How BPH Complicates Treatment for Prostate Cancer | Mark Scholz, MD | PCRI

Benign Prostatic Hyperplasia (enlargement of the prostate) is a common cause of high PSA, thus causing prostate cancer-related concerns and confusion, and in extreme cases can cause urinary symptoms and can even preclude a patient from radiotherapy in the event that prostate cancer is also present (if the prostate cannot be reduces in size beforehand by medication). Here, Dr. Scholz discusses the different ways that BPH can confound prostate cancer screening, diagnosis, and staging so that patients will be aware if any of these scenarios happen to them.
00:07 How can BPH affect PSA and the diagnosis and staging of prostate cancer?
3:20 How is BPH normally diagnosed?
4:34 Does BPH need to be resolved before radiotherapy for prostate cancer?
6:36 What are the surgical options for BPH?
7:23 How are urinary passageways evaluated prior to decisions about possible treatments?
8:29 How effective is radical prostatectomy for improving urinary flow?
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The Prostate Cancer Research Institute (PCRI) is a 501(c)(3) not-for-profit organization that is dedicated to helping you research your treatment options. We understand that you have many questions, and we can help you find the answers that are specific to your case. All of our resources are designed by a multidisciplinary team of advocates and expert physicians, for patients. We believe that by educating yourself about the disease, you will have more productive interactions with your medical professionals and receive better individualized care. Feel free to explore our website at pcri.org or contact our free helpline with any questions that you have at pcri.org/helpline. Our Federal Tax ID # is 95-4617875 and qualifies for maximum charitable gift deductions by individual donors.
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[@johnnyjohnson7642]

Don't ever underestimate the #, of ppls ⌚ watching your every move as a leader in information on cancer of the prostate,we cherish every word from the both of you,& we let our primary & urologist know we are armed with this info,not everyone practicing medicine is honestly having the patience best interest @ hand,we as a society must eliminate the greed in medicine, pharmacy industrial complex

[@jeffgarner3178]

I just had a Simple prostatectomy 4 weeks ago instead of a Radical Prostatectomy. I had a Prostate of 151 Grams and a gleason scale of 6 which means minimal cancer. My urinary flow had been completely shut down and had to wear a catheter for 2 months until a week after the operation. I opted out of a Radical prostatectomy knowing their are new treatments for cancer using MRI with focal imaging developed by David Woodrum MD out of Mayo Rochester which is now FDA approved. My Urologist with Georgia Urology has ordered the machine needed to do the procedure and we will get another MRI and monitor PSA in next 6/7months

[@nvan78]

Another informative video. Have both of these myself, BPH and low grade PC (Gleason 3+3), most recent biopsy showed 3 cores positive. Been on Flomax and Avodart for several yrs now, prostate 70cc or so and recent PSA reading of 11.2. MRI in the new year, so will see if anything else shows up. Also had a Cystoscopy couple of yrs. ago.

[@tongo148]

Thank you for this update.

[@cathum]

Great topic as usual - and good timing, my oncologist has recommended bicalutamide & zoladex to shrink the prostate before RT, giving me a great confidence in his approach! Thanks PCR!

[@benpayne4663]

thank you doc and alex.

[@bobstoddard1796]

What are the most recent thoughts on BPH and radiation? Any updated thoughts?

[@thomaslawson4253]

if after RP (GS 9) and RT ( f-18 spot on pelvis and 1 LN ) and 1 year ADT with not germ line mutations would 7 months of no ADT and maintaining < .06 indicate a favorable outcome.

[@anthonymiller6081]

I was wondering if your PSA blood tests are relatively normal but then an ultrasound detects a higher PSA reading if it indicates prostate cancer? I also have some of the symptoms of BPH and have been given 1 course of antibiotics and also Doubluts Tablets. I enjoy the information that you provide

[@JayRollins100]

Tulsa Pro took care of my BPH and prostate cancer in one treatment.

[@stillaliveandwell5291]

so far......

[@JayRollins100]

@@stillaliveandwell5291 if I ever need retreatment for cancer at least my prostate is now normal size thus allowing me not to have to deal with both issues at one time in the future. So even if I have recurrence, I consider it a win. No me bph thank goodness.

[@insearchof33]

...if the cancer is within 3 cm of the urethra.

[@clydefilas-mortensen1094]

I had an mri instead of a biopsy and my artifical hip implant created some difficulty in reading the mri. If I get a urolift (u2), will the metal from that procedure exacerbate the problem of reading mri's, pet, future scans? Will that u2 metal start to heat up or react?

[@stillaliveandwell5291]

Not supposed to according to ykw but just watched a video at a conference and it definitely did in the case he mentioned.

[@mcrocheti]

I'm 71, with a somewhat enlarged prostate (37 grams). It's large enough to have me up a few times each night to urinate. I also have prostate cancer, two tumours left side, Gleason 7 (4+3) and Gleason 8. I'm looking at RARP prostatectomy or SBRT with ADT as my primary treatment. I know that RARP will likely create separate continence issues, even if my BPH is gone. How would SBRT / ADT affect my BPH, as it shrinks my prostate?

[@stillaliveandwell5291]

They give good info but never any answers to questions. I have slight BPH with 40 cc size and had MRI-linac (Viewray MRIridian) RT nine months ago. I took too long to get treated but I wanted to find the right treatment so in hindsight I would have been much better off treating BPH first though it wasn't bothering me much. BPH has now flared up and there are not as many options after RT as the prostate tissue does not heal as well as stated in the video. Just got back from ER as I have my first UTI and it has been bloody and probably partially caused by enlarged prostate. Trying flo max but need to get rid of the UTI to see how effective it can be. I did not get ADT with RT (3+4) with intermediate risk on Decipher. Yes the prostate shrinks but it also gets hard and shrinking might not help much.

[@insearchof33]

@@stillaliveandwell5291 Is HoLEP an option after SBRT?

[@stillaliveandwell5291]

@@insearchof33 No, any treatment that would cause bleeding and require healing in the irradiated tissue is no longer an option since healing would be very very slow at best (but more than likely would not heal since it is dying) and probably require HO treatment. Urolift will work, but tricky in my particular case. 2 newer treatments I-tind and Opti lume may work, will find out at next appt. Doing really well on Flomax right now, very mild side effects, no ED (in fact the opposite), everything pretty normal don't even think about it anymore but would still prefer to be off the medication. Best deal would be a slowly (years) shrinking prostate as it dies and the problem solves itself.

[@dmcarden]

@@stillaliveandwell5291 this is my concern. Mine is 57 cc and am pursuing radiation therapy (sbrt or possibly proton). (2) gleason 8s so want to get something done soon. I'm now thinking about possibly tulsa pro.. sigh..

[@kennethbigos4051]

Question I would like to see Dr Scholz address. I had a RP on 9/26/22. 7 week post op PSA came back at .38. Surgeon called it "Persistent PSA" and suggested a 2 week follow-up test to see what may be going on. That test came back at .28. So my PSA seems to be dropping but not as quickly as is often mentioned (undetectable at 6 weeks). Surgeon told me that in some men it can take longer for their system to clear the PSA completely. So, if possible I would enjoy hearing Dr Scholz discuss persistent PSA and my specific issue of my PSA dropping slower than "normal"

[@Auggies1956]

I have a PSA of fourteen. Tomorrow I'm having a Cystoscopy to see whats going on. I have trouble going, and going to frequently. Plus I have lost twenty five pounds for an unknown reason since January.

[@wormsnake1]

How did things go?x

[@frankcedrone5544]

Casadex damage my legs and I can't walk without a walker

[@johnnyjohnson7642]

I depend on this information to make educated decisions on my treatment & I believe an educated consumer is the best medicine,diet,can play a major role in healing, exercise,etc.most can.are discovered @ autopsy,after patients lead a long life of longevity,just watching & monitoring psa,signs& symptoms is good also,any geriatric dr.will tell you that a lot of ppls, begin to die of natural causes @ 60, depending on there environment oxidative stress levels in the society

[@paulciardullosr.1288]

Some have said meds that shrink prostate cause cancer. Is there any validity there?

[@janetw9430]

We've been reading those side effects as well. My husband refuses to take them because they cause a more aggressive cancer.

[@anthonymiller6081]

You mentioned that men with Prostate Cancer can have larger prostates and yet it's said that BHP doesn't necessarily lead to Prostate cancer. So how do you explain that dilemma? BPH according to most experts doesn't mean or lead to Prostate cancer then how can Prostate cancer lead to BHP?

[@stillaliveandwell5291]

doesn't lead to it they both just can happen not guaranteed one way or another.

[@torgeirmolaug196]

I had radical prostatectomy (RALP) due to prostate cancer 9 months ago, and now I am almost unable to distinguish between post surgery pains (my prostate was 130 ml) and the burning urge to pee, wether it is 50 or 650 ml. Is that normal? (My PSA is below 0.1)

[@stillaliveandwell5291]

question for your doc

[@janetw9430]

So is BPH cancer?

[@seascape35]

No. Only excessive normal prostate tissue growth.

[@johnnyjohnson7642]

Very good??, But I don't feel allopathic medicine 💊💉 are the only answers, protocols methodology,how about acupuncture chiropractor homeopathic pelvic muscle FL., physical therapy, prostate milking, biofeedback, etc, spiritual cosmic healers,in combination with allopathic,psa,are good& 😞😔, thankyou for the info, keep it coming, literally ejaculation