Survivorship: Managing Side Effects and Living Well

Phillip Koo, MD [00:00:00] Tell us how often you should expect adverse events after surgery and what you could do to minimize those adverse events. I’m gonna ask Dr. Vapiwala the same and then Damon, I’m going to have you close us out for tonight, so Jim. 
 
Jim Hu MD, MPH [00:00:13] Sure, absolutely. So, I think, and this kind of gives insight into those who are shopping around or consulting different surgeons. So, if your surgeon is spending a lot of time talking about there’s a risk of damage to the rectum or there’s a risk of bleeding and needing transfusions, if you’re seeing someone good, you should be aware of those risks, but those things happen very few and far between, right? So the main thing that I tell people, erectile dysfunction is probably your biggest risk because, again, with modern techniques, with prostatectomy, where you’re sparing, you may even introduce the term radical, but as we’ve done this more, I think as good surgeons have done this, more you realize you only just want to move the prostate and be as gentle with all the other structures and leave him intact. And so, if you’re doing that, we’ve shown with more contemporary techniques that overall, regardless of age, all comers, the preservation of erectile function should be around 70%. You know, that again, some people will say, oh, that’s much higher than, you know, the 40% that’s published in some studies, but it’s important to realize that there’s multiple steps of this operation and everyone does those steps differently. 
 
Phillip Koo, MD [00:01:20] Great. I think that’s a great point, you know, it’s not a commodity, it’s a skill set and people have different techniques. Dr. Vapiwala, similar question, adverse events and what you can do to help mitigate that. 
 
Neha Vapiwala, MD [00:01:33] Absolutely, and I want to thank Mr. Vocke for sharing his story, you know, I will just mention, I think there is a common misconception that with radiotherapy that you’re not getting rid of the disease because you’re not removing the prostate, but the goals are still to eradicate the cancer. It’s just the difference is whether you’re leaving a prostate in place, which can have its own positives and negatives, certainly. But the goals for, for clinically localized cancer are absolutely the same there. And when we’re doing that in order to eradicate all the cancer. You know, we’re treating the entire prostate gland just like a surgeon would remove. And we are treating either a portion of the seminal vesicles or all of the seminal vesicles, depending on the concern there. So, depending on what that volume is, and we can also treat the lymph nodes. So, depending how much we have to include in our radiation field may determine what some of the side effects can be. The biggest one really tends to be or most common, I should say, is the urinary urgency and frequency, which I alluded to earlier, because you still have the prostate there and there can be essentially a narrowing of the urethra, which runs through the middle. And so, or perhaps your bladder is not squeezing as well against, you know, against the radiated prostate. And so, you have sometimes just a tendency to not fully evacuate or to feel like you have to go more often than you do. Now that for most patients can be short-lived, but in about 10% of patients over time, and again, this is 10 years after treatment, they’re 10 years older than they were. We already said generally patients that seek radiation oncologists and end up getting radiation tend to be older. And so, by the time they’re ten years out, some of that urgency and frequency, although attributed to the treatment may also, some of it may be background that would have happened anyway. And there are various ways that we try to manage that. On the erectile dysfunction side, again, tends to not be any immediate impact if we’re doing, again, radiation alone, like we typically would for clinically localized prostate cancer. So, without hormone therapy or other things that might affect libido, typically there’s no limitations on sexual activity and there’s real decline or change in erectile dysfunction. Erectile function in the short term, but perhaps two years out, three years out over time, there can be the development of scar tissue and some changes that lead to reports of changes in erectile function that patients now want medication or if they were already on medication, they may need higher doses or other therapies to help with that. Again, one of the biggest factors there is sort of your age and your baseline erectile function when we meet you before we even treat you. So that’s a big consideration. And then in terms of bowel, I think this is where radiation historically and even to this day can cause side effects that you won’t typically see with surgery, but we do have, and again, the biggest one there, in the short term, it might be that you are having more frequent bowel movements. Or actually a lot of my patients might err towards constipation for whatever reason. So that in the short term is not very dramatic. What we keep an eye out for longer term, particularly in patients on blood thinners, you know, heavy doses of blood thinner for their heart is the potential for what’s called radiation proctitis and some painless, typically painless rectal bleeding that can happen off and on in about 1 to 2% of patients. Again, typically, patients with reasons that might cause them to bleed more easily. Thankfully, in many cases, we can manage that with local treatments, with enemas, but occasionally you do need sometimes a laser or something to stop if there’s a particular blood vessel and the patient can’t stop their blood thinners or what have you. So again, it’s about long-term follow-up and managing these patients so that we can address these effects and also making sure they’re not constipated and they’re not straining and they are not putting pressure that might lead them to the bleeding. But again, thankfully these are quite relatively low rates in the grand scheme of the denominator of patients who get radiation for prostate cancer. 
 
Phillip Koo, MD [00:05:59] Great, thank you. So, Damon, last in closing, you’ve shown how you can live well with and after prostate cancer. Give some insights on how all patients can thrive well after going through this journey. 
 
Damon Vocke [00:06:14] Yeah, the first thing I’d like to say is just a shout out to Dr. Vapiwala because although I didn’t choose radiation, my dad had prostate cancer, and he got radiation treatment in his 70s and fully eradicated the cancer. So, it is a viable option, it depends on the patient. So, I want to thank the terrific doctors on the panel for all the work that you do to help people like me get through this process. Many times, quite successfully. So, thank you, whether it’s radiation or robotic or monitoring. So, thank all on behalf of all the patients and survivors on this call. For me getting through it, it’s just discipline in my own experience. It’s get back on your feet as soon as you can, move the body and then keep the mind occupied, spend time on things that you like to do, whether it is reading or watching old movies or whatever it is. Stay engaged with your friends and family and then spread the word. Tell your friends, your male friends, get your PSA checked, stay on top of it because it’s highly treatable. Don’t let it sit and create a problem that was avoidable. But it’s really discipline and it’s both physical and emotional. And you just gotta chin yourself up to dealing with it if you get that PSA and you find out you got a problem. Get the consultations that you need, speak to the professionals, talk to your friends that have had it, and then move forward. And you can live a long life after having prostate cancer. 
 
Phillip Koo, MD [00:07:49] You know those are great closing words and I will say that there are many men who do exactly what you’re doing, and they speak about it and they’re spreading the word and teaching others, and it really is therapeutic for yourself, and it really helps others as well. So really appreciate that. Dr. Vapiwala I know you have your hand up. 
 
Neha Vapiwala, MD [00:08:06] Oh, I don’t even think I meant to do that, but I was going to throw a heart in the chat to Becky’s comment for Mr. Vocke. I think that was beautifully stated in terms of the best way to proceed is to really try to live your best life through treatment after treatment and really engage with all of the support that you have around you, both within your medical team and of course your life beyond that. So, thank you for sharing that. 
 
Phillip Koo, MD [00:08:33] Wonderful, thank you all for sharing your expertise. I know it’s dinner time on the East Coast, so for all of you, enjoy your dinner and thank you, thank you again.