Questions about potential erectile recovery in cases of nerve loss

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pogmothoin
Regular Member


Date Joined May 2010
Total Posts : 84
   Posted 6/10/2010 8:46 PM (GMT -6)   
I'm not altogether clear on what to expect if they're not able to save one or both of the nerves. As I understand it, if both nerves are lost then pills won't do a thing. In that case, are pills totally out for post-op rehab? If one nerve is lost, then how much potential is there from pills alone? Can trimix injections do a thing if both nerves are lost?
 
I'm asking because my biopsy did not paint a pretty picture. The doctor is skeptical about saving the nerve on the right since the biopsy showed a GS of 7 (4+3) in 14 of 15 samples, and the right side of the diagram showed 94%/80%/93% involvement. On the left the story isn't as grim, but the doctor acted like he wouldn't be surprised if that nerve was also a lost cause.

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 6/10/2010 9:51 PM (GMT -6)   
The result is unpredictable. Many with both nerves spared are immediately fine, while others have no response. The same with nerve saving on one side. The pills boost blood flow to the area(helps healing and encourages blood flow) which will improve what is available. The injectables operate differently and are not dependent for the most part on working nerves....... they actually do (or are supposed to) what the nerves are supposed to do. Now having said that I, (because of extent of the tumour), had neither nerve saved. The pills, although prescribed for improved blood flow in the area had absolutely zero effect. That is until 18 months-2 years post op .......... now the pills will get me to about 50%. Not at all usable but it does look more impressive than my "normal" state. Can the nerves regenerate? ......... as part of the peripheral nervous system, yes they can ..... but how good this regeneration will be is variable. Not the usual source for medical information but WIKIPEDIA here has some understandable information

en.wikipedia.org/wiki/Neuroregeneration

Bill
Biopsy
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment: [/color]
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct '07 <0.1 undetectable
PSA Jan '08 <0.1 undetectable
PSA April '08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August '08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September '08 <0.01 (new lab)
PSA February 09 <0.01
PSA August '09 (2 year mark), <0.01
PSA December '09 <0.01 PSA May '10 <0.01


www.yananow.net/Mentors/BillM2.htm


Never underestimate old people ............ you don't get to be old by being stupid.


pogmothoin
Regular Member


Date Joined May 2010
Total Posts : 84
   Posted 6/10/2010 10:25 PM (GMT -6)   
Thanks for the input, Bill. Congrats on gaining at least some recovery of function in spite of the nerve lost. That's the first I've heard so far of that even being a possibility. What's your usual method for dealing with ED? Injections?

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 6/10/2010 11:02 PM (GMT -6)   
Pog,
For a man, it is difficult to get your head around the fact that, although erections and orgasm normally go hand in hand, (no pun intended) they are two completely different entities. Although probably more time consuming than with an erection, the end result (minus fluids) is still there. I still am gobsmacked by the fact that my orgasm, essentially without an erection, is now much more intense and eye-bugging than pre-surgery shocked (quite a few members have commented on this)...... (their orgasms of course, not mine smilewinkgrin). I have not been able thus far to bring myself to stick a needle in the ol' apparatus but as soon as I can convince my wife that , yes, she can do it (while I look away) then I'm up, up and away. yeah
Bill

Post Edited (BillyMac) : 6/10/2010 10:06:03 PM (GMT-6)


Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 6/11/2010 1:05 AM (GMT -6)   
Adding to what Billymac said (you can find anything on Wikipedia):

The nerves to the prostate that control erections are part of the parasympathic nervous system (http://en.wikipedia.org/wiki/Parasympathetic_nervous_system) and the part that is injured by surgery is a network of nerves called the prostatic plexus (http://en.wikipedia.org/wiki/Parasympathetic_nervous_system), that goes around the outside of the prostate. These nerve fibers go to the penis and act on other nerves cells in the penis--postganglionic cells (http://en.wikipedia.org/wiki/Postganglionic_cell), that control the blood vessels that control erections. These cells release acetylcholine that acts on blood vessel cells that release nitrous oxide, the causes release of a chemical called cyclic GMP that make the blood vessels dilate so more blood goes to the penis to make an erection. Drugs like Viagra block the breakdown of cyclic GMP (http://en.wikipedia.org/wiki/Phosphodiesterase-5), so that increases the effect of the nerve on the penis. What this means is that if there is no nerve input to the penis, Viagra can't do anything--you have have some kind of erection or Viagra can't amplify it.

When doctors tell someone that they "took the nerves" and yet that man still has erections, it must mean that some of these nerve fibers must have survived, anyway. Maybe these nerve fibers have a little bit different path in some people, and those guys luck out and their nerve fibers escape the knife because they aren't in the usual place.

Also, it means that if any of these nerves regrow, they somehow would have to find their way to the penis, and find the postganglionic cells in the penis (assuming that they are still there) and make a new connection. That seems unlikely. What must happen is the postganglionic cells in the penis that still are connected by the nerve fibers that survive after surgery must sprout over time and take take over control of the blood vessels that have lost their nerve supply.

pogmothoin
Regular Member


Date Joined May 2010
Total Posts : 84
   Posted 6/11/2010 5:16 AM (GMT -6)   
I had already known just a bit about the possibility of neuroregeneration in the PNS and neuroplasticity, but hadn't applied them to our situation with prostate cancer. Obviously there are NO guarantees, I just find it fascinating that anyone has found any degree of recovery at all after they were told the nerves were not spared. The doctor I consuted with last week said when they take the nerves it's not an all-or-nothing deal, they might be able to save a portion of the nerve fibers on either side. I'll be discussing that possibility with my doctor before I go into surgery.

lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 6/11/2010 10:14 AM (GMT -6)   
I am at 10 months post surgery (Davinci). Doc said he was able to spare 100% nerves on one side and about 60% on the other side.
I've been using Levitra with great success for sometime. This week I actually had my first erection with out any stimulation and had not taken the Levitra for at least 3 or 4 days. So was very happy and felt like a young guy again! When I see my Doc next I'm going to ask about cutting back on the Levitra dozeage.

Larry
Age 55 / age at diagnosis 54, PSA 5.1
Robotic surgery 08/12/09 at Vanderbilt, Nashville TN. 
Final Path report:
20% of the prostate Involved
Tumor graded at T2C
Overall Gleason 3+4 (7)
Lymph Glands Clear, Positive Margin Noted in Right Apex
 
First post Surgery PSA - 0
Six month PSA - 0


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/11/2010 11:50 AM (GMT -6)   
pog,

i will present still a different case. miracles do happen. as you can see, you have men with both sides spared, and total ED even after a couple of years. in my case, left side totally removed, right side left, because of surgical difficulties, and dr. noted that right side was damaged. yet despite that, i have had no ED problems. As soon as I had healed enough, was able to have full and regular errections, just as good as prior to surgery. my own surgeon is still amazed and puzzled to this day. in that dept, i am one of the lucky few. but there are other men here that have had no ED too, not many, but it can happen. I have recently been through SRT, and so far, the radiation hasn't effected me in the ED dept, still able to have full errections when desired.

i have never used a pump, sex pill, or injections. with all my other issues, thankful ED hasnt been one of them. so you never know what you are going to get until you get to the other side, that is one of the considerations a man should understand before undergoing surgery. there are no promises or guarantees ahead of time.

i wish you all the best in your decision and ultimate treatment

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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 6/11/2010 1:30 PM (GMT -6)   
As has been said above, your mileage may vary. Happy for all the success stories above, in my case it appears that Levitra is losing its power for me. So, I've just started considering the injections.
51 YO
PSA at Dx: 8.2
DaVinci RALP: 10/31/08 -- Great MD in New Haven, CT
Negative margins, no extra-capsular involvement
One nerve spared
PSA at 0 for just over a year now.
 
 


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 6/11/2010 7:23 PM (GMT -6)   
I had both nerves removed and have found that after one year, using Viagra does give me better than 50% erection. I use trimix (2.5) and I get a good erection that lasts about 1.5 hours. My doctor had told me that medication will be useless but I'm finding out that it is not totally true. May be the nerves are regenerating.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 5 months
2 months PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11 months PSA test 1/21/10 result 0.004
14 months PSA test 4/19/10 result 0.005


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6084
   Posted 6/13/2010 6:09 PM (GMT -6)   
Any of you older guys remember the John Wayne movie where he is a Navel officer at Pearl Harbor who suffers some sort of spinal injury. Nancy Olsen was the love interest, Might have to be over 60 for this one.He is paralyzed at least from the waist down. Lying on the table paralyzed with a mirror so he could see his feet. " I'm gonna move that toe, I'm gonna move that toe " was his mantra. Well for me " I'm gonna move that.........." Oh yea, He finally did and went to full recovery. It was based on a true story.
age 66 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of W Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
Dec 14,2009 psa 0.0 May 10 2010, psa 0.0

" Hypocrisy is vice's homage to Virtue " read it in Bartlet's book of quotation years ago stuck with me, can't remember who said it.


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6084
   Posted 6/13/2010 6:15 PM (GMT -6)   
Any of you older guys remember the John Wayne movie where he is a Navel officer at Pearl Harbor who suffers some sort of spinal injury. Nancy Olsen was the love interest, Might have to be over 60 for this one.He is paralyzed at least from the waist down. Lying on the table paralyzed with a mirror so he could see his feet. " I'm gonna move that toe, I'm gonna move that toe " was his mantra. Well for me " I'm gonna move that.........." Oh yea, He finally did and went to full recovery. It was based on a true story.
age 66 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of W Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
Dec 14,2009 psa 0.0 May 10 2010, psa 0.0

" Hypocrisy is vice's homage to Virtue " read it in Bartlet's book of quotation years ago stuck with me, can't remember who said it.


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6084
   Posted 6/13/2010 6:17 PM (GMT -6)   
oops
age 66 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of W Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
Dec 14,2009 psa 0.0 May 10 2010, psa 0.0

" Hypocrisy is vice's homage to Virtue " read it in Bartlet's book of quotation years ago stuck with me, can't remember who said it.

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