After the recent PIVOT (Prostate cancer InterVention vs Observation Trial) study results were published last year, having your prostate cut out in response to a prostate cancer diagnosis is certainly a less attractive treatment option. Because the study shows it doesn't really work that well, especially for early detection cases. In fact, more people who did nothing--the control group--survived when compared to the surgery group, but that is just a sampling phenomenon.

Prostate surgery really affects us. We're a community of men dedicated to enjoying sex later in life.  

While I personally don't think that any man should choose prostatectomy, I can't add the caveat that you should make the decision in concert with your doctor. The reason is, your doctor is a urologist, a surgeon who believes that prostatectomy really works because he has based his entire career on that assumption. So, you get fed a pack of lies, and lies by omission. My urologist lied to me, but he's not a bad guy. I really, really like him. He's been telling these lies to men for years and sincerely believes they are the truth. So, you're going to have to make the decision on your own.

Here's what you'll get in a nutshell.

1. No urologist will tell you that prostatectomy will *shorten your penis*. Who the @# want's to hear that? My poor willy is at least 1.5 inches shorter now when erect vs the day before my surgery. If you are hung like a horse you probably will be fine, but I was average at best to start. Now, I'd lose a dick measuring contest at a Korean middle school.

2. Your urologist will tell you that over 90% of men regain their sexual function. Lie. There have been around 10 studies over the years of post-prostatectomy sexual function, and only ONE of them reported such happy news. And that study was done by a famous surgeon and fabulous salesman (John Walsh) who makes his living cutting out prostates and running the wildly successful department at Johns Hopkins that hacks out thousands of prostates every year. The real percentage: nobody knows for sure but it's probably more like 50% of men who can have erections after prostatectomy without injections.

3. Your urologist will tell you that "most men" are continent after prostatectomy. Nope. Again, about half will drip urine for the rest of their lives. Try getting a BBBJ now, bucko. There are interventions for this, surgically implanted artificial urinary sphincters. But guess what, they don't work that well! Or, they work at first but then fail after a few years. So, it's pads and pull-ups. We don't call them diapers.

4. Some men -- around 5-10%, maybe more--nobody studies this shit--will lose their ability to have an orgasm. For those who can have an orgasm, many report that the orgasm is different. My own are much diminished. A few men will find orgasm is painful after surgery, a condition known as anorgasmia. You won't hear about any of this from your urologist.  

5. A good number of men who have surgery--around 20%--DIE ANYWAY from prostate cancer. So you get all of this good stuff above and still wind up with an always fatal, metastatic case.

So what should you do? There are some who say "nothing." Surgeons have to perform 14 prostatectomies to save one life. The other 13 don't necessarily die. The majority by far live with the disease for the rest of their lives. A few more die from prostate cancer but would not have been saved by surgery anyway. One thing for sure, all 13 won't have to endure the crap that I've told you about.

For those who can't stand idly by, there are other treatment options. Beam radiation, seeds, cryo, ultra-sound. These aren't 100% effective treatments either, but they are about as effective as surgery, and they all have less severe side-effects than surgery. Radiation in any form does cause loss of sexual function, but it almost never causes incontinence. Maybe it doesn't shrink your penis, either. Nobody has ever studied it, so who knows? I know one thing, it's 100% certain that prostate surgery shrank mine.

The biggest problem is not prostate cancer. It's a slow, slow cancer that most men would eventually get if they lived long enough. The problem is fear, and the decisions you make when you are afraid. Fear makes us susceptible to misinformation.

great post..the truth be told..be very wary gentlemen..

I only know one guy that claims no side effects from having his prostate removed, and who knows, he might be lying.  Everyone else I know has had varying degree of problems afterwards.  

The only personal account I trust came from my father, who drew the short straw and had almost all the negative effects you stated when he had his removed when he was about 78.  They first used the seeds, and then finally removed it.  He's now 93, but the only time I've ever heard him breakdown was when he was describing to me how they botched his surgery and ruined his life.  Here's a guy that survived getting shot at  for four years in the Navy during WWII, but it was the negative effects of his surgery that was more than he could take.  

Needless to say, this has had a profound effect on me as I'm now 63 and wondering if I'll share the same fate.  It's a travesty that we get "awareness" of every other fucking disease or condition endlessly jammed down our throats, but prostate cancer, the one that really matters to most of us, remains the subject nobody wants to discuss openly.

Thanks for your post and good advice.  Until there are better answers and solutions available, I think being both cautious and a bit skeptical about any course of treatment is highly recommended.

The OPmade a great post.. I think , however, anyone should balance this great information with their personal situation.

My brother in law had his Protate removed at the age of 53.. I have not wanted to bring this up with him and ask about side effects.. The guy played basketball in HS & college and was drafted by the pros.. but injuries made it impossible to play so he went to law school and is now a very successfull attorney in a large city.. translation- He always got more ass than a toilet seat..He married a gorgeous much younger woman when he quit playing around and now I wonder how he feels about all of this.. He had an agressive form of prostate cancer, soof course, you should pay attention to what a doctor may tell you and your individual situation... at his age and with his diagnosos I would have made the same situation..He's got 3 kids that he wants to see grow up..

I'm 64.. If I got the typical diagnosis.. I suspect I would opt for non-invasive treatment.. My Dad had the rooter rooter treatment for a swollen prostate and he was always peeing his pants after that until he died 2 years ago..

Incontinence is a problem with this procedure, too. Sanctura is a drug that helps a lot. I don't have problems holding it now that I'm on that medicine. Dick got smaller, hard to get a sustained erection, but do climax. The worst experience was right after the biopsy--I got sepsis. Got really sick. Really, really, sick. My brother had surgery and didn't have problems getting an erection, according to his wife. He later died of stomach cancer..

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but a close relative just went through several months of Female Hormones treatments (shrinking dick syndrome) but it reduced the size of the aggressive type cancer followed by targeted radiation.  He has been declared cancer free.  Supposedly, now the that the hormone treatments have stopped, the natural hormones are supposed to return.  He's married to the Wicked Witch of the East, so sexual function is unknown.  (He should hobby but hat's his decision to make or not.)

This sounds like "chemical castration", depriving the body of 100% of its testosterone.  It's a treatment for very agressive cancer but the possibility of a woody is slim to none.  They do have implants, some with a little pump they install in your nutsack (seriously, I'm not kidding), and I suppose that's better than nothing, but it doesn't appeal to me.  I had surgery two years ago.  I have to say that some of the original observations are true and it's very controversial if treatment is necessary at all.  But I did have a friend die of prostate cancer and it was really hard to watch.  He had been a vigorous very healthy athlete and two months before he died he was skin and bones, unable to even walk without help.  So when I was diagnosed I sought out many opinions.  Even the radiologist told me to have surgery.  For those who know about Gleason scores, mine was a 4+3 and when they biopsied the whole little bugger they came back with 4+4.  So, yes, I have to inject my johnson to get a decent hard on but compared with dying of cancer I think it's a small price to pay.  And the dribbling does decrease with time, it's almost non-existant now.

Last I heard, he's feeling better without the F/M hormones.

I was fortunate to have a friend rave to me about his experience with Proton Beam radiation a few years before I was diagnosed. With that heads-up, when my time came, I did a lot of reading and decided to go through that treatment. Proton Beam radiation is one of two major types of beam radiation therapy that was pioneered at Loma Linda Medical Center in Southern California over 20 years ago and is now available at more than 10 centers around the country. I chose this treatment because of cure rates similar to the other effective treatments, but with far less side effects, often none.

I finished my treatment a little more than a year ago. During and after the treatment I had NO side effects. NONE! Zero incontinence, zero impotence, zero loss of vitality. I'm an active guy and contined to hike, bike, jogg and ski during and after treatment. I'm not from California, so I was a temporary "bachelor" with an apartment during my 9 week treatment, and I hobbied more than ever throughout my treatment. I had a blast! To all the ladies who comforted me during my "difficult" time, THANK YOU - LOL! My penis definitely has not shrunk! From my reading and talking with other guys going through treatment, it sounds like minimal to no side effects is the norm. My friend had his treatment about 5 years ago and had some VERY minor side effects during treatment, which disappeared soon after. At 70 he remains an active skier (instructor, actually), cyclist, and apparently is happily very active sexually. We both have no indications of any return of our cancer.

Had robotic prostatectomy, 5 years post op.  No incontinence or erectile issues.  Endurance has been the only issue I deal with.  Good for 1/2 hr. to 45 min.  Beyond that my peter tires out, so I can't dawdle too long.  Not clear if this is advancing age, though, my being past 60.  I'm allergic to Viagra, so I would have been seriously disappointed if I had had more side effects.  

Cancer gave me some intimation of mortality, so I hobby on more than before!

I have BPH and going in for my second prostate biopsy in a couple of weeks. Given the PSA levels, probably about a 50-50 chance of cancel. My last biopsy, 10 years ago was clean. I jumped on the internet and ordered a DVD from Loma Linda regarding the procedure you mentioned, since I live in So Cal. Thanks again!

I got out of a miserable marriage, and started hobbying. Nothing like having your own mortality, staring you in the face, to make you re-evaluated your life priorities. Each new girl that I yearn after is added to my buck-list. And, it's so much pleasure and fun to realize each one.