Day 30 – Prostate Prospectus

or "witty wrap-up"  [expand title=”Show this Post” swaptitle=”Hide this Post” rel=”prostate-highlander” findme=”auto” trigclass=”noarrow prostate_text colomat-trigpos”]

 
not sure I have anything witty to add here… in fact, I've found the pressure to produce something on a daily basis has definitely affected my normal writing style – although perhaps the subject matter also had something to do with it.
 
but returning to the original premise of simply expressing my own experiences "living with prostate cancer" – I think I've accomplished that to some degree.  I've obviously glossed over a lot of the more mundane and minute bits, and so there may be room for a sequel some day (I hear the groans…!). But, it has forced me to do a lot of digging into my own recollections and sources of accounts in order to compose it and so the end result is definitely a better understanding and much clearer documentation of my experience than I've ever had before.
 
and I'll reiterate that "for me" and I believe for most folk with various cancers or any chronic disease – that it is indeed just something we "live with".  We're not survivors – surviving tends to denote the sense of having passed through something and come out the other side victorious (maybe damaged, but still victorious).  I don't see that as applicable to any cancer… regardless of how long one may supposedly be "cancer free" according to some test or set of criteria – there's absolutely NO guarantee that not a single mutated cell with malicious intent still remains in your body – even if dormant for a time – even a long time!  So, you don't ever get to a place where you can say "I've beaten cancer".
 
you live with it…
 
How you live with it, is another story.  You can believe you've beaten it and live in that dream world until it rears its ugly head once again, to destroy your self-satisfied head-space, but I don't think the trade-off is worth it – that "coming down to earth" again can be an extremely unpleasant experience that can completely overshadow the months or years spent in never-never land.
 
I think it's far better to come to terms with the fact that you "have cancer" and despite the state of the disease – active, under control, in remission, or whatever… you still strive to live as fully and as normally as you are able, given the circumstances.
 
How you do that… well… I can only share how I have been able to deal with things.  I have found that despite any set-backs, any nasty treatment side-effects, I can always know with absolute assurance, that the Lord has a plan for me.  I may not have chosen this path, and I certainly wouldn't wish it on anyone else – but, through it all – as I live with cancer, I can know that HE is walking with me, and as long as I continue to trust him completely for all that lies ahead, there's nothing to fear!
 
truths I can lean on:
 
Psalms     23:4   Even though I walk through the valley of the shadow of death, I fear no evil, for You are with me;
Hebrews  13:5  …be content with such things as ye have: for He hath said, I will never leave thee, nor forsake thee.
 
and so many, many more…  and although it certainly wasn't my "raison d'être" for writing this account, if you want to have the same peace, you can…  start by reading the Gospel of John in the KJV or NASB translations (readily available online) and you can find the answer in the person of Jesus Christ and his love for you.  You can always reach out to me at the email address in the header, if you have any questions.
 
I may write some follow-up posts from time to time… but until then – if walking a similar path, remember to do your research, find a well-respected clinic, demand 2nd or even 3rd opinions, never be pressured into anything, and accept that your choices may be different than mine or those of everyone else you know – but they are your choices to make!
 
finally – and this one is critical – marry an oncology nurse smiley

[/expand]

Day 29 – Pasteurization Proliferation

or "lather, rinse, repeat"  [expand title=”Show this Post” swaptitle=”Hide this Post” rel=”prostate-highlander” findme=”auto” trigclass=”noarrow prostate_text colomat-trigpos”]

 

so, since my first round of anti-androgen therapy (ending with my 3rd injection at the end of October, 2012), we've been back in that "watchful waiting" state, simply monitoring my PSA every 3 months with a view to start another round once I hit/exceed that magic number of 3.00
 
It's been more than 2 ½ years since I started that first round, and my PSA stayed non-existent or very low for the first year.  It first broke above 1.00 in February of this year (2014), and after staying fairly stable for the next 6 months, the test I had just two weeks ago, showed a jump from 1.12 to 2.78! 
 
I talked my oncologist into waiting for my next test result (which will be in early February, 2015), before we decide to start another round of hormone therapy – because I don't want to be on it over the holiday season this year.  However, given the jump, I can be almost positive that my next result in February will be well over the target of 3.00 – in fact given the last increase, it may be close to 6.00, which would be my highest ever! 
 
Therefore, I can look forward to starting another 12 to 15 months of "pasteurization" in February and then again another year or so after that, until we reach the point where testosterone deprivation no longer can keep the cancer in check. 
 
Where we go from there – I don't know…  there are new ideas and new treatment modalities constantly being trialed.  There may be some form of chemo in my future – although, that is something I dread and will try to avoid at all costs, as long as there are other alternatives.  Once the cancer metastasizes to the bone, which is common in prostate cancer, then there may be more extensively targeted radiation in my future – yea… some new tattoos!!
 
But for now… I'll try to limit my view to the next 2 months, without treatment and without lingering side-effects – and just enjoy the holiday season with my family which includes 3 birthdays, Christmas and New Years – and I'll try as best I can to ignore the 'merkin thanksgiving nonsense (except for the continuing Black Friday sales online) – what historically-challenged lunatic came up with holding Thanksgiving at the end of November?  Oh… Wikipedia seems to think that lunatic was old Abe… so, maybe I'll just withdraw that remark, so as not to offend all those in my family, living south of the border cheeky

[/expand]

Day 28 – Post-photon Pasteurization

or "singing soprano"  [expand title=”Show this Post” swaptitle=”Hide this Post” rel=”prostate-highlander” findme=”auto” trigclass=”noarrow prostate_text colomat-trigpos”]

at first glance, it may not seem germane… but look it up – throw "synonym" and "pasteurization" into your favorite search engine and check it out!  You'll find words/phrases like "made sterile", "neutered", "desexualized", "spayed"… and they're all appropriate!
 
as stated yesterday, they do call it "chemical castration" for a reason.  what I don't understand, is why they would spend over $5000 a year to keep a convicted repeat child molester "sedated", when they could chop his balls off for a matter of pennies and it would be permanent!   I sure don't want my tax dollars going to pay for the "chemical" option when a permanent and so much cheaper option is available.
 
anyway, leaving the political debate for now, let's get back to the efficacy of this option for prostate cancer patients.  There are basically two streams of philosophy on this treatment and now that there are studies showing no difference in longevity – I see no reason why the one is even considered any longer.  The two options are – permanent and intermittent use of anti-androgen therapy.  In the first – once you start on it – you stay on it until it no longer controls your cancer (ie. your PSA starts to steadily rise again).  The second option – the one recommended by my oncologist and accepted by yours truly, involves only 3 injections, 3 months apart and then we stop until the PSA once again reaches a predetermined level – in my case 3.00
 
is it effective – damn right! – in every respect…
 
on the day of my 2nd injection (3 months after my first injection) – my PSA had already dropped from 3.08 to 0.06 – and 3 months later on the day of my 3rd injection it had hit the "undetectable" mark of < 0.02 – where it remained for at least another 6 months – even though that 3rd injection was the last of the series.   So… in terms of knocking the crap out of my prostate cancer, by reducing my testosterone levels to almost zero – these injections did the trick.
 
Unfortunately they also do a lot of other really nasty things.  And, while I personally, couldn't care at all that they do these things to the folk receiving the injections as a preventative measure for repeat child-abuse offences… it is  certainly too bad that they also have the same effect on those receiving them to control their prostate cancer.
 
I'll just mention a few of the "unimportant" ones – like fatigue (sometimes extreme), hair loss, tender and/or enlarged breasts, weight gain, hot flashes, bone thinning and loss of muscle mass, memory loss and failing ability to concentrate. Not all of these will necessarily effect everyone undergoing anti-androgen therapy to the same degree, but all are traceable side-effects of the loss of testosterone.
 
Of course, the one missing from the list above is the only really "important" one and that – as this post was titled – is complete and absolute neutering!  You are a eunuch… and anyone who tells you different isn't getting the testosterone wiping result from the injections that they should be.  I don't know how else to convey some semblance of how absolutely crippling this is without using a lame example, that won't do it any justice… but…
 
(I'm strictly speaking to straight, red-blooded males here)
 
Imagine an unending parade of women of whatever flavour that normally "floats your boat" passing your front window totally unfettered by any clothing whatsoever and imagine the only thoughts crossing your mind being that they are blocking traffic and trampling your garden as they march by.  That's it!  Nothing else!  Not even the slightest recognition that it SHOULD cause some other sort of reaction – I mean NO typically "male" response whatsoever.
 
That's how it is… beginning within a month or two of your first injection and not ending until anywhere from six to twelve months following your last injection.  They'll tell you, each injection is only effective for 3-4 months, but after just a series of three, I bet you'll be very fortunate to even begin to feel anything again until at least 6 months following your last shot.
 
Remember the injectable drug cocktail that could work magic following the radical prostatectomy – well… it didn't do ANYTHING while on the anti-androgen therapy.  You truly become a eunuch in every sense of the word!
 
My only advice – to those men whose wives aren't as understanding as mine – is buy some toys and learn to fake as great an interest in frequent intimacy as your wives always have surprise

[/expand]

 

Day 27 – Post-photon Period

or "more www"  [expand title=”Show this Post” swaptitle=”Hide this Post” rel=”prostate-highlander” findme=”auto” trigclass=”noarrow prostate_text colomat-trigpos”]

 
trying to be too cute, I guess…  but, the period from January, 2005 until March, 2012 was simply more worried watchful waiting, getting my PSA tested every 3 months with checkup appointments every 6 months.  
 
actually, there was very little "worrying" during this period, with only a couple of blips, my PSA stayed below 1.00 for almost seven years following my radiation. Once again, we were keying on doubling times – but also had a rough target of 3.00 as the limit, before looking at other treatment options.
 
In December 2011, my PSA jumped to 1.28 and then by March to 2.34 – this last jump being re-checked only 9 days later at which point it was 2.68 – making the doubling time only 3 months, with our original target being a doubling period of 6 months.  So, it was time to act, and the most reasonable and typical option at this point was anti-androgen therapy.
 
Anti-androgen or anti-testosterone therapy is just a nice way of saying "chemical castration".  The treatments simply involve an injection every 3 months, so the process itself is painless (unless you don't like needles – and I think we've already established that once you get comfortable putting needles directly into certain sensitive parts of the male anatomy – a shot in the arm or butt is nothing).  The price on the other hand… is NOT painless.   Can you believe that a single injection costs a whopping $1,300.   That equates to more than $5,000/yr. in order to let you experience being genderless.
 
And having been "actively retired" in 2011, I no longer had an insurance plan to cover prescriptions and I don't even know if most plans would cover this sort of thing anyway – they really don't like paying for big ticket pharmaceuticals and if there's any way to wiggle out of it – they will!  In Ontario, however, there is a plan for low to middle income/retired/senior folk, that is not well advertised, nor easily navigated – called the Trillium Drug Program.
 
You can find it here:  Trillium Drug Program  and the basic premise is, your deductible is about 4% of your entire household's combined NET income.  This deductible is broken into 4 quarters with the Trillium "year" beginning in August.  So just as an example – let's say your family's net income was $50,000 – your deductible (what you have to pay) would be $2000 – but divided into 4 – so, $500/quarter.  Therefore once you've paid $500 in drug expenses in that 3 month period (ie. Aug-Oct, Nov-Jan, Feb-Apr or May-Jul) then everything after that would be paid for by the Trillium Drug Program.  
 
There's also a little trick to this, as you should be able to quickly figure out… taking my case as an example.  Let's assume the above numbers apply (they don't, but let’s use them).  My very first injection cost $1,300 – so, assume I had to pay a $500 deductible then the remaining $800 would be covered by Trillium… and so on every 3 months.  BUT, let's say I arranged with my oncologist to get my first injection (ie. prescription filled and used) on August 1st. And in preparation for my 2nd injection 3 months later – I get the prescription filled on October 28th.  Since both those dates fall in the 3 month Trillium quarter, not only would $800 from my first prescription be covered, but ALL $1,300 of my 2nd one.  You can see how doing this in "pairings" twice a year would save you an additional $1000 in drug costs – just for your injections… not even counting all the other prescriptions your family may have filled in that quarter!
 
this is just a little tip, for those without drug coverage or insufficient drug coverage under other insurance plans.  Not meant to be in any way "scamming" the plan – just making intelligent use of the plan's provisions for "quarterly" deductions.  Obviously if this was changed to be an annual deduction, you could only "bunch up" prescription filling once instead of four times a year.  Of course this is only for folks resident in Ontario and making something less than a zillion dollars a year in net income!

[/expand]

 

Day 26 – Post-prostate Payoff

or "focus on this"  [expand title=”Show this Post” swaptitle=”Hide this Post” rel=”prostate-highlander” findme=”auto” trigclass=”noarrow prostate_text colomat-trigpos”]

 
my first PSA result, 3 months following my radiation treatments was 0.02 on the border of being non-existent… they use < 0.02 to denote undetectable. Even my oncologist was surprised at the sudden drop, as usually it takes about 6 months to see significant decreases in the PSA levels.  So, a very positive result – in terms of my disease.
 
however, unfortunately, it wasn't the only result…
 
to explain a couple of the issues, you sort of need to understand how standard external beam radiation works.  I'm not going into detail – you can use Google for that – but the principle in its simplest terms, is to focus a photon beam or a series of photon beams to a point in your body that is the target – typically a tumour or an area suspected of being cancerous.  The problem is that this radiation has to pass through all the exterior mass of skin, fat, muscle (including organs) and bone to finally pinpoint on the target and exit out the other side.  True the unfocused portion of the radiation isn't as intense, but it's still radiation and the closer it comes to the target the more focused and more potent it is.  In other words a lot of other stuff is getting zapped in the process!
 
In my case, the beam(s) were targeting the prostate bed (area surrounding where the prostate used to be) and the line of site apparently started on my right buttock and went through from there.  At the point it entered it was about 7 cm (2.8 in) in diameter – quite clearly identified by the lovely sunburned circle on my cheek, which after a few months darkened to a roasted walnut colour and eventually after a few years disappeared.  While this "target" on my butt was a source of great amusement to my family it didn't (to the best of my knowledge) create any lasting damage.
 
however… also standing directly in the path of the radiation, and a lot closer to the target, was my sigmoid colon and rectum and "toasting" such a sensitive and mucosal part of the anatomy with a much more concentrated beam did not make for a comfortable result.  Ten years later it's still a raw patch easily detected during my biennial colonoscopies, and frequently causing bleeding, which should normally be very alarming – unless you know for sure what's causing it – which I do.
 
I'm sure there was considerable additional collateral damage, none of which I have as yet become aware – although it may exact a price in the future.  But, the overriding result being keeping my PSA readings at levels that didn't worry my oncologist again – until… tomorrow… cheeky

[/expand]

 

Day 25 – Post-prostate Photons

or "7 ½ weeks of bad-ass beams"  [expand title=”Show this Post” swaptitle=”Hide this Post” rel=”prostate-highlander” findme=”auto” trigclass=”noarrow prostate_text colomat-trigpos”]

 

preparing for this exercise was intense, as it involved the coordination of numerous volunteers over a period of almost 7 ½ weeks.  we needed folks to babysit when I was at appointments and my wife was working, folks to pick up after school and daycare, drivers for myself (due to unrelated health issues) and it was amazing the way friends and family – even some very distant family – came together to freely give of themselves and their time to help.
 
for most of this period, I had to be chauffeured because I had been suffering from some severe pain from pinched nerves in my neck and had to be on heavy doses of morphine – causing numerous side-effects, many of them not conducive to "safe driving" and despite 80 km round trip and the waits at the clinic, there were always volunteers willing to fill the role.   
 
in order to ensure complete accuracy, I was assigned to the same radiation machine for all appointments as the one which was used to initially measure and tattoo me.  this is a bit of a crap-shoot, because there were 6 machines and not all of them are created equal and they all had varying levels of maintenance issues throughout the period I was there… some were frequently down and many of them ran consistently late in their scheduling.  You get to follow the status of each on lovely big screens like an airport arrivals/departures display – showing if the machine was up or down and how late/early it was running, so the patients in the waiting area could judge exactly how much longer they had to gripe or knit or read or play with the many picture puzzles lying around the area.
 
My machine was without question the best-behaved of all of them – it was rarely running late and it was only down once for one whole day, and I was fortunately notified of it before leaving home.
 
The other consistency, was the radiation teams who were responsible for each machine – they stuck with the same one and although there were occasional swap-outs due to vacations (especially over the Christmas period), it was really helpful to see the same familiar faces each day.  These radiation therapists not only had the responsibility to operate and care for these machines, but the most challenging part of their job was dealing with their patients.  You should know that while some of us were symptom-free and many were walk-in and fully ambulatory, there are also very sick patients receiving radiation simply as palliation and these could be partially ambulatory or rolled over on gurneys from the main hospital thru the connecting tunnel.
 
Managing the needs of each of these types of patients, while maintaining a positive and encouraging demeanour and handling the intricacies of positioning and aligning each of these folk for their treatments takes some special people skills in addition to their education and training for the technology.   I was always impressed with the care shown to me, the quick call-ins (usually with minutes with my arriving) and the care of the machine, which only had that single breakdown and only ran late on 3 occasions that I remember.  So… once again I want to shout out a very warm and sincere THANK-YOU to my PLA3 Team (made up for the most part by the regulars Thomas, Christine, Debra, and Rosanna).   It may be unlikely that they would ever run across this post, but at least I took the opportunity – back then – following my last appointment – to let them know how much I appreciated not only all they did for me, but especially how they did it.  The PLA3 team rocks!

[/expand]

 

Day 24 – Post-prostate Penciling

or "my first tattoo(s)"  [expand title=”Show this Post” swaptitle=”Hide this Post” rel=”prostate-highlander” findme=”auto” trigclass=”noarrow prostate_text colomat-trigpos”]

 
so… we proceeded to phase II of treatment.   this was the first time my care was really transferred into the hands of oncology specialists (not counting my wife, of course), since until now all treatment and follow-up was handled by my urologist/surgeon.  This is _not_ the path of care that I would recommend to anyone without the kind of contacts and ready access to oncology consulting that I had because of my wife.
 
Don't ever START your "journey" (still hate the word in this context) without being referred to a dedicated cancer centre with experts in every possible treatment sector.   To begin with only a urology surgeon's input, is something like starting every DIY project with only a hammer.   As they say… if all you have is a hammer – everything looks like a nail… and similarly, to a surgeon – well…
 
that is not to denigrate my surgeon or associated care team, through my initial years, in any way – I went into this with my eyes wide open and an incredible knowledge base at my disposal, but… even so, knowing what I know now and given the much wider range of treatment options and even the variety of surgical options currently available – I would definitely want to be referred to my Regional Cancer Centre for a full investigation prior to making any decisions.
 
anyway, I had been put "on notice" in September when my PSA had doubled – and been referred to TBRCC.  This is where the inside connections come into play, as my wife was able to ensure I was seen by the radiation oncologist that she wanted me to see.  Not that any of them are "better" than the others (although obviously that will always be the case when measuring by some standard like experience, patient interaction, education, whatever…), but this was someone that she knew well and felt would be a good fit for me.
 
I had my initial consultation with him in early November – and a few weeks later I had my first appointment with the radiation team for measuring and marking… and by marking I mean "permanent marking" – yes indeed, my first (and second) and to-date – my only – tattoos.  They're not very exciting, being tiny blue dots, but due to the amount of work that goes into aligning them for the following 6-7 weeks of treatments – they don't want any chance of losing those markings, so they have to be permanent.  And like my surgical scar, they will remain unseen by all, but a handful of folk at the naturist resort in Curacao (I plan to visit when I'm 80), since they are high up on either hip.
 
now, I was scheduled for 33 "daily" radiation treatments, which you have to translate into "business" days – so, you can't count weekends or extra holidays over Christmas and New Year's, meaning what sounds like a month of treatments is really almost 2 elapsed months – in my case beginning on November 30th, 2004 and ending on January 18th , 2005.
 
at that point in time, my wife was not working at TBRCC, so the daily trips into the clinic were not co-ordinated in any way with her work schedule – or mine, for that matter… since I was fortunately on disability leave at the time – but were scheduled by the clinic, using what I believe was a dart board and a very spatially-disoriented booking clerk.  The amusing thing, is that they actually ask you, up front, what your preferred times are and then proceed to book you into anything but those times. smiley   However, using a combination of my wife's contacts and my magnetic personality, we were usually able to change the worst of the time-slots, that would otherwise have left me and my transportation team fighting rush-hour traffic out of Toronto.
 
next up –  9 ½  7 ½ weeks

[/expand]

Day 23 – Post-prostate Poppy

or "lest we forget"  [expand title=”Show this Post” swaptitle=”Hide this Post” rel=”prostate-highlander” findme=”auto” trigclass=”noarrow prostate_text colomat-trigpos”]

 

just a brief aside…  in case you hadn't noticed – the poppy in the header block, slowly withered away over the past 11 days – which was pretty much keeping pace with the dwindling number of folk wearing them on their coat lapels during that time – till now, I don't think you'll find one again until next year.
 
as with Remembrance Day, the periodic cancer "months" tend to bring some fleeting attention to specific cancers, but unless you are personally touched by the disease, it tends to fade from our memories pretty quickly.
 
and isn't that OK?  should we be constantly occupied with loss and illness – whether as a result of wars (past and present) or various diseases including cancers?  I don't think so… as an extremely wise man once penned at the beginning of the 3rd chapter of Ecclesiastes:
 
There is an appointed time for everything-
… A time to give birth and a time to die;
… A time to weep and a time to laugh;
    a time to mourn and a time to dance.
… A time for war and a time for peace.
 
so, let's return to our very "forgettable" story – tomorrow…  for now occupy yourself with something awesome – like your spouse, your children or the multitude of online early Black Friday sales surprise

[/expand]

Day 22 – Post-prostate PSA

or "watch the bouncing ball"  [expand title=”Show this Post” swaptitle=”Hide this Post” rel=”prostate-highlander” findme=”auto” trigclass=”noarrow prostate_text colomat-trigpos”]

 
the one constant following a diagnosis of prostate cancer – regardless of treatment – or no treatment at all… is the mandatory PSA tests on a regular basis – usually every 3 months.  this becomes a watch and wait scenario or "watchful waiting" as they like to refer to it… or the now more politically correct "active surveillance" or the over-the-top "expectant management", because they sound more like you're actually doing something – instead of sitting on your hands and simply keeping track of the quarterly PSA numbers.
 
usually, there's a target (could be an absolute number or a doubling rate) – that either your medical team has chosen or that you and your oncologist may have settled on together, and when your PSA hits or surpasses that target is when the next treatment regime is implemented – whether that be surgery (in the case of having done nothing previously), or radiation or something else.
 
in my situation, the first target following surgery was not something I was consulted on – but from correspondence from that period it appears to have been related to a doubling time.  All I know, is that it wasn't very high at all (in relative terms), but when you've had a radical prostatectomy that ideally was supposed to eradicate the disease – any reappearance of the prostate-specific antigen in your system – means they didn't get it all.
 
over the two years following my surgery, my quarterly PSA levels fluctuated between minimal levels of 0.07 and undetectable (which is what they call anything that's < 0.02).  It's a bit odd to see "something" and then 3 months later have it disappear again – but this happened a couple of times in that period.
 
however, in September 2004, just over 2 years since my surgery, I had a PSA result of 0.15 which (as infinitesimal as it is) was almost double my previous result of 0.08 – and my urologist had me have it retested – and when it came back the same, I was immediately scheduled for a consult with a radiation oncologist at the Toronto Bayview Regional Cancer Centre (yes, if you read the first couple of posts – this is what I will always call it).   
 
and so – the next phase of my "living with prostate cancer" began…

[/expand]

Day 21 – Post-prostate Props

or "you want me to What?"  [expand title=”Show this Post” swaptitle=”Hide this Post” rel=”prostate-highlander” findme=”auto” trigclass=”noarrow prostate_text colomat-trigpos”]

 
sorry for bailing yesterday – but sometimes life just becomes a lot more "interesting" than you expected and the day gets away from you…
 
getting back to my story of life now "after" prostate surgery – one of the expected results that occurs to one degree or another and for varying lengths of time, although rarely permanent is incontinence.  In my case it was definitely an issue for about 4 weeks, and a rather cute recollection was the amusement of my 3 yr-old to see that daddy was wearing pull-ups just like him – well… not really like his… I didn't have a multitude of options for colours and patterns, like he did (I couldn't find Sponge Bob decorated pull-ups in my size) and for some reason, mine cost about 10 times as much on a per/unit basis.
 
and of course, the other much more permanent and frustrating result was impotence.  As discussed, my surgeon was only able to save one of the two nerve-bundles – but even when both are successfully saved – it's very rare that things ever "perform" as they did before and in most cases only some, if any level of "unassisted" erection is possible.   And when they use the word "unassisted" they mean without the use of drugs or implants… because let's be honest – a lot of us haven't experienced truly unassisted erections since we were… well, a hell of a lot younger than we are now.
 
the initial concerns regarding the situation are usually addressed with your urologist during the normal follow-up appointments… which begin with "give it some time" and then progress to prescribing a variety of forms and doses of the "little blue pill" and its relatives – until you and your doctor arrive at the sad but undeniable conclusion that nothing in the realm of oral medications is going to help.  At this point there are some rather unappetizing options discussed involving surgical implants which may give a permanent erection that can be bent up or down as needed (yikes) or those that can be "pumped up" (inflated) when needed from a reservoir also completely implanted.  I recognize there are thousands of men out there that have these surgeries, but I'm obviously not in the minority of men who become extremely squeamish just at the thought of elective surgery to that part of our anatomy – no matter how important we may think the result will be to ourselves and/or our partners.  Additionally these surgeries can be extremely risky and even if willing to take the risk, you want a surgeon with a ton of experience with these and those are not easy to find.  In my case – I never gave such a procedure a first thought… let alone a second.
 
so, what to do… give up…  not if you can get referred to a Sunnybrook clinic that specializes in such things – but the answer may be almost as terrifying as the thought of implant surgery.
 
addressing this strictly to those of my own gender… besides getting kicked there or having surgery there – what can you think of that would be the most distasteful medical procedure or practice to be performed "there"!   well, I know lots of folk who find the thought of this occurring anywhere on their bodies – in fact to the point of avoiding it at all costs – or actually fainting, if confronted with the reality of it occurring.  If you haven't guessed by now, it involves "needles" and I'm not referring to acupuncture!
 
there are drugs – actually a cocktail of a number of drugs that when injected into the base of the penis, can make things happen that no oral drugs could ever hope to do – and in my case they had some level of success.  It wasn't 100%, and it didn't work every time (I think needle placement can be key), but it was certainly enough to be functional.  however… getting used to "self-injecting" with a needle into the very object that one normally associates with pleasure – in order to "get it to work" is very unnerving at first and never really becomes trivial.
 
and for what?  yeah… you can still experience pleasure and even have an orgasm – but, don't forget – the prostate's gone and along with it all those connections it made and things it was there for in the first place – so, it's a lot like having the "dry heaves".  There's no ejaculate (which means no cleaning up ;-), but in some cases the result following orgasm is a very pronounced "burning" sensation, which doesn't last long – but can certainly take the edge off the earlier pleasure.  Of course, the whole point has always been and will always be to satisfy your partner – not yourself, so no matter the cost…   right…?  right…?

[/expand]