Depression after PCa treatmen

[WhatHump]

One of the email missives led me to a post, 3 yrs ago, by a nice man who said he suffered severe depression after his RP.

This is a subject I'd like to broach with the group, if I may. Have there been any studies on this? Esp on guys who have ED or incontinence issues afterwards? (Esp permanent SE's) I think either of these two issues really hit a man where he has defined himself for decades.

I suspect depression is very common, for two reasons: the loss of one or more of the things that define you as a man. And, possibly a loss of testosterone after the loss of the prostate. (Talking only about RP) The first is rather obvious. The second a bit more contentious, possibly. A good friend is a DDS, but also has a couple PhDs in math and science. Bright and likes to read research. He went thru radiation for PCa years ago, and as part of his research a priori, he says he found studies that show the prostate does effect testosterone levels. (I forget the exact mechanisms. Possibly helps T from the testicles to mature or get absorbed, IIRC). I know my T level post-surgery was 333. (Sadly, I did not think to test it before the surgery). I'm told the range of "normal" is 300-1200, which is so wide as to be meaningless, imho. I consider 333 to be low. 26 mos out from my RP I know I do not feel like my old self. Less endurance. Harder to retain muscle mass. Struggling with some grade of depression. (I've had a couple episodes in my life, but always worked through them.) I exercise vigorously every day and then am active on top of that. Maybe what's happening is just that I'm 26 mos older, and as my MD girlfriend says, "Aging is not linear.". But, it FEELS connected w the RP and loss of prostate. My incontinence issues are minimal, but highly annoying. ED got better at year one, but never fully recovered, and taking drugs to make things work better, while I'm grateful, is also a PITA due to their own SEs. Both really bother me since they go against the sense of self I'd had for 62 years. But, mostly, I sense my T is lower than it once was, and this then adds to the sense of loss, and in itself can be a hormonal source of depression.

I'd be curious if there are any studies on possible higher rates of suicide among men who've been treated for PCa.

So, I'm curious other peoples' experiences. And whether others have seen research showing that the loss of the prostate does indeed lower a man's T levels. And does this, possibly in conjunction with SEs from treatment, raise the incidence of depression in men treated for PCa.

Thanks in advance.

Hump

[Tall_Allen]

It is a well-known risk:

onlinelibrary.wiley.com/doi...

link.springer.com/article/1...

bjui-journals.onlinelibrary...

ncbi.nlm.nih.gov/pmc/articl...

auajournals.org/doi/abs/10....

Both CBT and Mindfulness have had some success:

ncbi.nlm.nih.gov/pmc/articl...

ncbi.nlm.nih.gov/pmc/articl...

[WhatHump in reply to Tall_Allen]

Thank you!

[London441 in reply to WhatHump]

I had both ED and incontinence after surgery, both have been addressed to the best of my ability and options. I will never be the same but my cancer is either eradicated or not in evidence 4 years later. I opted for max treatment, disease control as a priority. I have no regrets.

I had a long and very healthy sexual appetite and function since my early teens, that is mostly over now. Good sex is about far more than copulation anyway. I am not depressed about it in the least. It was nice but it never ‘defined me as a man’.

Adaptation is the key. I have everything else. My physical and cognitive skills at 67 are exceptional, although I say so myself. I have a beautiful family and trusted friends, and work I’m passionate about, which I am better at than ever.

I’m fully aware not everyone can have all this, some not even close. However, I do believe that healthy habits, gratitude and daily, continuous acceptance of one’s fate can work wonders.

For those who feel the need to improve the best of what remains, so much help is available. Antidepressant drugs, viagra/cialis, pumps, implants, sexual rehab, exogenous testosterone, incontinence treatments, therapy-there are more good options than ever!

So many men obsess about what they used to be able to do, sexually and otherwise. I feel for them, but can’t identify beyond that.

[jimreilly]

Tall Allen has cited various relevant studies, and I think many of us would confirm your thoughts and those studies with our own experiences. We all bring our own personal histories and personalities with us to our cancer experiences, and we experience the treatments and side effects as individuals. If someone is not at all depressed by certain losses, that's great but many of us will be. And what we do about the results --including depression, if it happens--depends on our personal resources and the community resources around us. Depression can be a trap, in that it makes one less likely to have the motivation to do something about depression itself, i.e. it can be self-reinforcing and a descending spiral, feeding on itself. I encourage you, if you are suffering from it, especially since you now know for sure from these studies how common a result it is of prostate cancer and its treatment--to do something to break that cycle, with professional help if needed and anti-depressants if needed. (And, to be personal, my T levels are low, and I don't like it and the changes in my sexual expression, and I do take an anti-depressant--it helps.)

[dentaltwin]

There is still a widespread misunderstanding of what depression is. While a loss of continence/sexual performance may cause withdrawal and help to push someone toward depression who otherwise might not move that way (as can any significant personal loss or life-changing event), it is certainly NOT the same as sadness about a specific event. As someone who has had depression and anxiety long before my PC diagnosis, I can attest to that.

[Hidden]

In December 2022, I was as happy as I'd ever been in my life. Looking forward to retirement and all the things I was going to start doing immediately. Then a week after retirement, the diagnosis of prostate cancer is confirmed. I was immediately taken off of Androgel and my Testosterone level plummeted from mid 300s to 78 before the RP and then most recently, to 38. Depression is high in men with Low Testosterone. My depression was lifelong until I was put on the Testosterone Replacement and I learned that the way I felt was not normal. And I now feel that way again. I don't know if the surgery lowered my T levels. I do know that my penis is smaller than before and it wasn't too big to begin with. Dont' know if there is a correlation between that and lower T levels or if its just because of the nature of the surgery. I do know that prostate cancer specialists do not care about lower T levels or depression. Their only objective is to rid the body of cancer. And they are generally against prescribing testosterone replacement since it is linked to prostate cancer. It really comes down to what the patient wants though. Treat the low testosterone or the cancer? I can tell you that there are still cancer cells left in my prostate bed after my surgery in March. As soon as I am dry, I will have radiation and as soon as I have an undetectable psa level, I will resume Testosterone replacement. Getting a doctor to prescribe it might be a chore. But I would rather be happy for 10 more years than be miserable for 15 more years.

[CPGeek]

I had RP and I'm not depressed. And I have a history of clinical depression. As a subject of discussion with my therapist, I've only mentioned the medical aspects of the surgery, not the psychological aspects, of which I really don't have any, except maybe relief that for now, I'm done with the disease. As a gay man, however, there are sociological and cultural issues, beginning first off with aging. And that has been a major issue for discussion. By the time I'd had my RP, I had already come to terms with "aging out" of sexual activity. I was just too old to behave like a twenty-something. I'm as horny and turned on by the same things as I've ever been, and have not lost the ability to orgasm. If my testosterone levels have dropped, no one informed my libido. I still have my testicles, after all. I just lost the plumbing.

[Scout4answers in reply to CPGeek]

Do you still ejaculate or are you having orgasms ( feels like a spasm with out release of fluid)

[CPGeek in reply to Scout4answers]

I do sometimes squirt clear viscous fluid, which I've read is probably produced by the Cowper's glands. Not always, but it does happen if I'm well hydrated. Without the plumbing between the testes and urethra, ejaculating semen is no longer possible. I talked about this with my NP and she said it was probably urine, as in climacturia. I know what urine looks and feels like and urine this is not, at least not entirely. It's almost like clear lube. A better indicator of orgasm for me, even way before surgery, and was a major turn on for my partners, was massaging the prostate while orgasming. Of course, I can no longer call it prostate massage now that there isn't one there, but the sensation is still there. My partners could feel my pelvic floor muscles harden/contract and the longer they rubbed, the longer it would stay hard and the longer my orgasm would last. Knowing they had that kind of effect on me, for them, was as hot for them as it was for me, ejaculation or not, and they were equally amazed by how really hard my muscles get. I think a lot of men forget that orgasms last way longer than the moment of ejaculation. I guess the moral of the story being: both seeing and feeling someone orgasm is equally hot. Ah, fond memories. 🙂

[Scout4answers in reply to CPGeek]

Thanks for your candid answer. I am experiencing multiple orgasms which I would describe as muscle spasms, at the peak of my excitement. My partner can clearly feel them and sometimes they feel like there may be some discharge but it is hard to tell.

[j-o-h-n]

FROM the Net:

There was a man who lost one of his arms in an accident.

He became very depressed because he had loved to play guitar and do a lot of things that took two arms.

One day he had had it. He decided to commit suicide and went to the top of a building to jump off.

He was standing on the ledge looking down when he saw a man skipping along, whistling and kicking up his heels. He looked closer and saw this man didn’t have any arms at all. He started thinking, “What am I doing up here feeling sorry for myself? I still have one good arm to do things with. There goes a man with no arms skipping down the sidewalk happy and going on with his life.”

He hurried down and caught up with the man with no arms. He told him how glad he was to see him because he had lost one of his arms and felt ugly and useless and was going to kill himself. He thanked him for saving his life and said he knew he could make it with one arm if he could go on with no arms.

The man with no arms began dancing and whistling and kicking up his heels again.

“Why are you so happy anyway?”

The guy replied, “I’m not happy. My nuts are itchy!”

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 06/25/2023 2:23 PM DST

[addicted2cycling in reply to j-o-h-n]

Mustn't have had PCa and on ADT,

or like me an Orchiecotmy.

rhyming intentional 😂