Question about Brachytherapy long term effects

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NY-Sooner
Regular Member


Date Joined Sep 2009
Total Posts : 417
   Posted 4/19/2011 8:41 AM (GMT -6)   
My cousin who is 52 was just diagnosed with PCa with a Gleason 6 with  4 of 12 cores 10% cancer, and a psa 3.5. 
 
He is leaning towards seeds , but has been reading that Brachytherapy has no  ED side effects in the short term,   but after a few years, it can cause some major ED problems due to long term radiation damage to the nerves. 
 
He wanted me to ask here if anyone had Brachytherapy done years ago and if they can still can achieve normal hard erections after 5 or more years without drugs?  He also wanted to know what effect the seeds have on orgasm, and if you can still ejeculate seman in the same quantity as before? 

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 2669
   Posted 4/19/2011 9:06 AM (GMT -6)   
Dear Sooner:
 
I'm only 2 1/2 years post-brachy but will try to help answer your questions.  Yes, brachy can lead to ED and if so it usually occurs within a couple of years of the procedure.  Typically where you are sexually at 2 years is pretty much where you will be.  In my case that meant no ED.
 
Typically brachy leads to some reduction in ejaculate...sometimes even elimination of it like surgery.  In most cases it seems to be about 1/2 loss.  Orgasm and the sexual experience is exactly the same for me as before brachy.
 
Overall, the most recent consensus seems to be that long term ED occurs in about 50% of surgery patients and about 35% of brachy patients.
 
Hope this helps.
 
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1305643

Wigs
Regular Member


Date Joined Mar 2009
Total Posts : 89
   Posted 4/19/2011 9:45 AM (GMT -6)   
I was 10 years out from brachytherapy when my prostate cancer returned; however, during those 10 years, for the first 5 years I had no side effects; erection or ejaculate. Everything was normal. Around year 5 there was a change in the consistency of my semen. It became more of a gel and the orgasm was somewhat of an ooze. Around year 6, I noticed that my erections were not as hard as in the past. When asking my doctor about these symptons, he more or less related those issues to age. I was 52 or 53 at the time.

Am I saying that these issues are related to the brachytherapy? No. Am I saying that these issues are related to my re-occurance of prostate cancer? No. Am I sayin that these issues are related to my age? No. I'm just saying....

Wigs
Diagnosed @ age 46 - September 1997 - PSA 5.0 / Gleason 3+3
Seed Implant - January 1998 @ Trident Hospital, SC
PSA 2.4 - July 2007 / PSA 2.7 - July 2007 / PSA 3.0 - November 2007
Diagnosed @ age 57 - December 2007 - Gleason 4+3
Salvage Prostatectomy & Colostomy - March 2008 @ MSKCC, NY
Rectal/Urethra Reconstructive Surgery – August 2008 @ Cleveland Clinic
PSA < .01 – August 2008 / PSA <.01 – October 2008 / PSA < .01 – December 2008
Colostomy Reversal @ Cleveland Clinic – January 2009
AUS implant @ Cleveland Clinic – May 2009
PSA <.01 May 2009 / PSA <.01 August 2009 / PSA <.01 December 2009
IPP implant @ Cleveland Clinic – December 2009
PSA < .03 April 2010 / PSA <.03 November 2010

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3708
   Posted 4/19/2011 10:50 AM (GMT -6)   
All treatment options result in a certain percentage of patients having ED. The generally accepted rates for men with no ED problems before treatment are approximately 50% for surgery and 35% for Brachy. With surgery you start with 100% ED and at the 2 year point are about as good as it is going to get. With Brachy you start somewhere close to Zero and at two years end up where you are going to be. I'm at 2 years and have no ED and haven't noticed any change yet. The two most important factors in having ED from either treatment is starting with no ED and the skill of the doctor doing the procedure.
JohnT

Gleason 6
Veteran Member


Date Joined Mar 2011
Total Posts : 790
   Posted 4/19/2011 4:16 PM (GMT -6)   
It's so difficult to choose. There is no black and white. It all seems grey to me.
Age 61
PSA 4.3 9/10
PSA 5.5 2/11
PSA 7.1 3/11
Template Biopsy 6 pos out of 40 3/25/11 GS 6 (3+3)
CT bone scan neg
6/18 areas positive - 2 in left base, 4 left apex. 6/40 cores pos. 33cc.
Stage T1C
Uro said 2 in left base, 4 left apex, but looking at the path report, I see:
L apex anterior, L apex mid, L apex posterior, L apex lateral, L base mid, L base lateral

lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 582
   Posted 4/19/2011 5:32 PM (GMT -6)   
Wigs said...
I was 10 years out from brachytherapy when my prostate cancer returned; however, during those 10 years, for the first 5 years I had no side effects; erection or ejaculate. Everything was normal. Around year 5 there was a change in the consistency of my semen. It became more of a gel and the orgasm was somewhat of an ooze. Around year 6, I noticed that my erections were not as hard as in the past. When asking my doctor about these symptons, he more or less related those issues to age. I was 52 or 53 at the time.

Am I saying that these issues are related to the brachytherapy? No. Am I saying that these issues are related to my re-occurance of prostate cancer? No. Am I sayin that these issues are related to my age? No. I'm just saying....

Wigs
 
Hi Wigs
I find your story rather interesting.  I try to keep track of Pca trends for two of my friends who had brachytherapy at the same time I had surgery.  They were both G6 and considerably older than you (late 60s).  While I have struggled with ED, they have had few problems these first four years.  They both ask me what the future might hold for them..and me.  If I understand all the initials and stuff in your profile, it appears that you were diagnosed very young, had brachy and then 10 years of few problems.  After 10 years you had a major reoccurence that required surgery with additional surgery to repair continence and erectile failures.  Is that right so far?  What I am trying to discover, and the studies don't seem to help, is how common is that 10 year reoccurence issue?? How common are the other issues (ed & incontinence) you have needed to take care of??  Thanks for sharing. 

PSA July 2006 4.7 , Nodule found
biopsy 10/06 very agressive gleason4+4=8 identified
DaVinci surgery, January 2007
Post Ob confirms, gleason 4+4=8 with no extension or invasion
no long term continence problems
post surgery PSA continues to be undetectable at 4 years
ED problems continue, using bimix
born 1941

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3229
   Posted 4/19/2011 5:57 PM (GMT -6)   
here's what my radiation oncologist told me about the sexual side effects of seeds + IGRT.  he said that 50% of the guys who underwent the treatments would have some degree of ED and 80% of those would be treatable with pills like viagra.  he said if you had no performance issues before treatment you stood a better chance of not having any afterwards.
 
ed
 
 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3708
   Posted 4/19/2011 7:56 PM (GMT -6)   
Lifeguyd,
An important point in Wiggs condition is that the procedure for Brachy changed significantly in 1998, Wiggs was treated in early 1998. Different templets were introduced and different imaging that significantly increased the accurracy of seed placement. Prior to 1998 there were a lot of issues with dead spots because there was no way to insure that seeds were properly distributed. By the mid 2000s most Brachy centers were using these newer protocols and imaging technologies with significant improvement in cancer control.
JohnT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

richard0460
Regular Member


Date Joined Feb 2011
Total Posts : 49
   Posted 4/26/2011 12:22 AM (GMT -6)   
Hi I am just one month post seeds so my experience is not long but if anything my erections are better now than before seeds probably because I have been taking Cialis 10 mg 3x's a week as soon as I started ADT and ever since. Strum also recommended taking Trental 400mg twice a day as a preventative for two years to keep the arteries open and possibly protect from the long term effects of radiation, but so far I have three times tried to take Trental and each time I get a weird side effect-- my feet and hands get very hot-even though I reduce the dose each time. Snuffy Myers also recommends Trental. Dr. Mulhall at Sloan Kettering in his book Saving Your Sex Life recommends Cialis or Viagra before during and after radiation to protect the blood vessels. We shall see. I am very pleased with how my sexuality has returned so far. Its not quite normal yet.
Gl 7 3+4 (30%) 3 of 7 cores Sept 10 (Bahn), Endorectal MRI negative for ECE's, Sem Ves Involvement Nov 10, ADT (Strum) 4 months PSA after ADT .04 Prostate volume fell from 48 cc to 19 cc. Pal 103 Seeds (Grimm) March 30, 2011

JustJulie
Regular Member


Date Joined Mar 2006
Total Posts : 343
   Posted 5/3/2011 2:44 PM (GMT -6)   
Long term effects = none for us.
 
My husband is six (yes SIX) years out and we have had no long term side effects - he's back working, back to the gym and just celebrated his 50th birthday!
 

Wigs
Regular Member


Date Joined Mar 2009
Total Posts : 89
   Posted 5/4/2011 8:55 AM (GMT -6)   
lifeguyd,

I apologize for not responding sooner. I hadn't seen this thread since the day I posted.

I can't say that the 10 year time frame is one that can be expected after brachytherapy. I can remember just after my procedure reading about one having a re-occurance only two years after brachy. I would imagine that there may be others with a longer track record.

From what my doctor told me, brachtherapy had been around for about 8 years in 1998. At that time, he told me the success rate was basically the same as prostatectomy. That doctor told me that if the cancer returned, it would be a more difficult surgery. I didn't ask him what he meant by that. If I had, I might have chosen prostatectomy over brachytherapy. Anyway, it did come back and the resulting surgery was difficult and with side effects. According to the pathology report, all of the cancer was removed, but due to the radiation from brachytherapy the bladder, urethral, and rectal tissues were damaged, resulting in the tear in my rectal wall and the sutures reconnecting the bladder and urethra not holding and healing.

Wigs
Diagnosed @ age 46 - September 1997 - PSA 5.0 / Gleason 3+3
Seed Implant - January 1998 @ Trident Hospital, SC
PSA 2.4 - July 2007 / PSA 2.7 - July 2007 / PSA 3.0 - November 2007
Diagnosed @ age 57 - December 2007 - Gleason 4+3
Salvage Prostatectomy & Colostomy - March 2008 @ MSKCC, NY
Rectal/Urethra Reconstructive Surgery – August 2008 @ Cleveland Clinic
PSA < .01 – August 2008 / PSA <.01 – October 2008 / PSA < .01 – December 2008
Colostomy Reversal @ Cleveland Clinic – January 2009
AUS implant @ Cleveland Clinic – May 2009
PSA <.01 May 2009 / PSA <.01 August 2009 / PSA <.01 December 2009
IPP implant @ Cleveland Clinic – December 2009
PSA < .03 April 2010 / PSA <.03 November 2010
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