When we start this journey, there are decisions to be made regarding RP, radiation treatments and no one can accurately tell us the likelihood of ED, urinary incontinence, etc... A recent study of 5 year follow up post treatments is now available...and while this is not the science I keep touting as coming...It is helpful....and for those having issues, it may give some insight into what could possibly happen over time....
Findings In this prospective, population-based study of 1386 men with favorable-risk prostate cancer and 619 men with unfavorable-risk prostate cancer, most functional differences, measured with Expanded Prostate Cancer Index Composite scores, associated with treatments (favorable-risk disease: active surveillance, nerve-sparing prostatectomy, external beam radiation therapy, or low-dose-rate brachytherapy; unfavorable-risk disease: prostatectomy or external beam radiation therapy with androgen deprivation therapy) attenuated over time with no clinically meaningful bowel or hormonal functional differences at 5 years. However, prostatectomy was associated with worse incontinence over 5 years (adjusted mean difference of –10.9 for favorable-risk disease and −23.2 for unfavorable-risk disease) and worse sexual function at 5 years for unfavorable-risk disease (adjusted mean difference, −12.5).
Based on my own knowledge, the equalizing of short- vs long-term effects of many treatments over 5 years sounds about right to me. As for ED with PCa patients and older men in general, here is an article that indicates it is much more prevalent than most would like (or are willing) to admit:
What Fraction of Men Develop Erectile Dysfunction, Really?
No one knows the prevalence of ED. But with time, the proportion keeps growing.
Thanks for the reply, I do wonder what my treatment algorithm would be if I could choose again based on my knowledge base, but I really have no complaints because of how I am doing currently....If it ain't broke as we say in the WV... People usually don't choose anyway....It is the Urologist, MO, etc who decides the treatment regimen and determine what is offered...
And then you got the guys like me, who ended up in a treatment regime (or current lack there of) because his MO was out of the country and the decision to continue/stop ADT after 3 mos was made by moi. Still off treatment with sub 0.1 PSA and normal T levels 2 years and counting. Hoped for benefit is to have preserved effectiveness of SOC ADT when I need it in the future. A roll of the dice for sure, but one this 72 year old is happy to make.
Minor benefits (to us) for looking back. If I had known what I know now, I doubt I would have gotten PCa in the first place - and I definitely would have tested T, gotten a second opinion, and taken action early enough to keep my cancer organ-confined. But, as we are where we are, we can only go forward. Most of us who frequent these forums at least have the benefit of making much better decisions as we go in that direction.
Thanks, as always, for you contributions. Be Well - K9
Thanks for your reply. Indeed, the treatment options are changing and rapidly...It is why I believe we will be at Chronic Disease State within a few years with a 5 year OS for Stage 4 greater than 50%... I think one of the things that Dr Maha Hussain of Northwestern said in regards to treatment is that shamefully, too many patients are just being offered Lupron at initiation of treatment when they needed more...She estimated 70%...Would changing that alone bring 5 year OS to greater than 50% for Stage 4?? I believe so...
This is why it is so important to get an MO that specializes in PCa...
Thanks npfisherman for this interesting study. As mentioned the outcomes do enable clinicans to better inform patients when making choices and this is a good thing. You'll be very glad to know I didn't need you to interpret the science for me this time.
I am always happy to help.... it is good that MD's can tell patients about their odds for fecal and urinary incontinence and ED.... I believe the odds have been under reported previously especially on ED... When you get on this hell ship, it is good to know what your odds are for certain things... Now, if the ACS would get busy and update the OS rates since those still seem outdated...
Yes you're always very helpful - keeping across all the developments from a scientific perspective and making sure you include those items that recognise the QOL issues.
We'd be the ones in good company with you...Let's see ....we'll get a pistol for you to wear on the hip, a cutlass for the other side, and a dirk to slip into your boot... we are a dangerous lot.... Pirates of the Forbidden Forum...
Shall I draw up the Code? You know all pirates need to have a code or Articles . Hope the Captain's boat is seaworthy or at least has lots of life jackets. Sounds like you're going to make sure I'm well equipped at least for whatever dangers comes my way. I'm a better shot with a double barrel though if you're going to need me to defend you. The outfit doesn't sound too glamorous. Not at all like the women on Survival. I'll need some of the jewels/booty to add a bit of glitz. I hope you're in charge of fishing for dinner because if it's up to me we'd definitely starve. I could cook though. So when do we sail.... M
Arrrrggghhh, Matey. Shiver me timbers! Afraid I'm just an old hand of Davy Jones - and just trying my best to avoid his locker. Always keep a keen eye on the weather & Be Well - Captain Graybeard
I could be your First Mate and they can refer to me as Salty Fish fore and aft...or Salty Fish and Chips with a side of tartar sauce and a bit of ketchup.... for and aft...when does Long John's close?? I could go with a Fish and Chips and some hush puppies....
Next time we meet, will you have a parrot on your shoulder, a black doo rag, and an eye patch?? Perhaps a saber strapped on at the hip to give it the full pirate look.... Work on saying, " Arrgh, matey..."
Treasure Island implies a plethora of jewels so I vacated that location 5 years ago following my orchiectomy. As for an Oasis, that implies free flowing water and I sure have been seeking that for some time also; HOWEVER, I have been on Oasis of the Seas for some great cruising.
My land locked Dessert location would be anytime I'm riding my bicycles in comfort thanks to my banishment from Treasure Island. ;0) Had 75 miles of crank spinning-wheels rotating-tires humming isolation on my own Desert Island yesterday.
Keep up the cycling.....exercise is shown to be beneficial in our disease....interval training especially... I am interested in what kind of immunotherapy injection you got at the start of this journey...would you expound on that information?
I was offered an option to have a 3 drug combination in addition to my unorthodox treatment procedure that had not yet received approval as a combo but on their own each one had obtained successful results with other cancers. Only 5 years into this experiment and Dr. wishes I do not mention the drugs used. Thanks for asking. Will be happy to reveal if I come out on top of this Gleason 10 wrestling match.
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