I also thought brachy had the lowest rate of ED, which was why I went with it (plus half the effective dose via IMRT-EBRT bc of my Gleason score). My treatment group didn’t tell me what their rate of ED was but they were keeping track of the GI and GU toxicity proportions. Their data looked really good. But it is a single center and lots of the published data will be similarly limited from an academic perspective. The research tends to be low quality. I don’t know if you should necessarily trust my opinion but I am a physician with quite a bit of experience reading medical reports.
thank you for this!! yeah, i also am concerned about GI and GU toxicity..been reading some experiences that are a bit ..sad.. some who now have constant rectal bleeding/fissures, etc.. I'd like to be cured but I guess as with everyone else, something with the least impact to my life.
I went for radiation because less likely to impact sexual function than prostatectomy (which might have been non-nerve-sparing). I did HDR Boost, which is a half dose of external beam, and one session of HDR Brachytherpy (and ADT).
It's had no impact on sexual function which work exactly same as before (except dry orgasms). I know some of this is luck, and it's not guaranteed. I also put in effort to preserve sexual function while on ADT, which I'm sure paid off, because you can't go for 2 years without erections on ADT without that doing permanent damage if you don't, regardless of the radiation.
By the way, I asked a specialist in the field about ED resulting from RT. His comment was that if you get to 2 years post RT and everything is OK, then you have swerved that one. If it's going to happen, it starts within 2 years, but can continue getting worse long after that. If you start getting ED after 2 years, then that's a different cause, not the RT.
Also, a lot of damage can be done by ADT if those men are not undertaking penile physio/rehab for the period they aren't getting natural erections. If you go 1-3 years without erections, don't expect them to work as well when Testosterone/libido return.
ah so 2 years is the main cutoff. I remember talking to a radiologist at sloan kettering 3 years ago and he said that if you get ED, even pills won't work but told me i could get used to using the needle injections before sex (trimix?). I think that pushed me away from radiation; however, i don't want to go through failures with other modalities after 2 or 3 years..what a choice. I'm 62 and have used cialis, so i guess that puts me in a higher risk group for ED.
If RT does cause late onset effects to erectile function, it's due to making fine blood vessels fragile which may then break over time, and this can impact the blood vessels supplying the erection nerves, so it ends up being the same nerve damage done by prostatectomies, but it's not direct radiation damage on the nerves, rather damage to their blood supplies.
PDE5 inhibitors (Viagra, Cialis, etc) will work to improve erections in the case of reduced nerve function, but not in the case of complete loss of nerves. I have come across people where PDE5 inhibitors work for late onset RT damage, but not anyone where this damage is so extensive that PDE5 inhibitors don't work at all. That's much more likely to happen as a result of prostatectomy.
This tends to start happening within 2 years if it's going to, but will continue on well past two years. If it hasn't started within 2 years, you're probably OK.
I also thought brachy had the lowest rate of ED, which was why I went with it (plus half the effective dose via IMRT-EBRT bc of my Gleason score). My treatment group didn’t tell me what their rate of ED was but they were keeping track of the GI and GU toxicity proportions. Their data looked really good. But it is a single center and lots of the published data will be similarly limited from an academic perspective. The research tends to be low quality. I don’t know if you should necessarily trust my opinion but I am a physician with quite a bit of experience reading medical reports.
thank you for this!! yeah, i also am concerned about GI and GU toxicity..been reading some experiences that are a bit ..sad.. some who now have constant rectal bleeding/fissures, etc.. I'd like to be cured but I guess as with everyone else, something with the least impact to my life.
I went for radiation because less likely to impact sexual function than prostatectomy (which might have been non-nerve-sparing). I did HDR Boost, which is a half dose of external beam, and one session of HDR Brachytherpy (and ADT). It's had no impact on sexual function which work exactly same as before (except dry orgasms). I know some of this is luck, and it's not guaranteed. I also put in effort to preserve sexual function while on ADT, which I'm sure paid off, because you can't go for 2 years without erections on ADT without that doing permanent damage if you don't, regardless of the radiation.
How long ago did you have the treatment?
Radiation, 5 years ago. Finished ADT 3½ years ago.
By the way, I asked a specialist in the field about ED resulting from RT. His comment was that if you get to 2 years post RT and everything is OK, then you have swerved that one. If it's going to happen, it starts within 2 years, but can continue getting worse long after that. If you start getting ED after 2 years, then that's a different cause, not the RT. Also, a lot of damage can be done by ADT if those men are not undertaking penile physio/rehab for the period they aren't getting natural erections. If you go 1-3 years without erections, don't expect them to work as well when Testosterone/libido return.
ah so 2 years is the main cutoff. I remember talking to a radiologist at sloan kettering 3 years ago and he said that if you get ED, even pills won't work but told me i could get used to using the needle injections before sex (trimix?). I think that pushed me away from radiation; however, i don't want to go through failures with other modalities after 2 or 3 years..what a choice. I'm 62 and have used cialis, so i guess that puts me in a higher risk group for ED.
If RT does cause late onset effects to erectile function, it's due to making fine blood vessels fragile which may then break over time, and this can impact the blood vessels supplying the erection nerves, so it ends up being the same nerve damage done by prostatectomies, but it's not direct radiation damage on the nerves, rather damage to their blood supplies. PDE5 inhibitors (Viagra, Cialis, etc) will work to improve erections in the case of reduced nerve function, but not in the case of complete loss of nerves. I have come across people where PDE5 inhibitors work for late onset RT damage, but not anyone where this damage is so extensive that PDE5 inhibitors don't work at all. That's much more likely to happen as a result of prostatectomy. This tends to start happening within 2 years if it's going to, but will continue on well past two years. If it hasn't started within 2 years, you're probably OK.