The outlook for men diagnosed with prostate cancer has never been brighter. Doctors now have a variety of ways to treat prostate cancer, including surgery, radiation, and drugs that slow the growth of cancer cells. Both the safety and effectiveness of prostate cancer treatments has been steadily improving.
That’s good news, of course. But with so many different approaches to prostate cancer treatment, each with its own benefits and risks, weighing your options and choosing the most appropriate treatment...
Radiation therapy, whether by external beam or radioactive seed implants
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
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.