Hello!

[Nerka]

New person to board looking for a Gay (happy?) perspective. 60 year old. Gleason Score 7, MRI 2 spots RADS 4 1x1, & RADS 5 1x2, 27cm3 total. PSA last time was 10 and rising (Feb). Looking to get it treated. Have Chrohn's Disease so two surgeries (scar tissue) mean that robotic surgery is not a thing. Studies suggest Chrohn's will not add extra problems if radiation is done carefully.

I went to two radiation oncologist because it is just like surgery, always get a second option/opinion. First guy: "cutting edge", HDR and SBRT. Second guy: "tried and true", LDR and IMRT. I won't say one is better than the other, simply different. Leaning toward cutting edge, HDR or SBRT. Going to consult with my urologist and than follow up with chosen RO. Leaning toward "cutting edge"---

*SBRT is less invasive and not a chore anymore due to less fractions given. Good side effect profile especially rectally with SpaceOAR. Two potential problems. Maybe... 2nd cancers (Maybe 1/70 after 10 yrs) and less effective boners.

*HDR does a great job of getting ride of cancer and the new process just uses two visits. No seeds left in. Better erectile function than SBRT. More invasive though. Pain in the butt.

I figure both have great cure rates, and OK urinary & colon profiles. Sex stuff not so much. Maybe 70-80% retain erections. Loss of ejaculation (This kinda bugs me) and then maybe less orgasm? HDR maybe better on sex. I know your not doctors, but your personal experiences with either therapy would be grand.

Thanks!

[Leeaussie5]

Hi Nerka.

This is a tough time. Diagnosis to decisions on treatment. Fear and loathing of the disease and the treatment. I was there and I feel for you.

On the other side, Taking stock and adjusting. I do miss the loss of cum. I was told in advance that gay men miss it more than straight. I understand this. I loved sharing it. But I’m getting used to life without it. Orgasms are as good or better than ever. And I can have more of them than I did.

Drugs give me great erections. Often as good as when I was 18! That was a surprise.

I still top and bottom according to the desire and still enjoy both.

So there is good news. It doesn’t have to be the end of our sex lives.

To be honest, covid has had a bigger effect on my sex life than the pc. It’s taught me a whole new appreciation for porn.

Keep well and safe

[Nerka in reply to Leeaussie5]

Thanks Leeaussie,

I really appreciate your feedback. It does make me feel better about that. If I accept that part (Which it sounds like I will have to) the question remains about SBRT vs HDR. What therapy did you have? Any problems and were they uncomfortable?

[Leeaussie5 in reply to Nerka]

I went for the rp robotic surgery. I had a great surgeon with a very high success rate with minimal side effects. I did investigate radiotherapy but the radio doctors said I’d probably be better off with surgery because I was young (59).

[tallguy86]

Hi Nerka, First of all I am pleased you have and continue to do research and explore options, side-effects, etc. Every body and cancer has many variations and is different. My Pca was low grade and after six years of waiting I had to go for treatment. I opted for the SBRT. It's only been a week since the end of the (five fractions) The only side-effect I've been dealing with is urinary. Peeing frequently. AZO-medication-this is over the counter. I received a script for the higher 200mg dosage. Works great. I had no other pain or side-effects from SBRT. My erections and cum haven't changed nor has my libido. Whether this will change remains to be seen. The one thing most helpful to me related to anxiety-I never had any over the diagnosis or treatment, was information.!I asked lots of questions, read loads of great research studies, looked at all options and have a pretty good support system. I also worked in a hospital before retiring and was aware of patients receiving radiation treatments. So, I was familiar with some treatments and side-effects, etc. My RO did prescribe a low-dose of Cialis. I began using before, during treatment and continue to do so. I wish you the best during these trying times. Be safe and well!

[Nerka in reply to tallguy86]

tallguy86: Thanks for you feedback! Since SBRT is one of my two potential choices, this is helpful. I did read a study which suggest the first year cum is not so much an issue, but then it drops off quickly after that (Not sure how long ago you did this). One thing that matters for preservation of cum is the size of the prostate: larger is better. Mine is small at 27cm3. The weird thing is that after five years radiation therapy has erectile scores that are similar to "watching". Maybe the decline reflects older age... A couple of questions:

1) Did you consider LDR or HDR as an option?

a) If so, why did you NOT choose Brachytherapy?

a) My RO implies that you get slightly better erections with HDR, but since he does both SBRT and HDR is actually is agnostic about the choice. What was your primary consideration?

b) How do you feel about potential secondary tumors? The risk is not huge, but after 10 years it is there. Primarily bladder and bowel. Spacer helps with bowel. Secondary bladder cancer can be aggressive.

I know that is a lot of questions, but I do appreciate your imput.

[tallguy86 in reply to Nerka]

Nerka,

I am 72 yo and had a GS 6. low-grade.T his all began in 2014 so it has always been a slow-growing cancer. You are 60 yo and have a very particular medical issue. I am very healthy with the exception of GERD. I finished my 5th fraction last Monday (one-week ago) Have had minor urinary issues. That's it thus far. My initial and final decision was SBRT. I was uncomfortable with Brachytherapy. I looked at the side-effects and the restrictions involved with the implanting of the seeds. I love to ejaculate! And since SBRT is rather straightforward with only 5 visits and available I believed it was the best choice FOR ME. You have to consider your situation and what will be best for you! I weighed the benefits and the risks as you are doing as well. Will I lose all my cum? What will happen to my erectional (my word-lol) functions? Will I have dry orgasms? (advantage-no mess to clean and no stains). What about the future and other cancers? I don't want to discount any of those things however, I have learned a valuable lesson in life: all the things I worried about and thought would happen in a certain way...never quite did happen the way I thought or imagined. So I pretty much enjoy the moment and life as I am experiencing it now. Nobody and I mean nobody can say with 100% certainty what will happen to my body, your body or anyone's body! Yes, I encourage you to weigh all the risks/side-effects and benefits. Only you can make the final decision. And I certainly applaud you for looking at and weighing all the options carefully. And I hope whatever you decide you'll ultimately be at peace with your decision. Blessing and love friend! Joe

[dadzone43]

76 here with RP for G8. At 19 months PSA is nil. Sex life is not nil. Semen is nil and like many I miss that the most. My perspective at 60 would have been different in that I was married, not out and not having any sexual intimacy with my wife. I do not regret my choices.

[Nerka in reply to dadzone43]

dadzone43

Thanks for your perspective. Nice that sex life is not nil and reassuring. I hope I feel the same way you do and not regret my choices. If you had family that could be great support.