Prostate Cancer and Erectile Dysfunction
Nearly all men will experience some erectile dysfunction for the first few months after prostate cancer treatment. However, within one year after treatment, nearly all men with intact nerves will see a substantial improvement.
FOLLOWİNG NERVE-SPARİNG PROSTATECTOMY
Within one year, about 40 to 50% of men will have returned to their pre-treatment function. After two years, about 30 to 60% will have returned to pre-treatment function. These rates vary widely depending on the surgeon and how the extent of “nerve sparing” a surgeon can perform at the time of surgery.
FOLLOWİNG RADİATİON THERAPY
About 25 to 50% of men who undergo brachytherapy will experience erectile dysfunction vs. nearly 50% of men who have standard external beam radiation. After two to three years, few men will see much of an improvement and occasionally these numbers worsen over time.
Men who undergo procedures not designed to minimize side effects and/or those whose treatments are administered by physicians who are not proficient in the procedures will fare worse.
Men with other diseases or disorders that impair their ability to maintain an erection (diabetes, vascular problems, etc.) will have a more difficult time returning to pre-treatment function.
MANAGEMENT OF ERECTİLE DYSFUNCTİON
Oral medications relax the muscles in the penis, allowing blood to rapidly flow in. On average, the drugs take about an hour to begin working, and the erection-helping effects can last from 8 to 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. However, they are not for everyone, including men who take medications for angina or other heart problems and men who take alpha-blockers.
ALTERNATİVE TREATMENTS
Men who do not recovery erectile function after treatment can try injectable medication that pharmacologically induced an erection. The most common drug used for this is Prostaglandin.
MECHANİCAL DEVİCES
The vacuum constriction device creates an erection mechanically by forcing blood into the penis using a vacuum seal. A rubber ring rolled onto the base of the penis prevents blood from escaping once the seal is broken. About 80% of men find this device successful.
SURGİCAL OPTİONS
A three-pieced surgically inserted penile implant includes a narrow flexible plastic tube inserted along the length of the penis, a small balloon-like structure filled with fluid attached to the abdominal wall, and a release button inserted into the testicle.
The penis remains flaccid until an erection is desired, at which point the release button is pressed and fluid from the balloon rushes into the plastic tube. As the tube straightens from being filled with the fluid, it pulls the penis up with it, creating an erection.
Assuming the mechanics are working correctly, it is 100% effective, and about 70% of men remain satisfied with their implants even after 10 years. Because this procedure is done under general anesthesia, it is not available to men who are not considered good candidates for surgery because of other health reasons.
ERECTİLE DYSFUNCTİON FOLLOWİNG RADİCAL PROSTATECTOMY
Assuming the management of erectile dysfunction requires expert diagnosis and treatment.
Diagnosis includes sexual function history, general medical history, psychosocial history, medication history, physical examination, and appropriate laboratory testing.
Treatment follows diagnosis, and we provide a range of treatment options through the Clinic. Minimally invasive treatment options range from oral medications to medications administered directly to the penis to a mechanical vacuum device applied to the penis. Invasive treatments include implants or vascular surgery. We are particularly expert in the surgical treatment of patients with erectile dysfunction. The range of conditions we manage include penile prosthesis complications, penile vascular abnormalities, penile curvature, and abnormally prolonged erection consequences.
Psychological treatment is an important adjunct to managing erectile dysfunction. If our diagnosis suggests a psychological association with your erectile dysfunction, we may recommend that you pursue counseling with a qualified psychologist available through the Clinic. For instance, there may be relationship problems that negatively affect sexual functioning with your partner. Referrals can be made to the Johns Hopkins' noted Sexual Behaviors Consultation Unit.
Erectile dysfunction following radical prostatectomy for clinically localized prostate cancer is a known potential complication of the surgery. With the advent of the nerve-sparing radical prostatectomy technique, many men can expect to recover erectile function in the current era.
