← Return to Prostate cancer surgery: What can I expect & prepare for?

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@justmike74 , there can be a LOT of variables but I think my experience is pretty common...I'm 61

Expect to be very sore after the operation for a couple of days, it goes away fairly quickly. You'll wake up with a foley catheter inserted to relieve yourself. It's a pain in the neck but likely only for about 10-days to two weeks, goes by pretty quickly.

I was in the gym in about 3-4 weeks after the cath was removed, just went to the bathroom about every 20-30 minutes for the first few months. It was about 4 or 5 mos if I recall correctly before I could run and control well.

After that the variables are mostly dependent on amount of cancer that has to be removed and surgical skill. Once the cath was removed I was mostly continent with a little leakage when I tried to exert in any way, pass gas with any forceful assistance, sneezed or even blew my nose sometime. In these instances I'm talking about a few drops. I only wore pads for a couple days and more for a "just in case" insurance as opposed to real need. I was religious about doing the kegel exercises set of 10 at least 3 to 4 times a day. Some here swear by physical therapy to prepare for the surgery, if it had been offered to me, I'd have done it. Maybe ask your care team?

Within a 4 week period that was mostly gone, with odd exception, of passing gas by way of pushing. Mostly have to just let it go on it's own, or be standing over a toilet if possible.

The other biggie is ED, that I have had to deal with for the last 14 mos since the surgery, it is getting a little better and I can have a dry orgasm, but I don't get erect/hard enough for penetration most of the time without chemical assistance, although there have been gains in this regard lately. Apparently it takes a LONG time for nerve tissue to heal if it's going to.

In regard to what @melcanada has suggested, the way I describe the relationship to simplify to people is if prostate cancer was an animal, it eats testosterone and poops PSA. (obviously an oversimplification) So if you stop the testosterone production you can starve it. Not sure if it just slows it / makes it dormant or actually kills it, (that's a discussion I'm going to have with my radiation oncologist at the next visit), but, it can definitely slow the disease progression if you're "castrate sensitive". I'm on a drug for this called Orgovyx. It has it's own side effects which I guess are worth it if it's working. It seems a lot of docs don't prescribe this type of treatment to those getting the surgery, mine didn't.

Ultimately I had chemical recurrence and ended up with radiation as well. I got Salvage Radiation Therapy combined with the drug. It was prescribed by my surgeon but the radiation oncologist told me it only provided better outcomes 3%-5% of the time statistically. I'll take it. I think @kujhawk1978 may have provided some studies with slightly better numbers than this. He's posted some great research results you can look up here.

Knowing what I know now, I think I might have gone on it immediately after diagnosis unless a doc could've told me why I shouldn't. I'm thinking it may shrink / hide cancer making the surgeon's job a little more difficult but have never had that discussion. Maybe discuss this as well?

General health now? The only thing I'm dealing with now is the ED, everything else is almost normal except the waiting around for the next shoe to drop. That's an unfortunate psychological side effect of the disease. The best advice given to me is as soon as you are able, get out and enjoy yourself, keep active and try not to dwell on it.

Best of Luck to you !

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Replies to "@justmike74 , there can be a LOT of variables but I think my experience is pretty..."

Replying to myself, well that's weird...

Just looked up some ADT info, it only slows cancer it doesn't kill cancer cells.
and..
two different sites listed the fact that ADT before Prostatectomy is not the "standard of care", there wasn't an explanation as to why that is listed.

"The use of hormone therapy (alone or in combination with chemotherapy) before prostatectomy has not been shown to be of benefit and is not a standard treatment. More intensive androgen blockade prior to prostatectomy is being studied in clinical trials. "
https://www.cancer.gov/types/prostate/prostate-hormone-therapy-fact-sheet

Just to add to the details provided, I had blood in my urine for 3-4 weeks after RALP. Also, my penis and scrotum looked badly bruised but did not hurt. My surgeon said this was all normal and the bruising cleared up in few weeks. I never woke up at night to pee pre-surgery but after surgery I was getting up once or twice a night for the first 5-6 months. I'm 8 months post-surgery and my urinary function is just beginning to feel normal again. I can even drink a beer and not worry about repercussions.

I stumbled across this site recently. I had prostate cancer in 2008 and was an active participant on a number of bulletin boards,, looking for my solution. One of the things that struck me then was the lack of posts from >>> afterwards, whatever that turned out to be. It would have been nice to hear from someone well after the fact.

I had originally decided against a prostatectomy because of the difficult nature of the operation and questionable outcome (remember,, this was 2008). After several months of research,, and a month traveling around the country looking at the options, I wound up back in Boise, Idaho.

My wife's doctor suggested I take a look at Dr X, an ex boyfriend with s supposedly "terrible bedside manner". What did I have to lose at that point? I had pretty much decided on brachytherapy but knew from my research that the erectile nerves would be dead in two years.

Anyway,, Dr X did indeed turn out to be a character, brusque and a bit intimidating. St Alphonsus had just acquired the "new" Da Vinci robot,, and Dr X had moved from Portland to Boise to take advantage of the new market. He had done over 200 of the surgeries, and seemed overly confident.

I expressed by biggest fear, loss of sexual ability. He insisted that it wouldn't happen under his watch. It was supposed to be one night in the hospital,, it turned out to be two due the fact I had been a little too thorough with the GoLytely and they couldn't hear any bowel sounds.

I had no pain,, and in fact,, still have some of the Norco I was prescribed. A week after the surgery Dr X removed the catheter and I was continent the following day. It was a disappointment as I had bought this huge package of pads, based on what I had read on the boards!

Dr X had told me earlier that he wanted me to take a low does of Viagra, approximately 25Mg, daily to facilitate blood flow to the area. I managed to get a load of 100 mg tablets of sildenafil citrate from a pharmacy in India for about $1 each (remember again,, this was 2008. Viagra was unaffordable,, and my insurance had already told me,, "No Way,, Jose" are we going to fund this odd off label use.

He also had me get a penis pump, which the insurance did pay for, and he instructed me to pump daily, but avoid any climax. If this sounds strange,, so it did to me. But I followed his instructions.

Dr X had spent 2 hours and 45 minutes on the operation, working on me from a console on the other side of the room. You can view a Da Vinci prostatectomy on YourTube. Your key to your future sexual function is the surgeon's ability to tease the erectile nerves from around the prostate gland without damaging them. It takes time.

Dr X was seeing me weekly, and a month or five weeks after the operation, he said "I want to you go have sex". And so I did,, thanks to a sympathetic wife, the viagra, and the pump.
It was great. I had an uneventful recovery,, lots of sex, and am still sexually active at 78.
Of course,, I don't ejaculate,, but you can't have everything. The orgasm is still strong, and now I buy my "viagra" in Mexico (I live in Tucson) for $1 a tab,, and cut it in half.

I found this board because I want to go on HRT, specifically some form of testosterone. I stumbled across a post on Lupron. I'm right at the border of what my insurance would consider fundable for HRT, maybe 50 points too high. I was considering a month's worth of lupron just to get the number down below 200.

I had a 3 month lupron depot when the cancer was discovered. Few urologists will pass up this profit center if it's indicated. It was meant to buy me time until I discovered what I wanted to do. The Lupron lasted more than 3 months,, and after the prostatectomy I found that while I was sexually functional, I had much reduced libido.

I had a great PCP physician at the time, and in consultation with Dr X they decided that there was no reason I couldn't go on HRT. A month after starting the Androgel,, I had recovered all of my previous interest. I slept better,, was steadier, felt better,, but I discontinued HRT after three months because I just felt that I didn't need it.

So,, anyway,, my idea is to get a lupron shot, a week later get a testosterone test from my PCP, a referral to an endocrinologist , and voilá! I could get the Lupron from India,, or maybe easier,, from Mexico . I'm having my mouth rebuilt by a dentist in Nogales, so I'm down there every two weeks. When he's done,, my teeth will look like the attached photo (my wife), and I'll die with them.

To sum, for me, and I understand that everyone is different, removing my prostate was the best thing that happened to me. I had difficult to live with BHP, my life was focused on the nearest restroom; now I pee like a racehorse.

For you, the lesson is to choose your surgeon carefully. My wife is considerably younger than me, and was an OR nurse in a surgery center until a couple of years ago. Within the confines of HIPPA (naming no names), she would often comment on the highly different abilities of the surgeons she assisted. Some were talented artists,, some struggled.
My PSA remains undetectable (I still test it every year as part of my blood work). My other advice is,, do your due diligence. All the information you need is on the internet, much more available than it was in 2008. With the information you glean,, you will be able to make the decision that is right for you.

Good luck!
I remember how scary it was.