Honestly, my major concern after prostate cancer has been recovering erectile function. Now, three and a half years after my radical prostatectomy surgery, I am about ready to celebrate some successes and declare “enough” of struggling to get back what I lost when my prostate was removed.

After all, I am 65 now and can’t go back to being 60, 40, or 20. And my body is irrevocably different. The big challenge is to gauge where the heroic struggle to recover what was damaged by the cancer treatment (purple in the diagram below) meets the longer arc of natural aging (green in the diagram). And it would be a suitable topic for conversation between men who do and men who don’t have prostate cancer diagnoses.

Allowing the struggle for recovery to align with the arc of aging

Source: Mish Middelmann

And no! Shifting my focus towards fulfillment doesn’t mean I am giving up on curiosity, connection, growth, libido, love, sex, or fun. Rather, I am wanting to see my prostate cancer as a round of practice for aging in a good way.

So much to recover after prostate cancer treatment

For most of us, it’s a hero’s journey to recover what we can, after the gland at the very core of our male bodies has been either cut out or blasted with radiation. It is a physical, emotional, mental, social, and spiritual journey. Almost all of us have some issues with urine control and erectile function. All of us face either the threat or the reality of cancer recurring for the rest of our lives.

It takes courage and commitment to keep fit and healthy and regain as much quality of life as possible. Those of us with partners can get huge support from them. We also need to recognize that our struggle inevitably affects our partners and our relationships.

Markers for recovering continence and erectile function after prostate cancer

How I know I am getting towards “as good as it gets.”

• I haven't leaked more than a drop or two of urine in three weeks.
• I can experience sexual pleasure.
• My body can respond to my partner with at least some form of recognizable erection – sometimes only from cuddles and without direct stimulation. You can't imagine how important these signals are between partners until they are gone.
• Mentally, spiritually, and emotionally I have gotten used to that empty space at the core of my body, and create from that emptiness.

Permanent losses after prostate cancer treatment

But even three years after prostate cancer treatment, it is all a bit wonky and unreliable, and confusing. Why I am still wondering if this is as good as it gets.

• I’ll never again have the same unconscious confidence about not wetting my pants
• my sexual parts are less sensitive than they were
• my erections are a lot less durable and firm
• orgasms are more elusive

What is it like for men who get older without prostate cancer?

Together with my buddies in the Recovering Men support group and other prostate cancer survivors, there is a lot of frank, private discussion about the intimate details I’ve just summarized above. But many men, particularly those who identify as heterosexual, have a reputation for not talking about intimate matters in any detail. Particularly not outside the boundaries of their intimate partnerships. The more so, as the aging process sets in. Prostate cancer survivors are paving the way to new and more open conversations amongst men about intimate and vulnerable subjects.

There is often a kind of embarrassment for older men that we don’t fit the image of the “always on” insatiable 25-year-old hunk. And yet a lot of the value and attractiveness of older men is precisely because we are not so attached to simple virility as we were at 25. I am actively supporting conversations with those older men who are willing and able to share their experiences.

Acknowledging the arc of aging

"At what angle does your dingle dangle?"

Mish Middelmann

My hand gesture in the image above is a simple way of sharing ancient wisdom about accepting bodily changes with age, and in particular erections that are no longer so erect or durable. Men over 50 need to master the art of making love with a “soft-on,” sooner or later. This and more I am grateful to have learned from Mordecai Brodie on the remarkable Kadeisha training in sexuality. I took this extraordinary course 14 years ago and it still happens at least once a year.

When and how do sexual function and urine control begin to fade in men without prostate cancer? Yes, I know that drugs like Viagra and Cialis can mask the effects of aging. But the natural varoom of sexual energy, and its manifestation in our genitals, clearly changes as we age.

Mind the gap: Setting realistic recovery goals after prostate cancer

What is important for prostate cancer survivors is not to set unrealistic goals for ourselves. To do that, we need to figure out when we have completed the long struggle of rehabilitating our bodies to their new normal. And we need to factor in the natural arc of aging, particularly as it affects erectile function. There are lessons here for older men who are lucky enough not to have prostate cancer, too.

I want to enjoy the process of aging, letting my libido broaden and deepen into a love of life as a whole and a sense of flow and fulfillment. I believe I can remain sexually potent, fulfilled, and fulfilling my partner, while adapting to the new normal of my body and the longer, inevitable arc of aging. Please let me know if you have your own story to tell about this process.