What You Should Know about Erectile Dysfunction After Prostate Cancer
by Ronney Abaza, MD
According to the American Cancer Society, almost 200,000 men in the United States will be diagnosed with prostate cancer in 2009. Fortunately, while prostate cancer is very common, most men diagnosed with prostate cancer do not die of the disease. In fact, despite the reality that some prostate cancers can be very aggressive, the overall relative 10-year survival rate for prostate cancer is above 90 percent.
Because of this, more than two million American men are currently prostate cancer survivors. Prostate cancer is a very treatable, and often curable, disease. Therefore, the side effects of treatment are important to consider when making treatment decisions, particularly for younger men who may live for several decades after treatment. One side effect that is of great concern to men undergoing any treatment for prostate cancer is erectile dysfunction, or impotence, which is the inability to achieve or maintain erections adequate for sexual intercourse.
One treatment for prostate cancer in the U.S. is robotic prostatectomy, or removal of the prostate gland through minimally invasive surgery with the aid of robotic instrumentation. Similar to traditional, open surgery for prostate cancer, men will experience erectile dysfunction temporarily, or in some cases permanently, after surgery. Whether they regain erections in the coming months or years, and how quickly they will do so, depends on each individual’s preoperative erectile function, age, and stage of cancer, in other words, whether their cancer was too advanced to allow the nerves responsible for erections to be spared.
Physicians have begun to adopt regimens to aid men in recovery of erections after surgery. These regimens essentially aim to improve the chances for recovery and/or the speed of recovery of erections.
With radiation therapies (external beam or “seeds”), loss of erectile function is gradual over the weeks to months after treatment and may or may not return, as with surgery. Many men who have return of erectile function after either surgery or radiation will notice that their erections may not be as firm as before surgery or that they may have to use medications to help them achieve erection.
Physicians who treat men with prostate cancer have begun to adopt regimens to aid men in recovery of erections after surgery. These erectile rehabilitation regimens essentially aim to improve the chances for recovery and/or the speed of recovery of erections. A growing body of evidence supports the thought that encouraging quicker return of erections reduces the damage that comes from prolonged lack of erections, including scarring and reduced elasticity of the spongy tissues of the penis.
While scientific investigations in support of these strategies continue, the optimal medications, timing, and strategies for erectile rehabilitation have yet to be fully determined. Some surgeons will begin rehabilitation very soon after surgery, while others may begin medications even before surgery. Many physicians will use a class of medications that includes sildenafil (Viagra®) as part of a rehabilitation program, with low doses taken nightly or less often. Full doses of these medications can then be taken to augment erections once they are of good enough quality to allow sexual activity.
A vacuum pump is commonly used to maintain health of the spongy erectile tissues of the penis until natural erectile function returns or to augment partial erections to allow intercourse. Injection therapy involves at-home injections directly into the penis of medications that bring blood flow to the penis. This can be part of rehabilitation or a way to allow sexual activity before natural erections return or for those men who never have return of erections naturally.
Whether or not a man regains natural erections after prostate cancer treatment with or without rehabilitation, men should know that there are alternatives allowing return to sexual activity, including vacuum pumps, injections, and even surgical implants. Since most men diagnosed with prostate cancer will live for many years, they should understand that no matter what happens, they do not have to give up sexual activity.
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Dr. Ronney Abaza is assistant professor of Urology and director of Robotic Urologic Surgery at The Ohio State University College of Medicine, as well as co-director of Ohio State’s Center for Advanced Robotic Surgery.
This article was published in Coping® with Cancer magazine, November/December 2009.