Prostate Cancer And Gay Men
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Sex after cryotherapy

Hi all...

Any info please? I'm versatile and I wonder whether anal sex would still possible. I enjoy both roles and I understand that erection issues are always possible but how about the bottoming situation? Does the therapy make it s forbidden territory ? If no, after how long bottoming is a possibility? I understand that I'm looking at the sexual part, but hey... it's important to know such facts.


21 Replies

Was this whole gland cryo or focal cryo? If focal, just a few weeks until the rectal tissues are healed. Whole gland cryo usually results in complete impotence. It would probably cause bleeding in the necrotic tissue with a hard pounding. My RO had great general advice - go slow at first, and if it hurts, stop.


Thanks for reply :-)

Doing hemi-ablation since disease is present on one side. I could do focal but doc recommended hemi since it greatly improves outcome. He says sexual abilities retention 80% (I hope) and nearly zero incontinence. In One week, back to complete activities. Weil Cornell NYC- doc is waiting for newest machine in two weeks.


You should definitely ask the cryo doc about sex then. I hope you read the section about hemiablation here:

1 like

I have a choice between Cornell and Sloan... which is a better choice in your opinion?


Choose the right doctor, not the institution. Talk to several doctors offering different therapies. Ask questions like.. how many have they treated? How long has the follow up been? What are the oncological and toxicity results? What are the risks? What have they published about it? How has their practice changed? Ask if there is a patient you can talk to.


Absolutely :-)

Dr. Hu did my biopsy and he's done 450 prostatectomies in just two years. He loves what he does but is it morally ok to ask him so many questions? Such as experience with cryotherapy?

What concerns me is that the department is getting the newest machines... Would i be one of the first to "practice" ?

I have to decide in July or have no choice but leave it till November

Again... confined... 3+4... PSA less than 8... little or no symptoms


You're our gift in thirst times of crisis

God Bless You


Is it morally OK? It's more than OK, it's your responsibility to yourself to ask those questions. It's your body -- your life! He should be happy to answer any and all questions. If he isn't - find another doctor. If he tries to hide or gloss over something about his record, then there is something to hide. All the best doctors know their stats and are proud to discuss them.

I think it's a legitimate concern about being the first on a new machine. Let him practice on someone else.

I see no reason, with your minimal GS 3+4, that you can't decide in November. There is absolutely no reason you have to decide this month.

Some tips:

• Always have your questions in writing. Leave blank space in between to take notes on the answers, as you hear them.

• Some guys like to record it all on their iphones (with permission), but I've always found that written notes work better

• Bring someone with you. You will miss at least half of what the doctor said. De-brief with that person immediately afterwards and compare notes.

• Very briefly summarize what was discussed in a thank you email to the doctor.

• Never feel under any pressure to make a decision on the spot. If the doctor is insistent, tell him to go into the used car business and never see him again.


You're perfectly on the spot... had my questions on the phone... was alone and left out half the info (just forgot).

I'm in Manhattan and so much to choose from in case I have doubts.

Have two appointments next week- Cornell again and mskcc. Too much info to sort especially that I read so much to compare HIFU to Cryo... leaning to cryo but again doctor's expertise is equally important.

I'll get a verdict when I do ;-)


Here's a list of questions I would ask. He'll probably answer most during his introductory remarks, and as he answers some questions, he'll probably answer some others too. If YOU don't know what some of these things are, google them - you should know.

Questions for focal therapists:

1.Am I a good candidate for focal ablation? Why do you say that?

2.What about proximity to other organs – urethra, bladder neck, rectum?

3.How would you assess my risk of urethral stenosis requiring catheterization?

4.Is there a risk of recto-urethral fistula?

5.Should I expect some incontinence for a while? For how long?

6.What about damage to the neuro-vascular bundles on one or both sides?

7.What is the risk of losing the ability to have erections? Orgasms? or have painful orgasms?

8.What is the likelihood that I will still be able to ejaculate at orgasm?

9.Should I expect blood in semen? In urine? Is climacturia ever an issue?

10.Should I expect bleeding and sloughing of necrotic tissue through my penis?

11.How long after the procedure can I have anal receptive sex?

12.What is the likelihood that undetected cancer in the untreated area will become a problem? How will we monitor that?

13.What is the likelihood that cancer in the treated area will not be fully killed off? How will we monitor that?

14.Will we use imaging (mpMRI or PET/CT) to assure the cancer is gone? Will we do a follow-up biopsy? Is there a pathologist here who is expert at reading biopsies of ablated tissue?

15.How will we monitor progression after the procedure? Since my PSA from the unablated zone will always be there, how do we know if progression has occurred?

16.What is the cost of the procedure? Does that include anesthesia?

17.What is the cost of a re-do, if I need one?

18.Are any of the costs covered by insurance?

19.How many focal ablations (as a primary therapy) have you done?

Have you always used the same equipment? How has your practice changed over the years?

20.Are you going to be doing all of the really important parts of my procedure yourself?

21.What percent of those required re-dos?

22.What percent eventually needed other salvage therapies? What kinds of salvage therapies were used? Radiation? Surgery? Were they successful? What kinds of side effects occurred from the salvage?

23.What is the longest follow-up you’ve done of patients you’ve treated?

24.How long should follow-up be before we deem it a success, or am I always on “active surveillance”?

25.What kind of aftercare will you provide, and how will we monitor side effects, and for how long?

26. Will you regularly monitor my urinary and erectile recovery progress with validated questionnaires like EPIC and IPSS?

27.What is the best way for us to communicate? May I ask short questions by email?

Questions NOT to ask:

1.What treatments should I consider and which is the best for me? (this would be asking your doctor to be an expert in treatments outside of his specialty, and also to know which benefits and risks are most important to you – he doesn’t have time or inclination to be expert in all therapies, and he’s not a mind reader.)

2.If I were your father, what would you recommend? (You don’t know how he feels about his father (lol), and more importantly, what HE would feel most comfortable with is not necessarily what YOU would feel most comfortable with. This is your decision to make and live with – don’t give up your power!)


Amazing list... I will use most suitable ones and print to appointment. Thanks so much


I just came across a new study on cryo. They have a registry - data from ALL men treated in the US are part of the database. For intermediate risk men after partial-gland cryo, the outcomes were as follows:

• 5-yr biochemical recurrence-free survival (nadir+2)= 70%

• 1 yr incontinence rate= 5%

• 1 yr impotence rate= 53%

• urinary retention= 7%

• fistula = 0%


Fair results :-(

Might opt for focal cryo given the newer MRI guided cryo


Thanks for suggested questions. Found out that Presbyterian or at least the doc did 27 cryo in the last 2.5 years... I'm switching to Sloan. I have an appoint on Thursday. You're an amazing helper. Your suggestions are making a difference in my life. God Bless You



Jonathan Coleman at Sloan is their specialist in focal therapies. He does many experimental kinds, including IRE, if you are open to that. It would be a reasonable thing to do, if you can get an email for him, to send him this link: with a short note saying "I would like to discuss the issues raised in this article with you." Doctors at teaching hospitals love this kind of stuff.

In the NYC area the other big practitioners are Aaron E. Katz and Dan Sperling (who is now pushing FLA).


I will :-)

My index lesion is anterior and this makes it ideal for ablation as it is far relativelyfrom the edge where all the nerves are which cuts down on side effects.

Have a cool day



Dear Allen,

After meeting all the doctors needed,

I'm facing two options

Prostatectomy or SBRT

Or Brachytherapy

Hemiablation won't give a lot of peace of mind.

3 options left. Priority is incontinence. What do you think?

Your opinion matters soooo much to me. Priority is normal life- like everyone- sex? Not my priority. Incontinence messes up life every minute. Sex doesn't

That's where I am. Pushed up my travel plans as the disease is hijackingmy mind. I'll do treatment. Recover, then travel

Again. Thanks sooo much



Half the gland - just one side

The other half won't be touched


See comment on previous post. Was exclusively a top. No reason why anal sex would not be possible if desired.



Any idea how long after cryo anal sex would be possible?


Haven't a clue. I was unable to pee for two weeks and had to have a resection of the urethra. Don't know if that contributed to impotence. Both sides of the prostate were involved so my case is quite different from yours. I've been with my husband for 24 years. Married for five. Affection is more important than sex.


Thanks George

Very frankly, I rarely bottom but thinking 💭 If cryo is gonna kill my erections what about the other end lol

Doc told me that I would stay potent 90%... I hope

Again thanks sooo much


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