risk of impotence following RP?
Ron Winter
negative biopsies but PSA 12 and still rising rapidly)
The consultant who would do the operation tells me he has done around 100
ops so far and that of this 100 about 2/3 of his patients are permanently
impotent after the operation.
This seems like a grim statistic to me. I am 56 and currently have a good
(twice a week) sex life.
Is this 2/3 impotence rate typical? Would the fact that I am probably
younger than most and the fact that my equipment seems to be in good working
order make any difference to the risk of impotence? (My consultant says age
makes no difference).
Ron
David L. Casey, MD
Age does make a big difference. Also nerve sparing makes a difference.
Younger men who have "working parts" already and undergo nerve sparing
procedures are less likely to have ED problems afterwards...do I gather from
your post that you're having a RP despite negative biopsies for a PSA
elevation only? I would perhaps seek a second opinion on that decision
(IMHO).
Best of luck.
David L. Casey, MD
Denton Urology
Denton, Texas USA
http://www.dentonurology.com/
This communication is intended to provide general information, and in no way
is a substitute for face-to-face medical care. No implication of a
doctor-patient relationship should be assumed by the reader.
Sorry, but no questions or requests answered by private email.
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Ron Winter
has risen from 7 two yrs ago to 13.2 at the last test ). Two of the guys who
responded to my earlier posting had similar experiences but only got
positive biopsies when their PSA got to 14 and 15. Based on these slender
statistics I geuss I should expect my next biopsy to be positive.
Hartfox
up cancer than the basic PSA assay.
Although my husband who is also considering RP is 43 years old, the post-RP
numbers we've heard from three surgeons in NYC are pretty good -- 70-80% of
their patients have the same potency as before surgery -- and the numbers go to
90-95% when Viagra is added. Of course, it depends on whether -- and how much
-- of the nerve bundles they can leave intact.
I also suggest you read Patrick Walsh's book on Prostate Cancer.
Good luck.
Ben Fairbank
As one who had an RP at an age earlier than yours and had ED postoperatively,
let me give you my own personal point of view. You may or may not agree, but
at least it is probably worth thinking about. If you DO have PC (and a
positive biopsy must be regarded as definitive, if you have one), and do not
have it treated, you will probably succumb to it. That, in my opinion, is the
standard against which alternatives should be judged. Death versus everything
else. If you eventually have a positive biopsy, you must then decide whether
you will choose surgery or other treatment mode(s). As a young sufferer you
will probably be counseled toward surgery. Now, the question becomes whether
the penalties in quality-of-life are too great a price to pay for the
prolongation of that life. I will ignore the question of incontinence, since
you specifically raised the question of impotence. If, and I emphasize that it
is a question of IF, not WHEN, you have successful surgery and find that you do
have an impotence problem, you must now consider the possible remedies. There
are five that I know of, and may soon be one or two more. Surgically implanted
protheses, injections to induce an erection, inserted tablets to achieve the
same end, vacuum devices, and medications such as viagra. While there is no
absolute guarantee that one of these will be successful, the odds are awfully
good. Considering that the negative effects of death are, by concensus,
considered to be pretty powerful, the risks of impotence seem relatively
manageable. Unfortunately you must not count on a sex life equivalent to that
you had before surgery, but on the other hand nor must you consider yourself
consigned to the concupisencial limbo that postoperative PC patients found
themselves in ten or twenty years ago. In short, I believe your choices,
should you in fact turn out to have a positive biopsy, are
life-without-teenage-sexual-prowess, or
lack-of-life-in-which-case-sexual-prowess-is-of-questionable-relevance.
Ben F. (If replying by email, please delete the .antispam)
In article <7fo2aj$svs$1...@quince.news.easynet.net>, rewi...@easynet.co.uk
says...
David L. Casey, MD
b...@texas.net.antispam (Ben Fairbank) wrote:
(snip)
> You may or may not agree, but
> at least it is probably worth thinking about. If you DO have PC (and a
> positive biopsy must be regarded as definitive, if you have one), and do not
> have it treated, you will probably succumb to it.
(snip again)
I don't agree. It is true that many men do succumb to PCa (prostate cancer)
as it is a major cause of death and morbidity in and of itself. However, the
statement that every man diagnosed with PCa will probably succumb to it is
far from true. The statement does not take into regard the age and
concomitant medical status of the patient and may be misleading to older or
"sicker" men. I'll agree that for a younger or healthier "older" man the
impetus to treat diagnosed PCa is greater than in older or more frail men,
but the fact remains that we really don't know exactly what the cutoff is for
age and the treatment decision...probably there is no strict cutoff as
chronological age doesn't always (or maybe rarely) matches "physiological"
age. A rule of thumb is that we should select men for "curative intent"
therapy who would be expected to have a survival of 10 years or greater from
all potential causes of death. Another thing we must consider is that no
study has ever definitely shown that active "curative intent" therapy has
resulted in improved survival, though many health care professionals who
treat PCa believe this will probably be borne out with further study. Food
for thought, and I wish everyone the best of luck.
David L. Casey, MD
Denton Urology
Denton, Texas USA
This communication is intended to provide general information, and in no way
George Conklin
Ben Fairbank <b...@texas.net.antispam> wrote:
If you DO have PC
and do not
>have it treated, you will probably succumb to it. That, in my opinion, is the
>standard against which alternatives should be judged.
No, you should judge it against the facts, which show no
such thing at all. That is just your own personal opinion.
George Conklin
David L. Casey, MD <dlc...@my-dejanews.com> wrote:
>In article <1K9W2.18352$95.6...@news2.giganews.com>,
> b...@texas.net.antispam (Ben Fairbank) wrote:
>
>(snip)
>
>> You may or may not agree, but
>> at least it is probably worth thinking about. If you DO have PC (and a
>> have it treated, you will probably succumb to it.
>
>
>I don't agree. It is true that many men do succumb to PCa (prostate cancer)
>as it is a major cause of death and morbidity in and of itself. However, the
>statement that every man diagnosed with PCa will probably succumb to it is
>far from true. The statement does not take into regard the age and
>concomitant medical status of the patient and may be misleading to older or
>"sicker" men. I'll agree that for a younger or healthier "older" man the
>impetus to treat diagnosed PCa is greater than in older or more frail men,
>but the fact remains that we really don't know exactly what the cutoff is for
>age and the treatment decision...probably there is no strict cutoff as
>chronological age doesn't always (or maybe rarely) matches "physiological"
>age. A rule of thumb is that we should select men for "curative intent"
>therapy who would be expected to have a survival of 10 years or greater from
>all potential causes of death. Another thing we must consider is that no
>study has ever definitely shown that active "curative intent" therapy has
>resulted in improved survival,
In short, the sad state of statistics is that you are
completely correct: intent does not indicate any progress.
Cutting into a tumor does not root out the cause of the
tumor, nor its final result. The reason why all treatments
for breast cancer yield equal results is that none of them
are much of any good. Just today they finally figured out
that removing lymph nodes affects the progress of that
disease not at all in any way. We are 20 years from similar
research on prostate cancer, but I think you figure out what
the results are going to be.
David L. Casey, MD
I have great respect for Mr. Conklin but I think he's overly pessimistic. My
statement if read carefully will suggest that current treatment isn't doomed
to failure...in fact a number of men treated with curative intent DO have
successful outcomes. I do admit that _current studies_ do not show a
survival benefit to curative intent surgery or other therapy, but the fact is
that PCa screening has changed the time horizon on when we discover PCa in
many and the fact remains that in this slow growing tumor, we may not be able
to fully know how our efforts effect survival for many years because these
studies by definition require a long time to complete (they essentially
require cohorts of men treated and NOT treated to live out their "natural
lives" until death occurs from cancer or other reasons) and in essence not
enough time has passed to really fully evaluate claims pro or con...frankly
no one knows one way or the other what will be the outcome.
The only caution I urge is _NOT_ to blindly accept therapeutically nihilistic
arguments face value as treatment MAY (I emphasize this) impact survival in
the long-term scheme of things when all is said and done...the fact is we
simply do not know YET, and YET is the operative word. I appreciate Mr.
Conklin's opinions, and certainly we all know how controversial this topic
is...I am not the most "pro-surgical" urological surgeon around and certain
believe in very careful selection of men with PCa in terms of whether
aggressive treatment should be undertaken, but I also like to make sure a
balanced argument is put forward lest some lesser initiated individuals who
may lurk here or seek information here misinterpret such statements as Mr.
Conklin's as infallible fact...my statements are not infallible and neither
are Mr. Conklin's. Neither of us are "experts" in prostate cancer (in the
strictest sense).
I wish everyone the best of luck. I wish we had perfect answers, but we
don't. Time will tell, I hope...What can one do? Well, I don't know if the
study is still ongoing (it should be) but if anyone newly diagnosed has a
chance to participate in the PIVOT (Prostate Intervention Versus Observation
Trial) then I encourage them to do so. This is a long-term study that will
hopefully help to answer this question someday...
Best of luck to all.
David L. Casey, MD
Denton Urology
Denton, Texas USA
David L. Casey, MD
(snip)
> Cutting into a tumor does not root out the cause of the
> tumor, nor its final result.
(snip again)
Again not to be overly critical, but such statements as "...cutting into a
tumor..." taken in the context of the quoted sentence above serve to
illustrate an obvious anti-surgical bent on the part of Mr. Conklin. I again
do not advocate surgery for every single case of PCa, nor was the initial
argument just about surgery, but also concerned radiation therapy and all
other currently available forms of "curative intent" therapy. A radical
prostatectomy is intended to be a treatment for clinically localized prostate
cancer, and as such the hope is that the entire cancer can be excised with
margins such that no tumor cells are left at the margin of the specimen. A
radical prostatectomy is not a procedure that "cuts into a tumor" by design,
although positive margins do occur. I guess my primary criticism is that
such language is a subtle (or perhaps not so subtle) illustration of a post
of one who wishes to instill in readers (likely due at least partially to an
a priori conviction on his part) his opinion that surgical or other curative
intent therapy has no value whatsoever and is useless despite the fact that
the literature doesn't support conclusively his negative statements. Again,
so as not to be misinterpreted, the literature doesn't show conclusively any
survival benefit YET, but there are some studies that do show that curative
intent therapy can have an effect on some parameters that may be early
indicators of positive therapy effect (such as delay in development of PSA
recurrence in treated patients versus observed patients).
The other portion of the post indicates that Mr. Conklin expects knowing
"what causes the tumor" to somehow impact therapy once the malignant change
has occurred...I'm not sure how to answer this except to say that I fully
believe that if the tumor can be prevented, then that's wonderful--but this
has to happen before malignant histologic change occurs--sorry if that sounds
redundant, and I'm sure there's an oxymoron in there somehow. Many
discussions have been put forth regarding diet, supplements, tomatoes, etc.,
in the arena of "prevention" but so far the studies making these suppositions
are either poorly done or lacking in good evidence based scientific method
(largely, and IMHO) and I still don't know how this impacts a tumor already
diagnosed...I do not think we have any human malignant tumor that we can
coerce to "regress" to a benign nature via these "preventive" measures, and
the track record with alkylating and other cytotoxic chemotherapeutic agents
in PCa have been dismal likely due to the long time it takes for a PCa cell
to complete its cell cycle (rapidly dividing cancer cells such as testicular
cancers and hematogenous cancers like lymphoma and leukemia have responded
best to chemo due to the fact that they have rapid cell cycles, and thus
these agents have more 'opportunities' to attack the cells when they're
actively dividing and propagating).
In any event, I truly appreciate such a civil and stimulating discussion with
Mr. Conklin, and I expect this thread to continue. Best of luck to all and
enjoy your weekends!
joe connelly
seeds implanted and almost one year afterwards, if we
have sex once per month its lucky.
The Doc's put me on the pump and at first it works, now
it doesn't work well at all.
joe c.
Ron Winter wrote in message <7fo2aj$svs$1...@quince.news.easynet.net>...
Doug
groups. I don't know of one person who has had a Radical who has a
USEABLE erection. I think the urologists say that if your penis rises
up to "4 o'clock," they consider it to be an erection, even though you
can't do anything with it. Some serious, detailed studies about post
radical impotence are in order.