RP or Brachytherapy and ED

User

Posted 30 Jul 2019 at 12:42

I am 59 and have been diagnosed with prostate cancer albeit at early non life threatening stage. I have had the input and advice of 2 friends who have had this cancer and received a lot of information from them as well as the medical professional; my urologist, consultant urologist and oncologist specialising in this cancer. One of my friends made me aware of the on line support forums on this amazing website many of which I have read and found informative.

“Diagnosis: New diagnosis, intermediate risk prostate cancer

Current PSA: 6.8

Prostate biopsies: 2016, benign

MRI: April 2016, possible T2a N0 M0 (discussed at MDT

Low risk of suspicion)

Prostate volume: 20cc

Repeat MRI: March 2019, no significant lesion

Template biopsy: June 2019, Gleason 3+4=7 in 9 of 39 cores (15% pattern 4 max) Gleason 3+3=6 in 2 of 39 cores

Treatment options: All options for radical treatment”

I have discussed my pathology and MRI scans and options including radical surgery, Brachytherapy or radiotherapy with consultant urologists and specialist prostate cancer oncologist. The pros and cons of each have been explained including that oncologically, surgery probably offers me the best long term outcome but the compromise is ED.

I have decided not to go for active surveillance but rather to consider treatment options which in my case as a generally fit, healthy 80kg man have been narrowed down to surgery or Brachytherapy. I have no idea which to go for given both will deal with the cancer and appreciate that this will come down to a personal preference. I am more reluctant to go with surgery and so currently looking at Brachytherapy.

In both cases the ED is highlighted as an outcome and it on this topic that I am seeking very specific input, experience and advice. I would also appreciate receiving this from men of similar age who have undergone one or other treatment rather than just the medical professionals. I appreciate this is not something that many will feel comfortable talking about in an open forum and as I would like to ask some detailed specific questions on this topic i suspect a private conversation would be appropriate.

I am climbing Kili at the end of August and Prostate Cancer will be the charity for whom I will be raising funds.

Edited by moderator 30 Jul 2019 at 12:46 | Reason: Not specified

User

Posted 30 Jul 2019 at 14:12

There isn't anything about sex or side effects that can't be discussed openly on this forum and there are lots of existing threads with lots of detail.

You could read 'erecting the erection' and 'one wife's story of ED' for a no holds barred description of life after treatment.

The main issue will be whether or not you will be having hormone treatment with the brachy and, if so, how long for.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 30 Jul 2019 at 14:24

If sex is as important to you as I assume from your note, I would advocate active surveillance for as long as your medics think you can get away with it.

I have a friend in his seventies who has been on AS for over five years, with G3+4=7, albeit with the most intensive monitoring.

If you opt for surgery, you may end up free of cancer, but also short in penis length and function. The missing inches are referred to in medical parlance as ‘change in physical appearance’.

Best of luck whatever you choose.

Cheers, John.

User

Posted 31 Jul 2019 at 22:24

Thank you both for your replies.

As suggested I have now read many other conversations and threads.

I have to confess to not having heard of ‘change in physical appearance’; is this common in most cases and/or does it depend on which treatment one chooses?

User

Posted 31 Jul 2019 at 23:00

If you choose prostatectomy, your penis is likely to shorten by approximately the length of your prostate. That's because they cut the urethra at the top & bottom of the prostate to remove it and then join the two cut ends of the urethra back together.

If you have ED for a sustained period of time and do not use a pump or similar to maintain the health of the corpora cavernosa you will lose length and girth - if googling this, its proper name is penile atrophy aka 'use it or lose it'.

If you are on HT your penis and testicles will usually reduce in size due to loss of testosterone. You are likely to lose your libido which for many men means few or no erections - see penile atrophy above.

External beam radiotherapy & brachytherapy can (but doesn't always) lead to ED some years later - see penile atrophy above.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 01 Aug 2019 at 08:50

Hi I had a choice of robotic surgery or Brachytherapy in September 2016 and went for Brachytherapy.I had PSA 2.19 Gleason 3+4 =7 and 5 cores out of 20 positive.

I was 70 with no real problems as blood test was taken for HGV licence and blood in urine was picked up, click on my avatar for full details.I am getting on well with no great side affects, Ed helped with little blue pill and normal erections stating to return.

Good luck John.

User

Posted 01 Aug 2019 at 16:44

I was diagnosed with G3+4 PCa last year, aged 56. I went down the HT+RT route (RT in Feb/Mar this year) and have no regrets about doing so. RT was always my preference, and in my case was the treatment recommended by both my urologist and oncologist.

Happy to answer any questions you might have.

Cheers,

Chris

User

Posted 01 Aug 2019 at 21:13

Originally Posted by: Online Community Member

Testicles will shrink on HT, but that probably doesn't matter much. It's reported here they usually recover to some degree afterwards.

Shrinkage of penis on HT is avoidable. You need to have regular erections, using a vacuum pump if you can't get one naturally due to loss of libido. (You don't need to orgasm, and with reduced libido, that's more difficult.)

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