I was fairly well informed about
the sexual risks of surgery before I made my decision. This isn't to say that the prospect didn't scare the living snot out of me because it did. I had a somewhat circuitous route that I drove to get to my local second-run movie theater because it didn't go past the hospital. Just the sight of the hospital would make me so anxious and depressed that I couldn't enjoy the film, and my angst was 100 percent worry about
sexual side effects with almost no concern about
the surgery failing to deal with my cancer. And, actually, sexual worries were part of my slight preference for surgery.
I had a certain degree of ED before I was diagnosed. PDE5i drugs worked... usually... but I had the sense that that any cancer treatment was likely to push me over the line into dependence on injectable drugs for sex. You lose something with all of the treatments and since I was sort of so-so going in I figured to be a trimix junkie no matter what I did. I wasn't a member here at the time but I read some of our Trimix threads and took great comfort from them.
I had a really big prostate. I had been treated for BPH, for years, with Avodart, which had shrunk it from gargantuan to merely huge. I looked into brachytherapy but before they could seed my prostate I would have to spend some time on hormones to shrink it to a manageable size. (Past a certain size I am told the pubic bone gets in the way.) I also looked at radiation but they also wanted initial HT to reduce the size of the gland so they could use a smaller total amount of radiation to achieve the required dose in the prostate itself. So my choices (at the time) were 1) robotic surgery, 2) 6 months ADT plus brachy, 3) 1 year ADT plus radiation. Unfortunately, men don't always recover from ADT -- at least not completely -- and I reasoned that, since I was likely to wind up on Trimix no matter what I did then at least sticking needles in my privates would be more fun
if I wasn't chemically castrated at the time.
As things have turned out, my cancer was more aggressive and somewhat more advanced on my post-op pathology than it appeared on biopsy. I have been unable to avoid the ADT which was the deal breaker in my pre-op decision making. So, if I had known then what I know now about
ADT would I have made different decisions? I don't think so. I currently stick needles in my member three times a week, and sure enough, it's not that much fun on ADT. I was right about
that part. I do it because two years from now, when the androgen blockade finally wears off, I am hoping to once again have some sort of sex life and I will be cross with myself if I have let the required equipment atrophy.
If I had known then everything I know now would I have made the same decision? I dunno. Maybe. There is a combination of brachytherapy plus external beam radiation plus ADT that might have given the same probability of success as my current combination of surgery plus IMRT plus ADT but with fewer side effects. But that would sort of be cheating since I would have been using information I got from surgery to tell my former self that I had been misdiagnosed as Gleason 7(3+4) and that I was really a Gleason 9(4+5) and needed absurd over-treatment if I chose brachytherapy.
What I would tell my former self, if I could, is that I should have a mental plan for dealing with incontinence. I was so worried about
ED that I had worked out an in-depth plan with multiple fallbacks and contingencies; I believed I would be OK no matter what happened. That plan would have worked better if I had realized up front that incontinence is a big sexual problem. That aspect kind of blindsided me.
So losing my sex life to prostate cancer still remains unacceptable to me. I am currently about
nine months into a three-year hiatus. I have zero actual libido just now but I remain aware that, prior to my surgery, a fair amount of my easy-going mood was the result of endorphins from an active sex life featuring sex when I could get it and long showers when I couldn't. ADT left me capable of orgasms and they did still improve my mood and relax me. I would probably still be somewhat active despite the lack of libido if the ADT hadn't also made me depressed, requiring anti-depressants which make any sexual climax impossible.
So for the next two years and a few months I expect to be pretty cranky most of the time. Some of the other guys have said that ADT keeps them from thinking about
sex. That's interesting. It doesn't work that way for me. I think about
sex now about
as often as I did before. The only difference is that now those thoughts make me quite unhappy. But three years isn't forever. That's what I tell myself. On the other hand, starting at age 60 a three-year hiatus takes a noticeable bite out of your remaining sex life. I hate this disease.
Post Edited (PeterDisAbelard) : 3/17/2013 8:30:48 PM (GMT-6)