Reasonable expectations for erectile recovery after surgery

Very interesting and thanks for the information. Is there similar information for other types of treatment such as beam photon, proton and seeds?

Without taking anything away from your somewhat dismal warnings I have to point out that Dr. Mulhall's "return to the baseline" endpoint is a stretch objective that no current treatment modality can provide reliably. Treatments for prostate cancer take a bite out of a man's sex life -- all of them do. The sexual side effects of surgery are hard to miss. They hit you in the face like an incautiously thrown halibut in the Seattle City Market fish market. Then they gradually get better but you never get back where you were. Radiation, on the other hand, takes a much smaller bite, initially, but then your sexual function gradually slips away. Men who have had radiation also don't regain their baseline potency. They never even head in that direction.

It is probable that men who have had, say, SBRT, will be better off than men who have had surgery, but they don't regain their baseline either.

Patient-reported outcomes following stereotactic body radiation therapy for clinically localized prostate cancer.

Health-Related Quality of Life After Stereotactic Body Radiation Therapy for Localized Prostate Cancer: Results From a Multi-institutional Consortium of Prospective Trials

I would agree from looking at their graphs that the majority of the sexual decline happens in the first nine months, then one of the studies shows it rallying slightly followed by a believable largely-age-related decline and the other study doesn't show the slight improvement between months 9 and 12.

The 2011 Sanda et al study, while not exactly a happy read for most of us, does start to plug a huge hole in the information that has been available about sexual outcomes. Most studies talk about the results for previously-potent men, and, in effect, tell a man considering treatment that if he can spell the word "viagra" then all bets are off.

I understand that Mulhall is talking about the problem of overly-optimistic expectations. But we have a lot of younger guys here and I do worry about scaring them away from needed treatments. For the most part, what medical science takes away, medical science can give back, provided a man isn't too picky and provided he refuses to give up. Between pills and pumps and compression rings and injections and implants and all sorts of combinations of the above, it is rare for a man not to be able to recover a functional ability to get the job done after primary treatment.

..Yes, I am that young guy that was almost scared away from a recommended treatment because of fear that my penis would not recover from such harsh treatments. Well it has been 14 months since surgery, and 11 months since radiation started, and 11 months on Lupron with another 2 years to go.. Has my penis recovered? Not a cold day in hell. Will it ever? Let us keep hope alive, but a bettin man may wagger no probably not. I also use Dr Mulhall as my rehabilitation Doctor, and he has told me that I am a triple threat patient and natural recovery is at around 5%. My age, health and baseline performance are all a positive cause other than the treatments I incurred all is(was) well. Being young with aggressive PCa takes some getting use too. The side effects like ED are an added life changer also takes some getting use too, if ever. Though I do it less often than recommended trimix does work and helps a great deal with better than nothing syndrome. In fact last night was a trimix night and a good night it was, a learned appreciation for the injection. Well you can not get a better dialog between two more informative folk when you have Allen & Peter discussing matters, thanks guys..

....Appleseed......

TDubb said...
Maybe those who advise need to validate their own choices?.. Just a thought

Of course we do. How could we not?

I don't generally talk about my own situation - has little or nothing to do with the newbies, but as things have gone off the walls lately, I'm going to fess up.

Back in Sept. 2012, my PSA was starting to take off again. I was put on HT (6 month Lupron). That was about the time that I had my first indication that my total ED (since Oct 2009, except for Trimix excursions) might be getting better. Nocturnal erections seemed to be happening (was it a dream?). It was a brief change, as the Lupron killed any desire. That death lasted the 6 months plus another 8. Maybe more.

Things were beginning to show hope as my PSA started back up in Dec '13. And an interesting side note is that my T came up to 200 above what it was before the first Lupron shot. But my PSA followed it (from 3.1 to 6.5 in 45 days), and I am now on the next cycle of a 6 month Lupron shot.

But here is the confession - I am a no-nerves spared surgery guy. I have been taking 5mg Cialis for coming up on five years, trimix for three. I have had an erection that was provoked by a cute girl in the last few months. It will be five years in October '14.

Life is not without surprises. I still adhere to the mantra that what doesn't kill you will try again tomorrow. That "makes you stronger" crap is just that.

But, DO NOT GIVE UP. EVER!!

And with that, I will retire to my quiet but determined Mod role.

I had one nerve spared and this is one area I haven't had too many issues with...that is, when I am on a HT vacation...

"By one year after surgery, 93 percent of the men reported that they were dry -- that during the previous four weeks, they had not needed a pad or adult diaper to control urinary leakage. When the men were asked to say how much their urinary continence bothered them, 98 percent said they had either a small bother, or none at all. In terms of potency, at 18 months after surgery, 86 percent of the men were able to have intercourse. When asked about difficulty with erections, 84 percent of the men said they had either a small bother, or none at all. Looking at the potency rates by age, at 18 months after surgery, 100 percent of men in their thirties were potent; 88 percent of men in their forties, 90 percent of men in their fifties, and 75 percent of men in their sixties were potent.

Urologist-in-chief Patrick C. Walsh, M.D., who led the study, was not surprised at the success with urinary continence; he has reported the same results for many years. "In the long run," he says, "only about 2 percent of patients have significant long-term problems with urinary control" (defined as needing to change a pad more than once a day). "We are currently trying to eliminate that 2 percent." (See "Perfecting the Radical Prostatectomy.") The men's results with sexual potency, however, "are better than we've ever reported," says Walsh. They are also the highest potency rates reported at any academic medical center. "

urology.jhu.edu/newsletter/prostate_cancer53.php

I am 26 months post open RP, and I also had unrealistic hopes. I had nerve-sparing, but at 26 months I have ZERO function without ED meds. The only thing that works is trimix, which I can't stand due to the pain and 4-5 hour erections even with reduced dosages.
In view of my stats, I still would have the surgery again. However, I would probably go with the robotic in hopes I would get better functionality.

not sure why we have this same discussion every 6 months or so. I think it's because of an effort to trash one thing while selling another instead of sharing our experiences and the many variable and nuances involved. Here is another passage/link already shared here numerous times. I look forward to the day when this topic can be discussed honestly, in a detailed and nuanced manner, and without an agenda based on numerous issues including personal regret.

"If a patient has good sexual function without erection-enhancing drugs before surgery, Dr. Tewari tells him that he has about an 85 percent chance of regaining an erection firm enough for intercourse, although he may need erection drugs and it may take up to 18 months for his function to return.

This all depends on whether the cancer is early, away from nerves and contained. “The patient should not forget why they are getting this treatment,” Dr. Tewari said. “Keeping that focus in mind, can we do something to get sexual function back? Yes, but it depends on the cards we are dealing.”

Men who are older or who used erection drugs before surgery have a more difficult recovery. After surgery, patients undergo penile rehabilitation, which involves regular use of the drugs, even if the man is not having sex. The goal is to increase blood flow that will bathe damaged tissue and promote healing. After surgery, many patients will always need drugs, injections or other treatments to have sex, said Dr. Andrew McCullough, director of the Sexual Health and Male Infertility and Microsurgery Programs at N.Y.U. "

www.nytimes.com/2008/01/15/health/15well.html

Bluebird,

Yes, the unexpected happens. A surgeon I've worked with as he has written a book, believes nerves, to a limited scope, regenerate. My uro/surgeon told me early on that he believed the "nerves" were more than those that were close, and cut out.

Because of my insurance and a trickle of samples / yearly free month offers from Cialis, and an aggressive pharmacist who got trimix approved after three levels of denials, I kept taking/using the meds. I believe in my docs. They don't earn a penny from my samples and post-deductible med costs, so it is not a self-serving suggestion.

But I will say that 4 years out is on the edge. I am patient, but why I am is not something I'll share here. Just to say, that ability, it serves me at this juncture in my life.

I truly regret not having been able to go to West Point. That hurts. I did not meet an obligation.

TA,

I think "zero" falls in, mentally for a guy, with what us folks from the South consider "fighting words". It almost challenges one to fight back, regardless of the odds.

Worked that way for me. Prove him wrong! OK, took years, but ...