It's been a year since surgery and my latest (June) PSA is below detectable limits. That's great. More confidence that there has been no metastasis, but still have to be vigilant. Have a visit to City of Hope in early November.
Here is a summary of what is going on.
Erectile Issues
Erectile issue is slowly resolving itself. While I still use injections to obtain "useable" erections, I find that I can get a partial erection without the injection. Occasionally, I wake up in the night and find a fully erect penis (mine, of course). So, it appears the nerve sparing efforts worked. I'll just have to be patient. Doc said it may take 2 or 3 years to regain full erectile function.
A little discussed related issue after prostate surgery is urine ejaculation. I was told that after prostate removal, I would have dry ejaculations. This makes sense as there is no prostate to produce the lubricating fluid and the tubes from the testicles have been cut. But this is not the entire story. I found that, on some occasions, I had a copious amount of ejaculatory fluid. Searching the web, I found several discussions about this issue. It turns out to be the obvious - the ejaculatory fluid is urine. My testing with empty and full bladder showed the amount of ejaculatory fluid to be related to bladder fullness. A surprise, but it can be dealt with - pee before sex and/or use a condom.
Continence
I still have minor urine leakage. It is variable. On rare occasions there will be enough sudden leakage to show through my pants. Mostly it is just a tiny amount that shows up as yellow stains on my underwear.
I am at fault. I have not been doing my kegel exercises. I do them for a while and then get lazy. The result: yellow drawers. I guess I have to develop a more consistent regime of kegeling. I do not consider urine leakage to be any problem. At worst I can wear a "man pad".
Urinary Tract Infection
On my first doctor visit after surgery, I mentioned to the doc that my urine smelled peculiar. He said there was nothing in the surgery that affects urine odor. I just went away thinking my nose had just gone awry.
I looked on the web and could find little info on urine odor changes from prostate surgery. The only urine odor changes were related to infections. Since my doc had not mentioned the possibility of infection, I dismissed this as the cause. Also, in April of this year I had my annual physical that included a urine test which showed no sign of infection. But the odor persisted.
The odor seemed to get a little worse a few weeks ago, so I decided to try a regime of antibiotics just to see what happens (I bought some Amoxicillin for tropical fish on eBay). Within two days the odor was mostly gone. So I will continue the antibiotics for the full two weeks and see what is the outcome. I may have to go to a more modern antibiotic if the odor returns, but at least I have confidence that I have had a UTI for nearly a year. A little bothered that my doc had not been more on top of this.
Low Testosterone
I have had a history of decreasing testosterone level which is normal with aging. However, mine had gotten below 300 about a year and half ago. Due to the diagnosis of prostate cancer, there was no consideration of starting testosterone replacement therapy and this subject was put on the back burner.
But, now that a year has passed, I want to revisit T replacement therapy. I just don't have the get-up-and-go that I did a year or two ago. I blame this on my low T. I asked for a testosterone test in June and the results showed the level to be just above 200. To me, this seems really low as the normal value is around 600 or 700.
My surgeon said he will not consider T therapy until at least a year after surgery and then only if the PSA level was below detection limits. My local urologist has the same position. I plan to discuss this with my surgeon during my upcoming November visit. I have read many "learned" articles on the issue of T therapy after prostate cancer, and the recent ones all conclude that there is little basis for not starting testosterone therapy. We'll see how this goes. I may have to run down to Mexico and get some T.
The Bottom Line
While I don't like the idea that I had cancer, the outcome has been far better than I expected. Permanent limp dick and diapers was my fear. The reality has been easy to deal with. To me, the only issue that bothers me is the lack of energy. This may just be the normal result of getting older (I will be 70 in October).
Life is good.
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