Is ED an absolute given with surgery?

Hi Andy

Surgery does seem to create ED issues, some not too bad but others can have a big effect.

I suppose some just want to get the PC sorted and not going to worry too much about side effects especially if you are a bit older but obviously not everyone who is older is prepared to tolerate ED.

I went for Radiotherapy because of potential ED problems, I hope that someone comes on who has been through surgery without major ED issues.

Possibly the younger you are the more u might want to question it.

All the best

Steve 

Hi Andy B24

It stands to reason that, even after prostatectomy and with nerve sparing, you problably will have 100 % ED for x amount of time until you heal. The nerves that controls your erection are located extremely close to the prostate and by removing the prostate you probably affects the nerves and they need time to heal.

There are probably lots of people here who can tell you success stories of getting the erection back after prostatectomy but I don’t think anybody comes out directly after prostatectomy and after a few days have no erectile dysfunction at all. But i suppose that’s not what you meant.

Hopefully you will get lots of good responses from people having done Prostatectomy and after some time have had good erectile  ffunction again 

Best wishes - Ulf

Hi Andy,

I'm afraid I can't answer your question from personal experience as I had RT & HT, but this reply should bump your query back to the top of the list & will hopefully be seen by someone who can answer your question having had a prostatectomy.

Best Wishes,

Brian

Hi Andy,

I’m booked for surgery at the beginning of December and emailed the prostatectomy clinical nurse specialist (CNS) about this today. I am 58 with a T2c tumour at the front of the gland.
I was told at the surgical consultation that unfortunately ED should be expected for the first year or so. That said, he said nerve sparing surgery was clearly the way to do this because the nerves enter the prostate from the back of the gland. My histology after the biopsy showed that it had perineural invasion (around the microscopic nerves) within the prostate, which could explain the degree of ED I have been having over the past year or so. 
The CNS replied to my questions:

1. Could I see a psychosexual counsellor pre-op or was this only available post-op? Ans: There is a 2-3 month wait to see them but she would be happy to make the referral now if I wished. I will say yes to that.
2. Do I take a phosphodiesterase inhibitor (PDE5) - sildenafil/tadanafil - preop or only post op? Ans: I can ask my GP to prescribe sildenafil preop, free, but the hospital always prescribe tadanafil post op to maintain blood flow to the penis. A lack of erections can reduce the blood flow in the longer term, so they try to maintain it with PDE5s. Sildenafil (Viagra) takes 30-60mins to work and has a duration of action of about 4hrs, but tadanafil (Cialis) lasts 36hrs. One only gets an erection with either when aroused, not the whole time!
3. Do we get penile rehabilitation pre-op or only post-op? Ans: post-op. My friend in the USA who is a double professor of medicine and anaesthesiology called it “cock physio” which made me smile!

A really good resource is the booklet ‘Prostate cancer and your sex life’ available free on request from Prostate Cancer UK. 

My understanding is that with HT/RT it happens the other way around, in that erectile function is ok, although different from before, to begin with but may deteriorate over time.

I hope this post helps, even though it lacks experience at this stage.

Best wishes.

Hi Andy. I'm coming up to 9 weeks post op. I had unilateral nerve sparing on the right side. There's been no action since but I'm using a vacuum pump most days for "exercise".  On Viagra 50mg every 3rd day. I can get engorged and using a ring believe I'm ready for the next stage. My confidence is growing that I'll be able regain some level of function, even if it will be assisted. One has dry orgasm's which feels weird but the sensation is the same, even better? My wife's view when given the options of RT or surgery was to get it out. The surgery was a success and I'm to all sense and purpose clear at the first post op review. Clear margins and negligible PSA. 

It's a choice thing. For my wife and I the RT approach was a long haul whereas surgery, if all goes well, a one stop shop. We knew the possibilities of ED so it's no surprise. I'm 63 and active. I don't want to think of no action in the bedroom for the rest of my days but we remain close and that door isn't closed. We have talked through everything all the way through and that has been the most important part of the journey. I'll have a think about injections possibly after a period. Not sure what that period is yet. 3-6 months possibly. 

There's some videos on YouTube, an Australian physio who did her PhD on the subject. Well worth a watch. Look for "A touchy subject"

 RAS1961 

Is this the one? https://www.youtube.com/watch?v=NJ4Q6Y1T5s4 David

youtube.com/@atouchysubject

Hi again Andy, I’ve been looking into this a bit more and this is the best information I have found:

https://truenorth.movember.com/sex-after-prostate-cancer/

I won’t elaborate further as this seems to explain the true nature of ED after both EBRT or RARP. 

Best wishes.