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.”
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.
About the Author Reprints
I had robotic surgery in 2011 and have the same experience that many of you have noted here contrary to the report.
I have been cancer free, don’t wear pads/diapers and pee like a 12 year old for all these years ( I am now 77 )for which I am thankful. However I have lost about 1.5″, have ED and ejackulate urine.
Interestingly enough,
UCI (the Dr Ahlering team who did my surgery) recently put out a survey asking their patients to rank from most important to least important the things mentioned above. I believe most of us would say being cancer free is most important but all the others are close.
I would agree that cancer free is #1, but about 30% still get it again. I’m not blaming the doctors. Sometimes the horse had already left the barn and the doctors don’t realize it. My surgeon found nothing outside the prostate, margins etc. After a little less than 2 years, my cancer doubling time is 3 months. Not saying your loss is not significant, because it is, but I would give away my pickup if I could have been 1.5″ less than where I started. I lost more than half my length and when I bend over or sit down, it feels like my penis is trying to pull inside out. I will shortly be getting an Axumin scan to see if it has spread, to decide the next step. QOL has been in the toilet and not cancer free. No way to know if I had gone the radiation route if it would have got it.
This article is complete BS! I have 18 months post surgery with a loss of about 2 inches (which I could not afford as I was just average) in length and significant girth loss. My surgeon has done more than 1700 robotic surgeries and he never mentioned this before the surgery and has not asked since. He had to cut the nerve on one side of the gland and I have to use the tri-mix to get a poor hard on still at this point in recovery. There has to be a better way and better communications.
There is no way I would recommend radical prostatectomy to any man..yes the penis is at least 25mm “1 inch” shorter, and I have never recovered an erection since the op in 2012. Injections cause an erection but the results are painful. Viagra gives a partial erection but the resultant headache is a disaster. Never told about bowel problems, and ongoing difficulties in peeing, been back to urologist but nothing can be done now. What’s worse is that I now find from doc google my PSA score was quite low and other docs would not have operated but done a monitoring schedule keeping me intact and healthy.
I hadn’t a radical prostatectomy in 2011 and the cancer was into the nerve. Surgeon told me he rebuilt the urethra with a piece of harvested veinous material. How embarrassing it is now. I’ve lost length and girth in erection (7 inches to five inches) and when in normal state it looks like I am uncircumcised. I also do the trimix injections, but what’s the point with a five inch skinny little erection thst just doesn’t get the job done.
I too had my prostate removed several years ago and am no happy with the loss of length. I lost a little more than an inch. I was provided with a vacuum tube to regain some length. I thought that I was going to become a porn star, NOT!! The length of your urethra is the max, no matter what. Now I am using an injection of Trimix, to get erections. The shot doesn’t hurt, but the loss of length does. I can’t just stoke like I used to that I enjoyed so much. For some reason the climaxes are much more intense, but that still doesn’t balance it out. It seems to me that when a prostate is removed, there could be a reattachment of something that eliminates the loss of length. I had an enlarged prostate to begin with, so my loss is probably more than average. Anyway you look at it, no pun intended, it is humiliating when you take a piss and you nearly have to climb into the urinal or when you have sex. I still have a strong sex drive at 78, but the prep and action is diminishing my enjoyment, which in turn results in less sexual activity. All I have left are fond memories. Sad but true.
BULLSHIT on regaining length after a time. I had a urologist pull my penis to its maximum length, then said that’s it!! He told me that the urethra was shortened because it went through the prostate. I guess that they just rejoined the ends and called it a day. If I had it to do over, I wouldn’t have had my prostate removed, no matter what!!!!!
10 years ago i had radical prostatectomy , penis has shrunk.I am using penile clamp.
When i tighten down, it becomes painful.
This entire prostatectomy situation for me has been a night mare. I wanted the cancer to be gone which it is. I went from having a very good life to being sad and dreaming daily how my life use to be . You do not know what you have until it is gone. I have tried everything. I am at a total loss on what to do? If I knew what I know now I would have for sure rolled the dice . Quality of life is so very very important. It is very difficult to understand or see how a man feels after going through this. No one really tells you the truth or talks about it. I wish I would have had someone be honest with me before I made the decision. Now I just dream how life was. I am kind of shocked that losing the ability to have any meaningful physical relationships with the opposite sex would ruin my life as much as it has. I get going to psychiatrist which I have done etc is supposed to help but for me it had not . The thing that is perplexing to me is that I really never had any focus on my life as a sexual being before. Once again you do not realize what you had until it is gone. Most days even though I was very successful in the other parts of my life this element comes up in almost every facet of my every day life. I really do not know what the answer is at the present time?
The only thing I can offer is that you are not alone. I, like you, trusted my urologist too much. I did a quick search on the Internet and didn’t see any comments about this problem until after I was forever changed! My last urologist visit I went off on the doctor and let him know a sex change operation would be preferable to this. I have complained on almost every visit since my surgery and had really complained the previous visit. When he acted like I had never said anything about it before, I went off the reservation. He called trying to get my GP to put me on an anti-depressant. Luckily, I told my GP what I was experiencing several months previous. My next GP visit the doctor remembered what I had told him and he said it depressed him. If you look at some of the previous comments on here, Rod pretty much summed it up. I have had several surgeries, including neck surgery and none of them was life changing like this surgery!
Its been over a year since my treatments (radiation, radiation seed implants) and I am still measurably shorter and lost girth. I am pleased I can still achieve an erection, but there was no recovery of penis size/girth for me. I truly want to be my old self again!
I had robotic surgery and gland removal. I have the same results. It has been 6 years, and I am still at least 1 inch shorter than I was before. I too can get erections, but climax leaves something to be desired.