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Posted 9/20/2011 8:40 PM (GMT 0)
Jeez, who knew???

http://tinyurl.com/3mgrhoe

 

Posted 9/20/2011 9:00 PM (GMT 0)
The results pretty much matches what most of us in this forum already knew. The research could have been done with our membership for the same results. The finding that after 2 years men with surgery, Brachy or HT for PC have less than 45% chance of having normal erections. This sure does refute what certain Davinci Internet advertising docs report and claim to achieve for ED after surgery. I think too many of us have unrealistic expectations for ED after treatment. This leads to depression and low self esteem when ED doesn't improve all because our docs make exaggerated pretreatment claims.

Thank you jazzman for sharing this with us.

TWG

Posted 9/20/2011 11:28 PM (GMT 0)
In case any of you guys don't want to click the tinyurl, here it is:

http://well.blogs.nytimes.com/2011/09/20/predicting-sexual-recovery-after-prostate-cancer/?hp

"The findings, based on a study of more than 1,000 men treated for prostate cancer at multiple medical centers, show that whether a man is able to achieve adequate erections after treatment for prostate cancer varies greatly depending on a number of individual variables, including his age, the extent of his cancer and the quality of his sex life before treatment.

Over all, fewer than half of the men who reported good sexual function before cancer had managed to regain it two years after treatment. But the chances of sexual recovery varied widely. After two years, some men had less than a 10 percent chance of achieving adequate erections after treatment, whereas others had a 70 percent or greater chance of a relatively normal sex life."

Jeff
Posted 9/21/2011 12:45 AM (GMT 0)
In a follow-up study, they'll discover that prostatectomies cause incontinence. turn
Posted 9/21/2011 12:48 AM (GMT 0)
Maybe if they study it further they will also discover that your prostate is gone after surgery!
Posted 9/21/2011 11:07 AM (GMT 0)
Dr. Spamadi now he's the best
He gets the cancer where it rests
You'll be cured and feelin' fine
Back in the sack and making time
Little Willie feelin real woody
No E.D., you wonder, how he couldy
Remove the gland and make you 'the man'
Does 5 a day and makes $100,000 gran'
Now give a referral and that's his plan
What a doc and what a man
See his videos and on t.v.
This is the doc for you and me!!!

(Word-LOL) (-;}
Posted 9/21/2011 11:11 AM (GMT 0)
This would be a good discussion topic for GFMPH this week and we can even take the following poll to aid the research:

  1. Did your PC surgery result in any ED?
  2. Did your PC Surgery effect your continence?
  3. Was your prostate gone after surgery?

We could maybe sell our results to help pay for the next GFMPH tongue

 

Terry TWG

Posted 9/21/2011 12:35 PM (GMT 0)
 

Thank you Zufus, I am still laughing, keep the poetry coming.

Terry

Posted 9/21/2011 1:15 PM (GMT 0)
Zufus, you 'da man!  Maybe the boys at the GFMPH Meeting will perform this as a rap video (after a few beers of course) and upload to YouTube for all of us to enjoy.

Tudpock (Jim)

Posted 9/21/2011 2:52 PM (GMT 0)
Hilarious, zufus...although knowing everything that I know now ( and I’m going to go ahead and say that this is likely more than the average PC patient ), "Dr Spamadi" would be on my short list of surgeons I would go to in a heartbeat for the best possible outcomes in my diagnosis of localized PC seeking nerve-sparing surgery.   He is innovative in continuously improving his techniques, and I give him a lot of credit for that.   I'm not at all keen on his self-promotion, and I'd still bet $10 that he "seeds" certain of patients (perhaps in exchange for some sort of perceived “discount” or other benefit) for going out into the world and promoting him...but I place skills and outcomes much higher than the peripheral stuff.   Great rhyme on the peripheral stuff, though...
Posted 9/21/2011 3:07 PM (GMT 0)
There once was a Doc named Samadi
For prostates he has a re-me-dy
His skill is so great
You don't have to wait
The next day you have a big woody

(OK, rhyming on Samadi is pretty tough).

Submitted with some apology, because I agree with Casey that the guy is probably one of the best at what he does.  Maybe if I'd used him the ED problem would have resolved itself by now.  Who can say?

Posted 9/21/2011 3:16 PM (GMT 0)
It should also be noted that having "nerve-sparing" surgery doesn't seem to make much difference in the ED stats....
Posted 9/21/2011 3:44 PM (GMT 0)

Fairwind said...
It should also be noted that having "nerve-sparing" surgery doesn't seem to make much difference in the ED stats....

Uh....  Unless you are trying to make some obscure point which I totally missed, this reads to me like complete mis-information.  The population of men who have non-nerve sparing surgery are going to have a much greater challenge with ED than the population of men who have nerve sparing surgery.  Perhaps, Fairwind, you could clarify on whether there is some other point you are trying to make...?

From the referenced article:  "However, the researchers were able to determine which variables are most important for predicting a man’s erectile function after treatment.  ...  Among surgical patients, a man’s age and his P.S.A. score, which measures prostate specific antigen, and whether he had nerve-sparing surgery also helped predict his chances of resuming a normal sex life."

Posted 9/21/2011 4:42 PM (GMT 0)
Nerve sparing surgery is the best breakthrough in prostate cancer surgery whether the patient chooses RRP or RALP. It's not 100% going to keep a man potent, but nearly 75% in the general population will be potent, whether with VED5 drugs or without, when they have nerve sparing surgery. Some docs are better than others as well. I do believe that some docs can be in the 90% and some can be in the 60% success rates...

In my case, after I completed my years on HT, my potency returned to pre-surgery levels. There is little chance that this would be the case had my doc not spared my nerves...


Tony
Posted 9/22/2011 1:15 AM (GMT 0)
I dunno, Tony. Maybe you're right, but I think these stats are grossly exaggerated by the docs.

In any case, we'll never really know. It's all self reporting by the docs with no oversight. They can say their surgical techniques increase virility, make men taller and re-grow hair. Who's to dispute it?
Posted 9/22/2011 1:19 AM (GMT 0)

Fairwind said...
It should also be noted that having "nerve-sparing" surgery doesn't seem to make much difference in the ED stats....

Actually, Fairwind's comment is pretty accurate. If you slog through the details in the full article, it says that among men who had a prostatectomy, those with nerve-sparing surgery had a 37% likelihood of functional erections 2 years post-surgery, compared with 13% of those who had non-nerve sparing surgery. So yes, nerve sparing surgery is better, but the results are still pretty poor.

Full text of the article is here: http://jama.ama-assn.org/content/306/11/1205.full .

The table with all the stats is here: http://jama.ama-assn.org/content/suppl/2011/09/14/306.11.1205.DC1/JWE15120_09_21_2011.pdf .
Posted 9/22/2011 1:07 PM (GMT 0)
j53, your point is well taken. However, while the 3x improvement you point out is substantial, it really understates the unparalleled breakthrough impact of nerve-sparing prostatectomies.

What this table of data fails to do is to further isolate the critical variables. Numerous studies which have isolated only men with good erectile function before surgery have found that the return of functionality is in the 60-90% range. That range is found across multiple surgeons/institutions, with individual surgeons performing consistently in the higher or lower range depending on skill and experience.

The study results currently under discussion here includes men in a full range of erectile functionality. It would be a gross misrepresentation for any man to think that his functionality would improve after RP—it won’t, it will only be the same or worse.

So, in a likely scenario, if the data from this same study (with men median age 60) further isolated variables down to men with or without good erectile function before surgery instead of the entire population of men, those with functional erections 2-years after non-nerve sparing RP might not change much from 13%, possibly up as high as 20% (not much change), but those with nerve sparing RP would likely change from 37% to 60-90% (significant change and more significant delta from non-nerve sparing results).

j53, I don’t disagree with your comment, but when taken in isolation it doesn’t convey the completely relevant picture. Men with poor erectile function before surgery won’t have better erectile function after surgery…and that needs to also be taken into consideration when discussing the numbers. Nerve sparing surgery for those with localized PC, initially developed in 1982 by Dr Patrick Walsh and refined & improved many times by other refined techniques, was nothing short of a "miracle" breakthrough for men.
Posted 9/22/2011 5:44 PM (GMT 0)
Casey, we are in violent agreement. I agree that the nerve sparing RRP surgery pioneered by Dr. Walsh is a huge improvement over the methods used before (as someone who had the surgery myself, I'm very grateful to have those nerves spared!), and of course RRP is not going to actually improve anyone's sexual functioning as far as I can tell. My point, I guess, is that even with the nerves being spared, there's still a degradation of sexual function in most men, across all age groups and pre-op levels of sexual health.

Here's a chart from the research report. There are lots of lines here, but just for simplicity, let's take the case of someone age 60 who had PSA <= 10, a pre-treatment sexual function score of 80 (that is, pretty good but not perfect) and underwent nerve-sparing RRP. According to the chart, he's only got a 37% chance of having full erection recovery after 2 years.

If his pre-treatment sexual function score was 100 (that is, he was a stud muffin), he's got about a 55% chance of full erection recovery after 2 years.

Both are 2x to 3x as good as the non-nerve sparing surgery, but still show serious softening of the wood. Maybe it's an inevitable result of any surgery that removes a part of the male sexual system, I just wish the surgeons had been more forthcoming about this information beforehand.
Posted 9/22/2011 8:05 PM (GMT 0)
Despite the fact that this study was not intended to look at comparisons between treatments, I tend to look for that...especially given that I have an avowed bias toward brachytherapy.  And, as JT and others have pointed out, we tend to look for data that reconfirms our preconceived biases.  So with that full disclosure, I will submit the following comments derived primarily by delving into the "e-tables" with raw data that accompanies the study.  (And, yes, I obviously have too much time on my hands today!).

Anyway, if you look at the raw data some interesting comparisons come out.  First of all, the average age of the brachytherapy patients compared to surgical patients is higher (66 vs. 60).   Regardless of this, the brachytherapy patients who responded that they had post-treatment erections "firm enough for intercourse" was still higher than for post-surgical treatment (43% vs. 35%).  However the DROPOFF comparison was significantly more in surgical patients than even those numbers would suggest.  83% of the surgical patients started with erections firm enough for intercourse and that dropped to 35% after treatment.  Only 67% of the brachytherapy patients had erections "firm enough for intercourse" pre-treatment which dropped to 43% post-treatment.

Now admittedly there could be issues with sample size and some could argue that if this was done at 3 years rather than 2 then the surgical percentages would be better and the brachy percentages would be worse.  Nevertheless, the numbers as presented are consistent with other studies that indicate considerably better post-treatment quality of life with brachytherapy than with surgery.  The New England Journal of Medicine QOL study of a couple of years back is probably the most recent and broad study with the same conclusions.

Tudpock (Jim)

 

Posted 9/22/2011 9:13 PM (GMT 0)
As a continuation of the discussion of this article on the New Prostate Cancer Infolink this was posted:

article in the Washington Post gives examples of the ability of the models to project individual patient outcomes, as follows:

•For a 50-year-old man with good sexual function before treatment who has a radical prostatectomy, the probability of having good sexual function 2 years post-surgery ranges from 21 to 70 percent depending on his pre-treatment PSA level and whether a nerve-sparing technique was used.
•For men of any age with good sexual function before treatment who have external beam radiation therapy, the probability of having food sexual function 2 years post-radiation ranges from 53 to 92 percent depending on pre-treatment PSA level and whether hormones were used along with radiation.
•For a 60-year-old men with good sexual function before treatment who has permanent radioactive seed implants (brachytherapy), the probability of having good sexual function 2 years post-surgery ranges from 58 to 98 percent depending on race and body mass index. Apparently African-Americans and slimmer patients had better chances of retaining higher levels of sexual function.
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