PSA drops to 0.07, but a question - can SRT cause bladder neck strictures?

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Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 5/4/2011 11:30 AM (GMT -6)   
Good news.  My PSA dropped to 0.07 three months after SRT.  Bad news, I developed another stricture.   I developed my 1st stricture soon after surgery and now again soon after finishing SRT.  Has anyone else had a stricture problem after SRT?  I haven't been able to find anything in the literature about it. 
 
A cysto revealed a very healthy looking bladder opening with no visible radiation damage and just a little scar tissue causing the flow problem.  My uro has a new HD flat screen monitor wired to the scope so I could see what I'm dealing with.  A simple dilation solved the problem and doubled my flow rate.
 
All is well (again),  Carlos

Dx 2/2008, at age 71, PSA 9.1, G8, T1c
daVinci surgery 5/2008, G8(5+3), pT2c
BCR 2 1/2 yrs after surgery
IMRT, 68.4 Gy, 12/2010 - 2/2011
PSA 0.07 three months after IMRT

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 5/4/2011 12:16 PM (GMT -6)   
Carlos, I am the resident "expert" on chronic strictures. SRT can most definitely create additional stricture problems by itself. It's not super common, but hardly rare. My prior stricture issues from surgery, including 2 emergency dialations and 3 corrective surgeries, were only made worse with the SRT I underwent. This history was the main reason, that I had a suprapubic catheter the entire time I was undergoing SRT. The thinking was that my uro did not want me to deal with an emergency stricture situation in the middle of SRT or after, since I was prone to them.

With some guys, the sticture issues are a one or two time event, and normally a dialation or two will cure the issues. With a few of us, the stricture become chronic. I have read numbers in the 2-4% range of patients. Subicsquid and Pigeonflyer are two examples of guys here that had short term problems with strictures.

The SRT can cause some serious swelling issues during and after, especially at the bladder neck to urethra connection, which is touchy to begin with after surgery.

I hope for you, this dialation cures what woes you there, but if you suspect you are losing your flow, don't wait too long to contact your uro.

You definitely don't want it to become an emergency situation, and you don't want it to be an ER situation, as many ER's aren't properly geared to handle it without further damaging you in such a critical area.

I wish you best luck, and hopefully you won't be dealing with it again.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 5/4/2011 1:17 PM (GMT -6)   
I was warned by my URO and again by my RO that I could still suffer stricture problems even tho surgery seems to have fixed it for the time being. Wouldn't wish the problem on anybody. Hope your dilation is your last. Squid.
*Age 64, PSA July 2009 .66; Biopsy: 2 of 12 cores positive, Gleason 3 + 5
*open Surgery 10/22/09
*Post Surgery Biopsy Gleason 4 + 3; 2 positive margins
*03/11/10 - Bladder neck surgery for stricture
*PSA - 30 day/.07, 90 day/<.1, 180 day/.21
*07/27/10 - IGRT done - 39 zaps, 70 gys
*Post IGRT PSA - 9 mo. PSA, still <.1

Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 5/4/2011 2:32 PM (GMT -6)   
David, thanks for the input.  There's no worry about letting it get away from me.  I'm almost as bad as Worried Guy (Jeff) about monitoring my flow.  A good peakl flow rate for me is about 20 ml/sec and my alarm rate is 10 ml/sec.  I do stay out of the kitchen though.
 
Squid,  my previous dilations were similar to yours and had that little pop as the sound entered the bladder neck.  This time was different. No pop at all and the pain level was much worse than before.  May have just been a change due to radiation.
 
Carlos

reachout
Veteran Member


Date Joined May 2009
Total Posts : 739
   Posted 5/4/2011 2:51 PM (GMT -6)   
So what happens if you have a stricture while far from a hospital? Can you carry a self cathering device? Is there such a thing?
Age: 66
PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Continent right away, ED
Viagra, Cialis did't work, Trimix works well
Post-surgery PSA:
3, month: undetectable <.1; 6 month: undetectable <.014 (ultrasensitive); 9, 12, 15 month: undetectable <.1; 18 month detectable .05

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 5/4/2011 3:03 PM (GMT -6)   
Self cathing can be done, on a regular basis even, but it assumes that you can safely get the tube up all the way into your bladder. There are folks with MS, that self cath all their lives. With a severe stricture, its unlikely that you could do it effectively, and without harming yourself. That would be a call between the doctor and the patient. Again, my bladder neck was so damaged, it was ruled not safe to self-cath.

If you had to self cath, it pays to have the doctor give you an ample supply of lydacaine gel, to make the initial insertion easier and less painful. If you are not circumsised, its even more difficult to self cath.

The one time I had to go to my local ER with a full bladder, pain scale 10 going on, at night, it took 3 nurses and a lot of pain to finally get the smallest size french catheter into me. They did not listen to the on-call urologist from my group on the phone in the ER, and nearly caused a disaster. My uro was furious with the staff there, and had strong words to them about it later.

David
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 5/4/2011 3:04 PM (GMT -6)   
reachout,  my strictures formed slowly over many weeks.  I had plenty of time to get to my uro.  I never waited until I needed a catheter.  As I said earlier, a good flow rate is about 20 ml/sec, and I became concerned and monitored it regularly after it got down to 15.  I made an appointment when it dropped to 10.  Home measurements aren't precise but my uro was impressed with my method.
 
Carlos

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 5/4/2011 3:10 PM (GMT -6)   
Carlos,

Now you got me curious. How and by what method did you use to measure the flow that accurately? Some of my strictures were slow as you describe, but at other times, it was in a question of hours.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 5/4/2011 4:23 PM (GMT -6)   
David,  I tried to approximate the "average peak flow rate" that is normally used by uros.
 
First, always start with a full bladder.  Next, start and get a good stream going.  Then, simply pee in a measuring cup (units in ml) for 10 seconds. Finally, divided the volume by ten and you have a good estimate.  The official number I saw in a report suggested 19ml/sec and up as very good and less than 11ml/sec as poor.
 
Carlos

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 5/4/2011 7:28 PM (GMT -6)   
Sounds like a reasonable way to calculate that.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10
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