0 M0.
Perineural Invasion is identified.
No Extra-prostatic extension is identified.
Gleason 4 ranges between 0% and 40% of the tumor in these cores.
Cribriform pattern 4 is present.Gleason (3+4) with 4 out of 12 positive.

Currently I have met with two highly experienced surgeons - both robotic surgeons. This week I am also a meeting with a radiation specialist. I conducted an interview over the phone with the assistant to gather more information prior to my appt. One of the things she stated was that they would recommend an MRI. She stated that they would gain more information about the cancer, but was really of new knews to me was that they could also determine the urethra length thru the prostate. She stated if it was small in length that this would likely indicate I would be incontinent for life if surgery is chosen. I had not hear that before and was wondering if anyone else has. This particular office does targeted radiation and the guy is named Patrick Mclaughlin. He was a Professor of Radiation Oncology, ( I belive at Michigan State Univ. ) is the Medical Director for the Department’s community practices at Providence Hospital in Southfield MI and the Assarian Cancer Center in Novi. He supposedly pioneered MRI-guided vessel-sparing prostate brachytherapy delivered in combination with external beam therapy. She stated he would have no problem recommending surgery if it was the right choice. So I think this will be my last visit for opinions on the path to follow. For the record, Dr. Peabody of Henry Ford Cancer center said radiation was a good option but felt surgery would be the route to go. Dr. Johnston was the other surgeon and also recommended surgery. I honestly just want to hopefully be cured and be continent. How everything else goes would not be nearly as important to me. Thanks and any final thoughts would be appreciated,
Posted 6/21/2021 7:29 PM (GMT 0)
Does urethral length affect continence outcomes following robot assisted laparoscopic radical prostatectomy (RALP)? (2020, Full Text)

From the Abstract:

"Conclusions
MUL had no effect on baseline continence but had a positive and significant association with continence outcomes over 12 months post RALP."

From the Full Text:

"Conclusion
This is one of the largest studies investigating continence outcomes in patients undergoing RALP and its association with MUL. Strict inclusion criteria and definitions of continence provide the basis for an accurate analysis of post-operative continence outcomes. Membranous urethral length had no effect on baseline urinary incontinence but had a positive and significant association with continence outcomes over 12 months post RALP. The findings of this study will aid in pre-RALP assessment of patients, particularly where clinicians can employ an evidence-based approach to counselling patients regarding incontinence and recovery times based on MUL measurements. By educating patients who might take longer to regain continence based on their MUL measurements, this could potentially improve their psychological well-being and subsequently their overall quality of life. Future studies measuring ‘bother’ scores of the EPIC questionnaire could test the efficacy of such counselling."

_______________________________________________

Postoperative membranous urethral length is the single most important surgical factor predicting recovery of postoperative urinary continence (2020, Full Text)

"Conclusions
Our study highlights the importance of saving the MUL as long as possible in terms of continence recovery. This holds true for ORP even in the era of RARP and surgeons should not simply give up the prospect of early urinary continence in exchange for the patient's choice of ORP instead of RARP."

Djin
Posted 6/21/2021 8:43 PM (GMT 0)
For radiation you should also consult with Dr Alvarez Martinez at Beaumont. He is world renowned and a top specialist using High Dose Rate brachytherapy. Amazing to have such expertise right in your backyard to take advantage of.
Posted 6/21/2021 10:26 PM (GMT 0)
This is a relatively new study (last year), and I think this is the first time it's been mentioned on this forum. It's interesting that it was brought up by the radiation docs....it would be even more interesting to hear the surgeon's take on it.
Posted 6/22/2021 12:26 AM (GMT 0)
Is there any information that the RT will have a significant and possibly life long influence on continence, assuming nothing is botched?
Posted 6/22/2021 1:46 AM (GMT 0)
Billy I had double radiation 10 years ago. I piss like a race horse and never have a drop or dribble any other time. Radiation was very good for my urinary system.
Posted 6/22/2021 1:48 AM (GMT 0)

BillyBob@388 said...
Is there any information that the RT will have a significant and possibly life long influence on continence, assuming nothing is botched?

I have not been able to find a single study of the urinary outcomes of primary RT on patients with BPH symptoms.

Djin
Posted 6/23/2021 8:42 PM (GMT 0)
Hello everyone again,
I met with the Patrick McLaughlin (Radiation guy) in Novi Michigan. He was excellent. He gave me the most amount of information to consider so far. Bottom line is that he doesn’t recommend anybody making a decision without an MRI first. With that they can understand more about the cancer, it’s likelihood of being contained in the prostate and as well they will know the sphincter length. He said there is a small percentage of men that have a very small sphincter. If this is the case, and surgery is chosen, the risk of life long incontinence is much greater. If the MRI is favorable for surgery, he thinks surgery is a good option. He knows the surgeons that I met with and stated they are excellent. He did lay out what type of possible radiation plan would be offered. This includes initial seeds and later 5 weeks of once a day beam radiation. So for now I’m not doing anything until I get the MRI and review the results with him. Thanks for the push guys to get more opinions and facts during this process. It will be late July before I have results of all this to report further.
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