I'm new here...

Symptoms history: 3 years of weakening stream, PSA 1.6, normal DRE (no enlargement). This year PSA jumped to 2.5, abnormal nodes in DRE triggered biopsy (with second opinion): Gleason 8, 10 of 12 samples malignant w/parineural invasion in 2 samples. Robotic RP at Emory - St. Joseph's Atlanta late August, 2016. I am 71 yrs old in excellent health. Post-op path report indicated cancer cells in 2 of 9 lymph nodes (all 9 removed along with seminal vesicles during surgery). Watching for zero PSA at 3-month F/U end November, otherwise possible hormones/radiation. So far I have experienced two months of total urinary incontinence. This is predicted to last a minimum of three months but could be much longer. I am managing to hold some after sitting or overnight, but leakage is constant. I am interested in what I might expect indicating continence is beginning to return (doing a dozen reps of 10-sec Kegels 3 times daily). For ED: surgical team PA recommending Cialis/vacuum pump rehab; urologist prefers injections...any opinions?

[AlanMeyer Moderator]

Hello DHChops,

First off, let me say that it appears that you've found excellent treatment. Emory University is one of the US National Cancer Institute's "Designated Cancer Centers", a place where top quality research and care are found. It sounds like your treatment was very aggressive and your doctor is following up. I'm hopeful that they have treated you in time and will either have gotten all the cancer or will be able to radiate any that remains if necessary.

I have no personal experience of your type of urinary incontinence. My own treatment was with radiation. That causes the opposite problem - inability to urinate. Paradoxically, that forces patients to have to urinate very frequently (getting up 7 times a night in my case) because they can never fully empty their bladders.

My understanding of urinary incontinence is that. while some lucky men become continent in just a month's time, most require three to six months and some take up to two years. I have read that if, after two years, they are still incontinent, they're going to stay that way. However there are ways to deal with it ranging from adult diapers to clamps, to surgically implanted artificial sphincters. Searching Google for (urinary incontinence treatment after prostate cancer) will get a lot of hits.

As for ED, something that radiation patients DO experience, my personal view is that one should experiment with all the least invasive treatments first - Viagra and related drugs, and vacuum pumps (but be careful not to hurt yourself with too tight rings left on too long.) Also, and I think this is not given enough emphasis by most people, a couple should experiment with sex that doesn't involve penetration. I believe that highly satisfying and inventive sex with wonderful orgasms for both men and women can be had without penetration - and no pills, injections or devices are required. However, I have known men who were totally dysfunctional after surgery but, within a couple of years, were able to have intercourse again. Keeping sexually active seems to be the best way to preserve and improve what you've got.

Best of luck.

Alan

[Hidden in reply to AlanMeyer]

Thanks for the detailed note. I gave some thought to my options. I'm fortunate to live in the Atlanta area, so help at a great facility isn't too far away. I will expand the geography of options if this gets complicated...my November followup will tell.

You are right that treatment was aggressive. The PSA was a non-indicator for me and by the time the DRE picked up the tumor, it was presenting big time. I was stunned when they told me the lymph nodes were involved. Right now, it's a toss-up whether I'm facing more trouble down the line. I am NOT excited about hormones...

I have several acquaintances that run the gamut of incontinence resolution, from control right out of the chute on the one hand to indefinite trouble on the other. I've studied the options and am hoping for the best, but for now, I'm hunkering down, anticipating gold level status on the Kimberly-Clark preferred customer list.

I'm tuned in to your ED logic, although my urologist is not a fan of the pump. There is some negotiating flexibility here, I think. We'll see when the time comes. Right now, gaining urinary control is my top priority. Meanwhile, I'm on a Cialis generic to keep the blood flowing and tissues "stretchy."

[MelbourneDavid]

I've used injections for prostateprostatectomy caused ED a lot. After the first couple they were no hassle with an autoinjector like the injectease. The erections can feel really natural, although I had problems with it being too firm and lasting too long. I found riding a bicycle brings the erections down quickly, and nothing else does.

I have had problems with the pump sucking up the scrotum skin which is painful and inflates the wrong tissue.

For the incontinence, a pelvic floor physiotherapist can be helpful with targetted exercises aimed at your current issues.