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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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To preface my comments, I am a prostate cancer patient, not a medical professional who treats prostate cancer. I am passing on my personal experience as I navigate the diagnostic and treatment decision-making process. I am 74. My PSA is 5.6. My mpMRI displayed 2 PIRAD 4 lesions. My fusion-guided biopsy yielded 6 3/3 cores and 1 3/4 core (< 10% pattern 4). My dx was grade 2-favorable PCa in December of 2024. I am in reasonably good health and walk 3-5 miles/day. I identified my QOL priorities as (1) avoiding diapers, (2) minimizing grade 3 toxicity reactions to PCa treatment, (3) minimizing the risk of postoperative cognitive dysfunction that can occur in older adults (over 65) with increasing frequency with age after general anesthesia and (4) maximizing my time with my wife of 54 years. For those reasons, I investigated TULSA.
For those considering TULSA, I just had a consult at Mayo, Rochester, and heard that TULSA is not the best option for everyone. Unfortunately, this includes me, so it might be helpful to others to pass along my notes.
As I understand it, some specific criteria make TULSA an excellent option for focal treatment of PCa:
-the absence of any electrical or metallic implant
-PCa diagnosis of grade 1 or grade 2- favorable;
-clearly visible lesion(s) on mpMRI, preferably unilateral;
-absence of visible indication of a lesion that might approach the prostate capsule or seminal vesicle
-prostate size no larger than 5 cm (superior-inferior) and 6 cm (axial);
-lesions less than 2.9 cm from the urethral center to allow for an external margin around visible lesions;
-absence of prostate calcifications that interfere with ultrasound ablation;
-absence of pre-existing urethral stricture or stenosis;
-patient understanding/acceptance that PCa is a focal disease that may occur at any time in prostate tissue that remains;
-patient understanding/acceptance that post-treatment surveillance criteria for focal ablation are less definitive than surveillance criteria for RP or RT;
-patient understanding/acceptance that biochemical reoccurrence may occur and may result in an upgrading of PCa diagnosis and recommended treatment.
In my particular circumstance, the prostate lesions were on each side of the gland, which has significant calcifications. As luck would have it, both PIRAD 4 lesions were 3/3. The 3/4 core was not visible on the mpMRI. They need to see it on the image to know where to deliver the focal treatment.
I did my best to take accurate notes. If someone finds I've misunderstood the information, please correct it as soon as possible for other's benefit. I hope this may be helpful to others. I'm off to consider other options. The world is full of opportunity and good people!
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Hug
4 ReactionsGood write up gsd. The parameters for Tulsa Pro are more restrictive and you did a nice job recapping. Fortunately, I met all the criteria. You’re write up is a great example though of why it is good to go to a center of excellence like Mayo. They can guide you to the most appropriate treatment for your unique cancer situation. Many of our cancers sound similar when you are talking about Gleason scores, decipher scores, etc. , but there are many other variables.
Hi @gsd, please read over my experience
https://connect.mayoclinic.org/discussion/tulsa-pro-initial-experience/
When I was at Mayo they were complaining they were having a hard time seeing my lesion as well plus they didn't have Tulsa Pro yet anyway. But my lesion was visible on diffusion weighted images, but at Mayo they always use the contrast enhanced images. I know Dr Woodrum uses heavy loads of contrast. Just in case you may want to try Dr Scionti to see if he can see your lesions. He opts out of medicare, so he is all cash pay, but he knows MRI real well and knows how to use diffusion weighted MRI to see where tumors are. Basically liquid diffuses though tissue and the MRI can pickup the diffusing action, but cancer tends to not diffuse liquids so they can see on the MRI there is an area of low diffusion and that is a tumor. I am sure most places use the contrast enhanced, but when they are doing Tulsa they don't have contrast in you yet, and it is diffusion weighting that plays in. Anyway it is an option for you to check Dr Scionti, he knows how to see lesions not on contrast enhanced MRI.
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Hug
1 ReactionThis is super helpful. I went back to my Mayo MRI and noticed they did take both a DWI and CE imaging.
Pretty much every MRI ordered has DWI. They order MRI with and without contrast pretty much routinely at most places. It is what they use clinically that counts though. At Mayo they do not use the DWI in the urology procedures diagnostically. They are pretty much just contrast for clinical purposes. But because they take MRI with and without, sending to Dr Scionti he can look at the without contrast images or DWI images and say what he sees. Believe me they order MRI everyday almost everywhere with and without, but they use what they use clinically and the rest is just like filler at places. For brain tumors and so on the DWI is real key. But anyway... too much info probably.
Thanks@bjroc! I'm so appreciative of people like you who volunteer avenues to find solutions! Fortunately, my diagnosis allows me plenty of time to explore other treatments and other providers. I'll keep you updated!
Best wishes!
GSD
jcf58 your accounts of your experience with TULSA inspired me to investigate! Thank you for your contributions and for caring about others who are travelling this path unexpectantly!
GSD
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Hug
1 ReactionCan you explain a little more on these two points please? How are surveillance criteria less definitive? What leads you to believe that?
And, I believe biochemical re-occurrence can ocur for all prostate cancers. How is this different?
-patient understanding/acceptance that post-treatment surveillance criteria for focal ablation are less definitive than surveillance criteria for RP or RT;
-patient understanding/acceptance that biochemical reoccurrence may occur and may result in an upgrading of PCa diagnosis and recommended treatment.
@dbee The present standard treatment of choice for your condition is Monotherapy SBRT 5 treatments . Mon - Wed - Fri and Mon -Wed the following week and done , with the typical regular PSA followup and later 18 - 24 months MRI . Mono : NO ADT S --- T . Retain your quality of life .
@gsd You might consider NanoKnife . It's vastly outpacing TULSA-PRO worldwide .The USA is behind the curve on this succcessful treatment . Canada , Australia , Germany ( The EU ) , etc etc . have multiple centers of excellence performing this procedure Toronto, Canada is major high volume center .