Regardless of whether (a) the nerves were spared during surgery or whether (b) the most precise dose planning was used during radiation therapy, erectile dysfunction remains the most common side effect after treatment. This is because the nerves and blood vessels that control the physical aspect of an erection are incredibly delicate, and any trauma to the area can result in changes. However, even if you do experience some side effects of treatment, there is also room for optimism: many excellent options for managing erectile function exist on the market today.
However, within one year after treatment, most men with intact nerves will see a substantial improvement. The skill of your surgeon can have a significant impact on this outcome (the surgery learning-curve previously discussed), so it’s important to select your team carefully. Likewise, men with baseline erectile dysfunction and/or other diseases or disorders that impair their ability to maintain an erection, such as diabetes or vascular problems, will have a more difficult time returning to pre-treatment function. It’s important to remember that your functionality after treatment can only be as good as it was before treatment. The best predictor of how you will be after treatment is how healthy you were going into treatment.
Prostatectomy: Since the 1980s, most men are treated with what is termed a “nerve-sparing” prostatectomy...but as this seems to be outside of your indicated choices, no more discussion on this.
Radiation therapy: Similar to surgery, damage to blood vessels and nerves after radiation therapy can result in decreased erectile function over time. In general, radiation therapy has less of an impact on erectile function in the first 5 to 10 years after treatment compared with surgery, and approximately 70% of men who have baseline erectile function before treatment will keep erectile function after treatment. However, radiation therapy has a slower delay in erectile function decline than surgery; 15 years after treatment, the rates are similar to those who underwent surgery
. This is what's known as "late-term" side effects (or long-term effect); one of them. Many of the quality-of-life studies tend to focus on the results in the first 2 years (typical), so they don't generally take late-term effects into account. The late-term effects of RT are, of course, the key reason that many doctors recommend radiation therapy more frequently for "older" PC patients. 15-years later, it might not matter so much if you've got a drippy butt, or ED, etc. As I mentioned, this was my concern when I was diagnosed...but I was treated at age 50 (that was a key difference-maker). I didn't want a yet-to-be-born grandchild sitting on my lap saying, "What's that smell, grandpa?" As I said, though, if I was 10- or 15-years or more older at the time, radiation would have probably been my choice, too.
BTW, for this reply I've referenced material published by the Prostate Cancer Foundation (PCF) here
. Many of us here are donors to PCF, and have used/reused much of their material. They also publish some excellent info on PC and lifestyle/nutrition, largely from the UCSF medical research center, one of the top PC institutions. added later as an edit:
I'm sorry that I forgot to also say this earlier, but I would 100% agree with Tudpock's recommendation to have a 2nd opinion reading of your biopsy slides by Dr Epstein...especially with only one core positive at 4+3. The common issue is that hospital pathology departments read a lung cancer slide, then a prostate cancer slide, then a breast cancer slide. Cancer looks different in all of them. Epstein specializes in prostate cancer pathology...and he literally wrote the book(s), and his readings are generally considered "golden." He re-grades about
50% of cases...half up, and half down. Read the "Newly diagnosed..." sticky thread at the top of this page...it's Step #1. If you were to be re-graded at 3+3 (or possibly 3+4), for example, your best choice by far would be to do nothing. https://pathology.jhu.edu/department/services/secondopinion.cfm#
Post Edited (Blackjack) : 8/6/2019 12:27:05 PM (GMT-6)