Do ED medications work after treatment?

ED Meds
Hey T,

You might be interested in getting Dr. John Mulhall's book, "Saving Your Sex Life: A Guide for Men with Prostate Cancer." Also, if you google his name and prostate cancer you can find videos of his lectures covering the subject.

In talking with guys who have been treated for prostate cancer it is my opinion (I.e not based on any studies) that in general younger guys have fewer ED problems after treatment. Not all guys who have been treated for PCa suffer from ED. For those guys that do suffer ED, PDE5 inhibitors (Viagra, Cialis, etc.) may work. Others may have to use injections or implants. These are all reviewed in Mullhall's book.

Good luck in your fight withPCa.

T Paul said:

radiation alternatives
Thanks for the insight Swingshift and others. I am 52, T1C, PSA 1.6, Gleason 3+4=7, 3 of 14 biops positive on the lower right apex.

Based on my research and discussions with possible treatment providers I am learning away from surgery. Granted, I know little to nothing about treatments but at this point are leaning towards the idea of HDR Brachytherapy with optional IMRT however have read that this dual approach can lead to " overtreatment " so BT alone might be the way to go.

I am also very interested in SBRT which I believe is also called SRT. These may be different treatments. So much to learn and I welcome all of the experience and insight I can get.

Best to all!

CyberKnife - SBRT
If you're interested in SBRT, I and several other men here have been treated with a form of it called CyberKnife (CK) -- all with apparent success.

Your Gleason 7 may disqualify you for CK but your low PSA and low # of biopsy "hits" are in your favor. Only way to find out if you're eligible, is to contact a CK provider and ask.

IMHO, CK is the best form of external beam radiation treatment currently available because it is the most precise and can deliver radiation w/sub mm accuracy which minimizes the possibility of collateral tissue damage. The prostate is hit in 3 dimensions from up to 100's of different angles and the computer program (which controls the arm which delivers the radiation) can also control of body AND organ movement.

CK is modeled after HDR BT (high does rate brachytherapy, which is different than LDR BT (low dose brachytherapy). LDR BT is the one commonly discussed when considering BT. It's the one that PERMANENTLY places LDR radioactive seeds in your prostate. HDR BT uses strings of seeds of higher radiation dosage which are placed in your prostate only temporarily and are removed in a day or so. The risks w/BT (either LDR or HDR) is the improper placement of the seeds and/or the improper distribution/application of radiation dosages which can result in collateral tissue damage to the rectum, urethra and bladder.

I agree that using LDR BT in combination w/IMRT or other radiation techniques is probably a form of "overtreatment." If BT fails, you can always consider the later application of IMRT if needed but doing it immediately after (or before) seed placement seems unnecessary to me.

In order to save you some time, here are a variety of links that you may find useful in doing your research on CK.

Here's the CK Patient Forum, where doctors and patients discuss their experience w/CK:
http://cyberknife.com/forum.aspx?g=topics&f=2586

Here's the CK product site (the home site for CK manufactured by Accuray) which explains what CK is all about and where you can find treatment locations:

http://cyberknife.com/

And, here's a video of a Dr. Fuller (from San Diego who uses CK in his practice and who participates on the CK Patient Forum) presenting an introduction to CK in comparison w/other treatment methods:

http://link.brightcove.com/services/player/bcpid1311218266001?bckey=AQ~~,AAABMTO41yk~,0BDF4jnPRYk18rLHqrcfnGVhJxC-Y8Rm&bctid=1349680876001

Hopefully, you'll find this info useful. Please post again if you have any questions.

Good luck!

ED Post Treatment
Hello TPaul:

Many say that post treatment long-term ED rates are about the same for surgery and traditional radiation therapy. I personally believe long-term ED rates are better for RT patients because of the new advances in options (photon & proton), modern accuracy, and the thin-strand seeds now being used. Even if I am incorrect, the thought of the lightening strike of ED and urinary issues after radical surgery fightened me.

I am over a year out with 28 IMRT/IGRT sessions followed by 88 thin-strand Iodine seeds. This would be considered an aggressive RT approach. My gleason was 6 and PSA was only about 3.5, but I had dense tumor (85%) in the left side of my prostate. I never lost sexual function but did notice slight fall-off in erections. This is now recovering nicely. I volutarily used daily Cialis (2.5mg & 5mg) for a while afterwards as it seemed to be a smart proactive measure. I got the idea from Dr. Robert Carey (a PCa surgeon) in Sarasota. Some doctors call it proactive penile rehab. This approach is applicable to both RP or RT.

In any event, study surgery and raditaion therapy well before deciding. Talk to as many patients as you can. Insist on at least 6 references from any doctor you are considering and look to long-tern results over short-term. Once your treatment decision is made, make sure you have a very experienced doctor treating you (1000+ procedures minimum and some times as many as tripe that). Whether RP or RT, this is the single most importnat decison you can make after you choose a treatment direction.

I watched an online video by Dr. Snuffy Myers pointing to the post RT lack of nitric-oxide (NO) as an ED issue. NO is critical in the erection process and the ED drugs assit. I could not find any evidence that any harm would come from the proactive use of ED drugs. I'll never know for sure, but I think it helped me.

Good luck and God bless you!