After effects of prostate removal

[+ Trebor]

Recently found out I need to have surgery to remove my prostate following a biopsy showing some malignancy (7 (4/3)on the Gleason scale) and am wondering about the after effects from some of you who have experienced the surgery…I.e.  return to sexual activity…libido…orgasms…ejaculations…urine leakage?  Anything else I’m missing or ought to know? 
Thanks in advance 🙂

Edited January 18, 2023 by Trebor

[+ glutes]

You need to read this book, before you do any treatment:

Edited January 18, 2023 by glutes

[Guest]

8 hours ago, Trebor said:

Recently found out I need to have surgery to remove my prostate following a biopsy showing some malignancy (7 (4/3)on the Gleason scale) and am wondering about the after effects from some of you who have experienced the surgery…I.e.  return to sexual activity…libido…orgasms…ejaculations…urine leakage?  Anything else I’m missing or ought to know? 
Thanks in advance 🙂

I strongly urge you to get a 2nd and probably a 3rd opinion (maybe 4th). I can't give you an opinion because I don't know a lot of important facts in your case, but a Gleason score of 7 suggests active surveillance/watchful waiting may be a good alternative which needs to be seriously considered. If you choose active surveillance/monitoring, you can always change your mind if things go south. And the advice to read a book on the subject is a good one.

Before making an irreversible decision with permanent consequences, I highly recommend you consult with at least an oncologist, and probably with another urologist and a radiation therapist as well. I know this diagnosis is frightening, but you really need to have all of your options clearly laid out.

I do find it a bit worrisome that you said "I need to have surgery" rather than "I chose surgery." Even if you choose a more aggressive course, were you even presented with radiation as an option? There are advancements in technology which make radiation more attractive these days. Please make sure you're fully informed before going under the knife. 

This speaker is an oncologist, not a radiation therapist:

 

Edited January 18, 2023 by Unicorn

[Guest]

On 1/18/2023 at 11:17 AM, glutes said:

You need to read this book, before you do any treatment:

The above edition was published in 2010, so be sure to get the updated edition, published August 2021. I haven't read the book and can't vouch for it, but I would read some book on the subject, and this one seems to have good reviews. Above all, do NOT feel rushed into a decision. Gleason 7's are not aggressive, and you have plenty of time.

[Guest]

Here that urological oncologist discusses further the meaning of Gleason 7:

 

[Rod Hagen]

If IF you lose your prostate, I want you to know that I have had sex with many many men who no longer have prostates, and there is a sex life afterward.  A different sex life, but a sex life.  And with or without a prostate you will always be able to give and receive affection, and give and receive sexual attention.  

[+ glennnnn]

Such good advice 

[+ Trebor]

40 minutes ago, Rod Hagen said:

If IF you lose your prostate, I want you to know that I have had sex with many many men who no longer have prostates, and there is a sex life afterward.  A different sex life, but a sex life.  And with or without a prostate you will always be able to give and receive affection, and give and receive sexual attention.  

Thanks for sticking on topic Rod and dealing with my concerns and questions. I’m trying your understand HOW things will be different from those who have had the surgery or been with guys who have. 🙂

[Rod Hagen]

55 minutes ago, Trebor said:

Thanks for sticking on topic Rod and dealing with my concerns and questions. I’m trying your understand HOW things will be different from those who have had the surgery or been with guys who have. 🙂

Sure, so erections are almost certainly gone (maybe with Trimex not entirely gone?)  You can still get sucked.  You can certainly still suck. :-)    AND I have seen some guys without prostates get reasonably hard (again, Trimex?) Libido really depends on your personality, if you're a horny guy, you'll stay a horny guy.  Otherwise, it's something you'll have to work on, so focus on the things you like.  You can still get fucked, and it still feels good because it's all epithelial tissue in there, highly stimulate-able, it just doesn't have the added bonus of prostate stimulation. You can enjoy getting your ass eaten.   Some pee on me without meaning to, some don't.  Orgasms are impacted.  And of course kissing and cuddling and nipple play and armpitting licking and snuggling are all still on the table.  So, much is gone, but there's still a lot.  

Does any of that help?  

Edited January 23, 2023 by Rod Hagen

[+ The Big Guy]

There is a great deal of good advice here.  I would only add that the sex is different after treatment  and if your Doctor agrees that time is on your side i.e. low Gleason score and watchful waiting is an option, I would buy as much time as medically advisable before taking next steps.   I regret not having done so. 

[Guest]

6 hours ago, Trebor said:

Thanks for sticking on topic Rod and dealing with my concerns and questions...

On 1/17/2023 at 7:01 PM, Trebor said:

.... return to sexual activity…libido…orgasms…ejaculations…urine leakage?  Anything else I’m missing or ought to know? 
Thanks in advance 🙂

 

I'm sorry if you felt that my responses didn't answer your questions, although I certainly felt they were answering your second question. Maybe my prior response will be helpful for posterity. To answer your first question, there should be little effect on libido per se if there are no hormonal treatments (and normally there wouldn't be for someone getting a radical prostatectomy with a Gleason 7). Orgasms may occur, although probably less intense and with more difficulty, and definitely there will be no ejaculation. Urine leakage is common but rarely to the point of needing adult diapers (pads are all which would be commonly needed: just drops). That being said, I still hope you've discussed your situation with some different specialists and have been given enough information to make a fully informed choice. 

[pocono]

Around Christmas 2016 I was diagnosed (PSA had risen from 2.6 to 3.9 to 4.6 in a year, biopsy indicated 3+3 cancer in 2/12 samples... one sample 60% involved the other 20%). My urologist gave me lots of his time and went over the options. 

I chose to go to the University of Pennsylvania and have my prostate removed by an experienced Dr. (5000+ robotic procedures) in March of 2017. I was released 20 hours after surgery just needing Tylenol to control the pain. I needed a catheter for 9 days and had my first erection during that time. 19 days after surgery I drove myself 2 hours to NYC for a friend’s birthday. Two days later I went back to work. 6 weeks post surgery, I no longer needed urinary pads.

I asked my surgeon why I had done so well, he explained I was “young and fit” (57 years old and 30lbs overweight). 

Now, almost 6 years later it’s as if I never had cancer. My only reminders are some scars, no semen, and PSA tests twice yearly.

Good luck!

[LFABWC]

Man the problem with active surveillance is that you have Gleason 7 but it is (4+3)…. I dont think you would qualify for active surveillance…

in my case I just wanted the thing out!!!

Well, I have now that very intense orgasms after prostate surgery….without the mess, since there is no ejaculation.

I used a pad maybe for a month and a half…..after that no urine leakage at all.

erections, that’s another story!!!…I think I am going to end up with the injection thing….

[Guest]

4 hours ago, pocono said:

Around Christmas 2016 I was diagnosed (PSA had risen from 2.6 to 3.9 to 4.6 in a year, biopsy indicated 3+3 cancer in 2/12 samples... one sample 60% involved the other 20%). My urologist gave me lots of his time and went over the options. 

....

Well, I'm glad you were at least given options. I'm not sure if you were told that there is no evidence of improved survival in Gleason 6 patients who choose early intervention over active surveillance. In fact, there has been some controversy about whether to call Gleason 6's cancer at all:

https://ascopost.com/issues/december-25-2016/a-gleason-6-tumor-is-it-cancer-and-should-it-be-treated/#:~:text=Since the Gleason 6 lacks,detection%3B and needs no treatment.

"...according to genitourinary surgeon Bert Vorstman, MD, MS, FAAP, FRACS, FACS, a Gleason 6 tumor has no lethal potentiality. “No man has died from this so-called cancer. It lacks a number of molecular biological mechanisms normally found in cancerous-behaving cells. Unlike a typical cancer cell, this cell has a very long doubling time at 475 ± 56 days, so from mutation to a growth of about 1 cm in diameter takes some 40 years, and this disease is a recognized part of the aging process as some 50% of 50-year-old-men (60% of 60-year-olds, and so on) will exhibit areas of prostate ‘cancer.’”

Dr. Vorstman believes that population-based PSA screening has promoted overdiagnosis and needless treatments, many of which have debilitating side effects. “The non–cancer-specific PSA test mainly detects benign and Gleason 6 disease, leading to unnecessary treatments such as ill-founded and debilitating radical prostatectomy. This is the main reason the U.S. Preventive Services Task Force (USPSTF) concluded that the PSA test’s benefits were outweighed by its harms,” he declared.

Dr. Vorstman concluded: “Only the 15% or so of the high-grade forms of prostate cancer are potentially lethal, and only they demand detection (but commonly make little or no PSA change) and treatment. Since the Gleason 6 lacks the hallmarks of a cancer, it is a pseudocancer, not a health risk; does not progress to become a health risk; needs no detection; and needs no treatment.”"

 

Some Gleason 6's have been even known to regress spontaneously. But I'm glad you had an outcome you're happy with. But, yes, autopsy studies of US men who died for other reasons show that a man's age essentially equals the chance that prostate cancer will be found on autopsy. At 57, you had a 57% chance.

Edited January 24, 2023 by Unicorn

[Guest]

1 hour ago, LFABWC said:

Man the problem with active surveillance is that you have Gleason 7 but it is (4+3)…. I dont think you would qualify for active surveillance…

in my case I just wanted the thing out!!!….

Yes a 4+3 definitely might qualify, depending on some factors (tumor size and location, for instance). Unfortunately, when most men have cancer, the immediate reaction is simply "get it out!!!," and urologists rarely try to calm the waters (or, as was the case with the OP, even discuss the repercussions of surgery). Actual statistics and scientific studies/facts are rarely gone over with the patient. An oncologist might take the time to present the actual facts. 

Edited January 24, 2023 by Unicorn

[+ Tygerscent]

Did they also offer/mention to you Hormone reduction therapy using Bicalutamide and other substances like Lupron~?
 Bicalutamide is in a group of medications referred to as Antiandrogenics… These substances reduce the amount of testosterone in your body, (which exacerbates the growth of prostatic cancer cells), and ultimately reduces the size of malignancies if they are present~

  Reducing the over all scale of the situation can allow for a more precisely targeted treatment using chemo or radiation therapy and potentially spare healthy/effected tissue~ 

 Lupron is a shot (once every six months), and also reduces the levels of test in your body~ Other hormone reduction drugs include Orgovyx, (relugolix) and Xtandi, (enzalutamide)~ There are more… 

 Lowering your test doesn’t/isn’t necessarily accompanied by ED or loss of libido but, can happen in some patients~ Where you are with your Prostate Cancer can be an influence, (or not), in such cases~ 

[pocono]

6 hours ago, Unicorn said:

Well, I'm glad you were at least given options. I'm not sure if you were told that there is no evidence of improved survival in Gleason 6 patients who choose early intervention over active surveillance. In fact, there has been some controversy about whether to call Gleason 6's cancer at all:

https://ascopost.com/issues/december-25-2016/a-gleason-6-tumor-is-it-cancer-and-should-it-be-treated/#:~:text=Since the Gleason 6 lacks,detection%3B and needs no treatment.

"...according to genitourinary surgeon Bert Vorstman, MD, MS, FAAP, FRACS, FACS, a Gleason 6 tumor has no lethal potentiality. “No man has died from this so-called cancer. It lacks a number of molecular biological mechanisms normally found in cancerous-behaving cells. Unlike a typical cancer cell, this cell has a very long doubling time at 475 ± 56 days, so from mutation to a growth of about 1 cm in diameter takes some 40 years, and this disease is a recognized part of the aging process as some 50% of 50-year-old-men (60% of 60-year-olds, and so on) will exhibit areas of prostate ‘cancer.’”

Dr. Vorstman believes that population-based PSA screening has promoted overdiagnosis and needless treatments, many of which have debilitating side effects. “The non–cancer-specific PSA test mainly detects benign and Gleason 6 disease, leading to unnecessary treatments such as ill-founded and debilitating radical prostatectomy. This is the main reason the U.S. Preventive Services Task Force (USPSTF) concluded that the PSA test’s benefits were outweighed by its harms,” he declared.

Dr. Vorstman concluded: “Only the 15% or so of the high-grade forms of prostate cancer are potentially lethal, and only they demand detection (but commonly make little or no PSA change) and treatment. Since the Gleason 6 lacks the hallmarks of a cancer, it is a pseudocancer, not a health risk; does not progress to become a health risk; needs no detection; and needs no treatment.”"

 

Some Gleason 6's have been even known to regress spontaneously. But I'm glad you had an outcome you're happy with. But, yes, autopsy studies of US men who died for other reasons show that a man's age essentially equals the chance that prostate cancer will be found on autopsy. At 57, you had a 57% chance.

In my case, the pathology report on my entire prostate indicated my Gleason score was actually 3+4, and that a focal cell had escaped from the gland itself. My prostate was sent for further analysis (DNA) which indicates at the time of my surgery I had a less than 6% chance of cancer reoccurrence in 10 years. While I’m still doing well, recently my PSA has begun moving a very modest amount…not enough to cause worry yet. Bottom line, I’m doing well, enjoying my life, and pleased with the many decisions I was asked to make at the time of my diagnosis. 
 

 

 

[dutchal]

Prior thread with lots of information: