Wilderness- to answer your questions...
A potential downside of radiation I don't see mentioned here are longer term SEs I don't know how likely they are with current more precise technology - are they still a concern?
Urinary and rectal function return to baseline or better within a year. Late-term SEs (within a year or two) may occur, but are almost always transient. Chronic SEs are rare.
ED onset five or more years later?
ED after radiation, if it occurs, will occur within the first two years, more probably within the first year. Recent studies show that later onset ED is entirely age-related - because many men getting radiation are older, age-related ED is more likely to occur.
We're advised to be cautious about diagnostic radiation exposure increasing cancer risk - could there be secondary cancers ten or more years out? RP often results in immediate ED with some chance of recovery. I don't think it can generate secondary cancers.
As I wrote in a recent article, this is a very small risk, on the order of less than 5 in a thousand. Recent data from MSKCC shows that second primary pelvic cancers occurred at the same rate whether the patient had RP, RT or BT. It's probably about
the same level of risk as seeding of the cancer from surgical instrumentation.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 7 year results
treated 10/2010 at age 57 at UCLA
•PSA since treatment:
1/11:3.9 5/11:3.0 8/11:3.7 5/12:1.2 9/12:1.3 5/13:0.4 6/14:0.5
• SEs of treatment:
after 2 wks: mild urinary & rectal - last 1 wk
1 yr after: mild urinary