Best Prostate Cancer Treatment Options If You Have BPH Symptoms?

@dbee Was your MRI on the old 1.5 machine or 3.0 machine ?

@dbee A followup . I am approaching 85 and have been on AC with 4 cores Gleason 3 + 3 = 6 and 2 cores Gleason 3 + 4 = 7 . Recently I consulted with three (3 ) Radiation Oncologists at the Centers of Excellence in Cancer Treatments & Research - e.g. Princess Margaret Hospital in Toronto , rated in the Top 5 in the world . Also Sunnybrook Hospital , also in Toronto , where TULSA-PRO was invented .
I have BPH , was on Flowmax for years and have been on Dutasteride for 5 years . My prostate is 80cc .
ALL RECOMMENDED MONOTHERAPY SBRT -- SHOULD I DECIDE TO DISCONTINUE ACTIVE SURVEILLANCE . Quality of life is my 1st priority . NO hormone therapy for me - Not at my age . Not at any age if you can avoid it .

interesting. Wasn't aware of this. Will check into it at Mayo.

It was on Mayo 3T

When I first started my investigation, this treatment was at the top of my list. Given my age of 60, I'm right on the borderline for prostatectomy vs radiation vs focal therapy, making the decision difficult. When you did SBRT, did they discuss potential complications of the SBRT causing the BPH to get so much worse that it would block urine flow? I read that is a potential issue with radiation, and thus doctors recommend getting treated for the BPH before the radiation. Sounds like you didn't have to do that and your BPH symptoms weren't worse after radiation?

pdcar 4756 I'm glad to share my thoughts because reading others' opinions have been so helpful to me! I always want to remind others that I am a PCa patient working through my own options. I'm not a doctor who specializes in treating prostate cancer.

-PCa SURVEILLANCE AFTER ABLATION THERAPY: My understanding is that there are two significant differences between post treatment RP and RT surveillance criteria compared to post treatment TULSA partial gland ablation treatment surveillance criteria. The first, and most important, is there is much less post-treatment surveillance data for post-treatment Tulsa partial gland therapy. The longest surveillance data I've seen for Tulsa was for a moderate sized study (115 men) at 5 years presented as an abstract at the 2024 annual conference of the American Urological Association and published in Journal of Vascular and Interventional Radiology. Most (if not all) of us who are interested in TULSA have a prospective life span of longer than 10 years. So we are interested in longer-term surveillance data with a higher level of evidence than a 5-year study of 115. There are hundreds of studies published in peer-reviewed journals detailing post-treatment surveillance of RP and RT that have followed patient populations totaling tens of thousands. The second difference in post treatment surveillance after partial gland ablation is the factors used to determine treatment failure/biochemical recurrance (BCR), at least at an early stage, do not seem to be as certain as they are in surveilling RP and RT after treatment. After RP or RT, an indication of treatment failure seems to be ether a 3 consecutive prostate-specific antigen (PSA) increases of more than 0.5 ng/mL or a .2 ng/mL rise above the nadir PSA, (usually below .1 ng/ml). This would be followed by a mpMRI and a guided fusion biopsy if lesions were detected. The best data I could find for detection of treatment failure after partial gland ablation therapy comes from cryo-ablation studies. Because the therapy is partial gland, there is no set guideline for PSA nadir after treatment. There is still some prostate gland left producing PSA. There also don't appear to be any firm guidelines on thresholds of PSA level or PSA rise velocity that might indicate treatment failure/BCR. Also, apparently there is some scarring that occurs from the ablation that may make definitive reading of mpMRI more difficult. The standard follow-up surveillance in the cryo-ablation studies was an annual random needle biopsy. This may have been because they were studies and they were searching for correlating surveillance diagnostic criteria that were less invasive. Two cryo-ablation studies I reviewed did have treatment failures with sub 4 PSAs, with what I considered to be minimal increases in PSA, and were not visible on the MRI, but were picked-up with the random needle biopsy.

-PATIENT UNDERSTANDING/ACCEPTANCE THAT BIOCHEMICAL REOCCURRENCE MAY OCCUR AND MAY RESULT IN AN UPGRADING OF PCa Dx & Tx. This caution really accompanies all prostate cancer treatment. In my mind it is probably very relevant to partial gland treatment because there is prostate tissue that remains that may at some time grow a new prostate cancer. The studies I've read on partial gland treatment show that the median time from treatment to an upgrade in PCa diagnosis (getting worse) is longer than for Active Surveillance patients, but shorter than for RP and RT patients.

All this said, I will remind you of something that I think jcf58 said (paraphrasing because I can't find the direct quote): He was comfortable going with TULSA because it was less invasive, had less toxic side effects, and advances in PCa treatment are accelerating so that if he needs re-treatment, there is the real possibility that future treatment will be more successful with fewer side effects. If I had been a good candidate for TULSA, that is exactly how I felt. Of course, I'm interested in others input!

I hope this helps! You have my sincere best wishes!

@dbee I'm surprised you would consider a " PROSTATEGOMY " with a Gleason score of 3 + 3 = 6 . at age 60 .
Urologists want to proceed with surgery - IT'S IN THEIR JOB DESCRIPTION . "Surgeon " . Radiation Oncologists want to RADIATE .
Yes their is a concern with SBRT & BRACHYTHERAPY with BPH AND, a large prostatte . However your Urologist must feel yours is still minor or he would have switched you to another medication PLUS Your prostate is not considered large . Swelling should not be an issue .
Have you studied Dr. Patrick Walsh's book : " Guide to Surviving Prostate Cancer " -- a must read and often referenced on this forum .

@dbee . Most Urologists will insist that the MAJORITY , IF NOT ALL , Focal Therapies are still in the research stage .
Google : NanoKnife in Germany , NanoKnife in Toronto and NanoKnife in Australia etc . It will take you to various CLINIC SITES with the details of the procedure . I personally know several close associates who have had this procedure with great success . Ages 60 plus ( 70 & 75 .)

Thank you. Excellent response! As with any procedure like TULSA-PRO, it will take time to create the large amount of data that RP &RT have. But it will come. As part of my TULSA-PRO procedure at Mayo I agreed to be a member of a study group initiated by Dr. Woodrum so that this kind of information can be gathered. And you're correct, that folks who have TULSA-PRO procedures still have functioning prostates producing PSA. For me, this is part of that journey. I've gone through several decades of watching my PSA vary over time while steadily increasing, until I hit a level where action needed to be taken to ascertain what's going on. I will live that journey again, but at least I'm familiar with it, combined with the realization that prostate cancer is generally slow growing and one usually has time to react and treat before it becomes a real threat. As with any treatment for this disease, we end up balancing treatment effectiveness with side effects/quality of life. At age 78, quality of life was important to me. And if I have 10-15 years of life remaining, maybe this treatment will allow me the best chance for that quality of life......or maybe not. And if it should be maybe not, I still have all of the other options available to me but for RP, which wasn't available initially either. And I have optimism that in the next 5-10 years even better treatments will become available should I need them. That was my rationale coupled with my understanding that biological reoccurrence rates are about the same (15-20%) no matter the treatment. I've paid my money, and taken my chances........... 🙂 I hope I do so wisely. We shall see..........

pdcar4756, you will do great! You are getting treatment at Mayo, a center of excellence. When is the treatment scheduled? I'll put it in my calendar to give a prayer of support for you and Dr. Woodrum that morning.

Best wishes and let us know how you are doing!