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Sexual Side Effects of Prostatectomy

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Posted 3/12/2023 9:10 PM (GMT 0)
I know this has probably been brought up many times here. I am new.

With prostatectomy will I gain sexual function back?

Will I be pissing myself all the time?

Both of the treatments for this are horrible.
Posted 3/12/2023 9:30 PM (GMT 0)
The answer to both questions is very dependent on your surgery, age, and your health. For some yes, and for others no. I can only speak for myself, I had nerve-sparing robotic surgery. Amazingly I had night-time erections several days after surgery while I still had the catheter installed. As for incontinence, I do have minor stress incontinence which isn't a problem at all. Most men will experience this to some degree. If you have nerve-sparing surgery the probability of regaining sexual function is very possible. Without nerve-sparing surgery the probability is slim and the risk of incontinence goes up. If you are fully continent now, the probability increase for staying that way after surgery. A couple of years after surgery I had to get salvage radiation (positive margin) which again had very little effect on sex and continence.

Remember there are other options other than surgery such as radiotherapy. Knowledge is your best friend when it comes to making a decision on treatment.
Posted 3/12/2023 10:14 PM (GMT 0)
Thank you for your time lapilot

What is salvage radiation?

Why wouldn’t a surgeon not do nerve saving operation?

How can I know my stage?

Age 62
Gleason 8
PSA 7.5
Posted 3/12/2023 10:25 PM (GMT 0)
Fred, welcome to the forum.
Salvage Radiation, is radiation treatment given after surgery has failed. In other words after surgery where psa is not undetectable. It cleans up whatever was left behind.

A surgeon might not be able to spare the nerves depending on how widespread the cancer is within the prostate or possibly the location, where either of those two things require the surgeon to cut wider to get everything.
Your stage should be listed in the pathology report.

We highly recommend that guys newly diagnosed, request that they get a second opinion on the pathology, slides. Ideally, from an expert in PROSTATE Pathology, like Jonathan Epstein at Johns Hopkins Reading Prostate slides is very subjective and an upgrade or a downgrade could affect recommended treatment.

Another thing we highly recommend, is exploring ALL of your options. Speak with a surgeon, also speak with radiation oncologists. Some specialize in External Beam Radiation, others in High Dose Brachytherapy, and still others in SBRT (sometimes marketed as "Cyberknife")

There are many options for treatment, and they have come a long way in minimizing side effects, wtih new procedures and new technology, both in surgery and radiation.
Good luck and keep us posted
Posted 3/13/2023 1:09 AM (GMT 0)
Fred - Most of what you are thinking is based on treatments of 20 years ago. Surgery and radiation have come a long way since then. There is still risk with treatments but it is greatly reduced with modern equipment and methods. Given the proximity of the prostate and its role, it is almost impossible for treatment to not have some effect on urinary and sexual systems, now or in the future as you get older as well. That concern can be addressed when you start investigating all the treatment options.

As far as stage goes, your urologist should estimate your stage based his/her examination, PSA, imaging (MRI) and biopsy results. Only surgery would provide the exact stage information but it is not needed for decision making with your G8 pathology. You will be doing something. Hang in there, we all lived through what you are experiencing and it sucks. It will get better when you have a plan.
Posted 3/13/2023 4:02 AM (GMT 0)
Thanks for the response.

So your surgery didn’t work. You had to have radiation?
Posted 3/13/2023 10:53 AM (GMT 0)
Fred,

As others have said, ED and incontinence are possible after treatment--and so much depends on the specifics of your case. Radiation tends to have fewer of these side effects in the short term. As others have said, I will give the standard recommendations again:

* Get a second opinion on your biopsy report--have your slides sent to Johns Hopkins--your urologist will know how to do it.
* Make appointments with both surgeons and radiation oncologists at a top notch hospital/cancer center. (Where are you located, perhaps we can suggest where to go)
* I found it useful to get a large pouch portfolio to put all the paper in. Get copies of all your reports. Get a spiral notebook to write down questions to ask your doctors. If possible, take someone with you to your appointments to take notes. It's surprising how much information is coming your way, rapidly.

G8 is significant, treatment is definitely in your future. It is also curable. I wouldn't be surprised if they recommend some level of systemic treatment for you--such as hormones (lupron) for a short course to take care of any little buggers that have escaped the gland. I'd also think that if there are any indications of spread outside the gland, that surgery is moving down the list of recommendations--why have surgery if radiation is needed to take care of your pelvic area anyway?

Regardless, the answers will come, and clarity will arrive. The good news about PC is that it is generally slow growing, and there are numerous treatment options. The bad news about PC is that it is generally slow growing, and there are numerous treatment options. Hang in there.
Posted 3/13/2023 1:14 PM (GMT 0)
Fred, Although Gleason 8 put’s you in the high risk category, with the advancements in medicine today you can expect a cure. With any serious diagnosis I would recommend seeking out the best treatment team you can find. High risk guys may require more than a monotherapy and combinations of radiation and ADT offer very high success rates with mostly short term side effects. I hope you follow Halberts advice and make a fully informed decision. Best wishes and keep posting since we learn from one another. Terry
Posted 3/13/2023 1:45 PM (GMT 0)
4 years ago I was where you are.

Knowing what I do today, Brachy therapy, IMRT, and at least 6 months of ADT would my treatment option for G8 today. The cure rates are greater and the side effects are lower than surgery.

Get the best doctors.
Posted 3/13/2023 3:41 PM (GMT 0)

Fred61 said...
Thanks for the response.
So your surgery didn’t work. You had to have radiation?

Fred - No, I chose to have adjuvant radiation treatment as a preventive measure since my G7(4+3) from biopsy was upgraded to G9(4+5) per when the entire prostate was examined (this happens both ways quite often after surgery). There was also a small margin that I was concerned about and an intermediate Decipher score did not help in the analysis. Adjuvant means complimentary treatment and is loosely described as being within 6 months of surgery with a non detectable PSA after surgery.

I could have just monitored the situation with uPSA but the data was compelling to go ahead with ART and improve avoiding recurrence odds quite a bit. 2023 is a little different than 2018 so not exactly sure what I would do today. Probably try to get a PSMA scan done after biopsy to have more information for decision making.
Posted 3/13/2023 3:42 PM (GMT 0)
if your concern is permanent side effects i would strongly recommend you consider radiation. in fact in this day and age it befuddles me that anyone would choose surgery over radiation when they have a choice
Posted 3/13/2023 10:45 PM (GMT 0)
Probably because you only have your anecdotal experience to go on and haven’t considered any other people’s personal situations
Posted 3/13/2023 11:25 PM (GMT 0)

Fred61 said...
Thanks for the response.

So your surgery didn’t work. You had to have radiation?

Not sure if that was directed at me, but if it was, yes. My PSA was undetectable for 2 years, then slowly began to rise, and a year later i had radiation and hormone therapy. It wasnt terrible. A fairly decent % of surgery patients do need radiation afterwards, but not all, and probably not the majority, at least of those treated by a top notch highly experienced surgeon.
With your G8 i would definitely be looking at the various radiation options, not that surgery would be out of the question
Posted 3/14/2023 11:21 AM (GMT 0)
It befuddles me how the moderators of this board continually allow you to constantly post your boorish comments about the surgical option. Many of us here chose surgery and are glad we did. New visitors to this site may be seeking sound advice for PC treatment and surgery might be their best option. Your never-ending criticism of surgery helps no one.
Posted 3/14/2023 2:24 PM (GMT 0)
I will answer the two questions that are in the original post dealing with me personally.
Had RP in 2013 just turning 64. This was a more invasive procedure than the newer RALP which seems common now. The URO was young and had not a lot of PC surgeries under his belt when I was laid out on the slab.
Had incontinence for 2 1/2 months after surgery gradually tapering off as my wife and I were embarking on what was going to be our toughest 2 month bike tour in Europe. Took a bag of pads but threw them away shortly after starting cycling. Haven’t had any issues since.
ED: there was some nerve damage from the surgery but over time, there was improvement up to the point where for the last 10 years, I have been quite satisfied with my sex life.

I would like to add that PC is generally an older man’s cancer and speaking for myself, I do not have the same sexual vitality now as I had when I was 18 although I don’t think I would like to test my almost 44 year marriage proving this obvious fact by turning back the clock and letting the little head do all the thinking.

Dave
Posted 3/14/2023 10:42 PM (GMT 0)
Fred 61,



What is salvage radiation? It is radiotherapy after surgery had failed., I had approximately 1mm positive margin (determine by a post-surgery biopsy done by a pathologist). It took 2 years after surgery before my PSA became detectable.

Why wouldn’t a surgeon not do nerve saving operation? The two nerves are slightly attached on each side of the prostate and are outside of your prostate Surgeon will determine that during the actual surgery because of all of the factors involved with your specific cancer location.

How can I know my stage? That is determined after the prostatectomy. Your removed prostate will be sent to pathology for a pathologist to be stained, sliced and then viewed under a microscope.
Posted 3/15/2023 1:29 AM (GMT 0)
Sometimes, the cancer is entangled with or invades the neural vascular bundle. That’s what my situation was, so the surgeon spared the nerve on once side, but had to remove the one where the EPE was.
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