Predicting side effects

Hi again, group,

I've finally been scheduled for MRI guided biopsy of that PIRADS 5 area identified previously by MpMRI. It's still a month away, though, and I'd like to use the time productively. I'm planning to stay with AS if path. report still shows exclusively GS 3+3 but move ahead with RP or RT if 4+3 or greater is found.

Can anyone advise me as to studies of the ways pre-procedure bowel and urinary function might be used to predict short and long term side effects of RP or RT? I'm sure there is lots of variability as with all other aspects of this disease but I've had trouble coming up with good search results for research that looks specifically at how one's IPSS (International Prostate Symptom Score) might help predict incontinence after RALP, for instance. Or how a history of past hemorrhoids or polyps might predict bowel side effects following RT.

There must be lots out there. Any suggestions?

Thanks, as always!

Whippoorwill

Whipoorwill, I can share with you what my surgeon told me: That the variables for post-RALP side effects seem to depend on several things, not all of which are controllable or predictable. They are, in no particular order: Pre-surgery status--do you have issues now with either continence or ED? Expect that based on a 10 point scale, where 10 is how you were at 18...you'll go down 1 or 2 points. Second, the extent of the surgery will have an effect. Whether or not lymph nodes are extracted, how close they had to get to the nerves, etc. Add to that the slight variations in anatomy from man to man, you add another variable. Third is the skill and experience of the surgeon. Fourth..well, it's about your general health going in. Everything from blood pressure issues to obesity to how readily you heal.

i've heard similar comments about radiation.

The key point in all of this is to choose the best, most experienced TEAM you can get in with. And then, before your treatment day, eat right, exercise, get in shape, loose a few pounds.

My RO told me, "Yes there will be side effects, but we have potions and lotions to get you through."

Thanks doc,
Andrew

Good stuff. They'll be more. Better than what I got...

Just go with the best you can in whatever it is you decide to do. The rest is a crap shoot. One man's opinion. I also believe you'll be ok.

But there's certainly nothing wrong with studying.

All responses much appreciated! I will try to continue to absorb all this input and move ahead as needed when needed. Thanks!

Special thanks to Tall Allen for those further citations and clarifications! And while I'm at it, one of the things you pointed me toward included your own discussion of why hypofractionated RT may be more effective with PC. Here's just a portion of what you said:

"Radiation applied in fewer treatments (or fractions) — has been found to kill cancer cells more efficiently than normal fractionation (IMRT) or continuous fractionation (LDRBT). Because prostate cancer is especially susceptible to hypofractionation (technically, we say it has a low alpha/beta ratio of about 1.5), and because healthy nearby early-responding tissues are less susceptible (they have a higher alpha/beta ratio of about 10), healthy tissues are better spared by it."

I'm wondering about source(s) for that explanation and don't recall your having provided them at the time. The main radiologist with whom I've been consulting has been generally not supportive of SBRT or other hypofractionated RT approaches in my case on grounds that my prior TURPS, small prostate, etc., make it especially more likely that I would do better with standard fraction RT. Maybe I could share useful references with him?

Again, thanks to all!

Whippoorwill