TURP

[MBOY1]

About time bark in proton therapy (well pretty sure anyway) and my urologist says I need a TURP for my BPH. I’m sure I do need but hers my question. I know everyone says definitely get TURP prior to conventional external beam therapy in order to minimize adverse effects urinating during treatment plus improving long term issues but does anyone know sane logic holds true for proton beam? Thanks.

[Hidden]

Hi MBOY1 I am also about to start proton therapy (I think). As you know, they carefully screen folks to make sure it is the correct treatment. I had a turp years ago which did improve my stream, however hormone treatment will also reduce the size of your prostate and it may be combined with your proton therapy. I would recommend you wait and discuss this with the radiation oncologist at the proton center rather than acting independently based on your urologist's recommendation. Good luck!

[MBOY1 in reply to Hidden]

Yes I agree totally. Thanks. Have not been told that prostate was that large as all options have been offered including both regular brachytherapy seeds and also HDR Brachytherapy. They think there’s a narrowing in urethra causing issues. Also no one has mentioned hormone therapy either. PSA 5.95, Gleason 3 + 4, stage T1c.

[Hidden in reply to MBOY1]

MBOY1 as an FYI yesterday I had a consult with a very good surgeon at the UNM Cancer Center. He does a lot of prostate removals with a high success rate-low side effects. He said because of my TURP and scaring he would not do surgery, as it was sure to cause incontinence. He thought I should try active surveillance, which of course made me happy. I was diagnosed in Feb 18. I will still consult with MD Anderson on the Proton treatment. He did order an additional genetic test besides the Polaris and a 3T MRI. My PSA is 13.67, Gleason 3 +4 in two cores at -15%. He thought this was pretty similar to a 3+3 because of the percentage in the core. You might consider asking for an MRI or other tests to see what damage you had to the urethra. This might help with your treatment decision in the future. BTW I have used an intermittent catheter for 16 years. It sounds terrible but after learning how to do it you can empty your bladder when needed and not cause damage to your kidneys or bladder if you have urine retention. I do it 6 times a day. You can be tested with an ultrasound of the bladder to determine if you do have urine retention in the bladder after peeing. Same test can be used to see if your Kidneys are okay. I hope this isn't too much information.

[MBOY1 in reply to Hidden]

Thanks for all of this last info. I totally agree that the radiation oncologist needs to be comfortable with procedure, not the urologist.

[Hidden]

Hi I found an article that might interest you on the TURP as a risk adaptive strategy academic.oup.com/jjco/artic...

[MBOY1 in reply to Hidden]

Thanks. I understood about half of what I read. The study was solely for Gleason 3 + 3=6 and I’m 3 + 4. Still interesting and appreciated your thinking of me. After multiple opinions I’m afraid (pun intended) that I am scheduled for TURP on May 15 so I may have plenty of recovery time prior to starting either IMRT or Proton Therapy in August. At the very least I know it’s neccessary to be completed prior to either of those modalities.

[Hidden]

The study was for those not consider eligible for Active Surveillance even though 6 high PSA and similar to 7. It concluded that there were some positives that might allow continued AS by having the TURP, additional benefits include voiding symptom improvement. A TURP may rule out surgery in the future if you have scarring like me, but the immediate benefits look good. Andy

[MBOY1 in reply to Hidden]

Yes I agree. Since I have to wait several weeks post TURP prior to start of any treatment I can always have another PSA done. Would be very interesting if it went down and docs then may be okay with AS for some period of time. Would take some pressure off me this summer for sure. Thanks.

[MBOY1 in reply to Hidden]

Update.....

I had the TURP last Wednesday. Honestly it was as onerous as expected. Some complications when surgeon was working then big blood pressure drop when I got in my room. Kept me overnight. I’ve had catheter since then and dislike very much. I admire you guys who have more severe urinary issues requiring this more permanently. Should have removed tomorrow.

My whole schedule has changed so I now have some recovery time prior to starting proton therapy in San Diego early November. Then that should be it.

Again, thanks for all of support in this community. I read posts several times weekly.

[Jimraz]

I had Proton Beam radiation 9 years ago. Never heard of it, by the way, no side effects. Without a doubt, best decision of my life! Good luck

[MBOY1]

Where did you do it, Loma Linda?

[MBOY1]

UPDATE

So I had TURP on August 9. Catheter for a week. Noticed immediate improvement upon removal of catheter but symptoms seemed to reappear slowly over several weeks. Ended up going in last week for cystoscope which showed 2 strictures had already regrown (was told this is 4% chance?) one large one medium which explained difficulty urinating. Now back home with catheter for a few days. Was supposed to begin proton therapy tomorrow but this procedure requires several weeks to heal so now probably January start. Since I’m pushing treatment out farther docs recommending a Lupron shot to slow any growth. (I’m Gleason 3 + 4, PSA 7) thus Lupron was never part of my recommended treatment plan.

They are also suggesting a tapering self catheterization program to keep the opening clear just in case scenario I guess. I’m severely opposed to this being a wuss. 65 year old wuss that is.

Anyone out there with similar issues?

Thanks.

[MelbourneDavid in reply to MBOY1]

Sad to hear you're having such troubles.

The strictures are not the same as the original problem although they have the same effect. Strictures are generally a bit of scar tissue growing across the urethra, while the original problem was the prostate itself blocking the urine flow. I had a stricture near the penis tip after my radical prostatectomy and after an initial surgical treatment I inserted a cone into it daily for a couple of months. Self catheterization for a while to prevent a stricture recurring is pretty standard after treatment for deeper strictures and you'll get used to it quite fast. It's more than just in case - it massively reduces the chance of a stricture forming again in the same spot.

[MBOY1 in reply to MelbourneDavid]

MB. Thanks for the reply. You mention that it massively reduces chance of stricture. Do you know odds? I was told that it was only around 4% chance that strictures would form post TURP.

[MelbourneDavid in reply to MBOY1]

No, but it is the odds of a repeat stricture, having already had one, you need to ask your urologist about.

[MBOY1 in reply to MelbourneDavid]

Yes I see him this afternoon and also have a conference call with my radiation oncologist thursday. A uro friend mentioned another option last evening that I need to also ask about cortisone cream in urethra. Cortisone reduces scar formation. How often did you self catheter and how long did catheter stay in? Thanks.

[MelbourneDavid in reply to MBOY1]

I did not self-catheterize. I used a cone at the tip of the penis because that was where the stricture was. I did that twice a day for a few weeks, then daily for a few, then every second day,and stopped about 2 months after the treatment for the stricture. It inly stayed in for about 30 seconds. My memory of it is fading - it was almost 4 years ago.

I have chatted online with men who self-catheterized for stricture and othrs who self-catheterized to urinate for years after radiation effects., popping a catheter in several times a day.

[MBOY1]

Thanks for clarification. I had 2 strictures, one near tip and other much farther in which was why the daily catheter mentioned. Not to urinate but as you did, just keep in a bit to not allow atructures to grow back. I just can’t handle that. I also know men who do have to do so.