New York Times article "On sex After Prostate Surgery, Confusing Data"

Today's New York Times has an article in the Science Times section addressing current research on ED after prostate surgery.  The article cites a recent study by George Washington University and New York University that shows that fewer than half of men who had surgery felt their sex lives had returned to normal within a year, in comparison with the standard statistics cited by many physicians that 97 percent were able to achieve an erection adequate for intercourse.  The article notes the ambiguity of what constitutes "adequate for intercourse," and suggests that the more optimistic prognosis only creates unreasonable expectations, especially if one is lead to believe that one will be able to acheive an erection without chemical assistance.  According to Dr. Jason Engel at George Washington, the "adequate for intercourse" definition is misleading, and the better question is whether a man can have sex when he wants to, withor without drugs like Viagra.  According to Dr. Engel, only 47 percent of men who had robotic prostatectomy were able to have regular sex under that revised definition.  Not exactly an overly positive article (assuming the newer research is borne out by other studies), but I think most of us would  rather have a realistic understanding of our chances of recovery and whether we will be dependent upon ED drugs forever.

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Puget

I posted a link to the article earlier today "Prostate Cancer in the News" earlier today for anyone interested in reading it...Tim

I would be only too happy to end up using Viagra, if that's how the cards are dealt. Most of us would end up using it anyway, even if we didn't have the surgery since age is never too kind to the whole process.

I was heading there anyway. Viagra was fun. Made you feel 19 again. Ask the guys who have real ED and can't get an erection no matter what. I'm sure they would be thrilled if all they had to do was take a pill.

My cup is half full in this area. I'll be grateful for whatever I get!

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In the many responses to the article in the NY Times, one lady asks (I paraphrase) "Since prostate cancer usually strikes men in their late 40's & upward, Why are these men still interested in sex after 30 years or so of having sex?"

As a matter of fact I have asked myself the same question for months now.  It seems I should just be happy I had such a great time.  Why can't I just let it go? 

Basically, there are three reasons, I think.  (1) I started experimenting with it at a very young age (I think I was 10 at my first orgasmic experience.  I think most boys discover it quite young) and (2) I started experiencing it in a very loving relationship with my wife many years ago (I think I was twenty-smething...She was/is the first and only...and we waited until we got married).  (3)  It also feels really good, even in old age.

I am not willing just yet to say let bygones be bygones.  I am still alive... as we all are on the forum...and so is my wife. So I would like to keep having these wonderful experiences with my lovely... and I would like to hold my pee pee so I can do it without getting it all over her.  What's wrong with that?  But I am sure I am "preaching to the choir" on this forum. 

There.  I was arguing with myself and I think I won the argument.   

Based on my own experience and the comments of people on this site and others, I think the article correctly portrays the reality of sex after surgery. 

Many doctors "sugar coat" the sex issue with their patients.  I don't know if that is a service or not. The question comes down to "returned to normal".  Even younger men who have regained some sexual function admit that it is "different" than before surgery.

I blame the doctors who did not tell the truth.  My urologist kept saying "If you are motivated, we can find an answer for you".  The answer so far is NO.  It is not the same, it is not as good and in my case can only be accomplished with a shot.

 

The NY Times tells the truth. 

No question that for all of us, the priorities are (1) cure the cancer, (2) regain continence and only then (3) restore potency. For me, anyway, that does not lessen the importance of (3) and the depressing effects of not yet having achieved a "full" recovery. I agree that the sugar-coating does patients a disservice. I have wondered if drs are concerned that if they are more honest with patients still in the deciding stage, some might opt out of surgery for watchful waiting. I've asked my dr several times whether I can expect to regain "spontaneous" erections without drugs. His only answer so far is "It will be better with Viagra." Is that a yes or no? If the NY Times article is correct, it looks like a 50/50 proposition.

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Puget

My truths and my concerns:

Thanks, Marc, for your candid response. Does your dr offer any time frame for possible unassisted erections?

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Puget

Puget - Thanks.  Time frame up to two years..

I too think that a great disservice is done to PCa patients. I more or less had the feeling that my chances of recovering erectile function was excellent, but now realize that the surgeons and radiologists I spoke to glossed over that aspect of things, and my experience has been nothing like what I imagined in that area. I would go so far as to say I've had some depression as a result, and would have much rather had a better sense of what was likely to occur. The suggested new definition of erectile function after treatment is better than the typically used adequate for intercourse B.S.

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____________________

Prostate cancer diagnosed: May 15, 2006 (age 40)
Gleason score: pre-surgery 3+3=6; post-surgery 3+4=7
daVinci radical prostatectomy: July 25, 2006
size of tumor: approx 1.1 inches; negative margins from surgery

- number of pads/day at 3 months after surgery: 3 to 5
- number of pads/day at 4 months after surgery: 1 to 2
- number of pads/day at 6-12 months after surgery: 0 to 1

- 1st post-surgery PSA: 0 (Nov 2006); 2nd post-surgery PSA: 0 (Feb 2007)
- 3rd post-surgery PSA: 0 (May 2007); 4th post-surgery PSA: 0 (June 2007); 5th post-surgery PSA: 0

The search for timber: took Viagra/Cialis approx. every other day, ErecAid once a day, injections. Peyronie's diagnosed 7/5/07. Now on daily Cialis, L-arginine and pentoxyfylline. Peyronies has stabilized and significantly reversed.

- PGE1 batting average: .364 (4 for 11)
- Bimix batting average: .583 (7 for 12)
- Trimix batting average: .500 (1 for 2) Grand total 12 for 25 = .480

"Lost in the valley without my horses, no one can tell me what my remorse is..."

Very interesting data from that article... I agree, I prefer to get the most realistic understanding that I can of my future prospects. I don't feel my surgeons 'sugarcoated' the discussion in this area, but maybe glossed over it a bit.

Reading some of your posts on this thread has, once again, been enlightening, and maybe even a little encouraging.  My response above on this thread was more or less an emotional one and a reactionary one to some lady's postings about the above mentioned article (where is that link?  I can't find it.  I wanted my wife to read it.  Would someone post it again?)

Geon I am about your age and had the open surgery about the same time you had your DaVinci.  I visited with an ED specialist earlier this week.  It was an enlightening visit.  For one thing, he prescribed a quad-mix instead of a tri-mix.  I have not tried it yet, but hope to tonight.  I know the erection induced in his office was not what I had hoped but he seemed estatic estatic about it.  He said, "You can poke with that."  Well, yes, I can, but I know it will not be like old times.  After he saw it he wrote out the quad-mix prescription, so maybe I'll even have a better one tonight. 

I've read your words (and others) like "my wife has to support me for it to stay in", etc.  Every time I've had the drug-induced or pump-induced erection, it's only been 80% (that's what the specialist called it earlier this week).  I have only completed penetration four or five times and every time it's been difficult to penetrate and difficult to stay in.  I guess hoping for the old erection will not happen.  When I decided to start working on the ED problem, I was under the impression that the injections would produce a lifted-up, hard erection like the pre-surgery days.  I asked him how come it did not lift up the way it used to and he told me there was some kind of ligament that was related to or attached to the uretha which is severed in robotic or open surgery.  So I guess those of us here will never have that "stand up straight" thingy while we are standing on our feet.

I have just about decided that incontinence is going to be a way of life for me the rest of my days, so I might as well adjust to it.  I really get jealous when I read that someone has gone dry after only a few weeks.  But I am glad for them...but a little jealous too. 

The few times I have been intimate with my wife since the surgery, I have used a condom.  But that has caused a "binding" and subsequent pain which of course was not very encouraging.  I have driven by a condom store many, many times driving back and forth to work asignments and finally decided to stop and see if condoms came in larger sizes (I was told years ago by a druggist that "one size fits all."  I was happy to discover that this store had large, larger, and largest (is there anyone who really has a thingy that big???)  I settled for the large.  I'll attempt to try it out tonight, too.  It appears to be much thinner, too, than what I've purchased at Wal Mart.  I am hoping for more sensitivity and a little more freedom inside the condom.  Wearing a condom seems to be the only way to keep my sweet dry. 

Sorry for the rambling.  If someone could post the link to the NY Times article again, I would appreciate it.

Gene

Gene,

May I ask why the ED specialist switched you from trimix to quadmix?

Marc

May as well put the link in this thread... www.nytimes.com/2008/01/15/health/15well.html?ref=health

Gene, you are lucky to still need the "large" condoms. Pre-surgery, I was in the "larger" category, but the surgery caused me to lose a couple of inches in length (another disappointment). Interesting to read about the ligament thing too, I had never heard that.

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Prostate cancer diagnosed: May 15, 2006 (age 40)
Gleason score: pre-surgery 3+3=6; post-surgery 3+4=7
daVinci radical prostatectomy: July 25, 2006
size of tumor: approx 1.1 inches; negative margins from surgery

- number of pads/day at 3 months after surgery: 3 to 5
- number of pads/day at 4 months after surgery: 1 to 2
- number of pads/day at 6-12 months after surgery: 0 to 1

- 1st post-surgery PSA: 0 (Nov 2006); 2nd post-surgery PSA: 0 (Feb 2007)
- 3rd post-surgery PSA: 0 (May 2007); 4th post-surgery PSA: 0 (June 2007); 5th post-surgery PSA: 0

The search for timber: took Viagra/Cialis approx. every other day, ErecAid once a day, injections. Peyronie's diagnosed 7/5/07. Now on daily Cialis, L-arginine and pentoxyfylline. Peyronies has stabilized and significantly reversed.

- PGE1 batting average: .364 (4 for 11)
- Bimix batting average: .583 (7 for 12)
- Trimix batting average: .500 (1 for 2) Grand total 12 for 25 = .480

"Lost in the valley without my horses, no one can tell me what my remorse is..."

Geon, You first, then StrictlyInc...

I did not ask the doc why he switched and he didn't really say.  But here's what I think:  I told him about my difficulties in really getting hard enough to easily penetrate.  So he injected me and came back in about 15 minutes.  He used whatever medication he kept in his office.  It probably was not quad-mix. 

It got up to I suppose about 80% (It didn't "stand up", mind you) and I think by the time he came in it had gone down just a little.  He felt around on it (very professionally) and indicated I should be pleased with it, but that he thought he could help me do better.  One thing I have not mentioned here is that I do have diabetes.  It did not hinder me prior to surgery and my sugar numbers have never been real high.  When I mentioned that to him, he felt again, especially around the base and said that he could feel some ________ (I can't remember the word he used, but it was in reference to the sugar problem).  He said (which I did not know) that it did not matter the stage of diabetes.  All diabetes causes erection problems.  He then said, "I really think you were headed for problems with erection whether or not you had surgery."  That was a shocker.  So maybe the quad prescription instead of the tri was related to that. 

StrictlyInc,

Thanks for the link again.  I really want my wife the read the article.

Well, yes, I am thankful I didn't lose any size.  Or at least I don't think I did.  I don't exactly understand why one would lose size with the surgery, but I guess it has something to do with shortening the uretha.  I had never heard the ligament thing either and can't help but wonder if he was just redirecting my focus for the "lift" or if it is a fact.  Has anyone else ever heard that before?  I suppose it does not matter, except I've read several here mentioning theirs did not stand up like old times either.

Gene

Maybe your lack of lift relates to your size. As for why surgery causes length to be lost, my understanding is that it is related to snipping the urethra. Plus, I think the Peyronie's I developed from injections also caused some shortening. Prior to surgery I was told I could lose around 15% of length. I was also told using the pump can bring it back, which I haven't really seen.

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____________________

Prostate cancer diagnosed: May 15, 2006 (age 40)
Gleason score: pre-surgery 3+3=6; post-surgery 3+4=7
daVinci radical prostatectomy: July 25, 2006
size of tumor: approx 1.1 inches; negative margins from surgery

- number of pads/day at 3 months after surgery: 3 to 5
- number of pads/day at 4 months after surgery: 1 to 2
- number of pads/day at 6-12 months after surgery: 0 to 1

- 1st post-surgery PSA: 0 (Nov 2006); 2nd post-surgery PSA: 0 (Feb 2007)
- 3rd post-surgery PSA: 0 (May 2007); 4th post-surgery PSA: 0 (June 2007); 5th post-surgery PSA: 0

The search for timber: took Viagra/Cialis approx. every other day, ErecAid once a day, injections. Peyronie's diagnosed 7/5/07. Now on daily Cialis, L-arginine and pentoxyfylline. Peyronies has stabilized and significantly reversed.

- PGE1 batting average: .364 (4 for 11)
- Bimix batting average: .583 (7 for 12)
- Trimix batting average: .500 (1 for 2) Grand total 12 for 25 = .480

"Lost in the valley without my horses, no one can tell me what my remorse is..."

I've never heard of a ligament removal as part of the procedure or as the cause of a less than upright erection. I just thought it was because the blood leaks out, a temporary condition that can improve over time. If it's due to removal of part of the structural components, I wonder if other ligaments or muscles can compensate?

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Puget

Interesting about the ligament thing.  Anyone else here aware of the details?  Most I have spoken with who have injection success indicate really good erections, which I assume means upright and hard.

I am still working on my aim...lol....but sure hope for something at least close to "normal" in hardness and uplift.

Feedback?

Thanks for bumping this -- appropriate in view of the other impotence statistics thread we have going. There are many interesting comments on the NY Times article here: http://well.blogs.nytimes.com/2008/01/14/sex-after-prostate-surgery/

Like you, I have never heard of the ligament thing. But after some reading, I think they would be the ligaments that ....

[Remainder deleted to comply with forum rules]

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Age 63. Other than cancer, in good health; BMI 20

I'm really glad to see this article. Our doctor, althought we think he is good, didn't explain this to us before surgery. Its been the one question we have wanted to ask...will there a be a day that there will be no mention of pills, pumps, shots or whatever...just the good ole days? My husband woke up, walked around and went to sleep with erections. He was always ready and able, now there is hardly anything to work with. I know its been a short time for us but its really confusing as to know what is next. We have a strong marriage and I know it will all work out but I do wish the doc had been more open so we didn't have to turn to the internet everytime we had a question.

We are only using Viagra right now but thats so expensive that he can't take it everyday. 6 pills are $40.00 with insurance. Better than alot of people have but still hard for us to afford. No mention yet from our doctor for anything else. He seems to think we won't need it. We go back Tuesday for first PSA and there will be alot of questions this time.

Again, I know its only 1 month since cath removal but seems like an eternity. Kent had the Perineal and is completely healed other than the ED. Only uses a pad when going out "just in case". There has been no real dribble for awhile.

Just my thoughts. Kinda makes me sad there isn't more out there about the ED part. Would have helped us alot to know this ahead of time. I didn't know to turn to a forum like this in time for these questions.

My best to all

Cindy

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Age 51 Kent Cindy 49

Cindy,

Many here use alldaychemist.com for Viagra and similar meds......MUCH cheaper than in USA.

It is your business, of course, but I would suggest that your husband consider a medically approved pump and injections fairly soon if Viagra is not doing the trick alone.

Best wishes to both of you.

DanMan

Thank you, Danman,

I went to the site at one point but was worried about buying from them. It seems that alot of people do though so we will probably try it. I had changed my signature but it hasn't come up yet. Kent had full erections at first although not usuable. Now its not so good. We are going to talk to the doc on Tuesday especially about the pump and shots. Do the shots just last for one time? I guess this is all stuff we will find out. Has the pump helped you? So many questions...
Thank you again for responding and I will let all know about his psa as soon as we get it.
Cindy

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Age 51 Kent Cindy 49

Cindy,

I am not yet having unassisted erections, but studies have indicated that using the pump and/or injections leads to a higher eventual success rate for return of so-called natural erections (frankly, just using Viagra would be considered quite "natural" enough for me.  Would love to get to that point.)

When I began using the pump, my penis had been inactive for about 3 months.  It did not even look like its old self while in a flaccid state.  After using the pump for a while, it looks more like the old, pre-surgery penis.  More important, it is getting better blood flow from the pumping, which helps protect the internal tissues.  I try to pump daily.  Some here such as JamesC and Piano pump a couple of times a day, I believe.  Pumping is a chore...not painful but not erotic either....but I feel it is someting I need to do consistently.

Most urologists and studies seem to believe that injections are even more helpful as therapy than the pump.  In addition, injections cause erections, usually within 10-15 minutes of injection....and yes, one injection = one erection.  I am still experimenting to find the best formula for me, but have had some 80% erections with low doses when I hit the target area correctly.  Doctor gave me a tip Friday on using a more reliable injection technique, so I expect to find the right dose/formula for me soon, once I get a better aim...

The injections sting a little bit, but when using small insulin needles, it is not really bad.....just the thought of injecting one's self there is a bit troubling...lol.

My urologist believes strongly in using Viagra (or Cialis, Levitra), a medically approved pump (my insurance paid for most of the cost of mine) and injections......not one vs. another.......so I am using them all.  He is of the "use it or lose it" school of thought.

Hope this helps a little bit.

This information is a BIG help! Thats what I needed. Someone to tell me like it is. I've read so much on here, it all runs together sometimes. But to have it explained as you have, will make a difference when we go to the doctor. This way I know what to ask and to go on and get the pump ( if the insurance pays cause I hear its expensive). The injections sound scarry. I don't know if Kent could do it to himself and I think he would probably run from me if I tried. :)
Thank you for your straight forwardness. Thats the best way I handle things, no matter how hard it is to take sometimes.
You have been wonderful.
Cindy

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Age 51 Kent Cindy 49

My surgeon was up-front (pun intended !!) about the risk of impotence following surgery and advised me that it can take up to 2 yrs, but then he presented me with statistics from their practice that looked at my age group being in the 80th percentile and higher at the end of the first year. This may well be the case, however, at almost 9 mos out it will do good to cross the finish line at the 12 month mark given the current rate of progress, slow but steady. The surgeons are proud of their great statistics but some revert into pitching the "numbers game" to the prospective patients. I have no complaints with my guy at all, I am continent, which is a blessing, and showing steady progress with the ED. The office is very supportive and encourages aggressive tx to fill in until the return of natural activity.

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46 you when diagnosed, now 47
Pre-Op PSA 9.9
1 of 12 cores positive, Gleason 3+3
DaVinci on 9/5/2007
Post-Op Gleason 3+6, Negative Nodes and Margins
Less than 1% of prostate involved with CA
3 Month PSA 0.01, 6 Month PSA 0.01
Incontinence resolved 9/15/2007, one day after cath removal
ED showing significant improvement.
Cialis 5 mg every night.
Success with BiMix