Penile Rehab Queston

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lja3
New Member


Date Joined Oct 2009
Total Posts : 13
   Posted 1/15/2010 10:53 PM (GMT -6)   
I haven't written for awhile, but have been reading this site often.  I am now 9 weeks post RP surgery.  Initially, I had a very rough time with surgery, blood loss, pain, etc. but things have improved a lot.  I got my first post op PSA score last Monday and it was 0.001.  My doc asked me if I wanted to try to have sex now with my wife (yes, I do) and gave me samples of viagra, levitra, and cialis.   For starters, does this seem to be the normal route to gainimg erections again?  I have reas some postings that seem like some of the guys here are doing or have been instructed to do a lot more than just pop a viagra before attempting sex.  I guess all doctors handle this different, but is there a more active protocol than what I have been prescribed, or should I try this for awhile and then discuss again with my doc if things don't work.  I don't see him again until May 5th.  Appreciate any feedback.


Larry
55 years old
Diagnosed 8/27/09
PSA went from 1.2 to 3.4 over 18 months
Gleason 4+3=7
3 of 12 cores positive
Cancer 5% of biopsied tissue
Perineural invasion not identified
Cat scan negative
Bone scan negative
Sheduled fo da vinci rp on Monday, November 9th
 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 1/15/2010 10:58 PM (GMT -6)   
Hey, if they work, do it. The guys on here doing the other stuff cannot do it beccause it doesn't work.

Some guys however have no problem. You may be the lucky one. If the Viagara, cialis, or levitra give you an erection, you've found the secret code.

Otherwise, you may to enter the world of pumps, injections, etc.

Goodluck

Goodlife
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10


lja3
New Member


Date Joined Oct 2009
Total Posts : 13
   Posted 1/15/2010 11:12 PM (GMT -6)   
Goodlife,
 
What I am wondering is if I should be taking levitra, viagra, etc. efvery day as part of the healing process and not only when I want to try and get an erection.  It seems I vaguely remeber that being prescribed to ohter members on this site. 
Larry
  • 55 years old
  • Diagnosed 8/27/09
  • PSA went from 1.2 to 3.4 over 18 months
  • Gleason 4+3=7
  • 3 of 12 cores positive
  • Cancer 5% of biopsied tissue
  • Perineural invasion not identified
  • Cat scan negative
  • Bone scan negative
  • Had da vinci RP on Monday, November 9th
  • Surgery took 7 hours, lost 2 liters of blood, transfused 2 pints 
  • No cancer found outside of prostate
  • Strong abdominal pain for 6 weeks post surgery
  • PSA on January 5th at 0.001.
  • Using 1 pad a day and 1 pad at night
  • Next check-up on May 5th


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/15/2010 11:19 PM (GMT -6)   
Larry, can't help or advise you on the ED stuff, but a big congratulations for getting into the Zero Club, that is what it is all about, getting rid of that cancer. Hope the other part works out for you soon, too.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 1/16/2010 12:03 AM (GMT -6)   
Larry,

Many doctors prescribe smaller amounts for daily use, not for recreation, but to increase bloodflow to the injured parts.

When you want to have sex, usually you will take a 100 MG of Viagara, or 20 mg of levitra or Cialis.

I would try a larger dose, and see what happens. Most usually the drugs need to be followed by sexual activity. In other words, it just doesn't pop up and swtand at attention after you take the Viagara. Many men say it takes a lot more stimulation to get thibgs going.

I'm still dead. The trimix gets me up where I need to be.

Goodlife
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 1/16/2010 12:44 AM (GMT -6)   
lja3 said...
I have reas some postings that seem like some of the guys here are doing or have been instructed to do a lot more than just pop a viagra before attempting sex.  I guess all doctors handle this different, but is there a more active protocol than what I have been prescribed, or should I try this for awhile and then discuss again with my doc if things don't work.  I don't see him again until May 5th. 
Hello Larry,
 
Yes, you are correct in your observations about many more active protocols for penile rehabilitation, and also correct that doctors do handle it differently.  Unfortunately, sometimes we need to educate our doctors, which can be a tricky assignment, but it usually pays-off to be an "empowered patient."
 
Dr. John P Mulhall, MD, is an incontinence and impotence expert from Memorial Sloan Kettering in NYC.  He presented at the recent (Sept, in Los Angeles) 2009 National Conference on Prostate Cancer that patients need to be proactive with their doctors about attending to sexual/penile rehabilitation early.  He says that it can be an awkward subject and many doctors do not properly address it with PC patients, and visa versa.  This may cause long term problems for the patient because his studies show that erectile function (EF) success falls off sharply if treatment is delayed, especially beyond 6-months.
 
Even most of the basic post-RP programs I've heard of don't merely advise taking a PDE5-inhibitor (any of the big-3, which you also listed) and trying to have sex.  On the contrary, the most common programs I've heard of are much more rigorous in that they prescribe regularly (several times a week) taking a pill (or half a pill) and then deliberately work to achieve climax, typically advising to attempt this in the morning when the male body is most rested and commonly achieves natural morning erections.
 
I suggest reading more on Dr Mulhall's work by going to the website www.pubmed.com, which is an online library of medical research papers run by our National Institute of Health.  Enter into the SEARCH window this string (without quote marks, but with the capitalized AND) “timing of penile rehabilitation AND recovery of erectile function”, and you will likely be taken directly to one of Mulhall's paper abstracts.  The paper's concluding statement reads:  "These data suggest that delaying the start of penile rehabilitation after RP is associated with poorer outcomes for EF [erectile function]."
 
Your doctor does not have a very aggressive penile rehab program, as you have already noted & observed from readings.  You might want to take matters into your own hands (so to speak)!

 

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 1/16/2010 5:02 AM (GMT -6)   
as with all medications - read the label - for safety sake - you don't want to over do it - each medication has its own application and time table - the Levitra, viagra and cialis all need sexxual arousal to work - and they have different time periods in which to take it prior to sexxxual activitiy. Please read the instructions or even look up the product on the web and it will discuss ( what should have been told to you by your doctor) what to do.

I am on a low dose cialis - 5mg a day - to get things going - so I can attempt getting a bonnnner anytime during the day or night .. time will tell - ..slight improvement in that department...

what is great about the google site is you can simply ask a question and you get linked up to so many sites that can give you the information you need -

also - the Mulhall book is great - I have it - and even with all my research I have done, it answered and clarified a lot of fuzzy areas of concern -

good luck

BRONSON
.................
Age: 54 - gay - with spouse, Steve - 59
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis
location: Peteborough, Ontario, Canada
............


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 1/16/2010 9:10 AM (GMT -6)   
Thanks, Bronson, for also calling out the Mulhall book for Larry...I had forgotten to mention this in my post from last night when I spoke about his presentation at the PC Conference.

Most guys get one or two of the really valuable books by either Walsh and/or Strum while in their pre-treatment phase, and the recovery phase is often overlooked.

For completeness, the Mulhall book is: "Saving Your Sex Life. A Guide for Men With Prostate Cancer", and is available via online booksellers.

Peace
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