About to lock down 28 session IMRT; Side effects?

@jaygk (I had 28 fractions of proton radiation + 6 months of ADT.) My medical oncologist advised me about low libido and ED during radiation treatments, that the key is to continue doing it, despite the “want to” not being there.

Also, perhaps by ramping up my resistance-training and cardio programs to minimize the side-effects of ADT, that might(??) also have had the side-benefit of keeping the blood flowing “down there” as well; I don’t know. Much of what goes on “down there” is about hydraulics so, keeping the blood flowing would seem to be important.

So, I didn’t take the cialis-type medication to promote blood flow; just kept exercising, cardio, and kept doing it.
=========

Another thing to remember is to avoid radiation to the penile bulb —> https://www.icr.ac.uk/news-archive/avoiding-penile-bulb-with-radiotherapy-could-save-men-with-prostate-cancer-from-harmful-side-effects

@jaygk The important aspect of this therapy is to continue to get erections. If you are still getting nighttime erection and are sexually active it probably does not matter. However, Tadalafil 5mg (generic) is cheap and it will not hurt. As long as you are getting erections it does not matter that you did not start this before IMRT. It will be most effective for those that also have ADT and no erections since that will be for 6 months to 2 years. Most radiation ED is caused by vascular damage. That can cause nerve damage due to lack of nutrition and/or fibrosis of the spongy erectile tissue. Scholtz stated that there is no age adjusted increase in ED of patients with prostate radiation after the first 2 years post-treatment. It should not surprise anyone that 80 year old radiation prostate patients have more ED than 60 year old patients that had nerve sparing RT.

To answer your questions: 1) Yes 2) None after ADT ended. I cannot say the Tadalafil worked, but more importantly I cannot say it did not work. Someone tried a study, but it was flawed. There are both ethical and compliance concerns with any randomized study. Would you want to be in the placebo group? If you have ever taken any PDE5 pill you will know if you have the real thing so there is no blind patient group. I just considered this protocol cheap insurance. If not covered by your insurance cash pay from AARP mail (must be member) is $6.36 for 90 days ship included. For 360 days it is $23 from Mark Cuban's Cost Plus ($11 is flat fill & ship so more expensive with short prescriptions).

Thanks. I am not getting ADT. Decipher was 0.19.

Was very active before. Kind of nervous to try. Hope I don’t put too much pressure.

Did your Dr prescribe the Tadalafil?

@jaygk Yes, urologist. I asked and received 90 days with 3 refills for 360 total. This is fairly common medication at low dose so could get it from GP or RO. Tadalafil 5mg is also used as a weak flow improvement agent so can be dual purpose. I was able to drop Flowmax which gave me side effects. Have none with Tadalafil although muscle pain mentioned by some.

How did your radiation treatment go? Any side effects of note?

Not really.

Had to adjust the water day one from 12 to 40 oz. Need to move up to 50 oz today as they said yesterday was a little low. In and out in 20 min after changing.

Was nervous day 1 but getting used to is.

Little tired in afternoon but could just be my imagination.

My wife were active last night. Little nervous …but it worked. In an effort to keep the blood flowing (advice on this site). At the end felt a little weird/different….slightly painful. Wasn’t sure what to expect. But I will press on.

Day 4 today.

The gold markers make the aiming much more accurate and quick. Glad I did those.

Finish 28 sessions of EMRT at the University of Cincinnati today.

Rang the bell!!!!

I can’t tell you how good this feels to be through with this part of the journey.

One of the hardest things was deciding which treatment was right for me. There are many choices and you have to be your own advocate. There are many tests like Decipher and Prostox the doctors may not mention but factor in on the decision as to which treatment. I had consultations with a surgeon, 2 ROs, oncologist, gastroenterologist and a Tulsa Pro RO (wasn’t eligible).

The six week journey was mostly uneventful. One night of urinary urgency, but the Flomax knocked that down right away. Now I only get up once a night, which I think is a blessing.

Number of bowel movements have increased irritating some hemorrhoids but very little diarrhea. I read that this is normal as even with Barigel the rectum can be irritated.

Some fatigue, but I continued to work out every day and play golf.
On the weekends

My initial simulation was done directly after the Barigel and gold fiducials were placed. I must’ve been full of IV fluids and I had a hard time repeating that simulation for full bladder fullness during the first few treatments. A second simulation was done and I had a much easier time hitting the target.

It is such a relief to have made a decision and now I have to be confident that it was the right decision for me. I drove myself crazy with research and determining which treatment was best for me over the last year.

First psa test in 3 months.

Stay strong my brothers.

@jaygk Never been ‘inside’ but when I finished my 25 sessions, it felt like being released from prison.
You just wanna let out a big AHHHH…
Phil

Amen Phil. Amen.