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Medical Forum / Diseases and Disorders / Prostate Cancer / November 2006Ejaculation and orgasms after treatment
My IMRT was in September 2004, followed by Pd-103 seeds in October. Inova, just outside Washington DC did the treatment. I'm just past the 2 year point. It took 6 months for the Lupron to wear off and erections to return. That's 6 months after the 4 months that the shot supposedly lasted. By that time, my semen volume had fallen to a quarter teaspoon, maybe a half. Ejaculation changed from the normal squirt-squirt-squirt to a lazy dribble, an ooze, a seepage. The dribble isn't as satisfying as squirting. Sometimes, it seems almost like before. Mostly, it's just OK. Is this what it was like for you? Does it get "better" over time? How does the seeding and external radiation change squirting into dribbling? At first I thought that the "muscular" prostate contracted at orgasm. The radiation damaged the prostate to the point that it could not contract and force the semen to spurt. I did some web searches and found suggestions that at orgasm, the "urethral bulb", a cavity at the base of the penis surrounded by muscles, does the contracting at orgasm. If the urethral bulb and not the prostate, does it, is it the external radiation that weakens the orgasm and ejaculation? Do guys who only got seeds have better orgasms and ejaculation? What about surgery? What are orgasms like, is there any force to the ejaculation? -kh <tchtic@yahoo.com> wrote in message > What about surgery? What are orgasms like, is there any force to the > ejaculation? No need for it--- no prostate, no semen. Everyone's individual. Can't say at 68 I miss it. Otherwise things feel normal. >What about surgery? What are orgasms like, is there any force to the >ejaculation? > >-kh The force is the same for me, and the feeling is the same, despite being dry. Actually, the feeling is better than the 6 months prior to surgery, when I was taking Flomax. That seemed to greatly diminish the pleasure. > >What about surgery? What are orgasms like, is there any force to the > >ejaculation? [quoted text clipped - 7 lines] > when I was taking Flomax. That seemed to greatly diminish the > pleasure. 2 samples doesn't prove anything but it's interesting that you and Claude, who I believe also went surgery, report a "good" and not a diminished feeling. Could it be that the IMRT hits the muscles surrounding the urethral bulb, weakens them such that they can't convulse? I wonder if it gets any better with time. I have noticed subtle changes. At 2 years, I produce more semen than at 1 year and at 18 months. Erections are firmer. I wouldn't call them great and it takes a LOT of fantasizing and gentle stroking to perk it up. Anyone else notice orgasm changes at 1, 2, 3, 4 years? -kh >> >What about surgery? What are orgasms like, is there any force to the >> >ejaculation? [quoted text clipped - 21 lines] > > Anyone else notice orgasm changes at 1, 2, 3, 4 years? I don't remember exactly how old you are....in your 50's?....but from my 40's onward I noticed a decline in the firmness of my erections. You may reach a point where you think it isthe radiation that is responsible for the erectile decline....and perhaps diminished sensation in orgasm....when really your age is a more important factor. It's hard for those of us who do recover most of our function after a long period to determine how much of any decline is due to treatment or just to aging. Rught now, I'm perfectly happy where I am in that regard (and there's no wet spot that someone has to sleep in :-) ). Claude Claude. > I don't remember exactly how old you are....in your 50's?....but from my > 40's onward I noticed a decline in the firmness of my erections. You may [quoted text clipped - 8 lines] > > Claude. In my case, I don't think it's normal aging. I was diagnosed at 57 in late spring 2004. Prior to treatment I was good for several long sessions each week. I looked to be in my early 40's and still do. The Gleason 7 (4+3) and the 10+ PSA lead to the full court press, 8 months of Lupron-depot, 25 IMRT treatments from Inova's Linear Accellerator, and 97 Pd-103 seeds in fall of 2004. Between summer 2004 when the cute nurse jammed the horse needle of Lupron in my butt and until summer 2005, as my Testosterone gradually increased, I had zero libido and, well, my-cox-a-floppin. (I love that joke, about the name for the generic Viagra) After summer 2005, my libido gradually increased. I noticed that women weren't just funny looking guys and the way their boobs jiggled was interesting. The Uro-doc gave me samples of Vitamin-V and Vitamin-Cialis and I filled a perscription. For the next 6 months, fall 2005 through spring of this year, I experimented with taking a full 50 of Vitamin-V. It gave me a headache but got it up enough for penetration. This is more than stuffable but I can't crack walnuts with it. As the months passed, my libido has improved very gradually. Erections and orgasms too. It's hard to express this in words but I'm at 70%, 80% as far as firmness and experiential quality. You know how, sometimes, even when you were younger, an orgasm might be just OK? Maybe you were tired and it was the third time in two days? This is in contrast to when it'd been 3 or 4 months and you got a date with that older woman, you were in college and she was a 30'ish grad student, runway model good looks, blonde, blue eyes, smallish perky boobs. I'm in the just OK period. I hope things continue to improve. I have to work on my overall health, work off the Lupron belly, get my stamina back, upper body strength, cardio. The weak erections and mild orgasms are just part of it. -kh > After summer 2005, my libido gradually increased. I noticed that women > weren't just funny looking guys and the way their boobs jiggled was > interesting. > I hope things continue to improve. I have to work on my overall > health, work off the Lupron belly, get my stamina back, upper body > strength, cardio. The weak erections and mild orgasms are just part > of it. kh, I assume you had another PSA recently. As I recall, it's be steadily rising sinse going off HT. What was the result and what are your plans for that in the future? If you don't mind me asking.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 PSA <0.04 Non Illegitimi Carborundum > I assume you had another PSA recently. As I recall, it's be steadily rising > sinse going off HT. What was the result and what are your plans for that in > the future? If you don't mind me asking. I'm working on an Excel analytical tool for PSA's after treatment. I'll have another PSA drawn in mid-December. My PSA is rising and the docs don't like it. <----<<<< The 8 months of Lupron and subsequent 6 months or so of surpressed T, drove my PSA to <0.1. After that, my PSA rose in a straight line to 6.4 this summer. This is alarming. Some considerations: 1) the Lupron caused a false low for a year or so. 2) studies suggest that younger men have a more pronounced "bounce" 3) my PSA is rising into the 18-24 month "bounce" zone. 4) This isn't substantive but I've read that a "bounce" suggests a better long term outcome, maybe, in some cases, now and then, whatever, who-the-F-knows. 5) during the 18-24 period and now, at 25 months, I've got some urethral burning while pee'ing. I'm also passing a couple drops of blood a few times a month. 6) at the CAT-scan assessment after treatment, the Rad-doc practically crowed about how even and accurate his seeds were placed. Then this spring and summer, when we talked about the rising PSA, he kept pointing to his CAT-scans and shaking his head, "this was perfect work." and "I gave you xxxx Grays." As a data/science person, this suggests the cancer and prostate cell die-off is more effective with even distribution. No hot or cold spots. An even distribution kills off the cells in sync. They all go at once, at 18-24 months. If the die-off happens in sync, that *might* be confirmed by the burning and passing a few drops of blood. If it happens in sync, the PSA "might" rise higher than a less-than-perfect job. This is all my speculation. 7) a 6.4 IS HIGH. However it's not the highest that the Rad-doc is seeing. It's also 60% of my pre-treatment high. Kinda like a bounce to 2.0 for someone who had a 3.0 going in. 8) I've collected case studies of bounces that ultimately resolved. I have these in a spreadsheet and am working on "generalizing" the sheet so that anyone can enter their numbers and chart against other PSAs. When I'm done, I'll publish it to a website for others to use. So far, I am "in range", even with the 6.4. The question is my PSA at the 3 year point, that's October 2007. 9) I told the Rad-doc, I clocked a steady, level 9.6, 10, 9.8 for several years, the treatment drove it to <0.1 and now it's rising with a 2 month doubling time, what did you do, anger it??? ======= As for what I plan to do, I donno. I figure I gave it my best shot. 8 months of Lupron (mull over the reports of 6 months treatment being better than 2 years.) 25 sessions on the IMRT, the Pd-103 seeds. I'll be 60 next month. My dad died from a stroke in his early 50's. The rad doc raised the possiblity of trying a salvage radical or cryo. >From what I've read here, forget that. Having a salvage treatment and spending the next 10 years in diapers and impotent isn't very attractive. Like I told a pal the other day (she's caring for two older relatives and was depressed about her own aging, the cost of nursing care.) Maybe the retirement plan for us is to take up shark wrestling. She brightened up and allowed that sky-diving could work for her. My plan is to live. Work hard, get more exercise, home repairs, treat myself and others well, take a vacation. I know people who are 40, 50, 60, who are afraid to live. I'm not talking about shark wrestling. They spend their days watching TV, drinking themselves to sleep, wallowing in their misery, praying for salvation, complaining about having to work and losing their pensions in 2000-2001, waiting for Mr. or Ms Right. If I've got 10 years, I'm going to live more EACH year than they do in 20. That's the plan. -kh kh...You might be interested in the "bounce" information Don Cooley has collected over at http://www.psabounce.prostate-help.org/ ...Best wishes and good health, ron > > I assume you had another PSA recently. As I recall, it's be steadily rising > > sinse going off HT. What was the result and what are your plans for that in [quoted text clipped - 98 lines] > > -kh > If I've got 10 years, I'm going to live more EACH year than they do in > 20. > > That's the plan. That plan works! By that standard, I'm 823 years old now, and may die at about 1,023. I may have died seven figures richer without that plan, but it would have been 950 years earlier. When we were leaving college, Hal said "Well, it's all downhill now. Time to get a Lazy Boy and a big-screen (TWENTY-ONE INCHES!) TV". Until I laughed and he didn't, I though he was joking. I'm guessing Hal died of psychological old age about 770 years ago. There's more to life than money and/or years. I.P. > My plan is to live. Work hard, get more exercise, home repairs, treat > myself and others well, take a vacation. [quoted text clipped - 7 lines] > If I've got 10 years, I'm going to live more EACH year than they do in > 20. Well, you are taking it very well, I must say. I graphed it in Excel and it looks alarming. But, I'm no expert on Brachy and bounces. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 PSA <0.04 Non Illegitimi Carborundum > I graphed it in Excel and it looks alarming. No. It looks like it looks. I'm tracking mid range in modern bounces. This does not mean that alls well. Anyone can fail at 5 and 10 years. Surgery, Rad, any treatment can fail. The catch with rad is that it kills the cancer over a few years and, one theory, is that at the time that the cells die off, they release PSA. An even distribution of seeds, a thorough pattern of radiation applied to a healthy, younger patient *seems* to result in a more pronounced bounce. Similarly, for those who do bounce, the higher bounces *seem* to result in better, long term outcomes. Looping back in the train of thought, the even distribution of seeds, a more complete pattern of radiation, and a younger, healthier patient, where the cancer was detected through the rising PSA and subsequently biopsy and not because of "symptoms", suggests a better, long term outcome. The fact that the rad doc was pleased with his handiwork and then, 2 years later, shaking his head, speaks for another mechanism than the traditional, Higher PSA = BAD. I'm not saying that I've got it figured out or that I may not be in treatment failure. There's a chance of treatment failure. I'm saying that I won't know until seeding +36 months at the earliest. Consider this. I was treated in 2004. CAT-Scan guided IMRT and ultrasound aligned Pd-103 seeds. Modern stuff, probably didn't exist five years earilier, certainly didn't 10 years earlier. I was diagnosed via PSA, biopsy, and MRI, not the golden finger. The scientist in me says that this is a dandy research topic. Early detection, early treatment, more accurate and complete than in the past. Maybe the cancer and healthy, younger prostate cells die off in synchronization at 18 to 24 months and PSA bounces are higher than before? If not, I figure that modern medicine and I gave it my best shot. A guy gave me a $50 bottle of wine for helping him with a project. I'll be drinking it with a woman and we'll make whoopie like . it's . 19 . 99. A year after the treatment, I got a consulting contract, it gave me a jump in income and it's fascinating work. I see that you publish your email address. I'll send you the current Excel spreadsheet. This is very preliminiary but should give you an idea as to where I'm going. -kh > No. It looks like it looks. > [quoted text clipped - 3 lines] > Anyone can fail at 5 and 10 years. Surgery, Rad, any treatment can > fail. Did you check your PAP before treatment? Datolli has been tracking this and says it is a better indicator of success with radiation than PSA or Gleason. I believe for PAP scores under 1.5 it is a 98% success rate regardless of PSA or Gleason. John > Did you check your PAP before treatment? Datolli has been tracking this > and says it is a better indicator of success with radiation than PSA or > Gleason. I believe for PAP scores under 1.5 it is a 98% success rate > regardless of PSA or Gleason. No, didn't know about it. I looked it up in Wikipedia. I don't think that was in any of my panels. -kh ... > My plan is to live. Work hard, get more exercise, home repairs, treat > myself and others well, take a vacation. [quoted text clipped - 3 lines] > > That's the plan. That's an excellent plan. Some of us have been cured by treatment. Some of us have not. But all of us are old enough to be way past the half way point in out lives. For any who haven't done it, it's time to take stock of how we're doing and what we want to do with the time left. I want to do the same things as you. I want to take care of my family and leave a happy remembrance of me behind. I want to spend time with friends - which, by the way, is the way I think of a lot of what I do in this group. I'd like to do a little bit of good if I can. And I think I'll have another look at the Marxist classics - the ones by Groucho, Harpo and Chico, and have a good belly laugh along the way. Alan > By that time, my semen volume had fallen to a quarter teaspoon, maybe a > half. Ejaculation changed from the normal squirt-squirt-squirt to a > lazy dribble, an ooze, a seepage. I had a similar probem with the ooze before any treatment. I wondered if the cancer was effecting the gland to cause it. My uro said no. He said it was a normal part of aging. I'm 58. I had my iodine seeding on 10/23 and just finished my first five days of IMRT and I can tell the quantity of semen is down by about half, to about a half teaspoon. The blood disappeared about a week ago. I'm hoping when the radiation wears off the quantity may come back up for a while, but I think I read that the quantity will go down over the long run after radiation. I have read that porn stars do exercises to improve the force of flow. I would guess these are something like kegels. It could be that your muscle have atrophied during your down time. Let us know if you fine a good solution. John I was on a BPH med (I think flomax) that, after a few years, started to cause a 'dry ejaculation' which means hardly anything and it wasn't very satisfying--like the orgasm was cut short. I was then put on xatral and all went normal again. Wayne > I have read that porn stars do exercises to improve the force of flow. > I would guess these are something like kegels. It could be that your > muscle have atrophied during your down time. > > Let us know if you fine a good solution. I looked around the Internet and didn't find much. I did find a site that discusses the bulb muscle. ======================== Bulb muscle contraction is also erogenous, that is, it triggers a deep sexual sensation, which stimulates /encourages /forces thrusting to ejaculation. (Incidentally, bulb muscles are also known, erroneously, as "pc muscle," short for pubococcygeus which is a muscle in the actual floor of the pelvis totally unrelated to true bulb muscle, which is wrapped around the root or bulb of the penis. The root of the penis is easily felt because it is suspended from the pelvic floor like a gondola below a hot-air balloon. The functional part of our information is based on internet surveys and has to be interpreted accordingly. As I said, stretching of ridged band triggers a series of events which appear to be important for "intact intercourse." It follows that intercourse with the help of an intact prepuce is not necessarily dependent upon direct glans stimulation. However, this does not mean that the glans penis has no important function in intact intercourse. Our initial internet study supports the idea that reflex bulb muscle contraction triggered by ridged band stretching compresses the bulb of the penis. We all know that bulb muscle contraction compresses the urethra. It seems that compression of the bulb of the urethra itself, essentially a swelling of bulbous spongiosum surrounding the male urethra, sends a pulse wave to the glans penis. This bulbar pulse wave causes the glans to expand, triggering secondary reflex contraction of bulb muscles and so on and so on. ======================= http://research.cirp.org/news1.html This suggests that your idea of "exercises" might work Maybe the radiation or surgery damages the bulb muscle. In my case, there is some weak pulsing so perhaps I can tone up with Kegels. I sure would like to get the squirt back, even if I only shoot out a half teaspoon of thin-looking fluid, that'd be a nice improvement. -kh > What about surgery? What are orgasms like, is there any force to the > ejaculation? HELL, yes. It's just urine, but the volume and power is greater than when I was 20. It's often dry, but I'd guess that more than half the time, despite voiding in advance to stem the tide, I'll eject an ounce or three with considerable force. I.P. > My IMRT was in September 2004, followed by Pd-103 seeds in October. > Inova, just outside Washington DC did the treatment. [quoted text clipped - 3 lines] > It took 6 months for the Lupron to wear off and erections to return. > That's 6 months after the 4 months that the shot supposedly lasted. Exactly the same for me. 4 months worth of injections, 6 months worth of testosterone suppression. > By that time, my semen volume had fallen to a quarter teaspoon, maybe a > half. Ejaculation changed from the normal squirt-squirt-squirt to a > lazy dribble, an ooze, a seepage. Also same for me. > The dribble isn't as satisfying as squirting. Sometimes, it seems > almost like before. Mostly, it's just OK. > > Is this what it was like for you? Yes, though I think aging has something to do with this too. Is it as satisfying? Well, it's different, like being 60 years old is different from being 20 or 30. I'm just glad I'm still alive and having sex at all. There's lots of guys our age who don't, for reasons other than prostate radiation. > Does it get "better" over time? My treatment will be 3 years ago in January. So far, it hasn't improved and hasn't gotten worse. > How does the seeding and external radiation change squirting into > dribbling? I asked my rad onc that question once. He gave me a complicated answer that I don't remember. If you get an answer, please post it for the rest of us. > At first I thought that the "muscular" prostate contracted at orgasm. > The radiation damaged the prostate to the point that it could not [quoted text clipped - 11 lines] > What about surgery? What are orgasms like, is there any force to the > ejaculation? I can't answer any of those questions but I'll propose another speculation. Maybe a weakening of erections has something to do with it. Maybe the problem is not so much lack of force propelling the ejaculation as lack of resistance holding it back to create a buildup of pressure. Maybe a strong erection clamps down on the urethra, holding back the ejaculate and building up that pressure. If that's true, then days when you have a strong erection (maybe a long time since the last sex, heavy dose of Viagra, and/or particularly vivid imagination) will produce more satisfying results in the above sense than other days. Sex and sensuality are such psychological things that the satisfaction we get from them seems to me quite complex. If some parts of it don't work like they used to, we can often compensate by cultivating our appreciation of the other parts. Alan > Sex and sensuality are such psychological things that the > satisfaction we get from them seems to me quite complex. > If some parts of it don't work like they used to, we can often > compensate by cultivating our appreciation of the other parts. Well said :-) Mary > Alan another > speculation. Maybe a weakening of erections has something > to do with it. Maybe the problem is not so much lack of force > propelling the ejaculation as lack of resistance holding it back > to create a buildup of pressure. Maybe a strong erection clamps > down on the urethra, holding back the ejaculate and building > up that pressure. Being one who has neither erections nor ejaculate, and had fairly major damaging salvage radiation after RRP, I'd have to speculate that the psychological side of all of this is considerable. Orgasms, dry because of the AMS 800, can be quite intense. Or not. None of the physical variables you mention are present in my case. > > Sex and sensuality are such psychological things that the > satisfaction we get from them seems to me quite complex. > If some parts of it don't work like they used to, we can often > compensate by cultivating our appreciation of the other parts. > > Alan |
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