It’s been called the final indignity: after men have their prostate removed to treat cancer there, at least two-thirds find that their penis has shrunk, typically by nearly an inch. But in a much-needed glimmer of hope, a new study finds that, after the penis hits a nadir 10 days after surgery, it usually recovers to its pre-surgery length after a year.

The study of 102 prostate cancer patients in Japan “can help men to better understand the risks of a radical prostatectomy and make an informed choice when selecting a treatment option,” said Dr. George Suarez, a urologist in Miami who was not involved in the research, which is published in the journal BJU International (formerly British Journal of Urology). “At the end of the day, no man wants to risk sexual potency or have their penis shortened, the latter even if [it’s] only temporary.”

The shrinkage hits men especially hard because it’s a side effect that surgeons usually don’t warn patients about. While one small study (of just six men) found that the most common reaction to the loss of length was resignation — prostate cancer patients are often simply glad to be alive — on social media and in private discussions, many patients have a less sanguine view. They say in one internet chat room they were unprepared for the shrinkage, experienced adverse psychological effects, and resented having “to find this out for ourselves after the operation.”

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There is a continuing debate among prostate cancer experts over whether men are more likely to die (from prostate cancer or any other cause) if they are treated with surgery or radiation, but a 2016 analysis of 19 observational studies gave surgery an edge. That conclusion comes with an asterisk, however, because men who opted for surgery could be different — healthier, wealthier, under better medical care — than those who chose radiation, in which case it would be something about the patients and not the treatment that led to higher survival.

For their study, physicians at Kanazawa University School of Medicine in Japan followed 102 men who had undergone radical prostatectomy — surgery to remove the prostate — as part of cancer treatment. Using a ruler, they measured the length of each patient’s stretched penis (considered a proxy for an erect one) at room temperature while the men were lying down, before the operation and again eight times over the next two years.

Penis length was shortest 10 days after surgery, having lost an average 0.8 inch from before the operation. The larger the size of the prostate, the greater the shrinkage. But penis length “gradually recovered,” Dr. Atsushi Mizokami, a prostate cancer specialist, and his colleagues reported, until it was “not significantly different from [the] preoperative” length.

Their scrutiny of the anatomy, they wrote, offers the first detailed explanation of both shrinkage and recovery. Although animal studies had implicated nerve damage, the researchers found something else.

After the prostate is removed, the part of the urethra at the very top of the penis (it’s called the membranous urethra) retracts into the pelvis, MRIs showed. Anatomically, the tissue surrounding the urethra as it travels from the bladder through the (now-removed) prostate to the tip of the penis, the membranous urethra, and the penis itself act as a single integrated structure. As a result, the shaft of the penis gets pulled up into the pelvis, too. “Slight vertical repositioning of the membranous urethra after [prostate surgery] causes changes in [penis length] over time,” the researchers wrote.

But over the next 12 months the tension in the connective tissues that hold the pelvic organs in place loosens, they explained, allowing the membranous urethra to return to its original, lower position. The penis follows.

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  • This article is pretty typical of what the medical field says about this side effect. Their opinion is uncaring and is propaganda. You can’t cut an inch out of a “string” and think it will be the same length after. Lack of function (most are impotent after this procedure) plus the severed nerves and blood supplies from the procedure, seal the deal and the results sadly ARE permanent. Studies may say different, as most victims accept this side effect in time and are not proud to admit to having the affliction. Its effect is mostly psychological as the “appendage” has been otherwise rendered useless anyway but this additional side effect can be a serious emotional problem for one’s self image. This shrinkage is made even more permanent after time when the internal ligament also shrinks from lack of stretching. Yes, we are all glad to be alive to complain but there IS collateral damage that so far is pretty much being ignored/denied by those who might find a preventive solution.

  • 5 years post up and absolutely no recovery of any previous penis length.
    Oh, I’m happy to be alive but will never come to terms over both the permanent inability to attain an erection and the loss of nearly an inch of penis length. I am still struggling with depression as well as anger, frustration and sadness issues.

  • I also have difficulty believing this report. I have never talked to another prostatectomy victim who after a year, was not still devistated by the loss.

  • Well I’m 7 months out and my erections are improving but I have lost 1″ in length, in the hope that this article is correct and I will return to pre-operational length. I am disappointed that this topic was not highlighted by the surgeon at any stage. When I brought it up at my 6 month follow up answer was probably not caused by the operation?? Either ignorant in this area which I highly doubt or does not wish to face the issue with his patients.

  • From my research it seems about 80% have 1″ loss or less. The “other” 20% have as much as 2.5+ It can be pure hell if you were below average to begin with. Especially true if you were a “grower” with a very short flaccid. You may have to live with a new belly button under tension trying to pull it in further than it can go. Many urologists/surgeons will try to make you believe you don’t know what you started with! They don’t like to deal with the after effects. My urologist told me I need to quit focusing on it and go out and enjoy my life. If they had to live with these results, I think their approach to the surgery might change.

  • I can attest this is not temporary! I have lost at least 2 inches minimum with no grow back. Yes I used a vaccum device as prescribed with zero results after a year! So not sure were you are getting your results but they are not accurate!!!!!

  • I must be the odd ball after Davinci Surgery! I have pretty much have the same length penis and I have great urine flow, no waiting at the urinal anymore. The only drawbacks seem to be that on occasion if I am in a hurry I will have little urine on my underwear. As far as erection is concerned it is slightly not as hard as before surgery 9 years ago, erection lasts fully thru intercourse and after for about 3-5 minutes. I do have what I call a pseudo orgasm, a short sense of orgasm of course no ejaculate but a clear viscous emission from the cowpers gland during stimulation. I think in my case I made the right decision for surgery at age 66 versus the radiation options. The ED pills were mostly ineffective to create harder and longer erections with exception of very expensive per dose Stendra.

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