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Medical Forum / Diseases and Disorders / Prostate Cancer / December 2006Shrinking Penis
I am scheduled to undergo RP on Dec 07 but have been rather alarmed by the recent disclosure by 2 former RP patients I have spoken with that were operated on by the same doctor that will be performing my surgery told me that they discovered their penises had shrunk considerably (by 1-1/2 to 2 inches) after surgery! I have never heard of this before, and certainly no doctor I have consulted with ever mentioned anything about this. I have not even heard anyone complaining about shrinking penises following surgery in any of the newsgroups I've been reading and am wondering if this is normal or is my doctor using a different surgical technique than others. This doctor is very well respected and highly regarded in the community I live in and one of his 'claims to fame' is that he reports that in all of the hundreds of RP's he has performed he has never had a permanent case of incontinence following treatment. He claims that keeping the catheter in for a full 3 weeks helps in this regard. I would really like to hear from other RP patients willing to disclose what affects surgery had on penis size following surgery. After a lengthy and difficult period of denial followed by much time spent searching for the least invasive but best possible cure for PC with the least adverse side effects I finally gave up hope of finding a suitable treatment I could be comfortable with. I originally thought I would choose IMRT as my treatment of choice because it seemed so much less invasive than RP but because I was informed that my PC was fairly agressive I would also need at least 2 and maybe even 3 years of hormone therapy in combination with the IMRT to be fully effective and I would most likely be left permanently impotent following such aggressive and lengthy treatment. I must admit that in selecting the most appropriate treatment my biggest concern has been the scary issue of erectile dysfuntion following treatment. With this in mind I quickly lost interest in IMRT combined with HT. I was also informed that Rad. Seed Implants, HIFU, and various other treatments were not an option for me with a PSA well over the 20+ level. Living in Canada, robotic surgery is too new here, and there is not enough equipment or adequately experienced surgeons available to perform this operation within a reasonable time frame for this to be a viable option for me either at this late date. For these reasons, and after many serious discussions with my wonderful wife (together for 38 years now) I have very reluctanly decided that RP is my best option even though I will most likely be impotent for some time (temporarily I hope) following surgery. I have finally accepted that for the next couple of years I will likely have to rely on Viagra, Cialis, injections, penis pumps, etc to acheive a satisfactory level of sexual intimacy with the love of my life. This realization has been difficult for me to deal with. My big concern is that my wife and I still have a very healthy and active sex life and I am very distressed that we may no longer be able to sustain this extremely pleasurable activity in our relationship. Since I have always had a rather small penis measuring a little under 5 inches to begin with I can not afford to loose 1-1/2 to 2 inches after surgery as this will surely seriously affect the quality of our sex life. The thought of losing this important aspect of our marriage is driving me to despair and I am becomming seriously depressed thinking about it. I have even had serious suicidal thoughts recently and are considering cancelling the operation and just letting nature take its course. By choosing this route I would at least likely have a few more quality years of life and sexual intimacy before succumbing to this terrible disease. For the record: I am 59 years of age and have a Gleason score of 7 (4+3), my PSA is 25, and I'm stage T1c (no detectable lump during DRE). 2 out of 8 biopsy samples were malignant and these indicated being 5% cancerous. I was also told I had a surprisingtly small size prostate gland measuring just 25 cc's and this seems to puzzle the doctors I have spoken with as I'm told that most PC patients with PSA results at this high level usually have considerably enlarged prostate glands. A CAT scan and a bone scan show no signs that the cancer has metasticized so that can not account for the high PSA. I apoIogize for such a long winded message but I just had to get all this out of my system. I welcome your comments. Regards Norman Norman, I'm not a doctor, and somebody please correct me if I've got this wrong. It is my understanding that the penis shrinks because the surgeon cuts the urethra at the top and bottom of the prostate and removes that section of it that is embedded in the prostate along with the prostate gland itself. He then sews the two ends together. The shorter urethra pulls the penis in. If I've got that right (someone who knows more please jump in), some shrinkage in the penis is normal for any prostatectomy done with any technique. Because of your PSA above 20, your case is considered "high risk". It is very possible that RP will not get all the cancer out and you will still face the need for radiation and/or hormone therapy. The only way to find out is to get the surgery and then see what happens. If the PSA rises, you had bad luck and you'll wind up with radiation and possibly HT also. With either surgery or radiation there is a chance that you will not get erections again. Most men do, but some do not. Sex is likely to be somewhat different whatever you do. But sex is as much between the ears as between the legs. Most men who have had either RP or radiation are able to continue to have satisfying sex. Winding up with a short penis, or even a flaccid penis, won't kill your sex life if you and your wife are willing to work around the problems. Oral sex is completely unaffected by surgery and radiation, and various chemical aids are possible to help. If you have radiation, you can do it without staying on hormones for two or three years. You can have HT for a couple of months before treatment and during treatment. There's some evidence that that is the most important time to have HT. You can continue it for whatever period of time you want after radiation and stop it when you decide. Even if you stay on it for two years, it is my understanding that the majority of men, especially younger men such as yourself, do recover sexual function when they get off. At this point, I think the main thing is to make the best decision in terms of fighting your cancer. I don't know if that's surgery or radiation. There are arguments for both. But I think I would focus on that more than on the length of your penis or on lack of testosterone for some period of time. Best of luck. Alan Norman, I don't know how many inches I lost but mine is about half what it was before surgery. However, I attribute that to the fact that my surgeon and URO didn't offer me any followup advise on mantaining blood flow to the penis following surgery. I believe one should use viagra regularly for some time until the nerves heal and can perform on their own. This usually takes many months but it's worth it in the long run. If you don't use viagra regularly you can get scar buildup that is irreversable. It can take a few years for the nerves to complete all the connections so don't get disappointed. It took me almost three years before I could mantain an erection sufficient for penetration. Also while waiting for it to come back on line, my wife benefied the most as I was pleasing her more than ever before. It seemed our roles had been reversed. Ron S. > Norman, > [quoted text clipped - 6 lines] > along with the prostate gland itself. He then sews the two > ends together. The shorter urethra pulls the penis in. According to Scardino, that is almost certainly wrong. He explains in his book that the penis can't be pulled back into the body because of how it is attached. See pp368-370. He does say that damage to the nerves and lack of erections can produce shortening after a long time. But the shortening that some men notice right after surgery, if I understand him correctly, is usually not a true shortening. > If I've got that right (someone who knows more please jump > in), some shrinkage in the penis is normal for any prostatectomy > done with any technique. Not according to Scardino, at least. > Because of your PSA above 20, your case is considered > "high risk". It is very possible that RP will not get all the cancer [quoted text clipped - 33 lines] > > Alan >I am scheduled to undergo RP on Dec 07 but have been rather alarmed by the >recent disclosure by 2 former RP patients I have spoken with that were [quoted text clipped - 68 lines] >Regards >Norman Isn't it funny how the doctors rarely mention the penile shrinkage. From what I've read the best you can hope for is to only lose 11% of size. I've heard from many who lost much more, as much as half the size. I'm no doctor so this is just my layman's opinion but I don't think the shrinkage has much to do with the shortening of the urethra. I think it's a combination of the shortening, the nerves being messed up and the blood supply also being messed up. Many who use injections say they get as big or bigger when injecting which suggests to me that the shortening of the urethra is the least of the cause of the shrinkage. More likely the shrinkage is from the surgery screwing up the blood supply and/or drainage system as well as the nerves not sending the right signals anymore. Again, I'm no doctor but from what your have posted as to your current diagnosis and staging I don't see why you would not be a candidate for seeds and minimal HT. The only thing I see that must be telling the doctors you aren't a good candidate is the high PSA but your biopsy and DRE suggest you are a good candidate for just about every possible treatment option, at least to me. And with such a small prostate it would seem like seeding or radiation should be relatively easy. I'd get a second or third opinion. For the record: I am 59 years of age and have a Gleason score of 7 (4+3), my PSA is 25, and I'm stage T1c (no detectable lump during DRE). 2 out of 8 biopsy samples were malignant and these indicated being 5% cancerous. I was also told I had a surprisingtly small size prostate gland measuring just 25 cc's and this seems to puzzle the doctors I have spoken with as I'm told that most PC patients with PSA results at this high level usually have considerably enlarged prostate glands. ====== hi norman - i can sure relate to what you are going through. decisions, decisions, decisions. here's some input for you....... NORMALLY, they say that you will lose about 15% of length from the RP. now, this can be offset by the bladder, because after surgery, then bladder will drop in where the prostate use to be. this topic of the shortening has came up before and the answers are as varied as one can imagine. everything for no to little lost to some who lost a great deal. bottom line - it is a gamble - but life is a gamble. as to your high psa - prostate infections can be the source of that. did the put you on antibiotics before they pull the psa to get a better reading? 2 cores @ 5% sounds like you've got a very good chance of success. as to your post op love making......... i would recommend the book, "making love again" by the laakens. it is a husband and wife who fought with this issue as they went through the RP process. hope this helps. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc Good for your doctor to mention this topic that sometimes comes as a surprise after the fact. Shrinkage is the result of a somewhat shortened urethra caused by resectioning it after removing the prostate, rather than the loss of actual penis tissue. My doctor had me start using a vacuum pump about six weeks after surgery on a daily basis and this helped restore mine to what seems to be close to the original size. I also took a regular dosage of Viagra (25 mg. three nights per week) to increase blood flow six weeks after surgery. I had robotic surgery just over one year ago so the emotions that you describe are fresh in my mind. It is much better to be on this side of the cancer when it is easier to put things in perspective. If you think about quality of life issues, in the whole scheme of things, urinary continence probably ranks higher than sexual function. Sexual function is high on the list, but can be restored over time to something close to what you had before. During the recovery period, you can use a lot of creativity to sustain your relationship and it is not all bad to be so totally focused on the health of the penis. You will be able to have orgasms before you have erections. If the depression is too overwhelming, you may want to seek treatment for that, but it is normal to be depressed under these circumstances. Try to focus on how fortunate you are to discover this while it is treatable with a high likelihood for success. Although the outcome may change your sexual relationship with your wife, it will not end it. Death by prostate cancer is a pretty horrible thing and ultimately would be a much harder road than treating it now and focusing on recovery. You will be surprised how quickly you can get to the other side of this. Good luck! > My big concern is that my wife and I still have a very healthy and active > sex life and I am very distressed that we may no longer be able to sustain > this extremely pleasurable activity in our relationship. Since I have > always had a rather small penis measuring a little under 5 inches to begin > with I can not afford to loose 1-1/2 to 2 inches after surgery as this will > surely seriously affect the quality of our sex life. As another "5-only-guy", I sympathize with your dilemma. I went rad with 8 months of Lupron, I was essentially impotent for a year, maybe a year and a half, but who's counting. I have since regained erections and orgasms are improving. It takes more "stimulation" than before to get going. I don't know how the surgery will affect your length. I doubt that anyone does. There are reports of guys losing an inch or two and other reports of the length coming back. The length-loss is a minor issue compared to the risk of permanent ED and incontinence. (Hey Firefox 2.0 spell checks what I type! Amazing.) ED and incontinence is a minor issue compared to metastatic prostate cancer. My right middle finger is 3 and 1/4 inches long. My tongue extends about 3/4 inch. Both provide quality intimacy and a good experience, although I suspect that the wet, wiggly 3/4 inch does better than the 3 and 1/4. I've never asked and I'm just going by the sounds and leg kicking, so I could be wrong. -kh > that they discovered their penises had shrunk considerably (by 1-1/2 to 2 > inches) after surgery! I have never heard of this before, Yep, a few years back there were many posts here in regards to the "frightened turtle" effect, the shrunken penis. Not known to us at that time, with lots of "exercise" manually and via a pump, and viagra, some of this shrinkage can apparently be minimized. searching for the least invasive but best possible cure for PC with the > least adverse side effects I finally gave up hope of finding a suitable > treatment I could be comfortable with. Settings ones priorities is difficult. What is your number one priority, and then what are you willing to risk to hopefully achieve it. There is not too much black and white. We know of men who have had virtually no lasting side effects from one procedure or another, and of other men who experienced quite the opposite from the same procedure. > I must admit that in selecting the most appropriate treatment my biggest > concern has been the scary issue of erectile dysfuntion following treatment. My biggest concern was being around, alive, for as long as I could. My very understanding and supportive wife was of the same opinion. If you have not already learned this, what the man goes through, the spouse goes through as well. Emotionally, it might be even harder on the spouse, and this has nothing to do with sex. > My big concern is that my wife and I still have a very healthy and active > sex life and I am very distressed that we may no longer be able to sustain > this extremely pleasurable activity in our relationship. I still remember the last "normal" sex we had, the night before surgery, 5 years and 11 months ago, and it was great. Memorable. Since then no, it has not been the same, but that was not the end of sex. There have been frustrations, a learning curve, and ups and downs, and sex will never be the same again for us. On the other hand I feel that there is a greater intimacy between us and what we do have and share is rewarding and fulfilling. We sure do not take much for granted anymore. > just letting nature take its course. By choosing this route I would at least > likely have a few more quality years of life and sexual intimacy before > succumbing to this terrible disease. And how much quality would you have watching the beast gain on you without putting up any fight at all? Maybe it would work for you, it does for some I guess, but I had to fight an aggressive cancer as aggressively as I could to have any peace of mind. In my case I know it is going to get me, but I cannot just sit back and watch it come. Side effects I can live with. In the meantime life is good, and I refuse to let tomorrow ruin today. > For the record: I am 59 years of age and have a Gleason score of 7 (4+3), my > PSA is 25, and I'm stage T1c (no detectable lump during DRE). 2 out of 8 > biopsy samples were malignant and these indicated being 5% cancerous. I started out PSA 55 at age 55, with all samples showing from 25%-95% involvement, and the prostate was large and hard as a stone. Gleason 3+4 for three quarters, 3+3 for the other. An RRP was performed in spite of this to get rid of a large tumor load. EBRT of the pelvic cavity was aggressive, and I have been on Lupron three of the past six years. I am still here, I still have a great marriage to a beautiful wife, and we enjoy our life together. New challenges are on the horizon with this cancer thing, but we will take them as they come. > I apoIogize for such a long winded message but I just had to get all this > out of my system. I welcome your comments. On this site there is no need to apologize for a long post. It is a support group. We have active interests and concerns for the people who belong to this club. It has been said that we are all in the same boat, just in different positions in the boat. I have also become long winded, but I hope that there might be something here of value to you. You need some encouragement. Things are going to change, they already have, but it is not the end of the world. As you research and worry about side effects, remember the side effects of doing nothing to help keep it all in perspective. There is no reason to throw in the towel, and no reason to feel that your intimacy and love life is over. It's just going to change. Best wishes to you and your wife. Bob C > Norman wrote: > that they discovered their penises had shrunk considerably (by 1-1/2 to 2 inches) after surgery! I have never heard of this before, Yep, a few years back there were many posts here in regards to the "frightened turtle" effect, the shrunken penis. Not known to us at that time, with lots of "exercise" manually and via a pump, and viagra, some of this shrinkage can apparently be minimized. searching for the least invasive but best possible cure for PC with the > least adverse side effects I finally gave up hope of finding a suitable treatment I could be comfortable with. Settings ones priorities is difficult. What is your number one priority, and then what are you willing to risk to hopefully achieve it. There is not too much black and white. We know of men who have had virtually no lasting side effects from one procedure or another, and of other men who experienced quite the opposite from the same procedure. > I must admit that in selecting the most appropriate treatment my biggest concern has been the scary issue of erectile dysfuntion following treatment. My biggest concern was being around, alive, for as long as I could. My very understanding and supportive wife was of the same opinion. If you have not already learned this, what the man goes through, the spouse goes through as well. Emotionally, it might be even harder on the spouse, and this has nothing to do with sex. > My big concern is that my wife and I still have a very healthy and active sex life and I am very distressed that we may no longer be able to sustain this extremely pleasurable activity in our relationship. I still remember the last "normal" sex we had, the night before surgery, 5 years and 11 months ago, and it was great. Memorable. Since then no, it has not been the same, but that was not the end of sex. There have been frustrations, a learning curve, and ups and downs, and sex will never be the same again for us. On the other hand I feel that there is a greater intimacy between us and what we do have and share is rewarding and fulfilling. We sure do not take much for granted anymore. > just letting nature take its course. By choosing this route I would at least likely have a few more quality years of life and sexual intimacy before succumbing to this terrible disease. And how much quality would you have watching the beast gain on you without putting up any fight at all? Maybe it would work for you, it does for some I guess, but I had to fight an aggressive cancer as aggressively as I could to have any peace of mind. In my case I know it is going to get me, but I cannot just sit back and watch it come. Side effects I can live with. In the meantime life is good, and I refuse to let tomorrow ruin today. > For the record: I am 59 years of age and have a Gleason score of 7 (4+3), my PSA is 25, and I'm stage T1c (no detectable lump during DRE). 2 out of 8 biopsy samples were malignant and these indicated being 5% cancerous. I started out PSA 55 at age 55, with all samples showing from 25%-95% involvement, and the prostate was large and hard as a stone. Gleason 3+4 for three quarters, 3+3 for the other. An RRP was performed in spite of this to get rid of a large tumor load. EBRT of the pelvic cavity was aggressive, and I have been on Lupron three of the past six years. I am still here, I still have a great marriage to a beautiful wife, and we enjoy our life together. New challenges are on the horizon with this cancer thing, but we will take them as they come. > I apoIogize for such a long winded message but I just had to get all this out of my system. I welcome your comments. On this site there is no need to apologize for a long post. It is a support group. We have active interests and concerns for the people who belong to this club. It has been said that we are all in the same boat, just in different positions in the boat. I have also become long winded, but I hope that there might be something here of value to you. You need some encouragement. Things are going to change, they already have, but it is not the end of the world. As you research and worry about side effects, remember the side effects of doing nothing to help keep it all in perspective. There is no reason to throw in the towel, and no reason to feel that your intimacy and love life is over. It's just going to change. Best wishes to you and your wife. Bob C > searching for the least invasive but best possible cure for PC with the > > least adverse side effects I finally gave up hope of finding a > suitable treatment I could be comfortable with. Leave it to the experts. Research is ongoing and one day might have the answer. In the meantime - live! > > I must admit that in selecting the most appropriate treatment my > biggest concern has been the scary issue of erectile dysfuntion following > treatment. > My biggest concern was being around, alive, for as long as I could. Spouse's was too. > My very understanding and supportive wife was of the same opinion. If you > have not already learned this, what the man goes through, the spouse goes > through as well. Emotionally, it might be even harder on the spouse, and > this has nothing to do with sex. Yes. I suspect that she might prefer to be a 'deprived' wife rather than a widow. > > My big concern is that my wife and I still have a very healthy and > active sex life and I am very distressed that we may no longer be able to > sustain this extremely pleasurable activity in our relationship. It's better than no relationship. > I still remember the last "normal" sex we had, the night before surgery, 5 > years and 11 months ago, and it was great. Memorable. Same here. Although only a few weeks ago :-) > Since then no, it has not been the same, but that was not the end of sex. It certainly hasn't been for us either. > There have been frustrations, a learning curve, and ups and downs, and sex > will never be the same again for us. On the other hand I feel that there > is a greater intimacy between us and what we do have and share is > rewarding and fulfilling. We sure do not take much for granted anymore. We got to that stage years ago, when I had a brain tumour removed. > > just letting nature take its course. By choosing this route I would > at least likely have a few more quality years of life and sexual intimacy > before succumbing to this terrible disease. When would you decide to succumb? > And how much quality would you have watching the beast gain on you without > putting up any fight at all? Maybe it would work for you, it does for some [quoted text clipped - 3 lines] > with. In the meantime life is good, and I refuse to let tomorrow ruin > today. Hear hear! > > For the record: I am 59 years of age and have a Gleason score of 7 > (4+3), my PSA is 25, and I'm stage T1c (no detectable lump during DRE). 2 > out of 8 biopsy samples were malignant and these indicated being 5% > cancerous. Have it out. > I have also become long winded, but I hope that there might be something > here of value to you. You need some encouragement. Things are going to [quoted text clipped - 3 lines] > the towel, and no reason to feel that your intimacy and love life is over. > It's just going to change. Well said. As for things changing, it would be a boring life if it were the same all the time. Good changes are welcomed, taken for granted even, bad ones make us think and take advantage of what we have. > Best wishes to you and your wife. Seconded. Mary > Bob C >I am scheduled to undergo RP on Dec 07 but have been rather alarmed by the >recent disclosure by 2 former RP patients I have spoken with that were >operated on by the same doctor that will be performing my surgery told me >that they discovered their penises had shrunk considerably (by 1-1/2 to 2 >inches) after surgery! I have never heard of this before, and certainly no >doctor I have consulted with ever mentioned anything about this. I don't know why doctors don't tell their patients, but it is very common to lose inches. I did. > For the record: I am 59 years of age and have a Gleason score of 7 (4+3), > my PSA is 25, and I'm stage T1c (no detectable lump during DRE). 2 out of [quoted text clipped - 5 lines] > show no signs that the cancer has metasticized so that can not account for > the high PSA. Good luck Norman. We're all pushing for you.  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 If I lost size, it is due mostly to diminished, unstuffable "erections". I'd guess that at its peak size, which lasts about 3-4 seconds, it's within 10-20% of the same handful it always was. But guess what: it still does its two primary jobs -- voiding my bladder and producing orgasms -- just fine. Well, not always: when first pulled out of its confining pad in snug briefs, it is a short, fat, toad with lousy aim. A few seconds of freedom, however, and it expands to permit greater accuracy. Maybe some day, if I can ever ditch these pads and Jockey straight jackets . . . I.P. Hi Norman...I've inserted some comments within your post...Best wishes and good health, ron > I am scheduled to undergo RP on Dec 07 but have been rather alarmed by the > recent disclosure by 2 former RP patients I have spoken with that were [quoted text clipped - 5 lines] > any of the newsgroups I've been reading and am wondering if this is normal > or is my doctor using a different surgical technique than others. Here's an abstract that studied the question you pose, it will give you some idea of the possible range of variation. Note that only about 20% of the men experienced 15% or greater loss of size. The Journal of Urology 2003; 169(4):1462-1464 A Prospective Study Measuring Penile Length in Men Treated With Radical Prostatectomy for Prostate Cancer MARC SAVOIE; SANDY S. KIM; MARK S. SOLOWAY* Purpose: Some patients report that the penis is smaller after radical retropubic prostatectomy for prostate cancer. We performed a prospective study which measured penile length before and after radical retropubic prostatectomy. Materials and Methods: A total of 124 men consented to penile measurements before radical prostatectomy performed by the same surgeon. Repeat measurements were performed at 3-month intervals following surgery. Penile measurements (cm.) consisted of flaccid length, stretched length, depth of prepubic fat pad and circumference. Statistical analysis of penile measurements was performed using the paired samples and independent Student's t test, Pearson's correlation and analysis of variance. Results: Mean patient age was 59.1 (range 42 to 76). No patient had a penile abnormality, for example Peyronie's disease, or history of penile or urethral surgery. The size of the penis was significantly smaller after prostatectomy, and there was a significant difference for flaccid (p <0.001), stretched (p <0.001), prepubic fat pad (p = 0.02) and circumference measurements (p <0.01). Twelve patients (19%) had a 15% or greater decrease in stretched penile length. When dichotomizing groups at the cut point of 15% decrease, the independent t test of prostate size was not significant (t[df 36.7] = -1.83, p = 0.076). Nerve sparing was not significant in relation to change in penile stretched length, (F[df 2, 62] = 0.501, p = 0.609). Conclusions: Our findings support observations of decreased penile length after radical prostatectomy. Men should be counseled before radical prostatectomy that penile shortening may occur. > For the record: I am 59 years of age and have a Gleason score of 7 (4+3), my > PSA is 25, and I'm stage T1c (no detectable lump during DRE). 2 out of 8 [quoted text clipped - 5 lines] > signs that the cancer has metasticized so that can not account for the high > PSA. As your doc says, the high GS and PSA don't "fit" with the low T1c staging or the small amount of cancer found upon biopsy in a small gland. Was your DRE done by a uro? Have your biopsy slides been read by an expert PCa pathologist? In order to choose a therapy, it's best to get as much information as possible to define your clinical situation. If your disease is local, you might choose a different approach then if your disease is systemic. A PAP (prostatic acid phosphatase) test is a simple and cheap blood test that might provide further comment on the local / systemic question. A number of papers suggest that PAP>3 suggests systemic disease...Best wishes and good health, ron Dear Norman, > operated on by the same doctor that will be performing my surgery told me > that they discovered their penises had shrunk considerably (by 1-1/2 to 2 > inches) after surgery! I have never heard of this before, and certainly no I am > becomming seriously depressed thinking about it. I have even had serious > suicidal thoughts recently and are considering cancelling the operation and > just letting nature take its course. By choosing this route I would at least [quoted text clipped - 3 lines] > Regards > Norman Dear Norman, First of all, I'm sorry you are feeling so depressed. Nobody likes being told they have pca because it almost always comes out of the blue. It's like being kicked in the stomach. If you have had suicidal thoughts you need to talk to somebody about that right away and get some treatment. Forex, a clergyman might be good to talk to (have done that myself and I didn't even know the person before). Considering that you are seriously depressed you should see a psychiatrist. A lot of men in your situation, including my husband, have done that and been helped a lot by it. And try not to worry about the effect of all this on your wife. Like me, I assume she's more concerned about you than about herself. You say you have a good relationship with her and I'm sure her main concern is having you alive and healthy. Recently I spoke with a professor from CA (Nova Scotia) that has pca and he gave me the name of his associate whose specialty is counseling pca patients. I hope this person is near you but if not he would be good to talk to or maybe he could recommend somebody: Ross E. Gray Psychosocial and Behavioral Research Unit Toronto Regional Sunnybrooke Cancer Center Toronto, Ontario Unfortunately, I don't have his number handy so you to look it up online or call the hospital where he works. All I have in from of me is an article he co-wrote on "restoration of satisfying sex for a cancer patient with complete impotence." So he knows something about this topic. I can tell you that my husband had robotic prostatectomy a year ago and his penis is the same as it was before, maybe bigger. It's too bad I didn't take "before" and "after" photos so I could show you. You know, using injections, you can have a penis twice the size it was when you were 16. But hopefully you won't need any help. Even if the worst happens and you don't regain any erectile function you could have a good sex life using available therapies. I can attest to this personally. But hopefully you will get your natural erections back or manage with the help of Vitamin V (Viagra). What the men said is true: if you are onto this issue right away and work on "penile rehab" I think you can probably prevent some shrinkage. I want to read you something on this subject from a prominent pca doctor, Peter Scardino. I am quoting from "The Prostate Book", 365-366. I can tell you he is an authority you can rely on. Note that he mentions just ONE REAL type of penile shortening and that can be worked on. "PENIS SIZE AND SHAPE" "Removing the prostate does not pull the penis into your body and can make it shorter. The penis and urethra are fixed to the bones of the pelvis and cannot be dislodged. When the prostate is removed, the bladder is brought down and sewn to the urethra. The urethra is NOT pulled up with an effect like a retracted hose! Still, some men observe that their penis seems smaller or shorter after surgery. I'm aware of three reasons for this -- two misleading and one real. If there is intense scarring between the lower part of the abdominal incision and the penis, as the scar retracts, the penis may be pulleds toward the public bone and appear shorter. Alternatively, after the operation, some men gain weight for a variety of reasons, including sexual frustration. Fatty deposits over the pubic area can cover part of the penis, making it appear smaller. In both cases, there is no actual shortening, thought the penis looks shorter to the patient. WHEN ERECTION OCCURS, THE PENIS FILLS OUT AND FUNCTIONS NORMALLY. Genuine penile shortening can result from the long-term effect of damaged nerves and the absence of erections,NOT DIRECTLY FROM REMOVAL OF THE GLAND. While the mechanisms remain a mystery, in some men the delicate vascular channels of the penis atrophy and become hard and inelastic (fibrotic). Fibrous tissue does not expand when the penis fills with blood, so the organ remains shorter and erections may be as firm. On the next page he mentions PENILE REHABILITATION. "Many doctors urge prostate-cancer patients to use any effective means to have regular, frequent erection erection after surgery." So penile rehab isn't that bad. I don't think you would mind the exercise. I think you should talk to people like my husband who don't hang out on message boards because they have had pca, done well afterward and moved on with their lives. If you want to talk to him I can give you the number. I really wish you all the best. Leah I have never et a doctor who believes that the *internal* shortening of the urethra cause the *external* shortening of the penis. The urethra is firmly anchored where it passes through the perineum; it can't be pulled up into the abdominal cavity. >From what I have been told, I think disruption to blood supply (anyone who has ridden a racing bicycle will know the effect) and lack of nocturnal erections are the primary causes. However, for those who have RRP there is another factor: it is very common to get mild but permanent oedema in the lower abdomen as a result of the incision and general disruption to the abdominal wall. In my case, this has the effect of making my penis appear to be about 1/2" smaller because my belly puffs out around it. I can get back the "missing" length by pressing with the flat of my hand on my abdomen immediately above my penis. From this it should be obvious that during intercourse the "missing" length is still quite usable. SignaturePeter Headland >I have never et a doctor who believes that the *internal* shortening of > the urethra cause the *external* shortening of the penis. The urethra [quoted text clipped - 14 lines] > obvious that during intercourse the "missing" length is still quite > usable. There have been doctors and articles quoted in this forum that indicate that the shortening of the penis is a common side-effect of the surgery. That said, I have not noticed it. Possibly it is due to the fact that I had erections within 6 months and cultivate these as much as I can. Or it may be due to the fact that I simply never focused very much on the length of my member and therefore don't *notice* any difference. > There have been doctors and articles quoted in this forum that indicate that > the shortening of the penis is a common side-effect of the surgery. That > said, I have not noticed it. Maybe it's because when you lost 2 inches from your normal 11, the 9 remaining was still more than enough. -kh my 5 to 3, on the other hand, that'd be a loss! >> There have been doctors and articles quoted in this forum that indicate >> that [quoted text clipped - 5 lines] > > -kh my 5 to 3, on the other hand, that'd be a loss! Well, come to think of it, it is easier to zip up my pants. ;-) Remember those high school days when the erections occurred at very inopportune moments, and we had to walk down the hall with our books held in front of us? Little did we know that we'd be looking back on those as "the good old days." |
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