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Urology (Expert Forum)
After TURP?
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
After TURP?
by HenryH__0, Apr 06, 1998 12:00AM
White Male - Age 57. Kidney stone in Dec97. Urologist put in stent until stone could be crushed in early Feb98. In & out of hosp after crushing due to swelling of prostate and inability to urinate. Dr. advised prostate was very enlarged when stent was put in. Had 3 digitals over past 3 years, all said normal for age. Dr. said wasn't caught because enlargement toward bladder side.
Dr. performed a turp after removal of stent due to inability to urinate.
Turp samples came back as cancerous. Dr. said Gleason scale of 3 and cancer showed 5%.
Questions:
1. Dr. now says, due to turp, removal of prostate is not a good option as most likely would be extremely incontinent to point of open flow when I stand up. Is there more info on this and would it be worthwhile to seek second opinion?
2. Exploring radiation options and was interested in contour radiation. Urologist said due to turp we can not pinpoint location of cancer as biopsy is no longer possible. Only option is probably regular radiation. Is there any way to find exact location of cancer and use contour radiation to limit possible problems with rectum, etc.? Any sites or places I could get more info on this?
=========================================
Dear HenryH
Thanks you for your excellent questions! We at Henry Ford Hospital certainly do radical prostate surgery on patients after TURP without a significant increased risk of incontinence. From the information you have supplied, ( gleason 1+2=3, turp <5%), you have a T1A prostate cancer which has over all a good prognosis. In one series, 16% of men became symptomatic from prostate cancer within 8 years of diagnosis a T1a lesion on a regimen of watchful waiting.
The literature has shown that radiation will cure only about 40% of early disease but can delay cancer growth for ten or so years. Radiation patients still have complications of urinary incontinence, urgency of bowel movements due to the inflammation of the rectum and possible bleeding from the bladder. Some radiation oncologist , have recommended radioactive seeds to be placed in the prostate to try to decrease the exposure of the surrounding organs from the ill effects of radiation. Your TURP is a contraindication to seeds but should not be a contraindication to radical prostatectomy.
We know prostate cancer occurs in many different areas of the prostate at the same time so it is doubtful all of your cancer was resected in the TURP specimen even though your PSA returned lower. Some prostate cancers do not make much PSA.
A lot of factors go into determining if you are a good candidate for radical prostate surgery. Your age and general health are very important in your case. Your life expectancy is greater than 10 years assuming good health. If you are in good health, I would recommend radical retropubic or perineal prostatectomy because you have a long time ( the rest of your life) during which the cancer can come back if you receive radiation.
Drs. Menon , Stricker , Peabody and Keoleian are a few of our urologist which have a special interest in prostate cancer. We would be glad to see you for formal second opinion. If interested please call (1 800 653 6568) fo an appointment. If you decide to go with radiation we also have an excellent Radiation Oncology department. We can also arrange local accommodations through this number if this is
your need. Please bring any physicians’ notes and lab test results that you may be able to obtain. These will help us greatly.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Sincerely ;
HFHS-M.D. MS
*Keyword: prostate cancer, watchful waiting , radiation, radical prostatectomy
Dr. performed a turp after removal of stent due to inability to urinate.
Turp samples came back as cancerous. Dr. said Gleason scale of 3 and cancer showed 5%.
Questions:
1. Dr. now says, due to turp, removal of prostate is not a good option as most likely would be extremely incontinent to point of open flow when I stand up. Is there more info on this and would it be worthwhile to seek second opinion?
2. Exploring radiation options and was interested in contour radiation. Urologist said due to turp we can not pinpoint location of cancer as biopsy is no longer possible. Only option is probably regular radiation. Is there any way to find exact location of cancer and use contour radiation to limit possible problems with rectum, etc.? Any sites or places I could get more info on this?
=========================================
Dear HenryH
Thanks you for your excellent questions! We at Henry Ford Hospital certainly do radical prostate surgery on patients after TURP without a significant increased risk of incontinence. From the information you have supplied, ( gleason 1+2=3, turp <5%), you have a T1A prostate cancer which has over all a good prognosis. In one series, 16% of men became symptomatic from prostate cancer within 8 years of diagnosis a T1a lesion on a regimen of watchful waiting.
The literature has shown that radiation will cure only about 40% of early disease but can delay cancer growth for ten or so years. Radiation patients still have complications of urinary incontinence, urgency of bowel movements due to the inflammation of the rectum and possible bleeding from the bladder. Some radiation oncologist , have recommended radioactive seeds to be placed in the prostate to try to decrease the exposure of the surrounding organs from the ill effects of radiation. Your TURP is a contraindication to seeds but should not be a contraindication to radical prostatectomy.
We know prostate cancer occurs in many different areas of the prostate at the same time so it is doubtful all of your cancer was resected in the TURP specimen even though your PSA returned lower. Some prostate cancers do not make much PSA.
A lot of factors go into determining if you are a good candidate for radical prostate surgery. Your age and general health are very important in your case. Your life expectancy is greater than 10 years assuming good health. If you are in good health, I would recommend radical retropubic or perineal prostatectomy because you have a long time ( the rest of your life) during which the cancer can come back if you receive radiation.
Drs. Menon , Stricker , Peabody and Keoleian are a few of our urologist which have a special interest in prostate cancer. We would be glad to see you for formal second opinion. If interested please call (1 800 653 6568) fo an appointment. If you decide to go with radiation we also have an excellent Radiation Oncology department. We can also arrange local accommodations through this number if this is
your need. Please bring any physicians’ notes and lab test results that you may be able to obtain. These will help us greatly.
This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
Sincerely ;
HFHS-M.D. MS
*Keyword: prostate cancer, watchful waiting , radiation, radical prostatectomy
