The reality of sex after radical prostatectomy.

You're right on the line between the high end of medium risk and the low end of high risk. As someone who is very critical of most prostate procedures and thinks they are usually unnecessary, I think you should get some kind of treatment.

That said, I DO NOT think it should be prostate removal. If you are a candidate, FLA is the best option. From what I've read, grade of T2b is OK, T3A isn't, so its borderline. I don't know if they automatically say no if its a close call or not - but its worth finding out. if FLA will, the recovery is quick with no side effects.

If you aren't a candidate for FLA, some sort of radiation is FAR better than prostate removal. Your urologist, who doesn't do radiation therapy will throw out terms like "gold standard", when if fact, the difference in outcomes between removal and radiation is a couple of percentage points. About one in three eventually end up with ED after radiation ( 1-3 yeas later typically) but that can usually be successfully counteracted with Viagara/Cialis. Prostate removal will virtually guarantee that you'll never have an unaided orgasm ever again and leave you with a 40-50% chance of having one 18-36 months later with a pill.

I would start by seeing an interventional radiologist who performs FLA and going from there. Prostate removal is the WORST option with statistically insignificantly better outcomes over less invasive procedures with fewer side effects.

I agree with your comment on prostate removal means never having an unaided orgasm. In my case surgery+RT means 100% of the time ED meds are needed. And that it is very invasive is so true.

Barney

Do you mind me asking, what is life like WITH meds. Are you able to have a fairly normal sex life? Can you get a proper hard erection?

I do not mind you asking at all.

The situation depends on what treatment a person has:

surgery

radiation

androgen deprivation etc

Each treatment causes ED to some degree.

I had all three treatments, so have zero function without meds.

That said, the meds do work but what nobody tells patients is that after surgery the penis is much shorter and ejaculations are dry.

The real question is how worthwhile is sex given the above reality.

That said, if a man has 1 of the 3 treatments then his experience will be better than if he had to endure all 3 treatments.

One more thing:

the erections with meds look the same or better than pre treatment without meds BUT given the dry ejaculation and a smaller penis, sex does not feel anywhere like what it felt before the cancer treatment and so it is not a priority, at least for me.

Thanks.

Reduced size? Which procedure causes that?

Barney

Yes that is true. When they remove the prostate they have to attach the urethra to the bladder. You are going to lose 1 to 2 inch. Doctor do not tell you that because they do not feel you need to know. They tell you don't worry all will be the same.

Most are just trying to get you to have the surgery and worry about things after.

Ken

PiersCV

That would be a ** RADICAL PROSTATECTOMY **

Surgery, because they remove some of the urethra when they remove the prostate.

Ken what you say is true BUT in the interest of FULL DISCLOSURE it would have been the right thing to tell me before surgery. Of course I would have had the surgery with that knowledge, but it is a real shock to discover this after in my case, the RARP (Robot Assisted Radical Prostatectomy).

Robot Assisted in my case.

I'm sorry that they forgot to tell you that. Some doctors do not feel that it is important. I really am sorry. Before any surgery you should know everything that is going to happen

There are other surgery that do the same.

Doctor don't tell you about penile shorting with a stricture surgery (Ureteroplasty ) This happen all the time. There was a guy on here a few years ago that had it happen to him. He had the surgery and the doctor was doing a end to end Ureteroplasty the doctor at the time told him that he will lose 1/2 to a inch he said okay but when the doctor did the surgery he told him that it was worse then he thought and took 3 inches. He has trouble have sex with his wife because it kept felling out.

The doctor have to start telling me everything when you have a surgery it not right to keep anything from the patient.

I hope things get better for you....Ken

Barney that is no more then right. This way you can deal with it.

Ken

Thanks for your feedback. On the plus side, at least I had incontinence for only 3 months, when many guys have it for up to a year and a good proportion have it for life.

When I had radiation they didn't reveal that could make things worse. And it did!

I deal with it by knowing that "it could have been worse". I could have more problems eg regular hot flashes for a long period of time etc

Sorry for that they should have told you but it done know and you just have to move on....

Be safe...Ken

You know, it bemuses me why consultants try to conceal things.

Mine told me that biopsy carries with it a VERY slight risk of blood in the urine. A VERY slight risk of blood in the semen and an almost non-existent risk of sepsis.

Clearly he thought I didn't have access to Google.

Given that I had lots of blood in my urine, and semen and I was hospitalised for three days with sepsis it doesn't make me massively trusting of him as regards surgery!

If he was referring to a trans perenial biopsy then he was close to the truth. But if he was referring to a trans rectal biopsy, then he was not transparent at all.