Prostate cancer is the most common cancer among men. Surgical prostate removal, or radical prostatectomy (RP), is considered the treatment “gold standard.” The majority of surgeries are successful in conquering the cancer. However, even in the best hands, RP can result in loss of potency, also called erectile dysfunction or simply ED.
In many such cases, potency may return with or without assistance,
but the delay can be several months up to three years.
When ED occurs following prostate removal, it is from damage to blood vessels or nerves-but there are encouraging developments in the field of urology! A recent review of clinical literature by authors Robert Segal, MDCM and Arthur L. Burnett, MD reported on the full range of methods used by urologists to treat impotence following RP.
According to the authors, there is strong support for some program of post-RP penile rehabilitation, defined as medical treatment at the time of, or after, RP to improve the restoration of natural penile mechanics, which results in spontaneous EF [erectile function]. The rationale for beginning early treatment is that the erectile tissue requires blood flow to remain healthy and elastic while waiting for natural function to resume. In fact, penile rehabilitation appears better than no treatment in helping potency return.
If a patient experiences ED after prostate removal, Dr. Alarcon assesses the nature of the problem (blood vessel or nerve damage). He will then discuss options available to the patient, and the order in which they may be implemented. Treatments range from oral medication (e.g. Viagra®, Levitra® and Cialis®) to self-administered interventions (vacuum device, suppositories, injections) to surgical means of therapy. Dr. Alarcon helps establish realistic expectations, and explores lifestyle issues or other medical conditions that may also be interfering with potency. As potency returns, treatment diminishes. Even in the cases where spontaneous erectile function does not return quickly, or at all, the patient will have developed a solution that works for him and his partner.
The authors conclude with a reminder that ED has many causes, not just prostate cancer treatment. As you continue to grow older and live longer with an emphasis on maintenance of good quality of life, it will be incumbent on Dr. Alarcon to find therapies that suit you with respect to improved erectile response, while minimizing adverse effects and cost. Meanwhile, exploration is ongoing into prostate cancer treatments with fewer adverse side effects, such as focal therapies (for qualified patients) and new technologies such as HIFU. Hopefully, the day is not so distant when prostate cancer is successfully treated and high quality of life is preserved, including potency.
Segal, R and Burnett, A. Erectile Preservation following Radical Prostatectomy, TherAdv Urol. 201;3(1):35-46.