SRT and incontinence

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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 7/15/2010 8:19 PM (GMT -6)   
I know this is a concern for me. I suspect SRT is in my future (but maybe not).
 
I have been VERY fortunate in the continence area. I had my surgery in late January and pretty much all issues in that area have been resolved. I'm doing fine.
 
My concern: I know if you have a degree of incontinence when starting srt, it often gets fixed or worsens.
 
What if you are continent like I appear to be? I know there are problems with urgency that are usually temporary. But would I be likely to become incontinent to some degree?
 
Mel

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). As of 6/22/10, I would say I am 100% continent, but I do have (controllable) significant urgency.

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

Second post-op PSA on 6/21/10--0.02--Not too bad!


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7082
   Posted 7/15/2010 8:24 PM (GMT -6)   
Mel,
I was at one ppd at the start, now, a month after, 2-3 ppd and getting worse.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/15/2010 8:32 PM (GMT -6)   
I can't say Mel, as I started SRT with a SP cath in place in October, and still have one in place, don't know if I would leak or not once totally cath free. I was 100% dry before the SP was inserted. But my bladder hasnt had to function for almost 10 months now, I am a bit concerned about that if and when I am finally free of caths. They say that where you are before radiation, is where you will usually be after. But like all things PC, nothing written in stone and no consistenies between guys as a rule. Hope you don't need to find out.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 still in place


Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 209
   Posted 7/15/2010 9:49 PM (GMT -6)   
Mel, I was dry when I started and dry when I finished.  There was a lot of urgency and frequency from about the 3rd. week on and particularly close to treatment time because you need to drink about 20 oz of water prior to treatment. Have almost returned to normal after 5 weeks.  Developed rectal proctitis near end of SRT which still bothers me a little.  Hopefully you won't need the SRT. Overall bearable but a (not a pun) pain in the __.  Old Sailor

Dx 07/09 Age 67  -  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 but 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 38 sessions IMRT at Mayo Jacksonville on 4/12/10,  completed 6/4/10.  Few side effects except urinary urgency and  frequency during the day and some rectal discomfort near the end of therapy. 


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3889
   Posted 7/15/2010 10:02 PM (GMT -6)   
My surgeon told me I probably would need SRT and it would be important to regain as much continence as I could before that started because the RT would "freeze" the continence issue right where it was, good or bad, that would be it...
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. A "top" radiation oncologist here in Denver, equipped with the latest IMRT/IGRT/RapidArc machine says he can do better by me..


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1211
   Posted 7/16/2010 12:14 AM (GMT -6)   
Hopefully you won't need SRT, but for what it is worth, I was dry before I started, during SRT and after. Had a sore and slightly bloody butt for a couple of weeks, but was back to 'normal' about 6 week after finishing SRT. I guess we're all a bit different.
All the best to you.
 
Magaboo

Born Sept 1936
PSA 7.9
-ve DRE
Gleason's Score 3+4=7, 2 of 8 positive
Open RP 28 Nov 06 (nerve sparing), Post op staging T3a
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; 3 days before Rad Start=0.1
Salvage RT completed (33 days - 66 Grays) on the 19th Dec., 08.
PSA in Jan., 09=0.05; July 09=<0.04; JAN 10=<0.04; Jul 10=<.04


pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 447
   Posted 7/16/2010 2:06 AM (GMT -6)   
Mel, I was dry except for some stress incontenance if I forgot to kegal... I think the routine during SRT of having a full bladder for the treatment actually seemed to get me in touch better with the kegals and I actually ended up having LESS stress incontenance after the SRT treatments... Go figure! I was lucky in that I had no problems with urgency or frequency for urination during or after my treatments. All our bodies seem to react differemtly to SRT.

Anyway, I hope you do not have to go thru the experience, but if you do, it was not bad at all for me.

pasayten
After 3-4 years of annual PSA 4-6, biopsy recommended
59 y/o
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.
6/7/2010 First 3 month PSA result after SRT = 0.02   WAHOO!  as good as could ever be expected at the 3 month mark!  Thank You Jesus!
 


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2218
   Posted 7/16/2010 2:46 AM (GMT -6)   
Mel,
I was dry before RT started, but on the basis that I was going to the bathroom about every 75 minutes. And twice each night.
about 2/3 through RT I had lots of bother with urgency and frequency (every 20 minutes!) and had to use a pad to deal with the odd dribble that would have otherwise shown through my clothes.
I am now 5 weeks post RT and at about 75%, so I can just about go for an hour between bathroom visits and am up three or four times a night.
Another problem that returned was the leaking of urine during sex.

I think the time has therefore probably come for another of my "time & motion" studies to record exactly when I pee so as to have something down on paper to compare with the past and the future. (I find that sort of record a great help, otherwise you find it very diofficult to quantify and qualify this aspect of QOL.)

More to the point I hope you don't actually need RT or any further treatment.

And how about we all think positively about this and discuss it in terms of our Continence rather than our Incontinecne?

Alf
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)
June 11th 2010 finished RT - main side effect tiredness, but also the occasional small leak
June 27th My 50th Birthday - feeling better but still not 100% okay


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 7/16/2010 6:25 AM (GMT -6)   
Mel, we were told that SRT would probably put John back a couple of months in terms of incontinence. The urologist said "probably" not "definitely". I don't know if this is true if you are fully continent when SRT begins (which John wasn't when we thought he was heading for SRT last Summer).

I also wouldn't assume you're heading for SRT although I do understand your reason for thinking that way. Hope you're doing well.
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!


SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 7/16/2010 11:26 AM (GMT -6)   
Mel, I just finished treatment #32 of 39. Prior to IGRT I used one pad a day to cover occaisonal stress type squirt. That remains the same. Prior to IGRT, was getting up 1-2 times per night to go. Lately it has been every hour, every night. Urgency is the main problem. Really strong and definately a race to get it over the toilet in time. Seems like the bladder can sense the bowl at least 3 feet away!!!!!! Squid.
*Age 63, PSA July 2009 5.66
*Diagnosed July 2009, Biopsy: 2 of 12 cores positive, Gleason 3 + 5 = 8
*MRI and Bone Scan Negative.
*open Surgery October 22, 2009
*Prostate, both nerve bundles, seminal vessels, and lymph nodes removed during surgery.
*Post surgery Biopsy, Gleason 4 + 3; 2 positive margins
*ED - Yes 
*30 day PSA (ultra-sensitive) .07
*90 day PSA (standard) <0.15
*01/10 - bladder neck stricture. opened during cysto exam. Cath #2 in for 5 days.
*03/01 - bladder neck stricture. Dilated during cysto exam. Cath #3 in place.
*03/11 - Bladder neck surgery. Cath #4 in place.
*03/15 - Cath #4 out. Great urine stream. Unfortunately, incontinence back to post surgery level.
*04/14 - Six month PSA .21.
*05/15 - Incontinence basically under control.  99% dry.  Wear pad daily at work "just in case".
*06/10 - Started IGRT.   39 treatments scheduled.
 


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 7/16/2010 12:30 PM (GMT -6)   
Thanks for the info, Subic.
 
I believe this urgency is one of the (hopefully) TEMPORARY side effects.
 
Mel

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). As of 6/22/10, I would say I am 100% continent, but I do have (controllable) significant urgency.

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

Second post-op PSA on 6/21/10--0.02--Not too bad!


Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 7/17/2010 9:08 AM (GMT -6)   
 
Mel,
 
I was dry when I started SRT and had no problems.
 
Jerry1 
Age 70
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  4+4 = 8 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
10/15/09 PSA 0.3
10/26/09 surgery to remove 3 clips in bladder neck  
11/16/09 PSA 0.3
12/14/09 PSA 0.4 
12/28/09 PSA 0.5
Start salvage radiation treatments on January 18th. 
Finished IMRT
First PSA after 3 mos. 1.5 not good news

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