I mentioned my prostate a few months ago—a walnut-sized gland, tucked under the male bladder. You’d think, by its choke-hold on your urethra, that it is hanging over empty space, like Luke desperately gripping the Cloud City maintenance walkway. It is not. It is packed in like an iPhone chip.
Sometimes that grip is the problem. Prostates get old, they get irritated, they swell. They wake old men up at night, unable to vent their bladder. But mostly they are very quiet. Even when they become cancerous. Prostate cancer arrives with no warnings, no symptoms. It is insidious enough to have become the leading solid organ cancer; insidious enough to become one of the leading causes of cancer deaths among men.
And that’s where packed in like an iPhone chip becomes a problem. Surgery is one way to fight back against a cancerous prostate. Think Darth deli slicing—and presumably cauterizing—Luke’s wrist. While Luke simply dropped away at the Bespin gravitational constant, the packed-in prostate only comes out with other stuff attached. Part of your urethra, for example. And a few key nerves. As you might guess from their neighborhood, these nerves control urinary continence and sexual response.
In fact, urinary incontinence is a common post-surgical complication with a radical prostatectomy. I was pretty lucky in that regard. I could almost whiz at will right off the bat. And any problems got rapidly better. Five months in, an occasional drop gets through the faucet. But, hey, at 61 I was headed toward some leaky plumbing anyway. So I can’t really complain.
The other common post-surgical complication is sex. More precisely, the inability to have it. And you’d think that might be from a lack of seminal fluid. In its quiet unassuming life under the bladder, the prostate produces seminal fluid, that protein that carries sperm down your urethra to form ejaculate. Gone now, and with the vas deferens also cut by the surgeon, there is no ejaculate. But that is not the problem. It is quite possible to have a dry orgasm.
No, the problem is in those key nerves that get cut. Some control blood flow into the corpora cavernosa. They are the last switch on the track that sends the erection locomotive into the station.
Nerve-sparing technology—especially when used with robotic laparoscopic surgery—is meant to leave some of these intact. But that is not always possible. Exactly where the nerves are located is one issue. But exactly how close the surgeon must cut to the margins of the prostate is another. In my case, the primary goal was being alive 15 years from now. The secondary goal was to be able to pee when I wanted. Sex was third. That might sound strange, I know. But, like I said, I’m 61. I only know one way to live. I know one way to pee. But when it comes to sex, I know more than one way to skin a cat.
So, my prostate came out in its entirety, like it never existed. With it came those key nerves. Now lost in a trance, my penis no longer pays any attention to the world around it.
Rooting the waltnut-sized gland out completely means it was also possible to completely dissect it. (Along with some of the lymph nodes in my groin.) The resulting chopping and grinding revealed that the cancer had not spread to the margins of the prostate. Which means it had most likely not spread.
That’s good news. Barring other cancers, car accidents, a massive stroke, stray bullets, ebola, pit bull attacks, a repeat of the Spanish influenza—or whatever ancient evil virus is being released from the melting permafrost—I might actually be alive 15 years from now. To be sure, I’ll get semi-annual PSA tests for a few years. And not just any PSA test. A normal PSA test looks for that prostate specific antigen in parts per milliliter. To get serious, they test me now in parts per nanoliter. I went back to the surgeon yesterday to hear the results of the first such test since surgery. Mine was a statistical zero. Not a trace of that antigen, peculiar to prostate cancer, was found in my blood. So, yay!
Me and the doctor are very happy with our primary goal. We are pretty happy with our secondary goal. My urinary control is not perfect. But it’s close enough.
The tertiary goal needs some tweaking. The problem with being 61 is that you are only 61. Not getting an erection at 81 might fall into the category of the coffee maker being on the fritz. At 61, you are not really ready to hang up your jersey. What to do? Sildenafil—or tadalafil, vardenafil, udenafil, and avanafil—only works if your nerves are able to signal for blood flow. With no blood flow at all, vasco dilators are out. We could simply wait for the nerves to regenerate. You know, skin the cat some other way for awhile. But nerves regrow slowly. It may take years after a radical prostatectomy to be able to have a spontaneous erection. The problem is, that after a protracted period without blood going into the erectile tissue, the tissue starts to deteriorate. The sponge gets less spongy. (Yes, wives, that nocturnal erection your husband gets isn’t just because he’s oversexed. It’s partly biological housekeeping.) Apparently this deterioration can happen in months let alone years. So waiting too long ensures some damage will be done.
So we’re off on a new adventure. The scars are healing. The plumbing is as tight as can be expected. My PSA level is exactly where I hoped it would be. Now, my wife and I get to select an ED treatment. It’s not exactly the stuff of dreams. But, it’s the next chapter in our little saga about a walnut-size gland.