For prostate cancer the main one of the main survivorship issues is sexual function and that hit across the board whatever treatment modality you're using.
If that is affected it's because of the real estate it's because of the testosterone and also I think one of the main priorities for many of these patients.
So there are a couple of options, I think first thing is just having a frank conversation and helping deal with expectations, helping patients know that this is a common side effect and that it's something that's important to us, for them and we'll be able to manage those side effects as they come up
For many men that you know clear focus on the cancer treatment at the beginning but they want to know what's going to happen after and what an options am I going to have.
We are looking at strategies to protect erectile function and that might either be through how we deliver the radiation dose it might be through using combination modalities that allow us to do lower radiation doses, it might be through strategies of radio protective drugs.
I think that is an area that would for future research that we need to look into. There's also just the general issues of other health issues that come up with these cancer patients as they age and there having had previous treatments folks who are on androgen deprivation therapy have a lot of other health issues like the risk for osteoporosis and cardiac effects weight gain fatigue.
What I'm interested in is looking at you know how to make sure we're activating patients to take care of the rest of their health staying active, exercising, eating healthy and so that really needs to get rolled into other survivorship care plans and how we address survivors needs