Pls don't laugh at my questions . . .

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Wife with Questions
New Member


Date Joined Jul 2009
Total Posts : 2
   Posted 7/14/2009 9:05 PM (GMT -6)   
Hi -- my husband (an active 69) has just been diagnosed with prostate cancer (Gleason 7). He also has just developed an inquinal hernia. Were it not for the hernia, the oncologist advocates "watchful waiting". However, he says if surgery goes ahead for the hernia, he might as well do a prostatectomy while in there. My husband is leaning toward that option, to reduce the potential for 2 surgeries and concomitant recuperations. But he's scared about ED.

Here's the major question: we are aware of the potential for nerve damage and ED. But what I don't know is, once a prostate is removed, is there still a physical desire/urge for lovemaking? I'm not talking about the emotional impetus, but the physical impulses for activity ultimately leading to ejaculation.

Do men get pumps, or use drugs or other approaches just to please their partners, or because it is also satisfying to them? I ask because, as much as I enjoy sex (I'm 58), I want him alive and healthy and my companion, and sex is less important than those. I would rather his choice was based on health and longevity.

Am I making clear what I'm wondering . . .?

Thanks in advance for your help and thoughts.
Wife with Questions


hb2006
Regular Member


Date Joined Nov 2008
Total Posts : 299
   Posted 7/14/2009 9:12 PM (GMT -6)   
Hi

Most men after the surgery (regardless of which type), still have a strong libido. You will read of some histories on here, where that has not happened. But nothing has changed for me, I still have as much desire as before.

So your answer to the question in the third paragraph is both. I hope that I'm answering your question.
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, pT2c, 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.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25372
   Posted 7/14/2009 9:18 PM (GMT -6)   
Hello Wife With Questions, welcome to HW and our group. No one will laugh at your questions, they are all good ones. The answers would really vary from guy to to guy. I had surgery this past November, and I still have the same sex drive and desire for my wife as before, and I was fortunate and did not have any ED problems. You do realize that once the prostate is removed, the man will no longer be able to ejaculate any fluids, but he will still be able to have orgasms.

It would help if you could put some of his statistics out here for us to see. A gleason 7 can go either way, it can be the start of something agressive, i.e. a 4+3=7 Gleason 7, or it can be less agressive as in a 3+4=7 Gleason 7.

I wish you both well and keep us posted.

David in SC
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
Lastest 7/13 met with Rad. Oncl, they want to start radiation, 70 gray, I am still considering all options and opinions
 
 


coxjajb
Regular Member


Date Joined Nov 2008
Total Posts : 184
   Posted 7/14/2009 9:45 PM (GMT -6)   
My desire is the same as it was prior to my prostatectomy. Everything feels the same for me. Orgasm, while dry, is more intense now however.
Age 51
Pre - Op PSA, 4.3
Gleason 3+4=7
Stage T1C
da Vinci Prostatectomy 8/1/08
No issues with incontinence since day 1 after catheter removal
Mild ED. Levitra works well for me
Post Op PSA 0.00


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/14/2009 9:52 PM (GMT -6)   
Hi Wife,
Welcome to HealingWell. Your questions are very welcome. The experience with prostate cancer varies from patient to patient. ED and incontinence are proper fears before treatment. But most men do quite well with both, whether aided or not. Some guys, mostly those who undergo additional therapies, do have greater issues with ED. I am one of them. But my wife has stood by me in such incredible ways. We are both doing very well. Me with my cancer, and her supporting me with my cancer, while still taking care of everything else she always takes care of.

An active 69 year old with Gleason 7 does not have to rush to treatment. But if there is longevity in the family and he is in otherwise good health, an intervention is probably wise. Typically surgery is a good first option. But for each individual it is different. Perhaps looking into radiation therapies is at least wise and it offers more delayed effects from treatment. In addition, I don't think all oncologists would advocate watchful waiting with a Gleason 7. But there is plenty of time to make decisions. Keep looking at the olptions, and keep a close eye on that PSA. By the way, what is his PSA?

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


DS Can
Regular Member


Date Joined May 2009
Total Posts : 195
   Posted 7/14/2009 9:56 PM (GMT -6)   

welcome wifew/?,

Its great that you care and are involved with your husband's treatment.

To answer your question, "I would if I could but I can't(yet).  I take 25mg viagra daily to help prevent penile tissue damage. A full dose is not yet enough to achieve a full erection. I am able to achieve an orgasm but there isn't any fun in it.  It is more mechanical than satisfying right now.  It is getting better over time though.  For sure, the desire is there.  Try to maintain an intimate sexual relationship in the meantime. That may help to prevent physical and emotional barriers to have to overcome in the future. I know that there are other means of achieving erections but I'm not ready to go there yet. (mechanical again)

Keep in mind that everyone's treatment and recovery is different.  I wish you and your husband all the best,

Dan 


PSA 01/07 1.2, PSA 01/08 1.9, PSA 01/09 2.5
BIOPSY 02/24/09  PCa DX age 52
Right: 3+3=6, 3/6 cores 10% involved,PNI-Y
Left:  3+3=6, 1/7 cores <5% involved,PNI-N
LARP 04/09/09 nerve sparing. Final pathology:
GS 3+4=7, Margins uninvolved, 2 lymph nodes negative
Catheter out 04/17,1st no-pad day 05/03
25 mg Viagra nightly;100 mg:not ready for prime time
Followup PSA 05/28/09 <0.1
 
 


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 7/14/2009 11:27 PM (GMT -6)   
Hi, great questions, and ones most of the people here are better able to help you with than I as I'm just starting out on my prostate adventure having been eviscerated two weeks ago with a daVinci procedure.

However, hernias I've had some experience with. Two things: First, I'm puzzled by the thought of doing a prostatectomy 'while in there.' which seems to me a bit like saying you may as well get a root canal on a back molar while you're in having your teeth cleaned. I'd worry about making prostate treatment decisions based on hernia repairs. Second: I suggest you check out the Shouldice Clinic in Toronto Canada. They do nothing but hernia repairs for patients from all over the world. Some 12 surgeons each perform 400 to 700 hernia repairs a year. They have a phenomenal success rate and anyone I know who has been there raves about the place.
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good  


jacketch
Regular Member


Date Joined Apr 2009
Total Posts : 179
   Posted 7/15/2009 6:03 AM (GMT -6)   
coxjajb said...
My desire is the same as it was prior to my prostatectomy. Everything feels the same for me. Orgasm, while dry, is more intense now however.

This also describes my situation.
62yo
V10.46 Dx Feb-09
RRP 5-5-09
No adverse SE
PSA 6-19-09 -0-
 
Thriving, not just surviving!
 


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 7/15/2009 7:44 AM (GMT -6)   
I am close to your husband’s age and my wife is eight years younger than I am. I had a laparoscopic hernia repair about five years ago (both sides.) For me the hernia repair was minor surgery with no hospital stay. I took two days off from work, one for the operation and one for recovery, and we left for Europe three weeks later. My only disability was a doctor imposed lifting limit and some minor irritation around the incision site. I don’t know what your husband’s repair would entail but I am not sure that there is a particularly great benefit of combining hernia repair with a prostectomy which is a much more serious operation. You need to discuss this issue with your doctor – I suppose that undergoing general anesthesia twice adds risk, but I cannot competently add more.

As far as sex is concerned, my level of desire returned soon after surgery but I had to make some adjustments to my thinking. I was very used to the connection of desire and erection and so it was rather a circular reinforcement that I no longer had. My wife had somewhat the same issue: “He says he wants me but he doesn’t show it.” We had to develop better communication to make up for this. As of now we both achieve orgasm through heavy petting and are satisfied. I did leak urine at first but less so now – we just put down towels.

As you will see from this board, everyone has a slightly different experience but we are always happy to share.
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


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 7/15/2009 9:55 AM (GMT -6)   
chas036,
 
Your loss of libido is mystifying and may not be due directly to the surgery. I assume you are not (or have been) on any hormone ablation drugs, which means that your testosterone levels pre-and-post surgery s/b similar.
 
You know that 90% of an erection is mental and you, as well as most of us, have been challenged to a long-term game that we never wanted to play. Couple that with the fear of the urine and I think you know where I am leading to......it wouldn't hurt. I speak that because I also talked with a counselor for a few sessions. it can't hurt and it could help, especially since the other 10% (the actual erections) is not a factor.
 
Joey
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4121
   Posted 7/15/2009 11:41 AM (GMT -6)   

Dear Wife:

As David (Purgatory) said, it would be helpful if you could post a few more stats.  However, here are some preliminary thoughts:

1.  Most docs do not advise watching wating with a Gleason 7 cancer.

2.  You said "oncologist".  Is this a prostate oncologist you are visiting, a urologist, a radiation oncologist???

3.  Depending on you hubby's stats, and given his age, brachytherapy (seeds) might be a good option.  A uro-doc, as a surgeon, may not be to keen on this approach.  For this reason you should make sure your husband sees a radiation oncologist and a prostate oncologist so that you have a good feel for all of the treatment options.

4.  I also don't get your doc saying might as well do a two-for-one surgery.  That doesn't feel right to me.

Tudpock


Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 7/15/2009 6:56 PM (GMT -6)   
I also found no loss of libido -- only a loss of ability! With total ED, I started injections one month after surgery -- they have worked well. For me, orgasms are as good as or better than before and last longer.

Prior to surgery, I tended towards premature ejaculation. Now no ejaculation and no premature either -- if anything, I last too long.

Wifey -- if hubby does choose surgery, he can expect a period of ED. But even if the worst happens and he has total ED, it's not all bad :-)
Pre-op:
Age 63 at diagnosis, now 64.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Operation:
Non-nerve sparing RRP on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Post-op:
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
PSAs:
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
ED:
After a learning curve, Bimix injections (0.2ml) are working well. VED also works but we find it inferior to Bimix.


Wife with Questions
New Member


Date Joined Jul 2009
Total Posts : 2
   Posted 7/15/2009 10:50 PM (GMT -6)   
Thank you all so much for being so open and supportive in sharing your experiences. It makes dealing with all the challenges this has delivered so much easier!

As to other stats, I/we don't have any. I will have to ask the doctor (a chief urologist at the Prostate Center at Vancouver General Hospital.) All we were told was the 3+4 (7) Gleason and that they discovered one 10mm tumor. Prior to reading this forum, I didn't know what else we should know in the way of numbers, and I'm embarrassed to say I don't know the PSA scores. I will have to get more info.

Also appreciated are the comments re the dual surgery -- much to raise questions about with the doctor!
Wife with Questions


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 7/16/2009 12:08 AM (GMT -6)   
Hi again, WWQ,

If you're in Vancouver you really should look into Shouldice in Toronto. Most all of the cost except using some Aeroplan points to get there, will be covered by BC Health. There is no general anesthetic, and the repair is so good when I left, and I went to pick up my suitcase, and my wife yelled at me 'stop" the nurse laughed and said I was rock solid ---- I could lift the day after surgery anything I wanted to, or could, and a lot safer than before surgery. And while I was being stitched up my wife had a lovely time on Bloor Street. Not covered by health insurance.

No need to be embarrassed about not knowing the numbers. Any businessperson such as myself knows PSA is a Preliminary Statistical Analysis, right? It took me awhile to understand why a Gleason 7 in one case (3 + 4) wasn't quite what a (4 + 3) Gleason 7 was.

One further word of advice. As a Canadian you need to be aware that many of the posters here are our fine neighbors to the south who, not surprisingly, have an American centric view of medicine and therapies. In Canada you have treatment opportunities not available in the states. Also be aware your insurance allows you to consult with doctors and programs across the country. I met with urologists from several provinces, and consulted by phone with others. In all I had seven different urologists giving me their perspective. Each had valuable input. In addition I dealt with two doctors in the U.S. One at Mayo Rochester, and one at a large Eastern cancer center. They too were helpful and as they had both attended urology meetings in Canada knew something of our system as well as their own and were able to give me some real help in understanding what to watch for in each.

I wish you and your husband well and I hope you'll keep us posted.

Sleepless AKA Sheldon
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good  


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 7/16/2009 12:12 AM (GMT -6)   
I would think that if all the doctor gave you was the Gleason score and then expected you to make a decision about surgery or not I think it might be about time to look for another doctor
 
 
Age 64 From UK now in Thailand Baby boy born 2/14/2009
 First PSA was showing 9.73 on 1/21/09.   on 5/7/09 PSA 9.78  Free PSA 0.83   Free:Total  PSA 0.08 
1/28/09 Biopsy carried out 12 core results show no adenocarcinoma
5/15/0924 Core biopsy results Gleason'S Grade 3+2=5
Involving approx 30% of one out of 12 cores on each side no perineural or angiolymphatic invation identified
One side PIN High Grade Bone scan clear 
Open surgery planned for 7/27/09
 

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