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Enlarged Prostate after brachytherapy

jambocoo
Posts: 3
Joined: May 2019

I had brachytherapy 7 years ago, psa results every 6 months showing .001 score, excellent. Recently I had urinary problems and had a cystocopy done in which the urologist removed a stricture going into my bladder and all is good now. He advised me that my prostrate was enlarged and put my on Proscar to help shrink it. I have also been on Flomax for 7 years and felt I did not needed it anymore since my urinary stream is strong now. When I contacted my oncologist who did the brachytherapy he was not pleased that I had the surgery and told me to stop the Proscar and he put me on another RX which I have not picked up yet. It is supposed to strengthen the urinary wall into the bladder where the urologist removed the stricture. His nurse told me the prostrate can not be enlarged as it is dead from the seed implants and can not enlarge anymore. He has requested I meet with him within 4 weeks for a consultation on what has occured. I am curious as to whether I should listen to the oncologist or the urologist ?, can a prostate enlarge after brachytherapy or am I being torn between two doctors in a confict of opinion ?. 

VascodaGama's picture
VascodaGama
Posts: 2929
Joined: Nov 2010

Jambocoo,

Welcome to the board.

I want to congratulate you for the success with the brachytherapy. The constant PSA of 0.001 seems to confirm that the treatment has eliminated the bandit for good.

Regarding the conflict on the opinions of your doctors, at first impression I think that the comment from the nurse may not be true. The prostate may not be dead totally as she says, because radiation is directional to fields and brachy does not cover the whole gland. Even the reflected radiation does not reach tissues much far away from the spot where the radiated seed or rod is placed.

The traditional Brachy (low dose radiation) uses a number of seeds that are displayed at the critical areas/zones/lesions found in image exams and decided by the radiotherapist as its field to be treated. HDR Brachy apply higher volume of radiation via the insertion of rods which got higher possibilities to affect a larger area by the reflected radiation but again, it doesn’t cover the whole gland to kill all cells. Dead cells are then disposed off from the body and the area is occupied by benign prostatic cells still much alive. These are the ones that could be involved in hyperplasia (enlarged prostate) if the cancerous ones are considered to not exist anymore.

Flomax is an alpha-blocker that relaxes the muscles of the bladder, prostate and urethra avoiding urgency. It does not cure retention which most probably was the urinary problems you comment above. Strictures at the sphincter are dealt in the way done by your urologist explained by you above. Surely enlarged prostates cause stricture and the issue is treated with 5-alpha reductase inhibitors like the Proscar (finasteride) or Avodart (dutasteride). These are the ones that manage to stop the abnormal growth of prostatic cells by stopping the manufacturing of dihydrotestosterone. Please note that 5-ARI is known to halve the PSA (PSA=1 should be though as PSA=2).

Accordingly, my opinion is that a prostate can enlarge after brachytherapy.

Congratulations.

Best wishes.

VGama

 

jambocoo
Posts: 3
Joined: May 2019

VGama, thank you for your response, what you are describing makes sense to me. I have appoinments with both my oncologist and urologist and plan on making sure they both co-oridinate with each other to do what is best for my future treatment instead of arguing about it. Best wishes to you as well.

Jambocoo

Georges Calvez
Posts: 171
Joined: Sep 2018

Hi there,

I find it hard to reconcile an enlarged prostate with your PSA level, it is not always the case but the bigger the prostate the more PSA is produced, thus BPH , Benign Prostatic Hyperplasia, where the prostate increases to sometimes extreme sizes is associated with elevated PSA levels. Your PSA level is really consistent with not having a prostate at all as I suspect it is close to or at the limit of the ultra sensitive assay that they are using.

Best wishes,

Georges

jambocoo
Posts: 3
Joined: May 2019

Georges, thanks for your reply, my last PSA was done in Dec. I'm not due for another one till June, so keeping my fingers crossed it is still at the low level. Best wishes.

Jambocoo

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