Bottoming and Cancer Metastasizing

[Nerka]

OK. I have wanted to ask this question from the Radiation Oncologist/Urologist, but just couldn't (They probably couldn't answer it). If you are the recipient in anal sex and have prostate cancer, could "banging" on the old prostate cause the cancer to metastasize? I know that it doesn't CAUSE cancer, but can it change it?

[Tall_Allen]

No. There is a biochemical change that has to occur before a prostate cancer cell in the prostate can metastasize. Banging cells loose won't do it.

[Nerka in reply to Tall_Allen]

Ahhh! So it is biochemical process and not a physical process. Interesting.

[Nerka in reply to Tall_Allen]

I have this image of hitting a pinata. I can't get out of my head! LOL.

Pretty much made my decision about the Radiation Oncologist. Had a great talk with the RO. After talk leaning toward SBRT. My two concerns were sexual function (Bowel and Urinary function are an issues, just not a large one) and secondary cancers. Basically, sexual function with SBRT and HDR are roughly the same in his experience. He felt that the relative(additive) risk was actually very low. Also asked him about his experience with SpaceOAR in also reducing erectile dysfunction. He implied that was correct and that either way we would use it. Also, using Viagra (generic) to rehabilitate the penis. He shrugged his shoulders on that one but was OK with it. Wonder if insurance will pay for it, but generic is actually not badly priced.

[Tall_Allen in reply to Nerka]

I did daily Viagra for 6 months - not sure if it helped but I have no ED.

I'm not a fan of SpaceOAR. I think it's an excuse for the RO to get sloppy. It can't possibly help with ED -the rectum isn't anywhere near the NV bundles. My friend had an extremely hard time because of it.

prostatecancer.news/2017/01...

[daveh121 in reply to Tall_Allen]

Same here.

One doc suggested it but the others were unaware that it was a possibility. That one doc even offered to prescribe it if the others didn’t. The RO did after discussing it with him.

[Nerka in reply to daveh121]

It is an interesting thing. Probably no harm in trying it. That is my thought anyway. My ON and Urologist seem ok with it.

[Nerka in reply to Tall_Allen]

Interesting. I know some people are suspicious of SpaceOAR. "A device in search of a disease". If the doctor is being sloppy, chances are he/she is a sloppy doctor. Guess I would have to be on their tail!

But from what I have seen many studies suggest that SpaceOAR helps significantly, particularly for late bowel toxicity. From what I have been reading the ED damage in RT occurs primarily to the nerves and vascular system around penile structures vs. the nerve bundle in RP. Below I have some articles that show how I came to my conclusions (Not trying to be a know it all or smart ass. just showing how I came to my conclusions). I will say that I came across one article that suggested a more cautious approach on prostate/rectum devices but suggested that due to the nature of SBRT, it is probably useful there. Also came across an article that suggested little benefit form sildenfil for ED, but I came across several peer reviewed ones that suggested there were benefits:

ED damage from SBRT caused by arterial damage:

pubmed.ncbi.nlm.nih.gov/257...

Potency preservation SBRT:

pubmed.ncbi.nlm.nih.gov/241...

This is from a Phase I and Phase II clinical trial. Bowel and Sexual Function were improved with SpaceOAR:

urotoday.com/recent-abstrac...

This is from an article last month in JAMA doing a meta-analysis of 7 studies of SpaceOAR. Typically 66% less radiation:

jamanetwork.com/journals/ja...

Peer reviewed (2017):

pubmed.ncbi.nlm.nih.gov/282...

Here are studies about Sildenifil helping erectile function:

eurekaselect.com/72298/article

Peer reviewed article (2014).(ASCO presentation 2012:

sciencedirect.com/science/a...

Reviewers response in ASCO post (2012):

ascopost.com/issues/decembe...

With ADT (2019):

jmirs.org/article/S1939-865...

[Tall_Allen in reply to Nerka]

I think you missed the point. Yes, it does help with late bowel toxicity, but late bowel toxicity is a VERY low incidence side effect, affecting only 4% of treated men, and 2% with SpaceOAR. That's what I mean by a cure in search of a disease. The article, which reviews all the evidence you cited, explains more, if you care to read it.

[Nerka in reply to Tall_Allen]

We are probably just looking at different articles so our point of reference are different. I am looking at the Stage 3 review article in 2018 Urology. Oddly, the conclusions are different then the Prostate Cancer News article:

"Prostate-rectum hydrogel spacer application is a relatively safe technical procedure that is well tolerated and has a high technical success rate. Spacer application significantly reduces rectal radiation dose and results in long-term reductions in rectal toxicity, as well as improvements in bowel, urinary, and sexual QOL."

But I see your point about the numbers in the Prostate Cancer News article you cite as being fairly insignificant, and I see why you are skeptical about it. Next week I am supposed to make an appointment with my Urologist to discuss the treatment options. It will be interesting to get his perspective.

As an aside, your last note comes across as a touch condescending. Given you helpful advice and passion for this issue I doubt you meant it to come out that way. Perhaps my note before that comes across as negative and you are responding to that. If so I do apologize. That was not my intent.

[Tall_Allen in reply to Nerka]

Your comments indicated to me that you didn't seem to read the article, which was based on all the available research on the subject. At least, you didn't acknowledge the issues it raises, or even ask questions about what you did not understand. What you quoted was merely a simplistic overview.

I guess my "passion" comes from watching my dear friend suffer because of it. It costs about $4000 for an invasive procedure that is unnecessary for 96% of men. ROs can be lazy about contouring with it.

Your urologist is not a good person to ask - how would he know? A radiation oncologist is the type of specialist who studies such things.