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1 Year Post-RARP (Robot-Assisted Radical Prostatectomy)
Non-nerve sparing RARP in early Oct 2025. Post-surgery Gleason dropped from 10 to 9. Cribriform, but clean margins and nothing found outside the prostate. 4.61 PSA pre-surgery. PostOp PSA has not been as low as I would have liked: 016; .02; .09; .039; and .047. After the .09, an oncologist reviewed my case and advised continued monitoring, waiting on the next tests, which were lower. I will remain on 3 month testing under the care of my urologist who performed the surgery. Discussions on way forward should the slow rise persist were centered on salvage and ADT options prior to hitting BCR.
As far as the post-surgery incontinence, I wasn't as fortunate as some, but saw steady improvement until about 8 months. A bit stagnant now, with 2 light Tena pads per day, only stress incontinence with activity for the most part. I have cut down on Kegels recently to see what that will do, otherwise have been doing those regularly since before surgery. Given the nature of my surgery, the ED was expected and I have actually seen some improvement there without meds. I walk most days of the week and work out with weights regularly. Eating healthy, but still enjoying regular desserts, wine, beer, and of course too much coffee. Life is too short not to enjoy myself.
Lastly, my wife has been beside me…sometimes behind me with a swift kick, this whole way. I never thought I would be laughing and commiserating with her about how pads can suddenly catch what they shouldn't. Or walking the hallway with a bag strapped to me leg and a tube hanging out of my underwear, telling her I was bringing sexy back…So after a year, I have some leak, ED, and PSA ‘wangxiety’, but I am happy. Thank you all for your open and frank discussions, advice, and the support I see here for everyone traveling this road.
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Love how you and your wife are supporting each other and making the most of life.
Best wishes on your PSA staying low.
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1 ReactionThe incontinence can be solved for most people. Sounds like my incontinence was about the same as yours, though I could fill a pad in an hour and a half if I was really busy normally I would only need a couple a day. I had an AUS (Artificial urinary sphincter) put in And I no longer am incontinent. The devices are covered by insurance they have to be installed with surgerym they have to put you under. I had it done in June and activated in July and it is great, not to have to worry anymore. Some people may use a thin pad.
There’s also an implant that can give you on demand erections.
The American Society of clinical oncology (ASCO) has guidelines for when to do radiation treatment after the PSA starts rising following a prostatectomy.
From Ascopubs about what PSA to do salvage radiation.
≤0.2 ng/mL:
Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%).
Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.
0.2–0.5 ng/mL:
Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.
0.5–1.0 ng/mL:
Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.
This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/
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6 ReactionsThanks for the support and comments, all. Much appreciated.
@jeffmarc
Thanks, Jeff. Tracking all from earlier posts you have made. As always, appreciate the details. I have been a daily reader of most everyone’s posts since late 2025. Not quite ready to make those leaps yet, but they are options that I will explore as time goes and progress doesn't. I will certainly ask for treatment before .2 when the PSA rise and velocity demand it.
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2 Reactions@charlesprestridge
Thank you. And best to you and yours.
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1 ReactionRespecting and understanding your personal choices, have you considered eliminating alcohol and caffeine for a period of time in order to understand if there is any impact on continence?
It took me some time for my post prostatectomy bladder control to be fully continent and probably a full year after before my bladder would not too irritated with any caffeine or alcohol.
Of course, your wife may not be ready for a full withdrawal from caffeine and alcohol 🙂
Best wishes for your PSA staying low.
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2 ReactionsI, too, am one year post RARP (Mayo Jax). Non-detectable PSA. Very minor stress incontinence (heavy/strenuous exertion results in small squirt or dribble). Have resumed all activities. My issue seems rather unique. Perfectly sufficient erections, but no orgasm. Initially was prescribed daily cialis, with no effect. Added viagra on demand, no effect. A bit annoying/frustrating. Get aroused, feel a sensation in base of penis, but just can't get over the hump. Even ordered up some Rugiet. Urologist just scratching his head, saying he doesn't know what else to tell me. Referred me to a sexual health specialist. Will see how that goes. As for now, trying not to get discouraged; moving forward with the "practice makes perfect" attitude. I can be honest and say I never imagined I would miss the orgasm this much. Said the 65 y/o in otherwise great health. On a positive note, the golf game has never been better. I attribute that to better focus, as I'm no longer thinking about sex with every other thought. LOL!
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2 Reactions@jsh327
I have thought about doing that to see what it impacts, but I enjoy them in moderation, so the balance of light leaks and good patio time most often tips in favor of quality time. That said, I only have a couple of beers or a wine on the weekend. I enjoy stouts and porters mostly, and the occasional glass of red wine. I did cut it all out for about 3 months after surgery, but that was likely too soon to see the effects on the longer term. I never did cut the coffee completely and drink about three 8oz cups of good dark roast coffee with milk a day, spread out from the AM to the mid-afternoon, so that could be a contributing factor. Again the quality of the day comes into play and wins out.
Ha, you are right. She doesn't like cranky Dave. Already has me trained, doesn't want any retraining headaches.
Thank you and to you and yours as well.
@folmajt
Congrats on the year with good PSA and at least only light stress leaks, similar to mine it sounds. I hope you and the doc can eventually figure out what works with the orgasms or your body works the kinks out by itself. As many have said, it’s a unique journey for each of us, even though there are similarities. I am the opposite. Still there, but not a full erection. And way too much effort to get it there.
You definitely have the right approach. Enjoy the days and the golf!
Great attitude which will serve you well.