Chances of impotence post radiation-real world experiences

[LeastGreif]

I’m 48 and was diagnosed last year with advanced metastatic prostate cancer, affecting my lymph nodes, pelvic bones, and ribs. I finished chemo with Docetaxel in December. Given my age, I’m aiming for an aggressive treatment approach and am currently exploring radiation to the prostate and pelvic bones. One of my main concerns is the risk of impotence. For those of you who’ve had prostate radiation—have any of you been able to regain erectile function in the years following treatment? I’d really appreciate hearing your experiences and advice!

[TylexGP]

I used Tri-mix While on ADT post RT. After coming off ADT and some Testosterone recovery, generic viagra has work for me.

[LeastGreif in reply to TylexGP]

Thank you, how often can you use trimex? Any side effects?

[TylexGP in reply to LeastGreif]

You can use Tri-mix basically 3x’s per week. Make sure to alternate sides and sight of injections and clean techniques for injections. You can develop scar tissue from the injections but to date that has not been an issue for me.

[Mike1971]

Hi LeastGreif,

I did External Beam Radiation treatment on prostate (72,5 Gy) and lymph nodes (52,2 Gy) in 2022. I’m currently on Nubeqa and my erectile function is fine.

[LeastGreif in reply to Mike1971]

That is encouraging, congrats! Thank you.

[Tall_Allen]

Loss of potency is rarely an issue for men getting primary prostate. I never lost full erectile function, and my experience is typical. Age and baseline impotence are risk factors, but at your age and starting with good erectile function, you should have no problem.

The men you read about who lose potency usually have salvage radiation after prostatectomy or are aged.

Since potency preservation was of major importance to me too, I took 9 months of daily ED meds starting with the first day of radiation.

[LeastGreif in reply to Tall_Allen]

Thank you, this is encouraging. One of the three radiation oncologists I consulted mentioned that there is about a 40% chance of impotence two years after treatment, due to potential nerve and capillary damage. He also explained that he would not use rectal spacers in my case, as the cancer has extended from the prostate to an area close to the rectum.

His recommendation is fractionated IG-IMRT—specifically, 55 Gy delivered in 20 fractions over 4 weeks—targeting both the prostate and the pubic metastasis. He did not believe I would be a good candidate for comprehensive metastasis-directed radiotherapy, but he did suggest that focal ablative treatment could be an option in the future for any oligoprogressive or hormone therapy–resistant sites.

He also said he would not recommend SBRT due to the spread outside of the prostate.

[Tall_Allen in reply to LeastGreif]

If you care to, ask him where he got 40%. It is less than 5%, and then mostly in older men with with poor potency to start with. If you plan on having children, bank your sperm before prostate radiation.

Prostate radiation is only beneficial if there are 3 or fewer bone metastases on a bone scan (not a PSMA PET scan).

prostatecancer.news/2018/09...

I concur about the danger of rectal spacers when there is risk of spread to the rectal wall.

[MarkS]

I had 37 sessions of RT a year ago. I'm also on ADT. I've always been able to get an erection, albeit with a bit more effort, and that's without viagra of whatever. But I do exercise hard (for a 73 yo) which I think helps enormously.

[Tommyj2 in reply to MarkS]

Why would you think exercise is preserving your potency?

[MarkS in reply to Tommyj2]

I don't really know. However exercise is highly recommended on ADT and seems to be helping me a lot. Although I am really looking forward to getting off it, I am functioning pretty much at 90%. No hot flushes, limited brain fog, achy muscles but no depression. I think the exercise helps a lot on the positivity side, I come away from exercise sessions bouncing around with a big smile.

[LeastGreif in reply to MarkS]

This is positive. Thank you for sharing. So helpful to hear real world experiences.

[Mgtd]

OK! I may be an outliner like MarkS above but I had radiation to my prostrate and my entire pelvic area as a precaution to potential micro spread there. I will be 80 in two months. I also had ADT for six months.

My T returned 2 months post ADT. It is now back to its prior level of almost 700. I exercise every day - aerobics and resistance. I would consider myself to be in good shape for a guy my age.

I have not lost any sexual function. Based on your age I would expect your experience to be even better. Of course your “mileage” may vary.

[MarkS in reply to Mgtd]

That's very good for an 80 yo! I finish ADT in 9m time and I hope to regain testosterone then, though that may a bit hopeful considering I will have been on the ADT for 2 years. Can I ask, do you have an ejaculation now?

[Mgtd in reply to MarkS]

As a result of the radiation, no. However the intensity is excellent.

[LeastGreif in reply to Mgtd]

You are my hero! I hope to be doing that well at 80!

[Eieio]

this isn’t therapy advice. Just sharing my experience with a different approach. I had radiation first back in 20 2048 rounds and then ADT for two years. THIS WAS PRIOR TO REOCCURRENCE AND LATE 2024. What I will say is my radiation did not affect the impotency portion. What did affect it was the two years of Elgard and zytiga. My biggest mistake was not to maintain a constant vigilance towards weight training because my muscles wasted even though I worked out hard for a good 9 to 10 months it needs absolute weight. My tea came back to around 100 so I had a nice year and a half of being normal.

of course I needed some help with generic Viagra Tadalafil. My doctor prescribed a small daily dosage to keep blood flow, which is a great idea. I’m adding in excessive details for others so bear with me. It may be relevant to their situation.

with that said this is a long run survival strategy. So on my reoccurrence, I started back on eligard and xtandi with 4 rounds of sbrt to one met and a small suspicious lymph area. THE RADIATION FOR SEX DRIVE OR ERECTION ISSUES. What did it was the ADT the second time around? Much worse side effects, and zero libido.

so my next move is to look at the E2 estradiol patches. And I think this needs to be discussed more here because it does act the same as Elgar without wasting your muscles. The patch trial and stampede show shows a few areas that it may have correlation to you. But the estrogen keeps the testosterone down in equivalent to the other antagonist and anti-test meds. I think keeping your libido is primary because medication can get the other stuff to work, but if it’s gone in your pituitary and in your mind, it’s gone. I hope this helps. I have not gotten to the E2 patches yet. I’m running that by my MO who has never heard of it. Kind of scary for university of Miami health system

[LeastGreif in reply to Eieio]

Very helpful to have your experience shared. I will keep exercising and try to figure out the best formula to juggle this mess.

[j-o-h-n]

"May the intercourse be with you".

Good Luck, Good Health and Good Humor.

j-o-h-n

[kreg001]

Following my initial radiation treatments combined with ADT I was able to have sex with and without Viagra or Cialis. Time passed and there was biochemical recurrence treated by salvage brachytherapy. My prostate remains became non functional and I had painful dry ejaculations. Another biochemical recurrence with more ADT and I lost interest in sex. Did bicalutamide mono therapy, T rose, PSA plummeted, and I became interested in sex. When bicalutamide lost its efficacy and ADT alone became ineffective, T plunged but PSA rose. Now on Nubeqa with ADT and PSA is below detection limits. Also - no interest in sex. But, I enjoy my wife’s company, our children, and grand children. Every morning is a great morning!

[Adlon57]

After being misdiagnosed with Prostate Cancer in 2022-2023, I had 20 radiation sessions and three Decapeptyl SR injections, which at 68 has left me sterile, some throbs of testosterone, but basically sterile. Incontinence pads now a necessity 🤫🙄

[Tommyj2 in reply to Adlon57]

You were planning on having more children at 68 yrs old? Do you mean,perhaps, impotent? Not familiar with Decapeptyl….what is it?

[Adlon57 in reply to Tommyj2]

I never had any children, not advisable with persons with grande mal epileptic seizures🙄? I've had over 400 of the bl###y things, since 14! There is still something down there🤫, although realistically thinking seriously of having a vasectomy!🙄Triptorelin [Decapeptyl SR] as adjuvant to radiotherapy in patients with high-risk localised or locally advanced prostate cancer.