sex life

Kongo said:

Decisions and Questions
Hunter,

You ask a great question and I hope that those who have had the DaVinci procedure provide you some meaningful feedback.

Although I didn’t have an RP and chose Cyberknife instead, the research I did before I made my decision trying to answer the very same question you posed led me away from the surgical option. To me, quality of life after treatment was my number one priority and “quality of life” is basically code words for continence and sexual function, both of which topped my list of things I wanted to retain.

First, my situation was different (we are all different) than yours. At diagnosis I was ten years older and my pathology was less threatening. (Gleason 3+3, T1c, PSA=4.3, and I/12 samples positive at 15% involvement. I too was told by the diagnosing physician and other specialists that surgery was my best hope.

My research led me to another conclusion. Before surgery no doctor can guarantee the outcome or even ethically suggest that you’re going to come out the other end retaining all the quality of life priorities you went in with. If the doctor gets in there and detects cancer near or within the nerve bundles (a place PCa likes to thrive), he’s going to take them out. If the surgeon can conduct “nerve sparing” surgery be aware that much of the nerve bundles that surround the prostate and are necessary to get and maintain an erection are smaller than a human hair. Keeping the big ones is great, but no surgeon, no matter how skilled they might be is going to be able to save all the nerve bundles so even with helping drugs such as Viagra and Cialis there will likely be some loss of potency from before. The surgery will likely reduce the size of your penis as they reconnect the urethra plumbing between the penile bulb and the bladder. Sometimes the penis will return to normal size, sometimes it doesn’t. If you’ve got an extra inch or two in that department maybe that doesn’t bother you but frankly I wanted to keep everything I had. Some men who have had RP find that they squirt urine at the time of ejaculation. This is an issue that may or may not be a factor between you and your wife but it’s an aspect that most men are probably uncomfortable with initially.

The sexual function following treatment for prostate cancer is generally defined as the ability to achieve an erection sufficient enough for penetration at least once a month. Hmmm. If that is how you and your wife define a “normal” sex life then good for you but it didn’t meet my expectations.

Having said all that, I would keep in mind that just because some other men claim full sexual function after RP doesn’t mean you will enjoy the same success. So much depends upon the skill and experience of the surgeon, the conditions they find when they get inside, and how much other luck (both good and bad) happens along the way.

With a Gleason 3+4 you know that your cancer is more aggressive than a 3+3. I’ve read that recurrence occurs in about 35% of all RP cases but that number goes up the higher the Gleason score because of the likelihood that some cancer has already left the prostate and will eventually show up again with a rising PSA in the future that will require additional treatment. My personal belief is that the very act of surgery alone can increase the chance of spreading the cancer because of the likelihood of cutting across a margin and spilling cancer cells into the blood stream. I certainly wouldn’t consider a recurrence in 3, 5, or 10 years a “lights out” situation but it will require additional treatment and thus incur increased risk of impact upon sexual function.

I realize this paints a negative picture of surgery and in my situation (different than yours) this analysis led me to choose another path. On the other hand, at 49 you are younger, probably have more vitality, and likely possess less other complicating factors than someone 10 years or older than you (like me) that bode well for a higher chance of recovery of a full and rewarding sex life after surgery. As men get older other ailments (diabetes, obesity, heart conditions, and so on…) come into play that can dampen sexual potency and frequency. When combined with prostate cancer it’s hard to tell what is causing the decrease in function….old age, diabetes, being overweight, or the effects of your cancer treatment.

I am gratified and very happy to be able to say that after undergoing CK nearly 18 months ago that my sexual function has not decreased in the slightest, I’m still the same size as before, I don’t ejaculate urine, and I am lucky to be able to enjoy sex as often and as long as I like. I know that some men and studies have shown that there is a risk of decreased function years after radiation treatment but that hasn’t happened to me and I have not read of it happening to others who have had a similar radiation treatment. But again, everyone is different. One thing about radiation though, at least according to my radiation oncologist, is that if there is a decrease in the ability to have an erection that enhancing drugs such as Viagra work well to restore potency.

Some posters here are dead set against surgery in any situation. Others are strong fans. While I decided that surgery was not for me, I recognize that whatever decisions men make on how to treat this disease are deeply personal and highly nuanced and that many, many factors come into play.

This is one of the most difficult and important decision you will ever make. Your life literally depends upon it. I’m sure that if you do your homework, seek diversified professional opinions from both surgeons and radiologists, and have the support of your family that you will arrive at the best decision for you. Nothing is for sure or forever. We just have to make the best decision we can with the knowledge we gather and go forward. In this situation, there is never a going back.

Best to you.

K

The Nev said:

Normal
Hunter I'm not much different then you I was 54 when diagnosed, my PSA was 4.5 my Gleason was 3+4=7. The whole left side of my prostate was involved and very little cancer on the right side. I elected to go with the daVinci. My thoughts were if I go with radiation and it comes back there may not be much they can do, but if they do surgery then it comes back they can still do radiation. I read a lot and still my thoughts were flawed. I went with the surgery; I am now over 2 years post surgery and am 57 yrs old. I still have incontinence and basically no sexual function. So I wear pads everyday of my life some days are better then others but I pee myself everyday. To have sex with my wife I have to inject my penis with Trimix and they recommend only doing that every three days at most. So no matter what only a couple times a week. I’ve gotten used to the injection but I’m having a hard time getting used to the loss of an 1 ½ in, and the planning that goes into a sexual event and ejaculating urine If I don’t make sure my bladder is very empty before sex. Worrying about that makes sex less enjoyable then you might imagine. Just in case you think I had a shoddy Dr I went to MD Anderson in Houston and had a very experienced doctor. It’s just the luck of the draw. So a normal sex life there is no such thing after surgery NO ONE has a normal sex life; some get close but again NO ONE gets back to normal. Now the good side I still have no detectable PSA, and that is what I was after so success right! I have to admit if I had it to do over there is no way I would have the surgery, but that’s just me there are many that are very happy. So just my story not trying to sway you one way or the other purely information from a surgery patient. Good luck in what ever you decide, I’m not sure there is such a thing as normal after prostate cancer.

Swingshiftworker said:

Shorter Penis Length Following Surgery
The prostate is located between the bottom of the bladder and the top of the internal penile structure. For simplicity, lets just refer to the latter as the penis. You can do a Google search of the anatomy of the prostate for illustration.

When the surgeon removes the prostate, s/he attaches the bottom of the bladder to the top of the penis and, when this happens, the penis withdraws about an inch or so (which is about the size of the prostate) into the body cavity where the gap was created.

This problem is seldom discussed w/prospective surgical prostate patients and it wasn't mentioned to me. I found out about it myself and when I asked a surgeon about it, he said: "Your penis doesn't get shorter."

Technically, he was right, the penis doesn't get shorter -- it just "looks" shorter -- but that's still pretty important to most men. As you probably know, there are 2 basic types of penises: "showers" and "growers." If you've got a "shower, the loss of an inch probably won't be a big deal but, if you have a grower that's only a couple inches long to begin with, the loss of an inch in appearance could be a really BIG deal.

The medical establishment's "solution" to this problem (which only happens if you elect surgery) is to tell men to use vacuum pumps in order to stretch the penis and increase it's length but this advice is suspect.

Vacuum tubes have been used for some time by some men as a sex toy to temporarily inflate it's size (both length and width). However, there is no scientific evidence that I know how which proves that use of a vacuum tube will PERMANENTLY increase penis length.

So, once you have surgery done, just be aware that your "willie" may look a bit shorter afterward.

OBTW, the reason many men suffer incontinence following surgery is because the urinary sphincter at the bladder is removed. There is another urinary sphincter at the top of the penis too and after surgery the penile sphincter has to do the job of both. However, the bladder sphincter is the primary sphincter and there's a "learning curve" involved in getting the penile sphincter to work properly. In most cases, this is achieved in a year or less but some men never regain proper urinary control and have to have an artificial urinary sphincter (AUS) installed to take over the job.

Nev's story about his problem w/incontinence (and ED) is just one among many. You can find many more stories (as bad or worst than his) here and on other forums.