Managing BPH Before Prostate Radiotherapy: Options Compared

In this installment, Aurelie Garant, MD, describes seeing patients with both bothersome benign prostatic hyperplasia and clinically significant prostate cancer on a weekly basis. Her work-up includes International Prostate Symptom Score measures, post-void residual checks, and imaging to assess median lobe protrusion into the bladder neck, since that anatomy inherently increases bladder neck radiation exposure. She notes that many hypofractionation trials enrolled patients with relatively low baseline symptom scores, so patients presenting with high scores carry elevated risk of acute obstruction, emergency visits, or the need for self-catheterization education after treatment. These cases typically prompt a joint discussion between radiation oncology and urology to determine whether optimization is feasible within the window the cancer allows.

Daniel Welchons, MD, outlines the options for optimizing these patients, from alpha blockers and androgen deprivation therapy to procedural interventions when medications fail or glands are especially enlarged. He explains that his practice favors prostatic urethral lift in this setting because its mechanical, immediate relief of obstruction lets patients recover quickly and stay on schedule for radiation, compared with options like transurethral resection of the prostate that carry more tissue disruption.

In the next episode, "Evidence for Combining Prostatic Urethral Lift With Radiotherapy," Welchons and Garant unpack head-to-head trial data and Garant's own combined-procedure study, discussing what it takes to perform prostatic urethral lift alongside SAbR in a single session.