I am planning a robotic prostate surgery. I can't find any information about "dry orgasms" after the surgery. Qualitatively, how big a change is it in terms of sensation?

Good question.

The one thing that changes after radical prostatectomy for certain is the loss of seminal and prostate fluid during ejacualtion.

Actually some patients have urine that is expelled during ejacualtion.

The sensation of ejaculation is still there. In my experience, most patients say that the sensation is not quite as good as it was before, but some say it is actually better.

Please post back and let us know your experience afterwards.

Dr. Savatta

I had the laproscopic robotic surgery last august my psa number remain very low and i have gotten back urniation funcitons and sexual function appears to be comeing back, i dont how ever have any help in this part of the recovery as my wife will not accomodate or join me in any sexual endevours toward getting and reestablishing my ability to get or maintain an erection, can you suggest a path to follow under these conditons, please advise me if so

Would you please comment on whether there is a connection between sexual activity and elevated PSA. Also, why would test results given to a patient not break down PSA into free and that with protein. Thank you.

PSA can be done in many ways. Most often urologists including myself only order the total PSA, not the free and total test. If the free is ordered I usually do not give it to patients unless they ask. In general a low number (under 10%) gives you a higher chance of having cancer and a high number (over 25%) gives you a lower chance. Most patients would not understand the nuances involved in reading this test.

As for sexual intercourse, I do not think it causes a major jump in PSA. Patients who have intercourse the day before the test may have a slightly higher PSA value. When the studies were done to evaluate PSA values and risk of cancer patients were not asked to abstain from intercourse.

My husband has been diagnosed with very early stage prostate cancer; age 60. He has an enlarged prostate 54 g. For the seed therapy his urologist must reduce the size of the prostate and the side effects of this may be irreversible. Since his urologist only performs open surgery he recommended an acclaimed robotic surgeon. The robotic surgeon after reviewing my husbands test results stated that he too would have to reduce the size of the prostate prior to surgery. Does the size of his prostate prohibit removing the gland without reducing the size? Do most surgeons reduce the size prior to surgery? what would be the side effects if the size were not reduced?

Hi Karen,
I have never reduced the size of a patients prostate before robotic surgery. The side effects outweigh the gain in my opinion. An experienced robotic surgeon should not have difficulty in removing a prostata that size. I have removed many prostate between 100 and 200 grams and have not put these patients on medicines. If you take hormone injections it will actually make the nerve sparing more difficult usually. If you take avodart or proscar it takes a long time to work.

One of the big advantages of robotic surgery is you do not need to take medicines to shrink the prostate. I have written on large prostates in several places on my blog including this post.

Good luck.
Dr Savatta