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Erections post radical prostatectomy: What to expect?
My 55 year old husband has been diagnosed with PCA, Gleason 7 (4+3) with MRI revealing a grade 4 tumour in one side of prostate with an area of capsule where integrity is questionable. MRI also showed lymphadenopathy which we are assuming may be mets with off chance they are reactive lymph nodes instead as he had elastic ligation of hemorrhoids 10 days then again 3 days before the MRI (not ideal timing but MRI appointment was last minute). Bone scan and CT ok. Currently waiting for further consults on options but scheduled for RP early November as surgeon feels best option for his age and test results. From my attempts at researching RP side effects, erectile dysfunction very common, mild to complete. Surgeon told us expect 80% of previous erectile firmness at one year post RP. This seems very optimistic compared to information I have read however a lot of the study information on good old Google scholar comes from older surgeries prior to the anatomical research that improved nerve sparing surgical techniques. What we would like is more facts. We would like to go into the surgery (if that is final decision for next step which at his age sounds likely) knowing realistic expectations for post surgery complications including marked decrease or absence of erectile function. The 80% of original erectile firmness but otherwise no concerns seems overly positive to me. If true, is great. If not, that info leads my husband towards unrealistic expectations. We would like to be prepared based on scientific facts rather than wondering if surgeon just trying to soften the blow when delivering information on his cancer and treatment plan. Thank you for any additional information you may have or can direct us towards.
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Thank you! The video description lists presentation start times; 2:37:55 for the ED one.
One thought: PCRI posts videos of presentations by, in many cases, Mayo Clinic prostate cancer experts, and here we are on a Mayo Clinic prostate cancer website. Would it make sense to make such presentations available here?
I can see that there would be issues around them becoming outdated, so some sort of metadata would be needed...
This one seems kind of urgent to me, as there is a suicide rate associated with ED.
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1 ReactionSo many variables, , pre-surgery sexual performance ability, overall health, skill of surgeon, where was the cancer...
In my case, diagnosed in Jan 14 at age 57, no issues with pre-surgery sexual ability, skilled surgeon, nerve sparing, overall health excellent.
It was about 12-18 months after surgery when I was able to have useful erections. The only "help" I had was 5mg Cialis daily.
The road back to intimacy is a result of many things, one's relationship status, the health of that relationship, the willingness to explore new ways of intimacy beyond the traditional penetration, either as additive or replacement, depending on the outcome of the surgery...
Kevin
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3 ReactionsMy husband underwent a RP due to prostate cancer (Gleason 3+3) but then at the time of surgery, it was diagnosed as a 3+4 Gleason). His surgery was mid June and he is 90% continent and has absolutely no erectile function. He’s only three months and a week post radical prostatectomy so I think that it will take some time for things to heal. This type of surgery is considered to be major surgery.
One thing he has noticed is that if he has a couple of glasses of wine, it seems to bring on leaking or some incontinence. Another thing he has observed is that when he has to urinate, the urge comes on suddenly and he needs to get to a washroom right away.
Does anyone else experience these side effects? Thank you.
Hello, sounds like you’re husband is making progress. I had RP surgery nine months ago. I’m 98% continent now. I have leakage later in the day. There is a correlation between my energy level and leakage. I now longer experience sudden urges to urinate. I don’t drink wine. I’d guess the wine relaxes his muscles, later in the day, which could contribute to his leakages. Experiment and try some wine for breakfast. Enjoy!
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1 ReactionThank you for sharing. The feeling good and mostly consistent both sound good. At 9 months it is worrisome that still zero erectile function. From readings I have done and the video from the PCRI conference that was posted after this post, there sounds like there is still potential to continue to improve over at least another year or more. And a bunch of rehab stuff with meds and things that can do to help improve odds too. I hope it does eventually work out for you 🤞
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1 ReactionThank you for the video suggestion and link. The ED and urinary videos were very informative. Much appreciated.
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1 ReactionThanks. I’ll check it out.
Timeline for erection to return after prostatectomy
I've read three months to three years. Nerve sparing (or not) during surgery, rehabilitation programs afterwards, along with daily use of Viagra-like meds can make a difference. I've found these two sites to be helpful:
https://www.atouchysubject.com
https://rshealth.com.au/penile-rehabilitation-after-prostate-cancer/
My RP was in March 2022 when I was 68. My surgeon suggested 20mg of viagra daily for a year once the catheter was removed. Stimulation as often as possible was also recommended. I started to have encouraging results in June 2022 but only when standing and only when taking a maximum dose (100mg) of viagra. In Sept 2022, I was able to have an erection suitable for intercourse, again only when upright and only with 100mg of viagra. My progress was interrupted when I began hormone therapy (ADT) for a biochemical recurrence in October 2022. I was still able to achieve an erection with viagra during ADT but desire was lacking and an orgasm was not possible. Now, more than seven months since the start of my six-month regimen of ADT and four months post radiation, I recently had an orgasm again and have had intercourse in a variety of positions. Still waiting for my libido to fully return, however. I was helped tremendously during the past 15+ months by my girlfriend who was and still is a very active partner. Best wishes for your speedy recovery.