Erectile Dysfunction---what is the time frame for working on this

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Regular Member

Date Joined May 2010
Total Posts : 264
   Posted 6/6/2010 7:33 AM (GMT -6)   
In general, how long after the robotic surgery does the urologist start working on ED?

Do some urologists take a wait and see and let nature take its course and do treatments as necessary as the patient requests it?

Or is there some sort of standard protocol to try and get things working again a certain amount of time after surgery?

During my consultation, my urologist mentioned the different remedies (pump, shots, pills) but I don't remember the time frame.

Can ED be worked on before incontinence is under control or is incontinence gotten under control before ED is worked on.

Thanks, Dan
Here are some of my stats:
Father diagnosed with PC at age 72 - wasn't contained to prostate when found in 1992.
My PSA rose from 3.2 to 5.1 over the course of 1.5 years with Free PSA at 25% for the last two tests.
DRE showed no evidence of tumor but Uro thought my prostate was a little large for someone my age
PCa diagnosed 4/6/10 after biopsy on 4/1/10
1 out of 12 biopsy samples was positive with 5% of biopsy sample cancerous
Gleason 3+4
Da Vinci surgery scheduled for 6/1/10

Veteran Member

Date Joined Apr 2008
Total Posts : 1382
   Posted 6/6/2010 8:02 AM (GMT -6)   
I can't speak for everyone however for me it was two years before things started working down below. I have seen some men rebound as early as a few weeks. I think it is important to let nature take its course for at least a few months. Keep in mind this is invasive surgery and it takes time to heal. Good luck and keep us posted.

peace to you
My PSA at diagnosis was 16.3
age 47 (current)

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11

PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11
PSA Jan 15th 2010 is .13
PSA April 16th of 2010 is .16
Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores

Regular Member

Date Joined Nov 2008
Total Posts : 299
   Posted 6/6/2010 9:40 AM (GMT -6)   
There are lots of different opinions on this. But if you go to the web site of the Urologist in Chicago who pretty much discovered the the use of the PSA test in the 1990's, you will find that he suggests using ED drugs immediately after surgery.
My urologist waited until the catheter was out at two weeks post open surgery and then had me start on Viagra with a daily dose. I was on ED drugs prior to the surgery due to hypertension and had saved up pills. Once I found this web site and ADC, I switched to getting the drugs from ADC.
The ED drugs didn't help that much, so at 3 months I started using a VED. Then at 6 months, I went to Injections.
I would not wait very long, just my own personal opinion....
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, PSA June 29, 2009 0.00
PSA Sept 2009 0.00, PSA Dec 21, 2009 0.02, PSA March 29, 2010 0.03
ED Status- Currently using Trimix, Levitra daily for increased blood flow.
Noctural Erections have completely returned on a nightly basis, same hardness as before.
Stopped the injections except for "Fun" weekends. Really don't need them anymore.

Regular Member

Date Joined Mar 2010
Total Posts : 78
   Posted 6/6/2010 9:45 AM (GMT -6)   
Some folks recommend using "Twinlab L-Arginine, 500mg Capsules". I have not tried it yet, but maybe someone did

Veteran Member

Date Joined May 2008
Total Posts : 1010
   Posted 6/6/2010 10:26 AM (GMT -6)   
View the post on the John Mahall lecture and watch the entire series. If I had seen this two years ago I would have done some things differently.

Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
PSA 03/09 .38 six months post radiation and nine months into hormones
PSA 06/09 .36 or .30 depending on who did the test
PSA 09/09 .33 one year after IMRT and 16 months into hormone
PSA 03/10 .32 18 months after IMRT Still on hormones

Regular Member

Date Joined Jul 2009
Total Posts : 102
   Posted 6/6/2010 10:39 AM (GMT -6)   
I agree with Don. The lecture by John Mulhall is excellent and I really think my uro is taking the wrong approach by making me wait. The old saying is true, "if you don't use it you wil lose it".
Best of luck with your recovery.

Age: 65
DX: 7/10/09
Gleason: 7
Biopsey: 2 chips with some cancer cells out of 30.
Robotic Surgery: 9/10/09
Cath out: 9/23/09
1st post op PSA: 10/20/09 <0.1
2nd post op PSA:  1/25/10 <0.1
3rd post op PSA  4/19/10 <0.1
As of 4/26/10 Still Wet 3 pads per 24 hr. period

Regular Member

Date Joined May 2010
Total Posts : 264
   Posted 6/6/2010 10:46 AM (GMT -6)   
Thanks for the info!

Here are some of my stats:
Father diagnosed with PC at age 72 - wasn't contained to prostate when found in 1992.
My PSA rose from 3.2 to 5.1 over the course of 1.5 years with Free PSA at 25% for the last two tests.
DRE showed no evidence of tumor but Uro thought my prostate was a little large for someone my age
PCa diagnosed 4/6/10 after biopsy on 4/1/10
1 out of 12 biopsy samples was positive with 5% of biopsy sample cancerous
Gleason 3+4
Da Vinci surgery on 6/1/10.......waiting for post op biopsy

Regular Member

Date Joined Oct 2009
Total Posts : 314
   Posted 6/6/2010 11:58 AM (GMT -6)   
As you can see from my signature, I have no opportunity for sex, so this issue is hypothetical for me. In any event, my urologist/surgeon recommended using anything and everything to get erections as soon as the catheter was out. However, I opted to follow Dr. Scardino's advice, which as I recall is - like whether to do Kegels to help control urinary incontinence - wait and see if you actually need to do anything. "Wait" as in a few months, not years! Many men recover their sexual function naturally over time, although as more men start speaking out it is becoming clear that for most men sex is never quite as good in the years after treatment as it was before treatment.

In my case I can get erections and have orgasms fairly easily through mastur*ation [the filter deletes the word if I spell it out completely - go figure], although whether they would be firm enough and last long enough for actual penetration I guess I'll never know. After all this time I don't think about it much anymore.

No family history of PC.  PSA reading in 2000 was around 3.0 .  Annual PSA readings gradually rose; no one said anything to me until my PSA reached 4.0 in September 2007, at which point my internist advised me to see a urologist.   
Urologist advised a repeat PSA reading in six months = 4.0 .  Diagnosed May 2008 at age 56 as a result of 12 core biopsy.  Biopsy report by Bostwick Laboratories = Gleason 3 + 3. 
Interviewed two urologists - the one who did the biopsy and another - the latter had the biopsy slides re-examined = Gleason 3 + 3. 
Then went to M. D. Anderson Cancer Center in Houston in July 2008 and met with a urologist and a radiologist.  Biopsy slides re-examined yet again, this time by MDA's internal pathology department = Gleason 3 + 4.   
Chose da Vinci surgery over proton beam therapy; surgery performed at M. D. Anderson Cancer Center on August 15, 2008.  Post-operative pathology report = four tumors, carcinoma contained in prostate, clean (negative) margins, lymph nodes clear, seminal vesicles clear.  Gleason = 4 + 3. 
Minor temporary incontinence; current extent of ED uncertain due to lack of sexual partner; refused treatments for ED as being pointless under the circumstances. 
PSA readings: 
November 2008 = <0.1 ["undetectable"]
June 2009 = <0.1   
December 2009 = <0.1

Regular Member

Date Joined Feb 2010
Total Posts : 111
   Posted 6/6/2010 12:03 PM (GMT -6)   
Henry Ford Vatikutti institute holds a class the week following ones robotic procedure on this subject with a lecture and reps from the various methods available. Lectures can also be attended by ones significant other. One of the suggestions is to begin a regimen of ed pills such as Viagra @ 25 MG / at bedtime.

74 years old - Vatikutti DiVinci @ Henry Ford 2/10/2010. Here it is May 18th, zero pads and doing whatever I choose.
Gleason 3+4=7 - 2 of 12 cores effected @ 30% and 70% - nerves spared - margins and associated tiissues clear. Five week PSA was undetectable. Next one coming up in a few weeks.

Regular Member

Date Joined Jun 2008
Total Posts : 407
   Posted 6/6/2010 12:03 PM (GMT -6)   
I think it was about 30-days post-op when my Urologist started me on medications for ED.  There was little or no delay from the point of surgery to working on ED.  The incontenence and ED issues have been dealt with separately - and neither have been successfully resolved with me ... yet.

Age:  60 (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 light (woman's style) pad per day)

ED: Combination of Cialis and MUSE (alprostadil) once 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; 9/09: 0.0; 3/10: 0.0


New Member

Date Joined May 2010
Total Posts : 15
   Posted 6/6/2010 1:31 PM (GMT -6)   
My doc started me on low dose Cialis (daily) and the pump soon after cat removed.  According to him, not so much expecting immediate cure, but more to incourage blood flow to the penis and avoid damaging cells. In a few months we will try higher dosage and attempt to ger er started.  Made sense to me, but who knows for sure.
Good luck!
Mike, Weston, Florida
Dec, 2008: PSA 2.0
Feb, 2010: PSA 2.7 / Lump on prostate
March 2010: Biopsy / Gleason 4+3; 40% one side
April, 2010: Bone scan clear
May 14, 2010: DaVici Prostatectomy (age 63)
-Scattered small foci of prostatic adenocarcinoma Gleason 4+3 (right lobe)
-proportion of P gland invloved by tumor = 3%
- seven benign lymph nodes
- P size: 4.6X3.7X3.3 / 40.5 grams
- pTNM Stage: PT2a / regional lympth nodes PN0
Side effects: Dry mouth; swollen scrotem; rash; perineal pain
May 24, 2010: Catheter removed!! ED and continence journey started!
June 4, 2010: No progress re: continence; starting low dose Cialis today.

Veteran Member

Date Joined Jul 2009
Total Posts : 504
   Posted 6/6/2010 4:57 PM (GMT -6)   
You asked ?

"In general, how long after the robotic surgery does the urologist start working on ED? "

Mine started 2 weeks BEFORE. He had me taking Viagra and L-Arginine which really made sure Mr. Happy was in amazing shape Pre-Op

The order of your treatment is based on many variables that your Dr will decide which one is best for you at that stage

As for the L-Arginine Supplements, you can just eat a few walnuts and get the heart and blood flow benefits of Omega and Arginine. L-Arginine produces NO which increases blood flow and lowers BP

Daily ED pills right after cath removal promotes nocturnal erections which is the beginning of the recovery phase for ED. You may as well start looking now into how you will get those, most ins companies cover only a few a month ( if that).
Age: 52, PSA (2008)=1.9
Biopsy on 01/09/09, Gleason Score = 3+3
One (1) out of twelve (12) cores was positive, plus external nodule found
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Post Op Path 3+3
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, <0.01 - 3 months post-op
PSA 1/10 undetectable, <0.01 - 9 months post-op
Trimix provides 100% erectile function

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