Article: Post-prostatectomy RT adversely affects urinary continence irrespective of RT regime

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Redwing57
Veteran Member


Date Joined Apr 2013
Total Posts : 2257
   Posted 9/12/2017 9:49 AM (GMT -6)   
Another interesting article linked from the Uroalert email.

We so often hear echoed the standard urologists line of "surgery is better because you can always have radiation afterward if it doesn't work". Each person must make his own treatment choices, and one can only hope that more information helps make better decisions. No treatment for prostate cancer improves anyone's quality of life, and we generally are faced with selecting a treatment based on a constellation of side effects we think will be acceptable to us.

From the article:
CONCLUSION:
Postoperative RT adversely affects long-term continence; this negative effect is irrespective of time of initiation or indication for RT. These results suggest a need for innovative strategies of prostate cancer therapy with lasting oncological, functional and QoL outcomes.


Post-prostatectomy radiotherapy adversely affects urinary continence irrespective of radiotherapy regime.
55@Dx 4/16/13
Bx: 6/12 pos, G9=5+4 (80%, 60%), 4+5 (2@100%, 80%, 10%), PNI+
cT3a (3T mpMRI: Bilateral EPE, NVB+, SV-, LN-)

Pre:
Date PSA fPSA
9/12 4.1 15%
3/13 5.2 12% PCA3=31

Tx:
IGRT by IMRT, 44 done 8/28/13: 50.4 Gy pelvic nodes, 79.2 Gy prostate
ADT2 3 yrs: Lupron/Casodex, ended 3/16

PSA <0.1 : 8/13 - 5/16;
steadying? - 0.2-8/16, 0.5-12/16, 0.7-3/17, 0.8-5/17, 0.8-7/17

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3427
   Posted 9/12/2017 10:12 AM (GMT -6)   
I was 100% continent right after surgery..I waited 5 or 6 months and then had SRT... I am still 98.5% continent 7 years later. A few stress drips now and then. I must urinate every 2 hours or so, day and night....I attribute the frequent urination to the radiation..My chart reads "Terminal Prostate Cancer" so I have other issues to worry about..
Age now 74 . Diagnosed G-9 6/2010
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA <0.1 10/'11, <0.1 2/12, <0.1, 4/12 <0.1, 9/12, 0.8 3/13, 0.5 6/13, 1.1, back on HT. 5/16 stay the course, Lupron, Zytiga, PSA <0.1 10/16 no change <0.1 5/17 PSA 1.6 Chemo or Provenge next..

fiddlecanoe
Regular Member


Date Joined Oct 2016
Total Posts : 174
   Posted 9/12/2017 3:41 PM (GMT -6)   
Nine months after RP I was 100% continent. I just finished SRT and I'm no longer fully continent. But it's already improving less than a week after the last blast.
Age: 62
Diagnosed in July 2016 with G7 (4+3) PC & PNI
Bone & CT scans clear
Surgery at Lenox Hill Hospital in NYC, 9/12/2016
Post-surgery pathology showed G7 (3+4), with SVI and PSM
Lymph nodes clear
First post-surgery PSA October, 2016: <.008
Second post-surgery PSA December, 2016: 0.01
Third post-surgery PSA June 2017: 0.05
IMRT begun: July 18, 2017 (35 fractions)

mattamx
Regular Member


Date Joined Aug 2015
Total Posts : 184
   Posted 9/12/2017 4:24 PM (GMT 0)   
I had Adj RT eight weeks post surgery. Two years later I wear a pad per day to catch minor dribbles. I'm not really expecting it to improve. It's not really a big deal for me. A much bigger deal is having to pee all the time, day and night. Makes it very difficult to get adequate sleep. That's the way it was before treatment also. I thought the RP would improve the bladder issues...at least that's what the Uro told me. lol
The tragic recommendations of the USPSTF led me to where I am.
Dx: April 2015, Age 54, pT3bN0MX
Initial PSA: 20.8
Bx: All cores high volume G7 (4+3)
Bone scan and MRI: clear
RALP: June 2015
Pathology: G8 (4+4), focal areas of 5; Positive margins; 3 Nodes negative
Adj. IMRT: Aug 2015
PSA nadir: 0.1
Steady PSA increase. Recent PSA: 5.3
CT and bone scans, July 2017: Both clear

lapilot
Veteran Member


Date Joined Nov 2012
Total Posts : 790
   Posted 9/12/2017 4:26 PM (GMT -6)   
I was 99% continent right my urologist pulled the catheter out 10 days after my robotic surgery. Two years later I had IGRT/IMRT (70.2 grays) and now probably 95% continent. The 5% is stress incontinence and luckily is very minor.
Age 60, mpMRI 8/18/13 negative
biopsy 9/5/13, PSA 6.2, 13 core of which 6 are postive
pT2pNO
left laterial base 10% G6(3+3)
left laterial apex 10% G6(3+3)
right base 15% G7(3+4)
right laterial base 15% G6(3+3)
right laterial mid 60% G6(3+3)
right lateral apex 20% G6(3+3)
daVinci 11/11/13
path T2c N0 Stage IIB
PSA 0.1 to 11/15 then 0.2
11/15 IGRT 39 sessions 72 grays. ZERO problems.

BillyBob@388
Veteran Member


Date Joined Mar 2014
Total Posts : 2450
   Posted 9/12/2017 6:16 PM (GMT -6)   
Well, that is not good news for a high risk guy like me. Just one more reason for me to push additional treatment as far into the future as possible. yeah Another year or ten sounds good to me.
PSA 10.9 ~112013
Bx on 112013 at age ~65yrs, with 5 of 12 pos with one G9(5+4), 1 PNI, T2B.
RALP with lymph nodes at Vanderbilt 021914. (nodes clear, SV+, G9 down graded to 4+5, cut wide, but 1 tiny foci right at the edge of margin ) Pros. 106.7 gms!
At 15 months, not wearing a pad most days, mostly dry
PSA <.01 on 6/14 and all until 9/15 = .01, still .01 9/16, .02 on 3/17,6/17

RandyJoe
Regular Member


Date Joined Jan 2015
Total Posts : 255
   Posted 9/14/2017 6:04 AM (GMT -6)   
Randy was 100% continent 8 weeks after surgery. After SRT he uses 1-pads per day. Like most here, it's mostly dribbles, a little more if he lifts something heavy....or sneezes.
55 at dx PSA-7/'14: 26
Bx-8/14: 8 of 8 cores+(80-100%) GL7;
9/14-Bone/CT Neg.
10/22/14: RP
Post-Surg Path:GL9; LN+; margins+; SV+, L Bladder neck+
pT3bN1
PSA-7 wks post op-10.0; 11 wks post op-14.2;
ADT 1/15 to1/16
F18 PET/Chest CT/MRI-Neg. (3/15)
SRT complete 7/6/15
9/15 to 3/16 PSA <.05
PSA 6/10/16 .46; 7/8/16 1.0; 8/2/16 1.2; 8/26/16 1.7; 9/22/16 2.5
10/16- EMBARK
6/17-PSA<.05-meds stopped

tdnjam
Veteran Member


Date Joined Jan 2013
Total Posts : 507
   Posted 9/14/2017 1:01 PM (GMT -6)   
Based on the responses so far looks like I am the exception and not the rule. After surgery, I was incontinent. However I was nearly dry a year later when SRT was started. Since that time, incontinence has gradually gotten worse and now I am pretty much 100% incontinent going through 10 plus pads per day. Since my episode with the failed AUS, I have started using a penile clamp. It has helped tremendously, when used, cutting pad use in half. However, the clamp does cause irritation and I have to discontinue use every three or four days until the irritation subsides.
Age 62, Diagnosed at 58
6/12-PSA 4.6, Biopsy 12/19/12 Positive 4 of 12
DaVinci 2-14-13
Updated Gleason 4+3=7
First post op PSA 4-5-13 Undetectable
15 month post op PSA 5-16-14 0.3
Started SRT 6-25-14
Ended SRT 8-12-14
1st post SRT PSA 9-24-14 0.1
1year post SRT PSA 9-18-15 <0.1
18 month post SRT 3-10-16 <0.1
2 year post SRT 9-26-16 <0.1
31 month post SRT 5-1-17 <0.1

oldbeek
Regular Member


Date Joined Sep 2017
Total Posts : 23
   Posted 9/14/2017 10:38 PM (GMT -6)   
Found the Mr Dribblestop more comfortable than the Cunningham clamp.

tdnjam
Veteran Member


Date Joined Jan 2013
Total Posts : 507
   Posted 9/15/2017 1:31 AM (GMT -6)   
Thanks Oldbeek. That is what I use...although it is a bit pricey.
Age 62, Diagnosed at 58
6/12-PSA 4.6, Biopsy 12/19/12 Positive 4 of 12
DaVinci 2-14-13
Updated Gleason 4+3=7
First post op PSA 4-5-13 Undetectable
15 month post op PSA 5-16-14 0.3
Started SRT 6-25-14
Ended SRT 8-12-14
1st post SRT PSA 9-24-14 0.1
1year post SRT PSA 9-18-15 <0.1
18 month post SRT 3-10-16 <0.1
2 year post SRT 9-26-16 <0.1
31 month post SRT 5-1-17 <0.1

John_TX
Veteran Member


Date Joined Jan 2015
Total Posts : 787
   Posted 9/15/2017 7:35 AM (GMT -6)   
I was 99% continent when the cath came out and I'm still at that point, like Fairwind I need to urinate every two or three hours but my stream has slowed down and it takes longer to start the stream.
DX - 1-13-2015 (age 66) -- PSA 4.02 (9-16-2014) to 4.38 (12-5-2014)
RALP on March 2, 2015
G6 to G7(3+4) to G7(4+3)
Stage pT3aN1
06/2017 PSA < 0.1
7/31/2015 HT - six month's injection of Lupron
ART 11/2015, 33 sessions

teddy9
Regular Member


Date Joined Sep 2015
Total Posts : 101
   Posted 9/15/2017 8:01 AM (GMT -6)   
i have found the frequent urination to be minimized by eliminating caffeine, plus eating less of certain fruits - watermelon and cantaloupe in particular. these stimulate my bladder and I get high urgency. If it gets out of control, i take oxybutynin for overactive bladder. Have your urologist prexcribe.
psa 4.5, 4 cores by MRI guided biopsy 2/13 after 2 neg biopsies - gl 4+3, 8% cancer neg margins, neg nodes, RP 3/13, gl 4+3, PSA < 0.008 thru 7/14, PSA 0.01 10/14, 0.03 2/15, 0.04 5/15 0.046 6 /15, 0.79 9/15, 0.087 10/15, 0.108 12/15 , 1/16 firmagon & lupron - psa 0.015, 4-5/16 IGRT, 37 sessions,

9/16 psa <0.014, 12/16 0.012, 3/17 0.08, 06/17 0.18, 9/17 0.3

Gear
Regular Member


Date Joined Oct 2016
Total Posts : 154
   Posted 9/15/2017 8:49 AM (GMT -6)   
After surgery I've experience only a little stress incontinence. Finished SRT (68.4 grays) 8 months ago and the stress incontinence has increase some but not much.
DX 9/2011 @ age 50, PSA: 2.1, 10/6/2011 RP Da-Vinci
4-3 Gleason, PT2C, -SV, -Mar,+PI, NX... <.02 first 4+ years
Start SRT@ PSA 0.25, 38 Sessions-68.4 Gy, Finished 02/1/17
PSA: 5/17-.12, 8/17-.031,

Biker56
Regular Member


Date Joined May 2014
Total Posts : 64
   Posted 9/15/2017 9:22 AM (GMT -6)   
I think I'm a poster child for SRT going badly. I was continent within a couple of months of surgery but my PSA nadir was 0.23 and began rising almost immediately. I also developed a stricture which my uro opened with a laser treatment, saying it would have closed off completely during salvage radiation treatments. After the laser I could pee like a garden hose but there were a few dribbles again.

I questioned the choice of SRT with my rad/med onc, reasoning that with negative margins but rising PSA it must be systemic, but he brushed that off saying SRT was effective in 90% of situations like mine and much preferable to the horrific side effects of HT.

So began 36 salvage radiation treatments 200 miles from home. Fortunately my son had a place in the city where I stayed five days a week. Bowel aggravation and urinary burning and frequency set in early in treatment and incontinence worsened. I alternated between almost total retention to barely making it from the table to the bathroom before the dam burst. I was prescribed Pyridium which was useless and actually seemed to increase retention and Flomax which helped somewhat. Fatigue was a factor and continued long after treatment ended as did bowel disruption. The radiation veterans' adage "never trust a fart" is wise advice. Rectal bleeding appeared and was attributed to radiation damage by colonoscopy and internist and will still randomly occur 10 years later. Incontinence worsened and my stricture re-occured, also due mainly to radiation damage according to my uro. Basically everything leaked out a few drops at a time. This time the treatment was electro-cautery, and went right into my bladder (TURB). A blocked catheter had to be pulled early, incontinence was near total, I peed blood, clots and tissue chunks and had incredibly painful bladder spasms that forced bowel movements. Oxybutinin eventually relieved the spasms but traces of blood in urine also occasionally appeared years later. I now have a slow but stable stream and and frequent urge.

I began wearing a clamp (also prefer Dribblestop) just to be able to function and have been trying to convince myself to go for the AUS. I consulted with a uro specializing in the device who was very honest about the chances of being pad free (unlikely), revision (25% and eventually, almost certainly), infection (low but real risk). That combined with the stories of AUS complications on this forum have kept me from taking the plunge.

By the way, the SRT was a total failure and I am now on my fourth round if intermittent HT. HT is no fun, in fact it is awful but if I could find my long gone rad onc I would inform him that it was SRT that was truly horrific.
Age 60
Dx 2006, RP, Gleason 4+3, T2c, salvage RT, intermittent ADT
Incontinence and ED ongoing, trimix
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