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Treatment depends on urine flow /retention?

Posted 13 Jan 2023 at 18:24

Does anyone know: 

(1) which treatments for prostate cancer are dependent on the man having a fast enough flow rate? (before prostate treatment). 

(2) what rate of flow is usually deemed sufficient?  Is it 10 ml of urine per second for 20 seconds, or what? 

Reason I ask: I've been told that I may possibly be allowed to choose HIFU focal therapy  but I have to pass a flow test first.  There's no indication of what the "pass mark" is.

When I asked ( during one of those formal NHS phone calls)  the risk of retention was mentioned.  I'm guessing they think that HIFU, even though aimed at just one peripheral lobe where my cancer is (localised gleason 4+3, no mets), could cause my overall prostate to expand and potentially compress the urethra.

I'm told that my pre-decision flow test will include imaging my bladder full, and again when I've emptied it.  This is to check any pre existing failure to properly empty.  But again does anyone know, just how much retained urine would be deemed a problem, for deciding which cancer treatment to give me?

Background: the hospital previously indicated they'd be happy to give me radiotherapy if I choose it (EBRT + HT  I think they mean) even though RT swells prostates permanently, according to other threads here.



Posted 13 Jan 2023 at 22:01
If no members are able to answer your question precisely, I suggest you ask those who administer HIFU. I was started on Tamsulosin many years ago for a narrowed sphincter. Things were rather less precise at that time. I remember I just had to pee into a bucket while a lady nurse watched me and made a judgement on my flow. I went on to have RT and then HIFU (twice) without even being checked for flow, although it was known that I do not completely empty and need to pass more urine very soon after peeing, (Double Void). Of course some men have larger Prostates than others anyway and RT causes greater changes in the most radiated part of the Prostate. In fact, in the UK, HIFU for the majority of cases has been given as a salvage treatment for failed RT although it can be given as a primary treatment where required criteria is met. Other reasons why a man may be unsuitable for HIFU can be due to calcification in the Prostate, the tumour being in a part that the probe cannot reach to focus on or a man cannot pass the prerequisite preoperative tests.
Posted 15 Jan 2023 at 19:43

Thanks Barry. 

Ideally I'd get answers from the team who would administer HIFU.  But in practice, they talk to me only during those formal phone 'appointments' , with the person phoning not speaking very clearly and usually being someone who's been told to make the call and what to say, and isn't himself/herself a decision taker on what treatment will be given and why.

A recent call did make clear they don't want to give HIFU or other focal therapy unless I pass the flow/ retention test.  In retrospect I should have asked then, what's the pass mark? 

My next chance to ask  will be when I get the next call, presumably telling me whether I've passed or not..........


Posted 15 Jan 2023 at 20:07

I’m Not 100% sure of the numbers but I was turned down for a brachytherapy boost along with RT because of poor flow rate.

I asked what my flow rate was and I think they said 13ml/sec. I remember being surprised when I came home and found out the normal flow rate…but then maybe they’re expecting a flow rate of a teenager before they will do this procedure!. Or maybe they just didn’t want to spend the money on doing this because of my age?

Having said that my flow rate at night is poor…I think everything goes to sleep and takes a long to waken.

Edited by member 15 Jan 2023 at 20:09  | Reason: Not specified

Posted 17 Jan 2023 at 16:25
I think the difference is that EBRT may cause the prostate to swell whereas brachy is very likely to cause the prostate to swell - there is therefore a much greater risk of urinary retention with brachy. Also, catheterisation during EBRT isn't ideal but not impossible whereas catheterisation following LDR brachy may be more risky - the seeds are carefully placed (don't really want them moving with a catheter line shoved past them) and there is quite a high level of radioactivity for the first couple of months (enough that a man is advised not to have children / babies on his knee to begin with) so perhaps that also increases risk?

I don't think there is anything to suggest that EBRT causes the prostate to permanently swell?

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