No erection after 5 years after radical prostatectomy

About one month after my prostatectomy I was able to get a usable erection with the help of pills. That ended several years later when I started Lupron and Abiraterone due to a recurrence, the pills no longer worked and Trimix caused an erection that lasted 3+ hours no matter what the dose and Peyone’s Disease (when your erection goes to the side instead of straight ahead). We continued sex without penetration until a year ago when I had a IPP (inflatable penile prosthesis). I only wish that I had gotten it sooner. If you are able to have orgasms and are healthy enough for surgery, I highly recommend it. My wife and I are both very pleased with the results. My Medicare plan paid for it.

@tomf There is major fundamental physical and emotional loss involved in first losing ejaculation, then the ability to naturally get an erection, and finally losing your testosterone and becoming a menopausal woman. It takes a lot of courage to weather this, especially when low testosterone causes depression to start with. Having an understanding and supportive partner, gratitude, exercise and meditation have helped me immeasurably. Grieve the loss, but enjoy what you do have to the fullest.

@kila1988 I agree with Jeff Marchi that the only internal radiation I know if is HDR (high dose, short term brachytherapy) or Low Dose Brachytherapy (implantable permanent radioactive seeds).

I had one outpatient HDR procedure as a boost to 5 weeks of IMRT external beam radiation sessions. My first RO suggested the two HDR and done option early on (as you outlined) but I opted at the advise of my RO for the combo program

The HDR session was much easier than I expected. I had no pain, post procedure bleeding, and did not go home with a Foley catheter (thank God).

You should compare the combo external beam radiation + brachytherapy to the two HDR sessions for effectiveness and long term biochemical remission stats

Good luck

@briang1958

PSA doubled again in 3 months following 2nd photon beam therapy SBRT. So far both Iliac nodes zapped 1 at a time.
Back to the PSMA PETScan to find next metastatic foci(s).
Oh yeah, did I mention Cancer sucks then you die? (True Story!)

Turning 67 in 2 weeks, been doing this for over 10 years and almost ready to quit

Things will be improving in the future:

Dr Arthur Burnett has been interested in how to preserve erectile function after prostate surgery for many years. In this video he says he now has the ability to positively identify whether a particular area he might be about to surgically remove is important to the patient's ability to have an erection. He can stimulate the area and cause an erection during the operation and avoid removing that area if possible.

A problem is surgeons can't identify what is prostate cancer and what is not, during the operation. Pathologists can, but they usually examine tissue only after the operation is over.

The NeuroSafe trial showed that it is possible to drastically improve the number of patients who retain erectile function after surgery if a pathologist report is available during the surgery. Surgeons can remove a prostate from selected patients, without worrying too much about what if they are leaving cancer behind because of positive margins, if pathology on the removed prostate is performed during the operation. The surgeon can be informed about positive margins when still in a position to do something about it, i.e. more tissue can be removed in that area. Here is an interview with the doctors who did the trial

What I want to know is what the "neurovascular bundles" are "really" for, and why are they mentioned in the surgical report as having been preserved during the surgery, if they are perhaps "not" involved in achieving an erection? I was told by my doctor that they are for sexual function, yet I haven't had an erection in over eight months post-op (DaVinci Robotic-assisted Radical Prostatectomy). Here is an "AI" response to my inquiry about the bundles:
"Neurovascular bundles (NVBs) are critical anatomical structures in prostate surgery. They are located alongside the prostate gland, specifically flanking the posterolateral surfaces. These bundles contain essential autonomic nerves and blood vessels that play a significant role in erectile function and urinary control.

Key Functions and Importance:
Erectile Function: The nerves within the NVBs become cavernous nerves as they enter the corpora cavernosa, which are vital for achieving and maintaining erections.
Urinary Control: The NVBs also contribute to urinary function, making their preservation crucial during surgical procedures.
Surgical Considerations:
Nerve Preservation: During radical prostatectomy, preserving these bundles can lead to better functional outcomes, reducing the risk of erectile dysfunction and incontinence post-surgery. Studies indicate that preserving both bundles is more beneficial than preserving just one.

OK...so...if they are critical to erectile response and the urologist preserved them during surgery, then why can't I get an erection? Unless...the urologist/surgeon DIDN'T really preserve them, but lied in their surgical report. Who could ever check? How could anyone prove or disprove that they were preserved?

@rlpostrp My doctor also said he preserved all of my nerves...I never had incontinence but my surgery (not Da Vinci robotic) was January 2, 2020...almost 6 years ago and I still can't get an erection with getting a shot of BiMix, but it works, not perfectly but enough. I hope your situation improves more than mine...but I have no detection of caner with a PSA test every 4 months since my surgery and I can still hug my wife, my kids and my grand kids...I've tried to focus on the positive parts of my outcome...I'm alive an healthy still at 70 years old.

@briang1958 Hang in there bud! Sometimes the cavalry DOES show up when things look bleak!
Phil

@rlpostrp Nerves are very, VERY delicate structures. Preserving them is one thing; not traumatizing them is another.
Dissection of the nerves away from the gland is extremely difficult and tedious; even the best surgeons have no control over how they will respond, heal or function…a crapshoot, like everything else about this nightmare…
Phil

For what it is worth, orgasm is still possible even without an erection. This can be accomplished either with a willing partner or solo. I have had orgasms that have been every bit as deep as I had when I could still have erections.