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I would like to get your views on the protocol my specialist uses with particular reference to VED's and on demand vs prescribed PDE5 inhibitors.
"Penile rehabilitation includes all of the following
1. Good counselling and regularly attempts at penetrative intercourse, ensuring that psychogenic factors are kept to a minimum.
2. PDE5 inhibitors (which have everything to do with nitric oxide and cGMP) with all the debate around regular use vs on demand use.
3. ICI therapy, self injections, in conjuction with or without PDE5’s.
4. VED is available to us but not well received by patients locally and is not a standard of treatment in post prostatectomy penile rehabilitation at this stage, but is in no ways contra-indicated.
I usually initiate early rehab manoeuvres at about 6 weeks post op and start with PDE5 inhibitors on demand as there is no clear evidence that regular PDE5s do any better, although with the release of daily Cialis 5 mg (new) additional on demand medication may be beneficial but the jury not yet out in this regard"
Aloha,
This is strictly from my own experienced, 25 months after first half of total dose EBRT pelvic cavity second half IMRT ultra-sound guided prostate specific target, plus one year of 3 month Lupron Depot shots. I did not use any medical treatment or physical stimulation. Many months after treatment, I did start to get night erections, but still have not had any night orgasms (wet dreams are probably gone). It was early 2009 before we could even get some stiffness, not sufficient for orgasm. Only within the past few months could I achieve orgasm, not sufficiently stiff enough for insertion. This past couple of weeks there was nothing following the cysto, to much pain. Couple of days ago, we did succeed. So even with the high target EBRT dose to the prostate, the prostate valve/sphincter began to work as designed. This is what I was feeling with a catheter in place after the cysto. It was just like an orgasm, but very painful contractions. I removed the cath 3 days after the cysto. The orgasm is still a little painful, after feelings, like the valve was squeezed too hard. I think that the pain comes from the cysto scope probably breaks strictures around the valve, so the post cysto pain.
So, Terry, we are all different, use it or loose it is not 100%.
What this means, I think, is that part of the prostate is returning. So, I could expect to see a rise in PSA beyond the value, at which my oncologist would recommend going back on ADT. I don't know how we will tell if it is PCa or just a normal PSA for a 68 year old male.
Joe 68 Hamakua Coast
Hi Tim,
The VED played a big part in myself regaining potency. I used the device for fifteen minutes morning and night. It was difficult at first, resulting in much frustration and a bit on non belief on my part. The right technique is also a bit tricky to get right, but a bit of gel helps make a good seal. Anyway I persevered the exercises as we called them, and after three months with the help of Viagra, my wife an I were able to enjoy intercourse, something that we had not done for well over a year.
John
