Radiation not prostatectomy

Happy with Proton radiation as primary treatment.
No incontinence, sexual function was not affected except for dry ejaculate delayed for about a minute or two, then a trickle of seamen. No muss no fuss.
I am 3 years out. No regrets.
Good Luck with your choice.
Regards,
Kris

Brian, I responded on your other thread as to what I think of your current doctor so I will not repeat it here. I will tell you that, if and when you need treatment, you most certainly will have options other than surgery. At that time you should consult with doctors who specialize in LDR Brachy, HDR Brachy and SBRT. All of those are likely to cure you equally as well as surgery. Of course, AS is still a great option prior to that time.

To answer your question specifically, I had LDR Brachy over seven years ago. You can copy and paste my long winded journey from my signature. At this point the only SE I have is reduced ejaculate which has no effect on how sex feels to me. I have zero ED or urinary issues. Early on I had some urgency and frequency that was handled easily with Flomax and was eliminated within a few months.

Overall, the radiation treatments above offer cures equal to surgery. Their main value proposition is generally less onerous side effects. The main value proposition of surgery, IMHO, is the knowledge that you gain from a definitive pathology. That was not as important to me as the chance of fewer side effects but it is important to some folks so you will need to weigh these if and when you need to be treated.

Jim

Five years ago I had a combination of High Dose Rate Brachytherapy (two procedures) and IMRT external beam radiotherapy to and around the prostate and the pelvic lymph nodes (25 fractions). Due to my high risk I also had 36 months of ADT using Casodex, Lupron and Eligard, and Avodart in the form of Jalyn. I quickly had an undetectable PSA due to the ADT.

I had very normal and limited side effects from the radiation. During the IMRT period of about six weeks and for a few weeks after, I had greater frequency of both urinary and bowel, was a little gassy and had looser stools. Never had diarrhea or any other problems. All that went away within a couple of weeks after the IMRT stopped. From the brachytherapy I was sore for a few weeks and was careful not to choose hard chairs to sit. Since then I have had no side effects from the radiation.

I did make some dietary changes notably eliminating carbonated, caffeinated and highly acidic beverages. I drank lots of water, green tea and a nightly glass of red wine. My food cut down on meats and increased salads and other vegetables. I stayed with a fairly high fiber diet and was fine. I increased exercise and experienced no signs of radiation fatigue. Also there was not any burning of the skin.

Overall for me, it was a cake walk. I have had complete cancer control and really no lasting side effects from the radiation. My urinary and bowel functions are absolutely normal. Sexually, most men do find that after radiation they have very little fluid when ejaculating. Of course there is none after prostatectomy.

I am glad to see you considering radiation as it is as good or better than surgery for cancer control and most always leaves less severs side effects. What type(s) are you considering? What are the specifics of your diagnosis?

Brian

I did IMRT/IGRT Varian True Beam 45 sessions. I chose RT due to evidence of spread beyond the gland. As far as after effects I am still on HT so no libido. On the few occasions where I took a holiday I had modest erections after about three months off of the HT. The RT side effects did not last more than two weeks after the end of the sessions. Diarrhea and urinary difficulty. The treatment was relatively easy and I drove myself to each one over the nine week period.

My treatment was not successful in the long run as I had distant mets that were not discovered until years later. The good news is the area of original focus shows no cancer activity so I thing I made the right choice. If you have disease that is still local you have much better chances of success than I did. My prognosis was 20% chance of a cure at the time.

Good luck.

Brian,

I just had the first of two HDR BT implants done yesterday, round two occurs next Wednesday, so I am in the thick of things now so to speak. There are many others here that have had either RP, RALP, or RT of various kinds.

Ultimately I chose HDR BT because my research has indicated that the long term 10-15 year cure rates are nearly equivalent to prostatecomy yet the side effects for incontinence and impotence aren't as prevalent from a statistical perspective. That said, as my RO said, statistics don't really matter. If RT has very low rates of incontinence but you happen to experience it, then those stats don't really matter do they? So, we all play the odds when it comes to decisions like this, at least on some level.

My bet is that even if I have a recurrence twenty years from now, hopefully I'll have more and better options for recurrence treatment than exist today. Of course I'm hopeful that I'm cured for the remainder of my life. I'm also hopeful that my roll of the dice results in comparatively mimimal long term side effects from HDR BT.

I had LDR Brachy and IMRT 7 years ago for a G7 and psa of 40, never had ED and urinary function of frequency and urgency lasted about 8 week. No ejaculation, but I don' see that as a problem. Psa has been < .1 for years.

vaportrail said...
I had low dose brachy inplants and 52 guided ebrt zaps to treat my 4+3 tumor.

The last radiation treatment was 11 months ago.

I declined hormone therapy, and have been able to have sex, but with painful orgasms.

I also have chronic radiation induced cystitis, and proctitis.

They all cause frequent (I'm talking 20-30 per day) urgent, very painful, prolonged trips to the crapper. I take 3 types of laxatives every day, and the doctor recommends enemas, but they make me so nauseated, and ill, I can't do it...


I had several doctors telling me it's too early to have chronic radiation proctitis start again only 8 months after treatment but colonoscopy confirmed it in my case-

Vaportrail's story is a great example of what I was saying about stats. I'm sure when he made the choice to undergo LDR BT followed by EBRT, he was hopeful that he would fall on the side of the stats that included minimal side effects, but in fact, a subset of folks will experience grade 3 or higher rectal or genital radiation induced side effects. If any of us fall into these categories that include major cystitis or proctitis then the numbers just don't matter. We all must understand the roll of the dice and the chances we take with these major life decisions.

Vaportrail, very sorry to hear of your lasting high grade side effects. Here's to hoping that as time moves forward, things will improve for you over the longer term.

brian3222 said...
Surgeons told me with Surgery you get the sexual effects up front that tend to get better over time.
With RT, side effects are less up front but get WORSE as time progresses--the RT kills of the nerves.

The data arguably says that the sexual SEs of radiation are less than surgery, although keep in mind that everyone's experience is different. There are surgery guys with no SEs and radiation guys with some. But overall, most would say that radiation gives you a better chance re ED.

But the key noun in your quote is "surgeons" told me. Have you consulted with any ROs yet? And by that, I mean ROs that are tops in their field with an expertise in brachy or SBRT? If not, you're really not getting the full story.

I still hope you don't need radical treatment. (Pending additional data as per your other thread.) But to the extent that sexual SEs are important to you (and frankly, they're important to pretty much all of us), I'd urge to start learning more about different radiation regimens and weigh that against the pros and cons of surgery. There are no free lunches once you have any type of treatment--surgery or radiation--but then you can weigh the SEs that are most important to you.

PS I don't believe that RT "kills off" the nerves. Again, RT is not a free lunch, but if it kills off the nerves there are lots of guys here that are still waiting for that to happen.

Brian, I'm going to add my voice to those who are suggesting that based on your biopsy results, you're a great candidate for AS and if you're not seriously looking into it, you need to do that. I don't recall if earlier you've told us where you are and where you're getting your information. I agree with forming a team of all the specialties and keep talking till you find a doctor who will listen to you.