Radiation and Large Median Lobe

[BanjoPicker]

I went to my first Urologist appointment because of urinary problems. A DRE discovered a lump that was diagnosed as Gleason 7 (3+4). It was also discovered that I had a large median lobe that was likely the cause of my slow stream and urgency. There was a discussion between my Urologist (wanted to do a TURP) and my RO (want to radiate sooner). I completed 43 IMRT sessions 2 months ago. My urinary problems increased during radiation, but now have improved to a bit better than before radiation. Urgency is my main complaint. Question. Have you had a TURP or Rezum after radiation? Results? Did urgency issues resolve as the prostate shrunk post radiation without further invasive treatment?

[Tall_Allen]

The stream will probably improve over time. Avoid procedures for at least a year if you can.

[BanjoPicker in reply to Tall_Allen]

My RO said to give the prostate time to find equilibrium. He concurs with your advice to not quickly seek further treatments. He wouldn’t say my treatment would eventually have positive or negative consequences to my urinary problems. My stream is a bit stronger now at 2 months post radiation. Urgency is controlled by limiting the consumption of liquids before periods with absence of restroom options. Time will tell.

[BanjoPicker]

Urologist recommends a TURP to improve urine flow. He said REZUM has some inconsistent results based on changes to cell structure caused by the radiation. TURP will be scheduled for 13 months after my last IMRT treatment.

Update: I am scheduled for a TURP 13-months after the end of IMRT. Urologist said that he will not surgically over-treat the prostate and will focus treatment on the median lobe.

Update: It is now 6 months since I had a TURP. It took about 4 months for intermittent bleeding to resolve, but my Urologist said that was expected, because it was irradiated tissue that was slowly trying to heal. My urine flow is great and I now empty my bladder completely when newly voided. I still have minor urgency issues, but very controllable. I was told there were medications that can help with urgency, but I am holding off on starting medication to see if time will resolve the issue.