Best Prostate Cancer Treatment Options If You Have BPH Symptoms

I don't fully understand why you are seeking these major treatments like radiation, even proton. That is not the right call in your case. I was 3+3 for 2.75 years on AS. If my last biopsy hadn't gotten a higher grade they were going to do Rezum on me for the BPH. So you could do that if you have had multiple 3+3 biospy. Instead because of positive biopsy beyond 3+3 I did Tulsa Pro. Now going on 3 months my flow has gotten back to around where I was before Tulsa Pro and it will get better they say over the next 3 month. So Tulsa is good for BPH and cancer. But just 3+3 I understand they can do rezum. My Tulsa experience
https://connect.mayoclinic.org/discussion/tulsa-pro-initial-experience/

Thank you for the comment. Since I don't yet know whether my Gleason score has increased, I need to see that first before deciding on a treatment. But, I have been also looking at focal treatments, like Tulsa Pro, in the event it needs treatment.

Just out of curiosity, why Rezum for the BPH treatment, as opposed to some of the other options like TURP, microwave, etc.? Also, what is your age?

As I understand it, the benefit of Tulsa Pro is that they can address both the BPH and the localized cancer during the treatment, and have lesser side effects. Does that sound correct?

The drawbacks of Tulsa Pro, as I understand it, is that the re-occurence rates of the cancer are higher than either surgery or radiation, it often is not covered by insurance, and there isn't yet enough clinical data to make it standard of care for treatment. Is that also your understanding?

Tulsa Pro does seem to be an interesting option for me. I am very active, including international travel, and it would be very difficult if I was constantly battling incontinence.

I was 62 at Tulsa Pro treatment 2.5 months ago, now 63. Yes Tulsa is for BPH and localized cancer, perhaps the difference is Tulsa produces ablated tissue that can take up to 6 months to re-absorb so the BPH relief is slow and you may need alpha blocker for several months to 6 months still. I was told by the Mayo doc Rezum is quick, easy, and likely works well for my case, but he would go over more after my biopsy plus the alternatives. I never got there. The Tulsa recurrence rates don't differ that much from more radical treatments, but are slightly higher. That means utilize a guy that has done a lot because they know how to do the temperature at target lesion right, so that means they really work closely during procedure with a radiologist right there and a full team running the MRI and all. Tulsa has a medicare code already. It will be fully rolled into billing next January or a year from this writing, a rare few insurances cover it already but I can't tell you which one just a few people said they got it paid somehow in my reading. I think some doctors lean into new treatments, getting up to speed right away, plus have a setup with an MRI that isn't time limited and so on. Other doctors lean into traditional treatments so they don't have to bother with all that. As long as the one you select knows what they are doing is the best standard.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9231661/

First I agree with bjroc about not rushing to Pca treatment because of the BPH.

So, I had BPH symptoms before positive diagnosis 11/2019. I had been taking finasteride since maybe age 60. (FWIW: Finasteride apparently reduces PSA levels by maybe 50% so maybe my diagnosis should have come sooner/ lesion in the front of the prostate is not detectable by DRE.) My treatment (early 2020) was 5 sessions of proton beam treatment at Mayo Rochester. I had some urethra irritation after the 2nd treatment and the Radiation Oncologist switched me from Finasteride to Flowmax. I still take Flowmax twice a day and if I miss a dose it becomes apparent in reduced flow and more episodes of urgency. I would say that my symptoms of BPH have not changed much from the proton beam treatment.

I've considered treatment for BPH now (TURP, urolift, etc). A piece I don't understand is the function of the prostate in urinary continence. I assume that for those who opt for radical prostatectomy that the typical urinary incontinence post surgery has to do with the loss of the prostate helping continence and some incidental nerve injury. (Many report recovery of continence after some time).

FWIW: I think there are some focal treatments that don't involve the urethra (transperineally?)

Hope that helps.

How do people know they have BPH, and not something else causing the BPH like symptoms, such as the prostate cancer itself, or bladder issues?

And I guess you can get a BPH treatment after having had radiation? For some reason I thought that was an issue.

Finished 5 day sbrt 1/5/24.Take 1 flomax nightly,but am having to urinate just about every hour after going to bed around 11pm.

Look up IPSS score for BPH or something along those lines. We all fill these forms out one time or another. Not sure if they can do some BPH treatments after radiation or not.

I had BPH for a number of years. 2 MRI’s, both clean, 2 biopsies, the 2nd one showed cancer, 3+4=7. I chose RP. I was also informed that removal of the prostate is very difficult if radiation does not work. Surgery went without incident. I had NO incontinence issues at all, and I attribute that to doing Kegels(and prayer)religiously. My pathology report came back as Gleason of 4+5=9, and close to the capsule. So my biopsy was not completely accurate. Since then my first PSA came back < 0.01 so I’m hoping for more of the same. Make sure you leave no stone unturned before you make a decision. And get a surgeon you have 100% confidence. BTW, I was glad I had it removed. Had I waited longer, it could have been more serious. Best wishes!

Same for my husband post radiation 12/26 (last session) , the frequency has gone to every 2 hours from hourly. When up every 3 hours. And he’s gotten to every 2 days on Flomax as it was making him dizzy, seems to help. My guess is urethra was hit near prostate and swollen so not completely emptying bladder each time. Swelling must be coming down as frequency becomes less and burning with urination improves. Hang in there.

Look into the HOlep procedure for BPH. I've had BPH for about 20 years and took Flomax. 2019 was diagnosed having prostate cancer and been on hormone treatment Lupron. I researched BPH treatments but previous medical plan doctors wouldn't touch it because of the cancer. After switching medical plan and doctors I met with several urologist on best treatment for my BPH. They ultimately concluded HOlep (holeum laser embolism of the prostate}. Procedure is using a laser to core out the prostate of tissue surrounding the urethra and bladder taking pressure off the area and allowing normal urinary function. No surgery. All done through the penis. Excellent statistics with less than 1% incontinence. Outcome was 100% excellent with full relief and normal urination finally. Wish I had this done 20 years ago. Only issue was the catheter required for about a week. I'm 77. Check it out.