Question for prostate surgery recipients

great read/info for this newby but why so outdated?

jeffman said:

No erection does not equal no

No erection does not equal no sex life. There are a boatload of alternative methods. As a boomer who came of age in the 70's I can attest to that. Even when I could get an erection I didn't always need it. After my surgery I lost the erection but orgasms were the same , but without ejaculation. Sometimes you need to adapt as opposed to give up. I'm 66 , so far cancer free after 2 years and still have a good, but different, sex life.

jefman,

Iwould Be thrilled to know what you are calling sex Life without sex?

My sex life after RP is totally nonexistent.

MK

MK1965 said:

jefman,

jefman,

Iwould Be thrilled to know what you are calling sex Life without sex?

My sex life after RP is totally nonexistent.

MK

To answer your question MK1965:

In my experience/opinion "sex life" is not solely defined/limited to penetration by an erect penis. When there's a will,there's a way. In this case more than one way.

Thanks,

Jeff

mhl said:

prostrate surgery or proton

We went to see the surgeon who does robotic surgery and he could not promise that it would be nerve sparing. While there we were offered a trial with 3 arms one had this drug  Apalutamide,second arm had this combination apalutamide plus abirateroneacetate and GnRH agonist  and 3rd arm was surgery . We were told my husband was randomized to surgery. My question is does any one know anything about these drugs are they availble on the market? I am  also  trying to find out information about proton therapy for the cancer. Does anyone know anything about proton therapy?  Can you have proton treament and still have surgery. Any informaiton would be greatly appreciated. My husband has PSA 73 without symptoms no metastasis biopsy showed 90% cancer in all nine slides and the doctor on exam was not able to feel anything so you can see my confusion

Thank you

mhl,

Good luck making good choices in your husband's treatment.   Surgeons will spare the erectile nerves almost always, except when there is suspicion of cancer involved with them.  Hence, they cannot promise in advance to not remove them.   In usch cases, the nerves must be cut out, as any patient would want.  Also, if a person has cancer in his erectile nerves outside the gland, then if he chooses radiation instead of surgery, that must be radiated to kill all of the disease; otherwise, the cancer is simply going to spread.  Radiating them is going to destroy those nerves as much as surgically cutting them out would. In other words, if the erectile nerves are cancerous, any successful treatment is going to almost certainly render him equally impotent thereafter.

Proton is mostly regarded as a valid option.  Some insurance carriers will not pay for it, and many cancer centers do not offer it, but more and more are beginning to do so. Proton advocates used to make outlandish claims about its success and lack of side effects, but recent stuides from the past several years are pushing back against much of that.  These studies mostly, generally, confirm the effectiveness of PT, but deny its superiority to convetional radiation techniques.

Digital Rectal Exams are of very limited use, since they only sense the lower rear half of the gland; they tell the doctor nothng about the other half.

Your husband's PSA and volumetric level of involvement highly suggests that he has involvment OUTSIDE the gland.  This is NOT definite, but highly probable.  Negative PET scans, MRIs, or bone marrow scans do NOT prove lack of escape.  But they do constitue commentary on the extent of escape; that is, they indicate that any escaped tumors are currently too small to be seen on imaging.  I hope some of this clarifies to you what the doctors are telling you.  

max

Max Former Hodgkins Stage 3 said:

A few relevant thoughts regarding your post

mhl,

Good luck making good choices in your husband's treatment.   Surgeons will spare the erectile nerves almost always, except when there is suspicion of cancer involved with them.  Hence, they cannot promise in advance to not remove them.   In usch cases, the nerves must be cut out, as any patient would want.  Also, if a person has cancer in his erectile nerves outside the gland, then if he chooses radiation instead of surgery, that must be radiated to kill all of the disease; otherwise, the cancer is simply going to spread.  Radiating them is going to destroy those nerves as much as surgically cutting them out would. In other words, if the erectile nerves are cancerous, any successful treatment is going to almost certainly render him equally impotent thereafter.

Proton is mostly regarded as a valid option.  Some insurance carriers will not pay for it, and many cancer centers do not offer it, but more and more are beginning to do so. Proton advocates used to make outlandish claims about its success and lack of side effects, but recent stuides from the past several years are pushing back against much of that.  These studies mostly, generally, confirm the effectiveness of PT, but deny its superiority to convetional radiation techniques.

Digital Rectal Exams are of very limited use, since they only sense the lower rear half of the gland; they tell the doctor nothng about the other half.

Your husband's PSA and volumetric level of involvement highly suggests that he has involvment OUTSIDE the gland.  This is NOT definite, but highly probable.  Negative PET scans, MRIs, or bone marrow scans do NOT prove lack of escape.  But they do constitue commentary on the extent of escape; that is, they indicate that any escaped tumors are currently too small to be seen on imaging.  I hope some of this clarifies to you what the doctors are telling you.  

max

Thamk you so much for you response. My husband final dx prostatic adenomacarcinoma 80% of tissue and 4+3=7 gleasonStage 1 MRI and bone scan showed no metastsis with recomendation of surgery. Do you know if he tries proton radiation first can he still be a candidate for surgery. We are tryin to look at all options since there seems to be no mention of medications as part of the treatment plan.

Thank you

mhl said:

prostrate surgery or proton

Thamk you so much for you response. My husband final dx prostatic adenomacarcinoma 80% of tissue and 4+3=7 gleasonStage 1 MRI and bone scan showed no metastsis with recomendation of surgery. Do you know if he tries proton radiation first can he still be a candidate for surgery. We are tryin to look at all options since there seems to be no mention of medications as part of the treatment plan.

Thank you

mhl,

You asked a question that has traditionally engendered a fair amount of disagreement here. The conventional wisdom is that after radiation therapy, prostatectomy is not possible.  Some guys then insist that it is.  However, almost no surgeons will remove a prostate post-radiation application.  My own surgeon, who had done well over 1,000 RPs today, advertises as a surgeon who WILL do the complex surgery after radiation, but only a handful of surgeons have this rare sub-specialization.  After radiation, the gland become fiberous and very difficult to cut.  Hence, in real life for most patients, removal following radiation is not possible, and would likely be of little benefit anyway.

Radiation to the tissue that formerly surrounded the gland after it was removed IS possible, and it fact is pretty common, especially in cases of relapse.

You mention "recommendation for surgery." Recommended by whom ?  Probably by a urologist.   I suggest you consult with a radiation oncologist also, since his or her assessment may be quite a bit different.

Well, it comes down to gut (surgery) or nuke (radiation).  If the cancer has escaped the gland, most folks are advised to nuke.  If the cancer is contained to the gland, most folks are advised to gut.  In my case, I was advised to gut (gland removed; seminal vesicles removed; 8 pelvic lymph nodes removed; bladder neck reconstruction).  If your quality of life is dependent on preventing erectile dysfunction, I would probably go with the nuke.  However, in my opinion, nuke or gutting can cause erectile dysfuntion.  If your quality of life is dependent on defeating the cancer and adjusting to the side effects, then like most of us you have a tough decision to make.  Like I said, if the cancer has escaped the gland no need for surgery, just radiation.  I had my RARP 3/20/2018.  At this time, my PSA is undetecatble;  I am fully continent;  still having issues with ED.  Good luck on your journey.