Levitra Outcome

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Regular Member

Date Joined Mar 2009
Total Posts : 43
   Posted 6/22/2009 6:03 PM (GMT -6)   
Hi my extended friends, Hope all is well.. Hubby had RR on 02-17-09. Since then, his doctor gave him Levitra which we tried yesterday.. he had a very, very, weak erection,which was not penetrable. Needless to say, we were both dissappointed. My question is, do we still use Levritra hoping that it will work better as time goes on?. Or should we speak to his doctor about Viagra? Husband is 47 years old and in good health. Thanks all.. take care..

Veteran Member

Date Joined Feb 2008
Total Posts : 655
   Posted 6/22/2009 6:30 PM (GMT -6)   

Greetings Snuggleup.  Sorry the results weren't as positive as you would have liked.  It is still fairly soon after surgery so don't let it get you down.  That being said, I would consult with your doctor and ask him what he recommends.  While I wouldn't give up on Levitra after only one try, I would certainly be open to my doc's advise about other possible solutions.

One other thing I would add, and I trust you will take this comment with the spirit intended.  While Levitra works for me, it doesn't work without a lot of stimulation from my wife.  It's not like I take the pill and all of a sudden there it is.  I take the pill and after a few hours to let it take effect there is a lot of manual stimulation required in order to get the desired effect.  I know you are very involved in your husbands recovery as is my wife.  I am eternally grateful for all she has done to insure my progress.

Please keep us posted - it will come around one of these times.  It is a long road and you are still in early stages.  David

Age 55
Diagnosed Dec 2007 during annual routine physical
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 positive with 2 marginal
Gleason 3 + 3 = 6
RRP 4 Feb 08
Both nerves spared
Good pathology - no margins - all encapsulated - Gleason 4 + 3 = 7
Catheter out Feb 13 - wore pad for couple of days - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me

Veteran Member

Date Joined Apr 2008
Total Posts : 847
   Posted 6/22/2009 6:31 PM (GMT -6)   
At this early stage, any kind of erection is a good one. So I suggest persist with the Levitra -- things may well improve. Also it does no harm to try Viagra and Cialis too (not all at the same time!). Some men find a better response with one than another, but there's no way of knowing ahead of time.

It can take up to two years, even longer, to regain full natural erections. Other options to help bridge the gap are the VED (pump) and injections -- bimix or trimix. With some practice you may well find one of those works well.
Age 63 at diagnosis, now 64.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Non-nerve sparing RRP on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
After a learning curve, Bimix injections (0.2ml) are working well. VED also works but we find it inferior to Bimix.

Veteran Member

Date Joined Oct 2006
Total Posts : 626
   Posted 6/22/2009 7:02 PM (GMT -6)   

I do not want to sound negative about the ED drugs but studies have reported in the case of radical prostatectomies ED drugs are only successful for about 30% of the men. My surgeon told me the ED drugs were primarily for penile rehab and should be taken for several weeks to keep the blood flowing in the penis.  When I had become frustrated with no erection from the ED drugs(and I have tried all three) and asked for a prescription for the vacuum pump he told me at the time I would be back for a prescription for injections.  He was right and I have been using injections now for two years plus.  Now I am considering the next step of penile implants.  The point of all this is there are several methods of intervention while waiting for the return of natural erections or in my case moving on to the surgical answer of implants.  You do need to talk to your doctor but he will most likely counsel patience and discuss alternatives.  If your guy can get pass the fear of the injection then you really should consider them.  The injection is almost 100% successful and produces an erection very near normal.  In reflecting on my experience I kick myself for being too slow in moving to the injection.  Good sex is out there you just have to take the leap.


Diagnosed 7/6/06, 1 of 10 core samples, 40%,Stage T1c, Gleason 3+3
Da Vinci on 11/01/06, Catheter out on 11/13/06
56 Years Old
Post Op Path, Gleason 3+3, Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06, 6/25/07, 1/8/08
No more pads as of 1/13/07
Began injections in April '07

Regular Member

Date Joined May 2009
Total Posts : 476
   Posted 6/22/2009 7:47 PM (GMT -6)   
I think a weak erection four months out of surgery is outstanding! Every day it gets a little better as nerves heal. Do try alternatives, including other drugs, VED, injections. The more you use it, the better blood flow is to the nerves and the faster they heal.

It took me about 8 months to even notice any difference with Viagra. I am about 80% now - 12 months after surgery.

Previous 5 biopsies over 4 years negative

PSA going from 3.8 to 28

Father died from PCa @ 78 - normal PSA and DRE

Dx Nov 2007, age 46

PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke

6 rounds of chemo (Taxotere+Avastin)















followed by RRP at Duke (Dr. Moul) on 6/16/2008


Gleason downgraded 4+3=7

  Duke: T2c N0MX, one positive margin

  Sloan Kettering: T3a N0MX, extraprostatic extension, two positive margins

PSA undetectable for 8 months, then









6 Months ADT started 6/12/2009

IMRT to start mid-Aug

Regular Member

Date Joined Nov 2008
Total Posts : 299
   Posted 6/22/2009 8:50 PM (GMT -6)   
I totally agree with Tamu. I tried all three ED drugs for awhile and then went to injections at six months. Wish I would have tried sooner. Caverject or Edex injections will almost guarantee an erection equal to before surgery. The main issue is the alprostadil pain which you don't have with Trimix or Bimix.

I am still taking Levitra and have noctural erections again at 11 months. I get it from ADC as most of the guys do on here. I expect to be on injections for at least another year.
Age 60
PSA 2007 4.1
PSA 2008 10.0
Diagnosed April 2008
Biopsy: 6 of 12 cores positive
Gleason 4 + 5 = 9
CT and Bone Scan negative
Open surgery at Shawnee Mission Medical Center May 21, 2008
Right side nerves spared
Radical prostatectomy and lymph node dissection
Cather removed on June 3rd, totally dry on July 9th
lymph nodes negative
PSA Sept 28, 2008 0.00
PSA Jan 22, 2009 0.00
ED Status- Currently using Trimix, Levitra daily for increased blood flow.
Noctural Erections have completely returned on a nightly basis, same hardness as before.

Regular Member

Date Joined Mar 2009
Total Posts : 43
   Posted 6/23/2009 5:43 AM (GMT -6)   
Thanks all for your response,, David, read you waited a few hours for it to take effect, maybe thats where i went wrong. Hubby took it one hour before we began getting intimate. With alot of stimulation i might add.. :-) Could it be we started to soon. and should have waited longer for Levitra to take its full effect? Thanks all once again for putting my mind at ease.. Take care, GB

Regular Member

Date Joined May 2009
Total Posts : 60
   Posted 6/23/2009 10:41 AM (GMT -6)   

This "erectile issue" is very complex.   The Few, The Proud   -(maybe ex-jarheads?) who don't have ANY issue are indeed the Few and the Fortunate.  I've gotten almost all of my erectile ability back after 7 month post-op, but I worked hard at it.  I'm so tired of that stupid pump!  The O-ring seals have worn, but that's OK, a small amount of vacuum does the job now.

Looking back I realize that there was a lot of psychological baggage involved.  Desire to please my wife created performance anxiety.  The harder I tried, the softer the erection.  The ED meds and the pump get in the way of natural spontaneity.  Sex becomes planned,  like a trip to the dentist.  There was a certain amount of anger - I had never had a problem before.  Butthead Cancer!  All of this short circuits the brain's response to what should be a pretty focused effort  -and normally is!  Most guys think about sex when they are having sex, right?  (A lot of guys think about sex ALL the time).  Your significant other can think of anything she wants (the ironing?) and get away with it.  Not us.  We have to PERFORM.  Anything less suggests ...   well ... we all know what it suggests.

        The pump was the biggest help of all

It created a very useable erection right from the beginning, coupled with ED meds.  It eliminated the fear and anxiety.  With a dependable erection I could focus on the business at hand.    Anger became annoyance, a much less distracting emotion.  Initially, my reaction to the pump was "This is so GAY!"  It was an insult to my masculinity, another insult on top of  the insult of the PCa.  And, whether it contributed to my positive outcome, along with the meds, or the nerves just healed naturally, I will never know.   I used to try without it, still do and it's much better, but finally resigned myself to the inevitable. 

I would go the same route again, why take a chance with something so important?  At the very least, it must accelerate the healing process, and it does provide a temporary band-aid.

My urologist/surgeon pushed the use of ED meds immediately after surgery, and also recommended that I get a pump and begin using it at three weeks post-op.  3X a week.   I still do.  At our last meeting, he said:  "OK, now remove the ring and see if you can maintain a sustained erection once it's there".  Ouch.

  My wife has become addicted to the pump (it IS impressive what it accomplishes, limited only by the internal diameter of the pump cylinder),  and now I live for the day when she says:  "Honey, we don't need that thing anymore" .  That will be the acknowledgement that I have finally beat the cancer, and life has returned to normal.  Besides, who wants to carry that thing with them when they travel?  "Bag Check!"


Veteran Member

Date Joined May 2009
Total Posts : 2691
   Posted 6/23/2009 5:06 PM (GMT -6)   
Great posts on this topic. Keywest pirate said it very well as far as what is going through our brains.

The other thing I might add is what strength Levitra. Sometimes the doctors give minimum doses like 10 mg. May need more Levitra.
Age 58
PSA 4.47
Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09
Nerves spared
0/23 lymph nodes involved
pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.
Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Thankful for early diagnosis, and U.S. healthcare
Living the Good Life, cancer free
6 week PSA undetectable. 

Veteran Member

Date Joined Apr 2009
Total Posts : 990
   Posted 6/24/2009 1:33 PM (GMT -6)   
Figuring out ED drugs can be a considerable task. Each person reacts differently to each drug in terms of effectiveness, time to onset, duration, and unfortunately, side effects. If you find a drug which produces some result ask your doctor about changing the dose. I have noted that many men here are on double the "standard" dose with their doctor's agreement.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3 + 4 = 7
CAT scan 1/09 negative, Bone scan 1/09 negative

Robotic surgery 03/03/09 Catheter Removed 03/08/09
Post surgical pathology report. Lymph nodes negative, Seminal vesicles negative
Surgical margins positive, Capsular penetration extensive Gleason 4 + 3 = 7
At 6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
At 10 weeks: no pad at night -- slight unpredictable leakage day/1 pad.

Regular Member

Date Joined Oct 2005
Total Posts : 489
   Posted 6/24/2009 8:27 PM (GMT -6)   
hey Snuggs ..

Good that your Hub is trying out some Ed Meds. I am just a couple weeks ahead of him since surgery. Have been doggedly cycling thru L, C and V since about 3 weeks out. And using full doses every time. So far nothing to write home about. Maybe some nocturnals, but even those are barely noticeable. This got me to thinking the real reason Docs prescribe lower doses at first is simply one of savings (even tho often the price is the same no matter the dosage). Savings because no matter what dosage you are taking at first it ain't going to make any difference so why waste the full doses, right? But I've got a big stash of these meds and by god I'm gonna use em!

As mentioned elsewhere, don't forget using a VED. I and others have the Encore (with Battery pump). A good way to get usable erections on demand. My wife has become something of a Size Queen since I have been using it since the final result exceeds anything I could get naturally (but too bad it doesn't last longer). So, carry on, carrying on!
Age 58, 195lbs, 6'4", 57 at DX, PSA Aug2008 7 4 ... June2007 4.7 (BPH + LUTS)
Biopsy Nov2008 1 of 12 cores 5%, Gleason 3+3 - Sona showed 140+ cc (110 grams post op) prostate size.
02/03/09 open RRP surgery , Nerve sparing both sides, 1 day in hospital, Day 4 first BM,
Pathology Report: All margins clear - No Invasive spread - no change in Gleason score.
02/18/09 Cath out, passed a 1cm STONE within hours.
Using pump (Encore) daily since catheter out - working good with 2 rings.
04/01/09 Was Oxalate stone -- usually from kidneys -- X-ray Kidneys @ next PSA).
03/06/09 Started Levitra 20mg rehabbing -> no real effect yet (04/01/09) . (Same for Viagra @ 100mg)
04/01/09 PSA <0.1 (And starting Cialis daily @ 5-10mg) -- 04/19 nocturnals finally starting!

Regular Member

Date Joined Mar 2009
Total Posts : 43
   Posted 7/1/2009 6:59 AM (GMT -6)   
Thanks all for your options. At this point we are going to try Levrita again. Hubbys going through all sorts of emotions not knowing if this will be permenant. Neendless to say, I find that we have to work on timing. How do you deal with timing?

Regular Member

Date Joined May 2009
Total Posts : 121
   Posted 7/1/2009 10:21 AM (GMT -6)   
My surgeon, who does a lot of research and testing on ed and leaking and has been doing the inner cooling during surgery, basically said they have made progress on urination, but the ed is still a one year program while the nerves regrow, which takes about a year. He seemed fairly confident it will happen, just not quickly. We will see.
Dx'ed 5/08 one core 2%  out of 12  3+3 gleason
DREs all negative
PSA was in the 3-4 range then jumped to 7
I have the enlarged prostate, on the order of 100cc.  After taking Avodart for 3 months  my
PSA was cut in half.
I did Active S for a year but concluded that I didn't want a life
of biopsies and Uro meetings so we have
scheduled surgery for end of June 09.
Coming up quick.

Regular Member

Date Joined Jan 2008
Total Posts : 276
   Posted 7/13/2009 9:02 AM (GMT -6)   
I am 18 mos out of surgery and the oral meds are a hit and miss thing with me. It goes without saying that as time goes by I become more and more discouraged about the return of natural erections. Injections are a sure thing but doing them kills the moment for us, and then there is that trip to the ER early on that still rings in my memory so I am reluctant because having a priapism drained is NO FUN!! Enough griping, for me the Viagra works best, but also causes the most facial flushing with 100 mg, the Levitra and Cialis 10mg and 20 mg respectively work occasionally, but are unpredictable. My doc says I should be having natural erections and can't understand why I am not, testosterone is at the absolute bottom of normal range, said he wouldn't treat even if lower, so I am quite despondent over it all, oops, said I was through griping, thanks for listening.
46 you when diagnosed, now 48
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, 9 Month PSA 0.01
One Year PSA 0.01, 18 month PSA 0.01
Incontinence resolved 9/15/2007, one day after cath removal
ED showing significant improvement.
Occasional Success with Oral Meds
Success with BiMix

Veteran Member

Date Joined Nov 2007
Total Posts : 598
   Posted 7/13/2009 2:18 PM (GMT -6)   
Are you taking the viagra on an empty stomach? if your stomach is completely empty, you might find that 50mg viagra is enough to do the job and have fewer side effects.
Just a thought.
46 at Diagnosis.
Father died of Pca 4/07 at 86.
1/06 PSA 3.15
1/07 PSA 4.6 (Biopsy 3/07 just suspicious)
10/07 PSA 5.06 (Biopsy 11/07 1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC www.roboticoncology.com
Saved both nerve bundles.
Path Report: Stage T2cNxMx
-Gleason (3+3)6
-totally contained to prostate,
-10% involvement in L & R Mid lobes
PSA 0 at nine months.
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - Took 100mg viagra every night. for several months
Totally usable erections at 10 weeks, which disappeared over the course of a month or two.
ED bounce is what they call it. Now, at one year, ED is fine with viagra.
One year PSA - undectable!

Regular Member

Date Joined Jan 2008
Total Posts : 276
   Posted 7/14/2009 8:00 AM (GMT -6)   
Thanks for the thought Paul, I have tried lesser doses on a very empty stomach and while lower doses produced less flushing it likewise produced less actions elsewhere.
46 you when diagnosed, now 48
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, 9 Month PSA 0.01
One Year PSA 0.01, 18 month PSA 0.01
Incontinence resolved 9/15/2007, one day after cath removal
ED showing significant improvement.
Occasional Success with Oral Meds
Success with BiMix

Regular Member

Date Joined May 2009
Total Posts : 121
   Posted 7/14/2009 11:22 AM (GMT -6)   
I found the key to the ED meds is to use as little as possible so you need to experiment, 100mg of viagra would knock me out cold.
Dx'ed 5/08 one core 2%  out of 12  3+3 gleason
DREs all negative
PSA was in the 3-4 range then jumped to 7
I have the enlarged prostate, on the order of 100cc.  After taking Avodart for 3 months  my
PSA was cut in half.
I did Active S for a year but concluded that I didn't want a life
of biopsies and Uro meetings.
DaVinci on 6/24/09  UCI Med Center  Dr Ahlering, long surgery based on size and location
Final was 5% one side all clear, but had a huge 90 grm prostate
Now we work on pee control, ok at night but sitting is a big problem.

Veteran Member

Date Joined Aug 2007
Total Posts : 1015
   Posted 7/15/2009 8:27 AM (GMT -6)   
Hi snuggleup,

Patience is a virtue here. My surgeon says that men can come back from ED issues up to 12 to 18 months later. Being so recent out of surgery, I would not give up.

Every man responds to medication differently. In addition, there is the daily Cialis which has proven effective for many.

After he's had some time and exhausted the oral medications, he may wish to try injections. Typically the surgeon or nurse will walk him through and injection in the doctor's office and review the affect prior to giving him the first prescription. In the injection realm, there are many options as well.

I think you two are doing great so far!

All the best,

Da Vinci LRP July 31, 2007… 54 on surgery day
PSA 4.3 Gleason 3+3=6 T2a Confined to Prostate
6th PSA 06/09 still less than 0.1

Veteran Member

Date Joined Apr 2009
Total Posts : 990
   Posted 7/15/2009 9:29 AM (GMT -6)   
I posted a separate thread on my three month check-up but to summarize my doctor's advice on ED; patience, patience, patience. I feel so generally fit physically that I (and my wife) are ready for "pop a pill and lets go." but the doctor thought that was an unreasonable expectation. So we stay with petting and with me remembering that while previously she could tell by touch how excited I was, I now have to provide verbal feedback.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0

Regular Member

Date Joined Mar 2009
Total Posts : 43
   Posted 7/17/2009 5:23 PM (GMT -6)   
Wow... so very complex this Ed is..I give you my prayers, and hope that all my extended family here, overcomes this problem. Unfourtunely, this is a setback when dealing with prostate cancer. I am happy that you guys chose wisely,in having surgery to correct the problem, rather than thinking about your ability to perform if done.. Your input has helped us tremendously, and we look forward to trying other methods stated on this page.. once again,, Love to All.GB

Regular Member

Date Joined Mar 2009
Total Posts : 260
   Posted 7/17/2009 5:35 PM (GMT -6)   
I had my doctor visit today. He's genuinely concerned about my progress on all issues, ED being one of them. I told him Willy was still in a coma even after trying Levitra. His words were he want to try jump starting me with an injection of Trimex, so I have an appointment around the end of the month for that. The plan is for the doctor to make the first injection and then show me how to do them myself thereafter. Hmmm.

All the best to everyone,
Age 69, First ever PSA 7.8 taken June 2008, Biopsy July 2008, 10 of 12 cores positive, Gleason 3+3=6
da Vinci surgery December 10, 2008, catheter removed December 29 2008
St. Lukes Hospital, Bethlehem, Pa.
Dr. Frank Tamarkin
Prostate weight 73.0 grams, Gleason 3+3=6, stage pT3a
Tumor locations: right anterior apex, right posterior apex to mid
left anterior mid to base, left posterior apex to mid
extensive perineural invasion in right anterior apex, right and left posterior apex to mid
seminal vesicles negative

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