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(Very) Enlarged Prostate Treatment Options

JeffCa
Posts: 1
Joined: Mar 2012

Short story:  I am 54, and I was diagnosed with PCa about a year ago with 3+3 score (3% in 1 of 12 cores), PSA 13.9. gland size 155-160 cc (this was my first time finding out the size of my prostate, so I don't know if it was ever much smaller). I have since underwent a few MRIs, CT scans, bone scan (negative), more PSA tests (Dec 2012 was 20.3), latest PSA results (from last week) not yet returned. My last MRI a few months ago indicated the prostate to be 185-190 cc (that is not a misprint!). I feel no urinary discomfort. My last biopsy a month ago showed negative, but my doctor assured me they are darting around the cancer cells. My father also had PCa, but passed from lung cancer.

I am scared-to-death of surgery for many reasons (long recovery, catheter(!), incontenence and impotence). I had wanted to go the radiation route but my radial oncologist tells me that hormone therapy will only shrink my prostate by 30% (to about 130 cc), a far cry from the 40-60 cc ideal for radiation. My doctor told me I can "try" but after 6-8 months of hormones and side affects, it could mark me as ineligible for radiation (I suppose I don't have that option at all regardless). My doctor is recommending surgery.

Any thoughts on this?

hopeful and opt...
Posts: 1353
Joined: Apr 2009

There is a drug called Avodart that is being studied. One study" the reduce study" so far shows reduded progression of the disease among those diagnosed with low risk disease, as you have been. The drug also shrinks the size of the prostate, and I believe that the reduce study has surveyed men with large prostates since that can be a duel benefit. There are also other studies that are not as favorable, so the jjury is still out. You may wish to discuss this drug with your medical team.

Guidelines for active surveillance vary slightly. For example at Johns Hopkins, for low , low risk prostate cancer, it is less than 2 cores with 50percent or less involvement in each core, psa /prostate size ratio of less than 0.15 and a PSA of less than 10. Since you have a giant prostate your PSA is elevated. It appears that you are still a candidate for active surveillance, but I would speak with an expert in the fiield.

If you decide to continue with AS you may wish to consider this drug.

............................................

A friend of mine with a prostate size of about 100, just had sbrt. He did not have any hormones before this radiation treatment. He had problems with urinating before treatment, and had to have a cateter after treatment. He has not had a catheter during the last two months(he had treatment 3 months before. He is told that the prostate will atrophy over time.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Have you discussed the possibility of a TURP procedure to remove the excess fibrous material in your prostate?  It may be something you with to consider.  

janei1
Posts: 18
Joined: Dec 2008

My hubby had davinci 4 weeks ago. His PSA was 8.5. All cancer was confined to the prostate and his Gleason score was downgraded fro a 7 4+ 3 to a 3+ 4 which I understand to be good he had never had major surgery so it was all new to him especially  the drain and catheter and he managed quite well. Drain and cath were left in 1 week. His surgeon had done over 1000 thousand of these and told us my hubbies prostate was 2 time the size of a normal one and was on his top 50 for difficulty. Don't be afraid of the surgery because it seems to be well tolerated.  We chose the surgery because he wanted it gone and to get a true reading of how bad it was and the flea sons score was better. We would have never know that if we did radiation plus he can always have radiation later if it ever show up.  I an not an expert on this but this is what happens to us. Good luck 

VascodaGama's picture
VascodaGama
Posts: 1588
Joined: Nov 2010

Jeff

Welcome to the board. I do not understand your description and request.

Are you looking for a treatment to shrink your prostate or to treat the cancer (or both)?

Large size prostate glands make it difficult to radiate or dissect (surgery) if the aim is to treat cancer. The field of radiation to cover the whole gland would likely to increase the chances for damaging healthy tissue surrounding the gland. A surgeon may also need to dissect the prostate into pieces which would decrease the chances to get the whole cancerous tissues out of your body.

Hormonal treatments tend to be the best way for treating cancer in these cases, and by doing so, one could expect a substantial decrease in prostate size if the enlargement is a cause due to inflammation. In your case you could get HT firstly and then evaluate the pubic arch for a proper and final decision on a treatment to the cancer.

I think that the “percentage of shrinkage” you refer above is that related to the use of 5-alfa reductase inhibitors (Avodart or Proscar), commented by hopeful. These drugs could be part of the HT protocol.

In any case, before doing anything I would recommend you to discuss with your doctor about treating the enlargement firstly, probably starting with an anti-inflammatory medication to care for any BHP. This is commonly recommended to guys with high PSA levels and negative biopsies but in your case the cancer treatment can be postponed because it seems to have been diagnosed as low risk (Gs6 in one-out- of- twelve cores positive; 3%). Surely a large prostate will be producing “bigger” numbers too.

Here is a link that may be of your interest;

http://www.nlm.nih.gov/medlineplus/ency/article/000381.htm

Wishing you find an answer to your case.

VGama  Wink

yankeefan
Posts: 69
Joined: Mar 2013

my prostate is large, about 80 g, and i suffer from normal bph maladies. was recently diagnosed with pc, gleason 7 and am scheduled for surgery on 10 april. i can't imagine living with a 190 cc gland. even though your gleason score is only 6, i would (note, this is a layman talking) opt to get that thing outta there, though it's amazing that with that large a prostate, you have "no urinary discomfort." I have to go just about every hour and always with great urgency. given that your father had pc...that's another indicator that getting rid of that thing might be wise. i would also offer that with that large a prostate, a biopsy could easily miss something. bottom line, i agree with your doctor. find the best, most experienced prostate surgeon you can and get rid of it. my guess is that with a prostate that size the robotic approach would not be recommended. my surgeon recommended open / tradition  surgery for me because my prostate is large, and it's small compared to yours. you are only 54, you should handle the surgery well, assuming you are in decent shape. there are no guarantees, but with a good experienced surgeon you are likely to be fine and you won't have that huge prostate to deal with nor the risk of further prostate cancer down the road..btw, i'm 68. good luck!

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