Pissing in the Moonlight means (and I’m quoting Shakespeare here), To Pee, or not to Pee: That is the Question: whether Ti's nobler in the mind to suffer the Slings and Arrows of a Bursting Bladder, or to Take Arms Against a Sea of Incontinence, And by Opposing End Them?  In other words, to piss oneself to sleep.  For months, my sleep was interrupted every night causing me to urinate up to six times between 11pm and 7am.  Needless to say, not only was it inconvenient, but it was difficult to fall back to sleep so much so that I began taking Trazadone to get me there.  

More Some Side Effects of Prostate Radiation that Oncologists Kind of Tell you About; or, Cancer & LIM, Living in the Moment (Pt II)

As I alluded to in Part I, after my psychiatry session, two things changed for me…one, I was prescribed Zoloft and two, I began practicing Zen meditation. 

 More Some Side Effects of Prostate Radiation that Oncologists Kind of Tell you About; or, Cancer & LIM, Living in the Moment (Pt I)

Once upon a time, long ago and far away, the 60s, I was influenced a lot by what was happening socially, politically and spiritually.  It was a sign of the times…books we read, music we listened to, films we saw, drugs we dropped.  Of course, it was a time of political upheaval, not unlike today, which, for many of us, begged for a kind of “spiritual (re)awakening.”  In retrospect, it was kind of a “phase,” since neither I nor any of my hippy friends really continued with it, but then I was in my 20s and now I’m not.  Then it was a time of freedom to read and now, in some places, it’s not.  Then it was a time of sexual liberation and now it’s not.  Regardless, when dealing with prostate cancer and all its manifestations one may be inclined to think about existential things.  I’m reminded of something Jung said about one’s “Night Sea Journey,” that journey of “self-reflection and immersion into the unconscious mind.”  I read a lot of Jung in college, but I was also influenced by another major writer, Ram Dass and his book, Be Here Now.  After meeting with my mental health care providers I’ve returned to that text decades later with a different perspective.  I’m bringing this up to tell you that reading books such as this one along with mental health assistance (e.g. antidepressants, meditation) have helped me to live in the moment and when we have prostate cancer the moment is really all we have…

In a prostate survivor’s quest for the perfect post-Lupron stiffy, one may discover Eroxonin.  I first came upon it on a YouTube video.  It sounded too good to be true, but I thought what’s to lose at this point?  So, I began doing some research.  Online, I discovered “Eroxonin Stimulating Gel for Men - Male Massage Cream Helps Restore Your Confidence, 1.75 Fl Oz Sale price $89.99 Regular price $149.99.”  Wow and $60 off.  The pitch sounded just short of miraculous…

Well, they might tell you that it could, possibly, perhaps, perchance, conceivably, feasibly, maybe, in time, with luck, for all we know, happen, but they won’t because no one size fits all and they can’t guarantee an increase in libido so they won’t get into the weeds about it, the details.  But I’ll share something that happened to me.  A little over four months after I received my first dose of Lupron (i.e. recently), I woke up one morning…horny.  Couldn’t explain it.  Nothing I dreamt the night before, nothing I consumed the night before, nothing I watched on the telly the night before, nothing I drank the night before, nothing I smoked the night before.  I just woke up, horny.  As a matter of fact, as I focused on that horniness and why now, why then, I began to experience a slight erection.  Now, it wasn’t anything to write home about, I mean it wasn’t a full blown woody, but there was potential, enough potential that after a few strokes, it got a wee bit harder, not necessarily stiff enough for penetration, but close.  

More Some Side Effects of Prostate Radiation that Oncologists Kind of Tell you About or Not; or, The Four Horseman of the Sexual Apocalypse (Part III) Penile Atrophy

Before you guys run off half-cocked (no pun intended) this particular dilemma is not universal.  There have been some studies among men who have had prostate cancer that they’ve noticed penile shrinkage and not the kind we get climbing out of the pool.  “Complaints were more common in men treated with radical prostatectomy (surgical removal of the prostate) or male hormone-blocking drugs combined with radiation therapy, according to the study by researchers from Dana-Farber/Brigham and Women's Cancer Center (DF/BWCC). No men reported a perceived shortening of their penis following radiation therapy alone.”  One study had “twenty-five men (2.63 percent of the group) complained of smaller penises after treatment — 3.73 percent for surgery, 2.67 percent for radiotherapy plus androgen deprivation therapy (ADT), and 0 percent for radiotherapy alone. Radiotherapy included both radiation administered by an external x-ray machine, and brachytherapy — the implantation of radioactive seeds directly into the prostate.”

It’s truly difficult to put into words what a lack of libido feels like and what that lack of libido can result it.  No porn or other potions of pulchritude could replace the urge, the need, the desire to have sex with someone, especially someone you love, to share in that intimate, often unbridled, unfettered lust, something that might make the short list on Porn Hub. 

Convinced I was going to have to deal with hot flashes as long as necessary I’ll move on to Low Libido, ED, penile atrophy, and performance anxiety...the Four Horsemen of the Sexual Apocalypse.  I’ve been a sexually active cowboy all my life.  That’s not to say I wasn’t selective (I was), but in the crassest of terms, I fucked a lot, so when the day came (and it came on suddenly) at which time I became about as interested in having sex as I was in watching the National Dog Show, I knew I was royally fucked and for how long I didn’t know or did the experts.  The systemic urge to have sex, even talk about having sex, was totally MIA. 

So, maybe if you’re set on finding remedies for the hot flashes since you can’t tolerate them, let me assist you with that.  There are some anti-depressants that were suggested to remedy the flashes, like Venlafaxine (Effexor XR); Paroxetine (Paxil, Pexeva); Citalopram (Celexa); Escitalopram (Lexapro) ad astra, but they all had their own side effects not to mention the fact that a med like Effexor is about as easy to get off as is a moving train. 

 More Some Side Effects of Prostate Radiation that Oncologists Kind of Tell you About; or, Hot Flashes Pt. III
Picking up where I left off, I’d like to take each of those things I previously mentioned: 1) hot flashes; 2) low libido/ED/penile atrophy/ performance anxiety; 3) pissing in the moonlight; and 4) mood swings and depression. Think of them as them as a batting lineup with hot flashes leading off and depression batting cleanup.

While you’re receiving Lupron (aka Testosterone Deprivation Therapy) and for the 3-6 months post while your body is recovering, you will experience loss of libido and impotence. Once your testosterone levels return to your baseline, there’s a 50% risk of accelerated decline in erectile function from the prostate radiation (as you get older, it is normal to expect decline in erectile function).

More Some Side Effects of Prostate Radiation that Oncologists Kind of Tell you About; or, Welcome to the Land of Lupron (Pt I)

Now for the potential side effects of hormone ADT therapy, the polite way of not saying Androgen Deprivation Therapy, emphasis on the word “deprivation” the lack or denial of something considered to be a necessity, like sex.

More Some Side Effects of Prostate Radiation that Oncologists Kind of Tell you About
So, I and my urologist waited it out for over a decade, which included no fewer than four biopsies along the way. My PSA stabilize around 6 until it didn’t.

Some Side Effects of Prostate Radiation that Oncologists Kind of Tell you About
To enlighten my fellow prostate patients about how this all works I will start at the beginning. Not the very beginning, but the beginning when cancer was discovered. I had been under “active surveillance” for years.

I’m Mark Axelrod-Sokolov. I’m a university professor and a novelist I’m also a prostate cancer patient and have been for over a decade including many years under active surveillance until, as my urologist finally said to me “you’ve had a good run, but it’s showtime” meaning, radiation therapy. I’m writing this series of blogs devoted to the subject of prostate cancer and how it’s affected me in hopes that it might help other men who may be going through the same physical and mental anguish I’ve been going through.