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Best Prostate Cancer Treatment Options If You Have BPH Symptoms
I've been on active surveillance for two years. I also have some BPH-like symptoms and take Flomax for it. I may need to get treatment for the cancer. I do a biopsy next month.
I'm Gleason 3+3, 1 core positive, PSA under 4, low Decipher, but there's a chance it has worsened. The MRI showed the lesion is larger and my BPH symptoms have gotten slightly worse. Prostate size 66 cc.
In the event I do need treatment, I know surgery would address both the cancer and BPH symptoms, but am very reluctant to go that route because of the higher incidence of incontinence as compared to radiation.
But if I go with one of the radiation options, such as SBRT, IMRT, brachytherapy, or Proton, I'm worried that it will worsen the BPH like symptoms. And if it does, what do people do? Of course, there's also the possibility that the symptoms could improve, but it is my understanding that is difficult to count on happening with radiation.
Thoughts from those who had BPH like symptoms when they went into radiation treatment?
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I just finished Radiation treatment for prostate cancer with reason score 3+4. My symptoms of BPH slightly improved after treatment. Decision to go with radiotherapy rather surgery were the concerns of leaking and the long recovery.
@dbee First and foremost -- Always get a 2nd or 3rd opinion of your Biopsy results . I speak from experience . Also refer to Dr. Patrick Walsh's book " Guide to Surviving Prostate Cancer .
A true Gleason Score determines yoour treatment options . I am on Active Surveillance - 80cc prostate volume with BPH . I was initially on Flowmax for several years and have been on Dutasteride for 5 years to reduce the size of my prostate . Be aware that certain medications to treat BPH also lowers your PSA . For example if you are on Dutasteride like me for an extended period -- You have to double your LAB PSA . My Lab PSA is 8.4 my true PSA is therefore 16.8 .
This is critical when monitoring your PSA Velocity. . In your situation , even if you discover your Gleason Score is higher -- Research Monotherapy SBRT 5 Sessions ( 3 one week and 2 the next - alternate days ) . If you choose , you can have Rezum to address BPH and still have radiation .
Good luck -- Rember Don't panic and make a knee jerk , wrong treatment decision . Continue to educate yourself . And finally make a sound , educated decision .
In addition to TULSA PRO . NanoKnife is fast becoming a successful Focal Treatment worldwide , with the exception . The USA is slower .
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1 ReactionI saw this thread bumped and thought I'd give an update. 2024 was a strange year. My second biopsy found no cancer and the second MRI found no change in the size of the existing cancer lesion that was found previously in the first MRI and biopsy. So how is that possible? Most likely the lesion is small enough that the sampling from the second biopsy just didn't happen to capture any cancer cells. Good news for sure. I was relieved and Mayo said I could go 3-5 years before another biopsy. Awesome. However...
My PSA number in Jan 2025 came in high at 7.6. I had a partial TURP surgery (the median lobe only) in the summer of 2024. That helped my BPH symptoms some, but since then I've still had some issues and started taking Tamsulosin again. So it's possible the higher PSA is from irritation due to BPH, or something else.
I meet with the local urologist next week. I assume they will recommend another MRI which I will do either at Mayo, or have Mayo read it if I have it done locally in my city. I'm still trying to figure out whether another BPH treatment will have to be done before undergoing radiation, if the next MRI and next biopsy show an evolution of the cancer to something that needs treatment. I've thoroughly researched the BPH treatments and am pretty sure I would do aquablation or HoLep if treatment is necessary before radiation for the cancer. Appreciate all the input.
@dbee I would highly recommend a 2nd or 3rd opinion of your 1st Biopsy Gleason Score ( Pathology Report ) John Hopkins comes to mind . They likely missed the target area on your 2nd Biopsy . Have you discussed Dutasteride with your Urologist to address your BPH problem
My 1st Biopsy was negative . My MRI PI-RADS Score was a " 5 " . In complete conflict with a negative biopsy . My 2nd Biopsy , supported by a 2nd & 3rd opinion of the results nailed down my gleason score -- Four Cores Gleason 3 + 3 = 6 , Two Cores Gleason 3 + 4 = 7