Cancer S**ks and Prostate cancer really ****ks!

I thought this RT side-effects study was particularly insightful. It took a different perspective than other studies have.

After first demonstrating that the short-term adverse QoL impacts (both urinary and bowel) following RT do often recover for many men (but not completely recover to before-treatment levels, even in the highest quartile of recovery patients), the study then looked in more detail at the subset of men who weren’t on the lucky end. They drew an imaginary line at the bottom 10% of all RT participants and said: lets track the results of this sub-group over the long-haul (adverse long-term QoL).

The results were not really a surprise, given the prior hypothesis on late-term side effects. Not only did those men not get better in either urinary or bowel scores, they continued to get worse as time continued to go onward. Their worst score, in fact, was their last score.

So know that late-term RT side effects don’t effect everyone with RT, only an unlucky subset. But make note of another well-known saying (in addition to "never trust a fart") amongst RT veterans, “radiation therapy is the gift that keeps on giving.”

Here's the thing about SE's. The way I look at it, whether you go radiation or surgery, you're messing around with a very tightly packed, very fragile part of your anatomy, and it's hardly surprising that SE's happen. It's surprising, honestly, that they aren't worse and more common.

Denis, One side effect that is highly likely with either surgery or external beam radiation therapy is ED. One of Allen's blog posts shows that men subjected to EBRT do comparatively better, but most men suffer loss of erectile function. It is the most likely side effect to change your life after primary treatment so you might want to pay attention to how each of your prospective treating physicians relates to it. I think the likelihood of a poor outcome is soft pedaled by surgeons and radiation oncologists alike. I don't know whether any major prostate cancer treatment centers besides Memorial Sloane Kettering has a serious program to deal with sexual issues in the aftermath of treatment. At most places, you're pretty much on your own figuring out what's left of your sexual function and how best to cope with it. Not one of the doctors or nurses treating me for PCa has ever asked me about my sexual function -- before or after treatment. If sex is important to you, you might want to give this issue more emphasis than (what I believe to be) the remote risk of fetal incontinence. Welcome to the world of odds-based medicine!

LOL

Once again, people say all sorts of things - but what do the data actually show? Everyone is entitled to their own opinions, but no one is entitled to make up facts.

142- First- let me reiterate that we are talking about primary therapy and not salvage therapy like you had. if you have "alternative facts," show them and lets's look at them together. Alternatively, look at the evidence I just linked here - does anything in them change your mind? Moreover, can any info change your mind, and what would that info look like? Holding tightly to myths serves no one well. Let's try to expunge irrational beliefs.

Tomson- one of the myths is that erectile function is the same no matter what treatment. That's truthy. The reason is because men getting radiation on the average 10 years older than men getting surgery. But when you compare the maintenance of erectile function within each age category, radiation is far better than surgery. There is a chart from the Sanda study that breaks it down, and of course ProtecT shows the same thing (see myth #3 in the ProtecT article) because men were randomized.

I chose SBRT or HDR brachy because the maintenance of erectile function was so much better with those therapies. BTW- a group in Vancouver did an excellent analysis showing that half of the loss of erectile function after BT was due to aging. In fact, all of the erectile function loss due to treatment occurred within 9 months of treatment:

/pcnrv.blogspot.com/2016/08/half-of-long-term-erectile-function-ef.html

island time - again, the reason they "equalize" is because radiation patients are ten years older (median age is 70 in most studies). Saying that erectile function of a 75 yo post-RT is equal to a 65yo post-RP is really very much in favor of RT, don't you think?

Denis, I was not the mod who made the comment but we talk behind the scenes. I can assure you that his comment had nothing to do with you...you're doing fine!

Jim

Tall Allen said...

Let's try to expunge irrational beliefs.

I'm taken aback at the intolerance embedded in these words.

That's quite insulting to the men who have shared their personal experiences--very personal, indeed--which happen to be different than yours.

Island time said...

When asked if he'd treat me with SBRT..he said "yes."

Nice of him.



I'm going to wrap up my contribution to this thread by pointing out what we already know, before this thread heads south. Don't think in extremes or hyperbole (exaggeration). There are so many PC treatment side effects, and they are all non-trivial. Don't trivialize them. Don't deny that they exist. It's the severity of SE impact that varies widely, and to a to a large extent randomly.

Congratulations if you drew the random long stick on side effects; so sorry if you drew the short stick. There are men with unfavorable risk cases who must plow forward through them...often multiple modes/multiple non-trivial side effects. But if you are a new favorable risk PC, make sure your newcomer eyes are wide open beyond what your doctor tells you about. The HW/PC vets here want you to know that doctors frequently understate the frequency and severity. The strong consensus amongst the medical PC care community thought leaders is that immediate treatment is not your best choice. Carry on.

Post Edited (NKinney) : 10/10/2017 10:17:21 AM (GMT-6)

NKinney said...
That's quite insulting to the men who have shared their personal experiences--very personal, indeed--which happen to be different than yours.

I see you removed your post where you disparaged a member for providing his personal anecdotes.Insulting indeed! I, on the other hand, uphold the qualitative value of such anecdotes. But there is a quantitative difference between anecdotes and real medical evidence. Real medical evidence doesn't insult anyone. And there are consensual rules of evidence for evaluating them. If it challenges our cherished beliefs, then we are forced to let go of them (as I have had to do several times). If you feel insulted by medical evidence, just stick your head in the sand - no one will stop you - but I will not let the spreading of alternative facts go unchallenged.

This thread has run its course.

As each of you are reading this, please go back and re-read the rules.