opinions on using the purple pill?

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Regular Member

Date Joined Aug 2010
Total Posts : 245
   Posted 8/26/2010 10:44 AM (GMT -6)   
First, thanks to all who responded with congrats on the 0 Club news - had the hubby look at all the responses and since his keyboard skills are at a painful hunt and peck level, I'm passing on his smiling appreciation... 
Now, about the drugs for ED...  Some docs advise getting to work immediately on restoring function with pumps, pills and whatever the @#$% works.  Our pre-op packet from Catalona's office (ultimately didn't go with Chicago) and other resources say go for it, starting around 4 wks post-surg.  Our Boston surg seems to be in no hurry,  talked about healing first, and only with prompting prescribed Viagra.  Sensation is there, orgasms too, but there's no E.  Haven't filled the scrip - yet.  Unsure about the use or it lose it urgency, or the heal first thing from Boston surg....
Stats: Husband 60 yrs. old, psa 10/02 2.79, 12/06 3.64, 5/09 3.9, 10/09 4.6,  1/10 5.0
6 core biop 4/1/10, 1 core, right mid 5% adenocarcinoma Gleason 3+3, second core right apex highly suspicious minute carcinoma, Prostate MRI showed 15mm nodule,
nerve sparing manual rad. prosty Boston, 7/6/10  of 90 gram prostate
12 lymph nodes-neg, sem. ves.-neg, extraprostatic tissue-neg, margins-neg, 3+3 Gleason grade prostatic adenoc. present both sides
post surg: almost 100% continent

Veteran Member

Date Joined Sep 2009
Total Posts : 3172
   Posted 8/26/2010 10:49 AM (GMT -6)   

To help you make your decision on next steps for full recovery, I recommend viewing these 3 free online videos from Dr John Mulhall, who might be the most knowledgeable, most respected urologist dealing with sexual function after radical prostatectomy.


(Someone else posted this link here at this site a few months ago.  It is outstanding in helping one to understand what's going on.)


Regular Member

Date Joined Mar 2010
Total Posts : 208
   Posted 8/26/2010 11:24 AM (GMT -6)   

Thanks for this link. My husband had surgery 8/9 and his doctor put him on cialis the day after the cath came out (8/17). That seemed too soon to me but we were told it was to get the blood going to the penis. Well, it's worked very well, though he switched him to viagra because of side effects. He, of course, is very happy. One interesting fact in the video was that many men who early on have erections lose them around 3-4 months because of the effects of surgery. That seems to be a low point in the healing. I didn't watch the 3 entire videos, but plan to with my husband as they will be very helpful to us going forward. Again, thanks.

Husband diagnosed 3/10
Age 56, PSA 4.7, free 7.6%

Biopsy 5 of 10 cores positve-all right side-25% to 57%

Gleason 6

DaVinci surgery with Dr. Vip Patel scheduled 8/9/10

Post Op: Gleason 3+4=7
Negative surgical margins
Negative lymph nodes
No seminal vesicle invasion
No angiolymphaic invasion
perineural invasion present
Both nerve bundles spared

Regular Member

Date Joined Aug 2010
Total Posts : 245
   Posted 8/26/2010 11:54 AM (GMT -6)   
Thanks Casey - started watching but will resume when husband gets in and we'll watch together.  Really want to know the difference in the 2 opinions...

Steve n Dallas
Veteran Member

Date Joined Mar 2008
Total Posts : 4818
   Posted 8/26/2010 12:47 PM (GMT -6)   
Taking the BLUE pill a few weeks after surgery is done as part of the heeling process....Getting blood to flow there is the name of the game. Most of us were told to take it before bedtime and to not attempt to make whoopie.

Age 55 - 5'11" 215lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6
06/25/08 - Da Vinci robotic laparoscopy
05/14/09 - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
05/18/10 - 24 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.
Growing old is mandatory; growing up is optional..

Veteran Member

Date Joined Sep 2009
Total Posts : 3172
   Posted 8/26/2010 1:25 PM (GMT -6)   
NEIrish said...
Thanks Casey - started watching but will resume when husband gets in and we'll watch together.  Really want to know the difference in the 2 opinions...

You are welcome...

By “the 2 options”, I’m guessing that you are talking about whether to follow a post-surgical sexual function recovery protocol of taking PDE-5 inhibitors, or not taking them.

You mentioned that surgery was in Boston…I’m going to venture a guess that Dr Jim Hu was his surgeon (no need to respond to this; I did also see your posting on the upcoming D-F/B&W PC Symposium which tipped me off).  I understand that Dr Hu is an excellent surgeon, but he is also one of the minority of urologists who does not follow a sexual function protocol.  Dr Catalona, who you did mention, is among the majority who do have some type of protocol.  Most protocols are similar, and most involve use of a PDE-5 inhibitor (Viagra, Cialis, or Levitra).

One can find medical reports which support use of PDE-5 inhibitors, and others that say they are not necessary because sexual function usually is restored over time (to the same extent) anyhow.  [I should note for completeness that there are exceptions and some guys have lingering issues, but for the typical low risk PC case (like your husband's) after radical prostatectomy, sexual function eventually does usually return to a fully functional state at least close to the pre-surgery performance level.]  To my knowledge, there are no studies—and this point is relevant—that say that taking PDE-5 inhibitors is bad for you.

In hindsight, the use of PDE-5 inhibitors made the recovery period more tolerable.  Would I have eventually fully recovered anyhow?  Probably, given my case characteristics.  The fact is that I rather enjoyed their effect, and used them (until they ran out) probably longer than I needed to.  Nothing wrong, I figured, with getting a little enjoyment out of the whole experience!

(By the way, I'd like to give proper credit to whomever originally posted the link to those videos on this site, but I've forgotten who it was, so "sorry about that."  I bookmarked the site when it was originally posted, and have sent the link to several others in the past.  Excellent video.)

Post Edited (Casey59) : 8/26/2010 2:23:49 PM (GMT-6)

Veteran Member

Date Joined Jul 2010
Total Posts : 3596
   Posted 8/26/2010 4:09 PM (GMT -6)   
If you are trying for a good, solid erection, don't swallow Mr. Purple, chew it up and wash it down with a little water..They don't taste bad.. If it's going to work, it will work in ten minutes or less..When you chew them up like that, you get a slight "rush" from head to toe..
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third 12 core biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. I'm also looking at seeds combined with IGRT which seems to be having good results with high-risk patients..

Regular Member

Date Joined Aug 2010
Total Posts : 245
   Posted 8/26/2010 5:42 PM (GMT -6)   
No, Hu is into the robotic procedure, and my husband had manual. The 2 "opinions" I was referring to was how one school of thought believes it important to get blood flow into the organ asap for lower risk of ED and the other school that seems to think that complete internal healing comes first (I believe I remember the surg. saying how the nerves have been "shocked" and to allow them time) and wait around 3 months or so before "working" at it. We only rec'd the Viagra scrip by specifically asking for it . Right now his slow return to normal activity has irritated his incision line and it's been leaking at the base. A call to the office rec'd a reply that it was not a concern but to watch for signs of infection. He's said he often has a feeling of heat inside the whole general area, but has no symptoms of infection. We're using bacitracin for the incision and just bought a pair of farmer jeans to avoid pants waistbands. They're hysterical.

Regular Member

Date Joined Oct 2005
Total Posts : 489
   Posted 8/26/2010 8:56 PM (GMT -6)   

Welcome to a fellow Man (and Wife) From Mass.
Also I noticed the stats: Yours 90 gm prostate -- Mine 110 gm. Your PCa 5% of 1 of 6 (or 10?) cores and 3+3 -- mine was the same.

I started in ED therapy at about 4 weeks -- got my own Encore pump .. got my own ADC meds started. My uro was not very pro-active on the ED side -- although introduced MUSE fairly early on and I still use it to this day periodically. I could see where a Doc might not want to push Viagra or Cialis too early -- for one thing it is unlikely to do much very early on except in a very small percent of RP cases. Secondly, when you get the sticker shock for price-per-pill you will also know your Uro is trying to do you a favor by not bleeding you dry with co-payment costs. More the reason to go with ADC or some other foreign source if you insist on trying drugs to help kick start things.

One interesting thing that I have anecdotally observed is this: The larger the prostate at time of RP, the longer it took (if ever) to get back any erection action. I am still looking for more than just tumescence at 18 months and I know James C our moderator is also 36+ months (and a former 110 gm man) also still waiting for things to happen.

Have not done a thorough scan of other large prostate patients but perhaps a few more might chime in over time with their ED progress (or lack therof) to see if there might be any validity to Large Prostate == Long ED recovery times.

(I would speculate that it is either because it is more challenging to take out a large prostate ( and damaging nerves and arteries in the process) and also a large prostate will have been pressing on the nerves running beneath it all along -- possibly causing some damage even before surgery).

Have your husband keep on reading tho ... easy to do with just a few hunting and pecking fingers.


Post Edited (JimStars) : 8/26/2010 9:09:18 PM (GMT-6)

Elite Member

Date Joined Oct 2008
Total Posts : 25355
   Posted 8/26/2010 9:09 PM (GMT -6)   

My uro/surgeon was of the school of allowing healing before dealing with ED. I had open surgery, and due to complications, I was on a catheter for 101 days following my surgery. No attempt was made to deal with any potential ED during that time. Once the last catheter at that time was removed, I was able to have full errections with dry orgasm without the use of pumps, drugs, or injections. My left nerve bundle was removed, and due to complications, the right side was left intact but noted "damaged" on the surgical report. These surgeries, open or robotic, are very involved and complex, and I can understand why some surgeons, like mine, go for the healing first. I often wonder if the extra cath time, which is unusual for that length, aided in allowing me to heal properly from a nerve point of view. Toward the end of that 101 day period, I had a few in the middle of the night "woodies", and I assure you, that is something you don't want to happen with a foley catheter in place.

My advice, is to listen to what his surgeon says. Like most things surgical and PC, it varies too much patient to patient I wish him well in his recovery.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

Regular Member

Date Joined Aug 2010
Total Posts : 245
   Posted 8/26/2010 11:21 PM (GMT -6)   

Just finished viewing all of the videos from the link you provided, Casey, although my husband, with the nasty fatigue he's still feeling, had to get to sleep.  A lot to absorb, but basically it had more of the urgency I mentioned in the 2 different views of restoring E function post surgery.  The terms "atrophy" and "venous leak" left me uneasy.  Atrophy since our surgeon is not of the sooner the better school and I now have visions of tissue shrinking by the day due to non-use; venous leak since my husband lost over a pint and a half of blood during his surgery - those vessels had to be very damaged/cauterized.   First time I heard about "old blood" during the part about the pump!  Thank you again for the post.

To Jim - if you get a new thread started asking about a correlation  between removal of large sized prostates and current ED status, I'd be an active monitor.  I had to get the file out to record his stats and realized later I'd made a 5 gram error - it was a 95 gram prostate making it even worse if your anecdotal info proves to have validity.  Wishing you and your wife good luck with eventual complete recovery.  I think we'll be getting that scrip filled soon.  Our insurance has great scrip coverage too and my husband believes if it's not for recreational use but used for treatment of a medical/surgical complication it'd be substantially covered.  At least the cost won't be one more thing to worry about it... 

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4462
   Posted 8/27/2010 9:33 AM (GMT -6)   
NEIrish- the term venous leakage is used (Usually) only in the context of penile blood flow during the body's attempt at an erection. Said simpler, it means that the nerves still aren't repaired or restored to the point that they can trigger the veinous valve which normally will close to keep blood in the penis, producing an erection, or opening the valves to allow the blood to flow out, and the erection subsiding. Most guys get a real life dramatic demo of this when they use the penis pump the first time and their system hasn't healed to the extent needed to function normally. It is really distressing to pump up a nice healthy erection and then see it drop back down as soon as the vacuum is removed. smilewinkgrin That was my moment of truth, as far as realizing just what my status was, erection wise. So, if your husband has blood loss issues during surgery, that has no relation to the mentioned 'veinous leakage' in the video. Two seperate issues completely.

As far as gland size related to ED, I'd be interested in that thread. My 110 gram one, removed during open RRP, with the possible-probable stretching of the nerves, even before surgery had begun to give me ED, has surely contributed to my lack of any ED improvement at the end of 3 years now. My surgeon speculated that the size contributed directly to both pre and post surgery difficulties in ED. Even when 'nerves spared' there's still a lot of damage can happen to the bundles, and depending on the skill and determination of the surgeon, can result in men needing more months than others to recover. Thanks for bringing this discussion up, guys.
James C. Age 63
Gonna Make Myself A Better Man www.youtube.com/watch?v=a6cX61oNsRQ&feature=channel
4/07: PSA 7.6, Recheck after 4 weeks Cipro-6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, 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 Aug 2010
Total Posts : 245
   Posted 8/27/2010 4:09 PM (GMT -6)   
Thanks James - since I'm (and husband) are newbies here, perhaps you as moderator would get the best response when starting a thread survey on this. It seems like common sense to speculate about the correlation between prostate size and subsequent problems with ED after -ectomy. He'd had no indications, no problems before rising psa triggered this whole mess. Seems his prostate was enlarged but growing back towards the rectum (forgot the term) and he had no symptoms in bathroom or bedroom, nor during DRE, that it was so enlarged. First sign of it was during the imaging used for his biopsy. Gram weight size was noted after his prostate MRI. He had an awful time with rectal pain for 4 wks. or so post surg and (speculation again) we thought it had to do with not only referred pain but also how stretched the skin by the rectum must have been. I like that you're talking about "more months to recover", and not losing hope after the 3 yrs. post surg. Moderate thinking from the moderator!
Re: venous leaking - viewed the video link late after a worrisome day and there was a lot to absorb. Figured I get the husband to see it over the weekend. Thanks for the explanation!
And lastly: filled the scrip 30 minutes ago. 4 pills were $17.85 (should have been $96.00) We'd get the best deal when we receive a 90 day (36pills are considered a 90 day supply) scrip - only $20.
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