59 years old now, diagnosed Gleason 9, organ confined, in Sept 2019, PSA 7.4 at the time. Did radiation treatment+high-dose brachytherapy+2 year ADT.
Has anyone among you recovered their erectile function after such a treatment?
PSA was <0.1 and testosterone was <20 while on ADT. Finished ADT in Sept 2021. 6 months later, testosterone (T) is low-normal at 378.
I can't get an Er*ection though. I thought that when T came back, the erectile function (EF) would come back; but apparently radiation of the nerves in that area can reduce erectile function.
I was a good boy on ADT. I did weights at least 2x per week as recommended by London441 + aerobic exercise for 3x per week. I did some exercises recommended by Winkoliu which were good. And I ate intelligently. In other words, overall, I really stepped out of my normal, slothful box. But I guess the radiation did me in?
I know there are pills, pumps, and surgical things that can be done. But has anyone seen EF come back?
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For me, yes it came back. But with limitations, both in strength and time. Certainly the drugs helped, both low dose maintenance level for the vascular system and higher doses when activity was expected. The vacuum tube helped maintain length, too. I eventually moved to injection of Edex for lasting penetrations.
As I see it, all the positive effects -- natural recovery plus the drug and device assists -- are up against the natural aging process. I was near your age when I had PCa. That's the age when sexual activity starts to wane for many guys (for many reasons). For reasons both cultural, psychological, and physiological the sex slide gets steeper about then. Exceptions occur, we all hope we are one of them. So my advice is to use whatever helps, and don't expect any of them to work forever -- effectiveness comes and goes. Keep evaluating how they work, and try out others.
One radiation oncologist confided in me his observation that his gay patients had better functional recovery because the "kept in shape" by regular exercise and because sexual activity was a higher cultural focus. That pretty much fits what I've seen with friends and in the support groups I've been involved with.
At age 67, sexual function and interest came back as T recovered to about 700 about six months after HDR-BT/IMRT/18mosADT. The treatment did knock some wind out of the sails but still functional at nearly the same level. A lot of exercise and good food probably helps.
Hey Tim, I think that reaching 700 just 6 months after doing 18 months of ADT is unprecedented medically. Did docs say this? I'm not joking, based on the nomograms and curves I see, you're off the curves and out of this solar system. Blessings
I think there’s been others, but I had very high T to start with (1100), so I think that’s probably why it came back to that level. I exercise a lot and eat well, so that probably helped it come back quicker. One thing that may have helped was taking monthly Lupron every five/six weeks, so I wasn’t driving T to super low levels, just enough to keep it <12. Once I went seven weeks and T nearly jumped to the lower normal. So about five/six week intervals was optimum. Not doing 3-/6-month doses probably helped too. My T leveled off to about 2/3 of it’s previous level after 18 months of Lupron, so it looks like ADT could permanently destroy about 1/3 of a man’s T-generating ability in 18 months.
When you get off of ADT and your testosterone recovers to normal you will find out. If some level of ED persists there are multiple levels of workarounds that will make things at least work.
It isn't nerves (which are impervious to radiation), it is stenosis of the blood vessels (Scar tissue accumulation) that supply the penis. Hyperbaric oxygen therapy may help reverse that. Shockwave therapy, which is useless for ED caused by nerve damage (prostatectomy), is worth at least a discussion.
also came back for me after radiation and ADT but was only on ADT that time for 6 months. As others have said not quite the raging hardon of before but workable. Now on permanent ADT (orchiectomy) erections are history . I little viagra does produce a semi rigid ??? but no interest due to no T.
I participated in a study that was advertised here. U of MN. For gay men. Focused on effect of treatments on ED. It provided Sildenifil 3x/wk, 60 mg dose each time. Plus penis pump. The study recommended NuPath pump. A tad awkward at first. Made a fun time out of it with partner. It def helped. Btw, hated ADT and it hated me. But have function but certainly not as "strong" as pre-treatment. Continuing with Sildendifil. Seems to help. Other side effects - shrinkage, fucked up blood work, join pain, wt gain. loss of muscle mass and so on. Exercise seemed to help but wt gain remained. It's a struggle.
I know that this is of no help to you at this point. But for those of you reading this thread who are just starting ADT, it is possible to maintain sexual function during ADT. I have subscribed to the use it or lose it theory. It is possible to continue to have sex even when your desire has gone.7 months into Lupron I just had a great experience. My partner often has to initiate the session.
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2 years into Stage 4 Treatment 
After 2 years and 8 month vacation PSA back up 0.3 what now?
Rising PSA 1 year after radiation and 6 months after Lupron
Options after Detectable PSA one year after Salvage Radiation?
Third rise in PSA, Doctor says come back in a year.
