Terry: our numbers were the same

[Guest guest]

> While I was looking for something else (on keloid scars, actually)

I came

> across this study, published in 2001, which I think is of interest

in the

> light of recent threads concerning surgery and other treatments.

>

> THE DEVELOPMENT OF ERECTILE DYSFUNCTION IN MEN TREATED FOR PROSTATE

CANCER

>

> TIMOTHY SIEGEL; JUDD W. MOUL; MARIANNE SPEVAK; W. GREGORY ALVORD;

RAYMOND A.

> COSTABILE ; Ian M. Jr. From the Urology Service,

Department of

> Surgery, Walter Army Medical Center, Washington, D.C.,

Department of

> Surgery, Center for Prostate Disease Research, Uniformed Services

University

> of the Health Sciences, Bethesda and Contemporary BioStatistics,

Silver

> Spring, land, and Urology Service, Department of Surgery,

Madigan Army

> Medical Center, Tacoma, Washington

>

> THE JOURNAL OF UROLOGY 2001;165:430-435

>

> ABSTRACT Purpose: Erectile dysfunction is a common side effect in

men

> treated for prostate cancer. Previously published studies document

the

> incidence of erectile dysfunction in men treated for prostate

cancer to be

> between 20% and 88%. To our knowledge a prospective evaluation

focused on

> the development of erectile dysfunction in men treated for prostate

cancer

> has not elucidated components of its chronology or risk factors.

>

> MATERIALS AND METHODS: A centralized prospective database of 2,956

patients

> diagnosed with prostate cancer at a single institution was studied

in regard

> to pre treatment and post treatment erectile dysfunction. Of these

2,956

> patients 802 had sufficient information regarding erectile function

and

> comprise our study population. Factors analyzed in regard to

treatment and

> erectile dysfunction include treatment modality, that is radical

> prostatectomy, external beam radiation therapy and watchful

waiting, and

> ethnicity, patient age, clinical stage and tumor histological

grade.

>

> RESULTS: No significant difference was noted in the post treatment

erectile

> function between patients treated with radical prostatectomy or

external

> beam radiation (10% versus 15%). Patients selecting watchful

waiting had the

> lowest risk of erectile dysfunction. Clinical stage and race were

> significant predictors for the development of erectile dysfunction

in the

> watchful waiting and external beam radiation treatment groups.

>

> CONCLUSIONS: Erectile dysfunction develops in greater than 80% of

patients

> treated for prostate cancer. External beam radiation has the same

risk for

> erectile dysfunction as radical prostatectomy.

>

> Here are some extracts from the study:

>

> <snip> " Previous studies on potency after radical prostatectomy

have shown

> greater ability to preserve potency in younger patients with low

stage and

> low grade prostate cancer. Our study did not reveal a significant

difference

> in the development of erectile dysfunction in patients receiving

external

> beam radiation or radical prostatectomy based on age, clinical

stage or

> pathological grade. " <snip>

>

> <SNIP> " The low postoperative potency rates in our study

population reflect

> an honest assessment of sexual morbidity in a large, tertiary,

university

> backed, residency training program with multiple staff and resident

> surgeons. Of the patients 61% underwent a unilateral or bilateral

nerve

> sparing procedure according to the prospective data sheet completed

by the

> surgeons immediately postoperatively. Patients selecting watchful

waiting

> had the greatest chance of preserving potency at our institution

> (seefigure). The incidence of erectile dysfunction after watchful

waiting

> followup (17% decrease in potency) is similar to that in an age

matched

> population without known prostate cancer. Patients who elect

nonnerve

> sparing radical prostatectomy or external beam radiation therapy

should

> expect a high incidence (greater than 85%) of erectile dysfunction

after

> therapy. <SNIP>

>

> Although Kathy suggested that posting material like this might

serve to

> frighten newly diagnosed men and turn them away from potentially

beneficial

> treatment, I believe that all men should understand these issues

and be

> presented with data such as this.

>

> All the best

>

> Terry Herbert

> in sunny Kalk Bay, South Africa

> Diagnosed `96: Age 54: Stage T2b: PSA 7.2: Gleason 3+3=6: No

treatment. June

> '04: TURP. Sep '04 PSA 7.45 fPSA 42%

> My site is at www.prostatecancerwatchfulwaiting.co.za

> It is a tragedy of the world that no one knows what he doesn't

know, and the

> less a man knows, the more sure he is that he knows everything.

Joyce

> Carey

[Guest guest]

Hi there,

I don't know about the courage issue - it is said that the line between

foolhardiness and courage is a very fine one. But to answer your questions:

1. <snip> What did your doc say?<snip> I saw four doctors here in South

Africa, one in Australia (we had lived there and I was back on a business

trip soon after being diagnosed) and four in the USA. All said that I

should have surgery. On my return to South Africa I finally found an

oncologist who, while not exactly agreeing with what I proposed to do, said

that he learned something about cancer every day, so he couldn't say I was

wrong. And then I finally found an MD who had branched out into alternative

medicine who agreed wholeheartedly with what I was doing. After five years,

during which time I saw no doctors, my wife's concern drove me to a friendly

urologist. He agreed to examine me without any reference to previous medical

reports (which I thought was very noble of him) and suggested that I see him

on an annual basis since there was nothing alarming. He was quite surprised

when I handed over my file of reports, but didn't change his recommendation.

2. <snip> Have you had any symptoms of PC?<snip> Well, normally there are

no symptoms, until the disease is well advanced, or, rather, if there are

symptoms, they could be caused by many other problems, other than PCa. In my

case, the BPH (Benign Prostate Hyperplasia) with which I was diagnosed four

years before the cancer diagnosis began to cause more and more urinary

problems, so I had a TURP (Transurethral Resection of the Prostate) earlier

this year, which relieved those symptoms. The material recovered from the

operation showed quite a large volume of adenocarcinoma with a Gleason Score

of 3+3=6 and some tertiary foci of Gleason Grade 4. Other than that I have

had PSA tests at appropriate intervals, keeping track of my potential

doubling time, my fPSA levels and the like. Although PSA tests have their

limitations, mine show no sign of progression.

3. <snip> Does it worry you? Maybe you are not the worrying type, as I

am.<snip> I assume you mean my decision here? NO it doesn't, in the sense

that I don't sit here every day wondering if I did the right thing eight

years ago. I was much more worried in the first few months and years after

diagnosis, especially as I was told repeatedly that I was stupidly

wrong-headed. One doctor told my brother I had three years to live - five

tops. As time went by and I passed the first of these predicted hurdles, it

got a little easier, but like virtually every man I have ever communicated

with, it is always an uneasy time when it is time for my PSA test. Of course

I am concerned from time to time, especially when I get twinges in my joints

and bones and wonder if this is metastasis. But then I have had lower back

pain for over forty years: I had a knee reconstruction forty one years ago

and have had pain in my knees from time to time ever since: so those are the

more likely cause of twinges (plus growing a bit older!) than PCa

metastases. But I think you touch on a key issue here. My paradigm, the way

I look at life, has always been to take calculated risks. By that I mean

that I do not see my decisions as being a gamble, but rather an assembling

of all the information I can find on the issue I am to decide on, processing

that as best I can and then doing what seems best for me. That is what I

did, and have been doing ever since. I have learned a good deal in the past

eight years, from some very well informed people on this and other Lists. I

never stop learning, because I know that I know so little, and every time I

learn something new, I re-evaluate my decision to see if it is still

appropriate.

No matter what I learn in the future, no matter what happens to me, I will

have no regrets about the decision I made. It may turn out that it was not

the best decision for me, but I know that we cannot live in the past. What

was done was done. I feel must live for today and not be fearful of the

future - it may never get here.

Incidentally, if you are interested in my story it is on my You Are Not

Alone Now - www.yananow.net site, together with those of a number of men who

have chosen a variety of the options available (click on the Experiences

Link) and also on my Watchful Waiting site,

www.prostatecancerwatchfulwaiting.co.za

All the best

Terry Herbert

in sunny Kalk Bay, South Africa

Diagnosed '96: Age 54: Stage T2b: PSA 7.2: Gleason 3+3=6: No treatment. June

'04: TURP. Sep '04 PSA 7.45 fPSA 42%

My site is at www.prostatecancerwatchfulwaiting.co.za

It is a tragedy of the world that no one knows what he doesn't know, and the

less a man knows, the more sure he is that he knows everything. Joyce

Carey

Terry: our numbers were the same

--- In ProstateCa

I noticed that your PSA and Gleason scores are or were the same as

mine, and I admire your courage to forgo the surgery that I had

earlier this year.I knew there was a chance it would not spread, and

maybe it would not have. But I am not much of a gambler (except with

my career but that's another story). Have you had any symptoms of PC?

Does it worry you? Maybe you are not the worrying type, as I am.

Well, I hope your good fortune continues. What did your doc say?

[Guest guest]

> Hi there,

>

> I don't know about the courage issue - it is said that the line

between

> foolhardiness and courage is a very fine one. But to answer your

questions:

>

> 1. <snip> What did your doc say?<snip> I saw four doctors here in

South

> Africa, one in Australia (we had lived there and I was back on a

business

> trip soon after being diagnosed) and four in the USA. All said

that I

> should have surgery. On my return to South Africa I finally found

an

> oncologist who, while not exactly agreeing with what I proposed to

do, said

> that he learned something about cancer every day, so he couldn't

say I was

> wrong. And then I finally found an MD who had branched out into

alternative

> medicine who agreed wholeheartedly with what I was doing. After

five years,

> during which time I saw no doctors, my wife's concern drove me to

a friendly

> urologist. He agreed to examine me without any reference to

previous medical

> reports (which I thought was very noble of him) and suggested that

I see him

> on an annual basis since there was nothing alarming. He was quite

surprised

> when I handed over my file of reports, but didn't change his

recommendation.

>

> 2. <snip> Have you had any symptoms of PC?<snip> Well, normally

there are

> no symptoms, until the disease is well advanced, or, rather, if

there are

> symptoms, they could be caused by many other problems, other than

PCa. In my

> case, the BPH (Benign Prostate Hyperplasia) with which I was

diagnosed four

> years before the cancer diagnosis began to cause more and more

urinary

> problems, so I had a TURP (Transurethral Resection of the

Prostate) earlier

> this year, which relieved those symptoms. The material recovered

from the

> operation showed quite a large volume of adenocarcinoma with a

Gleason Score

> of 3+3=6 and some tertiary foci of Gleason Grade 4. Other than

that I have

> had PSA tests at appropriate intervals, keeping track of my

potential

> doubling time, my fPSA levels and the like. Although PSA tests

have their

> limitations, mine show no sign of progression.

>

> 3. <snip> Does it worry you? Maybe you are not the worrying type,

as I

> am.<snip> I assume you mean my decision here? NO it doesn't, in

the sense

> that I don't sit here every day wondering if I did the right thing

eight

> years ago. I was much more worried in the first few months and

years after

> diagnosis, especially as I was told repeatedly that I was stupidly

> wrong-headed. One doctor told my brother I had three years to

live - five

> tops. As time went by and I passed the first of these predicted

hurdles, it

> got a little easier, but like virtually every man I have ever

communicated

> with, it is always an uneasy time when it is time for my PSA test.

Of course

> I am concerned from time to time, especially when I get twinges in

my joints

> and bones and wonder if this is metastasis. But then I have had

lower back

> pain for over forty years: I had a knee reconstruction forty one

years ago

> and have had pain in my knees from time to time ever since: so

those are the

> more likely cause of twinges (plus growing a bit older!) than PCa

> metastases. But I think you touch on a key issue here. My

paradigm, the way

> I look at life, has always been to take calculated risks. By that

I mean

> that I do not see my decisions as being a gamble, but rather an

assembling

> of all the information I can find on the issue I am to decide on,

processing

> that as best I can and then doing what seems best for me. That is

what I

> did, and have been doing ever since. I have learned a good deal in

the past

> eight years, from some very well informed people on this and other

Lists. I

> never stop learning, because I know that I know so little, and

every time I

> learn something new, I re-evaluate my decision to see if it is

still

> appropriate.

>

> No matter what I learn in the future, no matter what happens to

me, I will

> have no regrets about the decision I made. It may turn out that it

was not

> the best decision for me, but I know that we cannot live in the

past. What

> was done was done. I feel must live for today and not be fearful

of the

> future - it may never get here.

>

> Incidentally, if you are interested in my story it is on my You

Are Not

> Alone Now - www.yananow.net site, together with those of a number

of men who

> have chosen a variety of the options available (click on the

Experiences

> Link) and also on my Watchful Waiting site,

> www.prostatecancerwatchfulwaiting.co.za

>

>

> All the best

>

> Terry Herbert

> in sunny Kalk Bay, South Africa

> Diagnosed '96: Age 54: Stage T2b: PSA 7.2: Gleason 3+3=6: No

treatment. June

> '04: TURP. Sep '04 PSA 7.45 fPSA 42%

> My site is at www.prostatecancerwatchfulwaiting.co.za

> It is a tragedy of the world that no one knows what he doesn't

know, and the

> less a man knows, the more sure he is that he knows everything.

Joyce

> Carey

>

> Terry: our numbers were

the same

>

>

>

> --- In ProstateCa

>

>

>

> I noticed that your PSA and Gleason scores are or were the same as

> mine, and I admire your courage to forgo the surgery that I had

> earlier this year.I knew there was a chance it would not spread,

and

> maybe it would not have. But I am not much of a gambler (except

with

> my career but that's another story). Have you had any symptoms of

PC?

> Does it worry you? Maybe you are not the worrying type, as I am.

> Well, I hope your good fortune continues. What did your doc say?

[Guest guest]

As my signature line, and my story, say I was 54 at diagnosis - 62 now.

All the best

Terry Herbert

in sunny Kalk Bay, South Africa

Diagnosed '96: Age 54: Stage T2b: PSA 7.2: Gleason 3+3=6: No treatment. June

'04: TURP. Sep '04 PSA 7.45 fPSA 42%

My site is at www.prostatecancerwatchfulwaiting.co.za

It is a tragedy of the world that no one knows what he doesn't know, and the

less a man knows, the more sure he is that he knows everything. Joyce

Carey

Terry: our numbers were

the same

>

>

>

> --- In ProstateCa

>

>

>

> I noticed that your PSA and Gleason scores are or were the same as

> mine, and I admire your courage to forgo the surgery that I had

> earlier this year.I knew there was a chance it would not spread,

and

> maybe it would not have. But I am not much of a gambler (except

with

> my career but that's another story). Have you had any symptoms of

PC?

> Does it worry you? Maybe you are not the worrying type, as I am.

> Well, I hope your good fortune continues. What did your doc say?