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CONTACT INFORMATION |
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J. Francois Eid, M.D.
50 East 69th Street
New York, NY 10021 |
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Ph: 212-535-6690 |
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Fax: 212-535-7025 |
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ED and Prostate Cancer |
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All types of prostate cancer treatment can cause erectile dysfunction. In the course of removing the cancerous prostate gland, due to their proximity, the nerves responsible for erection are often damaged. Additionally, radiation therapy of the prostate can lead to blockage of blood flow into the penis by damaging the penile arteries. Hormonal therapy will cause lack of desire and arousal as well as the inability to obtain a full erection. Over time, hormonal therapy will cause the penis and testicle to shrink. In addition to ED, which occurs after prostate cancer surgery, men may experience urinary incontinence and/or urine leakage during sexual activity.
Prevalence
According to the American Cancer Society, prostate cancer is least common among Asian men and most common among black men, with figures for white men in-between. Prostate cancer occurs in 1 out of 6 men. Treatment options include: Surgery- Da Vinci Robotic or Laproscopic prostatectomy, radiation therapy, hormonal therapy, occasionally chemotherapy, proton therapy, or some combination of these.
As previously mentioned, in the process of removing tissue surrounding the cancer, surgery may damage nerve function or interrupt blood flow. Radiation therapy for prostate or bladder cancer also can permanently damage arteries.
Rates of ED post treatment of prostate cancer vary widely across the world. Although there are many new nerve-sparing techniques aimed at lowering the incidence of impotence I still see upwards of 60% of treated patients having a significant degree of ED. Temporary impotence is also associated with these procedures and recovery can be expected up to the first 18 months following the surgery.
A significant number (40%) of patients following radiation therapy will also develop erectile dysfunction, especially if pre treatment with hormone therapy has been prescribed. ED following radiation therapy usually occurs 6 to 12 months after the treatment and is due to blockage of penile arteries and decreased circulation of blood to the penis. More recently, erectile dysfunction after prostate radiotherapy may not be related to dose exposure, research indicates.
"Erectile dysfunction after external beam radiotherapy (EBRT) for prostate cancer is not related to the radiation dose administered to the crura (base) or penile bulb," according to a study published in the International Journal of Radiation Oncology Biology Physics. Researchers "conducted a randomized dose-escalation trial of EBRT, comparing 68 Gy and 78 Gy doses in 96 patients." Two years later, "researchers found that 36 percent of the patients...suffer[ed] from erectile dysfunction."
Treatment of ED after prostate cancer
In most cases, the degree of your ED will be determined by your age and if you had experienced partial ED prior to cancer treatment. Patients with decreased erectile function requiring treatment with a medication prior to the surgery are unlikely to recover function. Patients with medical conditions affecting blood flow such as diabetes, high blood pressure, high cholesterol and heart disease are also less likely to recover the erections. The quality of the nerve sparing prostatectomy also plays a major role in determining potency. The more experienced the surgeon, the better. Older patients, over 65 years old, are more likely to have advanced ED.
Oral Medications
As you start feeling better after surgery, try using Viagra, Cialis, or Levitra. These medicines will help improve the blood flow to the penis and begin to “work it out”. This is the simplest form of treatment but is less than 40% effective in men with ED following prostatectomy.
Penile Implants
If oral medicines are not effective, there is only one choice that offers permanent results: The Internal Penile Implant is currently the best option. The Penile Implant is an approved medical option that has been used for over 30 years. During the course of a 45-minute outpatient procedure, the pump is inserted through a small one-inch opening in the scrotal sac. By squeezing the pump, fluid is pumped, resulting in a long lasting erection. Once inserted, there is no maintenance required for the pump and can remain in place for a lifetime. This option has the highest degree of partner and patient satisfaction.
Penile Injection Therapy
If you are unresponsive to the Oral Medicines and do not want a permanent solution you can try the Injection Therapy. This option is extremely effective but men lose their spontaneity and are required to refrigerate the medicine, fill a syringe, and then inject. This medicine is also very costly.
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