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Prostate Cancer Erectile Dysfunction Treatment

There Are Four Main Ways That Prostate Cancer Treatment Affects Erectile Function:

Management of erectile dysfunction following prostate cancer treatment – Dr Gregory Malone
  • Sex drive or libido Any treatment that decreases your testosterone level diminishes your sex drive. You can have a low libido and still obtain an erection, but it is usually more difficult for menwho have less interest in sex. Hormone therapy and surgical orchiectomy both decrease testosterone production. The former is reversible, and the latter is not.
  • Achieving a mechanical erection is controlled by the nerves and vessels that associated with the prostate and structures near the penis. Damage to these nerves and blood vessels during surgery or radiation can prevent and individual from maintaining the mechanical ability to have an erection.
  • Orgasm. Attaining an orgasm can also be more difficult after treatment when sex drive is low, or erections are not as firm. Some men will experience discomfort initially after treatment during climax, but this usually resolves.
  • Ejaculation may be minimal after treatment. The prostate gland and seminal vesicles which produce the ejaculate were removed and/or treated with radiation, so it is common to have a minimal or no ejaculate. An orgasm is different than ejaculation, men may be able to have an erection and reach an orgasm, however nothing may come out.
  • Radiation therapy however appears to have a slower delay in erectile function decline than surgery. By15 years after radiation treatment, the rates of erectile dysfunction are similar to men who underwent surgery.

    Prostate Cancer And Erectile Dysfunction:

    The prostate is an exocrine gland that is responsible for the urine control and the secretion of fluids which are useful outside the body. It produces a fluid that transports and nourishes the sperm to fuse with the female ovum or egg. Prostate cancer is the cancer in the cells of the prostate gland, prostate cancer by itself does not cause erectile dysfunction, it is the treatment methods that result is this problem.

    While prostate cancer is not the cause of erectile dysfunction, the treatment for this disease can lead to this complication. The following are the treatment methods in which erectile dysfunction is a common side effect.


    Erectile dysfunction is a common side effect in people that have undergone prostate cancer surgeries. Prostate surgeries involve removing the prostate gland, nearby tissues and even lymph nodes if the cancer has spread beyond the prostate. Radical retropubic prostatectomy and radical perineal prostatectomy are the two types of surgeries depending on how the prostate is approached.

    Radiation therapy:

    Hormone therapy:

    Hormone therapy is also referred to as androgen deprivation therapy or androgen suppression therapy. It aims at reducing the male hormones, called androgens and restrict their impact on prostate cancer as androgens help the growth of prostate.

    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.

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    What Can I Expect During Recovery From Prostate Cancer Treatment

    Time is the most important factor in recovery. The healing process for men who have had nerve-sparing radical prostatectomy is often 18 to 24 months or more, because nerve tissue requires a longer time to heal. How much erectile function returns depends on several things:

    • The type of operation you had . Most men with intact nerves will see a substantial improvement within a year of treatment.
    • Your age: Men under 50 or 60 are more likely to recover their erections than older men.
    • Your erectile function before the operation. Men who had good erections before surgery are more likely to recover their ability to get an erection than those who had previous erection problems.

    It is also very common to need medications to assist with erectile function, even if you did not need them before your operation.

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    Help For Ed After Prostate Surgery: The Basics

    Whats the secret to having a good sex life after prostate cancer? Its very simple, says Johns Hopkins urologist Trinity Bivalacqua, M.D., Ph.D. You use prescription erection pills. If they dont work, you move to injectable medications. If they dont work, you get a penile prosthesis. Also, having a loving and understanding partner always helps. Theres also the vacuum erection device . It is not a first-line treatment for ED because theres a high drop-out rate, Bivalacqua says. However, the VED can play a very important role in another aspect of surgical recovery: penile rehabilitation .

    First, the pills: When one of my patients leaves the hospital after a radical prostatectomy, he takes home a prescription for Viagra, says Bivalacqua. Does he take it every day, like a vitamin? No. Although some doctors prescribe the pills this way, its not what physicians call an evidence-based practice that is, the medical literature doesnt back it up conclusively. Instead, Bivalacqua tells his patients to take it as needed. It is very difficult for me to tell a man that he should spend $600 a month to take a daily erection drug, because the evidence of a quicker return of erections is just not there. However, he adds, taking a pill daily may provide a benefit, and a lot of prostate cancer patients want to take a proactive approach. If thats the case, then I encourage them to go ahead.

    Access To Treatments And Specialist Services

    The finding in this study that many GPs did not prescribe treatments for ED is a matter for concern. Surprisingly, 44% of urologists did not have access to all ED treatments, despite the National Institute for Health and Care Excellence guidance. NHS prescribing of PDE5is is often limited to once-weekly use, which may not adequately support menâs needs or specialist sexual rehabilitation programme aims. âStintingâ on effective treatments such as PDE5is can be a false economy, potentially resulting in treatment failure and the need for expensive secondary referrals. It is hoped that the recent availability of reduced cost generic sildenafil and tadalafil, and the lifting of restrictions on its daily use, will allow more men with ED to receive early treatment.

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    Management Of Erectile Dysfunction By Prostate Cancer Patients

    There are numerous types of treatments to address erectile dysfunction and improve patients quality of life. According to the Prostate Cancer Foundation, these include oral medications for erectile dysfunction, sildenafil , tadalafil , and vardenafil , relax the muscles in the penis, allowing blood to rapidly flow in. On average, the drugs take about an hour to begin working the erection helping effects of sildenafil and vardenafil last for about 8 hours and tadalafil about 36 hours. About 75% of men who undergo nerve-sparing prostatectomy or more precise forms of radiation therapy have reported successfully achieving erections after using these drugs.

    Men with heart problems are, however, recommended not to take these type of drugs. Surgery is also an option, but it tends to be a final option. To address erectile dysfunction, a penile implant, which is a narrow flexible plastic tube, is surgically inserted along the length of the penis. Then, surgeons attach a small balloon-like structure filled with fluid in the abdominal wall and a small button is released into the testicle. The button can later be pressed and the fluid rushes from the ballon into the plastic tube, resulting in an erection.

    How Can Prostate Cancer Treatment Lead To Erectile Dysfunction

    Erectile Dysfunction from Prostate Cancer Treatment | Prostate Cancer Staging Guide

    According to the Prostate Cancer Foundation, some level of sexual dysfunction following prostate cancer surgery is almost inevitable.

    To understand why, its important to understand how a male achieves an erection. There is a series of fragile nerves and blood vessels close to the prostate gland. These nerves stimulate muscles, allowing for increased blood flow. They also close tiny valves to keep blood in the penis at a high pressure, which maintains the erection. Any damage to the nerves can complicate this process.

    Thats why prostatectomies are often referred to as nerve-sparing prostatectomies. Depending on the stage and grade of prostate cancer, it can be easier or more difficult for the surgeon to remove the prostate without affecting any adjacent nerves.

    Prostate cancer patients who undergo radiation treatment may also be at risk for sexual dysfunction. Up to 70% of men who undergo brachytherapy or standard external beam radiation will eventually recover baseline erectile function after therapy.

    There are also newer treatment therapies like vessel sparing radiation therapy, which has an even lower rate of erectile dysfunction. As many as 78% of patients maintain baseline erectile function after treatment.

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    What Are Some Treatment Options For Prostate Cancer And Their Effects For Erectile Dysfunction

    Today, there are multiple treatment options when it comes to prostate cancer including GAINSWaves innovative shockwave therapy treatment. It is important to know treatment options and the possible risks affiliated with surgery or radiation treatment. Therefore, it is important to consult with your physician.

    Chemotherapy & Hormone Therapy

    Chemotherapy does not often cause erectile dysfunction, though it may affect the desire for sexual activity. Your desire may change over the course of treatment. Hormone therapy, a common treatment for prostate cancer, can lead to a loss of desire for sex, erectile dysfunction, and difficulty achieving orgasm, which tends to develop slowly over the first few months of hormone therapy.

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    Prostate Cancer And Occurrence Of Sexual Dysfunction

    Although the prostate is close to the penis, there has been no report of sexual dysfunction caused directly by prostate cancer. However, if a growing prostate tumor causes lower urinary tract symptoms, such as prostate hypertrophy, it could decrease sexual function. That would be a secondary reduction in sexual function caused by severe lower urinary tract symptoms, rather than a direct effect of the prostate cancer. That is, prostate cancer does not directly cause abnormalities of the corpus cavernosum.

    A sudden reduction in sexual function in patients with prostate cancer frequently occurs because of psychological instability caused by the occurrence of the cancer, and, in particular, depression., The occurrence of prostate cancer also often has a negative effect on the mental status of the female partner, causing a decrease in sexual function in the female partner. Because a diagnosis of prostate cancer simultaneously causes fear and anxiety in married couples regarding the effects of prostate cancer on their lives, it also creates an unstable mental status in their sex life, resulting in reduced sexual activity.

    When Can Erectile Dysfunction Occur After Prostate Cancer Treatment

    (PDF) Management of erectile dysfunction after prostate ...
    • Radical prostatectomy.Erectile dysfunction can begin immediately following the removal of the entire prostate and surrounding tissues, whether the nerve-sparing or non-nerve-sparing technique is used. If the nerve-sparing technique is used, recovery from ED may occur within the first year following the procedure. Recovery of erectile function after a non-nerve-sparing technique is unlikely but possible.
    • Radiation therapy. The onset of ED following radiation therapy is gradual and usually begins within 2 to 3 years following treatment. Without treatment for erectile dysfunction, ED is usually permanent.
    • Hormone therapy. When hormone therapy is used, ED may occur approximately two to four weeks following the initiation of the therapy and is usually accompanied by a decreased desire for sex. Without treatment, the ED may become permanent.

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    Ask Your Doctor About Solutions

    Patients should not be shy about discussing intimacy issues with their doctor. He or she may be able to prescribe medications to help. Certain medicationssuch as sildenafil , tadalafil or vardenafil are typically tried first. But these drugs may not help men achieve an erection if the nerves responsible are not healthy. In fact, the medications only work for a small percentage of men in the first few months after surgery, according to a 2017 study published in the International Journal of Sexual Health.

    Besides oral medications for erectile dysfunction, there are other options available to men with ED after prostate cancer treatment, says Dr. Shelfo. These include penile injection therapy, which involves injecting a small amount of medication directly into the base of the penis. That has helped many men achieve erections. Another option is an intraurethral suppository of medication, an external vacuum erection device, or surgery may be performed to implant a penile prosthesis.

    While regaining erectile function is not possible for all men treated for prostate cancer, it is important to remember that an erection is just one aspect of a satisfying sex life. Intimacy is another major component, one that may become more important as sexual relationships become more difficult after cancer 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.

    Dealing With Erectile Dysfunction: For You And Your Partner

    Erectile Dysfunction (ED) and Prostate Cancer Treatment

    The following information is based on the general experiences of many prostate cancer patients. Your experience may be different. If you have any questions about what prostate cancer treatment services are covered by your health insurance, please contact your health care provider or health insurance provider. This education material was made possible by a Grant from the California Department of Justice, Antitrust Law Section, from litigation settlement funds to benefit Californians diagnosed with cancer or their families.

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    What About Other Treatments For Erectile Dysfunction

    If Viagra and injections fail , other treatments may be appropriate. They include:

    • Vacuum constriction device. A cylinder is placed over the penis. The air is pumped out of the cylinder, which draws blood into the penis and causes an erection. The erection is maintained by slipping a band off the base of the cylinder and onto the base of the penis. The band can stay in place for up to 30 minutes. Although these devices can be effective, they generally have been less desirable for patients who have been treated with surgery. Many patients dislike having to use the band at the base of the penis and find it uncomfortable.
    • Penile suppositories. For this treatment, the patient places a suppository into the urinary tube using a plastic applicator. The suppository contains the drug alprostadil, which travels to the erection chambers. Alprostadil relaxes the muscle in the erection chamber, allowing blood to flow into the penis.
    • Penile implants. This option may be considered if the patient has had erectile dysfunction for about one year following cancer treatment and nonsurgical therapy has either failed or is unacceptable. An implant, or prosthesis, is an effective form of therapy in many men, but it does require an operation to place the implant into the penis. Surgery can cause problems, such as mechanical failure or infection, which may require removal of the prosthesis and re-operation. However, most men and their partners are very satisfied with these devices.


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