Hello, @rbtsch1951 - I sympathize and agree that the expected changes are concerning, but I will say there are reasons to remain hopeful. I am in some ways still in the worst part of my treatment, regarding side effects. I won't sugarcoat it - treatment is life extending, but also life altering. That said, my experience may be vastly different from yours, so I cannot tell you what you can expect. But here is how it is going for me, in case you might find it helpful.

The brief rundown: I am 51, diagnosed stage IVb (G8, cT3bN1M1) in Nov 2024 and in treatment since Dec (almost 8 months to the day since I started). Surgery was not an option, so I am on ADT (Eligard plus Zytiga) and I had six weeks of radiation earlier this year. I already had anxiety and depression prior to my diagnosis, and I'm not gonna lie, they are definitely worse now - but I am learning to adjust. My energy and stamina are gone, my body has changed shape in ways that make me very self-conscious and unhappy, and my sex drive and function are both at an absolute zero. Again, not sugarcoating - that's just my reality.

But the positives - my husband (56) is extremely understanding and supportive. He and I have learned to talk more openly about how we each feel about how things have changed, and he helped me to choose treatment rather than letting the cancer take its course (and he helps me to keep choosing to remain in treatment when I want to quit). Bottom line, he would rather have me alive and present for as long as possible without the same kind of physical intimacy we shared before, rather than another couple of years of sex with a much shorter life expectancy (my prognosis without treatment was 3-5 years due to the aggressiveness and advanced nature of my PCa).

I agree with @northoftheborder that sexual dysfunction for gay men does strike directly at our core sense of self (that is certainly true for me), and the loss of that function (and the loss of desire) is traumatic. I cannot compare or rank my trauma relative to anyone else's, but it definitely was devastating and extremely difficult to reconcile for a while; that said, now that my husband and I have had some time to adjust to my new normal, we have increased our emotional intimacy to the point where it is much easier to live with things the way they are without feeling such a profound sense of loss. After 20 years together, 19 with sex and 1 without, I feel as connected with him now as I ever have, if not more. [Admittedly, this is only possible because he is the absolute best person on the planet (not that I'm biased).]

Change like this is very scary. I felt like my entire identity and self-image have changed (not just from a sexual perspective, although that is certainly a non-trivial part of it), and it feels like an absolute violation of my body and my being. There are days when I don't think I have the strength to go on (physically and mentally). Aside from therapy, what keeps me going is allowing myself to be vulnerable and share how I'm feeling with my husband. At this point I do not know whether I will ever regain my sexual function, but I am learning to value and elevate other parts of my core sense of self that somehow did not seem as significant before as they are now (and frankly, I'm kind of enjoying being free from the shackles of a high libido).

I don't know if this is helpful at all, but just know that you are not alone in this - yes, it is not going to be easy no matter what treatment you receive, but my best advice is to make sure you don't try to bear the burden alone. As a fiercely independent person who does not like to feel vulnerable, that advice is as much for myself as it is for you.

Please understand this is still relatively new for me and I have been very much in the thick of things for the past eight months. I cannot share a perspective of what to look forward to in terms of "coming out the other side" yet (if there ever really is such a thing), but I have read many accounts from both gay and straight men that there are many reasons to (1) choose treatment even though it will change things in difficult ways, and (2) remain hopeful that things will get better over time. I hope to stick around long enough to be able to confirm that eventually from my own experience.

I hope you and your husband can find your way through this together. You are not alone.