Hi there !

Yes, it is. If cancer is detected in seminal vesicules, the chance of local
recurrence and/or distant metastasis is much greater. If cancer is detected
in the lymph nodes, it has already spread, so the surgery stops before the
prostate is removed. Hopefully, this won't be the case with you...

Men's orgasm has nothing to do with the actual sperm/semen. The feeling of
orgasm happens in the brain (as far as I know). That's why it is possible to
orgasm without ejaculating. Actually, it happened to me once, even though I
am only 27 and I have my prostate...

Good luck.

Gordan

Sandy,

You would benefit from reading the book, Dr. Walsh's Guide to Surviving
Prostate Cancer.  Don't read the latter chapters on advanced cancer, you
don't need that.

Yes, the seminal vesicles are removed too.  You won't need them any more,
and the pathologist needs to check them for cancer.  The surgeon removes
some of the lymph nodes to check them for cancer too.

You are lucky to have been offered bone and CT scans.  I certainly wasn't,
because like in your case, the chances the cancer has escaped were so small.
Sounds like you are getting good service.

50/50 chance of normal erections sounds pessimistic, especially for one so
young.  But if that's the surgeon's track record, then at least he told you.
I believe the surgeon who did my RRP claims 80 percent.

Dry orgasm just means everything's the same except no fluid is expelled.
The same pumping sensation, but nothing comes out.

jimhoney

Sandy,
What you described is completely normal.  The RRP does remove the
seminal vesicles.  The lymph node removal is for better pathology
determination.

Orgasms are in the mind.  With the seminal vesicles removed there is no
path for the normal orgasmic fluids to follow.  It is even possible to
have orgasms without erection.

As far as the 50/50 chance of "normal erections" - I'm 10 months post op
without return to function - but I'm in a trial using hormone
suppression and with the loss of libido, I'm not too surprised.

Good luck, and as others have stated, feel free to ask all the questions
you like.
DanR

The best surgeons can achieve 70-80 percent in younger men.

It is standard practice to remove the seminal vesicles because they
serve no function after RP and the pathologist will want to examine them
for spread of the cancer.   Also, the seminal vesicles are obvious
places the cancer may spread to, so taking them out reduces the risk of
spread somewhat.

It used to be that some lymph nodes were removed before surgery and
quickly examined for cancer.  If there was cancer present, the surgery
was aborted.  That is the way my Gleason 7 cancer was done---with no
cancer in the nodes.  But these days, for a Gleason 6  or less cancer,
many surgeons will proceed anyway without having them checked because
the likelihood of finding cancer there is so low.   Usually, they do
remove them for the pathologist to check after surgery.

You won't ejaculate, so you won't feel the sensations which are part of
ejaculation.   Otherwise, it is really hard to predict in advance,
because men differ so much in how they respond.   You should experience
pleasure during intercourse and it should rise to something of a
crescendo and then let up suddently, as a normal orgasm does.   But
different men report rather different sensations except for that.   Some
men, particularly younger men, do experience something intense very
close to what they experienced before.  Some even say it is better. For
others, the orgasm may be less intense.  But the thing to keep in mind
is that it is well worth the effort for most of us.

Remember also, that all impotence means is the inability to have an
unaided erection.   There are a variety of means to induce erections.
After surgery, your sexual desire should be the same, after a period of
recovery, as will your ability to experience sexual pleasure.   You
should be able to have a relatively normal sex life, if you and your
partner are willing to work at it.

Good luck.

At 47-years-old, it is widely agreed that the only reasonable course of
action, currently, is a radical prostatectomy.  Whether it is laproscopic or
by robot is up in the air and currently changing, but RRP is still the gold
standard for your age.

They did the scans to see if there was anything visible outside the
prostate.  When he operates, he will check (biopsy) some of your lymph nodes
to see if there is any sign of cancer in them.  If there is, then taking out
your prostate is widely considered moot.  So, he won't do it (probably).
He'll close you up and set you up for radiation in a few weeks.  But, if the
lymph biopsies come back O.K., he'll take out the prostate and seminal
vesicles.  They always take out the vesicles.  They are attached to the
prostate and useless without it.

I think it is probably higher than 50/50.  It sounds like, with 'practice'
most guys here attain occasional 'stuffable' erections within a year or two.
And yes, when you climax, your body feels no different, but nothing (or very
little) comes out of the penis.  The Cowper Gland is the only one left that
is still connected and secrets fluid.

Also inquire about IMRT (Intensity Modulated Radiation Thereapy), a
procedure which Sloan Kettering pioneered.  There are differences of opinion
as to whether or not external radiation is recommended  for "younger"
patients.  Get an opinion from a radiation oncologist as well as a surgeon,
then go with the one that sounds preferable to you.  The chance of normal
erectile function after IMRT is very good; there is very little chance of
urinary incontinence.

Orgasm is subjective.  Without ejaculatation (which also diminishes to a
dribble after radiation) the only thing you can say with certainty is that
your experiece will NOT be the same as before.  For me, it usually now is
less intense, as I experience orgasm the way you do.  With nothing to pump
out, it feels on the blah side much of the time.  Then there are times of
good mental and physical stimulation when it is just great.  But I have
never experienced ED from day one, so for that I'm thankful and hopeful that
it will continue (I'm one year post treatment).

Just remember that it is all probabilities with this disease:  the
probability that your cancer is confined; the probabilty that the chosen
procedure will cure it and it will not recur down the line; the probabilty
that you will or will not have side effects, etc. All choices are good news
bad news; it's always a question of deciding which is the least bad
alternative from your own viewpoint, as they all pretty much suck.

Having said that, remember that you have a form of cancer with a high cure
rate, that you likely will have a long life expectancy, and that you WILL
adjust to whatever happens.  People are resilient; you will adjust.

Good luck!

Hello Kastons,
I was 49 when dx'd   7 on the PSA and T2a.

I was afraid about all the things you describe, and mostly afraid of the
cancer!
I chose to get the cancer out, and salvage what comes.
I am fine, and now 54.
I have a wonderful sexual life with my wife.
I do use viagra, on occasion, and it really works well.
I do not have cancer.
Orgasms are just as wonderful prior to removal of prostate.
Yes, I missed ejaculation, but did not miss cancer.
So, keep your chin up partner, get rid of cancer, and work on the regaining
of your sexual abilities.
It does cum back.............

Good wishes, and please feel free to ask me any question.
I have been through this nighmare and now have a great view.....
John Loomis  RP 1999  age 49
Now 54, and doing fine.....

...

...
As Doug Taylor suggested earlier, I also suggest that you meet
with a radiation oncologist.  The conventional wisdom is that prostatectomy
is the right treatment for younger men, radiation for older men.  But
radiation techniques have improved a lot and it can't hurt to talk to
a radiation specialist - although you may still opt for RP.

Another option to check out is laparoscopic radical prostatectomy
(LRP).  Instead of making a long incision from the navel to the
penis, they cut small holes and insert long instruments, observing
the surgery through a fiber optic tube.  Sometimes this is done
with the assistance of a robot (the "daVinci robot").  Some people
think that LRP does less damage to the body in getting to the
prostate and offers a quicker recovery with fewer complications.

Sex after any treatment will not be the same.  The "dry" orgasm
is different.  It is over very quickly.

Adapting to the changes will be something of a challenge, but it's a
challenge that many men and women successfully meet.  Couples
who are determined to make things work, usually do.

As for the 50/50 statistic, when skillfully done by a highly experienced
surgeon, it is my understanding that your odds are better than
that - especially given your relative youth.  It is possible that your
surgeon is not highly experienced, or it is possible that he wants you
face the future with a full understanding of possible consequences
and not be shocked and dismayed if things don't work out.  So he
may be quoting a conservative figure for that reason.

Ideally, many people here believe that you want to get a surgeon
who does 100 or more RPs a year, in other words, not just a
specialist in urology, but a specialist in prostate cancer surgery.

Good luck.

   Alan

   You may benefit greatly from your next consultation. 50/50 is a really
low number for your age. Make sure you ask your URO how many of these he has
done, and how many per year? It should be at least 100. My guy was the top
man, and head of the dept at a great hospital.  My feeling is, the right
surgeon for you, will leave you feeling sure of your decision. He didn't
pull any punches, but told me my chances of recovery to normalcy would be
75%... and I was 52.  I  regularly have dry orgasms from the day I had my
cath removed till now.  Perfectly wonderful.  No tissues!
   It's a difficult pill to swallow, but face it.... you have cancer.  Your
life will be different from now on. Get rid of it.

Perhaps you didn't realize that almost all of the white stuff ("cum") is
manufactured by the prostate.  That is the function of the prostate, to
manufacture an environment that the sperm can live in.  The sperm is stored in
the seminal vesicles and mixed with the "cum" at the time of ejaculation.