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Prostate Cancer

IMRT or Surgery - Effects on Urinary Problems

03/28/2011

Question:

Three years ago, my PSA was 6 but biopsy was benign. I had no urinary issues at that time. Three years later, I started to experience some urinary issues (frequent urination, low flow but no incontinence). Although I feel I am getting complete emptying, my average urination is between 100 and 200 ml.

This prompted me to consult my doctor. My PSA was found to be 13 and biopsy showed Gleason 7 in 1/2 of one lobe. Bone scan and C/T scan were negative, so I am a candidate for either radiation or surgery.

I discussed this with the radiation oncologist who said my prostate did not appear to be enlarged (30 cc). He did not seem to see anything unusual. However, he gave me a trial sample of RAPAFLO. I experienced a few of the side effects (nasal congestion, reduced semen) but my average urinations only increased by about 50 ml.

So I am wondering which treatment (either radiation or surgery) is more likely to alleviate my urinary issues. Since the cure rates for radiation versus surgery are roughly a tossup, the answer to this question may help me make a decision.

Having consulted the radiation guy, I have an appointment with the surgeon next week, so maybe you can suggest questions I should ask him.

Answer:

Radiation will not improve your urinary symptoms, in fact they could worsen. While there is a risk of urinary in incontinence after surgery, this typically should improve within weeks to months. The frequent urinating and straining to void would not be an issue after surgery. Either treatment carries a risk of some degree of stress incontinence.

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Response by:

Lee E Ponsky, MD Lee E Ponsky, MD
Associate Professor of Urology
School of Medicine
Case Western Reserve University