Best Study of Consequences I Found

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Regular Member

Date Joined Sep 2009
Total Posts : 311
   Posted 11/19/2009 10:01 PM (GMT -6)   
Of all the information I reviewed while considering my course of action (and also consulting three surgeons, a radiation oncologist, and a general medical oncologist) the referenced study and article below from the New England Journal of Medicine was by far the most helpful to me.
The study followed 1200+ men and their partners for two years.  Interviews were conducted before surgery, and at 2, 6, 12, and 24 months.  Respondents were asked to guage their "degree of satisfaction" with "Changes in Quality of Life After Primary Care Treatment" in five areas, including Sexual Satisfaction and Urinary Incontinence.  The results are graphed out nicely in Figure 1 in the article referenced below;  you can keep clicking on Figure 1 it to get it to readable size.
I found the results more than interesting, and not that surprising from what I had learned anecdotally on this Board and other locations. 
For example, the men undergoing Prostatectomy were divided into Nerve-Sparing and Non- Nerve Sparing groups.  After two years, 40% of the Nerve-Sparing group reported they were sexually satisfied; only around 20% of the Non-Sparing group reported satisfaction.  The two groups were much closer on satisfaction levels with urinary continenece, roughly 80% and 70% were satisfied.
My personal choices, because of my situation, came down to Non- Nerve Sparing Prostatectomy (one bundle removed)  or a combination of Radiotherapy + NHT (hormones) for six months.  Surprisingly (at least to me), the Radiotherapy + NHT group reported about the same level of sexual satisfaction as the Non- Nerve Sparing prostatactomy group (roughly 20%) after two years.  That helped tilt things for me towards surgery as I decided radiation had its own problems, I was tired of dealing with enlarged prostate problems, and either way the sexual  recovery part was going to be a long shot.  Better for my wife and I to  know before hand.  The good news, for me, is that so far the continence control challenge has gone better than I could have hoped.
Well, here is the article.  I found, and still find, the data fascinating if not exactly what I would have liked.
Best to all, especially those considering their options.  Still reading my newspapers.  Here is the artilce from March 2008, New England Journal of Medicne.
NewsPaper Lover

Age 66

PSA:  6.0  on 07/31/09 having risen from 4.2 on 12/02/08.  Free PSA 23.5%.Other PSA History: 4.3 on 05/01/08; 3.3 on 11/15/07; 3.1 on 05/20/07; 4.0 on 11/30/06; 3.40 on 09/01/05.


Biopsy:  09/04/09  13 snips;  two positive.  Right Mid  4+3 = 7 and 15% of the total volume.   Right Lateral Mid 4+3 = 7 and 20% of the total volume.


DaVinci robotic surgery:  11/05/09.  Post surgery pathology:  margins clean, no invasion of seminal vessels, no upgrade of the Gleason scores, no evidence of cancer outside the prostate capsule.


Cathether removed one week later:  11/12/09.  Very minor dribbles for two days.  Stopped using pads after three days.  No pads or incontinence at night.  After years of an enlarged gland, nice to get a solid stream. 

Veteran Member

Date Joined May 2009
Total Posts : 2692
   Posted 11/19/2009 11:35 PM (GMT -6)   
Thanks. Good to know how each of our respective treatments stack up. There are times when we second guess our choices based on reports from another therapy choice.

Overall, the choices don't appear to be that different in their long term side effects.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections

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