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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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Your surgeon sounds optimistic to me. My own experience was very positive. I got most of my function back but I had 3 friends who can not have erections without hardware. All of the surgeries were done robotic, by solid surgeons. I hate to present anecdotal evidence of this kind of thing. My experience might be very different than study results. Here is what John Hopkins has to say. https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/erectile-dysfunction-after-prostate-cancer
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3 ReactionsThanks. I’ll check it out.
"Surgeon told us expect 80% of previous erectile firmness at one year post RP. "
I think many people get this line but with my limited access to real life info i think this is not even close to being truthful.
If you have an expectation of a sex life going forward and you are over 60, I suggest to all readers that radiation is your friend.
Your trip will be different from my trip however and others may suggest a better thing for you. Choose wisely. Good luck cos we all need some sometime.
Erections occur because blood is trapped in special veins in the penis. The blood gets there, and is trapped, as a result of nerve signals coming from the brain. Those nerves are traumatized, or even cut, during surgery removing the prostate. That trauma lasts 6-24 months while the nerves recover and grow back. The problem is, the special vessels which keep the blood in place during erection can shrink and even die without the constant nourishment of new blood. That's why we have spontaneous erections most every night, to keep the system functional.
Penile rehab is focused on getting blood into that area on a regular basis. Methods used include use of viagra class medicines, vacuum erection devices (penis pumps), and masturbation-like activity. Urologists may or may not be interested in helping with this. At a minimum, they should be prescribing viagra or cialis after the surgery.
I found the following to be a great source of information and help. Using the methods described in the online program I found there, as well as working on maintaining a semblance of sex life with my wife, helped me return to full functioning within 9-10 months following surgery, at age 74.
https://melissahadleybarrett.com/penile-rehabilitation-program/It's a frustrating process, as results are not apparent as quickly as, say, rehabing after a sports injury. But persistence and consistency pays off for many men. It's certainly better than hoping that everything will just take care of itself.
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2 ReactionsI do not. Is this a PT thing? Sex therapy thing, or what?
Congratulations on your quick bladder recovery!
Do you have a penile rehabilitation plan/program? Erectile function is a complex process which is significantly disrupted by surgery, even if there is nerve sparing. Now is the time to start a training plan.
The best recommendation I can provide is use Trimix. I know for some sticking a needle in your penis is a horrible thought. But it is not that bad, trust me. I have been doing it for over one year and I am three years out from my prostate removal. By the way, I am 77 years old. Good luck.
I also got a radiation oncology consult before deciding surgery was best for me. I wanted to know the full extent of the disease for future decisions. I am two weeks post op from
RP and have full urinary continence but have not tried for erections yet. We shall see.
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.
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.comhttps://rshealth.com.au/penile-rehabilitation-after-prostate-cancer/