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Prostate Cancer and Erectile Dysfunction

Erectile dysfunction, also called impotence, is the inability to develop or sustain an erection satisfactory for sexual intercourse.

Though prostate cancer is not a cause of erectile dysfunction, treatments for the disease can cause the problem. Among them:

Recommended Related to Prostate Cancer

Understanding Prostate Cancer -- Diagnosis & Treatment

Two tests are used to look for prostate cancer: a digital rectal exam and a PSA blood test. The PSA blood test looks for something called prostate-specific antigen in the blood. Who should have a PSA test and when is controversial: The U.S. Preventive Services Task Force does not recommend regular PSA tests. The task force say the tests may find cancers that are so slow growing that treatment, which can have serious side effects, would offer no benefit.  The American Cancer Society (ACS)...

Read the Understanding Prostate Cancer -- Diagnosis & Treatment article > >

  • Surgery to remove the entire prostate gland
  • Radiation therapy, whether by external beam or radioactive seed implants
  • Hormone therapy

Different treatments can lead to impotence sooner than others.

When Can Erectile Dysfunction Occur After Treatment?

  • Surgery. Some degree of erectile dysfunction occurs right after surgery to remove the prostate, regardless of whether the technique is performed that tries to spare the nerve that controls erections.

The severity of the erectile dysfunction depends on the type of surgery, stage of cancer, and skill of the surgeon.

If the nerve-sparing technique is used, recovery from erectile dysfunction may occur within the first year following the procedure. Recovery of erectile function after a non-nerve-sparing surgery is unlikely, but possible.

One study shows erectile dysfunction rates of 66% for nerve-sparing prostatectomy versus 75% for non-nerve sparing surgery at one year after the surgery. The use of vacuum devices or erectile dysfunction drugs after the body has healed from surgery may improve the quality of erections and speed the return of normal sexual function (see below).

If an erection can be achieved after surgery, one does not lose the ability to have an orgasm. However, they may be "dry" orgasms in which little (if any) ejaculate is produced. This results in infertility for most men, although most men are older when they are diagnosed for prostate cancer and may not be concerned. If desired, you could talk to your doctor about "banking" sperm before the procedure.

  • Radiation therapy. The onset of erectile dysfunction following radiation therapy is gradual and usually begins about six months following the treatment.

Erectile dysfunction is the most common long-term complication of radiation therapy. However, its occurrence decreases when more sophisticated treatments are used, such as radioactive seed implants (brachytherapy), intensity-modulated radiotherapy (IMRT), or 3-D conformal radiotherapy.

  • Hormone therapy. When hormone therapy is used, erectile dysfunction and decreased sexual desire may result approximately two to four weeks after the start of therapy. This is due to the testosterone-reducing action of the drugs.

How Is Erectile Dysfunction Treated?

Current treatment options for erectile dysfunction for men who have received treatment for prostate cancer include:

  • Oral medications, such as Cialis, Levitra, Staxyn, Stendra, or Viagra
  • Injections of medicine into the penis before intercourse (called intracavernous injection therapy)
  • Use of a vacuum constriction device to draw blood into the penis to cause an erection
  • Drugs taken as a suppository placed in the penis prior to intercourse
  • Penile implants

How Effective Are Oral Erectile Dysfunction Drugs?

  • Following surgery, as many as 60% to 70% of men who have had nerves spared on both sides of the prostate will regain erections. Results are less favorable for men who have had a single nerve spared or no nerves spared.
  • Following radiation therapy, overall, 50% to 60% of men regain erections with medication. However, current data are rather limited, especially for patients treated with radioactive seed implants.
  • Hormone therapy. Men treated with hormone therapy do not respond well to any erectile dysfunction treatments, but data are limited.

WebMD Medical Reference

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