This account is likely to be deleted in mid 2022 due to Flickr's restrictions on explicit content in free accounts.

 

There are no unrealistic medical diagrams or coy photographs of wizened walnuts here, but actual photographs of my body - or the relevant part of it - before and after my operation for an open radical retropubic prostatectomy in November 2016. I hope they may be in some way reassuring for those about to have a similar procedure, or have just had one, or the one in eight men (in the UK) who will statistically be diagnosed with prostate cancer. I know in my case I have been fortunate in that the cancer appears to have been removed along with my prostate. I don't wish to influence anyone with what action I have taken, this is just how I did it and what happened to me.

 

There are likely to be significant developments in the treatment of prostate cancer in the coming years, so what is posted here may well become just an artifact of history, and all the better for it.

 

At the time of my diagnosis in 2016 I was 74 years old, and I am 6' 2" in height with a weight of around 12 st 4 lbs (78 k) unclothed (a few pounds less at diagnosis). I am naturally slim, I have never been inside a gym, although I swim occasionally. I have never smoked or taken drugs and I drink a modest bottle of wine a week. I worked manually until 1976 when I moved to an office job. I am married with children and grandchildren.

 

The prostate is the generator of seminal fluid, is located close to the genitals, and its removal has significant effects on the sexual and urinary functions. Many, if not most, of those undertaking the procedure will be concerned about these effects. Consequently the photographs and some of the comments are explicit, requiring a free Flickr userid to see them all (the album holds the photographs in chronological order). I shall try to answer any questions that arise in the comments section.

 

Anyone entering the world of prostate cancer investigation soon loses any remaining vestige of embarrassment. Not only will you be half-naked or more, sideways on the gurney with someone - male or female - you have only met a few minutes before doing all sorts of things up the main prostate access point, the anus, but there's all the open discussions about erections, semen, and peeing yourself, and perhaps Viagra, vacuum erection devices and masturbation, quite possibly in the company of your wife or partner, and all those student nurses whom you agreed to help to train. It's all been done and seen before, just go with it.

 

There were no specific symptoms of my prostate cancer. I was 74 years old, I had become used to needing to urinate often, and occasionally I had small leaks, and at 74 my sexual abilities had considerably waned. After some minor stomach pain I had two digital rectal examinations (DRE), the first from my GP suspicious, the second as a hospital out-patient clear. Six months later I had a 'leakage episode', which led to a third DRE and a referral to a specialist. Another eye-wateringly vigorous DRE, a MRI scan and a surprisingly painless prostate biopsy (but a lot of blood) followed. In mid August 2016 I was diagnosed with prostate cancer, Gleason 3-4, T2 a/b. My PSA was 4.2 (it has always been low). My prostate weight was 56 grams, normal for my age is 30. From then there was no going back.

 

The choice was radiotherapy or a prostatectomy (wait and see was not a serious contender). As the end effects were fairly similar I chose prostatectomy, I was happier to be done with it. My health area did not offer a robotic procedure, but I could have opted to attend a different health area that did. After some research I decided to go with an open procedure anyway. I didn't mind the scar, or an extra day in recovery, and the outcomes were similar. The procedure took place on a late November Monday afternoon in 2016. When I signed the last consent form the surgeon asked me to estimate my sexual prowess. We agreed on an optimistic 2 out of 5. His last quip before I put pen to paper and departed to the preparation room was 'You'll never get an erection again'. How true that was.

 

I woke later with a neat 5" vertical row of 21 metal staples and a catheter. I had intermittent moderate to severe pain in my right side, and greatly feared but managed to avoid having to cough. But these things pass, and on Wednesday I was ready to go home. I was discharged on Thursday morning, complete with an essential bottle of Lactulose laxative and a box of 25 syringes to inject into my stomach daily. Thanks to the Lactulose I managed to perform a bowel evacuation on the following Saturday, five days after te procedure. Putting the last empty syringe into the sharps box was a great relief.

 

The catheter and staples were removed by a very gentle male nurse 15 days after the procedure. For the rest of the day I couldn't stop weeing myself. Initially I used several incontinence pads a day which was quite depressing. However it quickly settled down and I have been fortunate enough not to require any pads either day or night, but I pee frequently and there are occasional leaks. I don't wear light coloured trousers.

 

For a couple of years I had a regular six-month PSA test and a consultation with the surgeon. Now I'm down to 9-monthly PSA test and a phone call for the results with the rather alarmingly named Survivorship Programme. My PSA. so far, has remained undetectable at the five-year point.

 

As I was 75 at the time of the operation, my sexual prowess had faded considerably, to the point where getting an erection was rare and ejaculation well, hard work, although my penile stretched length was still a reasonable 6 to 6.25 inches. After the operation the stretched length was reduced to 6 inches and the girth similarly reduced. Whether the operation was nerve-sparing I never definitively discovered. Perhaps there is no defining yes or no line. I used a Bathmate vacuum pump for a year or so but it produced some oedema which was quite scary so I put that to one side. I massaged my penis most nights and tried a few Kegel exercises when I remembered. After four and a half years to my surprise and delight I noticed a definite response to sexual stimulation, to the extent that my penis thickened and had some increase in length, almost a soft semi-erection. Although this was pleasant and very welcome, in no way was, or is, it an erection. This may be the same response to sexual stimulation I would have had at 79 years old if I had not had the prostatectomy: I will never know. An orgasm is still achievable with a flaccid penis and has been since the operation, usually dry with rarely some odd drops of urine, with a different sense of relief and occasionally prolonged and intense, but only with a great deal of visual and manual stimulation.

 

I have tried generic sildenafil (Viagra) tablets, easily available online or from your GP, to aid penile rehabilitation by encouraging blood flow through the penis (that's what you tell your GP). In 50 mg doses the penis does thicken considerably, and shows a noticable bend to the left and a thicker portion close to the glans. I do not know if this is caused by damage when inserting the catheter or the procedure itself, but it does not affect my normal life. I didn't try a 100 mg dose as a side effect was an accompanying headache. Since the return of some sexual response I can just about achieve the same effect by manual stimulation.

 

I have had some fluctuations with what I assume is lymphatic fluid. The fleshy and fatty pad in front of my pubic bone has swelled and subsided, and my legs and ankles occasionally do the same. I don't do anything about it apart from an occasional rub. My overall weight fluctuates too but usually resolves to around 12 st 4 lbs (78 kg) unclothed.

 

In June 2022 my PSA blood test returned a reading of 0.11. I am now on three-monthly PSA tests. If the reading returns 0.2 then I will be referred to a consultant.

 

In September 2022 PSA rose to 0.16.

 

In January 2023 PSA was 0.31 ug/l. Well, remissiom lasted six years, but it gets you in the end. I don't feel any specific symptoms, just tired eaily and I have lost a little weight, around 4 pounds over the last few months. Now over to the consultant.