Post Op newbie questions - sex, size and appearance

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New Member

Date Joined Jun 2010
Total Posts : 11
   Posted 6/24/2010 10:24 PM (GMT -6)   
Greetings fellow Prostate Cancer warriors, I salute you in your/our fight against this disease.  This is my first posting.
My robotic surgery for prostate removal was May 24 2010.  I was diagnosed in March with a 4.8 PSA and a 6.5 Gleason score.  I am 53 years of age and in very good physical condition as I am a fitness instructor by profession.
My issue I am hoping to get information on is a delicate one.  As I recover it seems to me that there is a small valley or indentation on my lower abdomen where the base of my penis attaches, and the size of my penis overall seems to have reduced.  Any input from anyone on this?
As far as sex I have to say I rec'd no instructions/restrictions from my doctor and have not had any desire or thoughts in that direction anyway.  The postings I have read on this forum have been extremely informative and I look forward to more interaction.

Post Edited (jahfreak) : 7/4/2010 10:49:12 PM (GMT-6)

Veteran Member

Date Joined Jul 2009
Total Posts : 1267
   Posted 6/24/2010 10:37 PM (GMT -6)   
First, welcome jahfreak.

Now, your issue.

Ah yes, the mystery of the disappearing penis. Yet another in the saga of things they don't tell you about before they snip. At least they didn't tell me. Pity, I'd have liked to have said goodbye.

Here's the way I understand it. The bladder is up in there, pretty much fixed into place by whatever glue God uses. The prostate is below that, and then the penis. When the prostate comes out the surgeon has to attach the penis to something, at least if you're going to pee that is, and so naturally it gets attached to the bottom of the bladder. Now, the bladder won't come down, but the penis will retreat up, so guess what gets moved to make the attachment fit? Right.

I for one am glad my bladder isn't above my stomach.

jahfreak, your penis is the same size it always was, it's just filling in between the engine and the caboose so to speak.

Sheldon AKA Sleepless
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
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23 test again less than 0.02
PSA on Jan 8 less than 0.02
PSA on April 9 less than 0.02 

Regular Member

Date Joined Jan 2010
Total Posts : 363
   Posted 6/24/2010 10:46 PM (GMT -6)   
Welcome to the forum. Sorry you have to be here but you're very welcome.

Can't help with the indentation but the surgery does shorten the urethra, this can lead to a shorter willie when flacid. As for rehab' my uro' gave me a month long scrip' for 5mg Cialis and suggested I "exercise" it often. I (being a good patient) have taken her advice and after a few months length seems to be back to normal, hard to tell as full firmness is not yet available but getting much better. I'm now using 100mg Viagra (cut in half most of the time) from the forum's favorite internet source and it seems to work much better than the 5 or 20mg Cialis for me.

Best of luck in your recovery and remember the only bad question is the one you don't ask.
Diagnosed 12-09 age 55
07-06 PSA 2.5
01-08 PSA 5.5 (PCP did not tell me of increase or schedule follow-up!!!!)
09-09 PSA 6.5 Sent for consult with Urologist
11-09 Consult, scheduled for biopsy, found out about PSA from '08 (yes I was pissed)
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5, ain't much but I'll take it.
01-10 Bone Scan, "appears negative"
03-01-10 RRP in Durango CO by Dr Sejal Quale and Shandra Wilson, no naked eye evidence of spread, Vesicles and lymph nodes taken for microscopic exam.

03-16-10 Removal of cath' and pathology results of samples.
Multifocal carcinoma with areas of Gleason pattern 3, 4 and 5, Overall Gleason grade 4+4 with tertiary 5, Bilateral involving 21% of left lobe, 3% of right lobe, Invasion of left Seminal vesicle, Tumor focally present at left resection margin, 9 lymph nodes removed all negative, Tumor staging pT3b NO MX

04-23-10 PSA <0.04
05-03-10 1 week without pads
06-07-10 PSA <0.04

Veteran Member

Date Joined Dec 2008
Total Posts : 818
   Posted 6/24/2010 10:47 PM (GMT -6)   
I think Sheldcon is correct. However, I should say that one surgeon assured me that the bladder would descend to make up the length. I'm not sure she was telling me the whole truth. I am definitely nearly an inch shorter. However, other guys here said they have no decrease in length. Maybe some of us have movable bladders, and others do not.

Diagnosis at age 53. PSA 2007 about 2; PSA 2008 4.3
Biopsy September 2008: 6 of 12 cores positive; Gleason 4+3 = 7
CT and Bone scan negative
Da Vinci surgery at City of Hope December 8, 2008
Radical prostatectomy and lymph node dissection
Catheter out on 7th day, replaced on 8th day, out again 14th day following negative cystogram
Pathology: pT2c; lymph nodes negative; margins involved; 41 grams, 8% involved by tumor; same Gleason 4+3=7
PSA 1/22/08 non-detectable! 8-)
4/23/09, 07/30/09, Oct 2009, Nov 09, Feb 10, June 10 still undetectable (<0.01)!

Forum Moderator

Date Joined Jan 2010
Total Posts : 7082
   Posted 6/24/2010 10:50 PM (GMT -6)   
I supect I won't know about the real length until I see a real woodie. Having lost the nerves in the operation, that seems a bit unlikely. The "resting" state is no smaller than it was before DaVinci.

New Member

Date Joined Jun 2010
Total Posts : 11
   Posted 6/24/2010 11:54 PM (GMT -6)   
Thanks for the input (especially sleepless). My doc is not just overflowing with post op info so this is a great resource-outlet. Four weeks ago today I had the robotic surgery, I feel great other than some pain in the rectal and scrotum area. First post op PSA test is July 6.

Regular Member

Date Joined Jun 2010
Total Posts : 416
   Posted 6/25/2010 6:38 AM (GMT -6)   
Hi Jah.. Do a Google search, you will find the several studies showing that about 1/2 (+-) had some shrinkage. Since it matters most when the thing is working, I image those who get theirs to work again are pleased with that result.. and would be willing to "give an inch". This month around my 4 weeks I had the same rectal/scrotum issue.. it has since subsided... I think I worked the Kegel too hard, plus the recovery itself.
First ever PSA test Jan 2010 @ 51 years old. 4.0.
Digital exam in March 2010 showed 1 side hard, other soft.
Biopsy, positive in 3 of 12.
Davinci @ Boston Medical Center, May 17, 2010.
Was suggested prior to it was likely contained.
June 1 advised 3+-4 was really 4+3 per pathology. Pos margins.
Catheter removed June 1.. 1 pad/day, doing ok. ED, but not in rush.
Sore as heck down there, but doing much walking with my wife.
To meet with my Uri (1st meeting since) June 17 - 1 mo point, to discuss.
BMC already has me setup to meet with radiology.
Felling a little better each day. Cant tell if my expectancy just went from 10-15 down to 5-7, the information out there appears to be all over the place. I WILL NOT radiate my insides to the point of being a veg for the sake of a few years. QOL is primary to me. Selfish I guess. I pray for all of you as I do for myself, but must remember that i've had a pretty good 50+ years, and know others who have lost their children to disease.. so I dont have the nerve to complain!

Veteran Member

Date Joined Dec 2009
Total Posts : 1268
   Posted 6/25/2010 7:12 AM (GMT -6)   
You may want to take a look at Dr. Mulhalls talk.  He covers a lot of the stuff your doc didn't.  Its at:
PSA 11/24/2008 - 7.6
Pc Dx 2/11/09; age at Dx 62
RLP 4/20/09
Biopsy -  Invasive moderately differentiated prostatic andenocarconoma; G 3+3=6; PT2C; No evidence of Seminal Vesicle or Extraprostatic Involvement; Margins clear; Tumor identified in sections from prostatic apex.
70 gram prostate.
Immediately continent after removal of cath.
ED - Trimix works well; viagra @ 60%
PSA - 7/31/09 <0.06
PSA - 12/1/09 <0.06
PSA - 3/29/10 <0.06

Regular Member

Date Joined Dec 2009
Total Posts : 154
   Posted 6/25/2010 7:33 AM (GMT -6)   
Jah, i too have the mystery dent right where you say. I asked the doc about this at my last visit as i had never noticed it before the surgery. He was pretty non commital and gave me the you probably just never noticed it before answer but i`m sure it comes from the urethra reattachment. My surgery was in Feb and at this point i dont really see any loss in length and i`m having no problems. Good luck Tim
Dx at 50 in 12/09 Merry Christmas its cancer....
3 of 12 positive, right side only, psa at dx 2.6 free%14
gleason 3+3=6
routine physical, no symptoms
Da Vinci performed Feb 2k10 by Dr Marc Milsten [hes got mad skills]
99% continent from cath out, mr happy fully functional at 2 weeks out!
path showed same gleeson with no other blips other than one slight margin, organ confined 20% right, 5%left, 34grams
Hernia repair Mar 2k10, hernia was side effect of the surgery
30 day psa 0.03- 90 day psa 0.01

Veteran Member

Date Joined Jun 2008
Total Posts : 1804
   Posted 6/25/2010 7:34 AM (GMT -6)   
Jah, for my husband "junior" is definitely shorter. I also notice a slightly different shape in that his penis seems more blunt (rounded) than it was pre-op.

We too didn't expect this happen (didn't find this board til after his surgery). And you're right in that the average uro/surgeon doesn't go into great detail about the quality of life issues. We were given statistics about the % of men in my husband's age group (58 at the time) who regain continence and ability to achieve erection. Some men experience no problems in these areas, some do so for a short period of time, and some struggle with one or both for years. And it doesn't seem to matter whether or not the surgery spared one, both or neither of the external nerve bundles.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 6/25/2010 9:12 AM (GMT -6)   
My experience is that I lost about an inch flaccid, but regain the full pre-surgery length when erect. The erection brings out the parts that are 'hiding', it seems. As has been mentioned early and often stimulation, practice and even using a pump will help somewhat. Another thing is we sometimes gain a little weight aftert surgery and a larger belly can make it appear that we are shorter. If you have a gut, try holding it inward and see if the missing section 'magically reappears" smilewinkgrin
James C. Age 63
Gonna Make Myself A Better Man
4/07: PSA 7.6, Recheck after 4 weeks Cipro-6.7
7/07 Biopsy: 3 of 16 PCa, 5% invloved, left lobe, GS3+3=6
9/07: Nerve Sparing open RRP, 110gms, Path Report- Stg. pT2c, 110 gms., margins clear
3 Years: PSA's .04 each test since surgery, ED continues: Bimix- .3ml PRN, Trimix- .15ml PRN

Regular Member

Date Joined Jun 2010
Total Posts : 74
   Posted 6/25/2010 10:49 AM (GMT -6)   
jahfreak:  I have exactly the same indentation, and am shorter - not only that, but my natural "hang" moved from the right to the left.  Doesn't even appear to be the same little guy I've traveled with for 57 years, but I'm getting used to it!
Age at Dx:  56
DaVinci Prostatectomy:  10/28/98
Stage: T2C
Gleason - 3+4 = 7
Prosate:  52 grams
Incontinence - absolutely
ED - Indeed
Married, father of two (boys 18 and 17)
6 months later:  member of the "zero" club, working on one pad for 24 hours.  Took Cialis for 4 months (no apparent affect), just had my 1st tri-mix yesterday, that worked in spades!
All good here in San Diego

English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2218
   Posted 6/25/2010 10:54 AM (GMT -6)   
Welcome to the forum

Nothing like a skrinking willy to get you searching the web!

I think the readjustment of our bladders and penises to compensate for the prostate having been removed between these two bits of our body is a combination of the bladder dropping down a bit and the penis getting pulled in a bit. For some guys the bladder will drop morfe and the penis not disappeaer so much for others the penis is the bit that will move.

So the penis has not actually shrunk but moved.

And the difference may be much more obvious in the flaccid than the erect penis.

I'm nearly a year on from surgery and I guess I am still missing about an inch in the flaccis and half an inch in the erect version of little Alf.

I always had shallow dip in the skin at the base of my shaft about the size and shape for a small almond to fit in it. (What is name name for the male equivalent of the Mound of Venus? Mars's Hump perhaps? ) And yes it was more pronounced after surgery, but I may also just have noticed it more due to the hair removal down there. And of course putting the two things you mention together I can see that if the penis gets pulled in then the skin attached to the penis gets pulled in too, hence the dip.

I suggest doing all the appropriate penis exercise etc to get it where it likes to be.

Age at Dx 48 No Family history of Prostate Cancer
Married 25 years, and I cannot thank my wife enough for her support.
April 2009: PSA 8.6 DRE: negative. Tumour in 2 out of 12 cores. Gleason 3+3.
RALP (nerve-sparing) at AVL-NKI Hospital Amsterdam on 29th July 2009. Stay 1 night.
Partial erections on while catheter still in. Catheter out on 6th Aug 2009.
Dry at night after catheter came out
Post-op Gleason 3+4. Tumour mainly in left near neck of bladder.
Left Seminal Vesicle invaded, (=T3b!)
no perineraul invasion, no vascular invasion. clear margins,
Erection 100% on 15th Aug 2009, but lots of leaking of urine
Stopped wearing pads on 21st Sept 2009
Pre-op style intercourse on 24th Oct 2009 !! No use of tablets, jabs, VED etc. but...
Nov 17th 2009 PSA = 0.1
Can still get erections okay, and almost no leaking of urine, but since December 2009 I don't have orgasms, instead I just have intense pain in place where prostate used to be.
Mar 17th 2010 PSA = 0.4!!! referred to radiation therapist
April 13th 2010 CT scan.
April 28th 2010 Started Radiation Therapy (66Gy - 33 sessions)
June 11th 2010 finished RT - main side effect tiredness, but also the occasional small leak

Veteran Member

Date Joined Sep 2009
Total Posts : 664
   Posted 6/25/2010 2:27 PM (GMT -6)   
Alf and guys are killing me... the two of you should do stand-up prostate Improv! Hero
Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. involving up to 75%
da Vinci at Wash U, Barnes on 11/02/09 Non-Nerve Sparing on Rt.
Modified Pathology, Gleason 4 + 3 = 7. Gleason 7 present throughout Prostate involving 20% of the Gland. Surgical Margins Free of Tumor,
4 of 4 periprostatic Lymph Nodes Negative, 10 of 10 pelvic Lymph Nodes Negative. Seminal Vesicles tumor free. Extracapsular extension is absent Perineural Invasion is Identified, Vascular Invasion is not identified.
Post-op PSA 12/10/2009, Undetectable  <0.01
Post-op PSA 05/03/2010, Undetectable  <0.01
I hate this crap
Moved by individuals like Living1963


Veteran Member

Date Joined Jul 2009
Total Posts : 1267
   Posted 6/25/2010 2:59 PM (GMT -6)   
Hi Hero --- nice to see your name in print. I know I owe you an email from what, last December? I'm marinating our friendship.

Alf and I are actually booked at the Royal Palladium Theatre, London, in October for three nights. We're billing ourselves as Wee Willie And His Testicle Two. Alf and I will be the Testicle Two. We're currently searching for a Wee Willie front man. I don't suppose you'd get out of your beloved swamp long enough to be front man for us? You'd love the costume!

Sheldon AKA Sleepless
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
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23 test again less than 0.02
PSA on Jan 8 less than 0.02
PSA on April 9 less than 0.02 

Regular Member

Date Joined Jun 2010
Total Posts : 84
   Posted 7/4/2010 6:30 PM (GMT -6)   
Welcome to the club jahfreak
Sounds to me like your Doctor is not doing his job.  Sorry to hear that.  Your physical and sexual health is his job.   I would call and speak to him one more time to seek the satisfaction your deserve and get answers to the questions you have for us now.
I might suggest you write things down in preparation for that discussion and take a witness if possible to the face to face consult.  Failing success on that, find another Doctor.
Penal shrinkage is common for all the same reasons others have commented before me.  Although it is a liittle early in your healing process to impliment a full blown penal restoration plan, it is not to early to have one.  I see a couple of choices for you.  Try to dig such a plan out of your present Doctor along with drug samples, for free, to test a little later.  Barring success on that front, find another Dr.  or make you own plan.  I personally lost an 1".
On the subject of your overall recovery I wish to caution you to be patient and go easy.  That might me counter intuitive to your nature but please go easy.  You have had Major Surgery and the healing process takes far longer then we realize at the beginning of the journey.  Those tissues are wet and take longer to heal.
The moderator of this BB has assembled a nice list of resources for your reading. 
You will find  many answers to your questions by mucking around with those links.  They are a marvelous resource.
On the pain in your butt.  Keep things very clean along with a little extra skin care after bathing.  It feels good, makes you smell better and promotes you getting familiar with how your body looks and feels now after surgery.  A decent sized mirror would be helpful.  Normal activities within reason are encouraged as we heal.  Walking, swimming and mild exercise.  Lifting is not encouraged till later but I want to stress all these activities are normally part of a Doctors orders to their patient.  The fact that you have not had such normal conversations leaves me concerned.  Caution is the word of day on these issues and proceding under medical advice is always recommended and encouraged.
As you can see from the humorous tone of some of these guys, if we don't laugh we sometimes cry at the devestating effects Prosate Cancer has on our minds and bodies and our families. 
We hope to encourage you to do the best you can for yourself  and for all who are around close you.  We want you to succeed and be well.  Please read the particulars of my closing signature block.  We do that for a good reason.
Prostate cancer used to be a fatal diagnosis but during my lifetime has become less so.  We want you to know you can still have a full productive life.
Are you the same NO.  Are you OK, YES. 
I hope this helps a little and please keep us up to date on your progress.
Best Wishes Jim

Age 60 when presented to GP on 3 Aug. 2004 with elevated PSA of 13.8.
Referred to Urologist. Biopsy and bone scan in Oct 04.
Pathology report in Nov 04.  Initial Results are T2cNoMo carcinoma of prostate gland.
Had a RRP on 14 Feb 2005. Boy talk about irony look at that date again.
Dr. called 3 days after surgery. I want you both in my office tomorrow morning, we must talk now.
"I wish to apologize because I misdiagnosed your condition.
Biopsy of your organ says Staging is T3bNoMo. Please accept my apology."
At that moment I fell in love with my Dr. and have never changed my mind.
Followup radiation of the prostate bed started early June 05 and ran 42 sessions.
All PSA checkups to date, 5 1/2 yrs, are undetectable.

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