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stricture surgery before radiation

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I’ll be 70 in a few weeks and was diagnosed with prostate cancer about six weeks ago. My biopsy showed a Gleason 3+4 in right base involving 30% pattern 4 and Gleason 3+4 in right-mid involving 10% pattern 4. My PSA is 17. I’ve gotten two pathology reports and one is from John Hopkins. They were mostly identical. My CT and bone scans were clear. I’ve decided on IMRT and I received a 4 month Lupron injection last week. Based on a questionnaire and conversation with my radiologist and urologist, they would like me to start Flomax and schedule a scope procedure to examine me for any strictures. If they find some, they want to do laser surgery before radiation. I’m very undecided. I do pee 2 to 4 times nightly on average, if I’m patient I feel like I mostly empty my bladder, and my flow seems like it might be near normal for a 70 year old. During the day I’m fine and never feel like I’ve got to get to a bathroom immediately. l’d rather skip the Flomax and other procedures and concentrate on the cancer. I’m curious if others have faced this decision.

17 Replies

Have they done a flow rate study that leads them to believe that you are having significant urinary retention? Unless it's a serious problem, a laser TURP before RT may do more harm than good.

I was getting up 2-4 times nightly before my SBRT. I took flomax for it and continued it during and after my 5 treatments. I also took daily (20 mg) Viagra, which probably also helped with urinary symptoms. Symptoms, expectedly, got worse starting about 1-2 weeks after treatment and continuing for about 2 weeks after that. I was 57 at the time - being a bit older, your side effects may be a bit worse. Then the frequency and urgency started to go away, and I stopped taking Flomax. Now, I never get up at night to pee.

Thank you so much for sharing your experience. I haven't had a flow rate study and it hasn't been offered. I live in St. George, Utah and I'm guessing it's not available here. I've never taken medications which makes me unsure of the Flomax. But I've never had prostate cancer either so maybe I should be more open minded. I have two months before RT begins and I think I'll take my first pill after dinner this evening.

I've been to Zion and Bryce Canyon - what a beautiful area you live in! I think most urologists can do a flow-rate study - the equipment isn't very sophisticated. I think laser TURP is kind of drastic and may increase the risk of incontinence from RT. I guess the closest place that offers SBRT would be Las Vegas.

The only side effect of Flomax I noticed was orthostatic hypotension. If I stood up quickly, I would get light-headed. That lasted about 2 days until my body got used to it.

This is a pretty place, although it gets a little warm here in July. They have an SBRT trial going here in St. George but I didn't qualify for it. I'm considered an "unfavorable intermediate risk."

I’ve been thru TURP and proton beam radiation for PCa over past 1 1/2 years. Suffered recurrence of strictures twice, stones in prostate and one other growth of tissue that had to be removed so total of 5 cystoscopes where something was physically removed under general. Flow rate test is simple and non invasive, Even available here in St. George where I also live! Happy to connect with you locally and share any of my experiences that might help. It is accurate to say that TURP or any other procedure to make urinating easier should definitely be done prior to radiation. We researched that one quite a bit.

If you can afford it get a psma scan before they knock your psa down. Hopefully it will rule out anything being anywhere else. I wish I had just for piece of mind. My last dr visit ended with a comment that when I come off adt in February we will see if it returns. He said it could have been anywhere. I said thanks a lot.

I had BHP before being diagnosed with G-8 Stage 4 PCa. Flowmax helped a lot with flow, since I was getting up to pee 3-5 times at night during treatment and for a year afterwards, and I wanted to maintain the rate of flow. I'm still on Flowmax, and I'm now up 1-2 times a nite, which is perhaps normal for my 69 years. I would agree with Tall_Allen about not doing TURP etc, unless you have significant urinary issues....may do more harm than good. I'd suggest status quo for now. Before Flowmax, I was on 5mg Cialis, which was also good, but not covered by insurance.

I’d never ever thought I’d had Urethral strictures from my IMRT zaps way back in 2005. Guess my RO didn’t tell me the facts of strictures from burns during residual radiation. It doesn’t or didn’t help that I was self-cathetering 6-8 times daily. Neurogenic bladder Dx’d no discovered at same time as PCa. Things you don’t know and questions I didn’t ask.

Would an RO tell me now 14 years later that “strictures “ were radiation induced?

I don’t know.

My urologist says that TURP treatment is much more difficult after radiation because of scar tissue (induced by the radiation?). I've started on Flomax and last night only got up twice. It's probably still too soon for the Flomax to be the cause but I was encouraged.

I am using flomax to increase my flow and help with my BPH medicine. Works fine.

I had TURP surgery to deal with enlarged prostate and problems with weak stream and fully emptying bladder. Has your urologist done an ultrasound after emptying your bladder to judge whether it really has been emptied? This TURP surgery was ten years prior to prostate cancer diagnosis. I was steered toward external beam radiation but chose HIFU instead, at age 66.

My doc gave me a script for Flomax. I never needed it and never took one. Years later I was glad I had not when I found I needed cataract surgery. Apparently, Flomax can cause something called floppy iris syndrome that can cause issues with cataract surgery.

WSOPeddie profile image
WSOPeddie in reply to LeeLiam

Eeek. I took flomax for years, prior to TURP surgery. Should have had the surgery sooner but I was apprehensive.

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I was super advanced and under the care of a uro for five weeks waiting for a biopsy.. They gave me flomax. Hated it... I had to self catch.. Then I was given hyophen..It makes you pee blue and you feel rotten ., I went into k failure .. The Uro almost killed me . They told me after I got out of the hospital. We’ve changed our guidelines to get super advanced guys a biopsy quickly. Great. ! Then they installed tubes and a foley . You don’t want pc in your urology .

I agree with you getting on fighting the Pc ASAP before it advances.. Good luck ..

generic Flomax works for me ....been taking 1 pill at night and it has been a no brainer after IGRT...always had a slow stream , and the flomax keeps everything flowing perfectly .....yes take it ...~ David

Quoting you: "I've never taken medications which makes me unsure of the Flomax."

Let the games begin!

I never took meds before my Pca, now I use a Daily pill box to let me know what day of the week it is.... Today It's Monday... right???

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 12/23/2019 4:51 PM EST

It was urinary issues that got me to the urologist in the first place. I told my general physician that I was having urgency and frequency problems and thought it was age related (all of 52!). He said go to this uro. This led to a Flow test (more than great), PSA test (5), and a digital (something firm I didn't like), then a biopsy (Gleason score (3+4) =7. Since I had had 4 surgeries prior to PC, I was leaning towards RP. Post RP, no urgency or frequency problems. Post RP, urination is a whole 'nother ball game. I have no idea how radiation effects the urethra that runs through the prostate and the sphincter in the prostate. RP removes the prostate which means you are only left with the sphincter on the bladder. That involves retraining (kegal exercises) to learn how to control your pee. That is a subject of another post.

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