SRT and incontinence

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Veteran Member

Date Joined Nov 2009
Total Posts : 7269
   Posted 5/28/2010 9:34 PM (GMT -6)   
I'm curious about this.
I understand that if you are incontinent when starting SRT, things will not get better (probably).
Suppose you have recovered to where you are pretty much continent (say a squirt here and there). Will SRT undo that progress? Or are you likely to once again become incontinent.
I am hoping this is  just an academic question for me!!
Mel (next PSA in about 3 weeks)

63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3 was about 75 (way above the 35 threshold). That led to:

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms.  (Second opinion from Jon Epstein at Hopkins confirmed these results)

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent! Uh...OH. As of about 3/16/10 problems with constant urgency although no pads needed--feels like an infection but none showing in urine.

Update: since late March all is well in that area. I would say 99.9% continent (a spurt here and there, maybe 5 spurts per week).

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in mid-June.

Veteran Member

Date Joined Jun 2008
Total Posts : 1804
   Posted 5/29/2010 6:42 AM (GMT -6)   
Mel, while John wound up not needing SRT, we had begun the process with a radiation oncologist. She told us that incontinence would take a step or two back from the radiation but that the setback would be temporary - the urologist confirmed this but said that the setback would not be definite but was likely. Neither indicated that John would become completely incontinent once again, just that he would lose some progress in that area. They also discussed loose bowels likely occurring about half way through the treatment as well as some fatigue.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!

Old Sailor
Regular Member

Date Joined Aug 2009
Total Posts : 209
   Posted 5/29/2010 8:37 AM (GMT -6)   

Mel, I finished 35 of 38 IMRT sessions yesterday.  I was continent before IMRT and remain so. Most annoying however,  is urgency and frequency which the docs say is the most common side effect of IMRT and will subside about 3 weeks after IMRT.  I was told to drink at least a bottle of water about 45 minutes before start of IMRT session because a full bladder pushes the other organs up and out of way of possible radiation. There were several sessions when I thought I was going to "pee" myself on the table but made it to the head with the carpet "smoking" behind me!!  Also, I take two stool softeners everyday because second most common side effect is problems with defecation - so far so good.  I seemed to be a little more fatigued but continued to exercise everyday and never missed a day of work which makes me think since no pain, no gain?? In 2009, my docs at Mayo Jax published an article in International Journal of Radiation Oncology (Vol 76, No. 3 pp 735-740) called "Salvage Radiotherapy for Rising Prostate-Specific Antigen Levels after Radical Prostatectomy for Prostate Cancer: Dose-Response Analysis."  I would recommend all men having IMRT following prostatectomy read this very concise and comprehensive look at IMRT procedures, results etc.

The Old Sailor 

Dx 07/09  -  28 core saturation biopsy w/5 positive  (2 gleason 8, 2 gleason 7, 1 gleason 6)
RRP 8/13/09 Mayo Clinic Jacksonville
Path report upgraded gleason to 4+5=9
Negative margins, extraprostatic extension, seminal vessicles, lymph nodes.  Perineural invasion present.
Two month post surgery PSA 0.022
Five month post surgery PSA  0.081
Seven month post surgery PSA 0.190
Eight month post surgery PSA 0.217
Started IMRT at Mayo Jacksonville on 12 April, 38 sessions, so far very little if any side effects except urinary urgency and  frequency during the day. 

English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2218
   Posted 5/29/2010 8:43 AM (GMT -6)   

I'm about 5 weeks into SRT (finished 23 of 33)
As far an incontinence goes things have got worse for me. I now suffer from "frequency & urgency" a problem that many others have reported having had too.

I stopped wearing pads back in September 2009 which was about 10 weeks after da Vinci.
Prior to SRT starting I would regard myself as being about 70% of what I was before dx.
Getting up twice per night instead of once and going to the WC about every hour or so in the day time.

I'm now getting up every two hours each night to pee and going every 30 minutes during the day time. There is a continual feel that I think I need to go too, and the follow-up "drip-a-bit" saga has returned so I am now back to wearing pads if I have to leave the house. Though once put in I leave it in all day. No floods or anything that drastic, but it is still uncomfortable/annoying once again.

I am seeing the rad uro on Monday so I will now take her up on the offer she made last time to have some tablets to calm my bladder down. I've been taking the odd paracetamol(tylenol) too which she said might help a bit as well. Id prtefer not to medicate, but my primary concern now is that I have a big struggle before a session of RT starts to get my bladder full but not too full.

The doc said that this bladder issue could carry on getting worse until about two weeks after RT finishes and then it would start returning to about where it had been beforehand. I think the stats are that about 3/4 of patients recover their continence after a few weeks, the rest after a few months while there are a few (1% or less) have problems that last longer.

So at the moment I am keeping my fingers crossed (and my legs)

Age at Dx 48 No Family history of Prostate Cancer
Married 25 years, and I cannot thank my wife enough for her support.
April 2009: PSA 8.6 DRE: negative. Tumour in 2 out of 12 cores. Gleason 3+3.
RALP (nerve-sparing) at AVL-NKI Hospital Amsterdam on 29th July 2009. Stay 1 night.
Partial erections on while catheter still in. Catheter out on 6th Aug 2009.
Dry at night after catheter came out
Post-op Gleason 3+4. Tumour mainly in left near neck of bladder.
Left Seminal Vesicle invaded, (=T3b!)
no perineraul invasion, no vascular invasion. clear margins,
Erection 100% on 15th Aug 2009, but lots of leaking of urine
Stopped wearing pads on 21st Sept 2009
Pre-op style intercourse on 24th Oct 2009 !! No use of tablets, jabs, VED etc. but...
Nov 17th 2009 PSA = 0.1
Can still get erections okay, and almost no leaking of urine, but since December 2009 I don't have orgasms, instead I just have intense pain in place where prostate used to be.
Mar 17th 2010 PSA = 0.4!!! referred to radiation therapist
April 13th 2010 CT scan.
April 28th 2010 Started Radiation Therapy (66Gy - 33 sessions)

Forum Moderator

Date Joined Jan 2010
Total Posts : 7082
   Posted 5/29/2010 11:34 AM (GMT -6)   
No statistics to offer, but I was told by the urologist that setbacks in continence were likely, and that they could be permanent. That was a secondary reason that we waited a few weeks beyond the normal starting time in relation to the DaVinci date.

At 27 of 39 IGRT treatments complete, frequency & urgency have increased, I think very significantly, even after going completely off coffee and orange juice (they caused a lot of issues at the beginning even at just one cup & small glass a day). Carbonated beverages were risks before, now they are off the list completely as well. I was never "pad free", so no change there. The 500ml of water every morning before treatment has created a few "change of clothes" level accidents that probably would not have happened otherwise. Nightime accidents have been rare, but still happen, although normally I make it through the night without having to get up.

The biggest issue for me is fatigue. My days are getting shorter and shorter.

Regular Member

Date Joined Mar 2007
Total Posts : 447
   Posted 5/29/2010 1:33 PM (GMT -6)   
I was basically continent before SRT with only an accasional squirt of stress incontinence if I forgot to kegel at times when you should.

During SRT, I had no changes in urine frequency... maybe even less than before SRT as I was learning to hold urine for full bladder at treatment time.

After SRT, I have not noticed any stress incontinence... I am thinking the process of needing a full bladder for the treatments have strengthed and/or induced better communication between my brain and pelvic floor muscles. Made it more of an automated process than for me having to think to use kegals...

Anyway, I am glad of this particular side effect that occurred for my body. Interesting that our bodies can react so differently from one person to the other for similar treatments.
After 3-4 years of annual PSA 4-6, biopsy recommended
3/13/2007 - 12 point biopsy - Left 0/6  Right 1/6 Gleason 3+3 T1c
4/24/2007 - DaVinci performed at Virginia Mason hospital in Seattle
5/2/2007 - Catheter Out! Final pathology of Gleason 6  T2c Nx Mx, approx 20% of prostate involved, positive margin, but only at 2 focal points.  
6/28/2007 9 weeks incontinance... Overnite, went from 4-6 soaked pads a day from prev 8 weeks to 2 barely wet pads a day.
7/12/2007 11 weeks post-op  Minimal leakage...  one small pad a day
7/18/2007 First Post-Op PSA...  0.01 !!! 
9/10/2007 Pad free and ED at 75% with 100mg Viagra generic
6/26/2008 2nd Post-OP PSA at 14 months...  0.02 
12/2/2008 3rd Post-OP PSA at 20 months...   0.03
10/30/2009 4th Post-OP PSA at 31 months...   0.13 (moved and diff lab)
11/3/2009 Retest at my original lab...  0.11  (followup with Doc sched 11/10)
11/10/2009 Discussion indicated biochemical reccurrence and need for salvage radiation treatment. 
1/21/2010 Another PSA test at 34 months...  0.14
1/26/2010 IMRT Salvage Radiation Treatment started
                  32 sessions for 64 gys total.
3/12/2010 Finished 32 sessions...  No side effects to date except a little
tiredness.  Slight changes in bowel movements the last week...  
4/8/2010  Some rectal prostitis, but no change in urgency.  No urinary effects at all.  Now just waiting for the upcoming PSA test in June.

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