Over the years I had to pee more and more at night. Like, I've counted 10 times in one night. Get up, go to the bathroom, return to bed. Repeat 20 minutes later. My doctor noticed that my PSA number had increased, and my urologist did a biopsy that didn't show anything. My doctor thought I had an enlarged prostate with a correspondingly high PSA. I wished my prostate would stop strangling my urethra.

Eventually, my urologist had me get an MRI, which showed a concerning “hot spot”. He recommended that I have a “fusion biopsy”, which would merge the MRI with a live ultrasound to be able to zero in on the hot spot. This resulted in a positive test for cancer. My specific result was PROSTATIC ADENOCARCINOMA; Gleason Score 7(3+4). My urologist recommended a surgeon in the group.

The book Surviving Prostate Cancer by Dr. Walsh was very useful.

My options included:

• Watchful Waiting. Don't do anything except check periodically how fast the cancer is growing.
• Radiation, including Radiation Seeds. Burn out the cancer from the inside. While it would be cool to get a kickass tattoo, it wasn't for me.
• Chemotherapy. Take poison, hoping to kill the cancer before the poison kills me. Not encouraging.
• Radical Prostatectomy. Remove the whole thing. Since the enlarged prostate had been bothering me for a long time, I decided to go with this one.

Assuming that the prostatectomy is a success, there are 2 common side-effects that people are concerned with:

Erectile Dysfunction — This is the one people talk about more. It can be difficult to get/maintain an erection after the operation. This can be temporary, lasting 6 months to a year. Or it can last longer.

Incontinence — Not being able to hold urine in the bladder until you get to a restroom. This is the big one. While erectile dysfunction is embarrasing and makes sex harder (see what I did there?), incontinence is a bigger deal because there are multiple times a day that you have to manage to hold it in. Accidents can be more public than ED.

To avoid incontinence problems (which surprisingly is called continence), exercising the kegel muscles can help maintain control. First, you have to figure out what muscles you need to contract. While peeing, stop the stream by squeezing inside, but don't clench the buttocks. That's what you need to practice. I would squeeze and release as fast as I could 50 times, then do squeeze and hold for 3 seconds for 50 times. This is hard at first because you're not used to using these muscles. It can take a while before you can squeeze and hold for 10 seconds. After a while you can hold it for as long as you want without the muscle tiring.

Sadly, many of the older surgeons who do prostatectomies are of the opinion that sexual health isn't important, and that removing the cancer is the only consideration. Younger surgeons know that this is outmoded and it is possible to remove the prostate while preserving erection function (after some amount of time). Definitely talk to your surgeon about this! Don't be squeamish. They deal with male genitals professionally, and you deserve to have a doctor who cares about you as a sexual person, not just a body to cut up to remove the cancer.

• The Penis Project An awesome podcast from a urologist in Australia. In particular, episodes 50, 55, 61, 91 & 161.
• The Prostate Cancer Wives Facebook group. Has very good resources, but sadly the patient himself can't use it, as it's only for wives. I guess if you're single or gay you're SOL.