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Thread: Do Easy Erections Ever Return After Prostate Removal?

  1. #1

    Do Easy Erections Ever Return After Prostate Removal?

    Many men have reported on this forum that they can achieve an erection after prostate removal, but most say it takes more visual, mental, and manual stimulation to achieve and maintain an erection. Does anyone know if the nerves will eventually regenerate making achieving an erection easier, like it was before the surgery? If it will get better how long might this take?Any personal experience or input from doctors, books, research, etc?

    Thanks for any information you can provide.

  2. #2

    MarkinPheonix - Progression of Erectile Functioning


    All men and all surgeries are unique. For instance men have varying degrees of erectile functioning before surgery. Age and other factors can impact healing. During surgery, nerves can be totally destroyed, largely spared, or any degree in between. The way those factors pair up mean no one can predict your progression. Certainly patients on a forum could never predict your outcome. However there are some important points.

    RP damages or traumatize nerves (some are traumatized even during surgical healing right AFTER RP,). Of course some nerves are actually removed. Your surgeon should be able to qualitatively tell you the degree of nerve removal for the right and left nerve bundle.

    In any event, if nerves were spared, you will continue to get some improved nerve pathways for at least 12 months after surgery and possibly for 24 months. The chances are that it will never be exactly like it was but rarely, miracles happen.

    Sometimes intimacy and sex even improves as you and your spouse explore the possibilities.

    There are many things you can do to have a positive impact on the process and outcome.

    Improve healing and preserve penile health by increasing blood flow to penile tissue (including the large part of penile tissue inside of your body). Do this with a 1/4 Viagra nightly. Challenge yourself at least weekly with attempts at sexual activity (use it or lose it). You may want to take an entire Viagra at these times. A half of a 50 mg Trazadone tablet at night (prescription) also encourages nocturnal erections which maintain penile health.

    I would encourage any man that has a RP to strongly consider a Vacuum Erection Device (VED) to encourage blood flow. Penile tissue that is deprived of blood flow from erections or VED tends to lose elasticity. This can contribute to the seldom discussed loss of penile size that Urologists all know about. Here again, blood flow and oxygenation are thought to help prevent Peyronies Disease.

    Be careful with injuring a borderline erect penis during sex. Injuries can lead to Peyronies Disease which is much more prevalent in prostatectomy patients than the general male population. Lots of lubrication and controlled positions are important in the beginning.

    Things that help erections:
    Supplements L-Arginine 2- 4 grams per day. (recommended by many urologists)
    Horney Goat Weed
    Acetyl L-Carnatine & propionyl-l-carnitine http://www.peyroniesforum.net/index....pic,649.0.html
    Things that reduce erection
    Smoking, caffeine, antihistamines like Sudafed etc, adrenalin which can not only be triggered by sudden fear but also by performance anxiety.

    Here is a link that may help. The most recent posts are on top so start at the bottom. There are 5 pages on ED issues. http://www.peyroniesforum.net/index....ic,23.400.html
    History: Biopsy showing 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests beginning 2008: Feb .06, May .09, Jun .10, Aug .10, Nov .15 - SRT Dec 2008 ---Post SRT PSA 2009 Feb .10, May .09, Aug .06, Dec .04, 2010 Mar .04, 2011 .02, 2012 .02, ---- STARTED UP Feb 2014 .06, Jul 2015 .10, Oct 2015 .10, Feb 2015 .15, Jun 2015 .17, Dec 2015 .25

  3. #3
    Thanks so much for all the detailed information. Where did you get all this knowledge? Are you a doctor, nurse, or other medical professional?

    I asked my surgeons nurse if the erections would return to near normal and how long it might take. She said I was already ahead of the curve, and that nerve regeneration might go on for up to two years. I interpreted that to mean be happy with what you've got, and be patient things might get better.

    My surgeon, Dr. Tewari, started me on 20 mg of Cialis the night BEFORE surgery. And I'm to continue the 20mg every other day for at least 3 months, possibly longer. The doctor says this improves the blood flow to aid healing and prevent damage to the penis. A local urologist that worked with my surgeon for years told me they believe the Cialis may prevent the damage to the penis that causes the reduction in penis size. So far it seems to be working for me as I haven't noticed any change in penis size.

    Thanks again for all the good information.

  4. #4

    I am glad you asked. NO, I am NOT a doctor or a medical professional. I should have stated that but my post was already turning into a novel. I wish I had learned all I know about this topic in the objective studies of medical school. That would have been the easy way.

    I founded, and am the administrator of the organization and the forum I linked to. The overlap with this forum is that a chunk of prostate cancer patients end up with ED, Peyronies Disease (PD), or both. Most people with Peyronies Disease or ED however developed those conditions from issues other than prostate cancer.

    the Peyronies DIsease Society forum concentrates only on Peyronies Disease and the ED which is often associated with that condition.

    When my PSA recently became detectable it drove home the point that as devastating as PD and ED can be. There are things that are worse.
    History: Biopsy showing 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests beginning 2008: Feb .06, May .09, Jun .10, Aug .10, Nov .15 - SRT Dec 2008 ---Post SRT PSA 2009 Feb .10, May .09, Aug .06, Dec .04, 2010 Mar .04, 2011 .02, 2012 .02, ---- STARTED UP Feb 2014 .06, Jul 2015 .10, Oct 2015 .10, Feb 2015 .15, Jun 2015 .17, Dec 2015 .25

  5. #5
    Newbie New User
    Join Date
    Dec 2011
    Encouraging results!
    I am a 45 year old and had my prostate removed after being diagnosed with Stage 1 Cancer. 2 weeks after having my prostate removed I was having erections using low dose Cialis. 3 weeks mark I was able to have sex with my wife....... it was a little different but successful! I realize that it may be rare, but as my doctor said everyone is unique and every surgery is different.... I had the Da Vinci procedure.
    I hope everyone the best of luck and my support!


  6. #6
    Senior User
    Join Date
    Nov 2011
    To follow-up on Hawk's rehab description, I'd recommend reading "Saving Your Sex Life: A Guide for Men with Prostate Cancer" by Dr. John Mulhall. He lays out a rehab program that includes pieces Hawk described and the reasoning behind it. The surgeon that will be doing my RP uses a rehab protocol similar to this. His office has already begun the declaration of medical necessity to the insurance company to get the meds authorized and the vacuum pump. The book is a good read as one of the many datapoints to have when talking with surgeons and planning your care after surgery.
    Age 49, healthy, physically very active
    PSA 6.9
    DRE felt nodule on right side
    Free PSA 13%
    Biopsy 10/24/11, Gleason 3+4, all cores positive
    Surgery 1/26/12
    Pathology: T2c, Gleason 3+4, 1 mm positive margin at apex
    PSA 3/9/12 - 0.01

  7. #7
    Regular User
    Join Date
    Jan 2012
    Mark, I sure hope they do return...I had cryogenic surgery on June 14 and, so far, am not able to achieve a successful erection ( I just started taking the daily Cialis and I use a vacuum pump 1-2x a week, so maybe that will help turn to the green lights on again ). My interest and desire are still very much intact but the message is just not filtering down to the erection machinery! I see very few posts from men who have had the cryogenic surgery so there's not much info on what to be expecting in the way of a full recovery.

  8. #8
    Top User
    Join Date
    Aug 2010
    Southern California

    I have no ED problem except it is dry. Full function returned about 1 month after surgery. Surgeon said his experience indicated taking 5 mg Cialis helped and he prescribed 90 days supply. I actually only took them for a week. Finally, yes, luck played a role too.

    Some patients in my cancer support group reported it took some time but things improved over time.

    I also think a lot depends on individual situations, cancer stage, skill of the surgeon and luck. In my case the cancer was organ confined but was actually extensive, worst than the biopsy report. My surgery took longer than normal but both bundles were saved.


    I don't think keeping sexual function after robotic surgery is that rare. Many of the patients in my support group recovered.


    I do not know about cryosurgery. In fact I was always curious as how the doctor preserved the nerve bundles during cryosurgery. I was able to find information on how they could saved the urethra by worming it but no one mentioned how to warm the nerves or did anything to protect them during cryosurgery.
    PCa Dx 2010 at 65. PSA increased from 2.5 in 2000 to 10.7 in 2010. Four biopsies in 6 years. Final biopsy in 2010: 1 of 12 cores 5% cancer, G6
    CT, bone scans & MRI all negative
    Da Vinci 8/10; nerve sparing, catheter out in 7 days; no incontinence, no ED
    Post Op Pathology pT2N0Mx: organ confined; negative margins; lymph nodes & seminal vesicle not involved but PNI present; cancer extensive within prostate, multifocal G 3+3 and tertiary G 4
    Infected lymphocele diagnosed and treated in 2014, 4 yrs after RALP
    PSA <.1 for the past 6 years.

  9. #9
    Regular User
    Join Date
    Jan 2012
    newporter, my uro/surgeon's surgery nurse told me that one of the needles used for the freezing process is a "warming needle" that is exactly placed by ultrasound in a position to protect the nerves from the total 46 below zero effect that is used to kill the prostate and all of the contained cancer cells. The nerves are affected, of course, but the "warming" keeps them from being absolutely killed....they have a chance to regenerate. My biopsy and bone scan showed the cancer to be complely contained within the prostate. PSA prior to surgery was 2.2, today...7 weeks after surgery, it is 0.002.Was totally continent within 12 weeks but ED is still a lousy side effect but I'm hoping/praying that it will get back to normal.By the way I am 77.

  10. #10
    Top User
    Join Date
    Aug 2010
    Southern California

    Thank you for your response. I am learning a lot of new things from this forum.

    Good luck to you on your ED recovery.


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