Complications after surgery, in germany
Comments
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Worth NotingClevelandguy said:Question?
MK1965,
Robotic nerve sparing techniques have a much better rate of success on ED. Again that all depends on how involved the cancer was around the nerves. I think this was from the same report that you sighted, August 2016: "RARP(Robotic Assisted Radical Prostatectomies) series reported potency recovery rates of 32% to 68%, 50% to 86%, 54% to 90%, and 63% to 94% at 3, 6, 12, and 24 months after surgery, respectively . Kinda of variable probably based on the amount of nerves vs involvement of the cancer in the study. Just hope your on the high side of the stats..................
Dave 3+4
It is well worth noting that in any case in which a surgeon discovers cancer in or on the erectile nevers, and cuts them out, if that same person were treated with radiation (any form), then they, too, would require that the nerves be killed via radiation.
Otherwise, the cancer is left in the body and will begin raising PSA above nadir, at some future point.
But: perineural involvement, whether inside or outside the gland, is virtually never detectable tooday with virtually any scanning technique. When it is detected, it is virtually always via biopsy. Roll your dice the way you best see fit.
Removing the erectile nerves is not always a careless case of excessive caution. Sometimes, it is the only way to save a man's life, which is the goal of any first-line PCa treatment.
max
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Bottom LineClevelandguy said:All treatments have side efffects
Hi All,
I thinks it's pretty common knowledge that if you get surgery either open or robotic you will have ED & leakage issues, usually within a 0-12 month recovery time they lessen, sometimes if the surgery goes bad you are left with permanent ED or leakage.
With radiation very few side effects during treatment with possible side effects later on(month to years) sometimes severe, sometimes not(damage from the radiation on un-intended targets). People just need to be aware of the side effects and make your choice. There is no wrong or right treament option, you need to pick one if you want the cancer gone and then realize that you could or will have some of these side effects. Very simple guys, no magic here. As people on this board that have gone through these treaments we should share our experiences and make sure people coming her for gudiance know the risks of any treament. Again there is no right on wrong treament, surgery & radiation both have side effects.
My surgery was successful in removing my cancer(I hope,only time will tell) but I did walk away with a slight stress leakage issue which I am willing to live with as a consequence of my surgery.
Lets cut down on the personal attacks and help new people coming to this board gain from our experiences. A lot of these personal attacks accomplish nothing except making us look like immature adults.
Dave 3+4
Very likely, less than 1% of the men in the US with PCa read this forum. If you look at the number of "regulars" here, and then look at how many times each post is read by someone (without posting), then the number is WAAY less than 1% To paraphrase Macbeth, we are all a "sound and fury, signifying nothing."
I do view the forum as useful to those who partake of it; otherwise I would do what most men do, and forget that it exists. But flawed, definitely flawed.
RP will continue to be the cure of choice for more than half of all new patients, because people have an instinctive, intuitive desire to have a malignancy "gone." With improvements in RP recovery all the time, this will not change or decrease, regardless of what any man writes here.
RP is often called "barbaric" here. How "barbaric" is it to radiate an organ until it becomes charcoal, and then leave it in the body ? People fear cell phone wattage, and microwaves used to scare people to death. But, some men see 86 Gray of radiation as "more natural" than surgery. Very well. We are all simply men trying to become well in the easiest and least destructive manner possible. Ultimately, I believe that every writer here wishes to share the truth and be helpful. There are no perfect or risk-free ways to do this, however.
I read the other day about a famous English guitarist who had cancer a few years ago (you would know his name, but I will not state it here). He was (successfully) treated with radiation, and adjuvant chemo was the protocol. However, he refused the chemo, so as to not lose his hair. I am not making this up. And know that the hair loss would have been temporary.
I have never been an "anti-radiation" guy. I very nearly had RT myself, and know that it is usually a good choice, and many times, the only real clinical choice. All that I object to and see has harmful are the claims made against surgery. Valid numbers are often used, but taken out of any historic or clinical context. My two cents, for now.
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Another point against surgeryBottom Line
Very likely, less than 1% of the men in the US with PCa read this forum. If you look at the number of "regulars" here, and then look at how many times each post is read by someone (without posting), then the number is WAAY less than 1% To paraphrase Macbeth, we are all a "sound and fury, signifying nothing."
I do view the forum as useful to those who partake of it; otherwise I would do what most men do, and forget that it exists. But flawed, definitely flawed.
RP will continue to be the cure of choice for more than half of all new patients, because people have an instinctive, intuitive desire to have a malignancy "gone." With improvements in RP recovery all the time, this will not change or decrease, regardless of what any man writes here.
RP is often called "barbaric" here. How "barbaric" is it to radiate an organ until it becomes charcoal, and then leave it in the body ? People fear cell phone wattage, and microwaves used to scare people to death. But, some men see 86 Gray of radiation as "more natural" than surgery. Very well. We are all simply men trying to become well in the easiest and least destructive manner possible. Ultimately, I believe that every writer here wishes to share the truth and be helpful. There are no perfect or risk-free ways to do this, however.
I read the other day about a famous English guitarist who had cancer a few years ago (you would know his name, but I will not state it here). He was (successfully) treated with radiation, and adjuvant chemo was the protocol. However, he refused the chemo, so as to not lose his hair. I am not making this up. And know that the hair loss would have been temporary.
I have never been an "anti-radiation" guy. I very nearly had RT myself, and know that it is usually a good choice, and many times, the only real clinical choice. All that I object to and see has harmful are the claims made against surgery. Valid numbers are often used, but taken out of any historic or clinical context. My two cents, for now.
max
max,
you just unintentionaly made point against surgery mentioning refusal of chemo by famous guitarist so as to not lose his hair.
How much more important is to be potent and have spontaneous erections when man needs it then have a full head of hair ( unles that is part of your image as for Prince, Valderama, Bert Raynolds etc.)
If coronary artery bypass grafts CABG would have such a low recovery rate, thoracic surgeons would be out of business.
MK
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Best Wisheslighterwood67 said:Spoke to a friend
In my journey, I have been reading on this site and enjoy the factual side of RP vs RT. I have spoke to both in my hometown. I already posted what the RT person said. The RP person told me that he had leakage on the way home after the catheter was removed. He put another Depends on that night and in the morning no leakage. He said he does have leakage if he strains while doing something physical. He said he does get erections with the aid of cialis. He was diagnosed 14 years ago at 56. He is now 70. He told me his PSA was 0. Just based on reading on this site, there appears to be lots of approaches to treatment. All appear to have side effects. I do not claim to know nearly what some of you folks know on this site and I apprecaite your sharing information. We share a common enemy. There are a lot of human variables in these equations. Some are attitude; physical shape; mindset; emotional support. In most cases, hard to put a statistical value on the human side. So you listen to the specialists and weigh what they say and move on. I am in good spirits and at peace with my decision. I am going to fly the RP plane 3/20/2018. When I am done with this, I will post how I came out.
My spouse is new to the treatment journey so I appreciate your sharing how you decided which road to take. Mostly I want to say good luck and may all go well on the 20th. Sending you a hug and prayers that the Divine guides your surgeon’s hands.
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Good news
I have just found a newly updated site for evaluating surgeon records. This is one of the crucial "variables" that effect outcomes and make the difference between successful nerve sparing and unsuccessful. I am posting it starting a new thread.
Here are the three most crucial variables, though there are others that can affect outcomes. Any patient considering prostatectomy should weigh each of these variables carefully to make an informed decision and minimize risk.
" The severity of the erectile dysfunction depends on the type of surgery, stage of cancer, and skill of the surgeon."
In my case, I had surgeons scorecard as a reference for the skill of the surgeon, and my GP checked out local surgeons and their reputations and availability.
The type of surgery was recommended by a friend who had nerve sparing Davinci RP and was very confident in the local facilities.
Thirdly, I was Gleason 6 3+3, so getting surgery done early would also reduce my risk of permanent side effects.
Finally, my wife (a marvelous, wonderful lady) and many family and friends were praying for me. Life was pretty crappy before the RP, but i always felt heading into the RP, that i was being bouyed up with confidence. And even the side effects would have been better than alternating between daily Flomax, and foley catheters inserted when the Flomax couldn't cut it, meaning a trip to the emergency room to have a foley installed. I could not travel anywhere for fear of a shut down episode where i could go 16 or more hours without urinating... anybody who thinks that is no big deal should try it sometime.
Of course, one variable that is also affected by the others is the damage, stretching, and trauma suffered by the nerve bundles that transmit neural impulses back and forth from the brain to the prostate area.
There are other variables that probably should be considered, These first three are the ones Medscape mentions that effects outcomes in all of the studies they reviewed.
If you are a patient considering RP, be sure to minimize your risk, and in case your surgeon neglects to tell you, expect to lose 1-2 inches from the retraction to reattach the urethra, 6-8 months on average for incontinence recovery, and 1 to 2 years on average for ED recovery. For some, the recovery time is much shorter, for some they can be permanent. You want to maximize your recovery chances and reduce your risk.
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Side effects of radiation, and radiation versus surgery
For side effect of radiation alone, I googled SBRT, a radiation treatment that some of us ask patients ot consider.
6. Side Effects of SBRT. No patient has experienced complete urinary obstruction or urinary incontinence, and there were no severe (grade 4) complications. Mild (grade 2) urinary and rectal side effects were rare, 5% and 2%, respectively.
Here are various studies about SBRT for your consideration
...........................................................................................
Here I googled , "prostate cancer side effects surgery versus radiation therapy"
Radiation and surgery are treatments that destroy or remove localized prostate cancer. Both treatments also have long-term side effects, like bladder, bowel, and erection problems. In the first 2 to 5 years after treatment, the chance of having erection or bladder problems is higher with surgery.
Here are various comments and studies for viewing
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Thanksfullmoon50 said:Best Wishes
My spouse is new to the treatment journey so I appreciate your sharing how you decided which road to take. Mostly I want to say good luck and may all go well on the 20th. Sending you a hug and prayers that the Divine guides your surgeon’s hands.
I was in the military for 26 years. I was in combat communications. In all of my journeys I have never been alone. Through the good and the bad, the One won made me; the One who loves me has always been with me. Thanks for the prayers. Please pray for my family, they will have a long day on 3/20/2018. Again, thanks.
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In a nutshell
Exactly, a lot of variables. Never understimate the human one. Smile, I am.
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I apologize
Btw... I apologize to H&O and MK if my comments sounded like a personal attack. But my position on the matter remains, it is just that I did not express it in a diplomatic way. If I were Secretary of State, we would probably be at war with every nation on earth.
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Or....Grinder said:I apologize
Btw... I apologize to H&O and MK if my comments sounded like a personal attack. But my position on the matter remains, it is just that I did not express it in a diplomatic way. If I were Secretary of State, we would probably be at war with every nation on earth.
Grinder,
Or fired, by the Trumpster !
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American Cancer Society Website
This is from the American Cancer Society's own website:
Bowel problems: Radiation can irritate the rectum and cause a condition called radiation proctitis. This can lead to diarrhea, sometimes with blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases normal bowel function does not return. To help lessen bowel problems, you may be told to follow a special diet during radiation therapy to help limit bowel movement during treatment. Sometimes a balloon-like device is put in the rectum during each treatment to keep the bowel as still as possible while treatment is given.
Urinary problems: Radiation can irritate the bladder and lead to a condition called radiation cystitis. You might need to urinate more often, have a burning sensation while you urinate, and/or find blood in your urine. Urinary problems usually improve over time, but in some men they never go away.
Some men develop urinary incontinence after treatment, which means they can’t control their urine or have leakage or dribbling. As described in the surgery section, there are different levels and types of incontinence. Overall, this side effect occurs less often than after surgery. The risk is low at first, but it goes up each year for several years after treatment.
Rarely, the tube that carries urine from the bladder out of the body (the urethra) may become very narrow or even close off, which is known as a urethral stricture. This might require further treatment to open it up again.
Erection problems, including impotence: After a few years, the impotence rate after radiation is about the same as that after surgery. Problems with erections usually do not occur right after radiation therapy but slowly develop over time. This is different from surgery, where impotence occurs immediately and may get better over time.
https://www.cancer.org/cancer/prostate-cancer/treating/radiation-therapy.html
Of course, referencing "surgery" likely encompasses ALL types under the umbrella term "radical prostatectomy" and does not take into account the other variables I keep bringing up to no avail.
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Proctitis Anecdotes
I had 41 treatments of hi dose radiation 5 years ago. I developed chronic radiation proctitis and other gi tract problems ( Chrones type ). I also have chronic burn of the urinary tract. The symtoms have gotten worse.
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I am using the 25 mg supposititories for about 3 months following radiation procities diagnosis about 1.5 years after prostate seeding. I seem to be in a holding pattern. My doctor wants me to be let time work before going to the next step. I think his chosen route for me is to try a Formalin treatment is time and supposititories don't work. My problem is located in the rectum area.
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Hi, my Dad got radiation proctitis associated with severe pain and some bleedings. Do You know any treatment to improve his rectum and colon shape, tks
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I have after also gotten cronic radiation proctitis I have no bleeding but I have to get up several times a night because of loose bowel movements I had 45 radiation treatments and hormone treatments My gastrologist wanted me to go on canasa but with my insurance it would cost 447 dollars a month According to him this is the best treatment although it doesnt sound like there is a cure
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Hi--I was having the same problems as you but I was also having extreme pain with the bowel movements--It's been almost a year since the radiation and it has gotten better-except for flare ups every now and then--I also used proctosol--Here in Canada you can get a generic version of it called "Proctol"--it has the same ingredients and costs a lot less
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My husband had hormone treatment, followed by external beam radiation, followed by seeding. The seeding was done a year ago. He is now suffering intense pain from radiation proctitis. Would like to hear from anyone else who has had this problem. Thank you.
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Successful Surgery anecdote
"I've been wondering, how can one measure the outcomes of prostate surgeons. It seems to me that selection is based mostly on reputation, length of time doing, operation quantities, and quality of hospital association. How does one really know? As a medical professional, can you provide some insight?"
This person has the right idea... He wants to investigate the variables, in this case the outcomes of different surgeons, quality of hospital association, etc.
Who do you suppose wrote this inquisitive and insightful post in April 2009, congratulating a patient for a successful surgery outcome?!
Who could it have been?!
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more comparisons
http://www.med.umich.edu/urology/events/Other/PCNews.pdf
The chapter you want is on Quality of Life- that starts on page 6 of the document.
Strong evidence supporting surgery for overall Quality of life after treatment.
From page 6:
"It was found that each of the three common primary prostate cancer treatments (prostatectomy, brachytherapy, or external-beam radiotherapy) were associated with distinct patterns of change in quality-of-life domains related to urinary symptoms, sexual and bowel function, and vitality or hormonal function. These changes in quality of life were found to be significantly associated with the degree of outcome satisfaction among patients and their spouses or partners.
"Patients in the brachytherapy group reported having long-lasting urinary irritation, bowel and sexual symptoms, and transient problems with vitality or hormonal function. For all groups, urinary incontinence was at its worst by 2 months after surgery and then improved in most patients. Eighteen percent of patients in the brachytherapy group, 11% of those in the radiotherapy group, and 7% of those in the prostatectomy group reported having moderate or worse distress from overall urinary symptoms at 1 year. After prostatectomy, mean scores on urinary irritation and obstruction improved, particularly in patients with large prostates.
"Brachytherapy and radiotherapy were both associated with a reduced quality of life related to bowel function early after treatment, and the change lasted for a year or more. In contrast, no substantive change in bowel symptoms was detected after prostatectomy."0 -
more radiation anecdotes
I was severely burnt with radiation. It also hit my colon has cut scan and colon is all inflammed. The stretching and pulllin on inside is horrible. Nothing can be done but time will heal. Has anyone else had this?
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Posts: 6
Joined: Jun 2012Jul 27, 2012 - 7:43 amHi. I feel the need to warn people about IMRT radiation treatment. My husband had this done with Calypso technology. He had 45 doses of radiation. He is also Stage 1 so his treatments were not agressive. About halfway through, he started experiencing a lot of pain when he had to go the bathroom. It burns to pee and hurts really bad to have a bowel movement because your insides becomes raw from the radiation. He finished his last treatment 2 months ago. The first month after treatment was a 9 or 10 on most days for his pain levels when he had to use the bathroom and he had cramping during the day. This morning (2 months later), I heard him screaming and then crying on the bathroom floor. My husband is only 60 and he is strong man. I've never seen him cry like this and it is heart-breaking. The doctors totally minimized the pain factor when they originally talked us into doing IMRT (which is more expensive) instead of Brachytherapy. We now wish we went with Brachy. If you have not chosen your treatment yet, please consider this carefully. I'm also scared to think how much longer this will be until his pain goes away and he can resume a normal life.
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more anecdotes
Are you getting tired of anecdotal evidence yet? How do you think these people felt?
"Don't feel that you are alone. I too am 60 years old, I go to the gym 5 days a week, which includes a daily 4 mile run. I'm also a retired engineer who just had to drop out of my 42 session IMRT because of severe radiation sickness. I lasted exactly 5 weeks (or 25 sessions). I can no longer run or walk normally. I have a severe limp and can not climb or decend stairs without assistance. What was my Ocnologists answer to this? It shouldn't happen, but it did. So now I'm in personal rehab trying to get my hips and pelvis to work again.
I wouldn't recommend any form of radiation to anyone, if there is a surgical alternative. IMRT is based on technology first developed in the 1930's and the first medical implementations showed up in the 1950's. It's essentially 50 years out-of-date, and now we get accelerated Proton radiation, generated by a 3 story tall LINAC???"
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more
"Just had one of the worse bowel movements of my life. Felt like something ripped inside me. Blood was fairly flowing. Looked up on web and they were saying that about three years after radiation you get a ripped anus. Why don't they tell you about this? I am taking percocet for this one as it really hurts. Looked up on web and they said after three years, if you went through radiation good chance that you would experience painful. Bowel movements and bleeding.
I think this is really bad. It has just come up and now I have lost all energy. Has anyone else experienced tnis? "*****************
"My husband had cyber knife treatment last September 2011, with only mild side effects a week later. Now, more than 6 months later, he is having severe problems. For the last two weeks he has had pain , burning, urgency, and blood in the urine. He was prescribed an antibiotic and flomax for a week, which did not relieve his symptoms. Yesterday we back to the doctor. He did a cistscope to check his bladder, a sonogram, and urine test. He said that husband does not have an infection, and took him off of the other meds, and put him on vesicare. He said that symptoms are a result of the cyber knife surgery last September. He still has all of the symptoms, and cannot sleep because of the pain and having to constantly go to bathroom. Has anyone else had this, or have any advise ? Please let us know, as he is miserable. Thanks
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I am going to quit now. I figure, rather than talk myself, I would let other people speak about their own experience... I hope this is enough to prove my point about variables in ALL treatments.
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Hemorrhoids?Grinder said:more
"Just had one of the worse bowel movements of my life. Felt like something ripped inside me. Blood was fairly flowing. Looked up on web and they were saying that about three years after radiation you get a ripped anus. Why don't they tell you about this? I am taking percocet for this one as it really hurts. Looked up on web and they said after three years, if you went through radiation good chance that you would experience painful. Bowel movements and bleeding.
I think this is really bad. It has just come up and now I have lost all energy. Has anyone else experienced tnis? "*****************
"My husband had cyber knife treatment last September 2011, with only mild side effects a week later. Now, more than 6 months later, he is having severe problems. For the last two weeks he has had pain , burning, urgency, and blood in the urine. He was prescribed an antibiotic and flomax for a week, which did not relieve his symptoms. Yesterday we back to the doctor. He did a cistscope to check his bladder, a sonogram, and urine test. He said that husband does not have an infection, and took him off of the other meds, and put him on vesicare. He said that symptoms are a result of the cyber knife surgery last September. He still has all of the symptoms, and cannot sleep because of the pain and having to constantly go to bathroom. Has anyone else had this, or have any advise ? Please let us know, as he is miserable. Thanks
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I am going to quit now. I figure, rather than talk myself, I would let other people speak about their own experience... I hope this is enough to prove my point about variables in ALL treatments.
Hi Grinder,
Could it be Hemorrhoids? Sometimes when I have a large bowel movement my hemorrhoids bleed, feels like I'm giving birth to a Zucchini!
Dave 3+4
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Well,you just...Grinder said:more
"Just had one of the worse bowel movements of my life. Felt like something ripped inside me. Blood was fairly flowing. Looked up on web and they were saying that about three years after radiation you get a ripped anus. Why don't they tell you about this? I am taking percocet for this one as it really hurts. Looked up on web and they said after three years, if you went through radiation good chance that you would experience painful. Bowel movements and bleeding.
I think this is really bad. It has just come up and now I have lost all energy. Has anyone else experienced tnis? "*****************
"My husband had cyber knife treatment last September 2011, with only mild side effects a week later. Now, more than 6 months later, he is having severe problems. For the last two weeks he has had pain , burning, urgency, and blood in the urine. He was prescribed an antibiotic and flomax for a week, which did not relieve his symptoms. Yesterday we back to the doctor. He did a cistscope to check his bladder, a sonogram, and urine test. He said that husband does not have an infection, and took him off of the other meds, and put him on vesicare. He said that symptoms are a result of the cyber knife surgery last September. He still has all of the symptoms, and cannot sleep because of the pain and having to constantly go to bathroom. Has anyone else had this, or have any advise ? Please let us know, as he is miserable. Thanks
***********************
I am going to quit now. I figure, rather than talk myself, I would let other people speak about their own experience... I hope this is enough to prove my point about variables in ALL treatments.
...rained on my parade! I’d have said “pissed on my parade” but that’s hardly ladylike. BTW, I’m mostly joking. Kinda.
My spouse and I had a consult with radiation oncologist today. The news was a relief that the combined ADT and EBRT are curative in his case. This is after 2+ months of assuming he has bone mets and/or has treatment options limited by comorbidities. The RO was very reassuring about the outcome of 8 weeks of radiation to start after 60 days of ADT. I asked about side effects, both during radiation and long term. Stricture? Only with brachytherapy which he won’t be getting. Both urinary and bowel issues? Peak in early EBRT but are improved after about two weeks. Long term issues with both at less than 1% in his experience. He said the last time he observed chronic bowel issues was during his residency in 1992. Talked about hydrogel to protect rectum as patient’s choice but odds are patient won’t need it.
Hmm... Was he overselling his work? I had promised my brain a break from cancer for a bit so it’s my own fault that I’m reading your anecdotal evidence at 1 in the darn morning. I will revisit the topic though and that’s a good thing. Thanks. I think.
<— a wink.0
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