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Cancer: Prostate Message Board

Cancer: Prostate Board Index

Re: Side effects
Feb 5, 2019
Hi Dan and welcome to the Board!

It looks like you are doing very well with side effects after surgery, as some men do. That said, did they give you a program for “penile rehabilitation”? Even though you are doing well, that might be wise. Also, it is important that they use ultrasensitive PSA testing to monitor the effectiveness of the surgery; the test should be sensitive to less than 0.01 units of PSA. This is really important!

You may have good results with surgery, which does indeed cure many men with advanced (“high-risk”) cases like yours. I personally favor radiation for such cases, but a lot of men do choose surgery, so you are not alone.

Regarding your questions, you are also not alone in being misinformed about radiation by a urologist. He or she probably thought what they were saying was true, and at one time many years ago it was (and still is in places that practice out-of-date radiation). However, there has been tremendous progress in radiation for prostate cancer. It is now outstanding at curing or knocking back the cancer, especially in advanced cases, and the facts on side effects give radiation oncologists a solid basis for claiming their radiation treatment results in a lower short AND long-term burden than surgery. The simple fact is that doctors treating prostate cancer tend to be biased toward the treatments in which they trained and which they practice to earn their living. Also, really important, they tend not to keep up with advances outside of their own field: surgeons know surgery; radiation oncologists know radiation; and medical oncologists know drugs as well as have familiarity with the pros and cons of both surgery and radiation.

It is very well established that, once you get past actual radiation treatment and shortly after, when bothersome urinary and bowel side effects are typical, side effects are infrequent for radiation for years though in a very low percentage of cases they can appear later, such as around the 4 year point, roughly, or even later. The baloney part of what your surgeon led you to believe is that these side effects, though late (as all agree), are common. They are not. While there is a whole medical industry that deals with side effects of surgery because they are common, especially urinary and erectile function difficulties, you just don’t see that large scale of activity for radiation because the side effect burden is much lower (though not non-existent).

That is especially true with incontinence, which tends to bother most surgery patients to some degree, though often very mild and treatable so that the result is normal or near normal. With radiation, provided it is well done, urinary incontinence is usually not an issue at all, though brachytherapy (seeds) does have a somewhat higher rate than external beam radiation. This is well established by research, but many surgeons are not aware of advances in radiation over the past two decades, and they are not aware of how low the typical radiation side effect burden is following modern, image guided radiation. I doubt your surgeon deliberately mislead you; he well may have been a great surgeon – just not at all up to speed on radiation.

Radiation does tend to affect bowel continence, such as urgency, somewhat, depending mainly on the dose of radiation to the rectum, which is not desired but often unavoidable. At six years post treatment, I have never had an “accident,” but I experience urgency twice daily at predictable times. Some radiation treatments minimize the rectal dose, such as proton therapy. In the past several years, a rectal spacer, SPACEOAR, can be inserted prior to radiation; this puts space between the rectum and desired target so that the rectum gets little if any radiation.

There is a lot of research backing up the incidence of side effects with various therapies. Try looking at and linking to the free copy of the complete paper, especially Figure 5, which shows a bothersome (Grade 3 – requiring some kind of medication/treatment but not hospitalization) late side effect percentage of 5% or lower for most kinds of radiation, based on the average result found in each of the studies displayed in the graph. That means that 95 out of a hundred patients are likely to have no problems or only mild inconvenience with radiation side effects.

Regarding needing a condom for sex, that may be true for seeds for a time, but it is not at all true for any kind of external beam radiation. If your doctor failed to mention that, he was clearly giving you a highly biased sales pitch and trying to push you toward surgery.

I’m glad you are doing so well.

Good luck! :wave:

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