Live chat: sex and the prostate patient

2007-07-30 14:00:50.0 Administrator2: Welcome Dr. Lue, and thanks for chatting with us!

2007-07-30 14:00:55.0 kjohnson: Hello, my name is Kathryn Johnson and I read the article and wanted to know why proton therapy was never mentioned as a treatment modality?

2007-07-30 14:04:36.0 Dr. Tom Lue: Prostate cancer treatments are usually categorized as watchful waiting, hormone therapy, irradiation and surgery. Proton therapy is one type of irradiation therapy.

2007-07-30 14:06:14.0 kjohnson: The side effects from surgery and photon radiation seemed to be very extreme compared to those from proton therapy. Have you ever recommended proton therapy to your patients?

2007-07-30 14:06:15.0 kjohnson: Have you ever viewed the results of this modality?

2007-07-30 14:08:45.0 Dr. Tom Lue: Yes, I have recommended proton therapy to my patients and in fact one of my best friends had the therapy and he is doing well 5 years later.

2007-07-30 14:08:48.0 luir: Hi Dr. Lue: I’m a 76 y/o male and i was told that my PSA is 8.1 I feel no symthoms at all. What do you think my problem is?

2007-07-30 14:12:55.0 Dr. Tom Lue: Dear Luir:Yes, you definitely need to see a urologist. Several conditions can raise PSA such as infection, large prostate, cancer etc but only the doctor can determine it.

2007-07-30 14:14:04.0 Administrator2: Hi visitors, just an FYI-- we have a fair amount of questions here, so we’ll get to them as soon as we can-- don’t think your questions are being lost!

2007-07-30 14:14:08.0 al: What can be done to regain natural sexual ablity and maintaining urinary control after surgery.

2007-07-30 14:18:24.0 Dr. Tom Lue: Dear al:To regain urine control, the doctor or nurse will usually teach you to do muscle exercise such as Kegel exercise to build up the strength of the sphincter muscle. For regaining sexual function, the doctor usually will prescribe medication such as Viagra or vacuum device or penile injections to improve blood flow to the penis and speed up the recovery.

2007-07-30 14:18:32.0 ken: Hello, prostate was remove in 1996. And in 2000 I had a Sphincter in planted. I did not have erection after 1996 except twice after the Sphincter surgery. I the pills and the pump do not work and I have to inject myself. Finally, I have shrinkage. The article indcates normal I can regain normal size and sex life. How and where do I go? I live in West LA?

2007-07-30 14:23:29.0 Dr. Tom Lue: Dear Ken:Losing penile length can happen with old age or after prostate cancer treatment. If you use vacuum device several times a week, it may prevent further loss of length. However, it is difficult to get your normal length back. I would suggest that you see a urologist to discuss further treatment.

2007-07-30 14:24:26.0 kenwah: Having gone on disability after my radical prostatectomy, due to nerve damage in my left foot, I would really advise men to do some very deep “soul searching” before plunging into the reccommendations of most urologist’s to have surgery immediately. I’m not saying to NOT have the surgery, but at least thoroughly ask about ALL treatments and verbally voice all concerns regarding surgery. Including post operative conditions that will most likely arise.

2007-07-30 14:24:28.0 kenwah: I am a male 55 y o who underwent a radical prostatectom in Sept 05 and I have had subsequent nerve damage in left foot and also a severe strain to my sex life. Are doctors today a little “too eager” to insist on this operation?

2007-07-30 14:28:43.0 Dr. Tom Lue: Dear Kenwah:I do not do prostate cancer operation so my opinion is impartial. Yes, most doctors like to protect their territory so the radiation oncologist think radiation is the best, urologist think surgery is the best. But a good doctor should be impartial and give the patients all options, discuss risks and complications and let the patient make an informed decision.

2007-07-30 14:29:23.0 Patrick: I’m a prostate cancer survivor, I had tomo radiation and 24 hr seeded due to the advanced stage of my cancer. Everything in the article pretty much sums up my situation, shrinkage and not much desire. I also had 1 year of lupron treatment which has dropped my testosterone level down to 58 to 64. But I found the artilce very interesting and maybe theres some hope out there to restore some of the missing activity. Patrick

2007-07-30 14:29:47.0 Jim Cowles: Does Bicycle riding hurt the prostate?

2007-07-30 14:32:24.0 Dr. Tom Lue: Dear Patrick:You will regain some sexual drive once the hormone level comes back to normal range after completing Lupron therapy. You need to discuss with a urologist about therapies that can prevent penile shrinkage such as vacuum device or pills.

2007-07-30 14:34:23.0 Dr. Tom Lue: Dear Jim:In general, biking does not hurt the prostate unless you sit on the seat for a long time. This may cause mechanical compression and congestion of the prostate. You can take hot bath to relieve the congestion.

2007-07-30 14:34:34.0 kenwah: I was told that the radiation treatment was a “temporary” fix, and that looking in the future, I would be dealing with sexual dusfunction and anal leakage and itiching. Obviously, not a good prognosis or a directive I wanted to follow. Thank you at least, for your forthrightness on this subject.

2007-07-30 14:34:40.0 steve: I had radiation seeds implanted in 2000. Ejaculate is clear without any discernable “white” or sperm. Would there be any chance whatsoever that active sperm is in the ejaculate? Otherwise, my results have been fine. Would recommend radiation for anyone. Erections are about 90-95% of the size before implants and follow up external radiation.

2007-07-30 14:37:31.0 Dr. Tom Lue: Dear Steve: Most of the ejaculate is made in the seminal vesicle and the prostate and only less than one % is sperm. After radiation, you will have very little semen but you may still have sperm. The best way to find out is to have a semen analysis. Your doctor can order one for you.

2007-07-30 14:37:34.0 funkdelux121: Dear Dr; I’m 45yrs and had a normal prostate exam a year ago. This past January I told my doctor that I was having a decrease in sex drive and a slight dribble after I urinate. My doctor said that I might have prostitis and ordered a blood test. A couple of weeks later my doctor said that the blood test showed no problems and that I shouldn’t worry. But I still have no sex drive and still dribble. How should I direct my concerns to my doctor and what can I do on my own? By the way, i do have a vasectomy. Thanks...

2007-07-30 14:38:55.0 Administrator2: Hi folks, we have quite a backlog of questions here, so please bear with us! We’ll get to as many as we can, as soon as we can. Thanks!

2007-07-30 14:39:03.0 kjohnson: To Kenwah, ask your Dr about the advantages of proton therapy compared to photon radiation, you will not have the side effects.

2007-07-30 14:41:32.0 Dr. Tom Lue: Dear funk:Decrease in sex drive can be due to many things such as low testosterone, high prolactin, stress, marital problem, medications etc. You can certainly discuss with a doctor who specialized in sexual function. A little dribble at the end of urination is a common phenomenon in men over 40-50 years old. It is not a disease.

2007-07-30 14:41:35.0 wfoster: when would a supra pubic partial prostectomy be advisable over drug (proscar) treatment or green light laser procedure. my prostrate is approx 310cc and causes approx 300cc urine retention.

2007-07-30 14:45:53.0 Dr. Tom Lue: Dear wfoster:All 3 treatments can help your prostate problem. Proscar can shrink about30% of the prostate and may help your symptoms. Both of the operations can cure your problem. Which one is better? It depends on the experience of your doctor.

2007-07-30 14:46:41.0 Steven: Administrator: With only 20 minutes left to this session, and a lot of questions to be addressed, please direct all of us to the visiting doctors for one-on-one consult. Thanks

2007-07-30 14:47:12.0 Administrator2: Hi Steven, very good point-- thanks. And Dr. Lue has very kindly consented to stay a bit late so we can get to more questions.

2007-07-30 14:47:20.0 Steven: DR, i am 49, had the prostate surgery a 18 months ago, and now experiencing the “shrinkage” you alluded to in yesturdays’ paper

2007-07-30 14:47:21.0 Steven: Would I be a cnadidate for the “protein” therepy?

2007-07-30 14:50:39.0 Dr. Tom Lue: Dear Steven:I did not see the article (I am in SF) and don’t know what is the “protein” therapy. But you can certainly ask your doctor about vacuum device and pills or injections to prevent shrinkage.

2007-07-30 14:51:06.0 woneil: Hi Dr Tom, Can you describe the recovery process after the different treatments for prostrate cancer with regard to incontinence? Is the robotic surgery quicker to recover from in this area?

2007-07-30 14:55:04.0 Dr. Tom Lue: Dear woneil: Robot is a tool, just like knife is a tool for surgeons. The most important is the doctor’s skill and experience. At this time, the major advantages of robotic surgery are less blood loss and smaller scar as well as less pain. Can’t say much about impotence and incontinence yet.

2007-07-30 14:55:12.0 laurence: Dr. Lue: You keep mentioning ‘pills’ for shrinkage. What is the name of the pills?

2007-07-30 14:57:44.0 Dr. Tom Lue: Dear Laurence: Impotence pills such as Viagra, Levitra or Cialis. There is a study showing in men who recovered potency have less penile shrinkage than those remain impotent.

2007-07-30 14:58:05.0 joe: are there any new treatments for nocturia?

2007-07-30 14:58:08.0 joe: Is nocturia related to prostate health? Are there any new treatments for it?

2007-07-30 14:58:09.0 joe: Is testosterone therapy risky?

2007-07-30 15:00:21.0 Dr. Tom Lue: Dear Joe:Yes, there are good treatments for nocturia. You need to have your doctor do some tests to find our whether it is due to overproduction of urine, incomplete emptying or overactive bladder so the treatment can be directed properly.Testosterone therapy can be harmful if it is not monitored by a doctor.

2007-07-30 15:00:28.0 carlo: How do you overcome “ED” if you have high blood pressure and type-2 diabetes?

2007-07-30 15:00:42.0 larry: can you please email a link to the article being referred to in these questions, thanks - Lweinstein11@yahoo.com

2007-07-30 15:00:52.0 Administrator2: Hi Larry-- here’s the link: https://www.latimes.com/features/magazine/west/la-tm-prostate25jul29,1,5293820.story?ctrack=1&cset=true

2007-07-30 15:02:57.0 Dr. Tom Lue: Dear Larry:Both are bad for penis. If you control your blood pressure and sugar well, eating right and exercise regularly, you may see improvements. If not, you need to see a doctor to get treatment.

2007-07-30 15:03:09.0 steve: I’m 65 and my psa is 3.8 and have some problems with urination. Digital examination indicates no enlargement. I have little or no ejaculate. Is this a sign of a prostate problem?

2007-07-30 15:04:29.0 Dr. Tom Lue: Dear Steve:If you have some problem with urination and have little ejaculate, you do need to see a urologist.

2007-07-30 15:04:34.0 bc: Re shrinkiage, the article referenced you, Dr Tom Lue, as “experimenting with injecting several agents, including a protein ‘growth differential factor,’ into the area of the traumatized nerves.” Is this still only experimental?

2007-07-30 15:06:52.0 Dr. Tom Lue: Dear bc:The protein therapy is still experimental. The therapy is designed to help the damaged erection nerve to grow back. For shrinkage, you can use vacuum device to prevent it.

2007-07-30 15:07:12.0 laurence: Is there any demonstrated differerence in the potency or effectiveness of Viagra vs. Cialis or Levitra?

2007-07-30 15:08:41.0 Dr. Tom Lue: Dear Laurence:The potency and effectiveness of the three are about the same. The difference is in side effect profile as well as the duration of action.

2007-07-30 15:09:02.0 Don: I had a radical cystectomy 5-6 years ago, and my prostate was removed as part of the procedure. I have a penile implant, but it provides stiffness but doesn’t affect size. Is there anything that can be done to increase size at this point?

2007-07-30 15:11:41.0 Dr. Tom Lue: Dear Don:The size cannot be increased right away. However, if you pump up the device several times a week, the prosthesis will stretch the penis from inside. After a few years, when the device needs a replacement, the doctor can usually put a longer one in.

2007-07-30 15:11:44.0 laurence: well what ARE the various side-effects of the three pills? Cialis lasts a weekend, but is there a difference in the length of effectiveness of Viagra vs. Levitra?

2007-07-30 15:14:22.0 Dr. Tom Lue: Dear Laurence:The side effects of Viagra and Levitra are similar: headache, flushing face, indigestion, blurred vision. Cialis has the same side effects except it does not interfere with vision but may cause backache.

2007-07-30 15:14:44.0 Kent Oleson: Because of surguy the pill did not work and injections only work part way. Will a pump do better.

2007-07-30 15:16:12.0 Dr. Tom Lue: Dear Kent:Yes, you can certainly try vacuum device alone or with pills. It may work for you.

2007-07-30 15:16:25.0 bobby: doctor, i am 41, have some reduction in urine flow and some inability to completely void when urinating. i am on medicice which makes erection difficult and orgasms feel strange

2007-07-30 15:16:26.0 bobby: also, is the laser procedure where a i dont know the term but the roto rooting of the interior part of the prostate to improve urine flow. what are the percentages of sexual side effects, and what is the prognosis of this?

2007-07-30 15:20:04.0 Dr. Tom Lue: Dear Bobby:I think your problem can be managed with medicine. You may need to try different medications or a combination of two medications. Your urologist can work with you to improve your condition. It is unusual for a 41 year old to need prostate surgery.

2007-07-30 15:20:13.0 victor: I checked out some library books on prostate herbal remedies. I found the Saw Palmetto (85% fatty acids & sterols) to have reduced the slight pain, increased urine flow and reduced the excess urine. I started the regime 2 weeks ago.

2007-07-30 15:20:14.0 victor: Do you know the effectiveness of pumpkin seed? Have there been any studies on this herbal remedy. Saw Palmetto has no side effects.

2007-07-30 15:20:22.0 bobby: is there a better medicine which has very little side effects?

2007-07-30 15:20:24.0 victor: Bobby - I have found Saw Palmetto to help expel urine completely. The orgasms are getting closer to normal. I’ve been on Saw Palmetto (85% fatty acids & sterols) for about 2 weeks. I have noticed improvement within 3 days. I got the Saw Palmetto from Trader Joe’s for only $6.99 (100 tabs). This is about $15.00 cheaper than most other brands.

2007-07-30 15:21:32.0 bobby: thnk you

2007-07-30 15:23:24.0 victor: Bobby - The Saw Palmetto regimen is two 160 milligram tablets per day.

2007-07-30 15:24:29.0 Dr. Tom Lue: Dear Victor:I am glad that Saw Palmetto worked for you. A recent study showed that it does improve symptoms. However, patients on placebo also have the same kind of symptom relief. Therefore, I don’t think there is a scientific proof at this time.

2007-07-30 15:24:31.0 joe: After ejacalution, I suffer 3 to 4 days with extreme exhaustion, dried up fingertips (all 10) and poor cognitive function. From my research it’s extremely rare and no known treatment. I just started Levitra and it may have worked but it could be a placebo effect. Any clues that I can bring to a Forum with a few desperate people like myself?

2007-07-30 15:24:32.0 joe: the symptoms I described have been studied by a Dutch doctor. Referred to as Post-Orgasmic Illness Syndrome (POIS)

2007-07-30 15:27:17.0 Dr. Tom Lue: Dear Joe:Don’t know much about this syndrome. In general, if you exercise regularly and keep normal weight, you will be able to recover faster from the “exhaustion” after orgasm.

2007-07-30 15:27:24.0 Rick: Hi to all i was recently at urologist office and i told my doctor that i was not haveing a normal flow of ejactulation and he said i need to see a sex therapist. However i have seen one last year and it did not do any good. He orderan ultra sound on my testicles and found a small mass. I told him again i was haveing the problem as i have mention in the begining. Again he suggest sex therapist. so what you suggest?

2007-07-30 15:29:45.0 Dr. Tom Lue: Dear Rick:It is normal to see less ejaculate and experience less force of ejaculation when a man passes 40 years old. It will not do any harm to your body and you can still have normal fertility.

2007-07-30 15:30:19.0 victor: Dr Lue: Actually there have been scientific studies in Germany and Switzerland that have found it to be 65% effective. I am not sure how effective is this percentage in scientific terms, but it works for me (so far). Saw Palmetto is commonly prescribes in Europe. I am not aware of US studies. I’m sure the pharmaceutical companies don’t want this information to be public because they would lose money.

2007-07-30 15:30:23.0 ken: One more question. Why was I able to regain normal sex after 4 years, when I had the Sphincter inplanted, but only to lose it again?

2007-07-30 15:32:59.0 Dr. Tom Lue: Dear Victor:What I mention is a VA study and has nothing to do with a drug company. Most of the studies have no placebo control. The VA study was well designed and had a placebo control arm.

2007-07-30 15:34:29.0 Dr. Tom Lue: Dear Ken:Sexual function has nothing to do with your artificial sphincter. There must some other reasons for the loss of sexual function. I would suggest that you check with your doctor.

2007-07-30 15:35:18.0 Administrator2: Unfortunately, we’ve run out of time. Thank you all for coming to the chat, and thank you, Dr. Lue!