Should You Worry About An Elevated Psa After Prostate Removal
PSA stands for prostate-specific antigen and is often a very good indicator of how effective treatment has been, in case of prostate removal or other prostate surgeries.
After prostate surgery, the PSA level gets very low, but this result isnt always reliable. Thats why the patient should discuss the expected PSA levels after prostatectomy with their doctor.
A lower PSA level following the removal of the prostate gland is only a part of the overall picture. There are many factors to monitor closely after prostate surgery.
Contact A Mens Medical Clinic For Specialized Erectile Dysfunction Treatments After Prostate Surgery
There are many differentenlarged prostate or prostate cancer treatment options available today.
The most common postoperative erectile dysfunction treatments often include oral medications, penile injections, and the use of medical devices. Other possible treatments includeHGH therapy andlow-testosterone therapy.
Its important that you consult with a doctor to learn how to manage your unique sexual dysfunction issues such as ED after having prostate surgery. A trained physician can help you preventif not treatED symptoms.
The medical professionals at Proactive Mens Medical Center specialize in treating conditions that impact mens health. Our concierge approach positions your unique case at the centerpoint of our focus. We dont just give you a pill for ED and send you on your way. We treat the underlying issues that led to conditions such as ED, Low Testosterone, and more. Contact our office today to schedule an appointment.
What Determines Erection Recovery After Surgery
The most obvious determinant of postoperative erectile dysfunction is preoperative potency status. Some men may experience a decline in erectile function over time, as an age-dependent process. Furthermore, postoperative erectile dysfunction is compounded in some patients by preexisting risk factors that include older age, comorbid disease states , lifestyle factors , and the use of medications such as antihypertensive agents that have antierectile effects.
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Restoring Sexual Function After Surgery
Erections are controlled by nerves and blood vessels that run along both sides of the prostate. Because theyre very delicate, any trauma to these nerves or blood vessels can affect erectile function, says the Prostate Cancer Foundation. And if cancer is growing near the nerves, the surgeon might need to remove them.
Even if you dont have ED before surgery, you may experience it afterward. While ED usually lasts at least two to three months after surgery, it can last for up to two years.
To restore sexual function, your doctor may suggest:
- Oral medicine, such as Viagra® or Cialis®
- Penile injections that you use before having sex
Habits And Lifestyle Changes
Your healthcare provider may recommend making certain changes to your habits and lifestyle to promote blood flow and improve your erectile health. These may include:
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Treating any underlying health issues
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Changing your eating habits to maintain a healthy weight
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Exercising regularly to improve your cardiovascular health
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If you smoke, quitting smoking and nicotine products
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Limiting your consumption of alcohol
Weve talked more about the effects of good habits and lifestyle changes on ED in our guide to naturally protecting your erection.
Although these changes are unlikely to treat prostatectomy-related erectile dysfunction on their own, they can contribute to an increase in blood flow, better overall health and improved sexual function.
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Pelvic Floor Or Kegel Exercises
Leakage is usually predictable and not constant. It tends to come with activity or straining, acts like standing up or bending over, or coughing or sneezing. It is for this reason that incontinence resolves first at night when one is lying down and sleeping. What Dr. Engel asks his patients to do is simple, and follows common sense. Now that the patient is aware that he can hold his urine for 3-5 seconds successfully, he simply must squeeze his sphincter just before performing the activity that might cause leakage. It is a function of anticipating leakage and stopping it before it happens. It must be understood though that following this strategy will not get one out of pads. It will only lessen leakage. Time and healing of the bladder is what gets one dry.
The final message Dr. Engel wants patients to know then is that no matter how much they leak, or how well they anticipate their leakage and squeeze, it is never their fault, or a sign that the patient is doing anything wrong. Surgical skill does play a role, but in large part the timing of getting dry has a lot to do with plain luck. Just as with erectile dysfunction after prostatectomy, proper education and expectation is the key to avoiding disappointment.
Recovery Of Erectile Function After Surgery
Upon removing the catheter after surgery, many of you are probably hopeful that things return to normal again but this is often far from the case. As expected, the timeline of recovery varies from man to man, although erectile function can usually be the final hurdle to overcome. This is regularly the symptom holding you back from moving on with your life.
Up to 90% of men have erectile dysfunction in the early stages following a radical prostatectomy, therefore its mostly inevitable. Many of you wont feel any hints of sustaining an erection within the first 3-6 months, which can kill off any sort of hope for a spontaneous return. However, this emphasises the need to complete an early penile rehabilitation program which often includes a daily dose of Viagra, a vacuum device, lube and a box of tissues. Encouraging erections through sufficient stimulation is important, even if you dont achieve 100% of normal, to ensure that your penis tissue qualities are preserved.
Overcoming erectile dysfunction after prostate surgery is a long and enduring path for all men. Ensuring that youre covering all bases early and consistently within your recovery and not having too high of expectations are important elements to successfully manage. Visit us at www.onlineprostate.physio and let us help you get started!
LEARN MORE ABOUT EFFECTIVE MANAGEMENT STRATEGIES FOR ERECTILE DYSFUNCTION WITH OUR ONLINE COURSES
References
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Surgery For Prostate Cancer
Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the prostate gland.
The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles.
Does Having Prostate Cancer Have Anything To Do With Sex
To answer this question, lets take a closer look at the nature of this condition. Prostate cancer is defined as a malign tumor that is developing within the prostate gland.
Even though prostate cancer is the second most widely spread type of cancer among men, most prostate tumors grow slowly. Not only that, but also treatments may involve minimal to zero severe measures.
On the other hand, in advanced cases of prostate cancer, oncologists can recommend a plan of action that ultimately concludes with radical prostatectomy. This is a surgical procedure and its goal is to remove the entire prostate gland and, possibly, other adjacent seminal vesicles.
Now that the best and worst scenarios are well-illustrated, lets find out if prostate cancer can have any impact on the sex lifestyle.
In the best-case scenario, where patients require minimal medical care or none at all, the nerves and blood vessels that are needed for an erection remain safe, far from the malignant tumor. In other words, the desire for sex remains healthy from a physical point of view. However, patients may experience a loss of libido and, therefore, a drop in the sexual experience due to psychological reasons triggered by the diagnosis.
From this point on, maintaining a steady erection for a moderate duration becomes a struggle. Thereon, there are higher chances for erectile dysfunction or impotence.
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How To Maintain Your Sex Life After Prostate Surgery
Although prostate surgery can affect your sexual experience and performance, getting surgery to remove part or all of your prostate doesnt mean that you can no longer have sex or enjoy a satisfying sexual life.
If youve recently had prostate surgery, its important to talk to your healthcare provider before you make any changes to your health habits. Theyll be able to inform you about what you can do to restore and improve your sexual function after surgery.
Known Side Effects Of A Radical Prostatectomy
So, what happens to a man when he has his prostate removed? There is a multitude of effects that occur to men after they have had prostate removal surgery.
The procedure is major pelvic surgery, and, as such, it carries along with it many potential risks. In addition to the immediate effects of the surgery, the removal of the prostate causes long-term side effects that are generally permanent.
Until recently, these side effects about what happens to a man when he has his prostate removed have not been relatively well-classified.
Most side effects are those reported by urologists that are performing the surgery. This reporting has been, in past years, rather poorly detailed and sparse due to the surgeons not anxious to publicize the failures of a procedure, they have attached a gold standard label.
The most reported side effects are erectile dysfunction and urinary incontinence.
Unfortunately, even though doctors have filed reports, the bias of the doctors filing them is questionable.
For example, one report details one of the significant side effects, postoperative erectile dysfunction, occurs between 14 and 90 percent of patients. This is a relatively wide range.
Based on my many years of practice, it is a very optimistic estimate. And it is likely provided by urologists who either do not want to admit their procedure causes such harm or deny the side effects and results.
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Percentage Of Men Obtaining Full Erections 2 Years After Open Prostatectomy
15% 13%
It is still unclear how using the da Vinci robot for prostatectomy will affect potency effects. While, as mentioned above, it would appear that using the robot may increase chances of potency, and research into how all this may translate into earlier return or increased percentage of potency is still ongoing. It is known that using the robot reduces blood loss during robotic prostatectomy surgery, and length of hospital stay. Presumably this is indicative of a decrease in trauma and inflammation, which leads us to speculate that there may be a higher chance of potency. Urinary continence at zero pads, bladder capacity, and urinary symptom scores at three months are all also improved over open surgery results. The robot certainly has its benefits.
As mentioned above, medical therapy may aid in return to erections, but this has not as of yet been fully substantiated. Usage of sildenafil and newer erectile medications may potentially increase the potency percentages in the table above but this has not been proven. A recently presented study found that daily doses of 50mg or 100mg sildenafil for 9 months increased full erections by 7 fold when compared with a group who did not receive any medication.
Talking Counselling And Sex Therapy
Talking to your partner about your erection difficulties can help. Or it may help to talk to a close friend if you are not in a relationship.
Not talking to those close to you could be one of the main barriers to coping with this side effect. You might then find it easier to consider ways that could help.
Counsellors or therapists can help if youre worrying about anything to do with your sex life and sexuality. You can be referred by your GP to a counsellor or therapist within the NHS. You might need to go on a waiting list to see them.
Talk to your GP to find out what is available in your area. Your local hospital or your local Erectile Dysfunction Clinic might have this service.
The drugs used to treat erection problems include:
As drugs work best in men who have sexual desire, they might not help some men who are having hormone therapy. There is limited evidence to say these drugs work when having hormone therapy. But some specialists believe that they are still worth a try if you would like to give them a go.
Possible side effects of PDE 5 inhibitors include:
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Are There Any Surgical Techniques That Have Been Developed To Improve Erectile Function Outcomes
At this time, there are several different surgical approaches to carry out the surgery, including retropubic or perineal approaches as well as laparoscopic procedures with freehand or robotic instrumentation. Much debate but no consensus exists about the advantages and disadvantages of the different approaches. Further study is needed before obtaining meaningful determinations of the success with different new approaches.
Most Treatments Are Equally Effective
Assuming annual checkups, prostate cancer is likely to be diagnosed early, before it has spread outside the gland. Early detection means a good prognosis: The American Cancer Society estimates there were 239,000 new diagnoses of prostate cancer in 2013, but only 30,000 deaths a death rate of 13 percent.
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Talk About How You Feel
First off, it is essential to evaluate how you feel.
It is vital to talk about it if you want to improve.
Most men prefer not to talk about this with a professional, and they avoid the topic with their partners.
However, this position will only make things worse with your partner and cause anxiety to you.
After talking it out with a professional, you will see how easy it is.
They are trained to answer your questions and give you recommendations and a variety of options.
Sometimes men are anxious about erections after surgery because they read so much about it.
Their anxiety plays against them, turning a weaker erection function into a complete failure.
Thus, one of the first aspects to consider is your mindset, feelings, and emotions.
Therapy can help a lot if youre struggling.
It is sometimes appropriate to incorporate your partner in the talking, but it is not always required.
Is Another Treatment Option Better For Preservation Of Erectile Function
The growing interest in pelvic radiation, including brachytherapy, as an alternative to surgery can be attributed in part to the supposition that surgery carries a higher risk of erectile dysfunction. Clearly, surgery is associated with an immediate, precipitous loss of erectile function that does not occur when radiation therapy is performed, although with surgery recovery is possible in many with appropriately extended follow-up. Radiation therapy, by contrast, often results in a steady decline in erectile function to a hardly trivial degree over time.
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Risks Of Prostate Surgery
The risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:
- Reactions to anesthesia
- Blood clots in the legs or lungs
- Damage to nearby organs
- Infections at the surgery site.
Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.
If lymph nodes are removed, a collection of lymph fluid can form and may need to be drained.
In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.
Sex After Prostate Cancer Radiation Treatment
A radiation oncologist is likely to administer radiation treatments. External beam radiation is a treatment delivered through a machine used to aim high-energy rays from outside the tumor into the tumor. Brachytherapy or seed implant treatment places small radioactive seeds within the prostate itself, giving the prostate gland localized radiation therapy. Forty percent of men report ED after radiation treatment.
A clinical study was conducted to determine if tadafil preserved erectile function in men treated with radiotherapy for prostate cancer. Among 221 participants it was observed that daily use of tadafil did not improve sexual activity. The findings did not support the use of Cialis to prevent ED. While men may not have positive results with Cialis, penile injections and erectile dysfunction pumps are usually successful treatments.
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How Important Is Nerve
The short answer is very. All men in these studies had some form of nerve-sparing performed during their surgery so this review was not able to assess the effect of nerve-sparing on subsequent recovery of erections as there was no control group to compare to. Previous studies have convincingly demonstrated the critical nature of nerve-sparing . The decision to undertake nerve-sparing is made in advance by the surgeon and depends on the extent of cancer. Robotic surgery has allowed more precise and meticulous surgical dissection of the surrounding layers of the prostate. Indeed, 80% of UK prostatectomies are now completed with a da Vinci robot, the remainder split evenly between laparoscopic and open surgery. The outer layers of the prostate are a bit like an onion with several layers. The layer containing the nerves is like the brown skin on the onion and the surgeon can choose to cut inside this layer to leave the brown skin in place.
Is There Sex After Prostate Cancer Surgery
The surgical procedures that are needed in order to cure prostate cancer are invasive and may lead to long-term side effects. One of these side effects is impotence.
Nevertheless, even in the most severe cases of prostate cancer surgery, the affliction to ones sexual life can be reversible. Through extensive efforts over a period of around 12 months, a man who previously had a normal sexual function can regain potency. This is called penile rehabilitation which usually resorts to drugs or devices in order to accelerate the recovery of erectile function.
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