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ED and prostate?

User
Posted 20 Feb 2023 at 14:29

My story is a bit of a jumble but I’m mostly interested if others had ED as part of their initial presentation for prostatic issues and if that has improved with management?

the longer (and more boring) version is this:

after many years of perfect sexual function I started to become less able to get or maintain an erection. This became a bit embarrassing and I just gave up having any form of sex with my wife. It was quite depressing at the time and this finally became obvious in late 2018. I lived with it for some while but, after discussing it with my wife, I decided I’d see if I could resolve it. By this time it was 2020. I’d tried viagra but the headaches were horrible and the results less than spectacular.

it should be noted that I had started ramipril for hypertension in 2017 so I wondered if it was a secondary effect but the bp was under control. During work-up of my hypertension the ultrasonographer noted that my prostate was ‘bulky’. The Gp did not follow this up. 

I did see a GP in late 2020 and had a full set of bloods done including PSA which came back as 4.89

i was referred to the urologist on a 2 week track and had an mpmri in Dec 2020. A follow up appointment in Jan 2021 suggested that it was followed with a mri in one year. I had this mri in Dec 2021. This consultant had suggested I try tadalafil for my ED but it was worse side effects than with viagra. And no erection benefit.

the mri result was reported in early 2022 as a pirads 2 and to follow up PSA. 

the blood sample was taken in may 2022 and the date for reporting was initially going to be October 2022 but this kept being pushed back until at (most recent) October 2023. 

I had a follow up full blood screen including PSA for bp meds monitoring in Dec 2022 and reported the PSA to the urologist (7.89). Suddenly , apropos of nothing else, I got a phone call last week calling me to a phone appointment on Saturday. 

at that appointment it was reported to me that my last mri was pirads3 and the consultant asked if I’d been offered a biopsy. This was clearly new to me. He has now booked me for a DRE and discussion on biopsy to be done within 2 weeks. I’m deeply confused as to how this has all escalated when everything seemed so ‘hands off’ for so long. 

long and short - I still can’t get an erection of decent quality. 

what makes this a little bit worse is that medical and surgical management of problems is literally my job as a vet surgeon. 

User
Posted 20 Feb 2023 at 19:25
You had mpMRI twice and both times, nothing was seen to warrant a biopsy. Your most recent MRI result of PIRADS 3 is still equivocal but a biopsy is a sensible next step with PIRADS 3

It is good that you have been monitored annually - I can't see anything to suggest your doctors have dropped a ball.

Unfortunately, if you do go on to be diagnosed with prostate cancer, ED is not going to be improved by PCa treatment; the opposite is often true. Get the prostate cancer tests out of the way first and then you can concentrate on recovering your sex life - there are other things you can try such as injections, cream, a tablet that isn't tadalafil or sildenafil, vacuum pump / restriction rings. You could also try to learn a technique for flaccid penetrative sex - Chris on here can hopefully tell you how this has changed his life

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

User
Posted 20 Feb 2023 at 15:01
I , like you always had perfect sexual function , even though I drank quite a bit and had dark moods. I presented privately after a spell of ED and much reduced ejaculation. Did all the tests and noticed my psa was 6.7. I was 47 at the time. Quite frankly it was never followed and was even given Testosterone injections. Roll on 2 years and my psa was 15.

I’m now 8 yrs on and incurable with spread to lymphs and bones. Should have gone for suing I guess by the time I realised it all but was too late !

User
Posted 20 Feb 2023 at 20:45

Like yourself my only ‘symptom’ was ED. My GP took a blood test which showed a PSA of 5, with the MRI revealing a lesion graded as 5. The biopsy confirmed prostate cancer with my prostate being removed on 23rd December 2022 - eight weeks after diagnosis. ED following surgery is not an optional extra. I am on Sildenafil as part of my ‘recovery’ and have an appointment early March which will probably result in a pump being prescribed. Unfortunately this is something I have to live with until my body makes a recovery (fingers crossed). In the meanwhile intimacy is still possible and enjoyable. ED us something that can’t be rushed but which can, hopefully, be overcome.

User
Posted 20 Feb 2023 at 21:32

You've probably seen my posts but I've had an increasing psa for four years now (I'm 53). Last year I was 7, then in January this year 12 (the previous years showed gradual increases) Some people think it's an infection but I've not done anything like sex to get an infection.  This is because I've had ed  for about 6 months and no semen. I have another mri at the end of the week. 

The nurse mentioned on the phone about potentially having a biopsy and explained it. I said I'd need a general anaesthetic if possible because like you I'm not too keen on the idea. I won't turn down anything that will help get to the end of this but I agree with you!

What's also hard for me is that I'm adopted so I don't know my family medical history.  So I attempted to trace my birth parents over a year ago, and found out my other name, and my parents names. The other details were pretty shocking. Sadly both my birth parents have not ever tried to find me, and can't trace them so I'm at a brick wall.

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User
Posted 20 Feb 2023 at 15:01
I , like you always had perfect sexual function , even though I drank quite a bit and had dark moods. I presented privately after a spell of ED and much reduced ejaculation. Did all the tests and noticed my psa was 6.7. I was 47 at the time. Quite frankly it was never followed and was even given Testosterone injections. Roll on 2 years and my psa was 15.

I’m now 8 yrs on and incurable with spread to lymphs and bones. Should have gone for suing I guess by the time I realised it all but was too late !

User
Posted 20 Feb 2023 at 19:25
You had mpMRI twice and both times, nothing was seen to warrant a biopsy. Your most recent MRI result of PIRADS 3 is still equivocal but a biopsy is a sensible next step with PIRADS 3

It is good that you have been monitored annually - I can't see anything to suggest your doctors have dropped a ball.

Unfortunately, if you do go on to be diagnosed with prostate cancer, ED is not going to be improved by PCa treatment; the opposite is often true. Get the prostate cancer tests out of the way first and then you can concentrate on recovering your sex life - there are other things you can try such as injections, cream, a tablet that isn't tadalafil or sildenafil, vacuum pump / restriction rings. You could also try to learn a technique for flaccid penetrative sex - Chris on here can hopefully tell you how this has changed his life

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

User
Posted 20 Feb 2023 at 20:45

Like yourself my only ‘symptom’ was ED. My GP took a blood test which showed a PSA of 5, with the MRI revealing a lesion graded as 5. The biopsy confirmed prostate cancer with my prostate being removed on 23rd December 2022 - eight weeks after diagnosis. ED following surgery is not an optional extra. I am on Sildenafil as part of my ‘recovery’ and have an appointment early March which will probably result in a pump being prescribed. Unfortunately this is something I have to live with until my body makes a recovery (fingers crossed). In the meanwhile intimacy is still possible and enjoyable. ED us something that can’t be rushed but which can, hopefully, be overcome.

User
Posted 20 Feb 2023 at 21:00

Thank you Lyn, I think I keep needing to remind myself why I ever went looking for a problem in the first place. ED was literally all I was bothered about. I’ve now learned to ‘live with it’ and pretty much resigned myself that this will be the long term (or medium at least). To be honest the idea of biopsy gives me the absolute horrors so I have an intention to ask whether we ought not to just repeat mri before finally deciding on biopsy. We shall see. Dunno yet

User
Posted 20 Feb 2023 at 21:32

You've probably seen my posts but I've had an increasing psa for four years now (I'm 53). Last year I was 7, then in January this year 12 (the previous years showed gradual increases) Some people think it's an infection but I've not done anything like sex to get an infection.  This is because I've had ed  for about 6 months and no semen. I have another mri at the end of the week. 

The nurse mentioned on the phone about potentially having a biopsy and explained it. I said I'd need a general anaesthetic if possible because like you I'm not too keen on the idea. I won't turn down anything that will help get to the end of this but I agree with you!

What's also hard for me is that I'm adopted so I don't know my family medical history.  So I attempted to trace my birth parents over a year ago, and found out my other name, and my parents names. The other details were pretty shocking. Sadly both my birth parents have not ever tried to find me, and can't trace them so I'm at a brick wall.

User
Posted 20 Feb 2023 at 23:45
Good heavens, PCJ - prostatitis and urinary tract infections aren't caused by sex!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 20 Feb 2023 at 23:48
PS family history is probably irrelevant- the biggest risk factor for getting prostate cancer is being male. About 50% of men in their 50s have prostate cancer (60% of men in their 60s / 70% of men in their 70s) although many don't realise
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 21 Feb 2023 at 12:20

Originally Posted by: Online Community Member
About 50% of men in their 50s have prostate cancer (60% of men in their 60s / 70% of men in their 70s) although many don't realise

Please don't confuse indolent prostate cancer with that which needs treating to preserve quality/longevity of life.

User
Posted 21 Feb 2023 at 12:33

Many men have ED at time of presentation for prostate cancer, given that about 50% of 50 year olds have at least some ED and prostate cancer diagnosis tend to peak later than that in 70's. However, ED is rarely caused by prostate cancer, but as I just commented in another thread, it should always be investigated. It can be an early warning sign of many other things, such as diabetes, high blood pressure, atherosclerosis caused by high cholesterol, high BMI, all of which can be secondary to low Testosterone which can also cause ED directly.

[Repeating what I said on the other thread,] You need to go back to your GP and have the ED followed up. I would expect them to start with getting full blood counts, plus Testosterone, lipids (cholesterol), HbA1C, blood pressure, etc.

 
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