Considering High-Dose Rate Brachytherapy

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garyi
Regular Member


Date Joined Jun 2017
Total Posts : 307
   Posted 12/7/2017 8:34 AM (GMT -7)   
Care to share the name of your RO, Denis???
70 years old @ Dx, LUTS for 7 years
PSA's never over 3.0
Ulcerative Colitis since 1973
TURP 2/16, G3+4 discovered,
3T MRI fusion guided biopsy 6/16
14 cores; G 3+3, one G3+4, Grade T1b
Second 3T MRI 1/17
RALP 7/17 Dr. Gonzaglo The Univ of Miami
G3+4 Organ confined
pT2c pNO pMn/a
Mostly Dry
10 week PSA .32
12 week PSA .40
14 week PSA .42
17 week PSA .54
Persistent PSA - 1" tumor still in cavity

dbell
Regular Member


Date Joined Nov 2017
Total Posts : 30
   Posted 12/7/2017 11:51 AM (GMT -7)   
Good to see that you weighed all your options. And the SE do weigh in the decision process (at least for me).
Good luck and keep us posted!
Age 53
DX 11/17
PSA 5.1
G 3+3
1 core of 12 - 35% involvement, confirmed by MSKCC
AS currently - awaiting MRI 1/18

gift of breath
New Member


Date Joined Oct 2010
Total Posts : 15
   Posted 12/7/2017 4:59 PM (GMT -7)   
With me I had my prostate removed and it was the right thing to do because I had an enlarged prostate and severe urinary restriction. When you make your decision make sure you are 100% sure.
Diagnosed w/PC at age 62
6/1/09 PSA< 5.1
11/07/09 PSA< 5.6
DRE < abnormal
3/10/10 Bio <1 of 12 Pos
Gleason < 3+3, t1c
RP 6/15/10 Dallas VA
Post Op Gleason <4+3, t2c
Path clear all margins, tumor centralized in both lobes
both nerves saved
8/13 PSA< less than 0.01 (undetectable)
8/13 <1 pad
8/17 start Levitra (microscopic improvement)
9/9 > PSA less than 0.01 (undetectable)
11/9 > Dry
2/8> 0.01

Subdenis
Regular Member


Date Joined Aug 2017
Total Posts : 253
   Posted 12/8/2017 2:42 AM (GMT -7)   
My RO is Dr. Biagioli Medical Director Florida hospital. As to being a 100% sure, that is my hope but I think my decision making, in the end, will come down to an intuitive belief.

My current thinking is each of the major treatments has similar positive outcome statistics and similar SEs. The HDRBT is a much simpler procedure the post-op recovery is very easy and quick.
65YO healthy man, PSA 5/17 4.6, MPMRI, 5/17 lesion. 13 core biopsy 3 positive 3+3 and 1 positive in a lesion, All cores less than 30% 8/17 - the second opinion Yale pathology shows a small amount of (3+4) in one core, < 5%, decipher test shows intermediate risks, looking at treatment options. Strongly leaning towards HDRBT, meet with Dr, Patel in two weeks. Denis

SueCAll
Regular Member


Date Joined Jan 2015
Total Posts : 244
   Posted 12/8/2017 4:11 AM (GMT -7)   
Denis, I'm happy you've been weighing all your options. In the end you'll do what's right for you and be at peace with your decision. PS Do you ever sleep? I don't do a lot of it myself! Sue

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 3957
   Posted 12/8/2017 4:40 AM (GMT -7)   
Subdenis said...

My current thinking is each of the major treatments has similar positive outcome statistics and similar SEs.


Denis, I think if you will read back on many of the studies posted on HW re SE's, particularly those posted by Tall Allen, you will find that the SE's are NOT similar. Your inclination toward HDR Brachy should yield a significantly better chance of avoiding ED and incontinence than if you chose surgery.

Jim
Forum Moderator-Prostate Cancer. Age 62 (71 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Everything continues to function normally. PSA: 6 mo: 1.4, 1 yr: 1.0, 2 yr: .8, 3 yr: .5, 4/5 yr: .2, 6-9 yr: 1. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1

NKinney
Veteran Member


Date Joined Oct 2013
Total Posts : 737
   Posted 12/8/2017 5:33 AM (GMT -7)   
Subdenis said...

My current thinking is each of the major treatments has similar positive outcome statistics and similar SEs.



That's right. (You've been doing your homework!). For SEs, surgery has a sudden, abrupt impact and tends to get better over time, sometimes over years. RT has little immediate impact for most and tends to slowly degrade, for some, over time, sometimes years later. The two tend generally to converge over time; no two anecdotal cases are the same. For outcomes, it really depends on the risk category one is in. Favorable risk cases that don't need treatment tend to have great outcomes (but, duh, of course they do; they do as well as those who didn't seek immediate treatment ). It's when one starts looking at the higher risk cases where there is divergence, and unique case conditions make one choice superior over others...but you don't need to worry about that; yours is a very typical, very common favorable risk case of natural prostate aging.

Post Edited (NKinney) : 12/8/2017 2:20:44 PM (GMT-7)


Gemlin
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Date Joined Jul 2015
Total Posts : 620
   Posted 12/8/2017 9:07 AM (GMT -7)   
I would say the opposite, problems increase with time regardless of which treatment we choose. shakehead

American Cancer Society said...
Two years and 5 years after treatment, men in the prostatectomy group were significantly more likely than those in the radiation group to report urinary leakage and erectile dysfunction. But the problems increased in both groups over time, and 15 years after treatment, the likelihood of having these side effects was similar between the 2 groups. At 15 years, almost all the men reported having erection problems – 87 percent in the prostatectomy group and 93.9 percent in the radiation group.

Bowel urgency also increased in both groups over time until the extent of the problem was fairly similar between the 2 groups. Two years and 5 years after treatment, men in the radiation group were significantly more likely than those in the prostatectomy group to report bowel urgency. But at 15 years, researchers found no significant differences between the 2 groups.
shakehead

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8943
   Posted 12/8/2017 11:43 AM (GMT -7)   
I disagree with Subdenis, NKinney and Gemlin. What they, and most analyses, fail to take into account is that radiation patients are a median of ten years older than surgery patients. In most studies the median age for RP patients is about 60, whereas the median age of most RT patients is about 70. 70 is around the age that continence and erectile function naturally begin to decline, and 15 years later, at 85, we can all expect some degree of incontinence and impotence. In the only randomized comparison of the two, the ProtecT RCT, the median age for both was 62. The side effect profiles over time (out to 6 years) were quite different. The kind of EBRT technology they used was 3D-CRT which has a higher rate of side effects than IMRT. Even so, it exploded the following myths:

Myth #1: The side effects end up about the same for surgery or radiation

That's clearly not true for incontinence or erectile function, It is true for urinary irritation and rectal function, which are at baseline levels and similar in all cohorts at 6 years.

Myth #2: With surgery, you get the side effects all at once and steadily recover; with radiation, the side effects come on steadily and may hit you many years later.

What we've seen here belies that myth. There is some recovery of continence up to two years later, but not thereafter. After radiation, incontinence was a minor symptom (except to those who had it, of course), but it did not increase over the years. Urinary irritation/obstruction increased at 6 months for EBRT, but returned to baseline permanently thereafter. Rectal function scores also permanently returned to baseline levels after the 6-month time point.

Myth #3: Over time, erectile function is about the same for surgery and radiation.

As we've just seen, erectile function is much worse after surgery, and it never recovers much beyond 2 years.

/pcnrv.blogspot.com/2016/09/patient-reported-outcomes-from-protect.html
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

NKinney
Veteran Member


Date Joined Oct 2013
Total Posts : 737
   Posted 12/8/2017 11:44 AM (GMT -7)   
Someone quoted my previous post, then asked the question, “Are you saying that ED gets better for men after prostatectomy?” I saw this just before going out to lunch, and said to myself that, first of all I thought the answer to this was well known, but secondly that this question deserves a well-thought response…which I would do after lunch.

Upon return, I see that the poster has since returned and deleted that post/question, but in the spirit of “there are no bad questions,” I will give a (perhaps shorter) response to the now absent question…

Somebody said...
“Are you saying that ED gets better for men after prostatectomy?”



Yes, absolutely. ED recovery is different on an infinitely-varying scale case-by-case, but I will speak to the well-understood, well-documented general trend which most medical descriptions of the post-surgery experience align with. Moreover, and perhaps equally as important, it aligns closely with the personal (albeit anecdotoal) experiences of many here at HW/PC.

First and foremost, the most obvious determinant of postoperative ED is the preoperative potency status. It’s not going to get better after RP; and there are other factors which affect ED (broad topic; another day)…but high level is that if you had ED before surgery, that’s something that doesn’t improve. The other somewhat obvious factor is nerve-sparing; someone who did NOT have nerve sparing surgery is immediately subject to a much higher stack of issues. For the rest of this discussion, I’m really talking about nerve-sparing cases (such as Subdenis would likely have).

Second is the understanding that some men never recover erectile function from treatment even with meds…although (ultimately) a mechanical implant (another surgery) can simulate functionality (another broad topic for another day). The recovery CAN be influenced by the experience level of the surgeon due to the highly technical nature of RP, BUT broad randomness (rather, unidentified/unassigned causes) appears to be a greater factor because plenty of patients from very experienced surgeons experience extended or complete ED…it’s fact, though, that this happens more frequently with less experienced surgeons. Choose an experienced surgeon to stack the controllable odds in your favor for the best possible outcome. Period.

Finally, to the main point of the question, ED generally gets better after a post-PR recovery period. The recovery period varies like an impulse decaying function. Not to geek out too much, but our electrical engineering 101 textbooks provide similar graphical representations where the x-axis is time, but the y-axis is erectile funcationality. (See THIS) There is an impulse (surgery) and immediate response (ED), some recover functionality in weeks, others months, most within a couple years (and some never, as mentioned). [Some may argue with the use of this impulse response chart as a visual description…I think it’s a pretty good visual description, but I’ll point out one key difference influenced by the first factor which I talked about above, which is that the level of erectile function after RP rarely (never) returns to the same pre-surgery level…it’s going to be at least a little worse. Might be functionally similar, but not as good.]

Why is this 3rd point true? There is actual physical recovery which takes place. There is, for example, mechanically induced nerve stretching that may occur during prostate retraction, thermal damage to nerve tissue caused by electrocoagulative cautery during surgical dissection, injury to nerve tissue amid attempts to control surgical bleeding, and local inflammatory effects associated with surgical trauma. Different, "newer" surgical techniques can help to reduce some of these contributors (and there is continuous process improvement in surgical techniques), but no technique completely eliminates them. For example, lower heat energy—most obviously from cauterization, but also simply from the laparoscopic lighting techniques—is understood to result in better outcomes.

OK, got a little longer than I thought in response to the question which was deleted…but if someone stepped forward to ask the question (even though they then deleted it), then that tells me that there are probably many others who are thinking the same question and afraid to ask. Don't be ashamed to ask. No dumb questions.


Time to disconnect! Adios, have a great weekend...!

Post Edited (NKinney) : 12/8/2017 12:07:57 PM (GMT-7)


Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8943
   Posted 12/8/2017 12:26 PM (GMT -7)   
Back to the subject of HDR-BT...

I had an interesting email conversation with a physicist/inventor. He looked at certain advantages in the way external beam radiation is delivered, and wanted to adapt them to HDRBT. In an older technology, called 3D-CRT, the beams come from multiple directions and are shaped to conform to the 3D shape of the prostate using dynamic multileaf collimators. IMRT takes this to the next level by also varying the intensity of each beam according to the depth of the target. So, higher intensity beams are used to get absorbed by the deeper parts of the prostate, while lower intensity beams are used to hit the closer parts. This is why IMRT doses (with suitable motion tracking) can be specified down to the sub-millimeter level, and why the doses to nearby organs are so low and constrained.

With HDR-BT, the high intensity Iridium 192 X-rays spread out equally in all directions. Shaping is achieved with HDR-BT by varying the dwell times within the 15 or so catheters placed throughout the prostate. Because the prostate is held immobile by the catheters, dose can still be specified down to less than a mm and shaped to conform to the prostate. However, certain areas (near the catheters) get very "hot" and other areas can get "cold spots." Also, the X-ray dispersal can go everywhere. He invented a dynamically programmable filter for the catheter that allows for the beams to be directed precisely in the desired direction. This could be especially useful in decreasing the dose to the urethra. (With HDR-BT, the spot dose to parts of the urethra can get quite high, which is why urethral stenosis can be a particular problem).

It sounds like a great invention. I hope he is able to convince someone to conduct a clinical trial (he's tried it in mice).
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

dbell
Regular Member


Date Joined Nov 2017
Total Posts : 30
   Posted 12/8/2017 1:28 PM (GMT -7)   
NKinney said...
Someone quoted my previous post, then asked the question, “Are you saying that ED gets better for men after prostatectomy?” I saw this just before going out to lunch, and said to myself that, first of all I thought the answer to this was well known, but secondly that this question deserves a well-thought response…which I would do after lunch.

Upon return, I see that the poster has since returned and deleted that post/question, but in the spirit of “there are no bad questions,” I will give a (perhaps shorter) response to the now absent question…

Somebody said...
“Are you saying that ED gets better for men after prostatectomy?”



Yes, absolutely. ED recovery is different on an infinitely-varying scale case-by-case, but I will speak to the well-understood, well-documented general trend which most medical descriptions of the post-surgery experience align with. Moreover, and perhaps equally as important, it aligns closely with the personal (albeit anecdotoal) experiences of many here at HW/PC.

First and foremost, the most obvious determinant of postoperative ED is the preoperative potency status. It’s not going to get better after RP; and there are other factors which affect ED (broad topic; another day)…but high level is that if you had ED before surgery, that’s something that doesn’t improve. The other somewhat obvious factor is nerve-sparing; someone who did NOT have nerve sparing surgery is immediately subject to a much higher stack of issues. For the rest of this discussion, I’m really talking about nerve-sparing cases (such as Subdenis would likely have).

Second is the understanding that some men never recover erectile function from treatment even with meds…although (ultimately) a mechanical implant (another surgery) can simulate functionality (another broad topic for another day). The recovery CAN be influenced by the experience level of the surgeon due to the highly technical nature of RP, BUT broad randomness (rather, unidentified/unassigned causes) appears to be a greater factor because plenty of patients from very experienced surgeons experience extended or complete ED…it’s fact, though, that this happens more frequently with less experienced surgeons. Choose an experienced surgeon to stack the controllable odds in your favor for the best possible outcome. Period.

Finally, to the main point of the question, ED generally gets better after a post-PR recovery period. The recovery period varies like an impulse decaying function. Not to geek out too much, but our electrical engineering 101 textbooks provide similar graphical representations where the x-axis is time, but the y-axis is erectile funcationality. (See THIS) There is an impulse (surgery) and immediate response (ED), some recover functionality in weeks, others months, most within a couple years (and some never, as mentioned). [Some may argue with the use of this impulse response chart as a visual description…I think it’s a pretty good visual description, but I’ll point out one key difference influenced by the first factor which I talked about above, which is that the level of erectile function after RP rarely (never) returns to the same pre-surgery level…it’s going to be at least a little worse. Might be functionally similar, but not as good.]

Why is this 3rd point true? There is actual physical recovery which takes place. There is, for example, mechanically induced nerve stretching that may occur during prostate retraction, thermal damage to nerve tissue caused by electrocoagulative cautery during surgical dissection, injury to nerve tissue amid attempts to control surgical bleeding, and local inflammatory effects associated with surgical trauma. Different, "newer" surgical techniques can help to reduce some of these contributors (and there is continuous process improvement in surgical techniques), but no technique completely eliminates them. For example, lower heat energy—most obviously from cauterization, but also simply from the laparoscopic lighting techniques—is understood to result in better outcomes.

OK, got a little longer than I thought in response to the question which was deleted…but if someone stepped forward to ask the question (even though they then deleted it), then that tells me that there are probably many others who are thinking the same question and afraid to ask. Don't be ashamed to ask. No dumb questions.


Time to disconnect! Adios, have a great weekend...!


I was the one who asked the question (as you can tell I am a newbie) and do not have the vast knowledge that some of you may have with years of being a member of the "club". McKinney your answer seems to conflict with that of Tall Allen (an SBRT guy). I believed what most of the items that Tall Allen mentioned above regarding Surgery and Radiation. I am trying to get my hands around the long/short term effects of surgery vs. Radiation and was under the impression that the SE from surgery may be much more severe short and long term (in terms of ED etc.). I know 4 people who had surgery and after about 6-10 years have severe ED issues etc. (does not mean that is always the case, but still true). Again I am gathering information so I can make an intelligent decision someday down the road in terms of treatment. SE will certainly effect my decision if I have choice in treatment! Sorry if I offended anyone...Happy Holidays all and wish everyone a great and healthy 2018!
Age 53
DX 11/17
PSA 5.1
G 3+3
1 core of 12 - 35% involvement, confirmed by MSKCC
AS currently - awaiting MRI 1/18

Post Edited (dbell) : 12/8/2017 1:33:24 PM (GMT-7)


NKinney
Veteran Member


Date Joined Oct 2013
Total Posts : 737
   Posted 12/8/2017 1:48 PM (GMT -7)   
dbell, glad you came back to the thread...

Maybe I misunderstood your question first time around.

IF you were asking if surgery makes pre-existing ED problems get better over time, then NO...and in my "first and foremost..." paragraph I addressed that.

IF you were asking if the immediate, abrupt and typically complete effect of erectile disfunction in the days immediately after surgery get better, then YES. In the majority of cases this is true, as I described in my last post. My personal experience was very similar to many/most men posting here, and common in the literature...I had 2 or 3 months of recovery which spanned these common phases of initially no erection, then poor erection, then gradually improving rigidity, and now fully functional (with meds), similar to before RP although not quite as good quality (and, as I said, requiring meds).

Hope this clarifies...you might have been asking a different question than I answered. In hindsight, I can see how your original question (“Are you saying that ED gets better for men after prostatectomy?”) could mean either of the two scenarios I listed here...

Post Edited (NKinney) : 12/8/2017 1:52:09 PM (GMT-7)


dbell
Regular Member


Date Joined Nov 2017
Total Posts : 30
   Posted 12/8/2017 2:06 PM (GMT -7)   
NKinney said...
dbell, glad you came back to the thread...

Maybe I misunderstood your question first time around.

Hope this clarifies...you might have been asking a different question than I answered. In hindsight, I can see how your original question (“Are you saying that ED gets better for men after prostatectomy?”) could mean either of the two scenarios I listed here...


Nkinney, thanks for the clarification. Again, I was reacting to the general statement that "ED gets better after surgery"! I was not aware that in MOST cases, this is true. Thanks again for the clarification. yeah
Age 53
DX 11/17
PSA 5.1
G 3+3
1 core of 12 - 35% involvement, confirmed by MSKCC
AS currently - awaiting MRI 1/18

Post Edited (dbell) : 12/8/2017 2:14:11 PM (GMT-7)


NKinney
Veteran Member


Date Joined Oct 2013
Total Posts : 737
   Posted 12/8/2017 2:15 PM (GMT -7)   
So more accurately/more completely, the original short but potentially ambiguous statement would likely be better re-stated to: "The typically severe erectile dysfunction which is caused as an immediate side effect of prostate removal surgery generally improves after weeks or months of recovery, although typically lower or near the same, and never to a higher performance level, than it was before surgery."

I have little doubt that most of our PC "vets" knew the complete context of the original statement, but it always helps to get reminded of the newcomer's perspective. I was also a newcomer 8-years ago...sometimes I forget.
thanks




edit
Actually, I went back and re-read what I actually, originally wrote. it was brief, but pretty good after all...
NKinney said...
For SEs, surgery has a sudden, abrupt impact and tends to get better over time, sometimes over years.

Post Edited (NKinney) : 12/8/2017 2:24:41 PM (GMT-7)


dbell
Regular Member


Date Joined Nov 2017
Total Posts : 30
   Posted 12/8/2017 2:24 PM (GMT -7)   
NKinney said...
So more accurately/more completely, the original short but potentially ambiguous statement would likely be better re-stated to: "The typically severe erectile dysfunction which is caused as an immediate side effect of prostate removal surgery generally improves after weeks or months of recovery, although typically lower or near the same, and never to a higher performance level, than it was before surgery."

I have little doubt that most of our PC "vets" knew the complete context of the original statement, but it always helps to get reminded of the newcomer's perspective. I was also a newcomer 8-years ago...sometimes I forget. thanks


Thanks, that is little different than your original statement, but I hear ya. I will stop being a newbie someday, but for now it is what I am. I am also part of a club I never wanted to join as well...thanks! tongue
Age 53
DX 11/17
PSA 5.1
G 3+3
1 core of 12 - 35% involvement, confirmed by MSKCC
AS currently - awaiting MRI 1/18

garyi
Regular Member


Date Joined Jun 2017
Total Posts : 307
   Posted 12/8/2017 3:29 PM (GMT -7)   
After surgery five months ago my otherwise fine potency was slightly impacted. As of a month ago it's back to baseline, and I'm 72. No shrinkage, and I swear my girth has increased. I'm taking 5mg of Cialis daily. FWIW.

Sub Denis, as I've pointed out in a previous FL RO thread, you're working with the most experienced Brachy RO in the state. It will not be a picnic, but if it were me, that's the way I'd go.

There is no one I trust or rely on more than Tall Allen Edel, even if I might question his conclusions. His encyclopedic knowledge is only exceeded by his easy to follow presentation skills. We are fortunate to have him here!

NKinney.....you ain't half bad either smilewinkgrin

Post Edited (garyi) : 12/8/2017 3:32:16 PM (GMT-7)


NKinney
Veteran Member


Date Joined Oct 2013
Total Posts : 737
   Posted 12/8/2017 4:07 PM (GMT -7)   
garyi said...

NKinney.....you ain't half bad either smilewinkgrin



Gee, thanks. I think.

garyi
Regular Member


Date Joined Jun 2017
Total Posts : 307
   Posted 12/8/2017 4:17 PM (GMT -7)   
NKinney said...
garyi said...

NKinney.....you ain't half bad either smilewinkgrin



Gee, thanks. I think.


Take it to the bank, my brother smile

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8943
   Posted 12/8/2017 4:32 PM (GMT -7)   
Apologies to the OP for kidnapping his thread about hdr-BT...

dbell said...
I was not aware that in MOST cases, this is true.


You are quite right that it is not true in most cases, at least not with the average treatment. The PROSTQA study showed that, in a national multi-institutional sample, as of 2 years post-prostatectomy, only 37% of previously potent men who had bilateral nerve sparing were still potent enough for intercourse. So it is true that if close to 100% of previously potent men have at least temporary impotence immediately after surgery, 37% will have regained sufficient potency for intercourse by 2 years. Many of those 37% regain potency within the first year, and almost all the rest by the second year. Very few continue to improve after 2 years, but a few do.

www.europeanurology.com/article/S0302-2838(13)00847-6/fulltext

Results can be better if we focus on a world-class institution like MSKCC. There, patients were treated by top surgeons and had multidisciplinary follow-up (including penile rehab supervised by Mulhall). 48% of previously potent men had regained potency sufficient for intercourse by 12 months. Of the remaining 52%, 22%, 32%, and 40% had regained good erectile function by 2 years, 3 years, and 4 years, respectively. So that brought the total up from 48% at 1 year to 59% at 2 years to 65% at 3 years and to 69% at 4 years. This should provide encouragement to continue penile rehab.

/www.ncbi.nlm.nih.gov/pmc/articles/PMC4605865/

However, even at MSKCC, only 16% with good baseline erectile function got back to baseline function after prostatectomy without ED meds:

/www.ncbi.nlm.nih.gov/pmc/articles/PMC4742368/
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

dbell
Regular Member


Date Joined Nov 2017
Total Posts : 30
   Posted 12/8/2017 6:26 PM (GMT -7)   
Tall Allen said...
Apologies to the OP for kidnapping his thread about hdr-BT...

dbell said...
I was not aware that in MOST cases, this is true.


You are quite right that it is not true in most cases, at least not with the average treatment. The PROSTQA study showed that, in a national multi-institutional sample, as of 2 years post-prostatectomy, only 37% of previously potent men who had bilateral nerve sparing were still potent enough for intercourse. So it is true that if close to 100% of previously potent men have at least temporary impotence immediately after surgery, 37% will have regained sufficient potency for intercourse by 2 years. Many of those 37% regain potency within the first year, and almost all the rest by the second year. Very few continue to improve after 2 years, but a few do.

www.europeanurology.com/article/S0302-2838(13)00847-6/fulltext

However, even at MSKCC, only 16% with good baseline erectile function got back to baseline function after prostatectomy without ED meds:

/www.ncbi.nlm.nih.gov/pmc/articles/PMC4742368/


Thanks Tall Allen for the stats.....this clears some things up!
Age 53
DX 11/17
PSA 5.1
G 3+3
1 core of 12 - 35% involvement, confirmed by MSKCC
AS currently - awaiting MRI 1/18

Subdenis
Regular Member


Date Joined Aug 2017
Total Posts : 253
   Posted 12/9/2017 2:40 AM (GMT -7)   
Lots of good discussions here, thanks, everyone. One of the factors that have me leaning towards HDRBT is the ease of the procedure as compared to other RT and surgery. My doc said you could play golf the next day. Now that got my attention.

I also believe that this is a matter of risk mitigation. SE risk, treatment risks, and lifestyle risks. We each value certain things in life, which will drive our decision. Thanks again for proving your opinions and input. Denis
65YO healthy man, PSA 5/17 4.6, MPMRI, 5/17 lesion. 13 core biopsy 3 positive 3+3 and 1 positive in a lesion, All cores less than 30% 8/17 - the second opinion Yale pathology shows a small amount of (3+4) in one core, < 5%, decipher test shows intermediate risks, looking at treatment options. Strongly leaning towards HDRBT, meet with Dr, Patel in two weeks. Denis

Works Out
Regular Member


Date Joined Dec 2014
Total Posts : 239
   Posted 12/11/2017 6:38 AM (GMT -7)   
Your thinking is similar to what mine was. I chose HDRBT as my research led me to believe it was essentially as likely to lead to long term success as other treatments and it would have lesser risk of SE's. Things are going well so far.

Good luck.

Subdenis said...
Lots of good discussions here, thanks, everyone. One of the factors that have me leaning towards HDRBT is the ease of the procedure as compared to other RT and surgery. My doc said you could play golf the next day. Now that got my attention.

I also believe that this is a matter of risk mitigation. SE risk, treatment risks, and lifestyle risks. We each value certain things in life, which will drive our decision. Thanks again for proving your opinions and input. Denis

Born 1953 - You Do The Math

-DX Jan 2015

HDR Brachytherapy at UCLA 4/30/15 and 5/7/15

-2 cores positive - 30-40%
-Gleason 7 (3+4)

Post Procedure PSA's

8/15 3.5
11/15 1.9
2/16 2.6
5/16 1.4
8/16 1.0
11/16 0.7
2/17 0.6
5/17 0.4
11/17 0.31

Subdenis
Regular Member


Date Joined Aug 2017
Total Posts : 253
   Posted 12/11/2017 8:13 AM (GMT -7)   
WOrks out glad it is going well for you we are similar age and state of disease. My wife and I finalized the decision today HDRBT. Now move to get er done stage. Denis

dbell
Regular Member


Date Joined Nov 2017
Total Posts : 30
   Posted 12/11/2017 8:47 AM (GMT -7)   
Subdenis said...
WOrks out glad it is going well for you we are similar age and state of disease. My wife and I finalized the decision today HDRBT. Now move to get er done stage. Denis


Certainly where my head is at as well (when we look at treatment). Good luck with your treatment and keep us posted! You have made a good educated decision!
Age 53
DX 11/17
PSA 5.1
G 3+3
1 core of 12 - 35% involvement, confirmed by MSKCC
AS currently - awaiting MRI 1/18
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