Sex After Prostate Surgery

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Codger10
New Member


Date Joined Sep 2008
Total Posts : 7
   Posted 8/22/2009 12:03 AM (GMT -6)   
Nearly 12 months after radical prostatectomy sex sucks. My doctor was not as upfront about this as I believe he should have been. Had I known what I was facing I may have reconsidered such life-altering surgery. I'm wondering--do any of you share my frustrations and discouragement? If so, how are you dealing with it?

Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 8/22/2009 7:21 AM (GMT -6)   
Sorry about the sex. Usually your Uro will explain the side effects of surgery or any other procedure. Did he put you on a rehab program? That usually consists of a daily dose of viagra and a VED(vacuum erection device).. it is important to keep blood fo\lowing in that area to prevent atrophy. You did't post your Path report, gleason score etc. Were both of your nerves spared? That makes a difference whether you can have erections. You can also opt for bimix or trimix injections. They bypass the regular process to produce erections. I would try some kind of therapy as soon as possible to preserve what you may have left.
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
03/02/09- 1 yr. post-op PSA .09 Undetectable
05/13/09   PSA .18 (ouch)
Started IMRT June 13, 2009
Completed 37 treatments July 31, 2009 (66.6gy)


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2222
   Posted 8/22/2009 8:03 AM (GMT -6)   
Codger,
My Dr. did not discuss it that much but gave me material to read on the subject. At that point my goal was to get the cancer out. I am only 3 months out so I am not as frustrated, but sure do miss it. Not ready to give up on it and some posts suggest 1 year is not uncommon. We will see how this plays out but at age 60 I still have that desire. If it doesnt come back it will make me a little happier knowing that I had no morals in my 20's. LOL. But in all seriousness that is something that as men we have great difficulty with, but I also know at this age it is only a small part of what makes my life meaningful. If you ask me that question 1 year from now I might have a different resposnse but I am going to beleive that it will improve, just not sure when.
Michael
Dx with PCA 12/08 2 out of 12 cores positive
59 yo when diagnosed
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
Margins not involved
2 pads per day, 1 depends but getting better,
8/5 1 depend at night only
 started ED tx 7/17, slow go
Great family
Michael


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 677
   Posted 8/22/2009 9:23 AM (GMT -6)   
Codger10 said...
Nearly 12 months after radical prostatectomy sex sucks. My doctor was not as upfront about this as I believe he should have been. Had I known what I was facing I may have reconsidered such life-altering surgery. I'm wondering--do any of you share my frustrations and discouragement? If so, how are you dealing with it?
Yes, there are many comments here about that very problem.  I agree that many doctors do not do a good job of preparing patients for this difficult post surgery problem.  Even if we know intellectually that ED and urinary problems are the norm, it is still hard (but not hard enough shakehead  ) to deal with it when it is an everyday fact.
 
I hope you are now getting some guidance from your doctor.  That should be done from early in your post surgery recovery.  As others have said, you should be using a VED (pump), pills, and if necessary injections to help you regain some of that function.  That being said, we all know that is different than before.  It helps if you are in a loving and understanding relationship.  Your partner's attitude is a major factor in your post surgery enjoyment.
 
My cancer was very aggresive, my doctor called it lethal, so I am glad I had surgery.  However if I had been diagnosed with a limited Gleason 6 or less, I might have delayed treatment and enjoyed my sex life while I could.
PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Very Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8 with no extension or invasion
no long term continence problems
Post surgery PSA continues to be "undetectable"
One side nerves spared
Bi-Mix for ED 
born in 1941


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 8/22/2009 10:30 AM (GMT -6)   
I am not sure what the options for you would have been to "life altering surgery", but hopefully it did not include dying from prostate cancer.

There are many options out there for incontinence and ED, the 2 major side effects. For ED, there are medications, like Viagara which may help, there is a Muse drug which appears to work in a large percentage of men, and there are injections which also work quite well. Ultimately there are implants and other surgical options which can be inmplemented.

Talking with your doctor, or even changing doctors would be the first step in working with your issues. The great advantage we have in today's medical world, is that there are options.
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
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 8/22/2009 5:17 PM (GMT -6)   
Codger: a key factor is that if you were getting good erections before surgery, you should be able to get them after, by one or more of injections (or MUSE) or pump. Even if you are completely non-nerve-spared.

I suggest pump or injections first, because even if you are paying for them yourself, they are relatively cheap, and with practice can give very good results.

I feel disappointed sometimes that I can no longer get an erection at the drop of a hat, or any other item of clothing smilewinkgrin But there are compensations: With my preferred injections, I last a lot longer than before and orgasms are better. Oh, and no mess afterwards.

So for me sex is different and not as frequent as before, but there is still sex, and for that I am grateful.
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.
14 months: Occasional nocturnal erections.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/22/2009 7:04 PM (GMT -6)   
Piano, that was an awesome way to come to terms with your particular way of dealing with sex in your life. All the conversations and memory lane trips of how it use to be, was, could have been, never helps any of us, and trust me, I have done my share of that in the past year. I will still state plainly, hopefully to some of our new friends here, and I mean it sincerely and honestly, orgasms these days for me are so much longer in duration, and so incredibly intense, more than I had ever known possible for a guy, I no longer miss the old liquid portion at all.

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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, still talking option, 8/18 - had laser scope surgery to clear blockage, now on Catheter #7
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


FiftiesMale
Regular Member


Date Joined Mar 2009
Total Posts : 75
   Posted 8/23/2009 9:16 PM (GMT -6)   
I am curious, to those who recommend "daily" doses of Viagra (or other meds) and a pump. I do have a pump, and use it somewhat regularly. But 6 months after surgery, i think i am still under the mistaken notion that you can only take Viagra (and any other "meds") 2 or 3 times each week. What "doses" do you suggest, if one were to consider "daily" doses"?

Also, since we are talking about doses, what happens if someone were to "double up" on a dose (take 2 100 mg pills, instead of 1). What is, where is, the danger? I have no doubts that there is danger, i am just not knowledgeable enough on what the danger is? Is it a blood pressuee issue? Or is it a sexaul (priapism type) issue?, or what? Sometimes, when i get frustrated, and want a major erection, i have been tempted to take 2 pills (but never have). what happens if you OD on ED drugs? thanks.
Age: 53
8/1/2008: PSA 6.2, GP recommended retake.
8/27/2008: PSA 5.8 (%free 12.1) referred to Urologist.
9/10/2008: DRE - non palpable. Urologist recommended biopsy
10/21/2008: Biopsy appt: 10 samples taken
10/31/2008: Biopsy results; 1 positive out of 10 samples.
10/31/2008: Biopsy Results: Gleason 7 (3+4) , no evidence of perineural invasion.
10/31/2008: Referred to UCSF
12/19/2008: Transrectal Ultrasound at UCSF
12/19/2008: Consultation with Surgeon.
12/19/2008: Surgeon concurred on Gleason 7=3+4 (per slides).
2/24/2009: Robotic Assisted Laparoscopic Prostatectomy (DaVinci) UCSF
3/5/2009: Cathetor removal.
3/21/2009Post Op Pathology: margins negative/clear, Gleason 4+3=7
4/9/2009: first post-op Ultrasensative PSA: less than 0.01
Currently taking Viagra (since March 2009), Levitra (tried Cialis).
6/2009: Purchased and using Osbon manual pump.
7/28/09: 5 month Ultrasensative PSA: less than 0.01


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 8/24/2009 9:10 AM (GMT -6)   
Codger10 said...
Nearly 12 months after radical prostatectomy sex sucks. My doctor was not as upfront about this as I believe he should have been. Had I known what I was facing I may have reconsidered such life-altering surgery. I'm wondering--do any of you share my frustrations and discouragement? If so, how are you dealing with it?
How am I dealing with it?  My sexual activity doesn't define my life and having had the cancerous prostate removed and having the thoughts that I have a long life ahead of me because of that.  Likely ED resulting from the prostate surgery is common knowledge.  The choice between having the ability of having a hard-on and having "normal" sex and living a longer, happier and healthier life was an easy one for me.

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (1/2 light pads per day)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0; 4/09: 0.0

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/24/2009 9:43 AM (GMT -6)   
mavica, what a great attitude and testimony. that was the same thought process and decision my wife and I made before I did the surgery. our relationship after 35 years was not going to be defined by "normal" sexual intercourse. living the rest of my lfie and our life together had a much higher priority.

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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, still talking option, 8/18 - had laser scope surgery to clear blockage, now on Catheter #7
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 8/24/2009 9:46 AM (GMT -6)   
Amen ! Mavica & Purgatory

I chose life !
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
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/24/2009 9:50 AM (GMT -6)   
Any sensible person would, good life. If not, then one's priorities about life are wrong in my opinion. While I am in the tiny percentage that hasn't suffered any ED, we are aware that may change in the future if I have to go through salvage radiation and/or HT. So right now, we feel blessed that portion of our life is still functioning. As someone else said here at some point, I think I made up for anything I might miss out in the future back when I was young, unmarried, and had the morales of a hound dog back then.

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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, still talking option, 8/18 - had laser scope surgery to clear blockage, now on Catheter #7
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Jstars
Regular Member


Date Joined Oct 2005
Total Posts : 489
   Posted 8/24/2009 3:27 PM (GMT -6)   
Hey Fifties,

Yeah I have wondered about how much Viagra would be too much.

The most I have tried (once) was 150mg ... did not make much difference but that was in my wild early stages of recovery.

I know that Cialis is now being offered for hypertension(reduction) purposes at double the 20 mg dose. Ultimately though everything has to still work:

The entire brain to nerve bundles to Nitric-Oxide to GTP to cGMP (the stuff that ED drugs ultimately keep from being broken down) to blood flow in (and not OUT too quickly) all has to work.

If one part is not up and running yet then the rest of the chain of events is not going to happen and no amount of ED drug you use will help. Stupid slow recovering nerves!

And yes I think the hypertensive properties of ED drugs is what will kick at the higher than recommended dosages levels -- although I don't think it will cause more than maybe a 10-20 mmHg drop at any rate -- which for most people would still be safe (but I am no doctor so don't blame me). Also I dunno if having lower BP would be helpful for trying to get an erection, right??

And how about this interesting fact that you won't find anywhere else on the web:

BP at the penis level when you are standing is about 10-20 mmHg higher that at your heart level. I won't go into details of how I measured it - but it involved my trusty wrist BP cuff ;-) The higher BP levels explains the obvious reason for sitting up or standing after taking MUSE or Trimix or even ED drugs -- stay sitting or standing as much as possible (or if you happen to have a NASA Centrifuge handy that might work pretty good too!!).

keep on, keeping 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 size 140+ cc (110 grams post op).
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 oblong STONE within hours.
03/06/09 Started Levitra@20mg / Viagra@100mg / (04/01) Cialis@20mg -- no real effect (thru 07/2009).
04/01/09, 07/07/09 PSA <0.1 - Stone Was Oxalate stone -- X-ray no stones.
08/07/2009 - MUSE@1000mcg@Uro Office -- worked OK -- AlProstadil ache not bad.

Post Edited (JimStars) : 8/25/2009 11:08:14 AM (GMT-6)


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 8/25/2009 5:07 PM (GMT -6)   
After getting the generic Viagra at ADC at under a buck, I asked my Uro how often I can take it. He said it is safe to take daily at max doze or cut in half for maintenance purposes.

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

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)

PSA prior to treatment on 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60

RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins

PSA undetectable for 8 months, then 2/6/2009-0.10, 4/26/2009-0.17, 5/22/2009-0.20, 6/11/2009-0.27

Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, 7/23/2009-<0.05, T<10, IMRT to start mid-Aug

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