Radiation vs Surgery Gleason 3+4=7, Long Term Side Effects (Cyclist)

@kjacko thanks for your comments

@tactive 🤞👍

Once again I’m sorry you are too young to go through what lies ahead. Everyone is different but don’t make the mistake of I made and not get a second opinion. A big donar friend got me an appointment with a top surgeon at Mass General Boston, he told me if I opted for radiation not surgery and things didn’t go well I couldn’t do surgery. I was also 3+4 so when he told me if it was him he would do surgery, so I canceled my appointment with the radiologist which I regret. Had surgery didn’t get it all so ended up getting 6 weeks of radiation after all. It seems nerve damage has destroyed my sex life which pains me daily, many friends that I know that got only radiation got there sex life back after a year or more , good luck

@graybeard46
While your friends got their sex life back after radiation the fact is that radiation destroys the nerves that allow people to get erection. Well, they can get erections for a while, most people that have radiation lose the ability after a few years. Yes, most that have surgery do lose it right away.

You have options. Cialis can keep the blood flowing. Using a penis pump can get an erection, though it may not be stiff enough for intercourse. Injections of bimix or Trimix Can enable people to get significant Erections. If that doesn’t work, you can always get an implant which have about 90% satisfaction by people that have done it.

@jeffmarc I’m 2 yrs post surgery, tried everything nothing including injections work , few time I got a fair erection I have no feeling at all , my urologist agreed that 79 yrs old an implant wont allow me to feel pleasure so I have given up sadly which has changed my life , I feel like my wife is a roommate not the woman I enjoyed for 42 yrs

@jeffmarc
Most do lose it right away at least temporarily depending on their age at surgery. It does come back with many over an 18 month period with drugs to help with a regular RALP. Now the newer RS-RALP surgical technique is improving on that with many regaining sexual ability fairly quickly and even more so with something like Viagra. I was continent immediately and sexual function returned fairly quickly with Viagra at age 71.

Key Findings on RS-RARP Superiority
Faster Continence Recovery: RS-RARP patients demonstrate significantly higher early continence rates (at 1 week, 1 month, and 3 months) compared to standard RARP, with some studies finding it reduces time to continence by over 80 days.
Improved Sexual Function: Multiple studies and meta-analyses suggest improved preservation of erectile function compared to the standard approach.
Quality of Life (QoL): Due to faster continence and potency recovery, patients report improved QoL scores.
Comparable Oncological Safety: Despite higher visibility challenges, studies indicate no significant differences in biochemical recurrence (BCR) rates between RS-RARP and standard RARP.
Lower Complications: Evidence suggests RS-RARP may lead to a lower incidence of postoperative hernia and similar or lower overall complication rates.
PubMed Central (PMC) (.gov)
PubMed Central (PMC) (.gov)
+6

@wheel1
I should not have left my statement about people losing The ability to get an erection right after surgery, without more of a statement. I must’ve gotten distracted and didn’t go back and read it.

If nerves are spared, they definitely Have a good chance of being able to get one again. Some people are able to get back the ability to get an erection back even without the nerves spared, I could just take time as you say.

Diagnosed at 59; 3+4, though it was called aggressive; non-metastatic and castrate sensitive. I opted for external beam radiation therapy with ADT.

I've ridden a bicycle all of my life, even the recumbent during treatment. Then, after fourteen months of Lupron, just looking at my bicycles makes me tired. I haven't ridden outside at all this year.

Understanding that we all react to the cancer and treatments differently, I would have long discussions regarding the ADT. I stopped "early" because the prospect of getting worse by continuing for the full twenty-four months was overwhelming. I still don't know if I have found the bottom.

Gotta go, my hot flashes continue...

You may have already looked into this, but in case you haven't, I'd like to share something that may be helpful. Not all Gleason 3+4 prostate cancers are the same. Some 3+4 tumors are biologically similar to Gleason 3+3 disease and may be appropriate for active surveillance, while others behave more like Gleason 4+3 or even more aggressive cancers.

A genomic test, such as the GPS test (or another validated genomic test), can provide valuable information about the biological aggressiveness of your cancer. If your genomic score indicates a low biological risk, active surveillance—with regular PSA testing, imaging, and repeat biopsies when appropriate—may be a reasonable option instead of immediate treatment.

@acn25
Sorry you are having such a hard time with the ADT. I am 72, a biker, had RALP 9/25, BCR 4/26 and now am almost done with radiation. Started Estradiol Patch 6/17 instead of Orgyvx or other "traditonal" ADT due to the horrible side effects some people get (including you). I am also on Zytiga/prednisone.
I have some symptoms (pressure in my head that is hard to explain; it makes me tired), but no hot flashes or other ADT symptoms. And here's the thing: biking eliminates the pressure almost immediately. Also, my PSA is now <0.006.
If you are compelled to start an ADT again, you may want to look into the Estradiol patch instead.
Good luck with dealing with your symptoms and I hope you feel better soon.