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Posted 6/17/2017 10:43 AM (GMT 0)
I was given a prescription for a generic Viagra 40mg after my RP. At my check up last week my urologist asked how I was doing in that dept I told him the truth that I was not able to get an erection but that wasn't really the end of the world, at this point of time with my psa coming back at 0.13 3 months after surgery I think I need to consider all the options of treatment that are available one of course being ADT, now this is the part I don't understand. If they suggest getting rid of your testosterone because it speeds up PC why do so many of the urologists promote Viagra, pumps and etc? If your testicles continue to produce sperm that the body has to absorb if you don't have any seminal vessels like me wouldn't this continue to promote testosterone?
Posted 6/17/2017 12:23 PM (GMT 0)
SkyPilot:

You've asked a simple question with a complicated answer. A complete answer would fill a small book but I'll try to hit a few of the high points.

The first thing is that the two functions of the testes -- producing sperm and releasing testosterone -- are largely unrelated. Almost all of the testosterone is released into the bloodstream. There is testosterone in semen, it is true, but it is a tiny percentage of the total production. The sperm are released first into the epididymis where they mature and then through the vas deferens into the seminal vesicles. The vast majority of the testosterone produced is released directly into the blood via the blood vessels that run through the testes. The amount of testosterone that is released with semen, or the amount that might enter the blood stream from reabsorbing unused sperm, is tiny compared to what is released directly into the blood.

Second, I guess, is that both of these processes go one pretty much constantly whether a man is sexually active or not. While having lots of testosterone might cause a man to be more sexually active, having lots of sex won't raise a man's testosterone, and abstaining from sex won't lower it. So a urologist who gives his prostate cancer patients pills or recommends a pump is trying to help them regain as much of their normal function as possible, knowing that it won't affect their testosterone levels one way or the other.

The third thing is that the amount of testosterone seems to make a difference only at tiny little levels. There is a big difference between no testosterone and an itsy bit of it. Then there is some difference between that itsy bit and just a tad more. But the effect of each additional increment is less and less until, by the time you get anywhere close to normal levels adding more doesn't seem to make much difference. Its a bit like having a condition where you need to keep your toes dry. Stepping onto the wet concrete beside the pool does most of the damage. Stepping into the pool does the rest. But the kiddie pool is just as bad as swimming in the ocean.
Posted 6/17/2017 1:32 PM (GMT 0)
Pete that's something I didn't realize. Thanks
Posted 6/17/2017 2:22 PM (GMT 0)
My reading of your situation is that you will probably want to do salvage radiation to try again for a cure. Because of your high risk category your doctors will probably suggest a temporary period of ADT along with the radiation, or at least that's what they recommended to me a couple of years ago when I had mine. So you are probably going to be an out-of-the-pool-keep-those-toes-dry kind of guy for the next year or two.
Posted 6/17/2017 4:20 PM (GMT 0)
From the reading of quite a few reports and studies that have been done I'm kinda thinking along the same lines. How bad does the radiation and adt knock you down? Do you think I would be able to work during this time? I am a trainer of heavy equipment and do safety work so have to work safely. My father also had PC but it was the liver cancer that finally took his life but know from what I have learned wonder if it wasn't PC that ended up in his liver not sure if PC goes into the liver?
Posted 6/17/2017 10:02 PM (GMT 0)
I can't say anything about the impact of ADT on your ability to work, but if you are thinking of any of the external beam radiation therapies (IMRT, IGRT, Tomotherapy, SBRT, etc.), I really doubt that it would have much impact, if any, on your ability to work. I had SBRT (5 high-intensity treatments over a 2 week period), and I worked through the whole bit, including daily workouts at the gym.

I have no experience with ADT, but others can tell you their experience with it.
Posted 6/17/2017 10:17 PM (GMT 0)
Given your high PSA (>.10 post-RP) and SVI you're probably looking at ADT and SRT. My RO has cited studies that RT is more effective if combined with HT, and started me on Lupron earlier this year. There are numerous side effects of HT but you may not be hit by all of them. I never put on weight or grew man boobs, but the hot flashes, mental fog and mood swings have been brutal.

I'm sure if you are opposed to HT your RO will allow you to skip that. Not all are proponents of the combined regimen. I have read other guys say that toward the end of their SRT thay began to feel fatigued. I can't say just yet. If all goes well, I hope to start SRT in two months, after my AUS is activated. In the meantime, more Lupron.

Realize that your G9 and T3B w/SVI puts you in a very high risk category. Typically ART or SRT are recommended as soon as continence is regained. You do not want that PSA to go any higher. Good luck!
Posted 6/17/2017 11:06 PM (GMT 0)
Radiation will make you tired but ADT messes with your head, hot flashes, tiredness due to depressed T. ADT was by far the worst of my treatments. Your experience might be completely different from mine though.
Posted 6/18/2017 5:51 AM (GMT 0)
Surgery and radiation and androgen deprivation -- I call this combo the three-scoop sh:t sandwich and the ADT is easily the most flavorful ingredient. But the good news is that the radiation part is usually not that bad. I worked through my radiation and didn't miss a day of work. I did get fatigued during the last few weeks of the radiation and for about six weeks after it was done. That's very common; you can pretty much expect that the radiation will make you fatigued. It was a funny sort of fatigue. It didn't slow me down that much while I was doing stuff but if I sat down to relax I would fall asleep. My wife would take notes on whodunit TV shows so she could tell me who the guilty party was when I woke up during the end credits. Exercise helps with the fatigue. Caffeine only helps a little bit but I pretended it worked better that it does so the wife would let me spend more on coffee. The other common side effect is hemorrhoid flareups. But, since it is a common problem, your RO will know what to do about them. Just tell him and he will hook you up with some cortisone suppositories that will make a new man of you.

As for the ADT, it may slow you down but it won't stop you.

It's not at all unreasonable to expect to work through your SRT and ADT.
Posted 6/18/2017 12:49 PM (GMT 0)

PeterDisAbelard. said...
Surgery and radiation and androgen deprivation -- I call this combo the three-scoop sh:t sandwich and the ADT is easily the most flavorful ingredient. ....

That's a great description!
Posted 6/19/2017 10:17 PM (GMT 0)
Skypilot56,

With GS9, positive margins and detectable PSA shortly after surgery you best option is ADT immediately, and salvage radiation. A year and a half ago I underwent salvage radiation and it was a non-event for me. No discernible side effects during or after being nuked. I didn't change my habits or diet and stopped of at the radiation center Monday thru Friday on my way home from work for 2 months (39 @ 1.8 grays =70.2 grays).

By the way what do you fly. I had a PA28-180 until it became a submarine during a hurricane.
Posted 6/20/2017 4:39 PM (GMT 0)
Right now im flying 7ac champ i just picked up last week got my taylorcraft for sale.
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