Salvage Radiation and Impotence

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DanaA
Regular Member


Date Joined Jan 2009
Total Posts : 71
   Posted 6/29/2009 3:29 PM (GMT -6)   
It's been about 6 weeks since the prostatectomy. My boyfriend has about 1/2 the erection as before, but it's not capable of penetration. He can get an erection capable of penetration with the pump, but it only lasts a couple minutes at most. I' m wondering what to expect once he starts salvage radiation. He takes ED meds and uses the pump every day. Will he be less likely to get an erection with or without the pump? Will he likely lose desire also?
 
Dana

SO diagnosed 4/15/09 age 47
1/15/09=PSA 10
Dx 4/15/09=Right side= Gleason 4+4=7, 40% involved, 5 out of 6 cores positive, perineural invasion present
Left side+ Gleason 4+4=8, 60% involved, 5 out of 6 cores positive, no perineural invasion present
T2c
5/14/09=Robotic surgery at Cleveland Clinic by Dr. Gong
pre-op PSA 15, MRI shows extracapsular penetration
Pathology 5/21/09-T3a, N1MX, positive margins, 1 out of 13 lymph nodes positive, left nerves spared


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/29/2009 5:00 PM (GMT -6)   
Dana,

Looking at his stats you have posted. Has it already been decided that he will have radiation, or are you speaking of some future date?

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 5/9 .10, 6/9 .11, July 13 - meet with radiation oncologist
 
 


KeyWestPirate
Regular Member


Date Joined May 2009
Total Posts : 60
   Posted 6/29/2009 6:10 PM (GMT -6)   
Did the pump he is using come with a "ring kit"? The ring should fit tightly. A combination of lubrication plus the proper ring plus using the pump to set the ring at the base of the penis should prevent the blood from exiting the penis, maintaining the erection for as long as you like.

The pump in combination with the ed med fills the penis with blood and makes it large and rigid. The ring prevents it's release, maintaining the erection.


There are instructions on the vacurect site that may be helpful:

http://www.vacurect.com/howitworks.htm

DanaA
Regular Member


Date Joined Jan 2009
Total Posts : 71
   Posted 6/29/2009 8:18 PM (GMT -6)   
Thanks for the replies. He's pretty set on radiation. He has extensive positive margins, so both hospitals are recommending it, and he seems to prefer radiation before jumping into HT. I think he may still think the radiation can cure it. It will probably start in a couple weeks. He has the rings, but one was so tight he was scared to try it again. The bigger one gets too tight after a few minutes and he has to take it off. He heard about the injections, but is unsure if he'd be able to stick himself with a needle there.
 
Dana
SO diagnosed 4/15/09 age 47
1/15/09=PSA 10
Dx 4/15/09=Right side= Gleason 4+4=7, 40% involved, 5 out of 6 cores positive, perineural invasion present
Left side+ Gleason 4+4=8, 60% involved, 5 out of 6 cores positive, no perineural invasion present
T2c
5/14/09=Robotic surgery at Cleveland Clinic by Dr. Gong
pre-op PSA 15, MRI shows extracapsular penetration
Pathology 5/21/09-T3a, N1MX, positive margins, 1 out of 13 lymph nodes positive, left nerves spared


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 6/29/2009 10:15 PM (GMT -6)   
From what my doc told me, the salvage radiation itself does not usually make things worse in continence or ED department, but it does stop progress. That's why they prefer to wait a bit to let things heal. Radiation does not reduce libido, as far as I know, but if used in combination with HT, hormones do.

As you see from my stats, I am in somewhat similar situation, except for the lymph node. The radiation doc recommended hormons AND radiation as it has a better chance to kill off stray cells than either treatment alone. He especially mentioned that for pelvic radiation (I assume that your SO is going to do that, given the positive lymph node) the doze that can be safely delivered is smaller and the radiation needs all the help it can get (i.e. hormones).

You also may want to find out the post-op PSA prior to radiation regiment.

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere+Avastin)

PSA results:            1/8/2008-33.90, 1/11/2008-29.50, 1/31/2008-38.20,

2/21/2008-32.00, 3/13/2008-26.20, 4/3/2008-26.60, 4/24/2008-20.60

RRP at Duke (Dr. Moul) on 6/16/2008

Pathology:              Gleason downgraded 4+3=7,   Duke: T2c N0MX, one positive margin,

2nd opinion at Sloan Kettering: T3a N0MX, extraprostatic extension, two positive margins

PSA undetectable for 8 months, then 2/6/2009-0.10, 4/26/2009-0.17, 5/22/2009-0.20, 6/11/2009-0.27

6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516

IMRT to start mid-Aug


Pelahatchie
Regular Member


Date Joined Jul 2007
Total Posts : 86
   Posted 6/30/2009 7:11 AM (GMT -6)   
Dana,
 
So far the salvage radiation has not negatively impacted me sexually and I am coming up on 18 months post radiation.  I did have over a two year period between surgery and radiation and as an earlier poster pointed out that did allow me to regain most it not all of my pre surgery status.  I don't know how it would have worked out if the radiation had started six months post surgery but i do know they seem to have a pretty good handle on IMRT and preventing collateral damage while killing the cancer cells.  Good luck.
Age 45 at DX
 
DX 8/05 Gleason 5, Mayo clinic Second Opinion Gleason 6, PSA 2.8
 
Da Vinci surgery Dr. Dasari, Centennial Nashville 9/24/05
 
Pathology Report Gleason 6, 15 % on left side only very near to the edge of capsule, too close to call on margins, doc's said to watch it very closely, final decision T2A
 
PSA's have basically ranged from <.04 to .05 for two years.
 
no E.D. and no Incontinence, feel very blessed
 
PSA Nov 07 = .06
 
PSA Dec 10th 07 =.07
 
PSA Jan 4th 2008= .1
 
Started Guided IMRT on January 7th, 2008 to treat prostate bed and lymph nodes, completed on March 6th, 2008
 
PSA April 18th 2008 =.03
 
PSA August 18th 2008 = .01 or less, test only goes down to .01


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 8/18/2009 10:50 AM (GMT -6)   
diego82 said...

DirtyRottenSpammer this pill is a wonderful medicine, it gave me a brand new chance to have a normal sexual life.
Mods...looks like a spammer from diego82...need you guys to check it out [img]/community/emoticons/nono.gif[/img]

I got him, had to do some editing in your referral, it included the link... smilewinkgrin

Post Edited By Moderator (James C.) : 8/18/2009 12:34:46 PM (GMT-6)


flippin out
Regular Member


Date Joined Mar 2006
Total Posts : 137
   Posted 8/18/2009 2:31 PM (GMT -6)   
Thought I'd put my 2-cents in
its been 16mos since Radiation which was 17mos after surgery My surgeon was certain i would be as good as after surgery The radiologist felt I would loose most of my performing ability. AH HA Happy to report My surgeon "SO far" was correct. As before any of this all came about I was and am in pretty good shape and I believe it was do to my choice of surgeon. worry fist about the cancer everything else is just a bonus! The hardest day was the initial diagnosis the second hardest day was the recurrence. I feel confidence but not overconfident, Best to you both.
50 Diagnosed as type II Diabetic
54 Cancer Detected
55 Da Vinci City Of Hope California
57 Cancer rise in successive PSA's
57 Radiation Loma Linda Medical Center California


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 8/18/2009 3:28 PM (GMT -6)   
I completed IMRT about two weeks ago. (37 treatments). My Psa started to rise about a year or so after LRP.  I was about  85% back to normal (with viagra) in the ED department when I started radiation.  I have had no ED side effects yet
and am about the same.  My Rad Onc said about 70% of the men remain potent with medication after IMRT.  Don't know if this is true but so far so good.  I was hestitant about IMRT because of this issue but I was willing to gamble to hopefully stop the cancer.
Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin (.3cm)
T2C
4/16/08- Started Bi-mix injections 
5/15/08- 1st Post-Op PSA 0.07 Undetectable
8/11/08 -2nd Post-OP PSA 0.02 Undetectable
8/15/08- No more pads as of today  Whoopee!!!
11/13/08- 3rd post-op PSA 0.02 Undetectable
03/02/09- 1 yr. post-op PSA .09 Undetectable
05/13/09   PSA .18 (ouch)
Started IMRT June 13, 2009
Completed 37 treatments July 31, 2009 (66.6gy)


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 8/18/2009 4:25 PM (GMT -6)   
If he is having partial erections, the injections really would work well. The teeny needle really is nothing , but some guys just have this thing about sticking needles into that part of their body.

Just a suggestion, but sometimes the partner ismore able to do it for them, and can even be a somewhat erotic activity.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/18/2009 4:31 PM (GMT -6)   
Based on what my urologist/surgeon and my new radiation oncologist told me on this subject, and I am contemplating salvage radiation as we speak, where you are with ED when you start, should be where you end up with ED when you are through. You will definitely not improve after from what they told me independently.

David in SC
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, corrective laser surgery scheduled for 8/18,
meeting with Rad. Oncl on 8/14 about lastest PSA
 
 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 8/19/2009 7:08 AM (GMT -6)   
David, thanks for the info...pretty much what my doc also said, but I still have those little nagging questions in my mind about it.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/19/2009 8:11 AM (GMT -6)   
Les, my brother, as we all know well here, none of our choices are thrilling or easy, always seems like one has to choose the lesser of evils. I am starting to resign myself to that.

David
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, still talking option, 8/18 - had laser scope surgery to clear blockage, now on Catheter #7
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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