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Prostate Cancer and Erectile Dysfunction

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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:

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  • 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 usually 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 two years following the procedure. Recovery of erectile function after a non-nerve-sparing surgery is unlikely, but possible.

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.
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