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Penile health?

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User
Posted 04 Sep 2020 at 07:51

Hi, 

Has anyone with advanced prostate cancer been advised to use viagra for 'penile health' reasons?

My husband is on lifelong HT so it's not needed for any other reason. It was mentioned several appointments ago that using viagra occasionally contributes to penile health. At the time our head was full of other stuff like chemo and RT so I didn't ask more about it. Its the sort of thing we might mention to GP as a 'by the way....' question . But with systems how they are we d need to book a specific telephone appointment for it.

So I just wondered if anyone else with advanced prostate cancer uses it for this reason. Is there any point?

 

Mrs MAS

User
Posted 04 Sep 2020 at 14:04
Hi Mrs MAS, I agree with you. As sad as it is, if your penetrative sex life has ended and there is no realistic likelihood of it returning in the future, I can't see the point of taking yet another medication with its own set of side effects. I guess there may be a time in the future where his PSA stays low for a sustained period and he & the onco agree that he will try a hormone holiday, in which case his libido may return but in that case, he could perhaps have ED meds if needed.

I think that sometimes men who don't have advanced PCa can't imagine that the reality for most couples is that sex and intimacy dies soon after an incurable diagnosis .... either because of meds, grief, depression, anxiety, bone pain, bone / spinal weakness, lymphodema, fatigue, fear, anger, whatever. The total loss of libido means that for some men, it isn't simply that they don't feel randy - the thought of touching someone else's skin makes them shudder, the prospect of inserting a tongue in someone else's mouth or a penis into someone else's body part is actually repulsive. It was well described here by a past member as 'looking at my gorgeous wife's behind and realising it may as well be a lump of concrete'. If that is where Mr MAS is, I can't see any benefit in him taking Cialis.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 05 Sep 2020 at 17:34
That's very true- our urologist had a patient who had to pee sitting down because he lost so much length post-op. But I think that it is more likely to be that serious with surgery than with HT and I am struggling to imagine what 3 viagra a week could do to help.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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User
Posted 04 Sep 2020 at 11:09

I'm on hormone therapy, not as far as I know lifelong, but I was put on 5mg daily low dose Tadalafil by my GP the moment I went on to hormone therapy, and that was very much to try and protect the penis.

Some people are still able to get erections sufficient for sex or masturbation while on hormone therapy, and PDE5 inhibitors may help in this endeavour.

 

User
Posted 04 Sep 2020 at 12:28

Thanks Andy, I see the logic in that, for someone who may return to a sex life at some point, but I'm not sure about it if you have no future sex life at all.

 

Mrs MAS

User
Posted 04 Sep 2020 at 13:15

You may be able to have erections while on HT. I can, and it's possible the Tadalafil contributes to that. I didn't start taking it for first 6 months as I didn't I needed it. It was only a conversation with a urologist who said I should take it anyway, even if I didn't think I needed it, that got me on to taking it daily, so I can't be sure of the effect on me. It certainly is more difficult to get and keep erections, if you are able to on HT, and the lack of libido gives you little impetus to do so, and you must fight that - use it or lose it. The various urologists I work with at various support groups tend to say the 5mg daily Tadalafil is more effective for penile health than occasional Viagra (Sildenafil), because the Tadalafil achieves continuous dosing.

New treatments will come along, and it might be that you can come off hormone therapy eventually.

You might also be able to have intermittent hormone therapy eventually, and most people on intermittent hormone therapy manage to spend longer off it than on it.

I would not like to decide at any point that a return to some sort of sex life was never possible, but sex doesn't hold the same importance to everyone. Some people lost their sex lives for other reasons before prostate cancer, and are not concerned about having it back. It's something that varies considerably between men.

User
Posted 04 Sep 2020 at 14:04
Hi Mrs MAS, I agree with you. As sad as it is, if your penetrative sex life has ended and there is no realistic likelihood of it returning in the future, I can't see the point of taking yet another medication with its own set of side effects. I guess there may be a time in the future where his PSA stays low for a sustained period and he & the onco agree that he will try a hormone holiday, in which case his libido may return but in that case, he could perhaps have ED meds if needed.

I think that sometimes men who don't have advanced PCa can't imagine that the reality for most couples is that sex and intimacy dies soon after an incurable diagnosis .... either because of meds, grief, depression, anxiety, bone pain, bone / spinal weakness, lymphodema, fatigue, fear, anger, whatever. The total loss of libido means that for some men, it isn't simply that they don't feel randy - the thought of touching someone else's skin makes them shudder, the prospect of inserting a tongue in someone else's mouth or a penis into someone else's body part is actually repulsive. It was well described here by a past member as 'looking at my gorgeous wife's behind and realising it may as well be a lump of concrete'. If that is where Mr MAS is, I can't see any benefit in him taking Cialis.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 04 Sep 2020 at 14:45

Thanks both and I will re read your reply Lyn. 

Andy, I understand your position about not wanting to decide there would be no return and I hope you get there in future - but it was decided for us. 

When we were told Mr MAS' diagnosis, it was a total shock. The next sentence informed us of life expectancy and  he was immediately on the merry go round of HT/chemo/RT, the effect of HT on our sex life was not our first thought. 

When it was mentioned after chemo and before RT I was confused but had many other more pressing questions.

Obviously I miss it, being only 43 and whilst he is older he does too but we both feel it's a small price to pay to keep PSA low. Don't get me wrong if you'd have asked us a year and a month ago we both would have said it's a vital part of our relationship. An incurable diagnosis changes a lot of things! 

I just wondered if there was another good reason to be taking it that's not to do with sex, but I think you have answered my question, Lyn.

Thanks 

Edited by member 04 Sep 2020 at 15:59  | Reason: Wording

Mrs MAS

User
Posted 05 Sep 2020 at 10:55

I did read a post elsewhere about a guy who was struggling to urinate and keep clean because of a very shrunken penis. So keeping the penis healthy for non sexual purposes sounds quite important.

Thanks Chris

User
Posted 05 Sep 2020 at 17:34
That's very true- our urologist had a patient who had to pee sitting down because he lost so much length post-op. But I think that it is more likely to be that serious with surgery than with HT and I am struggling to imagine what 3 viagra a week could do to help.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 06 Sep 2020 at 10:08

Originally Posted by: Online Community Member
Hi Mrs MAS, I agree with you. As sad as it is, if your penetrative sex life has ended and there is no realistic likelihood of it returning in the future, I can't see the point of taking yet another medication with its own set of side effects. I guess there may be a time in the future where his PSA stays low for a sustained period and he & the onco agree that he will try a hormone holiday, in which case his libido may return but in that case, he could perhaps have ED meds if needed.

I think that sometimes men who don't have advanced PCa can't imagine that the reality for most couples is that sex and intimacy dies soon after an incurable diagnosis .... either because of meds, grief, depression, anxiety, bone pain, bone / spinal weakness, lymphodema, fatigue, fear, anger, whatever. The total loss of libido means that for some men, it isn't simply that they don't feel randy - the thought of touching someone else's skin makes them shudder, the prospect of inserting a tongue in someone else's mouth or a penis into someone else's body part is actually repulsive. It was well described here by a past member as 'looking at my gorgeous wife's behind and realising it may as well be a lump of concrete'. If that is where Mr MAS is, I can't see any benefit in him taking Cialis.

You seem to be of the view no one on hormone therapy is capable or has the desire for sex, and that's just not true. It is the case for some men for sure, but some other men are keen to continue and can achieve erections and sex while on hormone therapy. There are things that can help with this where it is desired. I'm not talking about sex at end-stage you describe, but many couples strive to lead as normal lives as possible for 10 or more years before then. Don't simply write it off for everyone.

User
Posted 06 Sep 2020 at 10:15

Originally Posted by: Online Community Member
That's very true- our urologist had a patient who had to pee sitting down because he lost so much length post-op. But I think that it is more likely to be that serious with surgery than with HT and I am struggling to imagine what 3 viagra a week could do to help.

This can come about due to prostatectomy, followed by hormone therapy related (or other cause) weight gain. The surgeon who does penile implants at UCLH has done the semi-rigid implants for this reason, not to have erections, but to make such a penis accessible again for hygiene and using things like convene sheaths which require some exposed length.

User
Posted 06 Sep 2020 at 10:24

Thanks to everyone for your information. 

 

Mrs MAS

 
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