Life after Prostate Cancer

SmokingCaterpillar  November 26 2024 05:59:39 PM

When I was about 60, I eas disgnosed with prostate cancer. You now there's a problem when you're called to a consultation and there's two people in the consulting room. I elected to have a radical prostatectomy (RP). I was the first person to have that operation in the newly installed da Vinci machine. It's described as robotic surgery, but that's not really accurate, I think. Describing something as robotic implies a certain amount of autonomy. The da Vinci system =, at least in 2013, when I had the operation, was effectively a remote control surgical system controlled directly by a surgeon at a console some distance away from me.

So, how did I get  there?

Well, it started with a screening program that my local GP ran. And probably still does. A routine blood test showed I had elevated levels of Prostate Specific Antigen (PSA). Elevated levels of this protein in the blood suggest a problem with the prostate gland, but it's not actually an indication of cancer as such, because other mon-cancer conditions can also cause elevated PSA levels.

However, it's worth investigating, so it was time for my relationship with my GP to get to a whole new level.

The next stage after the blood test is to actually check the prostate and its surrounding area. Digitally. That's digitally in the sense of a fingery digit rather than a numbery digit. Thankfully a rubber glove and a bit of lube made the experience not too unpleasant. In fact, I thought I was quite fortunate in that I was getting for free what a part of the population have to pay for.

My GP thought that the prostate was 'lumpy', indicating the possibility of tumours, so the next things on the diagnostic list was a biopsy. This involved a minor piece of surgery where a sampler is inserted into your rectum up to the prostate, and little core samples are extracted. A peculiar sensation. There was a little pinch feeling when the sampler was fired. The peculiarity was that it was an unfamiliar type of pain in an unfamiliar area. The surgeon mentioned that I might get blood in my semen as a consequence of the biopsy. A bit of an exaggeration, as ejaculation seemed to produce a haemorrhage. It sorted itself over a couple of weeks, turning from an alarming bright red sludge to an unappetising brown sludge before eventually returning to its customary off-white hue.

So, the cells collected in the biopsy showed a medium level cancer with negative margins (it apparently had not spread outside the prostate).

Then it was time to make my choice about how I was going to deal with it. Remember that this falls under the heading of 'elective' surgery. The point being that it's the patient who decides the treatment from the available options.

Well, I quite quickly decided that I was going for a radical prostatectomy. As far as I was concerned, it offered the best chances of success. I didn't like the idea of hormone therapy, where a possible side effect was developing boobs. An intriguing thought... Radiotherapy has some nasty possible side effects. All treatments of those treatments have documented negative effects on ED. But hey, I was sixty and I hadn't done all the fucking I wanted to do yet. Actually that's still my attitude at a shade over seventy. The other point is the using the daVinci system meant that the surgeon could perform what is called a 'nerve sparing' prostatectomy. There's plenty of information out there on the web and so I'm not going to go into any great detail - suffice it to say that the prostate is covered with nerves fibres that are important when considering the mechanics of an erection. In the old days, the surgeon would remove the prostate with all the attached nerves. Nowadays with a nerve sparing operation made possible by the precise dissection that be done by robotic surgery, nerves can be separated from the prostate and retained in the body. Even that separation means significant damage to the nerves, but they have a certain amount of regenerative potential; in my case it was almost 100%.

Now the thing is, men don't talk about things down there, really. I'm not sure why. So I'm going to get down and dirty from here on.

After the operation, when I woke up, what was the first thing to do? Why lift up the sheets and take a look at the old John Thomas. He was just lying there, a prunified shadow of his normal self. Muttering "What the fuck just happened?" Of this, more later.

It's now time to talk about catheters. I'd never had one before. For the uninitiated, a tube with a small inflatable bulb on the business end is pushed up one's urethra. Once in the bladder, the bulb is inflated slightly (I think it was saline) so it doesn't come out again. The other end of the tube goes into a collection bag. So you have this for 2 weeks. Including when you go to the toilet for number 2s and when you shower. A sort of symbiotic experience. Actually there was one piece of silver lining in the cloud - I found that I could sit through movies, consume unlimited quantities of liquids and not have to go to the toilets. A poor win, but in that state I can assure you that every small advantage is to be treasured.

Then it's taken out. The feeling was fantastic, leading me to jokingly request that it be re-inserted so I could savour the relief of it being withdrawn all over again.

My first post-op wank was dismal. A mere shadow of what I had experienced in the past. My penis was a mere shadow of its former self.

OK, so now there was the question of penile rehabilitation. Which translated, means that you try to counteract the effects of the surgery. Because we all love a stiffy, don't we?

There are a couple of ways of counteracting erectile dysfunction.

I can tell you though. You need patience. A shed load of it.

You can try things like penile injections. Apparently these work very well. But I'm not sure whether I'd have the courage. To. Stick. A. Needle. In. My. Dick. I took a more cowardly option - vacuum pumps. A bit like being sucked off by a robot. Didn't do anything for me, so I gave it up quite quickly.

Lots of practice. By that I mean, keep having orgasms as best you can. Even if they're weak and you don't get much of an erection. It doesn't matter. The old saying here is 'Use it or lose it'. Never a truer word uttered in this context.

Tadalafil. Just to be clear, Tadalafil is the generic name for the drug. It's often sold as Cialis, but that is a brand name in the same way that the generic drug paracetamol is often sold as Tylenol. there is There's some reasonable evidence that Tadalafil can help to regenerate nerve tissue. https://pmc.ncbi.nlm.nih.gov/articles/PMC4485415/ I was prescribed Tadalafil at 10mg twice per week or 20mg/week. Since then, I have moved to 5mg per day to give a 35mg/week dose.

And here's the thing. One thing that daily low doses of Tadalafil does is restore one signal of good penile health. The morning erection. While taking Tadalafil, I was experiencing morning erections similar to ones I had as a man in my twenties. Forgive me for the detail, but they're definitely high on the quality scale. There are sone side effects. The main one is indigestion (go figure) but that can be controlled by keeping fit and active, In my case, this problem has decreased possibly as I've become accustomed to iy.

The turning point was when I was in bed with an acquaintance, for want of a better word . We fooled about a bit for a while then drifted off to sleep. At some ungodly hour, I woke up with an erection. We were spooning in bed, and events went in a natural path. And it was fantastic. And I'm not exaggerating. I will always be grateful that that acquaintance of mine had the generosity of mind and body to bring me back from the edge. I will never forget walking into work the next day thinking, "Yeah. I can really fuck"

And there was a bit of icing on the cake. The damage to my nerves seemed to have given the ability to hold back an orgasm - it turned out that I could perform for extended periods of time and choose when to orgasm. Much to the delight off more than one acquaintance.

Orgasms are different. They're neither better nor worse. Just different. And with most radical prostatectomies, the seminal ducts are also taken out. So there's not semen when you orgasm. Which is kinda weird but sometimes convenient. It's good because it's less messy. It's good because if you're getting fellatio, you can orgasm without any spluttering from the fellatrix. I've not had any complaints about the lack of jizz, gentleman's gel or baby batter, whatever you want to call it.

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