Okay, after a long while of shrugging radical prostadectomy, I think I will might do it. I had feared the cutting of my internal paraphenalia, but a friend said it is not major surgery. Is it? I think I will get robotic. From another's experience, how bad is the pain? And I detest the thought of semen and sperm being trapped in me forever and no where to go... it's my phobia, I know. If climax is possible, does the sperm go in the bladder? I want to give those little buddies a better place to hang out than in the urine spa, lol. CarrotBoy
How Nasty is Prostate Removal Surgery? - Advanced Prostate...
How Nasty is Prostate Removal Surgery?
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CarrotBoy
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This is not from personal experience, but it indeed IS major surgery. How bad COULD it be? Like all major surgeries, most go well, with limited pain. Most men do not experience major problems, but you should carefully research the odds on each potential bad outcome (from more common sexual and urinary issues to less common outcomes like, well... death).
By almost all accounts, one of the biggest risk factors for poorer outcomes is WHO does the surgery, and WHERE it is done. The top experts are more expert. So this choice will skew the odds in your favor.
In the end, your outcome will be yours alone, an individual one. You will hear anecdotal accounts from other individual men who may say "go for it, it's a breeze" or "don't let them near you." They are extrapolating based a single personal experience, from the specific to the general, which may not be indicative of what you end up experiencing.
If you want to be more confident and free of doubts, talk to surgeons and happy patients. For less confidence, read urologist Anthony Horan's books or listen to oncologist Bob Leibowitz's lectures.
It is major surgery. And very complex too - only for well-experienced specialists.
When the prostate and seminal vesicles are removed (they always take out both), you will produce no semen. That's what those organs do - they produce semen.
You are talking about a different phenomenon called "retrograde ejaculation," that can occur in men who still have their prostates but are taking alpha blockers for BPH.
Thank you much.
in reply to Tall_Allen
Retrograde ejaculation follows TURP surgery for BPH.
Everyones surgery is different. My surgery was not that bad. I stayed home from work for 2.5 weeks for healing.
You will no longer produce any semen when the prostate and seminal vesicles have been removed but the testicles still make sperm cells but the body will reabsorbs them (they will not go into your bladder).
As the orgasm occurs in the brain it should be as intense as before surgery.
Why would you apparently equate the many rational concerns over a major surgery (that may not even have proven benefit) with a mere concern over one's next orgasm, which the OP did not even express?
My robotic surgery did not go as planned. Scans and tests showed contained to prostate, but when doc got in there he found a mess. All surrounding area was affected. No nerve sparring was possible as all nerve and venous bundles around and leaving prostate area were affected and tested Gleason 9/10. (helps to explain why I was starting to have ED problems for the first time in my life). One week with catheter, 6 weeks till diapers and pads were no longer needed. ADT for life or orchiectomy which is what I chose after chemo was complete and I had 30 days to recover..( 2 jelly beans in my sack weren't worth much anyhow. ) Best of luck to you, most of us have a better out come from the surgery than I had.
Thank you.
Had Robotic removal in 2011. The first night after surgery was not pleasant and the next day I did not feel well until they made me get up and walk. Afterward I was ready for discharge that afternoon. The Foley catheter is no fun but you get by. The incontinence went away in a couple of months and I was able to get an erection 7 months after surgery. Overall not a horrible experience. I would consider ADT before and after surgery which was not something that was pushed hard with me and I think it would have helped since I have had 2 recurrences and 2 IMRT Radiation sessions in 9 years. 1 session in the Prostate Bed and 1 in the Pelvic Lymph Nodes. Currently I am on Lupron and my PSA is undetectable.
There is no sperm ! They remove your ducts. And sex for most is history .
But when (if) you’re able to cum it’s urine not sperm so Pee before sex or use a Condom as your partner is likely to be pissed off (on)🤬!
in reply to Break60
The medical term for that is climacturia.
will2love.com/blog/climactu...
I wasn't even aware of that RP risk. I wasn't a candidate for RP anyway -- I was steered toward radiation after prior TURP surgery. Not keen on radiation either I wimped out and went with HIFU. 3 1/2 years later I have no regrets about that treatment choice.
Hey CarrotBoy. I wasn’t a candidate for surgery. I still have a prostate. If your dr says that you have clear margins surgery could possible be curative . That is the hope .
Thanks!
I had my prostate removed robotically. Yes, it is major surgery. I had to stay in the hospital for 3 days due to a bad reaction to anesthesia - I kept throwing up.
First day is painful - particularly when getting up to walk. But recovery is fast. I was walking 3-miles per day within about 4 days.
Foley catheter is no fun, but you get used to it. And it’s out within a couple of weeks.
As others have said, get an experienced surgeon. Mine was at MD Anderson. He’s done thousands. Had to wait about 4-months to get on his schedule. Definitely worth the wait. He was able to preserve the nerves in one side.
Not much of an issue with incontinence.
Used pads for a couple of weeks. Do your exercises! It’s very important.
My tissue samples from the surgery came back with “clean margins”. After almost 2-years, PSA is still undetectable.
Highly recommend getting the surgery if you are considered good candidate by your MO.
Hope this helps. Good luck on your journey! We are all pulling for you!
James
Wow James! That was a good and helpful reply! I appreciate that. Glad you recovered and are undetectable.
A question about MD Anderson. Is that the doctor, and what city/hospital? He could be better some staff here in rural PA.
Main : MD Anderson is the University of Texas MD Anderson Cancer Center located in Houston, Texas .
Also
Dr. Louis Pisters was my surgeon. He’s great. MD Anderson is an excellent hospital. They take patients from all over the world. And they have someone who helps you schedule your visit and explains how the entire process works to make it easy on incoming new patients. Highly recommend.
I chose a major cancer hospital. My Gleason was 7 and not a lot of it. Was supposed to all be contained in prostate according to the MRI and guided biopsy. Maybe they wanted to keep their good track record of getting all the cancer out because the surgeon said he had to remove all my nerves. I do have clear margins but PSA is .08 at 3 years after RARP. Erections were out of question, so I got an implant. Still no cure all. Nerves that supply blood flow to the glans and body of my penis are gone. That part of my penis is cold and limp. So I have a cold half dead penis stretched over 2 artificial cylinders. Not much feeling, so real difficult to orgasm. When I do, I get urine flow. Just dandy, right. Now let's talk leakage. Almost 3 years later I leak almost all the time. Lot of leakage when I am tired, straining or riding my quad. The surgery was a non event for me but the side effects are a major event. I would definitely look into other treatments or even active survaliance.
As you have already seen, both the surgical experiences and the outcomes vary widely. In my case, after robotic surgery I had such extreme pain the first time I got up and walked I couldn't believe it. And that pain, gradually lessening, persisted for weeks. I'm still angry at one of the docs on the hospital staff who thought I was exagerrating, even though I cannot remember who he was or what he looked like (these things are not rational). I was in the hospital for five days, if I remember correctly. Long term effects were, most importantly, incontinence, and I eventually had male sling surgery after a year and a half of using multiple diapers every day. Sexual function outcome was not as bad, but not exactly heartening either. But I'm alive, no recurrence of the cancer over ten years later. If I had it to do over again I might have tried something else, but I don't, so I'm not complaining, it was what it was. But the two important things to remember are that you cannot predict the outcome, i.e. you are taking a chance, and that the best way to improve your chances if you do have surgery is to pick the most experienced surgeon with the best track record possible. But, and I'm sure you know this already, you are taking a chance with any option you choose. Not an easy decision.
It beats the alternative, being six feet under!
May I ask if you’ve considered any radiation treatment in lieu of surgery ? If you are high risk then brachytherapy with 18-24 months of ADT may be a better alternative.
Schwah
I had mine in 2010. I originally scheduled it for a younger doctor in St Louis, where I lived at the time, who planned to do robotic surgery. Before time for the surgery I changed course and decided to travel to Chicago to have it done by Dr Catalona, the guy who helped develop the PSA test and pioneered nerve-sparing surgery. He only does open surgery, no robots. I spent a few days in Chicago and went home, then back to work after about six weeks.
When I spoke to him on the phone a few weeks before the surgery, I asked about nerve grafts, in case they had to remove the nerves. He said he has worked before with a plastic surgeon on the floor below him who had experience at that sort of thing. I didn't meet Dr Kim until after the close of business hours the evening before my surgery and he was about to run off to a dinner appointment, but he said if I wanted a graft, he'd make time in the OR the next day to make it happen.
They had to keep me under longer than usual to wait for Dr Kim to have a chance to step in, I was on the table about 7.5 hours total. About six weeks after my surgery I learned that the cancer had already escaped my prostate and I was put on salvage radiation and Lupron. Still, after 18 months, just like Dr Kim said, the graft started working. It wasn't like I was 18 again, but it definitely worked! The reason it took 18 months is a graft doesn't conduct signals, it just tells the nerve where to regrow. I was only about the 5th or 6th bilateral graft he had done. He happened to be doing his fellowship in Texas when they were doing some pioneering work on this sort of nerve graft. Thankfully I was a beneficiary of that.
It is fairly major surgery but in most cases it will go well.
Most men will recover from the incontinence although it can be a bit depressing at the beginning when the catheter comes.
If the surgery was nerve sparring then there is a good chance you will retain the ability to have an erection but orgasm can become a bit of a non event.
Certainly no walk in the park for me. But I did not anticipate it would be its major and complex surgury, that needs a seasoned docs hand. Robotic was my choice in 2016. Sex has been great and a was grateful to have enjoyed it until 2016 but not in the cards for me now. Although gave me life extension I'm sure. Life is a series of tough choices, that was one more. Incontinence for several years. One week post OP no fun and recurrences o plenty although still forging ahead, round two of chemo in the books. But sending you this message so not all bad. All you have to fear is fear itself. FDR.
What's your age? _ What's your Gleason count? _What are the arguments from you Doctor to take LIFE from you? _ Have you or your Doctor considered other options?
For 24 years I have lived with cancer not accepting RP nor castration and still alive and feelling good. I am 83 and with courage I have lived most of the time quite well: 17+ years with a marvelous sex life (this is not a small thing); also, my father has been diagnosed at 75 and has lived a reasonable life till 86 when a motorciclist killed him. Meanwhile I have lost my 2 best friends (about my age) for RP and several others to what I believe is the most stupid thing doctors want us to accept. Do not give up to LIFE. Say NO to fear and fight. There are other options. At present I am on Fenbendazole but there are many options both on Medicine and alternative tratments.
Hi vivamais. Congrats on enduring 24 years - and still more to come.
I am dreading radical prostadectomy, but need to decide soon. My family is urging me to do it, as expected. I was told in was a 3+4 in March, but one doc says it's really 4+3. My age is 68. With a dozen or more (I believe) potent supplements, I lowered my PSA from 21 to 8. Bone scan 4 weeks ago said I did not have spread. I am going to a large hospital tomorrow to get a second opinion/ recommendation of type of treatment. I heard of a discovery from Dr. Joanna Budwig of Germany where you mix flax oil with low-fat cottage cheese, and it has brought about reversals for cancer patients in many countries. I can explain more about why it works. Ever heard of Jason Winters Teas, also good for shrinking tumors, and good for weight loss.
My big question is this. If a person is on the right track to self-healing, how can we get re-tested, and why aren't we?? If I am healing, what a shame to go in and cut the prostate out! I heard that the body wants to heal itself. Stuck on the fence about RP.
With a PSA down from 21 to 8 it looks you are on the right track to live for many years without problems. During my 17+ years on wait and see I have been on Dr. Matthias Rath Therapy (Vit.C + Aminoacids) and it worked till the day I accepted the sugestion of un Urologist to cut Vitamin C from 5 to 2 grs. a day. That has been the end and now I know that I could go on with 5 grams Vit. C and some sodium bicarbonate to avoid kidney stones.
I have been successful with RSO (Cannabis Oil) for 10 months but after that time the cancer returned because I have been scamed trying to get the real RSO (never buy in the Internet). I have been in Germany (Munchen near Kassel) trying "Miraculous Diets": I have no reason to believe in these Diets. Now I am on Fenbendazole and getting good results _ go to mycancerstory.rocks and Fenbendazole.com. I am feelling quite well for the last 3 months (with PSA dropping) and next 5/18 will have my 3rd. test.
I also have tried the CyberKnife treatment: it worked for some time but in the end it failled because I had too many metastasis but this is something that may work for you and it is much better than the barbaric PR. It has worked quite well for some men in the Clinic where I am now doing Xofigo, while on Fenbendazole.
Be careffull with family and friends that know nothing about your problem. They love you but have fear and fear is worst than the cancer.
Bro,
If you decide to have surgery, I believe you will survive with flying colors. I had my robotic RP performed at UCI 15½ years ago when it wasn’t as well perfected as it is today. I was Dr. Thomas Ahlering’s 225th patient and as of today he has performed thousands of robotic RP’s. My surgery took place on Tuesday afternoon, took one Vicodin Wednesday morning and was discharged later that day. Saturday morning I drove myself down to San Diego and spent 30 minutes with my marina neighbor’s 10 year old daughter on my waverunner jumping waves in San Diego Bay while still sporting a catheter & bag under my jeans. I’m now 77 and still enjoying life in Thailand
Tall_Allen has already answered your ‘semen’ and orgasm questions; however, in my case I lost a significant amount of my nerves due to the tumors extending beyond the prostate which has reduced the intensity of orgasms. That being said, I am pleased with the orgasms that I still have.
My best to you, Ron
Thank you brother Ron.
Since you appear to be having success with your diet and supplements, I might suggest that you contact Richard Wassersug who is the transdermal estradiol (tE2) guru. Richard has been a mentor for many men including myself. Your mature age of 68 is also in your favor since many men in that age range have chosen to do little or nothing and continue to do well into their 80's. I have been using tE2 gel for a couple of years now and my most recent PSA was 0.01.
Good info there. Where is Richard Wassersug, and where can I get tE2 gel? What is is made of? Thanks!
Dr Ahlering (UC Irvine) did mine in December, 2019, I was #1939. Surgery was at 1PM, I was home the next morning. A little pain but after a week and with the catheter removed I was much more comfortable. No incontinence or other SE's. Unfortunately, less than a year later I experienced a biochemical recurrence.
If you choose to go this route choose your surgeon wisely. Find one who does robotic surgery on a regular basis and has years of experience with hundreds of surgeries under their belt.
Totally agree!
Hi . I was diagnosed with T3 , Gleason 9 ( 4+5) and
had my prostate removed in April 2012. Not robotic , just the old slash and grab,. Serious, it went very well. My surgeon Dr Saad had performed thousands of it. Experience of the surgeon is key. I was out of the hospital after 3 days. . Walking was not easy for 48 hours.
Genitals were black and blue and grossly swollen for a few days.
Incontinence for a week and since then no problem.
Getting back in shape took 4 or five weeks (could nt lift anything heavy for a month).
Had 33 radiotherapy rounds as adjuvent in the following months and found the side effects of that longer lastins and more annoying
Erectile disfunction ( the cancer spread did not allowed erectile nerve spraring) but modern chemistry does wonders. I have been using Caverject with no hesitation. And it became very routine after a few times.
Orgasm with no ejaculation feels weird at first, but just as pleasurable.
And I am alive, and had been since then in the best shape I ever was and that,s the point as far as I am concerned
Good luck. take it one day at a atime and reach out.
Amen
Well I don't recall ever seeing "paraphenalia" in print. Good luck, whatever you choose.
Sperm gets reabsorbed into your stuff below. It's major surgery, don't let them soft peddle it. I'm glad I had it.
My open surgery sucked big time. Lots of pain and pain pills. They took seminal vesicles, nerve bundles, and 25 lymph’s, all infected. 6 week recovery.
I tried the little blue pill for about a year. Also the seed deposit in the tip is the penis, the penile pump, and then the injections. All were hit and miss. Now I have state of the art prosthesis. Works well. Dry ejaculate but other than that feels the same.
Robotic surgery in 2015. Nothing fun about it, but if you go in strong you will come out strong. The worst part for me was 10 days with a catheter. Very uncomfortable. After that it took about 2 to 3 months start feeling normal again and I was skiing by month four. Good luck.
I had the robotic surgery in early 2018. Most men recover well and most side effects dissipate over time. It depends on the surgeon you choose, how advanced the cancer is and its aggressiveness, and your own anatomy. If I had it to do over again, I would have chosen radiation + Lupron, as I am doing now for a recurrence. Some have incontinence issues post surgery, some erection problems, and some experience another side effect not mentioned very often, That is loss of length. Most lose an inch or less. Some 2.5 - 3". I had erections at about 4 months, but 1.5" long. Flaccid was/is painful even today when sitting because of how much tension there is from the very shortened urethra. I CANNOT under emphasize how important it is to use a very experienced surgeon. All treatments have their own set of problems. This is not meant as a plug for radiation. I know of some horror stories from radiation and I don't know how mine will turn out. What you do depends on a few things including your Gleason score, PSA and what you can live with. Some do end up with permanent incontinence or loss of erection. In the end, life trumps the side effects.
The surgery Its self is not that bad. There is some pain after but it is tolerable. I really hated having to drag the catheter bag around for 17 days. I was unlucky in that I developed a urinary tract infection , so that caused me some increased discomfort .
It's the after effects of the organ removal that I hate the most. Not ever being able to ejaculate is something I will always miss.I'm not really worried about my guys drowning in a sea of urine,. It is the lack of the visual of producing an ejaculation that I miss and so do my sexual partners. I do more often than not ejaculate urine now, some people are not exactly turned on by this. Then there is the lack of real sexual functioning. It has taken me 3 years to get to where I can if I'm lucky and really stimulated produce an erection that is firm enough to insert somewhere . I can get very erect using the Caverject injected into my penis ,but with that I get quite a bit of pain through out the duration of the erection. I also find it difficult to orgasm so if a great hard on is not mandatory for my partners needs I prefer to go chemical free. Then there are the incontinence issues I have finally gotten to where I can hold my urine most of the time. However package is very likely if I try to lift heavy objects or have. Suprise cough or laughter. I absolutely refuse to have any more surgery so I won't be getting an artificial urinary sphincter or a penis implant to address either issue.
So if you are prepared for the condition and after effects of the surgery the actual operation is not so bad. I guess I'm curios as to why you have the choice of having or not having surgery. My cancer left me with basically I choice have the procedure and live or don't and die. I'm still not happy with the choice I made. I think sometimes doctor's don't take into account the negative effects the procedure will have on a persons life. I wish I would have chosen quality over quantity. Living longer does not always translate into better.
I had a RP the old fashioned way, since I had two hernias (right and left) repaired at the same time. Went in the hospital on Friday night came out Monday Morning. No problem during the procedures, except for the foley you have to wear for a few days. Little urine leakage that subsided after a few months. No boners for this owner. All my sperm is now stored in my tits... Do your Kegels now... For memory sake, you may want to take a picture of your erection now... Make sure you get a good surgeon who's done many RPs...Check him/her out!!! Take soprano lessons and keep your eye out for stiletto heels and a vibrating carrot.....
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 05/14/2020 6:35 PM DST
in reply to j-o-h-n
😂😂😂😂
I had Davinci robotic surgery on 8/21/19. The physician promised nerve-sparing if possible (it was). Since I was Gleason 9...I was apprehensive of what they might find. Post-op was 2.5 days in hospital after surgery. The at home routine of cleaning an pump drain and being on a catheter was difficult from an psychological aspective....but have your doctor describe in detail what will be required and what you will see during that crucial first week. Mine did not. I suffered the unusual complication of lymphocelles (liquid build-up in abdomen) which was very painful and required 3 visits to the emergency room before they figured it out. I spent 2 more days in hospital after getting drains reinserted. My URO was too cavalier in follow-up....but the best Davinci surgeon in the area. The incontinence is another blow...but it gets better. After 8 months both incontinence is almost nil and ED is under control. I miss not having semen at climax...but I have climax...so I can live with that. Post-op PSA was .01 and the next 2 quarterlies were .05. I have resumed all of my original activities at the same level..no medications....but deal with the uncertainties we all do no matter what the treatment.
Let me know if you have other questions.
My prostatectomy was in 2006 by a guy who was near retirement and had done many thousands without a robot. He offered to have another doc do it with the robot, but I doubt any docs had done 1000+ with a robot at that point.
It is definitely a major surgery. Without the robot, I think mine was 3+ hours. When I woke up in the recovery room, my pain was 8.5 and rising on a 1-10 scale. But they got that under control quickly with dilaudid. I stayed about three nights in the hospital and was pain free with no pain meds when I went home.
I was 54 years old, but felt 90+ when I awoke. Each day I felt about 5 years younger. I scheduled two months off work, but played my first round of golf at 6 weeks (and scored well !). At two months, my strength and stamina were 100% even though I took my time in getting back into cycling and tennis. I had no problem with continence, and have perfectly fine erections with sildenafil. I think my orgasms improved because they last longer and are more intense. I don't miss the semen at all. As one of my friends says, "so you can have sex on a white sofa?".
Pay no attention to strangers who try to tell you how important or unimportant your sex life is. Only you know what is important to you.
I liked learning of your experiences and your advice. Thank you.
I was strong before my Robotic RP and 💪 after a few days of recovery in March 2019. I was fortunate. No side effects, i.e., incontinence, ED, etc. PSA after surgery undetectable at 0.01 and just now in May 2020 at undetectable 0.02.
I did Kegels and yoga and lost 20 pounds.
I exercise everyday and at 62 am grateful.
It was scary when I found out.
I had a radical prostatectomy in 2018 and I have no regrets, Almost no pain, no more cancer, my erection and my urine control are as before. If you want my advice, take an experienced surgeon and robotic surgery with nerve preservation.
Indeed the big difference after this surgery is at the climax. Semen normally consists of secretions from the prostate (30%), seminal vesicles (60%), cowper glands (5%) and sperm cells from epididymis / testes (5%). When the process of ejaculation is triggered it is the emission, all these glands propel there liquids very quickly in the prostatic urethra by the ejaculatory ducts, vas deferens and the small ducts of the prostate, the semen is mixed under pressure to inside the prostatic urethra. Then the sphincter relaxes to release the semen and the muscular contractions at the base of the penis expel the liquid out of the penis powerfully.
When you have a radical prostatectomy, it's a big plumbing job. The prostate is removed completely as well as the 2 seminal vesicles, the vas deferens and ejaculatory ducts are also removed and the bladder is sutured directly to the urethra. When we have this surgery, it is not a retrograde ejaculation that we have but a dry ejaculation, The 2 glands (prostate and seminal vesicles) which produce the major part of the semen are completely removed and the vas deferens are not reconnected as a man who had a vasectomy.
In my case, I found the same erections as before and all the same sensitivity in my penis and I still have pre-ejaculatory fluid but when the climax comes I no longer have the sensation of emission of semen and tension at the base of the penis, the first times it's weird... This is followed by the same powerful muscle contractions but nothing comes out of my penis, it's surprising at first to see that this reflex persists even if there is no more liquid to expel. I have absolutely no pain whatsoever, it's nice and I feel the orgasm in my head like before and no worries about the mess 
So for me this is the only difference I have after this surgery and the most important is that I am completely cured of this cancer but I cross my fingers
HiPierre! Thank you for sharing your experience, because I'll probably need RP and I can't stand the thought. I'm glad you went into detail because I had a lot of questions about it. Was your pain from the surgery unbearable? Did you hate the catheter? I also hear people on this site say that they leak urine during sex. What is the likelihood of that?
I understand all your questions, when we have to undergo this big surgery that affects our sexuality, it's normal and I was questioning myself a lot too. I had a high psa which forced me to have exams, I didn't even know what the prostate was and that semen was ejaculating because of this gland. I had never had a urinary problem and my ejaculations worked like a teenager but I had localized cancer and the best solution considering my age was to remove everything. The best advice I can give you is to choose a nerve preservation robotic surgery and a competent surgeon and you will not regret it.
With such surgery I had quite severe pain for the first 3 days and after a week it improved greatly. This is the only surgery I have had in my life but I can tell you that on the pain side it was not that bad, the digestion problems due to anesthesia were more difficult than that lol. The catheter is quite unpleasant, especially since it affects the glans and it is sensitive, I had it almost 2 weeks and at the end my erections started and I had it again and it was not very pleasant.
For the urine it is sure that it is different, I practiced the kegels before and after the surgery which helped me a lot to strengthen the remaining sphincter. As soon as I removed the catheter, I thought I was holding back because the prostate did it for me before. after a week it was going very well. For sex I have not had since but only masturbation and I waited 1 month after surgery, I sometimes had small leaks at first but it was quickly resolved. The only difference is that I can urinate even if I am fully erect
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