The reality of sex after radical prostatectomy.
Posted , 8 users are following.
I am 54 and I've just been diagnosed with prostate cancer. It's Gleason 7 (4+3) and I think T2A. right lobe.
I am told that surgery is the best option
The current consultant says that I have a 60% chance of ED even with Viagra after surgery because he can only save the nerves on one side. However I am speaking to a more advanced clinic who may be able to save both sides.
I am imagining that sex is going to be at best a rigmarole after surgery and probably not hugely satisfactory. But can anyone tell me otherwise?
0 likes, 46 replies
PiersCV
Posted
Thanks oldbuzzard
I've got an appointment to see a leading surgeon on Monday who does HIFU.
Is FLA suitable for people with a lot of cancerous tissue? Because I seem to have a lot!
PiersCV
Posted
Okay, so I am currently assessing my options. As I understand it they are as follows:
Have I missed anything?
barney34567 PiersCV
Posted
There are plenty of options, each with its own likelihood of success. Do not focus on the side effects of treatment, focus I suggest on how successful a treatment can be. That way, if you need more treatments, you will need the least amount of treatments.
oldbuzzard barney34567
Posted
I disagree strongly here. Side effects can be horrible and make the life you save much less worth living. And the difference in the results between many of them is minuscule. Prostate removal is literally a percentage point or two better than radiation, with much more chance of permanent side effects and a long recovery that includes diapers, often for months - yet any urologist will call it the gold standard. And in a way it is - it guarantees that they get their share of gold.
If you are a candidate (you're borderline from what I understand) for FLA, do that. Start by seeing an international radiologist. No permanent side effects and a quick recovery. If not, do radiation. Your 5 year outcome is virtually identical between the two - so do the seeds if you aren't an FLA candidate.
barney34567 oldbuzzard
Posted
Sorry I may have poorly expressed myself. I meant that YES there are side effects, some bad some more than bad. But I did not mean that if the price to pay is as you write "side effects so horrible and make life...less worth living" then that is a price worth paying. Not at all. As some say, "if the cure causes more trouble than the disease, then give me the disease".
Your comment on gold is spot on!
kenneth1955 PiersCV
Posted
PiersCV
Men that are looking into BPH procedure and Cancer have to do there research before they pick a procedure.
At 54 you have to decide if you can live without sex. Doctor do not care about your sex life they feel that a side effects are worth the procedure. You have to look into anything you can. Maybe a simple Prostatectomy would be better. They would go through the bladder and remove the prostate and this way none of the nerve bundles would be touched. There are many way it can be treated you just have to fined one that has the lease amount of side effects.
I'm 64 and for me I have been looking at many ways to get rid of prostate cancer if I every get it. And I for one will not do anything that will mess up my sex life or any of my function.
Good luck to you. Think before you do anything.....Ken
PiersCV
Posted
I am currently looking into options that don't involve RP.
Given that I am probably T3A with Gleason 7 and its a high volume tumour what are
my options?
oldbuzzard PiersCV
Posted
Possibly (but not likely) FLA, otherwise some wort of radiation. But before you do any thing, ask about 5 year and ultimate survival with your number vs watchful waiting. Often (but not always) the difference is minor.
PiersCV
Posted
A friend of a friend is one of the leading RP surgeons in the UK. He says that with the stage and Gleason score of my PCa anything but surgery is high risk.
My PSMA PET is clear aside from the tumour though.
PiersCV
Posted
So I went to see one of the UK's best known surgeons this afternoon. He does HIFU and robotic surgery.
He says the tumour is too big for HIFU and the cancer is too high risk. He says I need a RP and quickly because I have only just caught it in time, it is also growing quickly. I suggested after Christmas and he said, "no, before the end of November.
He says he can only save the nerves on one side and at best I have 50/50 of ED.
He also seemed quite concerned about the pathology of the tumour.
According to him, any focused therapy is a bad idea because the tumour is too large. If the tumour were smaller he would do HIFU or recommend other focused treatment.
PiersCV
Posted
By the way he says I will only lose 0.5 inches of length because my prostate is small.
PiersCV
Posted
OK, well, I had a RARP 8 weeks and 2 days ago. I am now sans prostate. Prostateless. I am deficient in the prostate department to the tune of one. I have all my nerves on one side and 50% on the other.
Continence is not bad. I am not wearing a pad right now. Things seem to have come together quite well and over the course of a single day, unusually. In the morning I was leaking, in the afternoon I wasn't. This was the first day back at the gym, so maybe I regained "muscle literacy".
I'll put a pad in tonight as I plan to have a couple of beers. Or three.
The one thing I cannot do is fart. If I try to pop one out I tend to pee myself. So now I pass wind like a lady - sitting on the toilet.
But the big question, what of my sex life?
I am pleased to tell you that I am having erections like a nineteen year-old and I am currently considering a second career in porn.
I'm kidding. I can get an erection with the use of Viagra or equivalent, but it's a bit of an effort and it tends to fade in and out. I have managed to have penetrative sex 1.5 times, but it was not brilliant.
In pursuit of a more immediate solution for bedtime antics I am, this afternoon, collecting a vacuum pump. Let's see how that goes.
In terms of how things look and perform - I appear to have lost no penile size at all. In full flight I am the same as I was before this whole malarkey began. I cannot, or course, ejaculate. However, sometimes fluid other than urine seeps out after orgasm. Other times urine seeps out, if my bladder is not completely empty. I am given to understand that the semen now ends up in the bladder and could be, if necessary, recovered should I require it.
Orgasms are different. I miss the sensation of ejaculation, though the actual orgasm seems longer. With practice maybe things will improve and I'll have as good an experience as I used to, but in a different way.
So far, so good, then. I am going for a PSA test in about ten days, so if you'd all please say a prayer to your god for me. I have a hunch that if I require no further treatment I will probably regain a reasonable sex life. However, hormone or radio therapies could yet FUBAR the situation should they become necessary.