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Loss of semen

User
Posted 02 Jul 2024 at 19:36

Hi this is all new to me and this is my first post. I've been diagnosed and currently waiting for treatment (removal of prostate for me) but I've not had treatment yet and find I have erectile dysfunction but more so since having the biopsy. I think I was shocked, even though I was warned, that what came out after ejaculation was blood, that has recently stopped but I'm now finding I don't have semen coming out or it doesn't look like semen it's very watery and just wondering if anybody else has had this issue and is it normal. I seem unable to find answers and work to late to contact any support worker or nurse by phone. Sorry 

User
Posted 04 Jul 2024 at 08:22
Semen is vastly overrated - sex is so much more fun without all the mess :)
User
Posted 04 Jul 2024 at 08:30

Semen contains many components from different glands which is mixed at ejaculation. The prostate produces a clear watery fluid which contains PSA, accounting for about 40% by volume. Seminal vesicles produce the thick white component which accounts for about 50%. The remaining 10% is from the Vas Deferens which includes the sperm, and from cowpers glands (which produce precum).

If you stick loads of needles in the prostate and make it bleed, it's not surprising if you disrupt the workings for a while. In your case, it may be that the ejaculatory ducts which carry the seminal vesicle contribution are still swollen or blocked, so that component is missing. It would likely recover given enough time, but that might not happen before the prostatectomy, after which you'll lose all semen except the cowpers gland contribution.

Bicalutamide does appear to shut down the seminal vesicles more so than the prostate (or maybe just sooner), resulting in watery semen. (It is probably the case that the watery contribution from the prostate no longer contains PSA too.) The hormone therapy injections shut down production of all the semen components.

As to erectile dysfunction caused by biopsies, it does seem like this is a potential issue, although relatively rare and minor, and for just one biopsy, not usually noticed. I've seen the suggestion that men who do a long time on active surveillance might gradually accumulate ED from the multiple biopsies, a tiny amount each time. The ProtecT trial showed that those randomised to Active Surveillance initially had same decline in erectile function by 10 years as those on active treatments, and this was significantly worse than men of a similar age never diagnosed with prostate cancer. However, the Active Surveillance arm includes those who had to switch to active treatment due to disease progression, so it's difficult to tell if this is only in the men who had active treatment, or if it also applies to those who were able to stay on Active Surveillance for most of the 10 years and hence had the most biopsies over time.

Edited by member 04 Jul 2024 at 08:33  | Reason: Not specified

User
Posted 03 Jul 2024 at 07:26

D,a very similar story to myself after the Biopsy, although I didn't get the erection problems, I got blood in the semen,followed by pink  colour, then rusty colour. Following that it was the very watery semen.

Hope all goes well with your treatment .

Thanks Chris 

User
Posted 03 Jul 2024 at 10:09

Pretty much the same here - pre-existing ED got worse after my biopsy (48 cores taken under general anaesthetic) and after the blood in semen was flushed out, what little I produced was very watery.  I was on 150 mg bicalutamide (with a side of 20 mg tamoxifen to mitigate against moobs) whilst waiting for surgery, so that may also have had an impact.

Best of luck with your treatment.

Ian

User
Posted 03 Jul 2024 at 20:05

D, I went for a second opinion following my first biopsy, I took along the MRI scan. The consultant took one look at the scan and said that is of no use, it just shows a traumatized prostate.

I waited four months from biopsy to surgery and the quality of semem progressively declined.

For many guys who had surgery shortly after biopsy they probably don't have a long term view if the effects. 

In my day it was PSA,DRE then MRI scan 

Thanks Chris 

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User
Posted 03 Jul 2024 at 07:26

D,a very similar story to myself after the Biopsy, although I didn't get the erection problems, I got blood in the semen,followed by pink  colour, then rusty colour. Following that it was the very watery semen.

Hope all goes well with your treatment .

Thanks Chris 

User
Posted 03 Jul 2024 at 08:12

Thanks Chris. That part I sort of knew about and expected it's the bit after that I wasn't expecting. The loss of semen or that's how it appears to be but thanks for the reply 

User
Posted 03 Jul 2024 at 10:09

Pretty much the same here - pre-existing ED got worse after my biopsy (48 cores taken under general anaesthetic) and after the blood in semen was flushed out, what little I produced was very watery.  I was on 150 mg bicalutamide (with a side of 20 mg tamoxifen to mitigate against moobs) whilst waiting for surgery, so that may also have had an impact.

Best of luck with your treatment.

Ian

User
Posted 03 Jul 2024 at 12:27

Thanks Ian 

Hopefully I can get it sorted then. Not had surgery yet and not on any meds yet so was just a little confused as to why this had happened. I expected blood but once gone I expected semen to be back to normal 

User
Posted 03 Jul 2024 at 20:05

D, I went for a second opinion following my first biopsy, I took along the MRI scan. The consultant took one look at the scan and said that is of no use, it just shows a traumatized prostate.

I waited four months from biopsy to surgery and the quality of semem progressively declined.

For many guys who had surgery shortly after biopsy they probably don't have a long term view if the effects. 

In my day it was PSA,DRE then MRI scan 

Thanks Chris 

User
Posted 03 Jul 2024 at 20:19

Hormone treatment - leads to no semen

Removal of prostate - leads to no semen.

Sorry, that's the future!😕

User
Posted 04 Jul 2024 at 06:12

Thanks for that and yes I know but I've not yet had treatment of any kind which is why I was asking 

User
Posted 04 Jul 2024 at 06:14

Thanks Chris 

I'm currently at 3 months since diagnosis but told I've had it longer and as yet not had treatment so that's helpful to know. Maybe it is normal and how the cancer starts to effect us 🤔 

User
Posted 04 Jul 2024 at 08:22
Semen is vastly overrated - sex is so much more fun without all the mess :)
User
Posted 04 Jul 2024 at 08:30

Semen contains many components from different glands which is mixed at ejaculation. The prostate produces a clear watery fluid which contains PSA, accounting for about 40% by volume. Seminal vesicles produce the thick white component which accounts for about 50%. The remaining 10% is from the Vas Deferens which includes the sperm, and from cowpers glands (which produce precum).

If you stick loads of needles in the prostate and make it bleed, it's not surprising if you disrupt the workings for a while. In your case, it may be that the ejaculatory ducts which carry the seminal vesicle contribution are still swollen or blocked, so that component is missing. It would likely recover given enough time, but that might not happen before the prostatectomy, after which you'll lose all semen except the cowpers gland contribution.

Bicalutamide does appear to shut down the seminal vesicles more so than the prostate (or maybe just sooner), resulting in watery semen. (It is probably the case that the watery contribution from the prostate no longer contains PSA too.) The hormone therapy injections shut down production of all the semen components.

As to erectile dysfunction caused by biopsies, it does seem like this is a potential issue, although relatively rare and minor, and for just one biopsy, not usually noticed. I've seen the suggestion that men who do a long time on active surveillance might gradually accumulate ED from the multiple biopsies, a tiny amount each time. The ProtecT trial showed that those randomised to Active Surveillance initially had same decline in erectile function by 10 years as those on active treatments, and this was significantly worse than men of a similar age never diagnosed with prostate cancer. However, the Active Surveillance arm includes those who had to switch to active treatment due to disease progression, so it's difficult to tell if this is only in the men who had active treatment, or if it also applies to those who were able to stay on Active Surveillance for most of the 10 years and hence had the most biopsies over time.

Edited by member 04 Jul 2024 at 08:33  | Reason: Not specified

User
Posted 04 Jul 2024 at 10:28

Great detailed reply thanks that dies help me understand what could be causing the issue better 

User
Posted 04 Jul 2024 at 10:29

I guess yes 🤣 but wasn't concerned about tgat part of it so much but thanks 

 
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