New info from meeting with RO Yesterday he says because my prostate is enlarged ( 158 grams estimate from MRI, about 5 x normal) he thinks that having a TURP prior to radiation might be a good idea.
His thinking is; radiation may swell my prostate and if my urethra were to close off flow during the 28 day procedure they would have to go in and do a TRUP at that point and it would be worse as the radiation could complicate the healing of the urethrae.
From Mayo Clinic web site
Overview
Enlarged prostate with benign prostatic hyperplasia compared with normal prostate
Benign prostatic hyperplasia (BPH)Open pop-up dialog box
Transurethral resection of the prostate (TURP) is a surgery used to treat urinary problems that are caused by an enlarged prostate.
An instrument called a resectoscope is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra). The resectoscope helps your doctor see and trim away excess prostate tissue that's blocking urine flow.
TURP is generally considered an option for men who have moderate to severe urinary problems that haven't responded to medication. While TURP has been considered the most effective treatment for an enlarged prostate, a number of other, minimally invasive procedures are becoming more effective. These procedures generally cause fewer complications and have a quicker recovery period than TURP.
Here are some of the alternatives I have found:
Does anyone have experience with any of these
Traditional Treatment Methods for Enlarged Prostate
Treatment options
Alpha blockers
5-alpha reductase inhibitors
Combination therapy
TUMT
TUNA
Water-induced thermotherapy
Surgery
Laser surgery
Open simple prostatectomy
Lifestyle changes
Recognizing BPH
If trips to the restroom require sudden dashes or are marked by difficulty urinating, your prostate may be enlarged. You’re not alone — the Urology Care Foundation estimates that 50 percent of men in their 50s have an enlarged prostate. The prostate is the gland that produces the fluid that carries sperm. It grows larger with age. An enlarged prostate, or benign prostatic hyperplasia (BPH), can block the urethra from transporting urine from the bladder and out of the penis.
Keep reading to learn about traditional treatments for BPH.
BPH treatment options
Don’t resign yourself to living with BPH. Addressing your symptoms now can help you avoid problems later. Untreated BPH may lead to urinary tract infections, acute urinary retention (you can’t go at all), and kidney and bladder stones. In severe cases it can lead to kidney damage.
Treatment options include medications and surgery. You and your doctor will consider several factors when you evaluate these choices. These factors include:
how much your symptoms interfere with your life
the size of your prostate
your age
your overall health
any other medical conditions
Alpha blockers for BPH
This class of medications works by relaxing the bladder neck muscles and the muscle fibers in the prostate. The muscle relaxation makes it easier to urinate. You can expect an increase in urine flow and a less frequent need to urinate within a day or two if you take an alpha blocker for BPH. Alpha blockers include:
alfuzosin (Uroxatral)
doxazosin (Cardura)
silodosin (Rapaflo)
tamsulosin (Flomax)
terazosin (Hytrin)
5-alpha reductase inhibitors for BPH
This type of medication reduces the size of the prostate gland by blocking hormones that spur the growth of your prostate gland. Dutasteride (Avodart) and finasteride (Proscar) are two types of 5-alpha reductase inhibitors. You’ll generally have to wait three to six months for symptom relief with 5-alpha reductase inhibitors.
Medication combo
Taking a combination of an alpha blocker and a 5-alpha reductase inhibitor provides greater symptom relief than taking either one of these drugs alone, according to an article in Current Drug TargetsTrusted Source. Combination therapy is often recommended when an alpha blocker or 5-alpha reductase inhibitor isn’t working on its own. Common combinations that doctors prescribe are finasteride and doxazosin or dutasteride and tamsulosin (Jalyn). The dutasteride and tamsulosin combination comes as two drugs combined into a single tablet.
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Stand the heat
There are minimally invasive surgery options when drug therapy isn’t enough to relieve BPH symptoms. These procedures include transurethral microwave thermotherapy (TUMT). Microwaves destroy prostate tissue with heat during this outpatient procedure.
TUMT will not cure BPH. The procedure does cut down urinary frequency, makes it easier to urinate, and reduces weak flow. It doesn’t solve the problem of incomplete emptying of the bladder.
TUNA treatment
TUNA stands for transurethral needle ablation. High-frequency radio waves, delivered through twin needles, burn a specific region of the prostate in this procedure. TUNA results in better urine flow and relieves BPH symptoms with fewer complications than invasive surgery.
This outpatient procedure can cause a burning sensation. The sensation can be managed by using an anesthetic to block the nerves in and around the prostate.
Getting in hot water
Hot water is delivered through a catheter to a treatment balloon that sits in the center of the prostate in water-induced thermotherapy. This computer-controlled procedure heats a defined area of the prostate while neighboring tissues are protected. The heat destroys the problematic tissue. The tissue is then either excreted through urine or reabsorbed in the body.
Surgical choices
Invasive surgery for BPH includes transurethral surgery, which doesn’t require open surgery or an external incision. According to the National Institutes of HealthTrusted Source, transurethral resection of the prostate is the first choice of surgeries for BPH. The surgeon removes prostate tissue obstructing the urethra using a resectoscope inserted through the penis during TURP.
Another method is transurethral incision of the prostate (TUIP). During TUIP, the surgeon makes incisions in the neck of the bladder and in the prostate. This serves to widen the urethra and increase urine flow.
Laser surgery
Laser surgery for BPH involves inserting a scope through the penis tip into the urethra. A laser passed through the scope removes prostate tissue by ablation (melting) or enucleation (cutting). The laser melts excess prostate tissue in photoselective vaporization of the prostate (PVP).
Holmium laser ablation of the prostate (HoLAP) is similar, but a different type of laser is used. The surgeon uses two instruments for Holmium laser enucleation of the prostate (HoLEP): a laser to cut and remove excess tissue and a morcellator to slice extra tissue into small segments that are removed.
Open simple prostatectomy
Open surgery may be required in complicated cases of a very enlarged prostate, bladder damage, or other problems. In open simple prostatectomy, the surgeon makes an incision below the navel or several small incisions in the abdomen via laparoscopy. Unlike prostatectomy for prostate cancer when the entire prostate gland is removed, in open simple prostatectomy the surgeon removes only the portion of the prostate blocking urine flow.
Self-care may help
Not all men with BPH need medication or surgery. These steps may help you manage mild symptoms:
Do pelvic-strengthening exercises.
Stay active.
Decrease alcohol and caffeine intake.
Space out how much you drink rather than drinking a lot at once.
Urinate when the urge strikes — don’t wait.
Avoid decongestants and antihistamines.
Talk with your doctor about the treatment approach that best suits your needs.
High Gleason, Low PSA
Suggestions for next steps. Plan PSMA PET CT. If PSMA scan positive Would Bx be next step. If not would Bx still be indicated?
TURP for prostate cancer patients
Patient-reported outcomes after open RP, laparoscopic RP & permanent prostate brachytherapy.
