Time flies, it has been 10 years since the Indian Ocean earthquake and tsunami, which struck on Boxing Day in 2004.

What was thought to be an earthquake with the magnitude of 8.8 was subsequently revised to be as high as 9.1, and recognised to be the third largest earthquake ever recorded by the seismograph.

The earthquake had triggered a series of deadly 30m tsunamis, killing 230,000 people in 14 countries. The tremor triggered other earthquakes as far as Alaska.

I don’t want to end 2014 by writing about a depressing history that affected mankind. Ten years though, it is unsettling for me to learn that my hometown and a large part of the east coast are affected by one of the worse flooding ever recorded in Kelantan on Christmas and Boxing Day.

Naturally, having moved to Kuala Lumpur a long time ago, I worry about the safety of my friends and family at home. As the water rises by the hour, the more isolated they are from the outside world.

The last I heard from my mother was that the electricity was cut off for safety reasons. This reminds us how vulnerable we all are against the forces of nature, even in the 21st century.

On that note, I would like to answer a reader’s email about his journey of adversity is life.

Dear Dr G,

I am a 64-year-old man who had an operation for the removal of prostate cancer several years ago.

In 2008, I was diagnosed having stage I prostate cancer. The doctor told me the disease was diagnosed early as my PSA was 11, and all the scans showed the disease had not spread.

As I was 58-year-old then, I agreed to have the removal of the cancer by keyhole operation. The doctor told me the cure rate was high and the complications of erectile dysfunction and urinary incontinence were low.

After the operation, I was rather sad to learn the cancer was actually more extensive than initially anticipated.

The surgeon needed to remove more tissues to eradicate the tumour. As a result, I am now experiencing erectile dysfunction and urine leakages that required regular pads.

I have seen several specialists, who prescribed me pills for the ED, but they seem to have no effect at all.

I wonder if you can help me? Can you explain to me why did everything go wrong?

Why are the pills not working for me? What other options do I have?

Can anything be done about the urinary incontinence?

Could I have avoided all these complications if I had opted for robotic operations?

Hope to hear from you soon.


Like the forces of nature, prostate cancer is poorly understood and can be unpredictable.

Although, clinicians try their best to work out the prognostic factor that determine the outcome and success of operations, these are purely predictions, and the probabilities are all based on statistics obtained from other patients.

It is normal to doubt decisions when scrutinising the matter retrospectively. Many men consider surgery as the only option, especially when facing the disease at a younger age.

Radical Prostatectomy, or the operation to remove the prostate gland, should eradicate cancer completely, especially during stage I/II.

However, due to the proximity of the organ to the nerve and vessels supplying the pelvis, the complications such as erectile dysfunction and urinary incontinence are sometimes unavoidable.

Although many advancements have been made for the treatment of cancers in the last two decades, namely the keyhole and robotic surgery, most of the techniques result in faster patient recovery, but not necessary in the protection of sexual function and continence.

It is not uncommon for men not responding to the pills for ED after Radical Prostatectomy.

This may be caused by the irreversible damage of the neurovascular bundles of the sexual organs during the operation. When facing such detrimental complications, other none medical treatments should be considered.

The treatments for severe urinary incontinence and erectile dysfunction may include injectable and prosthesis.

The injections of the agents to expand the blood vessels of pelvis has high efficacy, otherwise, the surgical options of prosthesis also carry a high success rates.

Prosthesis such as artificial sphincters is also available for patients with incontinence after operations.

My late father used to tell me: “In the time of crisis and adversity, the true strength and resilience of a man will prevail.” With that, I wish all a Happy New Year and hope 2015 will bring a brighter year will less threats from the forces of nature.

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