The news that five million American males are now brandishing their tubes of ‘Androgel’ and other testosterone-delivering gels, etc. is not surprising. The post-45 lot seem to believe they’ve found a new lease on life where biceps pump up, and flabby abdominals turn into hardened six-packs. Their brains work better, or so they claim, so what can go wrong?
Well, how about aggressive prostate cancer – then having to get a surgery or radiation treatment that leaves you with having to use penile implants, endless Viagra and penile injections?
It is amazing how many sites one finds on doing a Google search that pooh-pooh any evidentiary connection between testosterone increases and prostate cancer. One site I located actually referred to any such connection as a “myth”. I have news for them: they are living in a fool’s paradise and furthermore are encouraging male readers over 45 into taking immense risks that they’d be better off avoiding. The truth is that "testosterone fuels prostate cancer growth" and prostate cancer is "the only type of cancer susceptible to testosterone inactivating pharmaceuticals" (According to Dr. Mark Scholz, in 'Invasion of the Prostate Snatchers', p. 42).
Two nights ago on an ABC News segment on testosterone fixes, a muscle-bound 60+ year old was shown flexing his biceps and bragging about all his energy ….and so on. Hey, great! But I just hope you’re ready when you have to be treated for prostate cancer – whether radiation therapy or a radical prostatectomy leaving you dependent on penile shots, implants or PDE5 inhibitors, or worse, never being able to get it up again because the cancer is so aggressive that you’re put on female hormones. (With large breasts you will want to hide, to boot).
Dr. John P. Mulhall, author of an academic monograph entitled: "Sexual Function in the Prostate Cancer Patient," also wrote a less technical book for actual prostate cancer patients and their significant others, entitled: "Saving Your Sex Life: A Guide for Men with Prostate Cancer". He makes clear the extent men will have to go to in a process of “penile rehabilitation” to regain sex lives after prostate cancer. In this case, sex lives that can be hampered not only by erectile dysfunction, but painful orgasms and dry ejaculations – even if they do take enough Viagra or penile shots to get the machinery working.
As if that isn’t enough to terrify any macho fool idiot into halting an enhanced T -regimen unless absolutely necessary, there is the prospect of surgical error leading to infection (c. diff.) and vesicularectal fistula such as reported by Dr. George Rinaldi on p. 20 of 'Invasion of the Prostate Snatchers'. Rinaldi was not one of the lucky 50% who emerge from radical prostatectomy relatively unscathed. He ended up farting through his penis and saddled with other complications before having to get a colostomy!
Apart from such extreme consequences, something like 50% end up wearing diapers for the rest of their days. This is possible because in the course of the prostatectomy (the most frequently chosen treatment) the urethra has to be sliced in two different places (since it passes through the prostate) then the base of the bladder has to be resected to the remaining part of the urethra excised from the prostate base.
One problem with the above is the response that “it won’t happen to me” – resorting to the exceptionalist meme. But I have news for these guys – it can happen to you unless you’re lucky enough to get the skilled hands of a surgeon that can minimize the collateral damage. Oh, and if you’re thinking about using that fancy dancy da Vinci surgical robot to do it, think again. Accumulating evidence discloses this thing will actually produce worse results unless – I repeat – unless, the prospective surgeon using it has at least 600 such operations under his belt. You really want to take a chance with some clown who's only done 12 or even only 100? Good luck on that!
Radiation treatments, which many opt for instead of surgery, are also dependent on the soundness of the center's treatment planning system and the skill, experience of the radiation oncologists delivering the doses. One thing you don’t want is an excessive dose of radiation which occurs in what’s called an “administration error” which can leave your bowels suppurating and your bladder in a mess, or ulcerating. Oh, and if you’re game for that new method using a giant linear proton machine, just be sure the oncologists administering the treatments don’t have a “geographical miss” – where the proton beam misses the cancer site totally and uh, goes through your bowel or bladder instead! As for a geographical miss hitting your penis instead, well we won’t go there, but it could make a clever horror flick!
Apart from incontinence, the greatest risk that surgical patients face post-op is loss of erectile ability. .The incipient damage is called "atrophy" which increases in probability the longer a patient goes without erection post-surgery. (Mulhall, p. 98) Atrophy is, in fact (ibid.):
"a scarring of the erectile tissue, and if the erectile tissue scars, the patient will never get his own erection back and will always struggle with medication".
Dr. Mulhall goes on to note (ibid.) that "the incidence of erectile tissue damage, as measured by the presence of venous leak is very uncommon before the fourth month after surgery. However, at eight months after surgery it "occurs in about 30% of men and at one year 50% of men".
If any former Mr. T-using Muscleman has these effects post -surgery, and is also unable to sustain enough blood flow he has another little complication to look forward to: a misshapen penis! Mulhall invokes the "use it lose it" saying here. In some cases, indeed, prolonged disuse engenders organs which are badly misshapen (bent as in a U-shape) and essentially unusable because of unequal scarring in different tissues.
Any guy seriously thinking of aping the muscle-bound CEO spotlighted on ABC News (in his T-regimen) would be advised to watch the video below first and pay close attention! Note the particulars of treating low testosterone, including the fact: a) testosterone can vary during the day so the time you get the blood test is critical, and b) the low testosterone can be due to multiple other causes than natural, including stress, fatigue, diabetes or other hormonal imbalances.
http://www.webmd.com/prostate-cancer/video/testosterone-replacement-prostate-cancer
If a guy has no T-problems and just wants to “muscle up” to look better, I say just be prepared for what’s coming later. It might also help to imagine yourself long past the cancer treatment stage when your dick is U-shaped, your breasts are bigger than Mariah Carey’s (so much you want to hide from your wife) and you have to wear giant diapers just to go to the corner 7-11.
Showing posts with label Da Vinci robotic surgery. Show all posts
Showing posts with label Da Vinci robotic surgery. Show all posts
Wednesday, June 5, 2013
Sunday, October 7, 2012
Is There Sex After Prostate Cancer Treatment? Good Question!
Perhaps the more apt question, given we KNOW the sex has to be different, is: What is the quality of sex after prostate cancer treatment? And to answer this question presumes not only knowing which treatment modality we are talking about, but the manner in which delivered. For example, if radical prostatectomy, then was it delivered via “robot” as in the da Vinci procedure, or via the hands of a skilled surgeon. (Typical books, and medical sites like Hopkins suggest the robotic surgeon ought to have at least 1,000 under his belt for a decent outcome).
If radiation, then what form: external beam or HDR (high dose rate) brachytherapy – where the source is directed inside the gland (such as I had done – see my blog on it “The Longest Day and Then Some”). If HDR Brachy, then where was it done, at which site?Do they specialize in it (like UCSF's Helen Diller Cancer Center) or is it one of many modalities they offer but for which prostate cancer treatment is no more focused on than say, breast cancer. All these matter. But given the lack of specifics let’s employ a more overarching addressing of the question.
Let’s understand first that testosterone presence is critical for prostate cell growth and function.Thus, these cells and their function are sensitive to the presence or absence of testosterone. Since prostate cancer cells are derived from the prostate gland it ought to come as no surprise that they’re also dependent on testosterone for survival. Cancer cells proliferate when testosterone is present and shrivel up and die in a mass cellular suicide called apoptosis when absent. Removing the whole gland can effect this, and also dosing it with high levels of radiation ….or having the cancer patient take large amounts of female hormones. (TIP treatment)
Cut the gland out and you also cut out the basis for testosterone production associated with semen production. Dose it with radiation and you ‘fry’ the prostate cells and cancer cells and reach basically the same result. Ingest enough female hormones and ditto. The issue for most guys who choose a treatment then, is twofold: 1) get rid of the unwanted cancer cells or growth, and 2) Preserve some semblance of sexual function. Obviously if the whole gland is removed and ancillary erectile tissue – say in a radical prostatectomy, then achieving (2) will be more difficult. It’s also one reason many guys on radical prostatectomy and de Vinci procedure net forums often complain about not having been fully informed of the loss of sexual function and the extreme lengths they must go to in order to recover it. As one guy put it on one forum after reading how another member complained about priapism after taking too large a dose of Viagra to stay hard ….”Well, there are some guys who can’t even dredge up enough desire to even want sex if we have to go to those lengths.”
The concerns are less for radiation therapy such as the HDR brachytherapy (single treatment) I had, since the basic organs, gland and tissues remain in situ. The entire pelvic floor isn’t re-adjusted as it is for radical prostate surgery or da Vinci surgery. Still, treatment modes vary and so does the competence of those who deliver them. As my wife put it, even putting the prostate template in place – suturing it to the perineum- can vary significantly from one treatment site to the next. One small error in the template placement means the indexers will not deliver the dose to the correct locations. That can be catastrophic. The dose delivered is also critical – too much and you can't preserve function, too little and you do but the cancer comes back. You need the maximal optimal dose for the grade and stage of the cancer!
As for surgery, another risk which isn’t much mentioned (but ought to be according to the men on the surgery forums, some of whom have threatened “legal action” against their urologists for not giving them the full lowdown) is penile shrinkage. Dr. John Mulhall, in his book, Sexual Function in the Prostate Cancer Patient, notes an average of ½” shrinkage after radical prostatectomy - no matter how done. Overcoming this often demands an aggressive regimen including: Viagra, vacuum pumps and injected prostaglandins. But as Dr. Mulhall notes, to be effective the therapy needs to be started almost right after the operation. Trouble is most men are in no mood after having to have Foley catheters inserted in their urethras for days or weeks, not to mention a good deal of post-op pain and possible complications (i.e. need for a pelvic drain in case of abdominal infection after da Vinci robotic surgery)
In terms of HDR monotherapy (brachytherapy) effects, the St. Joseph Prostate Cancer Center notes (in terms of HDR brachytherapy – such as I had):
“Erectile dysfunction (ED) is often difficult to quantify; however, men who do not have ED prior to HDRB most often maintain sexual function after HDRB. Men with ED prior to HDRB will likely continue to have ED after the treatment as HDRB is not a treatment for ED”
Other than this it’s hard to gain a handle. The UCSF Patient Guide for Sexual Rehabilitation – in terms of post HDR monotherapy sexual indicators- notes that the initial ejaculations will be either bloody (laced with black blood, or old blood), “thick” and off color, or non-existent. Up to now I’ve no idea but suspect likely bloody ejaculate if there was anything. Just a guess. Obviously, from my point of view, any remote consideration of even attempting ejaculation is out of the question so long as urinating delivers a burning sensation! (So try to imagine what forcible expulsion of prostate contents would do!)
One site run by an RN who also offers massage therapy and other post-op aids, notes serious difficulties following just about any kind of prostate cancer treatment and observes even healthy males post-op will likely have much difficulty gaining and sustaining erection. She actually recommends males in this predicament just agree to use “mutual masturbation” with their wives (assuming they're willing) as a solution though she acknowledges some patients – out of religious inhibitions or proscriptions- might have problems with that.
The UCSF Guide includes a section on “solutions” to any sexual dysfunction, which range from using a “penile implant” (i.e. an inflatable device surgically implanted into the penis) to the use of a suction device or “penis pump”. Neither of these will likely be very appealing to most guys, so they also include use of Levitra or Cialis but at higher doses than what would ordinarily take - say for ordinary ED. (This may be why the guy cited earlier on the radical prostate surgery forum complained of priapism, which is a painful erection lasting 4 or more hours.)
Another aspect not much discussed is that of “dry orgasm” or retrograde ejaculation. This is normally associated with a prostatectomy but can also occur after radiation therapy. In the former case tissues associated with the muscle that normally blocks off the entrance to the bladder have been removed. In the normal case prior to the surgery, contracting muscles always force the semen unidirectionally through the penis outwards.
After the surgery, with the loss of muscle tension and control, this is no longer possible, plus the bladder neck is frequently enlarged after surgery so that it cannot close completely. Hence when the muscles associated with the urethra contract the semen is ejaculated backward through the open internal sphincter and into the bladder. This is later flushed out in the urine.
IN the case of radiation treatment, the dry orgasm is of different physiological origin since the sphincter muscles are not affected. In this case, since the whole volume of the prostate has been irradiated. My wife actually corrected me on that, as I’d earlier believed it to be a more directional treatment. Her point was that the IPSA software contour solutions provide a 3D "tunnel" around the urethra and rectum to protect them from the maximum delivered doses. The point is that the cells that produce prostatic fluid (the milky stuff that mixes with sperm to produce semen) are basically killed off with the affected prostate cells. Since the seminal vesicles also receive a dose of radiation (perhaps up to 10 Gray in my case or 1000 cGy) any sperm cells produced are also killed off.
In other words, after the last 'old blood' is ejaculated there’s really nothing left: all or most of the sperm cells are “cooked away” as well as the cells that generate prostatic fluid (this of course is also why one expects PSA to fall). Given there’s basically nothing left “in the tank” then there’s nothing to ejaculate. You get the sensation (at least part of it) of doing so, but nothing is being expelled.
No, I’ve not experienced any of this yet because I haven’t attempted anything! However, it falls within the bounds of what a former Nucletron Corp. radiotherapy consultant told me before I received my own treatment (he also went to UCSF for early HDR brachy), but at that time they were still delivering the dose in two treatments. Only in the last 5-6 months have they adopted the one time HDR treatment based on a study done by Dr. Alvaro Martinez at William Beaumont Hospital-Center which showed that the results for a single treatment were good, with low toxicity. (See, e.g. http://dr.beaumontphysician.com/news/pages/single-dose-brachytherapy-treatment.aspx )
So UCSF changed over to that regime.
Here’s the skinny: While many may insist that men make too big a deal out of post-treatment sex activity and add ‘You ought to be glad you’re just alive!” the truth is more complex, and the self-identity of most of us is bound up with our ability to sexually perform. Erase that, and you erase a lot of self-worth, though true …not all and not necessarily the most crucial aspects. But from reading many of the prostate cancer blogs and forums, and the degree of depression and anger in many men (especially a LOT of younger guys in mid to late 30s and early 40s, whose wives left them because of their difficulties in performing post-treatment) it is still no small deal. And little wonder 90% of these depressed guys had the radical prostatectomy and were neither informed fully of the side effects in terms of prolonged incontinence or concerning the loss of erectile ability and sexual function in 75% of cases. This may be one reason most weren’t merely depressed but bloody angry to the extent of threatening legal action against urologists.
It seems that not only do we have lots of work to do in getting information – full information – to men facing prostate cancer and treatment options – but we also need the urologists, oncologists to deliver the flat out truth instead of wishful thinking fantasies – as per their patients' expected post-op sex lives!
If radiation, then what form: external beam or HDR (high dose rate) brachytherapy – where the source is directed inside the gland (such as I had done – see my blog on it “The Longest Day and Then Some”). If HDR Brachy, then where was it done, at which site?Do they specialize in it (like UCSF's Helen Diller Cancer Center) or is it one of many modalities they offer but for which prostate cancer treatment is no more focused on than say, breast cancer. All these matter. But given the lack of specifics let’s employ a more overarching addressing of the question.
Let’s understand first that testosterone presence is critical for prostate cell growth and function.Thus, these cells and their function are sensitive to the presence or absence of testosterone. Since prostate cancer cells are derived from the prostate gland it ought to come as no surprise that they’re also dependent on testosterone for survival. Cancer cells proliferate when testosterone is present and shrivel up and die in a mass cellular suicide called apoptosis when absent. Removing the whole gland can effect this, and also dosing it with high levels of radiation ….or having the cancer patient take large amounts of female hormones. (TIP treatment)
Cut the gland out and you also cut out the basis for testosterone production associated with semen production. Dose it with radiation and you ‘fry’ the prostate cells and cancer cells and reach basically the same result. Ingest enough female hormones and ditto. The issue for most guys who choose a treatment then, is twofold: 1) get rid of the unwanted cancer cells or growth, and 2) Preserve some semblance of sexual function. Obviously if the whole gland is removed and ancillary erectile tissue – say in a radical prostatectomy, then achieving (2) will be more difficult. It’s also one reason many guys on radical prostatectomy and de Vinci procedure net forums often complain about not having been fully informed of the loss of sexual function and the extreme lengths they must go to in order to recover it. As one guy put it on one forum after reading how another member complained about priapism after taking too large a dose of Viagra to stay hard ….”Well, there are some guys who can’t even dredge up enough desire to even want sex if we have to go to those lengths.”
The concerns are less for radiation therapy such as the HDR brachytherapy (single treatment) I had, since the basic organs, gland and tissues remain in situ. The entire pelvic floor isn’t re-adjusted as it is for radical prostate surgery or da Vinci surgery. Still, treatment modes vary and so does the competence of those who deliver them. As my wife put it, even putting the prostate template in place – suturing it to the perineum- can vary significantly from one treatment site to the next. One small error in the template placement means the indexers will not deliver the dose to the correct locations. That can be catastrophic. The dose delivered is also critical – too much and you can't preserve function, too little and you do but the cancer comes back. You need the maximal optimal dose for the grade and stage of the cancer!
As for surgery, another risk which isn’t much mentioned (but ought to be according to the men on the surgery forums, some of whom have threatened “legal action” against their urologists for not giving them the full lowdown) is penile shrinkage. Dr. John Mulhall, in his book, Sexual Function in the Prostate Cancer Patient, notes an average of ½” shrinkage after radical prostatectomy - no matter how done. Overcoming this often demands an aggressive regimen including: Viagra, vacuum pumps and injected prostaglandins. But as Dr. Mulhall notes, to be effective the therapy needs to be started almost right after the operation. Trouble is most men are in no mood after having to have Foley catheters inserted in their urethras for days or weeks, not to mention a good deal of post-op pain and possible complications (i.e. need for a pelvic drain in case of abdominal infection after da Vinci robotic surgery)
In terms of HDR monotherapy (brachytherapy) effects, the St. Joseph Prostate Cancer Center notes (in terms of HDR brachytherapy – such as I had):
“Erectile dysfunction (ED) is often difficult to quantify; however, men who do not have ED prior to HDRB most often maintain sexual function after HDRB. Men with ED prior to HDRB will likely continue to have ED after the treatment as HDRB is not a treatment for ED”
Other than this it’s hard to gain a handle. The UCSF Patient Guide for Sexual Rehabilitation – in terms of post HDR monotherapy sexual indicators- notes that the initial ejaculations will be either bloody (laced with black blood, or old blood), “thick” and off color, or non-existent. Up to now I’ve no idea but suspect likely bloody ejaculate if there was anything. Just a guess. Obviously, from my point of view, any remote consideration of even attempting ejaculation is out of the question so long as urinating delivers a burning sensation! (So try to imagine what forcible expulsion of prostate contents would do!)
One site run by an RN who also offers massage therapy and other post-op aids, notes serious difficulties following just about any kind of prostate cancer treatment and observes even healthy males post-op will likely have much difficulty gaining and sustaining erection. She actually recommends males in this predicament just agree to use “mutual masturbation” with their wives (assuming they're willing) as a solution though she acknowledges some patients – out of religious inhibitions or proscriptions- might have problems with that.
The UCSF Guide includes a section on “solutions” to any sexual dysfunction, which range from using a “penile implant” (i.e. an inflatable device surgically implanted into the penis) to the use of a suction device or “penis pump”. Neither of these will likely be very appealing to most guys, so they also include use of Levitra or Cialis but at higher doses than what would ordinarily take - say for ordinary ED. (This may be why the guy cited earlier on the radical prostate surgery forum complained of priapism, which is a painful erection lasting 4 or more hours.)
Another aspect not much discussed is that of “dry orgasm” or retrograde ejaculation. This is normally associated with a prostatectomy but can also occur after radiation therapy. In the former case tissues associated with the muscle that normally blocks off the entrance to the bladder have been removed. In the normal case prior to the surgery, contracting muscles always force the semen unidirectionally through the penis outwards.
After the surgery, with the loss of muscle tension and control, this is no longer possible, plus the bladder neck is frequently enlarged after surgery so that it cannot close completely. Hence when the muscles associated with the urethra contract the semen is ejaculated backward through the open internal sphincter and into the bladder. This is later flushed out in the urine.
IN the case of radiation treatment, the dry orgasm is of different physiological origin since the sphincter muscles are not affected. In this case, since the whole volume of the prostate has been irradiated. My wife actually corrected me on that, as I’d earlier believed it to be a more directional treatment. Her point was that the IPSA software contour solutions provide a 3D "tunnel" around the urethra and rectum to protect them from the maximum delivered doses. The point is that the cells that produce prostatic fluid (the milky stuff that mixes with sperm to produce semen) are basically killed off with the affected prostate cells. Since the seminal vesicles also receive a dose of radiation (perhaps up to 10 Gray in my case or 1000 cGy) any sperm cells produced are also killed off.
In other words, after the last 'old blood' is ejaculated there’s really nothing left: all or most of the sperm cells are “cooked away” as well as the cells that generate prostatic fluid (this of course is also why one expects PSA to fall). Given there’s basically nothing left “in the tank” then there’s nothing to ejaculate. You get the sensation (at least part of it) of doing so, but nothing is being expelled.
No, I’ve not experienced any of this yet because I haven’t attempted anything! However, it falls within the bounds of what a former Nucletron Corp. radiotherapy consultant told me before I received my own treatment (he also went to UCSF for early HDR brachy), but at that time they were still delivering the dose in two treatments. Only in the last 5-6 months have they adopted the one time HDR treatment based on a study done by Dr. Alvaro Martinez at William Beaumont Hospital-Center which showed that the results for a single treatment were good, with low toxicity. (See, e.g. http://dr.beaumontphysician.com/news/pages/single-dose-brachytherapy-treatment.aspx )
So UCSF changed over to that regime.
Here’s the skinny: While many may insist that men make too big a deal out of post-treatment sex activity and add ‘You ought to be glad you’re just alive!” the truth is more complex, and the self-identity of most of us is bound up with our ability to sexually perform. Erase that, and you erase a lot of self-worth, though true …not all and not necessarily the most crucial aspects. But from reading many of the prostate cancer blogs and forums, and the degree of depression and anger in many men (especially a LOT of younger guys in mid to late 30s and early 40s, whose wives left them because of their difficulties in performing post-treatment) it is still no small deal. And little wonder 90% of these depressed guys had the radical prostatectomy and were neither informed fully of the side effects in terms of prolonged incontinence or concerning the loss of erectile ability and sexual function in 75% of cases. This may be one reason most weren’t merely depressed but bloody angry to the extent of threatening legal action against urologists.
It seems that not only do we have lots of work to do in getting information – full information – to men facing prostate cancer and treatment options – but we also need the urologists, oncologists to deliver the flat out truth instead of wishful thinking fantasies – as per their patients' expected post-op sex lives!
Monday, July 30, 2012
Verdict Is: Prostate CANCER......So Now What?
Well, 12 days had elapsed and to be truthful, I had been living in a "fool's paradise". I believed the old saw that no news was good news, and that with almost 2 weeks gone past the prostate biopsy the only reason the urologist hadn't called by now was the result had to be negative. Wrong conclusion! The urologist was actually out of town on an 'emergency' for a week so was incommunicado. But he did call today, actually his nurse, and informed me that 5 of the 12 extracted tissue samples were positive for cancer - with two of the samples displaying high Gleason scores, of 6 and 7. That means the malignant cells are aggressive. The good news is they're contained and relatively localized.
I am scheduled to meet the urologist tomorrow at 10.15 a.m. and he will discuss my options at this point. I do know he is a Da Vinci robotic procedure specialist so will be eager to go that route. However, my reaction will be 'Not so fast'!
After reading the account ('Hello, Prostate Cancer') of Dr. Steven B. Mason in the latest issue of the Region VII Intertel Newsletter, I definitely do not want to go that way. Not with excruciating pain, with 12 weeks of post-op recovery and being basically hobbled to the point of a cripple. Mason noted that one ("not uncommon") complication he had was a "pelvic abscess" and having to go back into the hospital after 8 weeks "with a drainage tube poking out of my belly a second time". At the end of his 12 -week ordeal (which he says he'd never have gotten through without a mate) he states he retained urinary control, but many sources suggest rates of incontinence approaching 50% after Da Vinci robotic surgery. It ain't as neat and straightforward as many have been led to believe.
The options? Well, proton beam therapy (which is VERY expensive, averaging $48,000 a treatment) and HDR brachytherapy - for which my wife was an expert treatment planner before retiring. The HDR stands for "High Dose rate' and it entails a procedure in which radioactive seeds (usually of Iodine) are implanted into the prostate by way of hollow needles through the perineum. The implanted seeds then release specified doses of radiation to the affected region and thereby kill the cancer cells. (This is also the method that Warren Buffet has elected to use in treating his own prostate cancer.)
We just talked on the phone to a guy (who used to work with wifey) and had HDR monotherapy done last year, at the Univ. of California - San Francisco, and he said it entailed just three sessions - each in the hospital - over 5 days total, and there have been no side effects, whether to urinary function, inflamed rectum or other. He said the only incidental discomfort was from a reaction to the local anesthetic but that this was unusual. The great thing is he was up and about in just a week as opposed to being laid up like an invalid on pain killers for 12 weeks.
Of course, negative nabobs note that if the radiotherapy doesn't work then your pelvic area will possibly be too damaged to then have surgery. But hey! Them's the breaks of the game! Nothing is assured, as I am finding out. Even PBT or proton beam therapy can have its nasty side effects including the need for resection of intestines or even needing evacuation (ostomy) bags worn permanently if the treatment goes awry. Surgery meanwhile invites high rates of infection, including from prolonged use of catheters, as well as possible strokes. Not everyone walks away from it unscathed, or clean as a whistle.
You basically take your pick of treatment, go with it, and (hopefully) live with it without regret. But there are no ironclad guarantees. Anyone who wants such guarantees has no business living. Life is a crap shot each time you wake up in the morning. Ask those people still recovering after going to the Batman midnight movie premiere in Aurora, CO ten days ago.
So I will let blog readers know what the upshot is from the meeting tomorrow. In any case, I also have other medical issues to deal with as well including a possible perforated eardrum. (For which I have to see an ENT specialist on Thursday).
When it rains, it pours!
I am scheduled to meet the urologist tomorrow at 10.15 a.m. and he will discuss my options at this point. I do know he is a Da Vinci robotic procedure specialist so will be eager to go that route. However, my reaction will be 'Not so fast'!
After reading the account ('Hello, Prostate Cancer') of Dr. Steven B. Mason in the latest issue of the Region VII Intertel Newsletter, I definitely do not want to go that way. Not with excruciating pain, with 12 weeks of post-op recovery and being basically hobbled to the point of a cripple. Mason noted that one ("not uncommon") complication he had was a "pelvic abscess" and having to go back into the hospital after 8 weeks "with a drainage tube poking out of my belly a second time". At the end of his 12 -week ordeal (which he says he'd never have gotten through without a mate) he states he retained urinary control, but many sources suggest rates of incontinence approaching 50% after Da Vinci robotic surgery. It ain't as neat and straightforward as many have been led to believe.
The options? Well, proton beam therapy (which is VERY expensive, averaging $48,000 a treatment) and HDR brachytherapy - for which my wife was an expert treatment planner before retiring. The HDR stands for "High Dose rate' and it entails a procedure in which radioactive seeds (usually of Iodine) are implanted into the prostate by way of hollow needles through the perineum. The implanted seeds then release specified doses of radiation to the affected region and thereby kill the cancer cells. (This is also the method that Warren Buffet has elected to use in treating his own prostate cancer.)
We just talked on the phone to a guy (who used to work with wifey) and had HDR monotherapy done last year, at the Univ. of California - San Francisco, and he said it entailed just three sessions - each in the hospital - over 5 days total, and there have been no side effects, whether to urinary function, inflamed rectum or other. He said the only incidental discomfort was from a reaction to the local anesthetic but that this was unusual. The great thing is he was up and about in just a week as opposed to being laid up like an invalid on pain killers for 12 weeks.
Of course, negative nabobs note that if the radiotherapy doesn't work then your pelvic area will possibly be too damaged to then have surgery. But hey! Them's the breaks of the game! Nothing is assured, as I am finding out. Even PBT or proton beam therapy can have its nasty side effects including the need for resection of intestines or even needing evacuation (ostomy) bags worn permanently if the treatment goes awry. Surgery meanwhile invites high rates of infection, including from prolonged use of catheters, as well as possible strokes. Not everyone walks away from it unscathed, or clean as a whistle.
You basically take your pick of treatment, go with it, and (hopefully) live with it without regret. But there are no ironclad guarantees. Anyone who wants such guarantees has no business living. Life is a crap shot each time you wake up in the morning. Ask those people still recovering after going to the Batman midnight movie premiere in Aurora, CO ten days ago.
So I will let blog readers know what the upshot is from the meeting tomorrow. In any case, I also have other medical issues to deal with as well including a possible perforated eardrum. (For which I have to see an ENT specialist on Thursday).
When it rains, it pours!
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