Prostate cancer is the most common non-cutaneous cancer in men. Treatment for prostate cancer most commonly involves surgery to remove the prostate or radiation therapy to the prostate gland. Erectile dysfunction (ED) is often a consequence of these curative measures but effective therapy is fortunately available.
The first step in treating erectile dysfunction following prostate cancer treatment is to avoid the problem all together. Surgeon experience can play a major role in preserving sexual function following prostate cancer surgery. Surgeons with expertise in nerve sparing techniques can preserve the nerves responsible for erectile function. In expert hands, up to 60% of men can regain their baseline sexual function following prostate cancer surgery. So, my first suggestion to men worried about their erectile function after prostate cancer surgery is to choose their surgeon wisely.
The second stop in treating erectile dysfunction following prostate cancer treatment is to optimize health. This means that men need to have their ED risk factors identified and treated in order to improve their general health which will translate into better sexual function. By treating risk factors such as obesity, high blood pressure, elevated cholesterol, anxiety and tobacco abuse men can actually improve their baseline erectile function as well as their potential response to ED treatments.
Men with persistent ED following prostate cancer treatment need to voice their sexual concerns to their treating urologist. Some urologists who treat prostate cancer may not be experts in treating sexual dysfunction so men should discuss this with their attending physician. Chances are they will know a urologist who specializes in sexual dysfunction and be more than happy to make an introduction if they are not well versed in current treatment modalities.
Once the patient gets to a sexual health expert multiple treatments will be made available to them. Some men may require testosterone replacement therapy (TRT) if they have testosterone deficiency. TRT was formerly contraindicated in men with a history of prostate cancer but it is now considered to be relatively safe when used appropriately. Testosterone therapy can help restore normal sexual function and improves response rates to ED treatments.
Oral drugs like Viagra, Cialis, Levitra and Stendra may be effective for some men following prostate cancer treatment and will often be used as first line therapy.
When oral drugs fail, medication can be placed directly into the penis using the urethra. Muse (a urethral suppository) and Trimix gel can be placed into the urethra to generate an erection. Medication can also be injected directly into the penis to induce an erection. Injection therapy is the most potent form of ED treatment and works in up to 80% of men following prostate cancer therapy. Edex, Caverject and various compounded mixtures (Bimix, Trimix, Quadmix & Pentamix) can be used.
Another treatment option for men with ED following prostate cancer therapy is a vacuum erection device (VED). This is a prescription mechanical device that fits over the penis generating an erection using negative pressure. The VED has about a 50% satisfaction rate when used alone.
Various ED treatments can be combined to provide excellent results in men who fail mono-therapy. For example, oral drugs like Viagra can be combined with intraurethral suppositories or penile injections. The VED can be used with oral drugs or penile injections. Combination therapy may be required in men with severe ED following prostate cancer surgery or radiation. When combination therapy fails there is still hope. Surgical implantation of an inflatable penile prosthesis is an outpatient surgical procedure that can restore normal sexual function in men who have undergone prostate cancer therapy.
In summary, prostate cancer treatment can lead to erectile dysfunction in a significant percentage of men. Choosing your treatment wisely, especially when surgery is being considered, can minimize the sexual consequences of prostate cancer therapy. Optimizing general health and reducing ED risk factors is an important part of any post-treatment ED strategy. Various treatment options are available alone or in combination that can yield excellent results. When all else fails, surgery can restore erectile function.
The bottom line: do not give up on your sex life after prostate cancer treatment.
Posted on Tue, March 4, 2014
by Marc Richman, M.D. filed under