In 2018, the United States Preventive Services Task Force made the following recommendations regarding prostate cancer screening:

https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening

These recommendations were based on a single study that showed that men diagnosed "early" with prostate cancer lived about the same length of life as men diagnosed "late" with prostate cancer.  They concluded that since screening and early detection of cancer was not extending life, and might result in a 5-10 minute uncomfortable procedure (a prostate biopsy), that we should reconsider prostate cancer screening.  In doing so, we can decrease the diagnosis of prostate cancer, and thus decrease the expensive treatment of prostate cancer which can result in harm to the patient.  With Medicare spending out of control, and an increasing Medicare population (10,000 baby boomers retiring daily), if we don't screen, we won't diagnose cancer, thus decreasing expensive cancer treatment which results in saving Medicare money.  

Here's the problem IMHO:  

If I ask you what is more important to you, "how long you live, or how well you live", which would you choose?  Truthfully, I think most would choose both.  I want to live a long time and have a good quality of life!  If you treat significant prostate cancer early, before it spreads, it can be cured.  However, if you find it late, after it spreads, it can't be cured.  At that point, the cornerstone of treatment is chemical castration (reducing your testosterone to castrate levels) because testosterone makes prostate cancer grow faster.  Removing testosterone slows down prostate cancer growth.  Thus, with metastatic prostate cancer, and chemical castration, the growth of prostate cancer can be slowed to allow a normal length of life.  However, testosterone is a large part of what makes males into men.  Without it, you have hot flashes, you lose your sex drive, you lose muscle mass and bone density, you are prone to early onset dementia and depression, you have much less energy, and your ability to focus decreases, etc. for the rest of your life.

The linked statement above doesn't mention anything about chemical castration and living years with the side effects.

To make matters worse, it clearly states that you should have a discussion with your patients and respect their decision whether or not to continue prostate cancer screening (i.e. an annual PSA blood test, and a rectal prostate exam or "DRE") between the ages of 55 and 69, and to not screen men over 70.  This is based on an average life expectancy of 78yrs.  However, 78yrs is the average taking all comers, including those who die in car accidents in their 20's, heart attacks in their 40-50's, and those who live to 110.  The longer you live, statistically, the longer you will live.  Someone who is healthy at 65 has a better chance of living longer than 78 than someone who is 10.  Not everyone is going to die at 78.  People are living longer and are more healthy longer than ever before.

What many primary care physicians and providers have taken away from that statement above is "I don't have to do prostate exams anymore".  It doesn't say that!  At my last physical, my Nurse Practitioner told me that she was trained that she shouldn't do prostate exams.  I still requested one, and she refused.  

Bottom line, not everyone with prostate cancer needs to be treated.  Some men with low grade cancer can be watched and avoid possible complications of cancer treatment.  However, we will miss the opportunity to cure the men with more aggressive cancers if we don't screen and diagnose the cancer before it spreads.  Truth is, if you live long enough, you will likely get prostate cancer.  You will probably die with it, not of it.  But some will die of it and it is a slow painful death.  

If you have a family history of cancer, or if you are African American:
-you should start screening at age 40 with an annual PSA and DRE.  
If you have multiple family members with prostate cancer or a family member with high grade (aggressive) prostate cancer:
-you should get genetic testing to see if you are at risk.  There are genes associated with prostate cancer that are also associated with an increase risk of pancreatic, breast and ovarian cancers.  
Those with a strong family history of breast, ovarian, or pancreatic cancers, should also get genetic testing.

Otherwise start annual screening at age 50.  After 70, the DRE is optional, but the PSA should be done as long as you are in good health. In fact, it's probably worth getting a PSA in your 40's just to be safe.  If it's low (less than 1.5ng/ml) then wait until 50 to continue.

PSA should be age adjusted.  Prostates grow with age and bigger prostates make more PSA.  Someone in their 70's with a PSA of 4ng/ml is probably OK.  But someone in their 50's should have a PSA less than 2.5ng/ml.

Just my 2 cents.

My co-worker's wife said it is one operation she really appreciates. She said the lack of ejaculation makes it great. No more decision to spit or swallow and no creampie or wipe up clean up. She said she wish he got it much sooner to when he found out.

I go in for my 2nd biopsy middle of this month.
Diagnosed with the lowest grade cancer & have been in monitoring mode for 2 years.
I'm not looking forward to this, taking 2 days off from work too.

On a more serious note, glad you’re doing well.

depends on your surgeon. there's several really good surgeons out there. i was up and at 'em 6 days after surgery. remain continent and everything works. the hard part with the catheter for me was having my dick taped to my knee for a week.

Just wait until yo go to pop a nut off thats a whole new experience
It was 3 months after my Urolift and it still hurt

They told me that they could monitor mine for a year or so and see what happened but after the biopsy I said "Screw that, I'm getting the surgery".  With how the cancer was so widespread across nearly my entire prostate I'm glad I went ahead and had it done.  

Good luck, I hope everything goes well for you.

I thought once you got the surgery you loss the ability to make a boner?

People also say low T makes you not have the boner either...that's a fuckin lie....my total T is like 120 on a scale that doesn't even start til 180....and I am a walking bone-dee

@guyknight

you care to explain?

My wife would be HIGHLY disappointed. The cream pie is her favorite part.

I was diagnosed with Prostate Cancer back in October, PSA results were a little high for being 48yo at a 4 but not terrible.
But I was having other symptoms like blood in Urine and Semen.

MRI discovered a tumor and then off to a biopsy which discovered early cancer cells in 3 of the 12 biopsy cores and just a Gleason of 6 (3+3) but the doctor was concerned with the size of the area.

I'm just starting the process of monitoring right now, next blood test is in March

I keep thinking to have the RARP but I'm a single guy and I am concerned about the recovery of function/erection after surgery

Glad you are doing OK.

I'm 67 and was diagnosed 3+3=6 in August of 2020 and have been under active surveillance ever since. Doc says at my age, I'll likely die from something else.

Luckily your numbers are a little better than mine were so waiting a while might work better for you.  It's a tough fucking decision for sure.  Maybe die of cancer in the next 5, 10, 15, 20 or 30 years or get it out early and run the risk of being limp dicked and pissing yourself for life. I really struggled with it for a while but with how widespread mine was and showing signs of extracapsular extension, I think I did the right thing... provided my erections come back that is.

Its painful for the first couple of months and even 3 years later it still isnt like it was before
I should add that the first nut was like being kicked in the balls as you start to squirt

Do you have a normal sex drive post-op? Or does that (hopefully) come back with the boners? Will you report back here when the ol' pork sword has its comeback eruption? It's going to be like Krakatoa after a year on the sidelines.

I had BPH. Ended up getting a HOLEP proceedure done, after 7 months of a catheter. The catheter sucked. I had the surgery, came home, and two weeks later I was back in for bleeding. That was back in August.

I still wear a diaper. Not so much for not being able to control my stream, but, every now and then, just a little dribble. I still get wood, just, not a lot to do when it happens. I did start hitting the weights, and fixed my diet. I've dropped about 25 lbs in as many weeks.

For info, my prostate was 300 ml. The average is 30. Since I am a lymphoma survivor, they ran cancer tests, but I came back clean on those, and clean on my pet ct. Consider myself lucky. Hang in there, do the kegels. It gets better.

Well I still seeing the wife's books so I think the drive is there. Honestly, I've been so swollen and sore until the last 1-2 weeks I really haven't had much time to ponder it.  I'll be starting my "rehab" this week so maybe things will start to happen soon.



300!  Holy shit!  I can't imagine how rough that must have been.  Mine was 58 and the only symptom I had was a slightly reduced flow.  Good luck
brother, I hope you find some relief.

Glad your recovering OP, hope it continues to get better for you.

I was diagnosed in 2022 (age 53), PSA was 4.03 and then 5.4 so they did a MRI then a biopsy to confirm in Nov 22. 3 of 12 samples were positive and gleason of 6. Was given all the options of just watching, IMRT or surgery. They said it was very slow growing and localized but I opted for radiation.

The worst part of the process was drinking a liter of water an hour before and having to hold it during the process, every weekday for 9 weeks. The feeling of letting loose after the daily treatment was glorious.

Started treatment in Feb 23 and completed in April 23 so about 9 months now since completion. PSA check at 6 months was 3.8 but doc said it won't stabilize till about a year plus my testosterone is still pretty high for my age. Things aren't quite back to normal but "it" works most of the time when called upon. That's been the only lasting effect so far but hopefully gets better over time.

If anyone has questions about the radiation option, I'll be glad to help if can.

Best of luck in your recovery OP.

eta: Forgot to mention they implanted 3 or 4 gold "seeds" for image tracking/alignment of the prostate. That way by far the most painful thing about the process, almost passed out. I told my coworkers they must now refer to me as goldmember

Did you consider proton therapy? Was that an option with your diagnosis?

I think if I was married or in a seriously committed relationship then the decision for surgery would be easier, but being single and still wanting to "perform" does weigh on my mind.
Also my doc has said due to my age that radiation is not recommended due to the long term effects it can have when I get older and the possibility it can come back vs. surgery.

March is more blood work and then later this year will be another biopsy to see the next course of action.

A buddy of mine had some kind of prostate surgery and had a catheter for about a week.  He said his doctor gave him a prescription for suppositories that had opium and belladonna in them that really helped, but made him really loopy.   While he hated the catheter he did enjoy not having to get up a bunch of times in the middle of the night to go and pee.

No PSA check today, that's scheduled for March.  I'm free to resume exercise, have a fresh script of low dose Cialis to keep the blood flowing and been given the go ahead to have "a bourbon or three".  He said everything had gone as good as it could and thst from what he's seen he doesn't expect my PSA to be an issue.






The only options I was presented by two different urologists was radiation, removal or active surveillance.  Both agreed that surgery was the best option given my options.  In the end I agree.  My gleason score went from 6 at the biopsy to a 7 according to the MRI which was later backed up by the pathology report.  
Just the fact that I had extracapsular extension reinforced that the decision to have it removed.  I think if I'd waited another year or two then it would have likely spread beyond the prostate.

It's still a huge worry even in a relationship.  We had a very healthy sex life before this so I worry that if the erections never come back then she'll suffer right alongside me.  While that's entirely true as there more than one way to skin a cat it still a huge concern.  It's things like this that really test a relationship.   Hopefully mine is as strong as I think it is.

The told me the same thing about radiation.  I felt like I just be trading one problem for another.  That's why I decided to act sooner rather than later so I'd have my best chance of getting rid of the cancer and also limiting the side effects of surgery that can only get worse as I get older.  FWIW, my primary urologist told me thst given my age and the lack of erectile issues prior to surgery were in my favor.  He said something along thr lines of "worst case you'll have to take a pill."  The surgeon has been a little more conservative in his estimates but so far I'm trending toward the lower end of the projected time-line.

damn man, that sucks

So I just had my second biopsy, this morning.
Should have the results in a couple of weeks.
Wish me luck.

Best of luck to you.  I'm hoping you have better results than I did.

I will help the bump

The prostate, and why it causes so many problems for men

In recent weeks, two prominent men, Britain's King Charles and Defense Secretary Lloyd Austin, revealed they were dealing with prostate issues.

CBS News chief medical correspondent Dr. Jon LaPook offers us a prostate "user's guide," and explains PSA tests and the process of diagnosing and treating ailments such as benign prostatic hyperplasia and prostate cancer.

I would imagine gettin a woody is the least of hos concerns. Sayin a prayer for all those who have been thru similar scenarios as OP.

Biposy coming up in a few weeks for me.  I had problems with peeing.  I peed and then had the feeling I had to pee again right after.  Even though there was less than an ounce of urine in my bladder.  Normal PSA and all my bloodwork looked ok. Took all the prostate meds to try and help out.  Nothing worked.  October last year the doctor decided to do the scope and look at my bladder.  He found a tumor in my urethra that was causing the problem.  He took a part of it and Transitional Cell Carcinoma was the diagnosis from the lab.  Then I had MRIs and CT scans of my midsection.  Hyperdense tumors in my kidneys and liver.
Well, they want to get biopsies of the prostate, bladder, kidneys, and ureter to find out where it started. I was told it normally doesn't start in the urethra, it comes from somewhere else.  Well, I guess I will find out more soon. I am hoping for either easily treatable or stage 4 so I don't have to deal with it for long.

I'll say a prayer for good results for you brother.  If there you need someone to talk to shoot me an IM.  Sometimes it takes a day or two for me to get back but I'll get back for sure.

My advice for the prostate biopsy is to have a driver even if they don't require it.  I couldn't understand why I needed one since they weren't giving me any pain meds or putting me to sleep.  After I felt odd, it's tough to explain.  I was glad to have a driver though.  It's no fun but nothing to worry about either.

You're right, it wasn't.   It's hard to feel like getting laid when it feels like you,ve been kicked in the taint.    I appreciate the prayers. Thank you.

Prayers sent out for you.  I am hoping and praying for a miracle for you.

Prayers sent.

I hate that for you.  Like you said, you're alive, and that counts for a lot.  When I made my decision to have surgery that was one of my top two concerns, the other was pissing myself for life.  But I decided that being around as long as possible for my wife and kids was the priority and I'd just have to deal with any issues as they came.  As hard as it is to grasp, there is more to life than having sex.  Although I do hope that mine will work again soon, if it doesn't I'll do my best to stay positive and do the best thst I can for the people I care about and try to enjoy life as much as possible.

Did any of you notice changes in your loads before the issues were diagnosed?
I'm 45, can hold urine for days and solid stream when I go, but semen is barely cloudy, about a fourth of what it used to be, and not really white at all. Seems like there's no real spurt any more.

I've had testicular infections in the past and also had testicular trauma in my twenties. Whatever lifted my nuts when it's cold took a permanent vacation years ago.

Just kind of curious if you saw any symptoms prior to diagnosis

The only symptom I had was reduced urine flow, nothing else. If you haven't seen a urologist it might not be idea to do so.

Well the results from my recent biopsy were favorable.
Still the same low grade cancer so I'm still in the monitoring mode.
The thing that killed me the most was the requirement for the cath.
It was removed in recovery which wasn't bad but for the next 3 days, taking a piss was painful as all hell.
I'm not looking forward to the next one which will eventually come up.
Counting my blessing tho.

Feel a bit like like you were pissing turpentine?  I had that for about 24 hours after my cystoscopy but luckily I didn't after my prostate surgery.  I'm glad you got good news.

I had my PSA level checked this morning and it is 0.0.  No further treatments will be needed, only monitoring from this point.  I'm basically back to normal, working around the house, lifting, exercising, etc. is no problem.  The incontinence issues are basically gone.  Still no erections, but that's normal for the time period.  Waiting for that work itself out is going to take patience.  It's easy to get frustrated and lose sight of the big picture but a day like today helps for sure

Prayers out for everyone in this thread dealing with prostate issues. I'm wishing you all the best outcomes possible.

Glad to hear this!

Best of luck, OP..  I wrestled with prostatitis a few years ago. I was diagnosed with BPH.  I endured a biopsy, it was not fun.  Psa is 1.09

Incredible news, congratulations!!!

Glad to hear of your great results.  I will having the surgery sometime in June and of course a little apprehensive but never the less it I believe it is the best option for me.

This. They drained almost a gallon. They couldn't believe it either.

7 months with a catheter and a leg bag. Then, the Holep proceedure, back in July. I'm getting by with tighty whiteys and shields now. Went through the diaper phase.

Catheters are the worst.

Prostate cancer is a fear for me. Cant imagine going into surgery being told no more boners after this.

So can you get the flag to full mast?

Im not asking to be mean

Eta, sorry asked and answered already

congrats man!

would a pump help the erections?