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
dantec PiersCV
Posted
I know two people who had radical robotic prostatectomies (RRP) done for prostate cancer at Sloan in NYC by Vincent Laudone. They had no ED, and no incontinence starting from day one. I have heard of others who were operated on by local surgeons in Connecticut where I live who ended with both problems.
There are a couple of other surgeons at Sloan who have done thousands of RRP's. Unfortunately there are only a few select surgeons in the world who can be trusted to do this operation properly. If you go with one of them your chances are pretty good.
Samadi in NYC is also supposed to be a top guy on this field.
derek76 PiersCV
Posted
If it is a life or sex situation there can surely only be one choice
kenneth1955 derek76
Posted
Hey Derek
Hope your well. I would pick the one you would think I would....
All the best...Ken
joe34587 PiersCV
Posted
You might consider a focal laser ablation (FLA). They can remove cancers withing 1 or 2 mm of critical nerve bundles without damaging the nerves. I had the procedure for BPH and now have a terrific flow and no ED, no incontinence and no retro. If the cancer is IN the nerve bundle that is more challenging.
The doctor who did mine has done 200+ prostate cancer treatments and 50+ BPH treatments with his 3T MRI-guided laser. He only works on prostates. (Dr K in Houston.)
However it was not covered by insurance and did cost a substantial amount $21K. But at your age of 54 if the cash is available and you can preserve your function maybe worth a look.
Good luck.
Joe
kenneth1955 joe34587
Posted
Hey Joe
Thank you for letting him know about FLA I was just going to send him a PM. I was doing some research and have been trying to see. I thought I read some where that FLA was covered for cancer but not for BPH.
Yes Dr. K is very good and he does care. It may be worth him at least to talk with him. He has done many for cancer.
Take care...Ken
joe34587 kenneth1955
Posted
Hi Kenneth - thank you so much - I think you are right that it is covered for cancer but not yet for BPH.
Joe
oldbuzzard PiersCV
Posted
This is complicated. First, there are other treatments that are just as effective. Your urologist won't tell you about them because he doesn't do them. The best one (posted about by others) is FLA - or focal laser ablation. If you're a candidate, you won't have any sexual issues at all and recovery will be way faster and easier than with prostate removal. Next would be radioactive seeds. They lead to impotence roughly 1/3 of the time, but it takes a couple of years (if its going to happen) and can it usually be overcome with Viagara/Cialis, ect. IMO, its a much better option than prostate removal.
Second, sparing both nerves only gets you to 50/50 on impotence. And you'll never be able to have sex again without a pill. There are better ways to treat this than prostate removal, which is by far the worst way. You have the lowest gleason score that makes treatment advisable - and you're only 54. If you're an FLA candidate and its covered or you can afford it if not - that'd by far the best option. Radiation is #2. I would go see an interventional radiologist. The guy in Houston that someone mentioned is one of, if not the best.
PiersCV
Posted
Guys
Thank you all for your replies.
I am still at the point of only having the information provided by my consultant. However I am a cynical type and realise that I will only be told what suits him.
I am based in the UK, so US surgeons are not appropriate for me.
PiersCV
Posted
I've received the biopsy report today with consultant's comments, which I didn't previously have.
Apparently the cancer is T2b to T3a.
The right lobe is quite comprehensively affected. The left has some areas of Gleason 6.
To a layman it appears that my prostate is pretty much shot.
He says in his letter that the options are surgery or radiotherapy and hormone therapy. I am still going to look into the other options suggested by you guys and particularly Kenneth.
barney34567 PiersCV
Posted
I had RRP at age 51. It was nerve sparing but I need pills for sex as ED is very much part of life.
Your focus should not be on whether you'll have sex or not, but how to minimise treatments. As you ,mention T3a, it's a safe bet that the consultant who wants to perform RRP will thereafer suggest you have radiation therapy as well.
Have you had any scans recently?
kenneth1955 barney34567
Posted
Barney
This is a very hard decision for any man. Of course you want the best treatment but you also do not want to have any problems. It can take up to 3 years to get a erection because the nerve bundles are damage after the surgery. No man at any age if they are sexual active whats to here that.
Having a RRP is enough to deal with but to have radiation do??????
He needs to see if this is the way to go or is there something else that he can to. In the UK there are other option ( Not has many as the US ) He should go and get a second opinion. That decision he should not rush into. Especially if the one doctor tells you that can can only save the one bundle.
I wish that FLA was available in the UK. Tried to see what else was done. There are some other choices and if he could come to the US and do FLA. That would be great Every man is different and he should have what he feels that is right for him. But does he want to give up a part of his life. He will not be the only one affected by his decision his wife or partner will have something to say about it.
Being divorced the decision would only be mine. I have already been looking at different way of prostate cancer treatments. I do not have prostate cancer now but we never know and I have already decided if I get prostate cancer that I will not have any treatment that would effect my sexual function. Erection or ejaculation
They are coming up with a lot of new procedure other then taking out the prostate.
I hope God helps him make the right choice for him because he will be the one that will have to deal with any of the side effects not the doctor he just moves on to the next patient.
All the best....Ken
barney34567 kenneth1955
Posted
I agree, everyone is different and the treatment(s) chosen should reflect this.
Very true your comment on a 2nd opinion. Nobody should rely on just one. But most important is to have a detailed scan to show if the cancer is or has spread. I think getting such a scan is key before getting a 2nd opinion as that will make the 2nd opinion far more relevant.
PiersCV
Posted
I had a bone scan yesterday and await the results.
I am also going to have a PSMA PET scan.
kenneth1955 PiersCV
Posted
Good morning.
Yes you need all the test you can get and see what the first doctor tell you. Then take all your scans and any other test you have gotten and see another doctor for a second opinion.
But what it really comes down to what do you feel you need to do. Because your decision will change your life. You do not have to do anything if you don't want to. It is your life.
All the best.....Ken
barney34567 PiersCV
Posted
Very glad to hear you're going to have a PSMA PET scan. It is very worthwhile.