1. < Prostate Cancer

Best Prostate Cancer Treatment Options If You Have BPH Symptoms?

Posted by dbee @dbee, Jan 25, 2024

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?

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

jcf58 | @jcf58 | Feb 4 2:44pm
In reply to @pdcar4756 "Thank you. Excellent response! As with any procedure like TULSA-PRO, it will take time to create..." + (show)
@pdcar4756

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..........

Jump to this post

I am a little late responding today as I’m on vacation in Hawaii. pdcar summarized my feelings in one of the earlier posts. I chose Tulsa pro because of the low risk of side effects, minimally invasive, and all other options were on the table if cancer returned. Including Tulsa pro again. Also the fact that I was being treated at the Mayo Clinic and they would be watching me like a hawk, gave me great confidence in my decision. My hope is some of these less invasive procedures will become the gold standard for men 10-15 years from now.

REPLY
pdcar4756 | @pdcar4756 | Feb 4 5:31pm

Yes..............we who choose TULSA-PRO are like those same group of guys who chose SBRT when it first was introduced. 🙂

REPLY
mark1952 | @mark1952 | Feb 4 6:26pm

Hello, dbee,
I was diagnosed with BPH before discovering I had prostate cancer. 4+3 7 intermediate unfavorable. My prostate at that time was about 50cc. I wanted an RP so it would solve the BPH, but was not a good candidate for that. Yesterday I finished up with 4 months of Orgovyx (ADT). Have completed 26 radiation sessions of IGRT, 13 more to go. To address your question, I can say that after the treatment I have had so far, my urination is more frequent, more urgent, more difficult to start, and more painful when I have urine in my bladder. How much of this is related to Orgovyx, and how much to radiation, I don't know. But I do suspect the radiation has swollen my prostate and narrowed my urethra more than it was. I am hoping some of these symptoms will lessen in the weeks or months after all treatment stops. My RO evades answering my questions on this. She just says that we'll have to wait and see what happens. Two close friends had the HoLEP procedure recently at Mayo FL and they are very pleased with their results. I am told I can do that after radiation, but not sure how well the radiated tissue will heal. Maybe there is some less invasive procedure that would help? I have taken Tamsulosin (FLOMAX) and Tadalafil (Cialis) with poor results. Wish I could be more helpful. Best of luck to you.

REPLY
2 replies
gsd | @gsd | Feb 4 10:21pm
In reply to @mark1952 "Hello, dbee, I was diagnosed with BPH before discovering I had prostate cancer. 4+3 7 intermediate..." + (show)
@mark1952

Hello, dbee,
I was diagnosed with BPH before discovering I had prostate cancer. 4+3 7 intermediate unfavorable. My prostate at that time was about 50cc. I wanted an RP so it would solve the BPH, but was not a good candidate for that. Yesterday I finished up with 4 months of Orgovyx (ADT). Have completed 26 radiation sessions of IGRT, 13 more to go. To address your question, I can say that after the treatment I have had so far, my urination is more frequent, more urgent, more difficult to start, and more painful when I have urine in my bladder. How much of this is related to Orgovyx, and how much to radiation, I don't know. But I do suspect the radiation has swollen my prostate and narrowed my urethra more than it was. I am hoping some of these symptoms will lessen in the weeks or months after all treatment stops. My RO evades answering my questions on this. She just says that we'll have to wait and see what happens. Two close friends had the HoLEP procedure recently at Mayo FL and they are very pleased with their results. I am told I can do that after radiation, but not sure how well the radiated tissue will heal. Maybe there is some less invasive procedure that would help? I have taken Tamsulosin (FLOMAX) and Tadalafil (Cialis) with poor results. Wish I could be more helpful. Best of luck to you.

Jump to this post

mark1952, thanks for posting your experience with IGRT!

First, congratulations on finishing your PCa treatment protocol! I hope you rang the bell loudly and celebrated!

I too have moderate BPH symptoms, so that is a factor in sorting through my treatment options for PCa treatment. I was asked to complete the AUA Lower Urinary Symptom (LUTS) Questionnaire and undergo a uro-flow test/bladder sonogram to better inform my advising doctors of my pre-treatment lower-urinary tract symptoms. If I remember correctly, my AUA LUTS Questionnaire score was 13. My urine flow was 8ml/sec and the remaining residual bladder volume was 130ml. Did you have any evaluation of your BPH done prior to your IGRT? If so, sharing that might be helpful for me to compare your experience with one I might expect.

Thanks again for posting and congratulations!

REPLY
2 replies
gsd | @gsd | Feb 4 10:26pm
In reply to @gsd "mark1952, thanks for posting your experience with IGRT! First, congratulations on finishing your PCa treatment protocol!..." + (show)
@gsd

mark1952, thanks for posting your experience with IGRT!

First, congratulations on finishing your PCa treatment protocol! I hope you rang the bell loudly and celebrated!

I too have moderate BPH symptoms, so that is a factor in sorting through my treatment options for PCa treatment. I was asked to complete the AUA Lower Urinary Symptom (LUTS) Questionnaire and undergo a uro-flow test/bladder sonogram to better inform my advising doctors of my pre-treatment lower-urinary tract symptoms. If I remember correctly, my AUA LUTS Questionnaire score was 13. My urine flow was 8ml/sec and the remaining residual bladder volume was 130ml. Did you have any evaluation of your BPH done prior to your IGRT? If so, sharing that might be helpful for me to compare your experience with one I might expect.

Thanks again for posting and congratulations!

Jump to this post

Correction: LUTS= Lower Urinary TRACT Symptoms.

REPLY
breadmaker | @breadmaker | Feb 5 11:16am

I didn't see any mention of PAE - Prostatic Artery Embolization. It isn't for cancer - just BPH - but might be a solution for you if you think you have time before you go with a treatment of your PCa.

You'll want to discuss this with your medical team of course.

My brother did this - he does not have PCa - and it was very helpful for his BPH.

Here's one video from Johns Hopkins. The image quality of the video is poor, at least for me. About 20 minutes in Dr. Holly touches on cancer aspects. (Bottom line - not enough data.)


There's also several discussions on this site on PAE.

REPLY
clandeboye1 | @clandeboye1 | Feb 6 12:41pm
In reply to @mark1952 "Hello, dbee, I was diagnosed with BPH before discovering I had prostate cancer. 4+3 7 intermediate..." + (show)
@mark1952

Hello, dbee,
I was diagnosed with BPH before discovering I had prostate cancer. 4+3 7 intermediate unfavorable. My prostate at that time was about 50cc. I wanted an RP so it would solve the BPH, but was not a good candidate for that. Yesterday I finished up with 4 months of Orgovyx (ADT). Have completed 26 radiation sessions of IGRT, 13 more to go. To address your question, I can say that after the treatment I have had so far, my urination is more frequent, more urgent, more difficult to start, and more painful when I have urine in my bladder. How much of this is related to Orgovyx, and how much to radiation, I don't know. But I do suspect the radiation has swollen my prostate and narrowed my urethra more than it was. I am hoping some of these symptoms will lessen in the weeks or months after all treatment stops. My RO evades answering my questions on this. She just says that we'll have to wait and see what happens. Two close friends had the HoLEP procedure recently at Mayo FL and they are very pleased with their results. I am told I can do that after radiation, but not sure how well the radiated tissue will heal. Maybe there is some less invasive procedure that would help? I have taken Tamsulosin (FLOMAX) and Tadalafil (Cialis) with poor results. Wish I could be more helpful. Best of luck to you.

Jump to this post

@mark1952 Talk to your Urologist about Dutasteride I am 85 , was on Flowmax for several years . I have been on Dutasteride for 5 plus years -- much improved .
NOTE : If you are on Dutasteride, like me ,for several years : " YOU HAVE TO DOUBLE YOUR LAB PSA RESULT " I have no side effects .

REPLY
1 reply
rsprehn | @rsprehn | Feb 7 11:13am
In reply to @clandeboye1 "@mark1952 Talk to your Urologist about Dutasteride I am 85 , was on Flowmax for several..." + (show)
@clandeboye1

@mark1952 Talk to your Urologist about Dutasteride I am 85 , was on Flowmax for several years . I have been on Dutasteride for 5 plus years -- much improved .
NOTE : If you are on Dutasteride, like me ,for several years : " YOU HAVE TO DOUBLE YOUR LAB PSA RESULT " I have no side effects .

Jump to this post

My urologist says that Dutasteride will reduce the size of the prostate by about 30% also daily. Cialis 5mg will reduce the size of the prostate with other benefits as well! Ron

REPLY
clandeboye1 | @clandeboye1 | Feb 7 12:22pm

@mark1952 In addition to reducing the sizee of your prostate . It also lowers your PSA number . Therefore when you are on it for a long term , years , you have to double your LAB PSA NUMBER .
My LAB PSA NUMBER IS 8.4 MY "TRUE PSA " IS 16.8 .
I believe my Family Doctor was not aware of this , nor did my drug store advice me .
My GP indicated , INCORRECTLY, , that my increasing PSA was a result of my BPH .
I personally advocated to consult a Urologist , who proposed a Transrectal Biopsy - NO WAY AND NO PRIOR MRI . I scheduled an MRI in the USA and a Transperineal MRI Fusion Biopsy in a different city ( Toronto ) . The biopsy result was negative . In complete conflict with my MRI PI - RADS 5 Score . The Torontoo Urologist was elated -- NOT ME . I scheduled a 2nd Transperineal Biopsy with 16 cores , instead of the 5 cores the first time . Six cores came back positive -- I then had a 2nd & 3rd opinion of the pathology results to finally determine my " MOST LIKELY Gleason Score " Prostate Pathology Results are far from an exact science. That's why I would never take the first results as the baseline or bible .
An MRI is mandatory in the UK before all Biopsies , which are now Transperineal . Some countries have banned TRANSRECTAL BIOPSIES .
Posted from Canada .

REPLY
mark1952 | @mark1952 | Feb 7 6:24pm
In reply to @gsd "mark1952, thanks for posting your experience with IGRT! First, congratulations on finishing your PCa treatment protocol!..." + (show)
@gsd

mark1952, thanks for posting your experience with IGRT!

First, congratulations on finishing your PCa treatment protocol! I hope you rang the bell loudly and celebrated!

I too have moderate BPH symptoms, so that is a factor in sorting through my treatment options for PCa treatment. I was asked to complete the AUA Lower Urinary Symptom (LUTS) Questionnaire and undergo a uro-flow test/bladder sonogram to better inform my advising doctors of my pre-treatment lower-urinary tract symptoms. If I remember correctly, my AUA LUTS Questionnaire score was 13. My urine flow was 8ml/sec and the remaining residual bladder volume was 130ml. Did you have any evaluation of your BPH done prior to your IGRT? If so, sharing that might be helpful for me to compare your experience with one I might expect.

Thanks again for posting and congratulations!

Jump to this post

Sorry, gsd, no evaluation of BPH prior to radiation. Should also mention that the radiation I have had so far (still 10 sessions to go) has inflamed my rectal wall, despite having SpaceOAR gel implanted to protect the rectum. Will discuss with RO on Monday. Sure hope this pain will not be permanent.

REPLY
1 reply
View MoreView Less
Please sign in or register to post a reply.