Radiation with large prostate

I have posted in other post's about my Pca and am interested in hearing about what I'm currently considering.
To rehash, my second biopsy showed increased volume of G6 but when I sent the slides to John's Hopkins they saw one core as G7 out of my 8 core's DRE did not show any sign that it was not confined to the prostate (I know that is not fail proof)
I think because of the volume, I should have treatment however, right now I'm off my testosterone therapy because the oncologist said it may help to shrink my prostate. I'm off some 35 days now and am already feeling down and a little irritable. I have very low natural testosterone and cannot see a life without TRT because I suffer greatly.
So I'm grasping at straws here but barring surgery, can they still do radiation even if my prostate does not shrink?
I'm not 100% against surgery I'm frankly scared of having to wear depends for the rest of my life or using a catheter for the rest of my life.

It has been about a year since my last biopsy so I'm thinking maybe a CT scan and maybe another biopsy but I seem to get more answers here then from the oncologist who I saw once a couple of years ago and now just talk on the phone when he can squeeze me in. Covid-19 has made it hard to get a face to face here in Manhattan so his last advice was to stop the T and get a test 44 days after my last injection to see where my testosterone level is but that does not mean my prostate is smaller so I do not quite understand. I told him to forget about androgen diprivation I will not do it.

Sorry about the rant but I just want to know what can be done before this thing becomes aggressive.

Glen

Thanks and I do feel like we are brothers. I happen to like the doctor I have Dr Deustch at Columbia but I am going to have to insist on a face to face.

A couple of things I have to consider. There is a chance my cancer has not advanced and can still be a candidate for AS. Second, why must the prostate be reduced? Dr D. specialize's in Brachy but said it will not be good for me and that was my first choice.

Look I want to be absolutely sure that treatment is the only option and not AS-is that wrong of me? and my other main concern is quality of life vis-a-vis testosterone. I cannot overstate how miserable I am without it. So yeah I'm looking for an "out" and I do not think that is unreasonable.

I am not sure what you mean by proactive doctor. My urologist wanted me on androgen Dipr then cryotherapy and both options were not for me so yeah he was proactive but not they way I wanted, Dr D wants a smaller prostate and I am stopping my TRT to see if that helps. My next question after we get my blood work back will be "Okay now that my T level is down, now what?" CT scan to see? and if not, can we proceed anyway?
If Dr D gives me good reasons that radiation will not work then I'd want a biopsy to see about progression.
If it has progressed then I figure surgery will be my final choice.

I have come to rely on good information here and I am not seeking a magic answer-just options and idea's.

I will get the blood test on the 4th of October and then call a few days later and insist we meet. If Dr Deutsch does not meet then of course I may return to upstate or another clinic in Manhattan. So I have a plan but want to be armed with as much information as possible. Maybe someone with a large prostate had radiation and is here on HW then of course I'd like to hear what happened.

BTW I have no issue with meeting the doctor, he has been reluctant to see me in person. I did try an MRI at his request but it was a nightmare with me waking up in the tube with my severe claustrophobia and sleep apnea. I asked if somehow they could do radiation with only a CT scan and he said yes.
In a perfect world he'd have a decent image of my cancer but I have issues and therefore am a "problem" patient.

Thanks for answering my post. I will update after I get the bloodwork done and see Dr D. in person. Last time he called I was on a train and between the noise and my memory I was not able to ask all I wanted to ask. I will see him in person that is a promise.

Glen AKA Billypilgram (Manhattan and Upstate NY)

Thanks Duck2

Thanks Duck2

I will see if my naturally low testosterone works to reduce the prostate. I doubt I will use medications to reduce it unless they have some that does not lower my testosterone too low. I am naturally like 50 which is very low but not castration level.

I suppose I will have to take the risks at some point. As I've stated throughout, I do not take testosterone to feel better or build muscle, I take it because without it life is miserable to the point of not wanting to live.
I have emotional issues caused by PTSD which may be the reason it effects me so profoundly but fact remains that I'd rather take risks of adhesions and such then stay off testosterone for too long. I suppose 6 months might be my limit.

I understand this must be strange to others but I have to live in my mind and body and I know what my choice will be.

Thanks again to all who post

Glen

Radiation therapy for large prostates is most limited with permanent seed brachytherapy. I have seen limitations in the 50-60cc size.

HDR brachy therapy can accommodate much larger though I haven’t seen any absolute limit. Both conventional fraction and hypofractioned external beam radiation can be used with significantly enlarged prostates.

What is the estimated size of your prostate? I suggest you seek out a few radiation oncologist including one that specializes in HDRBT and get a proper assessment.

Thank you JNF and Cyclone

I Will look through my lab,s and get more information. I Am not sure they had prostate volume but I remember it was like 3.5 X4 in size. Centimeters I think. On the train now so using tiny keyboard and can barely write.

Glen

Thank you JNF

I Have to find my paperwork to get more information. My PSA has been steady at 4.1 to 5.1 had wildly variations in the past as high as 7.4 but that was due to infections that cleared up with 30 day's of Cipro. The doctor used to give two weeks worth but my family doctor decided to be aggressive and do a whole month which worked.

BTW first genomic test was very low risk the second by Decipher rated it higher.

I Will search for records

Glen

Thanks Michael

Dr Deutch of Columbia university hospital is exactly that. I really have to see him face to face and I will next month

On cell phone cannot write much

Glen

Whoops the DRE did not show volume, it was from CT scan results

G

Thank you Gemson I will look that up and talk to the doctor about it.

As for sexual issues. That ship has sadly pretty much passed for me. Even without Dutasteride, I often have the "No bang" or at best, a slight spurt. (in the past it was quite robust) Thankfully my wife is the same age and menopause has done a number on her sex drive so while we are still affectionate, sex at least for now is not happening. Feels weird even saying that but it is what it is for now; Who knows what the future may hold.
I kinda remember reading something about Dutasteride causing anxiety which I'm prone to but my memory is not clear and maybe it was another BPH medication because I did refuse one in the past for that reason.

I am still not going with a strong stream and still have the dribs and drabs and have to urinate often so thus far stopping the testosterone has not really changed that issue

Thanks again

Glen

Thank you

I am on board for stopping my testosterone replacement but I can not take ADT in fact, my hope is to get back on testosterone as soon as possible. My quality of life is very important and my emotional make up causes all manner of distress when my testosterone ebbs. My natural T number is 50's or below due to years of opiates for chronic pain.
Maybe the external beam may help shrink or at least I hope.

I get a lot of information here and am grateful to this forum and the people in it.

Glen

Larger prostates (>75g) can be a little more difficult to remove via RALP, but there doesn't appear to be a difference in functional outcomews. If RALP isn't possible, an open procedure can be done. You may not choose surgery as your primary treatment, but I would not consider prostate size as a reason to. Surgery is a way of dealing with PCa and BPH.

There is really nothing magical about robotic vs an open RP. The latter has a statistically slightly greater average blood loss (although the surgical notes for my open procedure estimated my blood loss at only 100 cc) and hospital stays that average 1/2 day longer.

Djin

Blood test came back
Hepatic panel okay
PSA 4.2
Testosterone 45
Doctor called suggested ADT to lower testosterone even lower than my natural 45. That's 52 day's from last injection.
I told doctor that I apologize if I make his job harder but I'm already in rough shape at testosterone at 45 and will not take ADT medications. I said let's do a DRE and talk. He said of course and we meet November 4th. Dr Deutch said he can off radiation therapy even with me not doing ADT.
My PSA has been steady my cancer is a low grade albeit higher volume so I believe radiation therapy will be of benefit. I suppose after treatment we can monitor and still do biopsy but I may be getting ahead of myself.
I wish I were made of sterner stuff and was able to live with low T but I'm not.
Hopefully I'll have more information after I see doctor in person. It's going to be only the second time I will see him.

Glen