ED injections question

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Paul in Pa
Regular Member


Date Joined Sep 2008
Total Posts : 23
   Posted 1/2/2009 10:46 AM (GMT -6)   
I started on the prostaglandin injections last month--the ones that are made by the compounding pharmacy. I've had variable success--increased my dose as per my urologist, but have noticed that the dose that works great sometimes at other times requires penile rings to work and lasts barely 30 minutes. Currently i'm at .3 to .4 ml of the double concentrated strength. It seems to me that if i have a partial erection when injecting it doesn't work as well. Just wondered if there are tricks to this to increase the reliability. Also i'm a little nervous about the fibrosis side effect--how do you know if your getting that? can you feel it? How do they treat it if you develop it?
Thanks!
Paul
53 years old
DX 4/08
Radical Prostatectomy 7/29/08
PSA 14 at diagnosis
Gleasons 3+4
Path good--all in gland, nodes negative, margins clear
Nerves spared
Still with some incontinence/pads
Some rare erections with viagra, one good enough for penetration


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted 1/2/2009 11:42 AM (GMT -6)   

Hi Paul

  With the prostaglandin (aka.alprostadil "caverject') you usually have a more potent mix than just the bi-mix. I use the bi-mix because of pain issues with the straight prostaglandin. I will add the prostaglandin to the mix in the future if I need to.  My results have been very good most of the time.  Occasionally when I am tired or otherwise distracted I do not do as well.

I have found that a little "warm up" with the pump helps with a better erection.  However, I was told to not use the pump after the injection. 

I have had some tissue build up.  In my case you can feel a harder vein like ridge on either or both sides of the penis. There is a pronounced curve that seems to increase with the intensity of the erection. My urologist said to just monitor the plaque and to cut back usage slightly.

If you have more questions, I will try to help.


PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06
stage T2A  -  Psa 4.7
Gleason agressive 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8
No extension or invasion identified
Few continence problems
PSA 90 day (-.01)  , (6 month -.01) , (9 month +.02) , (1 year +.02) ( 18 months +.02) (two years+.02)
Using bimix for ED
 
 
 
 
 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 1/2/2009 11:46 AM (GMT -6)   
You mention a compounding pharmacy, but don't say which drug you are using and what the ratio is. Is it Bimix (2 drugs) or Trimix (3 drugs) or even a single one similar to the Caverject? In any case, several guys here have developed the following technique to erection success:

Using a penis pump and rings, PARTIALLY pump up, until just beyond first plumpness, then apply a ring small enough to hold what you got. Prepare the injection, do the injection in the 3 or 9pm position on the penis, midway or so from the head and the body. After injection, leave the ring on for a minimum of 2 minutes, while slowly and very gently massaging the penis to spread the drug throughout the penile cavities. Then remove the ring and continue stimulation (gentle) until a good erection is attained. Don't use the pump after the injection. You will probably find that the firmness is increased with stimulation and that it can be revived with more stimulation, until the drug stops being effective. Never longer than 4 hours, though.

of course, you must first determine what strength and amount of drug that works for you, then follow the course of action that works for you. This takes experimentation and patience. If you can tell us what you are using and how much, we can maybe help you dial it in.
James C. Age 61
Co-Moderator- Prostate Cancer Forum
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 Nerve sparing open Retropubic Radical Prostatectomy
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
Post Surgery PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 1 Year-.02.


GBINAB
Regular Member


Date Joined Apr 2008
Total Posts : 206
   Posted 1/2/2009 2:49 PM (GMT -6)   

Hi paul,

i am a bit surprised your  Uro gave you Injection that early in the recovary process , i would think with open surgery (as i have  done as well ) you  need  at least a year into it ....expecially when you seen some  erections with viagra as your profile posts....natural means of erections such as oral meds or VED would  do good for the long run ...

just wanted to drop in my opinion as i been through that road ..

 

GB

Good Luck smilewinkgrin


April 2007 PSA 8.4 for last 6 months biopsy shows PC 3+3=6
June 13 2007 Nerve Sparing open RP / Dr. Christopher Johnson at St. Francis Hospital NY.
4 days later home for Fathers Day, and Catheter.
Removal of catheter 10 days later , incontinence not an issue, no pads used from the get go.
1 month PSA next to not detected

ED is a longer battle:
1 month out start using occasionally Cialis and 50MG Viagra to promote blood flow with no response.
3 months and 6 months PSA not detected
ED 6 months mark starting with VED therapy and being more aggressive with meds , in addition taking Folgard supplement daily.
April 2008 : 10 month out and start seeing some serious improvements with ED while using Meds and VED , can achieve erections, Mid nights erections almost on a regular basis , and uncontrolled 90 % erections spontaneously.
1 year visit on June 13 2008 woohoooo!!!

UPDATE 1 YAER FOLLOW UP
ED: With Viagra Usable erection for intercourse , AND AT 80% without any medications !!
Fully continent since removal of catheter.
PSA one year : 0.0 as of 6/13/ 2008 BIG Wooohoooooooooo!!!!
 
UPDATE AS OF Dec 2008 (18 months out)
 
PSA  stil Undetectble!!!!
No continance issues!!!!
ED Mostly  getting better  with oral meds and the right woman  = good  sex
80% without any help   and 95% with oral Meds ... 100% with  VED
hope to keep progressing and by 24 months get back to 100% potency  WooooHoo!!!
 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 1/2/2009 3:13 PM (GMT -6)   
GB, my Uro started me on first, Caverject, then Bimix and Trimix at 3 months post catheter, as a part of aggressive rehab therepy. It really isn't uncommon to start around the 3 months mark.
James C. Age 61
Co-Moderator- Prostate Cancer Forum
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 Nerve sparing open Retropubic Radical Prostatectomy
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
Post Surgery PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 1 Year-.02.


apacker1950
Regular Member


Date Joined Nov 2008
Total Posts : 122
   Posted 1/2/2009 4:48 PM (GMT -6)   
I have found if I do a pre-pump before injection that I cannot get a usable erection.  I've tried this a few times to make sure that was the reason for failure.  I get the best results if I roll Mr. Happy between my palms for a few seconds right after injecting then placing pressure on the injection site for around a minute to avoid a hematoma.  This has worked well for me for nearly 3 years now.  Funny how what works for some doesn't for others.  I guess we all just need to experiment until we find what works for us.
 
Good luck and Happy New Year to everyone.
 
Allan
Age 54 at Dx.   Currently 58
Jly 05- PSA 8.1
Sept 05- PSA 10.7
Sept 05- Biopsy revealed 9 of 12 cancerous, Gleason 3+3=6, T2 stage
Bone scan and cat scan showed hot spot on hip bone.
Oct 05- Surgery for bone biopsy.  Pathology showed benign growth, no cancer in bones. Who ever thought I would be happy to only have PCa?
Nov 05- PSA 15.4
Nov 18, 05- Nerve sparing open RP at Huntsman Cancer Center, SLC, UT by Dr. Robert Stevenson. 
Home after 3 days.Cath out at 2 wks.
Incontinence gradually improved for about 3 months to 100% continence.
ED- Tried the big 3 pills with no results
Feb 06- PSA undetectable, Started VED which worked but caused discomfort with constriction rings.
May 06- PSA undetectable, Dr. gave me an Rx for Trimx injections. They work great.  Still use VED on off days without constriction for therapy.
Aug 06- PSA undetectable 
Nov 06, May 07, Nov 07, May 08, Nov 08 - PSA undetectable
ED appears to be perminant but doing great with Trimix.


GBINAB
Regular Member


Date Joined Apr 2008
Total Posts : 206
   Posted 1/2/2009 5:01 PM (GMT -6)   
James C. said...
GB, my Uro started me on first, Caverject, then Bimix and Trimix at 3 months post catheter, as a part of aggressive rehab therepy. It really isn't uncommon to start around the 3 months mark.

I guess some Uros are more agressive than others ....maybe i should have been as well ..
keep us posted
 
Good Luck !!
April 2007 PSA 8.4 for last 6 months biopsy shows PC 3+3=6
June 13 2007 Nerve Sparing open RP / Dr. Christopher Johnson at St. Francis Hospital NY.
4 days later home for Fathers Day, and Catheter.
Removal of catheter 10 days later , incontinence not an issue, no pads used from the get go.
1 month PSA next to not detected

ED is a longer battle:
1 month out start using occasionally Cialis and 50MG Viagra to promote blood flow with no response.
3 months and 6 months PSA not detected
ED 6 months mark starting with VED therapy and being more aggressive with meds , in addition taking Folgard supplement daily.
April 2008 : 10 month out and start seeing some serious improvements with ED while using Meds and VED , can achieve erections, Mid nights erections almost on a regular basis , and uncontrolled 90 % erections spontaneously.
1 year visit on June 13 2008 woohoooo!!!

UPDATE 1 YAER FOLLOW UP
ED: With Viagra Usable erection for intercourse , AND AT 80% without any medications !!
Fully continent since removal of catheter.
PSA one year : 0.0 as of 6/13/ 2008 BIG Wooohoooooooooo!!!!
 
UPDATE AS OF Dec 2008 (18 months out)
 
PSA  stil Undetectble!!!!
No continance issues!!!!
ED Mostly  getting better  with oral meds and the right woman  = good  sex
80% without any help   and 95% with oral Meds ... 100% with  VED
hope to keep progressing and by 24 months get back to 100% potency  WooooHoo!!!
 


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 1/3/2009 1:44 PM (GMT -6)   
I started injections 3 months out with bimix (.5ml) and have had good results so far. I have a little curvature but Dr. cannot feel any fibrous tissue. Some of the guys here notice curvature even without injecting after surgery. One theory is that it develops from the shortened uretha after surgery, another that it is from the shots. Who knows. I inject once a week and the curvature has not progressed at all in the last several months.
Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin (.3cm)
T2C
4/16/08- Started Bi-mix injections 
5/15/08- 1st Post-Op PSA 0.07 Undetectable
8/11/08 -2nd Post-OP PSA 0.02 Undetectable
8/15/08- No more pads as of today  Whoopee!!!
11/13/08- 3rd post-op PSA 0.02 Undetectable


Paul in Pa
Regular Member


Date Joined Sep 2008
Total Posts : 23
   Posted 1/5/2009 7:49 AM (GMT -6)   
Thanks all for the responses!

I use a single medication, a prostaglandin solution made by a compounding pharmacy--not the caverject exactly but equivalent i guess; I assume its alprostadil or something equivalent. I started with the lower concentration but once I got above .5 ml went to the double concentration (10mcg to 20 mcg I assume). I was up to .4 ml of the double concentrated dose when I tired James C.'s advice with a pump, ring, partial pumping, injection, penile massage then off with the ring---what a difference (my wife sends her regards :-) )! Good result lasted almost two hours; was a little uncomfortable toward the end--I'm sure I'll be backing off the dose. I have noticed some discomfort with the prostaglandin but I don't find it too uncomfortable.

Thanks again for the info--
Paul
Paul
53 years old
DX 4/08
Radical Prostatectomy 7/29/08
PSA 14 at diagnosis
Gleasons 3+4
Path good--all in gland, nodes negative, margins clear
Nerves spared
Still with some incontinence/pads
Some rare erections with viagra, one good enough for penetration


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 1/5/2009 8:23 AM (GMT -6)   
I'm glad the pump and inject deal works for you. For a while, it seemed that only Danman Bob , someone else whose name I can't remember and I was having consistent success with it.
James C. Age 61
Co-Moderator- Prostate Cancer Forum
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 Nerve sparing open Retropubic Radical Prostatectomy
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
Post Surgery PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 1 Year-.02.


SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 328
   Posted 1/5/2009 8:28 AM (GMT -6)   
Has anyone gotten this fibrosis, doc never told me about this!!! Told me to do the injections twice a week. What is it, and how can it be fixed if you get it?
Age Dx 37, 7/2008
First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008
Biopsy : 6 out 12 Postive all on right side, Gleason 7 (3+4).
Bone Scan/CAT Scan: Clear 7/2008
Cystoscope: Normal 7/2008
Prostate MRI: Normal 7/2008
Da Vinci Surgery 7/2008
PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
First PostOp PSA 9/2008: <0.01
2nd PSA 12/2008: <0.1 (Different Lab then 1st)
3rd PSA 3/2009
 


carver
Regular Member


Date Joined Jan 2009
Total Posts : 27
   Posted 1/5/2009 8:43 AM (GMT -6)   
I have used Caverject/Edex for a decade. One nerve set spared. Partial erection. When I first started injections I used one half of the 10 mg dose. Over the years I have had to increase the doseage to 90 percent of the 20mg dose. You probably , in conjnction with your doctor, have to increase your dose. Too much can cause a painful erection so you have to increase your dose carefully! Hope this helps!

GBINAB
Regular Member


Date Joined Apr 2008
Total Posts : 206
   Posted 1/5/2009 9:58 AM (GMT -6)   
SHU93 said...
Has anyone gotten this fibrosis, doc never told me about this!!! Told me to do the injections twice a week. What is it, and how can it be fixed if you get it?

Hi Shu , i am not familiar with the symptoms but i know it is good  to continue  penile rehab if by a pump or masterbation and injections , however you are still early in the recovery stage, it took me about 10 months to start feeling some form of usuable erection without any meds.
good  luck and keep practicing
 
keep us posted i would be interested to know more about  this as well
GB
April 2007 PSA 8.4 for last 6 months biopsy shows PC 3+3=6
June 13 2007 Nerve Sparing open RP / Dr. Christopher Johnson at St. Francis Hospital NY.
4 days later home for Fathers Day, and Catheter.
Removal of catheter 10 days later , incontinence not an issue, no pads used from the get go.
1 month PSA next to not detected

ED is a longer battle:
1 month out start using occasionally Cialis and 50MG Viagra to promote blood flow with no response.
3 months and 6 months PSA not detected
ED 6 months mark starting with VED therapy and being more aggressive with meds , in addition taking Folgard supplement daily.
April 2008 : 10 month out and start seeing some serious improvements with ED while using Meds and VED , can achieve erections, Mid nights erections almost on a regular basis , and uncontrolled 90 % erections spontaneously.
1 year visit on June 13 2008 woohoooo!!!

UPDATE 1 YAER FOLLOW UP
ED: With Viagra Usable erection for intercourse , AND AT 80% without any medications !!
Fully continent since removal of catheter.
PSA one year : 0.0 as of 6/13/ 2008 BIG Wooohoooooooooo!!!!
 
UPDATE AS OF Dec 2008 (18 months out)
 
PSA  stil Undetectble!!!!
No continance issues!!!!
ED Mostly  getting better  with oral meds and the right woman  = good  sex
80% without any help   and 95% with oral Meds ... 100% with  VED
hope to keep progressing and by 24 months get back to 100% potency  WooooHoo!!!
 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 1/5/2009 1:30 PM (GMT -6)   
shu93, here's a good read that discusses fibrosis, along with some detailed ed therepy stuff.
palpable-prostate.blogspot.com/2007/08/ed-after-prostatectomy-part-2.html
James C. Age 61
Co-Moderator- Prostate Cancer Forum
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 Nerve sparing open Retropubic Radical Prostatectomy
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
Post Surgery PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 1 Year-.02.


GBINAB
Regular Member


Date Joined Apr 2008
Total Posts : 206
   Posted 1/5/2009 5:51 PM (GMT -6)   

Thanks  JC  tha is  a very informative an helpful  link,

as i said many times i wish  had known pre surgery about this forum , and made  all my  research better , i was  just taking my sweet time  post surgery to let my nerves heal first before i started my Penile Therapy  and  rehab with the VED (at the 6 months mark) not thinking about developing fibrosis or any of the other problems mentioned following a prostate surgery....

 would think if  started ealier in the pocess with rehab it would have promoted  faster recovery from ED as well ... not that i can not acheive  any erections now but i am thinking it might have been of better quality and sooner maybe...( iam reffering to natural erections)

i guess the only  symptoms of fibrosis  would be the fact one can not avcheive a quality erections that lasts for a normal intercourse...my Uro also did not stress the fact of VED rehab early on ..  at present i can get a 100% with the VED and constriction ring   but still  at 90% with oral meds only ... well i guess i shoul get back into   agressive   rehab  now that i am at the 18 months mark , at least up to 24 months... with that said ... (and i quote Piano here  as he said it before ...)   got to go off and run to my PUMP .. lol

 

Happy PMPING everyone ...

GB smilewinkgrin smilewinkgrin

James C. said...
shu93, here's a good read that discusses fibrosis, along with some detailed ed therepy stuff.
palpable-prostate.blogspot.com/2007/08/ed-after-prostatectomy-part-2.html


April 2007 PSA 8.4 for last 6 months biopsy shows PC 3+3=6
June 13 2007 Nerve Sparing open RP / Dr. Christopher Johnson at St. Francis Hospital NY.
4 days later home for Fathers Day, and Catheter.
Removal of catheter 10 days later , incontinence not an issue, no pads used from the get go.
1 month PSA next to not detected

ED is a longer battle:
1 month out start using occasionally Cialis and 50MG Viagra to promote blood flow with no response.
3 months and 6 months PSA not detected
ED 6 months mark starting with VED therapy and being more aggressive with meds , in addition taking Folgard supplement daily.
April 2008 : 10 month out and start seeing some serious improvements with ED while using Meds and VED , can achieve erections, Mid nights erections almost on a regular basis , and uncontrolled 90 % erections spontaneously.
1 year visit on June 13 2008 woohoooo!!!

UPDATE 1 YAER FOLLOW UP
ED: With Viagra Usable erection for intercourse , AND AT 80% without any medications !!
Fully continent since removal of catheter.
PSA one year : 0.0 as of 6/13/ 2008 BIG Wooohoooooooooo!!!!
 
UPDATE AS OF Dec 2008 (18 months out)
 
PSA  stil Undetectble!!!!
No continance issues!!!!
ED Mostly  getting better  with oral meds and the right woman  = good  sex
80% without any help   and 95% with oral Meds ... 100% with  VED
hope to keep progressing and by 24 months get back to 100% potency  WooooHoo!!!
 


mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 377
   Posted 1/11/2009 9:44 PM (GMT -6)   
I've been down this road before, GBINAB is a motivator for all of us ED guys! Every urologist seems to have a different protocol depending on how motivated you are after surgery. I told my urologist I wanted penile rehab after catheter came out on 09/22/08. I do small dose of Viagra daily along with bimix/trimix solutions 2x/wk. Injections are OK but have variable results, sometimes great erections, sometimes not, sometimes TOO MUCH ERECTION like today. I overdid it with trimix today, erection for close to 4 hours. I'm still hope some day natural erections will occur and that's why I go through this process..................prostate CA survivor
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