Gee, Steve...  I think Alan's statement is pretty accurate and includes
sufficient qualifiers.

The effects of radiation do not stop when the last treatment is applied or
when the last PCa cell commits suicide or fails to replicate itself.  People
who tan themselves brown all their lives often find they've caused
themselves cancer 20 years later.  My SIL had a benign tumor radiated 20
years ago and is now suffering from white and gray matter loss, is in a
nursing home and may live another 10 years with her brain continuing to
decay.  How many Heroshimans and Nagasakians (and U.S. Airmen) died 20, 30
and 40 years after exposure?  Radiation is great stuff, but personally I
worry what will happen to me in 2023 if I'm cured of PCa.

However, there is a caveat to the ADT story.  If one is on it for many
months, sometimes the effects are long lasting and sometimes permanent.

Steve,

I was thinking of the following kinds of side effects:

1. Damage to the tissues around the prostate.

See the recent thread on "Seeding and Rectal Radiation Burns".

As part of my one year followup, my radiation oncologist did a
proctoscopy and I watched the image in real-time on the video
monitor.  He showed me the damage to the rectal wall, and the
smooth tissue of the rectum as it appeared beyond the range of
the x-rays.  He told me that sort of damage was normal.  It hasn't
caused me any pain or bleeding, but other people have apparently
gotten worse cases than I have and have seen such problems.

Bladder damage has also occurred in some patients.

2. Impotence.

I came through radiation with potency largely intact.  I think it has
suffered some, but it's hard to tell for sure since I'm getting
steadily older too (darnit!)

I was told going into radiation that impotence was a real possibility
and, apparently it has happened to quite a few radiation patients.

3. Bladder or bowel incontinence.

I believe the incidence of bladder incontinence is much, much
lower than for RP, but it is not zero.  Bowel incontinence is not
zero either.

4. Increases in risk for secondary cancers - mainly of the bladder
or rectum.

The increased risk is apparently small, but again, non-zero.  I
believe that you and I had a discussion about that some time
ago and I found some citations for it.

In raising these issues, I'm not trying to scare people away from
radiation.  In my personal view, radiation poses fewer risks than
surgery - which is why I chose it.  The risk of incontinence is
far less.  The risk of infection must be close to zero.  The risk of
serious blood clots must be near zero (a friend of mine almost
died from this after an RP).  The risk of some kinds of damage
to peripheral structures is less - another friend of mine has lost
feeling in a large part of one of his legs after surgery - at Johns
Hopkins no less!

I think it's very important for patients to understand that all of the
treatments for prostate cancer, certainly including surgery,
radiation, and chemotherapy, do great violence to the body.  ADT
can do significant damage as well - as witnessed by those of
us who have had joint damage after ADT.

I believe that every man should choose his treatment with his
eyes wide open, understanding that he's taking significant risks
with any treatment.  If nothing bad happens to him - that's great.
If something bad does happen, at least he won't feel, as so
many men do, that they were blind-sided by the after effects
and made their treatment choices without understanding what
could happen.

   Alan

Gee, man, don't go getting testy on us. It has nothing to do w/ my
"sensabilities" or "pointing out [your] error" - it has everything to
do w/ the quality of advice you will get here: post garbage and you
will get garbage. Incredible as it may sound, every now and then there
are guys who post here who do not know the difference between a <.1 and
.1, which, of course, is fundamental. Although we are indeed laymen, if
anyone wants decent advice they need to be as "clinically perfect" as
they can be because many of us have dealt w/ this long enough to know
that the devil is often in the details.
Although it is rare, some days I do not check the group so you are
generally on your own. And I'm not taking the bait in your sig. Good
try, though.      

Bill Denton
RP 2/12/02
PSA .93
Memphis

Don't sweat it. Some of us appear foolish most, if not all, of the time.

I.P.