I'm sure I've written this before, but I can't find it in searching...
When comparing treatments for sexual function, these are things you might think of...
For radical prostatecomy (RP), a significant factor is if you have nerve sparing or not. This will depend how close the cancer is to the rear and lower surfaces of the prostate where the neurovascular bundles run along the surface, and carry nerves that generate erections. If these can't be saved, you won't be able to have natural erections. The surgeon will be able to give an idea before the operation, but they won't know for sure until they are doing the operation. After the operation, erections won't work, but if the nerves are saved, erections will come back typically between 6 months and 2 years later in around 60% of cases. Erections often aren't as powerful, particularly in the case of partial nerve sparing, and this might be a significant issue in the case of anal sex. PDE5 inhibitor drugs can help (cialis, viagra, etc) by amplifying the effect of the working nerves, but won't work in the case of no working nerves. Your GP can supply these generally at a maximum of 1 a week under current guidelines. In the case of loss of nerves or failure to recover after nerve sparing, there are some other options. Vasodilator drugs such as Caverinject and Muse pellets work for most people but can be painful in some cases. Vacuum pump with cock rings is another possibility, but less satisfactory and probably not for anal sex. Implants can work well, and can either be semi-rigid permanently erect or inflatable. They are particularly suitable for people who had ED before treatment, and can get them back to a better place than they started. They have a small infection risk, and if that happens, it's a disaster with no options anymore. RP will also shorten your penis. When your prostate is removed, around 5-6cm of urethra through the middle come out with it, and to join the urethra back to the bladder, the bladder is pulled down and the urethrea is pulled inwards towards it, so you might lose around 3cm erect length, depending how large your prostate is and how much the bladder will pull down into the space. There's a risk for urinary continence too. You will probably be incontinent afterwards but this usually comes back - your brain has to relearn to use the external urinary sphincter for primary continence, rather than the internal urinary sphincter which is removed with the prostate. RP is quite a major operation even when done keyhole, and will leave you recovering for several months afterwards.
There are different types of radiotherapy (RT). External Beam RT (EBRT) is perhaps the best known, but you might be a candidate for seed brachytherapy (internal radiotherapy, where radioactive seeds are inserted into the prostate which work slowly over a year until their radioactivity has decayed away). RT is much less of an assault on your body than RP. Many people continue working throughout EBRT, and Brachy might just require a week or two to recover (longer for a manual job). RT is almost always given with hormone therapy (HT) because the two together have much better outcomes - you are hitting the cancer with two things at once. HT is usually given for 18-36 months with EBRT, but sometimes for as little as 3 months with seed brachy - it will depend on your case and the protocols in use at your treatment centre. The RT and HT both have their own side effects. RT will upset the bowel and bladder during treatment and for up to 6 weeks afterwards, but usually gets better. Some people do have permanent changes such as urgency and slight incontinence as these side effects don't always completely go away afterwards, but they usually do. RT doesn't normally cause any erection problems at the time, but has potential long term side effects, which can include a very slow loss of erections years later (in around 30-40% of cases), and there's a very small risk of the RT causing bladder or bowel cancer very many years later, which is slight concern for younger patients. HT has a long list of potential side effects while you are on it (although no one gets all of them), but they mostly go when you come off HT. Reduction (and in some cases complete loss) of libido is one of them, and that may make it difficult to get erections, although the mechanics still works fine, and it can impact relationships - both partners need to be prepared and understand what's happening. It is important that you do continue to have regular erections though, as a period without them will damage the erectile tissue in the penis, resulting in shorter and less solid erections when you come off hormone therapy, but with regular erections, this is completely avoidable.
Anyway, these are some things to ponder, but I would not disagree with your leaning towards RT.
Edited by member 23 Sep 2019 at 19:13
| Reason: Not specified