Unless surgery is really necessary...

[Handdrummer777]

... please carefully consider getting radiation treatments instead.

Radiation delivery systems have more accuracy than ever, with less chance of late-onset ED, vs surgery. Even with a great surgeon and nerve-sparing intent, until you're opened up, how much nerve-sparing is possible only then becomes apparent.

If you are ok with the current 2-1 odds against erectile recovery, go ahead with it. And if penile shortening, sometimes by > 2" , is also acceptable, please proceed.

I know there are many things to consider...and Qol is a biggie.

Yes, there are more salvage options available with surgery. But there are expanding salvage options for radiation patients as well.

Statistics now clearly show the superior erectile outcomes of men who take the radiation option -- especially those who undergo SBRT, for example, which needs just 5 treatments.

And if you have recently had RP, here's a final thought to protect the fragile libido in the first weeks and months post-RP, when total or near-total ED is the (hopefully-temporary) new normal:

Get an Elator, the device that allows a man with zero, partial or full erection to have successful penetrative sex. An amazing invention which gives the penis a "spine" that holds it stretched-out firmly.

Protecting and shoring up libido is at least as important as recovery/preservation of erections. Take it from me, who just completed 18 months of ADT.

Best of luck, whichever path you choose.

[nebear2]

While I agree with you on saving libido and other potential side effects of a radical prostatectomy, I respectfully disagree with you on pushing radiation. When choosing the radiation method first you eliminate the potential for doing surgery down the road. Accordingly to my partner's Dr. radiation produces so much scar tissue that it eliminates surgery down the road. Thus, choosing radiations eliminates a major option, surgery, from your arsenal in attacking prostate cancer.

[Handdrummer777 in reply to nebear2]

Yes, correct, BUT salvage surgery is a bad option anyway -- no nerve-sparing is possible. Permanent severe ED is the assured outcome.

Go directly to implant, if PSA is stable for a time.

[nebear2 in reply to Handdrummer777]

Getting an erection while important for sex, does not justify increasing odds of death due to cancer. IMHO

[Handdrummer777 in reply to nebear2]

I do understand your concern about not increasing odds of death.

However, my current understanding is that RP & RT have very similar long-term survival outcomes. So, you are not decreasing your chances long-term in choosing radiation.

[mkljajic in reply to nebear2]

Choosing radiation does not eliminate surgery. More and more surgeons are trained to do surgery after failed radiation.

Agree with OP, surgery produces severeED, sometimes temporary, more times permanent. Also, loosing 2+ inches of length is not fun. When you add incontinece to all of these, surgery in my opinion, has disastrous results and huge impact on men’s life after RP.

Had surgery, experienced all of the SE.

[joek99]

I myself weighed all the options, talked to many doctors, and chose to have surgery.

What I would recommend to anyone is talk to a lot of doctors and to many of us who have already gone through the decision-making process. I wish I had found the prostate support group for gay/bi men in my city while I was making the decision, because there is a lot of knowledge in that room.

I am not a medical professional and would never dream of making a blanket recommendation favoring one treatment or another based on my own experience. There are so many factors that come into play.

You have posted at least a couple times negative opinions about surgery. So for me and perhaps others who had decided to have surgery, it feels like you are second guessing our decisions for us. And for those who are in the decision-making process, I am concerned about swaying someone against surgery when it may be the best course of action for them - regardless of the reasons.

So for those guys reading this who are in the decision-making stage, read all the posts on this site and others, as well as books out there on it, talk to lots of other guys who have experienced it, and get several medical opinions! If you want to know about my decision and my experiences with surgery, happy to discuss with you.

[Handdrummer777 in reply to joek99]

I do see your point about , with second-guessing. And I suppose I am. I feel uncomfortable putting myself in that antagonistic-sounding a role. It just seems to me that so much Qol is on the line with surgery, with not-so-good odds of erectile recovery in general, compared to radiation.

You're certainly correct that everything in each man's individual unique case should be considered in arriving at a descision.

[Handdrummer777 in reply to Handdrummer777]

I do see your point about second-guessing...