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huge median lobe and on active surveillance

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User
Posted 26 Mar 2023 at 11:08

Hi. Just joined. I have been on active surveillance since 2018. The more immediate practical problem is a very enlarged median lobe protruding into my bladder causing retention if I don't self-catheterise. I already have a compromised bladder and want to protect it and my kidneys. If I didn't have prostate cancer I could have a range of options such as TURP but they would make having the prostate removed in the future more challenging with more complications. I feel tapped in this situation. Any ideas? Thanks.

User
Posted 26 Mar 2023 at 19:47

Kevin, there is at least a one guy on here who had a radical prostatectomy after turp. There is info that suggests a turp can be carried out to treat the urine symptoms and not treat the cancer. "Sometimes a TURP is done to treat symptoms only, not to cure the disease."


Complications have left me with a very, very small bladder, a suprapubic catheter and leg bag. Guys do have SPCs and a flip flo valve. Not ideal, but you did ask for ideas. 


I am sure the scholars will be along to help.


Thanks Chris 


 

Edited by member 26 Mar 2023 at 22:25  | Reason: Quote added

User
Posted 27 Mar 2023 at 09:30
Thanks Chris. So you had it taken out? Do you now have a very small bladder due to reconstruction of the bladder neck?
User
Posted 27 Mar 2023 at 10:41

Kevin, I had RARP in 2014 , I did form a urethral stricture at the joint between the bladder neck and urethra. In 2017 I had salvage RT, that caused quite rare damage to the bladder and I cannot hold more than a few mls of urine.


Thanks Chris 

User
Posted 27 Mar 2023 at 14:02

I don't think a TURP will compromise a future prostatectomy, but you should ask a prostatectomy surgeon.


Being on Active Surveillance, one thing you might think about is that having lower urinary tract symptoms due to an enlarged prostate would probably also be fixed by having a prostatectomy, so if your AS status is at a point where you are considering treatment, then needing a TURP would perhaps be another factor weighing in favour of getting treated as that would remove the need for the TURP. Of course, that's assuming you come out of the prostatectomy continent, otherwise you may be swapping one symptom for another.

Edited by member 27 Mar 2023 at 14:04  | Reason: Not specified

User
Posted 28 Mar 2023 at 12:41
Kevin, when my husband had his RP surgery last year, his ward mate had had TURP years before and then went on to have RP sane day as Mike. So it can be done. This was in Cambridge but worth discussing with your surgeon. Best of luck. X
User
Posted 28 Mar 2023 at 13:12
I am with Andy - having RP now seems sensible - seems a bit daft to have a TURP if there is a good chance RP is going to be needed at some point anyway. After my husband had RP, he commented that he could pee like a teenager again!!!! .
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 28 Mar 2023 at 14:58

Kevin, just curious, are you saying a TURP would make RP more challenging because you have been told that . Or are you asking if a TURP would make RP more challenging.😀


Thanks Chris 

User
Posted 29 Mar 2023 at 14:47
Thanks so much everyone for these replies. I'm really pleased I joined the forum.

I had a meeting with my consultant yesterday. He is recommending TURP as I do go into retention sometimes, particularly after drinking a lot in a short space of time (e.g. a evening out). The middle lobe / "ball valve" seems to be the problem there. When I get home I self-cath and it's fine so that is buying me time to think. Most of the time I'm OK. Also my cancer is currently low risk and so RP seems too drastic (he agreed). But yes, I see the logic of killing two birds with one stone. "In context with our study, men with MLE and prostate cancer may be ideal candidates for RP in that both the cancer and urinary problems can be treated with one procedure."
https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC3866055&blobtype=pdf

I've read that RP is more challenging after TURP and has poorer outcomes but the consultant said still achieves removal of cancer.

"good chance RP is going to be needed at some point anyway" is the crucial question. Do I improve my life now with a TURP and hope the cancer doesn't progress or go for the drastic but certain option?

I guess sit tight, watch the PSA and keep cathing to protect kidneys etc. It's all so complicated isn't it?
User
Posted 29 Mar 2023 at 19:40
The advantage of having the TURP is that the excess tissue removed will be closely examined in the lab so you will end up with a detailed and reliable analysis of the prostate cancer situation - more reliable than your biopsy was! Hopefully that will allow you to continue AS with confidence
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 30 Mar 2023 at 08:35

Thanks Lyn. Yes, I was hopeful I could go for one of the minimally invasive approaches like Rezum but they won't do anything but TURP because of the pathology opportunity it gives.


Couple of interesting articles ...


https://www.sciencedirect.com/science/article/pii/S2287888215300702


https://academic.oup.com/jjco/article/45/8/785/833260


 

Edited by member 30 Mar 2023 at 08:55  | Reason: Not specified

 
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