Low PSA and sexual implications after prostatectomy?

User

Posted 08 Aug 2023 at 16:08

Hello

I have just been diagnosed with prostate cancer. But my PSA hasn't moved hardly. Why? And how to deal with PSA after intervention?

Historical:

My PSA has always been pretty low. The last 5 samples:

6/20              1.11
11/20            0.7
5/21              0.83
3/22              1.12
4/23              1.11

On April 23 I went to the toilet a little more often (urinate) than usual. So I consulted a urologist. He sees that there is "something". MRI. Diagnostic PI-RADS 5.Biopsy. Result: Group 3. 5/14. All right side. Gleason scores 7 (4+3). I am now waiting for the MRI scans for possible metastases. So, I discovered it a little by chance. I am 67 years old, healthy, no other pathology except a little overweight (BMI 27), no drugs and still sexually active...

The urologist told me, in a consultation that lasted less than 10 minutes , that there were 2 possible treatments: radiotherapy or surgery (= removal). Without going into too much detail in the pro and against radiotherapy he told me that the best will be prostatectomy. And even then, he gave me little detail other than that there was a risk of urinary problem and / or erection problem. When I told him "but without erection there is no sex life", he replied "I did not say that there would be no more sex life, but it will be different". Regarding radiotherapy he also told me that if I took this, it will no longer be possible to do a prostatectomy afterwards. He also told me that I could take a 2nd opinion.

Since then, I have read several books on the subject, which have already clarified me on a lot of issues. But I still have questions:

My PSA has not moved (or little) for 5 years. How come? Because from everything I've read, PSA is THE marker for prostate cancer.

If we assume that, in my case, there is no correlation between PSA and cancer, how to track this after an intervention? (surgery). I mean, if now my PSA is not correlated with cancer, I guess it will be the same after surgery. And if I go for prostatectomy , there will be no more “rectal inspection” either. So how are they going to know if there is a recurrence???

If I want to take a 2nd opinion, will it be better with another urologist or a radio-oncologist?

Is it true that we can no longer do a prostatectomy after radiotherapy? If so, why?

After what I've read, I'll be tempted to go for a prostatectomy. The only thing that makes me seriously doubt is the sexual side. I live with a young partner (55), so I'm not at all "at the end"😊... So what is the truth and the probabilities that it turns into a disaster (= zero sex life)? I read about injections ... But if a sexual intercourse turns into a medical act, I think I will not want it anymore ... I would like to hear opinions from men my age (say 60-70) and their sexual experience after a prostatectomy.

Thank you in advance for your answers. And I will post here the rest of the events, intervention and results...

PS: I apologize for the mistakes in my English, because it is not my native language.

Thank you

User

Posted 08 Aug 2023 at 17:34

I can try and answer a couple of the points raised.

Radiation Therapy - in your case Brachytherapy which inserts radioactive seeds into the prostate, affect the cellular structure of the gland (someone referred to it becoming like concrete) which then makes RARP much more complex and may require an open surgery rather than RARP - it's not impossible but is much more complex.

As for the sexual side, if they can save the nerves then it's 50:50 that you can regain erections after a period of time, maybe 12 months. There are vacuum devices, drugs and injections that can help or you can find other ways of enjoying yourselves in the bedroom. But, yes a prostatectomy will impact your sex life compared to what it is currently.

User

Posted 08 Aug 2023 at 18:14

Hi Flyingdutch. Unfortunately PSA is a very blunt instrument when diagnosing prostate cancer. It can sometimes give false positives and false negatives. However as a tool for checking for recurrence it is a lot more useful. If you have a prostatectomy then you have no prostate producing PSA, so any PSA reading would indicate it's coming from cancer. Even if you opt for the radiotherapy route your PSA prior to treatment serves as a reference point for future readings after treatment. I can't give you any success rate figures for erectile recovery but if you have full nerve sparing I would have thought it would be better than 50 : 50. I had partial nerve sparing surgery 18 months ago. I take Tadalafil to assist with erections. They are not as good as they were prior to surgery but they are good enough for intercourse. Whatever the outcome don't consider your sex life to be over. A lot of people on this forum will testify to having a good (but possibly different) sex life after prostatectomy.

User

Posted 08 Aug 2023 at 19:15

Here is my story which may help. I had prostatectomy at the age of 71 twelve years ago. I am continent except when I am sexually excited! My erections were rather weak and not very long lasting before the surgery and after the surgery they were even weaker. We have managed to re-establish our sex life with vacuum pumps and in many ways our sex life is better than before the surgery. Have a look at my post with this link:

https://community.prostatecanceruk.org/posts/t28948-Re-establishing-Sex-Life

'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.' Richard Feynman (1918-1988) Nobel Prize laureate

User

Posted 08 Aug 2023 at 22:09

Bear in mind if you go down the HT/RT route you might be on HT for 3 years with zero libido. It’s strange not having any desire and also having partial ED, but if you both are prepared to work at it and experiment you can still have an amazing sex life, it’s just different…what I’ve found:

I’ve No desire to get started, even when kissing and cuddling. Despite loving someone intensely you just feel empty and sad. It can be quite emotional sometimes.
Touch and feel are very important …there are so many erogenous parts of your body. For me it’s inner thighs, perinium, nipples, scrotum…when touched they can give me a good erection.
Penetration is not comfortable at the moment because of Peyronie’s disease caused by treatment. I couldn’t orgasm through penetration anyway I don’t think.
Orgasms still happen through manual stimulation but they come on quite suddenly and are strong, but dry.
Im not nearly so sensitive after orgasm, whether it’s due to it being dry I don’t know.

so, still having fun, not as frequent as before but the sense of achievement and satisfaction is amazing when it does happen…gives you hope for the future.

User

Posted 09 Aug 2023 at 00:13

There are at least 27 different kinds of prostate cancer. Most but not all produce PSA. However, if you had one of the rare types that doesn't produce PSA they would know that from your biopsy result. Does your biopsy report say that you have adenocarcinoma? If so, that is the most common type and you would be monitored by PSA following treatment just like almost everyone else ... just because your PSA is low doesn't mean it is unreliable.

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

User

Posted 09 Aug 2023 at 20:36

Hi flyingdutch,

I am sorry that you have recently been diagnosed with Prostate Cancer.

Other people have answered your technical questions about the reliability of PSA tests. I can only answer one of your questions: 'how was your sex life after prostatectomy'?

Unfortunately, I was unlucky and had a bad experience, but please be reassured that not everyone has the same experience as me. You might be luckier than I.

I had surgery 14 months ago and still have very poor erections. They are certainly not good enough for penetration.

I have been using the vacuum pump and injections for 8 months and a low dose of Cialis /Tadalafil for 10 months. It is getting slightly better, but it is a slow process. ( I also had urinary incontinence, which has an impact on sexual practices, but this is much better now).

I am sorry that my experience has been negative and I hope that it won't alarm you.

As others have said, the alternative treatment of Radiotherapy with Hormone Therapy would have meant that I would probably have had no libido. I didn't want that (as well as the increase in emotionality that many people report on Hormone Therapy).

One positive outcome of surgery is that when they remove the prostate they examine it in the laboratory and they can see whether the original assessment of how extensive the cancer is was accurate or not. This is called the Histology Report. (In my case, it was slightly worse that the biopsy had indicated, so I was glad that I had had the prostate removed completely).

I wish you well in whatever treatment you decide to have.

Best wishes,

JedSee.

User

Posted 10 Aug 2023 at 20:36

Hi flyingdutch

I can understand how you feel because I have been there 12 years ago, at the age of 71, and I now I am here still enjoying my life with my wife as much we were enjoying before my prostatectomy. I was very lucky that inspite of a very difficult surgery I made a good recovery, be it with 99.9% continence (I only leak when sexually excited, not convenient but we deal with it!). Because of my age my erections were waining and after surgery they were never going to be 'usable'. My wife (married for 57 years and known each other fir 61 years!), and I did not wish to be 'at the end ' as you put it so well! We did not fancy using and drug like viagra or risk any invasive treatment and opted for the VED (Vacuum Erection Devices). It required an entirely different way of making love but in many ways, for our age, our active sex live has had an extended lease. It is amazing what a couple can achieve with love, good communication, imagination, sense of humour and desire to re-establish their intimate life. Whatever treatment you choose runs the risk of incontinence, ED etc. I have explained in some detail how we re-established our sex life in the following link.

https://community.prostatecanceruk.org/posts/t28948-Re-establishing-Sex-Life

Edited by member 10 Aug 2023 at 20:39 | Reason: spelling

'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.' Richard Feynman (1918-1988) Nobel Prize laureate

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