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The Health Issue


There's a new prescription of choice for men recovering from prostate surgery--sex, and plenty of it

July 29, 2007|Paul Lieberman | Paul Lieberman is a Times staff writer.

Dave Shanbrom thought he was crazy thinking about sex. He had cancer, and you were supposed to worry about life and death. But his was the prostate variety--he was one of 234,000 American men so diagnosed last year--and he'd heard about the side effects, no matter which treatment you picked. So he flirted with doing nothing. "I did consider, 'Erections, cancer? Erections, cancer? Erections, cancer?'" he recalls.

Shanbrom is with 16 other men in a small conference room at the east campus of Los Robles Medical Center in Westlake Village. All have had prostate cancer. Some chose to treat it with surgery, others radiation, others hormones. Several tried what they used to call "watchful waiting," now "active surveillance." One fellow's cancer had spread to the bone, to the hip. Then again, he's 87.

"How old are you?" someone asks Shanbrom, who is seated at one end of the table in jeans and a white T-shirt. "Fifty-five," he says, the youngest in the room.

He first came here months ago hoping the support group would help him choose a treatment. Now he's back to report in. He says his wife had reassured him, "I'd rather have you for a lot of years"--meaning however he turned out. So he'd signed on for surgery in May, the robotic variety, at City of Hope Cancer Center in Duarte. Four weeks later, he's already out and about, back on the road selling supplies to area bakeries.

Oh, yes, the sex business. His fears about that had grown worse at the hospital when he learned about another possible side effect. As if the likelihood of impotence wasn't enough, "this unusual thing came up, that after this surgery guys can experience getting smaller"--what the Seinfeld crowd famously called shrinkage. "So I was a little bit concerned about that."

Ah, but he says there was a twist, an unexpected ripple in post-care today for many prostate patients. Shanbrom explains how a nurse injected him with a rice-sized erectile-enhancing pellet while he was in the hospital, and how he was sent home with Viagra and succinct instructions from his surgeon, Dr. Timothy Wilson, regarding his sexual apparatus. Use it, he ordered, as soon as you possibly can.

Actually, Shanbrom says, Wilson's precise words were, "If you don't use it, you lose it."

It wasn't long ago that prostate cancer often was discovered too late to be treated successfully, and talk about sex would have seemed frivolous, at best. But the PSA (Prostate-Specific Antigen) blood test developed in the 1970s made early detection possible. The complication was that the nerve bundles that connected the brain, via the spinal column, to the penis were so close to the prostate--the gland that helps men produce seminal fluid--that they often were traumatized, if not nicked, during the operation, making impotence a common consequence.

In 1983 a Johns Hopkins doctor introduced a surgical technique to "spare" those nerves. And one potential remedy for impotence surfaced the same year when English physiologist Giles Brindley stunned a gathering of the American Urological Assn. in Las Vegas by dropping his shorts to demonstrate the impact when a smooth-muscle relaxant was injected into the penis. As counterintuitive as that sounds, relaxing the muscle is what allows blood to rush in, making the organ swell. The next leap forward was the 1998 introduction of Viagra, whose most effective spokesman was a prostate surgery patient, former U.S. Sen. Bob Dole.

Dr. Peter T. Scardino, chairman of the department of surgery at New York's Memorial Sloan-Kettering Cancer Center, says today, even with a seemingly successful operation, "three months [afterward] most men are having trouble" obtaining erections. With patients not yet of Medicare age, though, about 6 in 10 will be "pretty damn normal" within two years, he adds, while three others will "need something" to help them and "1 out of 10 won't recover." The sequence is reversed with the other common form of treatment, radiation: Afterward, most men maintain sexual function at first, only to have what the commercials now call "ED"--erectile dysfunction--hit large numbers of them over the next five years.

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