Why Is There Increasing Concern At This Time Regarding Erectile Dysfunction Issues Following Radical Prostatectomy
The reality of the recovery process after radical prostatectomy today is that erectile function recovery lags behind functional recovery in other areas. Patients are understandably concerned about this issue and, following months of erectile dysfunction, become skeptical of reassurances that their potency will return.
Theme : Treatment/provider Satisfaction/dissatisfaction
Some men reported dissatisfaction with the treatment they received, while others were happy with the treatment and the care they received around the treatment. The majority of men talked about being happy they were cancer free. Several men talked about their frustration with their providers sole focus on the surgery and the lack of resources or help with side effects from treatment. Men who were dissatisfied talked about the lack of support and help from their providers while men who were satisfied with their care commented on the support and help they got from the provider throughout treatment. Some men felt the provider did not really understand them in terms of their priorities and their feelings about sexual function. Some patients regretted the particular treatment they received or that they received treatment at all. The participants said the following:
Man 17: Uh, were alive, ok? I was Gleason 7. My statistical life expectancy would be about 12 years, you know, thats average. Could be less, could be more. If I did not get treatment. And, uh, my mentality– and still isI got it out, out of my body.
Man 1: I think back. Maybe I shouldnt have done it . And go with the shorter quality of life rather than a long life a longer life with the situation.
Theme : Importance Of Support And Understanding
Not surprisingly, the men and partners we interviewed impressed upon us the need and importance of support and understanding, from their partner and from others in their lives, including their families and support groups like the Us TOO International Prostate Cancer Education and Support Network. An essential element of this support was communication, especially with the partner, which could be very difficult for both parties. To enable this communication, it was crucial for men and their partners to be open about their intimate feelings and concerns. The participants said the following:
Man 13: Im in a great relationship really for the first time in my life with a woman who really I dont think doesnt care what we do as long as were together. We enjoy sex a lot not just to be active, just to have intercourse. Without her I dont think I would be as far along in getting my sex life back to where I want it to be. Its got to do with her and shes put up with so much.
Man 9: I come here shaking like a leaf, man. I get in here with a bunch of guys that had been where I was about to go and man they gassed me up with that strength. And like I said, when I came in I was shaking like a leaf. When I left out I was empowered.
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What Is Prostate Cancer
most common cancer in men in the United States, according to the Centers for Disease Control and Prevention .
Prostate cancer occurs when cells in the gland divide uncontrollably. This leads to a lump, or tumor, that draws nutrients and blood away from other vital functions in the area.
Acinar adenocarcinomas, or slow-growing tumors, are the most common type of prostate cancer
Thousands of men die in the U.S. every year from prostate cancer, but the CDC highlights that most men who have prostate cancer are over 65 years of age and usually die from a
What Can I Do Rehabilitation And Aids
Studies suggest that starting a program to promote erections about six weeks after surgery can help some men recover sexual function. Different methods are available, depending on your particular case, your level of motivation and the judgment of your surgeon. These penile rehabilitation programs focus on increasing blood flow to the area to encourage healing and help men have regular erections that are hard enough for penetration. Having two to three erections a week, even if there is no sexual activity, helps keep the tissues in the penis healthy.
There are different options to treat ED, and they may or may not be part of a rehabilitation program:
- Oral medication: sildenafil/Viagara®, tadalafil/Cialis® or vardenafil/Levitra MUSE
- Vacuum erection devices
- Penile self-injection with a prostaglandin: alprostadil/Caverjet/Edex
Talk to your provider in Roswell Parks Genitourinary Center about the options available to you.
Read Also: Major Causes Of Prostate Cancer
Pelvic Radiation Therapy Effect On Erections
Prostate, bladder, colon, and rectal cancer are sometimes treated with radiation to the pelvis. This can cause problems with erections. The higher the total dose of radiation and the wider the section of the pelvis treated, the greater the chance of erection problems later. If radiation therapy is part of your treatment plan, talk to your doctor before it starts. Ask how your arteries and nerves might be affected by radiation therapy so you know what to expect.
How May Erectile Dysfunction Affect My Sexual Relationships
Prostate cancer and its treatment can affect your desire for sex. Every man is different but the feelings caused by having cancer and the physical stress of treatment can affect the way you feel about your body and your relationships. Some men talk about feelings of a loss of their role within the partnership or family. This can sometimes affect a mans self esteem and confidence. For others, the physical effects of treatment may lead to tiredness and a lack of energy. Physical changes after some treatments can also affect the way you feel about your body and appearance . All of these things may result in a lack of interest in sex.
If you are feeling tired or under stress, tell your partner how your feel. Loss of interest in sex does not mean you lose interest in a loving and supportive relationship. There are ways to remain physically intimate without having sex. If you are used to a close physical relationship, it is important to remember that hugs, cuddles and kisses maintain intimacy, provide support, and do not have to lead to sex.
Management Of Ed In Primary Care
In particular, there seemed to be inadequate management of ED in primary care, including failure to implement early and structured strategies, combination ED management strategies and, in some instances, any ED treatment at all. These issues seemed to reflect restricted access to treatments and services and lack of confidence in managing ED. This suggests a need for better targeted training and education, particularly for practice nurses. Many GPs see relatively few patients with prostate cancer, whereas practice nurses encounter men with ED more frequently, presumably when administering ADT injections or providing care for concomitant conditions, such as diabetes. In the UK there has been minimal undergraduate/postgraduate education in sexual medicine and human sexuality. We also found a lack of assessment of EF before and after prostate cancer treatment, with low usage of formal/validated measurement instruments and no routine structured evaluation of ED management efficacy.
Cavernous Nerve Interposition Grafting
Studies have shown that microsurgical end-to-side grafting of the sural nerve of the leg or the femoral nerve to the cavernous bodies could achieve effective results in patients whove had prostate surgery.
This surgical technique helps to restore the nerve connection to the erectile tissues and cause an erection. With the help of medication, as high as 50% of patients following prostate surgery gains satisfactory erection for normal sexual activity
The article is a part of our series on What is Erectile Dysfunction: A Complete Guide
John P MulhalCavernous Nerve Stimulation and Interposition Grafting: A Critical Assessment and Future Perspectives,Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1477600/
Ilan Gruenwald,Boaz Appel,Noam D. Kitrey and Yoram VardiShockwave treatment of erectile dysfunction,Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3607492/
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How Soon After Prostate Cancer Treatment Can I Be Sexually Active Again
This will depend on what type of treatment you have had and how you feel. It could be several weeks, for others it may be a lot longer for erections to return. Some men will never be able to keep an erection without the help of artificial methods like medicines or medical devices . If you were having problems having erections before treatment, this will not get better after treatment.
Can Other Treatments For Prostate Cancer Cause Erectile Dysfunction
Other treatments for prostate cancer, including radiotherapy and brachytherapy can also cause erectile dysfunction. Brachytherapy involves delivering doses of radiation therapy directly to the inside of the prostate rather than on the outside of the body as with normal radiotherapy.
Hormonal treatments, given as injections, tablets or a combination of the two, help to manage the progression of advanced prostate cancer by blocking the effects of the male hormone, testosterone. Testosterone helps prostate tumours grow, so blocking its action helps to prevent further growth of the tumour. It isnt a cure, but is often used in conjunction with other treatments. This kind of treatment can also cause erectile dysfunction due to the loss of testosterone.
Cryotherapy, where cancer cells are killed by freezing them using tiny probes inserted into the prostate can also cause erectile dysfunction. This is because cryotherapy also may damage the nerves controlling erection.
What type of treatment you have for your prostate cancer will be determined by the stage and speed of growth of your cancer.
If you suffer with erectile dysfunction after treatment, how long this may last and how much it affects your life will also depend on your type of treatment and the severity of your prostate cancer.
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Finding Help For Erectile Dysfunction
Discussing sex-related conditions or prostate health can be uncomfortable, but understanding these conditions and how they affect overall health is critically important for every patient experiencing ED. Once a health care provider knows that the patient has this problem, they can prescribe medicines that often take immediate effect or refer the patient to a specialist for other treatment options.
Even if you choose not to treat the ED with direct therapies, going to the doctor will help you uncover any of these underlying medical problems. Identifying the organic cause and prostate cancer treatment can help relieve the symptom of ED.
Treatments for prostate cancer that may also indirectly improve ED include surgery, radiation therapy, systemic therapy and focal therapy. Detailed information about treatment options is available through Siteman Cancer Center.
Treating Prostate Cancer and ED at Washington University
Washington University Division of Urology and the Washington University cancer specialists at Siteman Cancer Center help treat patients experiencing these related conditions. Washington University offers a multidisciplinary approach, which employs the combined expertise of urologists, interventional radiologists, endocrinologists and psychologists when it comes to making a diagnosis and developing a treatment plan for ED. Siteman has a number of innovative treatment options for prostate cancer.
The Prostate Gland And Prostate Cancer
The prostate gland is a male reproductive organ that sits around the urethra, the outlet tube for urine, just below the bladder. The glands surface is usually smooth and regular. The prostate is about the size of a walnut.
The prostate gland releases a clear fluid into the urethra that represents up to a third of the semen during ejaculation. One of the functions of the fluid is to carry the sperm and help sperm movement.
The prostate also helps the drive of semen during ejaculation.
Recommended Reading: Prostate Cancer Symptoms In Males
Hormone Therapy Effects On Erections
Hormone treatment is commonly given for prostate cancer. Men given androgen deprivation therapy are at a high risk for sexual problems, including loss of sexual desire and erectile dysfunction. Erections may or may not recover when ADT is stopped. Erectile dysfunction drugs do not usually work in these cases because they don’t help with the loss of sexual desire.
What Have I Learned By Reading This
You learned about:
- Why prostate cancer treatment can cause erectile dysfunction
- What can be done about erectile dysfunction
- How erectile dysfunction may affect your sex life
- What your partner can expect
If you have any questions, please talk to your doctor or health care team. It is important that you understand what is going on with your prostate cancer treatment. This knowledge will help you take better care of yourself and feel more in control. It will also help you manage any side effects you may have from your treatment.
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Providing Your Medical History
At first, the doctor will probably ask you about your medical history. Do you have any chronic illnesses? What illnesses and operations have you had in the past? What medications are you taking, if any? Your doctor is also likely to ask about your psychological well-being and lifestyle: Do you suffer from depression? Are you under a lot of stress? Do you drink alcohol? Smoke? Use illegal drugs? Have you felt a loss of affection for your partner? Have you recently grown interested in a new partner?
As part of this health history, be prepared to tell your doctor specific details about the symptoms that brought you to the office and when they began. Your doctor might want to know how often you had sex before the problem started and if there have been weeks or months in the past when youve had erectile dysfunction. Your doctor may conduct a written or verbal screening test.
If the cause is clear a recent operation for prostate cancer, for example the conversation may move directly to your treatment options. Otherwise, you may need to answer more questions to help the doctor narrow down the possible causes and avoid unnecessary testing.
Is Erectile Dysfunction A Sign Of Prostate Cancer
Prostate cancer like any other cancer is the abnormal growth of cells forming a tumor in the prostate gland. It is the 3rd leading cause of death and the most common cancer in men. Prostate gland is a male reproductive gland that produces prostatic fluid that helps in the greater motility of the sperms for the fertilization of the egg.
Prostate is located anterior to the rectum and inferior to the urinary bladder, encircling the urethra. Although, prostate may have other cancers, including small cell carcinomas, sarcomas, transitional cell carcinomas, neuroendocrine tumors adenocarcinomas are the most common tumors found in relation to the prostate gland.
Adenocarcinomas originate from gland cells, which are responsible for making prostatic fluid.
Radiation Therapy And Sexual Function
Sexual dysfunction occurs in 20~80% of patients who undergo radiation therapy. Radiation therapy may cause injuries, including to nerves, if the radiation range expands to the trigone of the bladder, ectopic ureteral orifice, posterior and lateral rectal wall, and bulbo-membranous urethra. Complications that occur after radiation are classified as early and late. Early complications occur in tissues that undergo rapid mitosis, like the intestinal mucosa, and are typically reversible, whereas late complications occur due to injury of the microvessels, and are irreversible changes.
Generally, the main complications that occur after radiation therapy, such as proctitis, urethral stricture, edema of the penis and lower extremities, and erectile dysfunction, have been shown to occur at incidences of 10% or less.17 Additionally, the frequency of maintaining erectile function after radiation therapy has been reported to be approximately 50%, which is higher than that of radical prostatectomy.18 Formenti et al19 reported no increase in the frequency of sexual function abnormality after adjuvant radiation therapy following a nerve-preservation radical prostatectomy. Litwin20 reported no difference in quality of life among radical surgery, radiation therapy, and observation groups, but found that patient satisfaction with sexual function and voiding symptoms was lower in the radical surgery group than in the other two groups.
Can Anything Be Done For Erectile Dysfunction Caused By Prostate Cancer Treatment
Yes, there are things you can try if you have erectile dysfunction after your prostate cancer treatment. You should keep in mind that the following things will affect your ability to have an erection after your prostate cancer treatment:
- How good your erections were before your treatment
- Other medical conditions you have like high blood pressure or diabetes
- Some types of medicines you may take such as medicines for high blood pressure or antidepressants
- Things you do in your life such as drinking or smoking
- Your age
- The type of prostate cancer treatment you had
It is important that you and your partner speak with your doctor or healthcare team about what you can do. Your doctor or healthcare team will speak with you about what might work best for you if you have erectile dysfunction. It is important that you speak with them since some treatments for erectile dysfunction can affect other medical problems you may have.
Types of treatment for erectile dysfunction include:
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Other Things That Affect Erections After Surgery
A wide range of ED rates have been reported, even in men who havent had surgery. But for the most part, the younger a man is, the more likely he is to regain full erections after surgery. Men under 60, and especially those under 50, are more likely to recover their erections than older men.
- Strength of erections before surgery: Men who had good erections before cancer surgery are far more likely to recover their erections than are men who had erection problems.
- Other conditions, such as Peyronies disease: In some men, the penis can develop a painful curve or knot when they have an erection. This condition is called Peyronies disease. Its most often due to scar tissue forming inside the penis, and has been linked to some cancer surgeries, such as surgery to remove the prostate . Still, Peyronies disease is rarely linked to cancer treatment, and it can be treated with injections of certain drugs or with surgery. If you have painful erections, ask your doctor for help finding a urologist with experience treating this disease.