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Prostate Cancer and ED

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.

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


Prevalence:

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. Unfortunately fewer than 10% of men will experience a return of their pre prostatectomy erectile function. Clinical trial data obtain for the FDA approval of Viagra, Cialis and Levitra also showed that only 37% of when with ED after prostate cancer surgery responded to oral medications. The majority will need a more advanced treatment.  

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."

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