Do Meds help for non-nerver sparing patients

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Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 3/13/2009 2:21 PM (GMT -6)   
As you can see in my bio, I had non-nerve sparing surgery. I've been practicing with a VED and getting an erection but not hard enough for IC. My doctor didn't prescribe any ED medication so my question is, would ED meds help me get erections fir IC or is that a waste of time?
Age: 67
Retired in 2001 and living in Austin TX.
PSA 3.5 free PSA 11%
Dx 12/30/08
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed on Feb 9th
Surgeon: Dr. Randy Fagin, Austin TX.
Post op Pathology report:
Prostate weighed 57 grams
size:5.2 x 5.0 x 4.9 cm
10-20% involved
Bilateral
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx
Negative margins
Lymph nodes: not dissected
seminal vesicles clean


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 3/13/2009 5:15 PM (GMT -6)   
I think your Doc will give you a prescription when you go back for your first post operative PSA.  From my experience I tried Viagra and all it did was make me feel flushed and not quite right.  I have since used Cialis and it has provided some life although not adequate for IC. 
 
I am almost 10 months out and it is a slow process.  I still have hope of more recovery as time goes on.  I have had success with a VED, but had to use two rings.  It is better than nothing, but is certainly not ideal just from the inconvenience, and some discomfort.  I now use Trimix in conjunction with Cialis and this does the best job.  I have also used Trimix, Cialis, and a VED.
 
The difficulty with injections is getting the dose correct.  You need to start slow because if you get too much it can be painful.  Of course it is not fun to inject, but actually is not near as bad as the mental anguish associated with the injection.  I wish you well.

RB
Age 61 (now 62)
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.01 10/30/2008


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 3/13/2009 5:21 PM (GMT -6)   
As I understand it, oral medications (eg Viagra, Cialis) require some nerve function to do their thing. They work on the blood supply aspect of the erection. With no nerves left, those meds don't function, so I've never even tried them.

However if I ever see any evidence of natural erections, and one year out, I don't -- that would indicate some nerve regrowth, so then I would be tempted.

So my opinion -- probably a waste of time (and money!) now, but don't rule them out in a year or two.

Another option that can work well in the non-nerve-spared are penile injections. Scary at first, but I find the results are well worth-while.
Age 63. Other than cancer, in good health; BMI 20
Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores
7 March 2008, RRP, non nerve sparing
Two nights in hospital; catheter and staples out after 7 days
Continent, no pads needed from the get-go
Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm
6-week and 7-month PSAs: 0
Bimix injections working well 


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 3/13/2009 5:45 PM (GMT -6)   
Thank you guys. I guess that is why my doctor didn't prescribe ED medications. Having no nerves makes their use pointless. I'll stick with the VED for now just to keep the blood flowing every day and I'll try the injections when the time comes.
Age: 67
Retired in 2001 and living in Austin TX.
PSA 3.5 free PSA 11%
Dx 12/30/08
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed on Feb 9th
Surgeon: Dr. Randy Fagin, Austin TX.
Post op Pathology report:
Prostate weighed 57 grams
size:5.2 x 5.0 x 4.9 cm
10-20% involved
Bilateral
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx
Negative margins
Lymph nodes: not dissected
seminal vesicles clean


sterd82
Regular Member


Date Joined Sep 2006
Total Posts : 187
   Posted 3/13/2009 10:19 PM (GMT -6)   

I had non-nerve sparing RP...and follow up radiation.  My doc prescribed Cialis...with no initial response...but after I came out of ht, I found the Cialis worked...not great, but I've gotten usable erections with it.  

Now that's a rare outcome, and I'm a bit younger, but it might be worth a try! 


Sterd82
Age 48 - pre-surgery PSA 39 (at age 45)
Open Radical Prostatectomy 6/9/2006
Pathological Stage T3a, Positive Surgical Margin
Gleason 3+4
PSA rose to .24 in November of 2006
6 month hormone therapy initiated December 1. 2006
36 sessions of IMRT Ended Feb 1, 2007
PSA as of May 25, 2007 undetectable
PSA as of November 29, 2007 undetectable
PSA as of May 14, 2008 undetectable
PSA as of November 25, 2008 undetectable


Bob D
Regular Member


Date Joined Mar 2008
Total Posts : 199
   Posted 3/14/2009 1:43 AM (GMT -6)   
From what I have read over the past year, nerve preservation is required for
proper blood flow to the penis. The nerves can regenerate at the rate if 1/8 inch a
month. So it could take a while. Lets hope you do regain enough function to allow the
meds to help. From everything I have seen and experienced, at least a partial natural erection
is needed for the meds to allow mr. happy smilewinkgrin to fill with enough blood to be firm enough for penetration.
    1. Age 59, psa 4.7 in Jan. 08. Biopsy: one positive sample out of 13. 1% of one sample cancer. Prostate removed on 3/5/08. Open Surgery. Northeast Georgia Medical Center, Gainesville Ga. Nerves spared. Cath out 12 days later. Continence good. No pads needed since 6/10/08. First PSA: Less than 0.1 on 6/17/08. First erection five days post op and have been improving well since then. Full erection now possible (less than four months post op) with the assistance of Cialis.  Post Op Biopsy : No malignant cells in lymph node. Gleason 3=4=7. Tumor on both lobes. Urethral margins/apex free of neoplasia. Right and left seminal vesicles free of neoplasia. No invasion of prostatic capsule of the resection margins are noted by the tumor. Tumor occupies 10 to15% of the prostate gland. Path staging T2c, NO, MX- Group staging II.  Focal areas of perineural invasion by tumor are noted. 80% natural erections and full erections with 10mg Cialis. 9/22/08-Took 10mg Cialis on Monday night, had very usable full hard erection at night, the next morning, and the following Thursday morning, 60 hours after original dose !! Orgasm quality Excellent.!!!!! I am pleased with the progress so far. Married to same wonderful woman for 39 years. She is still beautiful and sexy as ever. A great help in my recovery !!: 3/12/09: Full natural erections with penetration. 10mg Cialis makes them easier to maintain but I have had several med free full erections lately, Yipieeee !!!!!!!

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