Help For Ed After Prostate Surgery: The Basics
Whats the secret to having a good sex life after prostate cancer? Its very simple, says Johns Hopkins urologist Trinity Bivalacqua, M.D., Ph.D. You use prescription erection pills. If they dont work, you move to injectable medications. If they dont work, you get a penile prosthesis. Also, having a loving and understanding partner always helps. Theres also the vacuum erection device . It is not a first-line treatment for ED because theres a high drop-out rate, Bivalacqua says. However, the VED can play a very important role in another aspect of surgical recovery: penile rehabilitation .
First, the pills: When one of my patients leaves the hospital after a radical prostatectomy, he takes home a prescription for Viagra, says Bivalacqua. Does he take it every day, like a vitamin? No. Although some doctors prescribe the pills this way, its not what physicians call an evidence-based practice; that is, the medical literature doesnt back it up conclusively. Instead, Bivalacqua tells his patients to take it as needed. It is very difficult for me to tell a man that he should spend $600 a month to take a daily erection drug, because the evidence of a quicker return of erections is just not there. However, he adds, taking a pill daily may provide a benefit, and a lot of prostate cancer patients want to take a proactive approach. If thats the case, then I encourage them to go ahead.
Prostatectomy Procedures Linked To A Decline In Male Testosterone Levels
Despite having a high success rate and allowing countless men to regain full control of their bladder, recent studies have revealed a potential downside when it comes to prostatectomies, insofar as some men have experienced a decline in testosterone following surgery. One study, in particular, which was published by Johns Hopkins Medicine, explains in great detail the relationship between the two.
However, before diving into the details of the study, we should first take a moment to familiarize ourselves with how the prostate works. Contrary to popular belief, the production of testosterone, the primary male sex hormone, does not start in the testes but rather the brain, namely the pituitary gland.
From there, the pituitary gland produces a separate hormone known as the luteinizing hormone, which regulates heat in the testes. When the testes become warm, testosterone production increases further and stimulates the prostate gland, which plays a critical role in the male reproductive system. Because the prostate surrounds the urethra, it also plays a role in the male urinary system.
Restoring Sexual Function After Prostate Surgery
Prostate cancer affects nearly 1 in 7 men. Fortunately, its a very treatable condition, especially when its caught early. One of the most common treatments for prostate cancer or having an enlarged prostate is to undergo prostate surgery, also known as a prostatectomy. This surgery comes with a very high success rate, boasting a 10 year survival of nearly 90%, but just like any other surgery it will come with potential risks and side effects.
According to the Prostate Cancer Foundation, one of the most common side effects of a prostatectomy is erectile dysfunction. Luckily, there are plenty of ways to fight back against erectile dysfunction and restore sexual function while recovering from prostate surgery.
What Kinds Of Surgeries Treat Urinary Incontinence After Your Prostate Is Removed
There are two types of surgery for urinary incontinence: the urethral sling and the artificial urinary sphincter. Usually, the incontinence needs to last for about one year after the prostatectomy to be sure there is not going to be further improvement before your healthcare provider suggests this type of therapy.
What Typically Increases The Risk Of Complications From Prostate Cancer Surgery
Complication risks can be increased if prior surgery for unrelated reasons was done in the area or if we have to do extensive surgery to remove the cancer. But complication rates also go up dramatically when we do surgery on patients who have failed other prostate cancer treatments, such as radiation therapy.
Radiation is a very effective treatment for prostate cancer, but it doesnt work for everyone. In these patients, we often believe the cancer has recurred or persisted in the prostate without spreading, so removing the prostate following failed radiation treatment a procedure called salvage prostatectomy is potentially curative.
Salvage prostatectomy is more technically challenging than radical prostatectomy. Patients who have already had radiation therapy often have scarring in and around the prostate, which can make tissue in the area very difficult to separate while performing the operation. As a result, patients undergoing salvage prostatectomy have a much higher risk of urinary incontinence, and a higher rate of developing more scar tissue, strictures which is a narrowing of the urethra that blocks urine flow or injury to adjacent structures like the rectum.
The Risk Of Your Cancer Coming Back
For many men with localised or locally advanced prostate cancer, treatment is successful and gets rid of the cancer. But sometimes not all the cancer is successfully treated, or the cancer may have been more advanced than first thought. If this happens, your cancer may come back this is known as recurrent prostate cancer.
One of the aims of your follow-up appointments is to check for any signs that your cancer has come back. If your cancer does come back, there are treatments available that aim to control or get rid of the cancer.
Your doctor cant say for certain whether your cancer will come back. They can only tell you how likely this is.
When your prostate cancer was first diagnosed, your doctor may have talked about the risk of your cancer coming back after treatment. To work out your risk, your doctor will have looked at your PSA level, your Gleason score and the stage of your cancer. If your prostate has been removed, it will have been sent to a laboratory for further tests. This can give a better idea of how aggressive the cancer was and whether it is likely to spread. If you dont know these details, ask your doctor or nurse.
Effects On Orgasm And Ejaculation
A number of factors involved with prostate cancer may change how a man feels about sex. Understanding the risks may help people deal with these consequences.
Removing a prostate gland entirely for cancer treatment means that ejaculation will no longer be possible. Instead, the man may have a dry orgasm.
Some surgical treatments may lead to a disorder called retrograde ejaculation. With this condition, the semen does not leave the body during orgasm. Instead, it goes into the bladder and leaves through urination.
Other prostate cancer treatments may result in smaller ejaculations. Hormone therapy may also reduce the intensity of orgasm sensations.
Cancer That Clearly Has Spread
If the cancer has spread outside the prostate, it will most likely go to nearby lymph nodes first, and then to bones. Much less often the cancer will spread to the liver or other organs.
When prostate cancer has spread to other parts of the body , hormone therapy is probably the most effective treatment. But it isnt likely to cure the cancer, and at some point it might stop working. Usually the first treatment is a luteinizing hormone-releasing hormone agonist, LHRH antagonist, or orchiectomy, sometimes along with an anti-androgen drug or abiraterone. Another option might be to get chemotherapy along with the hormone therapy. Other treatments aimed at bone metastases might be used as well.
What Is A Urethral Sling Procedure And How Does It Help With Urinary Incontinence
In the urethral sling procedure, a synthetic mesh tape is placed around part of the urethra, moving the urethra into a new position. This is a minimally invasive procedure, which means that the surgeon only has to make a small incision in the perineum .
Your provider may recommend a urethral sling procedure if you have mild to moderate urinary incontinence after a radical prostatectomy that hasnt improved using other more conservative measures. It’s highly successful in helping men overcome incontinence, or reduce episodes of leaking urine.
Before the surgery, the provider may do some tests, including the following:
- A urodynamic study, to test how well the bladder is working.
- A 24-hour pad test .
- A cystoscopy, a test in which the doctor looks inside the bladder with an instrument called a cystoscope.
You dont have to donate any of your own blood before surgery.
How Do I Prepare For Surgery
Your surgeon will meet with you to answer any questions you may have. You will be asked about your health history, and your doctor will give you a general physical exam. If your intestine needs cleaning, you will be given a prescription for a laxative medicine to take the evening before the surgery.
All patients are asked for a blood sample. Depending on your age and general health, you may also have an , a chest X-ray, lung function tests, or other tests to check your body’s ability to handle the stress of surgery.
Finally, you will meet with an anesthesiologist who will discuss the type of anesthesia you will be given for surgery. You will also learn about pain control after the operation, which might include a PCA pump.
What Happens After The Surgery
Before you wake up from the surgery, the surgeon will place a catheter into your penis to help drain your bladder. The catheter needs to stay in for one to two weeks. You may need to stay in the hospital for a few days, but generally you can go home after 24 hours. Your doctor or nurse will also give you instructions on how to handle your catheter and care for your surgical site.
A healthcare worker will remove the catheter when ready and youll be able to urinate on your own.
- blood in your urine
All surgical procedures come with some risk, including:
- reaction to anesthesia
- infection of the surgical site
- damage to organs
- blood clots
Signs that you may have infection include fever, chills, swelling, or drainage from the incision. Call your doctor if your urine is blocked, or if the blood in your urine is thick or getting worse.
Other, more specific side effects in relation to prostate surgery may include:
Urinary problems: This includes painful urination, difficulty urinating, and urinary incontinence, or problems controlling urine. These problems typically go away several months after surgery. Its rare to experience continuous incontinence, or loss of ability to control your urine.
Sexual dysfunction: You may experience changes in orgasm and loss in fertility. This is because your doctor removes the semen glands during the procedure. Talk to your doctor if this is a concern for you.
Instructions may include:
Does Viagra And Cialis Work After Prostate Removal
During recovery, medications like Viagra and Cialis will help. Viagra can restore impotence and contributes to more pleasurable sex life.
A study published in the Journal of Urology reported that 53% from a total of 80 men who underwent radical prostatectomy had their erection function restored after taking Viagra.
But is Viagra an addictive drug?
Many men experienced a high rate of improvement in their sexual performance due to medications such as Viagra, Cialis, or Levitra. If you have been wondering whether these medications are addictive, you should know that the active ingredient in Viagra, sildenafil, is not an addictive substance.
These medications work by increasing the blood flow to the penis and facilitate the erection process. Addiction is brain-triggered, but Viagra does not target the nervous processes in the brain. That is why it is considered a safe option for those who want to faster recover their sexual potency after prostate cancer treatment.
During Treatment For Advanced Prostate Cancer
When treatments such as hormone therapy, chemotherapy, or immunotherapy are used for more advanced prostate cancer, the PSA level can help show how well the treatment is working or when it might be time to try a different treatment.
Treatments should lower the PSA level , although in some cases they may just help keep it from rising further, or even just slow the rise. Of course, other factors, such as whether youre having symptoms from your cancer and whether imaging tests show it is growing, are also important when deciding if it might be time to change treatments.
If the cancer has spread outside the prostate, the actual PSA level is often not as important as whether it changes, and how quickly it changes. The PSA level itself does not predict whether or not a man will have symptoms or how long he will live. Many men have very high PSA levels and feel just fine. Other men with low PSA levels can have symptoms.
Cancer That Is Thought To Still Be In Or Around The Prostate
If the cancer is still thought to be just in the area of the prostate, a second attempt to cure it might be possible.
After surgery: If youve had a radical prostatectomy, radiation therapy might be an option, sometimes along with hormone therapy.
After radiation therapy: If your first treatment was radiation, treatment options might include cryotherapy or radical prostatectomy, but when these treatments are done after radiation, they carry a higher risk for side effects such as incontinence. Having radiation therapy again is usually not an option because of the increased potential for serious side effects, although in some cases brachytherapy may be an option as a second treatment after external radiation.
Sometimes it might not be clear exactly where the remaining cancer is in the body. If the only sign of cancer recurrence is a rising PSA level , another option for some men might be active surveillance instead of active treatment. Prostate cancer often grows slowly, so even if it does come back, it might not cause problems for many years, at which time further treatment could then be considered.
Factors such as how quickly the PSA is going up and the original Gleason score of the cancer can help predict how soon the cancer might show up in distant parts of the body and cause problems. If the PSA is going up very quickly, some doctors might recommend that you start treatment even before the cancer can be seen on tests or causes symptoms.
What Are Pelvic Floor Exercises And Can Improve Erection Quality
As we age, we lose muscle tone throughout your body. That includes the muscles that men need to maintain erections. However, there are physical exercises men can do to reduce erectile dysfunction. The best ones are known as pelvic floor exercises or kegels.
Those muscles are the core of how your body maintains blood flow to the penis and therefore keeps erections strong.
They put pressure on the veins in your penis, preventing blood from flowing back into the rest of your body. If they arent strong enough then even if you can get an erection, you wont be able to keep it.
The process starts with identifying the muscles you need to activate. Thats best achieved by lying down with knees bent and feet flat on the floor. Thats when you breathe out and squeeze your pelvic floor muscles for 3 seconds.
Its important that you identify the right group, at the base of your buttocks, on either side of your perineum. It can be easy to mistake other muscles, such as the legs or stomach for the pelvic floor.
Once you are confident you have the right muscle group, then doing the exercises in a seated or standing position three times a day can firm and strengthen the muscles, with a likely improvement within four to six weeks.
Some men find that after the initial strengthening that options like Pilates become appealing as not only are there many exercises which improve the pelvic floor, but they can improve overall posture and strength.
How Is Urinary Incontinence After Prostate Surgery Treated
If you find youre having issues with mild to moderate leakage after surgery, your healthcare provider might suggest starting with noninvasive therapies like medications or physical therapy exercises for the pelvic floor muscles. These treatments may also cut down on the number of times that you have to get up each night to pee.
These methods can sometimes help men who have mild to moderate leakage. Men who have persistent leakage or a more severe problem may need surgery if they do not want to continue to use pads.
What Is Considered An Elevated Psa After Prostatectomy
After radical prostatectomy, the doctors will perform a PSA test in order to determine whether there are some prostate cells left in the body. This usually happens when the disease is advanced at the time of surgery and could have already spread to other parts of the body. It is considered elevated PSA after prostatectomy a PSA greater than 0.2 ng/ml. If the prostate cells are grown enough to generate detectable levels of PSA, this could be an alarming point both for the patient and the doctor.
It is important to note that a level of PSA that is not alarming when first diagnosed with prostate cancer is a reason for concern when being tested after surgery. The reason is that usually, the prostate generates a certain level of PSA. But after being removed, the level of PSA is expected to be zero unless the prostate cells had already spread to other parts of the body.
According to the Prostate Cancer Foundation, about 20-30% of men have PSA recurrence after five years of initial prostate cancer treatment . As a patient, the prospect of PSA recurrence can be very worrisome. What many patients do not know is that not all modified levels of PSA after prostate cancer treatment indicate the same diagnosis. Some types of levels are much more troublesome than others and treatment approaches can vary tremendously case by case. Not all changes in the PSA mean a recurrence of prostate cancer after robotic surgery or other forms of treatment.
About The Challenge Dose
- When you take the challenge dose, take the medication on an empty stomach. Take it about 2 hours before your evening meal.
- The medication takes 30 to 60 minutes to start working. It will last in your system for up to 8 hours. At any time during these 8 hours, try to become sexually aroused through contact with a partner or yourself. Write down what happened and tell your doctor during your next visit.
- If you havent had any response after trying the challenge dose for 4 weeks, call your doctors office. Your doctor can refer you to our Sexual Medicine team.
Prostate Specific Antigen Blood Tests
- Have a PSA blood test done at the following times:
- 6 to 8 weeks after surgery
- 3 to 6 months after surgery
- 12 months after surgery
If you can, have your PSA blood test done at a MSK location. If you cant have it done at a MSK location, you can go to a medical office closer to where you live. Have the results faxed to your MSK doctors office.
MSK doctor: ___________________________
Does Penis Size Change After Prostate Surgery
editorial processScott Sundick, MDMedical Review Board
One specific type of prostate surgery, the prostatectomy, can cause a decrease in the size of the penis. While it is true that the size of your penis can be altered by prostate cancer surgery, there are many types of prostate surgery and many do not cause any change in size.
What Treatment Options For Sexual Dysfunction Are Safe After Prostate Surgery
All of the treatment options come with risks, even the all-natural ones. You need to be careful about sourcing supplements, being confident in the supply.
Many US-based manufacturers were caught by the FDA selling natural Tongkat Ali which actually contained prescription ED drugs! Likewise, overtraining can lead to injury or soreness. However, theres no doubt that the natural approach is safer than the alternative.
Only purchase Tongkat Ali supplements from a reputable company that provides 3rd party lab tests to prove that it is an unadulterated and safe supplement.
If you are looking for a safe and natural testosterone boosting supplement that contains Tongkat Ali, we recommend our Testo-Booster supplement.
The side effects from the most commonly used ED pharmaceuticals include minor ones, such as headache, flushing, runny nose and pains in the stomach or back.
In some cases, dizziness and a sudden drop in your blood pressure can take place. Thats why men with heart conditions have to be evaluated by a physician before they take it, and may have to rely on a lower dose.
Around 1 out of every fifty men who take those drugs will also experience painful or persistent erections.
The highest risk group, however, is those who undergo surgery to get an implant. Thats why its always the last choice. As the surgeon needs to make an incision into the scrotum, penis and often the abdominal wall, there is a risk of infection.
What Happens At A Follow
Discussion with your doctor or nurse
At each appointment, your doctor or nurse will ask how youve been since your last appointment.
Tell them about any symptoms or treatment side effects youve had, as well as any other problems or concerns. You can tell them how you are feeling emotionally as well as physically. You can also discuss any practical problems you might have, such as problems at work or with day-to-day activities. You may be given a questionnaire about your physical, social, emotional and practical needs. You might hear this called a holistic needs assessment form.
Your GP or hospital doctor or nurse can help you deal with side effects, or refer you to someone else who can. For example, if you have problems with leaking urine , they might refer you to a continence service. Or if you have problems getting or keeping erections , they can refer you to an erectile dysfunction service. They can also help you get support for emotional problems, such as feeling anxious or depressed, and practical problems, such as managing your finances.
You might feel embarrassed talking about some of the side effects of treatments, such as erection problems. But remember doctors and nurses see people with these problems every day, so be as open as you can. They are there to help.
PSA test
You may be asked to avoid any vigorous exercise or ejaculating in the 48 hours before a PSA test, as this could cause a temporary rise in your PSA level.
Dry Orgasm And Infertility
Both the prostate and the glands responsible for semen production are removed during surgery, which is a common prostate cancer treatment. If you received this treatment, youd still be able to have an orgasm but youd no longer ejaculate.
This means that youll no longer be fertile. If you plan to have children in the future, you may consider banking your sperm before your surgery.
The Prostate Gland And Prostate Cancer
The prostate gland is a male reproductive organ that sits around the urethra, the outlet tube for urine, just below the bladder. The glands surface is usually smooth and regular. The prostate is about the size of a walnut.
The prostate gland releases a clear fluid into the urethra that represents up to a third of the semen during ejaculation. One of the functions of the fluid is to carry the sperm and help sperm movement.
The prostate also helps the drive of semen during ejaculation.