New here - two weeks post-RALP

Hello everyone,

My life has been a whirlwind since last August. I had been taking supplemental testosterone for a while, and a visit with that doc in August turned up a high PSA. Despite a lot of recent research showing that TRT does not increase the risk or rate of progression of PCA, my TRT doc cut things off immediately on that front. I can't really blame him. Most of the research on "saturation" theories of Testosterone and PCA are still fairly new.

And, to back up a bit, for years I suffered from depression, insomnia, anxiety, and other things that doctors wanted to medicate with anti-depressants, sleeping meds, anti-anxiety meds, etc. The testosterone cured all of that in weeks and those meds are gone.

I was told by my TRT doc that I could resume treatments as soon as a urologist cleared me. My PSA in August was 5.0, in September, a DRE was clear and a PSA done right after the DRE was 5.3. In October, I saw the urologist, and my PSA was 4.9. He wanted to do a biopsy to clear me. I wasn't thrilled, but went along. Gleason 3+4 was the result, despite only a 25% chance of a positive result.

I met with the RO's and surgeons at two teaching hospitals, had my pathology slides re-read, and finally opted for surgery at Dartmouth. The surgeon didn't even remove any lymph nodes, telling me that the nomograms indicated less than 1% chance of them being affected. Surgery went off without a hitch, except for higher than average pain levels afterward. The doc told me that the pain levels were higher because I'm a serious weightlifter, and he had to punch through a thicker muscle wall than most people have. I also had a small umbilical hernia that was fixed during the surgery and that's been a bit painful.

I had the catheter out on 1/14, and I've had fairly good urinary control so far. One pad per day, and the only real leakage is when I either fart or sit down for a bowel movement. Impotence, of course, is there for now, although the nerves were spared and the doc things things will return just fine.

So, when I had to stop the testosterone, I felt like all the other problems would return immediately - depression, anxiety, insomnia, poor performance in the gym, brain fog at work, loss of focus, etc. Yet, it didn't happen quite that way.

I was absolutely fine in those areas, until late last week. The catheter was out, the post-surgery pathology was all great and the doc is convinced I'm cured, and I just need to wait out the impotence issues.

So after putting (hopefully) the worst of this behind me, why did I suddenly get slammed with all of the mental issues from before? I suppose I might have been so focused on dealing with the cancer that I never had time for those things to return earlier.

But, I'm now back at work, and I'm in a position of high responsibility in a small company, and I feel like I can barely function.

I've read that this isn't uncommon, but it just makes no sense. I don't want to go back on the other meds, especially because anti-depressants are likely to worsen any recovery from impotence.

I know that I can return to TRT in July if my 3-month and 6-month PSAs are at zero. But right now, mentally, I wonder how I'm going to make it that far. Obviously, the impotency thing is depressing to everyone. But, shouldn't I be feeling happy that the cancer was low grade and contained and I'm on the good side of things? Considering some of the other stuff I've read on this forum, I kind of feel like an a** for even bringing this up. I know there are others who would trade with me in a moment.

Yet, I can't seem to shake off this sense of impending doom and calamity - this creeping malaise, to paraphrase a song.

Thanks.

Welcome to the forum. Sorry you are struggling. Your doldrums might not be T related. The month or so after the catheter comes out is the traditional time for surgery patients to become depressed and angry. That's when it starts to sink in that recovery is going to be a prolonged process, and it grinds a man down.

There are anti-depressants that have fewer sexual side effects. The best doctor to help you with something like that would be a psychiatrist (psychologists don't prescribe drugs) although a medical oncologist might also be a possibility -- they have lots of experience with anti-depressants.

Keep us in the loop. There's quite a bit of interest in T supplementation after RP here on the forum and we'll be interested in your story going forward.

Good luck.

DallasDave,

I really had numerous treatment options, but the desire to go back on the testosterone drove my treatment choice. It was a major life-changing medication for me. Not a single negative and it improved my life tremendously. All of the docs I saw for the PCA agreed that surgery should be my choice if I wanted to resume testosterone, and when I told them how it had improved my life, one of the docs went so far as to give me a high five.

And, I agree with your other statements. The treatment and visits and everything else are a big focus that dominate your life for a while. Now, I'm supposed to be over that and doing everything else I was doing before, while still dealing with the ED and minor incontinence, and I honestly feel like I need a month of vacation to recover from the past five months.

DML

I feel for you guys and fully understand your emotional swings . It's very important to keep busy and achieve short and Long term goals. Depression and anxiety worsen when you feel out of control. If your stats are good you need to forget about it and focus on other things. If you can't stop worrying about it you definitely need to seek counseling.

I don't know anything about TRT or it's effects, but I have a lot of family experience that make me sure psychotherapy should be pursued whenever I hear unexplained changes in mood or ability to function.
We are all INCREDIBLY complicated beings on a journey of self-discovery and self-acceptance (happiness). "Unexplained" things usually do have an explanation (biological or psychological) and discovering it can make all the difference.
You have a LOT going on and professional guidance as you sort though it can speed your self discovery and recovery.
Mikey

dmlvt,

Boy, I hear you. I'll be two yrs out of RALP this April. Have zero PSAs so far and am really grateful for that. But have been poking along with T reading in low 200's. Like driving on interstate in second gear. Poor sleep, somewhat down, little interest in, ahem, you know. And the dumbell routine on alternate days still exhausts and makes me really sore (expected, yeah, but no improvement after six months seems wrong...).

My uro is of the "saturation theory" school. Says I might want to wait another office visit or two (every three months until two yrs out, then every six months), but then I could consider TRT and says it might really help me. But I'm thinking hard on it. If I did TRT and got recurrence later, would be saying to myself, over and over, "What the **** were you thinking! Just couldn't leave well enough alone, huh?"

Hope all goes well for you. Please keep us posted -- we are a small subset of post-RALP guys, but need to share info.

Robert