80% of Men Face This After Prostate Surgery. Few Are Told.

I've sadly had two partners, 20 years apart, and both of them no longer alive. And the way they discovered that they had a chronic illness to begin with was when they noticed that they had erectile dysfunction.

I have not spoken to a single person who wasn't surprised how big that problem really is. The numbers I have seen vary from 80 to 84%. So staggering, no matter how you look at it. So 80 to 84% of people who have gone through the radical surgery for prostate cancer suffer from erectile dysfunction.

Hi, this is Suzanne Noble, and you're listening to Sex Advice for Seniors. And if you've been a longtime listener, then you know that one aspect of sexual health that I'm particularly passionate about is erectile dysfunction. And I don't know if I've actually ever shared the story of why I am so passionate about that, but primarily it's because I've sadly had two partners 20 years apart and both of them no longer alive. And the way they discovered that they had a chronic illness to begin with was when they noticed that they had erectile dysfunction. And at first, especially with one of them, because he was a man in his early 60s, I put it down to age. I told him he didn't really need to worry. He became quite preoccupied with the fact that he was experiencing this as it hadn't really been a problem previously, but as it turned out, he actually did have quite a serious illness and he died. And Suzanne Noble. So when I was able to speak to several urologists, thanks to my work with this podcast, I really learned a hell of a lot about erectile dysfunction, a lot more than I ever thought I would ever know. So I'm really pleased today to actually speak to somebody who's really working at the cutting edge of solving erectile dysfunction for many men. And that's a guy called John Plate, who's the CEO COO and co-founder of a company called Nordic Stem Cells. So, John, welcome to Sex Advice for Seniors.

Thank you very much. I look forward to talking about erectile dysfunction and everything else we could get into.

Yeah, great. So listen, to start with, we know that erectile dysfunction is especially common after radical prostatectomies. How big really is the problem?

Yeah, that, that problem is— I have not spoken to a single person who wasn't surprised how big that problem really is. The numbers I have seen vary from 80 to 84%. So staggering, no matter how you look at it. So 80 to 84% of people who have gone through the radical surgery for prostate cancer suffer from erectile dysfunction. And since this is the most common cancer form for men and, and the surgery is done Tens, if not hundreds of thousands per year in a place like the US. Those numbers are amazing. And we don't hear that much about it considering how big the group is. We don't hear so much about it. And I'm sure you can, I'm sure you can with your experience, you know, and I have my own theories and my own experiences is why that is.

Yeah. I mean, I went to see a urologist to speak about erectile dysfunction. Not so long ago. And one of what he said, and actually what men have told me who have gone through this procedure themselves and were shocked to find out that they no longer were able to get an erection, was, we don't really talk about this too much with our patients because we just want them to get through the cancer. We just want them to overcome the cancer. Their sexual function, that's a secondary thing, but What I know from speaking to men, some of whom are friends of mine, is that when they discovered that they weren't able to have an erection, they were quite traumatized, quite frankly, by, by this. And of course, what they then found out when they asked about it was, well, yeah, yeah, I mean, of course, you know, like, your nerves have been severed. We know that's like, like, what did you think was gonna happen? And well, yeah, you might get it back. So it was like, okay, so do you think you could have told me that? So yeah, I know.

Now you're left with that feeling. Well, that would have been nice to know. I've had the same conversations and the doctors, if they want to talk about it, they're quite black and white about it. We are here to treat a cancer. It's a serious thing and we've treated it. And I think it has to do with a number of things. It has to do with how doctors are actually, uh, stovepiped within a medical system. I'm here to treat this. I'm not a sexologist, et cetera. But we hear that very frequently, that the focus in most countries and most hospital settings is on curing the cancer and less so, if at all, if I may be a bit critical, on whether you have a sexual function afterwards. That's why we actually call it the silent aftershock. Because you can imagine your relief that you have survived prostate cancer. We all know people who don't survive prostate cancer, only to find out that there is an aftershock. There is something you haven't been told. I'm sure you, you don't think about it the first month, but then after 2 months and 3 months and 6 months, you realize, oh my God, I actually have a much lower quality of life than I imagined when I went into this surgery. And for sure before I had the surgery. That's a bit of a price to pay.

Yeah, completely. And I suspect as well that part of that is around shame in talking about it, because I know that a lot of men are just really ashamed of talking about erectile dysfunction at all. So it's not something that they would have necessarily thought to bring up when they were going into surgery. You know, I suspect lots of men are just thinking, I've got cancer. And I want to get through it. So they're also quite focused on that without thinking about the subsequent side effects of the surgery. And then of course, on top of that, you've got some cultural issues sometimes that I've spoken with people around about how doctors feel about talking about sexual function in general, which is there are some cultures where they simply don't want to talk about it. It's a bit of an embarrassment for them, right? So then the men that I've spoken to, if they did want to deal with this aspect of the, of the surgery, it's almost like in some cases they have to go and find a specialist who just wants to talk about sexual function because they may find that their doctor is quite dismissive of it. I hate to say this, but you know, it's what I've heard because they're just glad they no longer have cancer. And as far as they're concerned, they've done their job. They've done it, right? Cured you of cancer.

Emily, I come from a family of doctors, so I think I'm entitled to be a bit sort of making fun of it a little bit. But doctors are advanced mechanics. And you came in and you had an engine problem and they fixed the engine problem. They do not see it as their job to tell you that there might be a little bit of a problem with another part of the engine later on.

Yeah, yeah.

I went through it myself actually recently when I had a cancer operation where they removed half my thyroid and they were very happy. We removed it. It's successful. But what they failed to, and then the system, and I mean this, I don't mean this disrespectfully, but the system loses interest in you because you're cured. It's done, right? Go and see your GP. But, but what happened actually is, well, you, my metabolism wasn't exactly where it should be, et cetera, et cetera. But you're a little bit left to your own devices. And they also did not mention it beforehand. So I think the educated patient that comes in with prostate cancer can still not be expected to know these things. So we have a job, actually, of telling people who are now in the situation that there are things you can do. And this is recent. You can do things to eradicate or to improve on the symptoms, but now you can also do something with the actual root cause of it.

Yeah, completely. And I know we spoke about this just before the show, that we both have family members who have gone through a prostatectomy procedure and both struggled with this. And one is a very close family member to me. And when I tried to bring up some of the aspects around rehabilitation, he himself did not want to talk about it. He was like, you're a family member. We're not talking about this. Okay. We're not talking about my dick. And so, you know, for me, I feel part of my responsibility in doing sex advice for seniors is actually because I feel very strongly that men or women need to know how to advocate for their own health. And they need to know the right questions to ask doctors, and they need to know how to represent themselves when they go see a medical professional because they can't always be assured that that medical professional is gonna ask them the questions that need to be asked, especially if a person is at a later stage of life where often there's an assumption that their sexual life has come to an end. And that is just a complete fallacy in many cases. And so patients need to advocate for their own sexual health and they need to go in with the right questions is how I feel very strongly about this because if doctors are not going to ask the questions and people need to go to doctors and know what to ask, like what, what's going to happen after this procedure? Like, what can I expect? Am I going to regain my erectile function? You know, how long is it going to take? What's the average? Like, what's What steps can I take now? I mean, I know that, you know, just completely separately, I know a friend of my parents and she had a hysterectomy. And one of the things she did was get super healthy before that, like did a lot of strength training, got really fit because she knew that taking out a lot of these organs was going to be a really significant operation. And if she didn't get super fit, forget about, you know, she'd be in bed for the next 6 months. So she knew that in order to recover quicker, she needed to become super healthy. And I suspect there is an aspect of that as well to surgery around the prostate, like what, you know, what are the steps? But let's move on to Nordic Stem Cells and what you're actually doing there to support men with erectile dysfunction.

Yeah. So a group of doctors in Denmark where I'm from, a group of doctors at the Ørensøgedanken University Hospital decided that they were working with stem cells and they had reason to believe that stem cells, your own stem cells, mind you, could actually help in the treatment of erectile dysfunction. They then chose the group that is the hardest hit group, and that is the group that has undergone the radical prostatectomy, because simply because the surgery has created lasting damage. Applied for funding, as you do in the system. They applied for the funding and got the funding, and they did a Phase 1 clinical trial. A Phase 1 clinical trial is where you look at the safety and the efficacy of it. So is this safe? Otherwise forget it. But is it also effective?

Uh-huh.

And that, that study and the results of it actually went a bit around the world. So it was, the study showed that they could treat 73% of this hardest hit group.

Wow.

It also showed a few other things that I'll share in a second. And that, that information went around the world. First, it went to The Lancet and into eBiomedicine and these, these serious journals for doctors and other people in pharma, but it also went to Australian news and British news, et cetera. Because there is no treatment up until then. Nobody had been able to point to a treatment. We all know, we all know treatments to use maybe the wrong term, but we all, we know how to treat the symptoms of it, Viagra, et cetera. But nobody had ever been able to once and for all do something about the underlying problem.

Yeah. Yeah.

That group, that search study was led by Professor Søren Scheich. And he had the vision. He's a researcher through and through and throughout his life, a fabulous researcher. But he also had this feeling that, well, wouldn't it be nice if I could actually, for a change, take my research and actually apply it and help a lot of men? And we'll get to that, a lot of couples, because this is not men's only, is it?

Yeah, absolutely.

And he worked very closely with who is now my co-founder, Adam, who is his son-in-law.

Right.

Okay. Adam is a, is a fantastic entrepreneur. Adam and I found each other. My background is more corporate. I have also been an entrepreneur for a number of years, but my background is more corporate. So I worked in companies that Americans will recognize, Boston Consulting Group or Cambridge Technology Partners. See, I like Boston area, obviously. Yeah. So I know a fair bit about scaling and processes and getting this to actually glue. And so does Adam, by the way. Yeah.

Yeah.

So with this professor as our medical advisor, a clinic was opened in Costa Rica.

Oh, wow. Okay.

Yes. Yes. So Costa Rica is the preeminent stem cell treatment capital of the world.

Is it?

20, 30 years ago, they decided that they wanted to be that. So they had legislation. They made it rather hard to get medical licenses. You needed clinical evidence, which of course supports us.

Yeah.

So the reason we chose Costa Rica is simply we can, we can treat the world from there, the US market predominantly because they don't have to travel so far, but we can treat it from Costa Rica. And it's a cluster in that usual cluster thinking where once you have quite a number of serious stem cell clinics, you also attract the best doctors and the, and the best microbiologists, et cetera. So we are actually the only clinic in the world that treats erectile dysfunction with your own stem cells. We can get into what that means, but the psychology of it is that it is that your own stem cells, they are not grown in a lab or from someone else, is hugely important for people. And of course, there's also the clinical reasons is that there will be no rejection. And this is one of the things that that clinical trial actually showed.

Very interesting. And so typically, if a person comes to the clinic, how long would they expect to be staying there? And what's the period of time that this takes to actually be able to see significant changes?

So you could say the good news first. Good news is that this can be done very quickly. It can be done in 3 days. And the procedure itself is a total of 6 hours.

Oh, wow.

So you come in on one day, you go and see the doctor who will do the liposuction for you because you need 400 milligrams of your own fatty tissue. And if you know a little bit about liposuction, 400 milligrams is nothing. People do it if they are hugely overweight. So 400 milligrams is nothing. There is no inconvenience in it. And he is the leading doctor in Costa Rica. And a through and through brilliant guy. So you go and see him and he tells you what's going to happen the next day. You will be fasting. Please, could you drink some electrolytes? Please show up at this hour. Do you have any questions? And people can feel at ease. These people, obviously, we have asked all of the questions we could think of in the process leading up to it. But still, at the end of the day, you want to look him in the eyes and answer the questions. Or have him answer the question, feel good about it. The next day you go in and this is in a hospital setting. So we are working with the leading hospitals there called Sima. It's in a hospital setting, which again makes everybody feel very comfortable. And that's where, where you have your liposuction. Once that's done, you're actually done in 2 hours. You walk 60 meters to our clinic, which is also within the compound. Where another doctor team will inject a very condensed, uh, portion of stem cells, not nearly 400mg, not even a tenth of that, into the penis in 6 places. And this is where it gets sort of very technical. This has to be done by people who are, first of all, specially qualified for stem cell injections and also follow the protocol that the professor and his team actually developed in Denmark. Once that's done, you will have very limited discomfort, uh, and, uh, you will go back to your hotel and already the next day you're allowed to travel. So you can do it over a weekend.

Wow. Amazing.

And that, that, that is rather amazing. And then we get to where it's very important that we are very straightforward. This takes time because you have damaged nerve tissue, you have damaged vascular conditions, which means that That needs to regrow.

Yeah.

So what we do is after 3 months, we follow up. You actually get from us a way of measuring. It's a ring you put on your penis while you sleep and that measures your erection. And as, as you know, Suzanne Noble Noble, there's a scale for measuring erections.

Yeah.

Yeah. It's an international scale so that every doctor can talk to every other doctor and find out. Is this improving or not, rather than just sort of a bit of hearsay. You do that after 3 months, 6 months, and 9 months. After 3 months, you will definitely have moved up the scale. After 6 months, significantly. And after 9 months, you will actually have, actually have erectile function similar to when you were significantly younger.

That's amazing. That's incredible.

It's amazing. And, and there is also always this caveat. We want to be serious people and there's, they treated 73%. That also means there is a 27% group that they were not able to treat quite so successfully. And there are reasons for that. If you, if you have chronic conditions, if you are incontinent, if you are diabetic, if you, there can be all types of reasons, which is why when you do a clinical trial, you want to show the honesty of it. You want to say, look, 73 is very impressive in our world. But in our case, what we feel we should do is we are very diligent in our conversations with people. So the information they give us, the information we ask, the evaluation our doctors make before we even consider whether you're eligible.

Yeah. Yeah.

Will make sure that in your individual case, the chances of recovery are very high.

And can I ask, how much does it cost?

Yeah, you can. You can. It costs $22,500.

Okay.

And that includes everything about the treatment. But not your travel and your hotel, et cetera.

Sure, sure.

We actually, now we get into the details of it. We're very happy to help with all that because we want to create a VIP service, so to speak.

Yeah, yeah.

So we, uh, my co-founder and I will always be present. There will be someone taking care of you from A to Z. Basically, we want to make this as comfortable as possible because Both Adam and I are in this to change people's lives, to give people the quality of life that they used to have. As you alluded to, we have found out that many couples decide, once they find out that the husband has erectile dysfunction, they decide, uh, not to do much about it.

Yeah.

Um, 50% of those couples can actually use Viagra and it has some effect.

Yeah.

Yeah. 50%, 50% of the 84 we had before that have erectile dysfunction will not react to it.

Yeah.

There are many ways in a relationship. There are many ways to be intimate. And there's also the happiness that the husband is no longer sick. And we can just imagine the kind of conversation that goes on. But what we know now is there is actually something to do about it that is rather to the core of it, to the root cause of it. And that's our little crusade.

Yeah. And I'm curious to know whether in, we talked about, you know, the ring that can measure, which is the ring that I've been working on, the FirmTech ring.

Yes.

Ring. So that's a, that's really good for being able to see actual real progress, especially when men are sleeping. What about other things like pumping, for example? Do you recommend pumping after this particular procedure to speed up the recovery? And just a secondary question, I'm curious to know if the age of the patient also has some impact on their recovery period.

I'll answer to the best of my abilities. The pumping is by all doctors I have spoken to and read what they're saying recommended after surgery.

Yeah. Yeah.

After surgery as a part of your healing process, it is recommended. Our medical team does not recommend it, does not recommend it after our surgery. So it's after the prostate surgery. It seems to be common practice.

Yes, it is. Yeah.

Whereas after our surgery, it's simply not necessary.

Okey-doke. Okay, that's clear. Yeah.

And, and you had the second question, sorry.

And the second question was, does the age of the patient impact their recovery period? So my expectation is that just, you know, that it takes longer to recover from surgery if you're a 70-year-old man than if you're a 50-year-old man, I would expect. Do you see the same in this case?

I have not seen it. I have actually not seen it. I would sort of commonsensically think that there might be a bit of that going on, but the stem cells you're using are your own and they are the stem cells that are formative, that can be formed into any kind of stem cell and any kind of tissue. So I don't think, I don't think it's a barrier, but what, what now that we're talking about age, what is, what is relevant is to say that each evaluation that the doctors make of your eligibility takes everything into account. And your age, most definitely the doctor will also take your age into consideration. And as always, they look at the entire picture and say, based on lots of experience, yes, we think you should go ahead with it.

Yeah. Yeah. And I would expect, as you said, that, you know, we haven't really talked about the complexities around erectile dysfunction. We've been talking specifically about one very, you know, particular example when a man has a radical prostatectomy. But also, of course, we know that men who are diabetic, men who are overweight, men who are unhealthy, you know, there's many, many reasons for ED. And some of them are to do with their vascular health. Some of them obviously are psychogenic. So they're more to do with their, you know, what's going on in their head, anxiety, performance anxiety, I expect that if a man's had a radical prostatectomy but is in all other ways a healthy male, then he's probably a much better candidate than a very overweight man who's had a radical prostatectomy and perhaps has got secondary cardiovascular issues that would also be impacting on his ability to have an erection.

I'm afraid, yes, exactly like that. Those are the hard facts. That's exactly the situation. So the doctor will make an overall evaluation, not to get people's hopes up when there's no reason for it and not to waste people's time and resources.

Yeah.

Even ours. So it is very important to get, get that evaluation right, which is actually why our medical advisor who did the actual clinical trials is the one doing the evaluations.

Yeah. And I think, you know, also what we're saying is that, and I've always said it as well, is that there's no shortcuts here when it comes to overcoming ED. I mean, this is, this procedure will work if the conditions are there for it to be able to be successful, but if the conditions aren't right, it's not gonna suddenly be some magic pill that you can take and it's suddenly gonna work. Similarly, I always say to guys, like, you can take a blue pill and that may temporarily mask what is a much more significant problem that's going on. And eventually that problem will catch up with you if you don't actually do something about it. So, you know, the best thing you could do—

that is how it is. But if I can paraphrase ever so slightly, is that you can do a lot about the symptoms. Yeah, you most definitely can. There is a, as you know, there's a penis pump. You can do injections. You can obviously do many type Viagra and all the similar products. You can most definitely do that, but you are not solving the problems. And a lot of these, a lot of these treatments was not really treatments, but a lot of these things are rather expensive. What you lose is of course the impulsiveness of your sex life. And this is what we hear from a lot of both women and men. Is that the impulsiveness has gone away. And what we also hear from patients of ours is that they're saying, I got my ordinary sex life back where it was. And that's really what they translate. They are the ones that translate it into quality of life. So there is still, in my humble opinion, something earth-shattering here in that something that has never been treatable is actually entirely treatable for 73% of the population with this problem.

Yeah, it's amazing. And is your goal— you're, as an entrepreneur, I'm assuming that your goal is that once you have gotten a certain number of patients and successfully cured them of ED, are you planning on scaling this to other territories?

You can do that. You can do a number of things and we will probably do them all. But like, one of the things we constantly want to do is share our findings with the world. You know, there's a lot of noise in this world. We have our clinical studies. We want to continue to show results and share them with the world because we, the world of stem cell treatment, at least 10 years ago, was a bit of a cowboy world. Whereas we want to be the serious people that don't do things based on evidence, that actually live up to the promises we make and are very transparent about everything. And in terms of geographical expansion, we're a little bit hampered by which countries actually allow stem cell treatments. So as you may know, being British after all, they, they, the UK is, is looking into changing their legislation based on overwhelming evidence. So the UK could be a place, United Arab Emirates could be a place. We basically just want to serve as many people as we possibly can. And Costa Rica is already a destination for a large number of Americans. They're very, very comfortable with it.

Sure.

And I know it to be a very safe and solid place. Um, but it's a bit far for European to travel.

Yeah. Yeah.

So we would consider for logistical and practical reasons, uh, an expansion in due course.

Yeah. Interesting. And of course I'm in Thailand, so, you know, maybe you'll come out, maybe you'll come out to Southeast Asia and, and do something here, but it's been, it's been so interesting. I found this so fascinating. And I think anything that supports men to be able to regain their sexual and, you know, erectile function. It's got to be a good thing. And I think that the cost, when you compare it to treatments like shockwave therapy, for example, which are also very expensive and don't perhaps have the same degree of efficacy that this seems to have, it's, it's actually, it's actually not that expensive for, you know, lots of people. And it's great to hear innovation in this area because I think that this area has definitely lacked a lot of innovation and left a lot of men feeling quite lost.

And probably because a lot of people haven't spoken out for a number of very understandable reasons. So we, even you and I, well, maybe not so much you, but when I found out, I was shocked how big the problem actually was.

Oh yeah, me too. I mean, you know, I just to close off, it's like 50% of all men over 50 have some degree of erectile dysfunction. I mean, it's huge. Similarly, 50% of all women over 50 have GSM, which is also huge. And we also have— we also have problems in getting help in this area. So it's, it's a problem on both sides. And I suspect that part of the reason for that is because, as I said before, when you reach a certain age, it's assumed that sex is kind of off the menu, and you don't really have to worry about it. And I know just You know, speaking personally, that when I've gone to see a doctor, took me 6 months just to get testosterone. And that has changed my life. It's just changed. It's, it literally has changed my life. And it's not— when I finally got to see someone, he was like, oh yeah, of course you can have it. But up until that point, I was told that it, you know, maybe I could see someone and maybe not. And it wasn't taken very seriously. So I do know that the medical community is as much responsible for the lack of innovation in this area as anybody else, because unless they take our sexual life seriously at whatever age we are, then really nothing's going to happen. And it's down to entrepreneurs like yourself and other people that I know that I've spoken to, to be able to actually do something that's quite incredible and can change people's lives. So I think it's amazing what you're doing.

Thank you very much. Thank you.