THERE WAS NO RESPONSE TO AN UPDATE REMINDER IN 2012 SO THERE IS NO UPDATE.

Over the years immediately preceding my diagnosis for PCa, I was fighting an ongoing battle with thyroid instability, after a total thyroidectomy in 2000. Included in my treatment plan in 2005 and 2005 was the introduction of topical testosterone.

The use of this hormone, in the face of PSAs that were already hovering around 4, even with a small, smooth, symmetrical prostate, nothing palpable, meant my urologist felt it prudent to check PSAs every 4 months. Later in 2005 we saw a rise beginning, and finally with the PSA reaching slightly above 6 (not sure the exact number, seems someone organized my papers and I can't locate that yet, will revise later), it was decided to biopsy, and the result was PCa present, one lobe, 20%, Gleason of 7, and was staged based on this at T1C.

I was devastated, but not terribly surprised. Watching the slow rise in my PSAs I anticipated that eventually I would face this, and was preparing myself for this diagnosis (if you can call pa Nicky about the impact, and the potential losses to me) Up to that point, I had good sexual function, with some slight venous leakage, helped by the use of constrictive rings. PDE-5 inhibitors, and I tried them all, worked but variously, and gave me headaches.

My urologist told me to make a decision fairly soon, and left it in my lap (no pun intended). I explored IMRT (Intensity Modulated Radiation Therapy), tomotherapy (which would have involved 9 weeks of travel, living away from home, and also surgery (Da Vinci Prostatectomy). My urologist was OK with the tomotherapy, (even though I knew he far preferred to have it out)but said I'd need to go on Lupron for 6 months minimum.

Knowing the side effects of that modality of therapy, and dumping that on top of the thyroid fatigue and challenges I had been battling, I opted out of that. Since I am a Nurse Anaesthetist, the option of surgery felt comfortable to me, and after my reading I decided that Da Vinci was for me. It also limited the post op recovery, once again playing better into my hand that held a strong thyroid suit (fatigue, weakness, etc). Minimal surgical insult, OR time, small incisions, limited blood loss, etc.

I was operated on Jan 8, 2006 at Henry Ford in Detroit by Dr. Mani Menon. Dr. Menon was my personal urologist's choice and was also featured in a major news magazine the month before, so I felt I'll get the best result anywhere.

My recovery was very quick. Home in 24 hours, catheter out at one week with no leakage of the anastomosis, and done with pads by about 6 to 8 weeks. I have very little leakage still. I continued with PSA checks every 4 months for 2 years, then every 6 months. They have all been "undetectable".

As for sexual function, well, that is a different story. In spite of the "nerve sparing" approach, I have found very little response, no matter what I tried. Orgasmic function also diminished at first, but has slowly returned to normal now. I do have some filling in the morning, and some with sexual stimulation (actually a lot of stimulation over a long period of time, very focused effort), but no where near enough for sex, penetration. I began within 2 weeks of my surgery what I think was a fairly aggressive rehab program. PDE-5 inhibitor daily when I had them, VED daily at a minimum, and Trimix injections a few times a month.

The injections produced erections, although somewhat uncomfortable, and began to see some curvature, also required using a ring after injection to maintain the erection. I've stopped those some months ago, concerned about developing a Peyronie's, and also worried about the impact on the corpora in terms of scarring/fibrosis as it would impact sizing of a prospective implant.

I continue however, with the VED daily, and find it acceptable for both masturbation and intercourse, for up to 30 min. However, it is a pain in the ass, and after 2 1/2 years of pumping, and recognizing that I am long past the point of return, I've decided it's time. So I am now scheduled June 10 with Dr. John Delk at the U of Arkansas Med. Ctr, for an implant. Our discussion was that it will be an Ultrex 700LGX w/MS release. I am ready for this, and feel that my diligent pumping regimen has left me with a penis that flaccid stretches to a size very close to my erect size. So should get an implant that I'm happy with. We'll know in about 2 months.

My wife has been very supportive, in all regards, including her support and interest in the implant. Although in my mind I know that the most important aspect of this cancer treatment plan is that I don't die from it. And secondly that I have good urinary continence. Having said this, I have from the beginning been someone who has had a very difficult time with the changes sexually that this has wrought on me. I went through several months of depression and continue to have considerable loss of self esteem. For this reason, and in the light of what appears at this point to be a good result thus far w/ regard to PSAs and urinary continence, I have decided to deal with the sexual impact, and finally get what is a very successful, and well received solution to erectile losses, and get my implant. (I'm a Harley rider, so plan on renaming my penis, "Harley II".) Gotta laugh about this a little too.

I appreciate Glen's efforts here, and others that have offered wise and experienced counsel.

I will keep this site posted as to my progress.

Gary

The update would be, that in June, 2008 I underwent a penile implant at the Univ. of Arkansas in Little Rock, Arkansas. Dr. John Delk did my procedure, and all went well, and I am now very very happy with what I have. I too, like so many on our support group, wish I had not waited so damn long for it. Sorta would have been nice about 30 years ago:-)

My PSA are going very well, 5 years out, my PSAs remain at 0, so I'm very relieved, and encouraged, as is my urologist.

As for the implant, that has been a blessing. Unfortunately, my wife of 43 years and I divorced last year. I cannot say that the prostate cancer, and all that involved for me, did not have any role, but obviously after that many years, it was by no means the sole issue.

I have moved on, and with regard to sexual function, after the implant, I have dated several, and it has been a huge hit, for both my partners, and myself. I do have some difficulty with orgasms, but that is workable, and just being able to be fully intimate with a woman is worth tons to me. I know it is very personal, and perhaps for some, too much information, but all of my partners, love it, and have yet to meet a woman who was repulsed by the idea, quite the opposite. I think the big difference, is not just the ever present erection, but more the improvement in my self esteem, and confidence.

Thanks for your continued interest in helping men with the site, and the updates. I am willing to be a mentor to anyone who wishes to talk about any of it.

Gary Rich

Gary's e-mail address is: gary.r.rich AT gmail.com (replace "AT" with "@")

NOTE: Gary has not updated his story for more than 15 months, so you may not receive any response from him.