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Prostate Cancer And Gay Men
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Anal Sex After Salvage Radiation and / or Radiation to the Pelvic Lymph Nodes?

To what extent has anal sex changed for you after salvage radiation to the prostate bed and / or radiation to the pelvic lymph nodes? Has it even been enjoyable for any of you? I'm assuming that there hasn't been a medical study on this, but if there is, please let me know.

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How has it affected you?

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I haven't experienced it yet, but after consultations with multiple oncologists, it appears to be the recommended route (of course, with ADT -- for six months). I have time – perhaps three to nine months – to brace myself and make a final decision, as my PSA is still below .1, but rising.

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The time to treat is at the lowest PSA you can, if there is evident recurrence (adverse pathology, pattern of uPSA rise). If removal of your prostate didn't dampen sensation, I doubt radiation will. Radiation only minimally affects nerves.

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I should clarify and note my stats: In this case, I mean receptive anal sex. My stats are 3+4, 14 PSA prior to surgery, surgery was 3 ½ years ago, negative margins – no evidence of cancer spreading outside of the prostate at that time. PSA velocity (post-prostatectomy) is not yet measuring at a consistent rate because the test results are so low at this point, but it’s at about 11 to 12 months as of my last exam, which was a late March 2019 reading of .066. Next PSA exam is at the end of this week. I appreciate your response.

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With no adverse pathology, you can hold off on treatment until (1) your uPSA is over 0.03 and (2) it has risen on two subsequent measurements or at a rate of at least 0.05 per year:

pcnrv.blogspot.com/2016/08/...

I assumed you meant anal bottoming.

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Thanks again! Much appreciated!

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That’s a great question!! Men, please share.

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Thanks for sharing. Interesting.

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Same question but after RALP...

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Before I had my prostatectomy, I asked John Mulhall of Sloan Kettering -- who is considered by many to be the world’s leading specialist when it comes to penile recovery from prostate cancer treatments -- this very question. Yes, it’s a different area, but Dr. Mulhall has knowledge of gay men’s issues, is comfortable discussing them, and he has at least one nurse who specializes in the experiences of gay men who suffer from prostate cancer, which is a huge additional benefit of coming to this office. Dr. Mulhall did suggest that I wait awhile. It’s been a few years and I can’t say with certainty, but I believe the suggested wait period was somewhere in the area of "at least" eight weeks – of course, with feedback from the surgeon. I waited longer – perhaps double to triple that time because it takes a while for most of us to improve from the extreme incontinence and erectile dysfunction that typically greets us immediately following surgery. Plus, I wanted to play it very safe. Having said that, some patients who have a prostatectomy do eventually end up with scarring in their rectum which makes anal sex “different” or more uncomfortable or even painful. Three plus years later, well in advance of my future salvage radiation, one of my radiation oncologists has checked for scarring with a DRE, and he didn’t find anything of note. Of course, he couldn’t have gone in that deep -- but, I can say haven’t noticed any difference in that area while having sex. Having said that, one of his nurses has suggested that the prospects may not be as hopeful following salvage radiation. Later this year, I will be following up to get a better sense of the prospects. For now, I'm hopeful that some of the patients on this site have informative experiences that they can share.

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The whole purpose of the RESTORE study from U Minn is to address these questions because very little to nothing is known. I hope that you are involved. I was able to get back to anal sex eight weeks after my RP. Sensation is pretty much the same even with the absence of the prostate. The sensory nerves still seem to be there. Those other nerves that make you hard are "off line" still. I am seven months post-op.

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The results of the study will be interesting to see. I am involved and agree that others should make sure that they sign up (if there is still availability).

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They are still "recruiting" [wink/wink]

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What is euphemistically referred to as "radiation therapy" is really cooking the tissues. How could there NOT be scarring following that?

None of my oncology team (surgeon, MO and RO) asked my sexual orientation. Perhaps not necessary because my partner started attending all the consultations after the diagnosis was reached. But I like to challenge my doctors NOT to assume, so I am out and explicit. I am also a physician who can be direct and tough on my doctors with feedback from the patient perspective.

Idle curiosity: where was your icon photo taken? Curious about the backdrop.

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The backdrop is Petra, Jordan. I can only agree with your rhetorical question. My thought is that It's really a matter of how bad it will be.

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I had hoped to go to Petra three years ago but my travel companion (a woman from my church) got afraid of the "Terrorists" and declined to go. I could not convince her that Jordan is a stable monarchy not overrun with terrorists.

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You are quite right. During this trip, which included travel to other countries in the area, without question, I felt safest in Jordan.

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I hope you understand that anal sex includes manual manipulation of the prostate gland. As long as there are cancer cells why would you take a chance of injuring your prostate and have these cells go into the blood stream? You understand that the prostate gland is the back end of an erection. So I waited until they told me I no longer have cancer and I have a dry orgasms now. What I am trying to say is that with the erection I do not believe anal sex is as enjoyable. I have had PCa for eleven years and I learned how to have love making by caressing and oral sex and learning to love someone on a physical, financial, spiritual, intellectual, and emotional levels. Anal sex may not be the only way for a relationship.

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It is important for me to note that my oncologist has informed me that having anal sex would "not" spread the prostate cancer. Even though my prostate was removed, I had the very same concern that you just mentioned (which certainly seemed valid to me), so I checked it out just to be sure. Having grown up in New York City throughout the height of the AIDS crisis and watched as people were literally dying around me, I’m fully aware of all of the alternative ways of providing affection and did so for many years. I mean no offense whatsoever and I only speak for myself when I say . . . been there, done that, and I ain't going back.

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I understand your decision better, thanks for the answer.

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Here's a new set of recommendations that has just come out in the UK regarding how long gay men should wait to have anal sex -- based on each specific treatment option.

dailymail.co.uk/health/arti...

Here's a quick overview from the article:

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WHAT ARE THE GUIDELINES' WAITING TIMES?

According to guidelines put together by doctors and surgeons, men being tested or treated for prostate cancer should leave the following time gaps from receiving anal sex to avoid internal injuries, incorrect test results or damage to their partner:

One week before a prostate-specific antigen (PSA) blood test

One week after a biopsy using a needle through the perineum (between the scrotum and anus)

Two weeks after a biopsy using a needle through the rectum

Six weeks after surgery to remove the prostate (radical prostatectomy)

Two months after external beam radiotherapy

Six months after permanent seed brachytherapy

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