Predicting Sexual Outcomes After Prostate Cancer Treatment
Information about a mans baseline characteristics and prostate cancer treatment plan can help predict erectile function after treatment.
In order to provide men with more personalized assessments of their risk of erectile dysfunction, researchers have assessed how several patient and treatment characteristics affect sexual outcome after treatment. The primary outcome of interest was whether the patient had functional erections suitable for intercourse. This outcome was assessed two years after treatment with prostatectomy, external radiation therapy, or brachytherapy.
Why Can Prostate Issues Cause Erectile Dysfunction
Prostate concerns commonly occur in men as they age, and the first symptoms may be difficulty urinating, or more frequent trips to the bathroom in the middle of the night.
But, is there a correlation between prostate problems and developing erectile dysfunction?
Both of these conditions increase in frequency as men get older, so it is difficult to know if one is definitely correlated with the other, but there may be a few things going on when you have prostate problems that can lead to issues in the bedroom as well.
Below, we will cover just how issues with the prostate gland including benign prostatic hyperplasia , and prostate cancer may have impacts on erectile function.
How Erectile Dysfunction Affects Patients With Prostate Cancer
Regardless of whether the nerves were spared during surgery or whether the most precise dose planning was used during radiation therapy, nearly all men will experience some erectile dysfunction for the first few months after treatment. The reason for this is simple: the nerves and blood vessels that control the physical aspect of an erection are incredibly delicate, and any trauma to the area will result in changes to the natural order, explain the Prostate Cancer Foundation regarding the causes for erectile dysfunction in prostate cancer patients.
Erectile dysfunction can, however, vary and about 40 to 50% of patients with intact nerves start to see improvements a year after the treatment. After two years, about 30 to 60% of the patients are expected to return to their normal function before the treatment. However, not all treatments can spare the patients nerves. In the case of radiation therapy, erectile dysfunction is not a such common side effect, affecting only about 50% of the patients, while in the case of brachytherapy, between 25 and 50% of the patients are affected. Erectile dysfunction not only affects patients sexual life, but can also cause emotional problems.
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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.
Will Treatment Cause Erectile Dysfunction
When youre sexually excited, nerves cause tissues in your penis to relax, allowing blood to flow into the organ. The nerves that control erection are very delicate. Surgery or radiation for prostate cancer may damage them enough to cause ED. When you have ED, you cant get or keep an erection.
Radical prostatectomy is a surgery to remove the prostate gland. When your surgeon removes the gland, they may damage the nerves and blood vessels that run along it. If theyre damaged enough, you wont be able to get an erection following the procedure.
Today, doctors can do nerve-sparing surgery, which helps prevent permanent ED. Your surgeon can still touch those nerves and blood vessels, causing ED as a temporary side effect. Many men have trouble getting an erection for a few weeks, months, or even years after their procedure.
Radiation therapy also damages blood vessels and the nerves that control erection. Up to half of men who have radiation for prostate cancer experience ED afterward. In some men, this symptom will improve with time. Sometimes radiation side effects dont appear until a few months after the treatment. If ED starts late, it may not be as likely to go away.
A few treatments can help with ED until youre able to have erections on your own again.
Additional treatments include the following:
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What Is Benign Prostatic Hyperplasia
Well get to that, but first lets explore the prostate to understand how this condition may affect its effectiveness.
Your prostate is a part of your reproductive system responsible for producing the fluid that goes into your semen.
For a walnut-shaped gland, its a big part of your fertility and does impact your chances of having children.
The prostate surrounds the urethra at the neck of the bladder.
In cases of benign prostatic hyperplasia, the prostate becomes enlarged without being cancerous.
Because of the increase in size, the gland presses against and pinches the urethra, making it harder for urine to flow out.
In response, the bladder walls become thicker, eventually weakening the bladder and making it unable to empty the urine in it completely.
This may lead to complications like urinary tract infections, bladder damage and blood in the urine.
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Brachytherapy And Sexual Function
Unlike conventional radiotherapy, which may cause radiation-induced side effects, like inflammation in the tissues near the cancer tissue due to radiation, brachytherapy only irradiates the cancer tissue, reducing this complication. Brachytherapy has been widely used in the USA and Europe for the past 10 years. Now, it accounts for approximately 30% of the early treatment of prostate cancer. After prostate cancer surgery, incontinence, a common postoperative complication, occurs in 50~90% of patients who undergo the operation, and above all, erectile dysfunction may occur in 10~90% of patients who undergo such surgery. Thus, many patients who undergo such surgery suffer from inconvenience in their daily living after the surgery. In the case of brachytherapy, urinary incontinence and erectile dysfunction occur in 0.6% and 14~35% of patients, respectively, who undergo it. Thus, the frequency of erectile dysfunction is significantly lower in the brachytherapy group than in the conventional surgery group.
What Foods Can Cause Interstitial Cystitis
No research consistently links certain foods or drinks to interstitial cystitis , although many people find that certain foods and drinks can make their IC symptoms worse, such as alcohol, caffeine, and high-acid foods.
Interstitial cystitis is a chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain.
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Additional Tests That May Aid Prostate Cancer Diagnosis
There are few other diagnostic tools or tests, which can be performed before you have a prostate biopsy, that may help your physician gather more information about your specific case. These procedures may help determine the likelihood of the presence of cancer and its aggressiveness and increase the accuracy of a biopsy when performed. Those tests include:
4Kscore blood test is a molecular test that helps predict the likelihood and risk of a patient having aggressive prostate cancer. If youre a patient whose PSA values are borderline for a prostate biopsy or you have a condition that could be aggravated by a biopsy, your physician may use this test before to help determine whether you should get a biopsy or a repeat biopsy.
Urine sample testlooks for biomarkers that may indicate the presence of prostate cancer cells in a patients body. This test may also be helpful when trying to determine whether a patient should be rebiopsied or not.
The use of multiparametric MRI imaging of the prostate gland before a biopsy has been a game changer in prostate cancer diagnosis, increasing the accuracy of biopsies over standard biopsies. The mpMRI doesnt replace the standard biopsy, but by improving its accuracy, it may help decrease the number of biopsies needed.
The mpMRI has a higher resolution than a standard prostate ultrasound. This increases the ability to see suspicious lesions in the prostate, providing additional targets for the biopsy to sample.
What Is The Importance Of Preserved Erectile Function
In considering the impact of the various treatment approaches for prostate cancer on their quality of life, many patients place paramount importance on the possibility of retaining natural erectile function. This matter is frequently important to young men who by age status are more likely to have intact erectile function than older men however, for all men having normal preoperative erectile function irrespective of age, preservation of this function is understandably important postoperatively.
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Radical Prostatectomy And Sexual Function
Radical prostatectomy is the standard treatment method selected for the treatment of local prostate cancer limited to the intraprostate region. As endourological treatments using an endoscope or robot have been used more frequently recently, the frequency of radical prostatectomy has been decreasing. It is, however, still the most important treatment method for local prostate cancer.
Previous studies using animal models reported that cavernosal nerve injury caused increased collagen in the corpus cavernosum, apoptosis in the cavernosal smooth muscle, and cavernosal fibrosis. Additionally, due to increased transforming growth factor-1 and decreased prostaglandin E1 and cyclic adenosine monophosphate in the corpus cavernosum, and the secretion of cytokines and endothelin-1 from injured nerves, veno-occlusive erectile dysfunction may then occur as a result of structural changes in the corpus cavernosum . Direct injury of the neurovascular bundle during radical prostatectomy may also cause arterial erectile dysfunction due to injuries to the cavernosal artery.
Pathophysiology of erectile dysfunction following radical prostatectomy. ROS: reactive oxygen species, TGF-: transforming growth factor-beta, ET-1: endothelin-1, PGE1: prostaglandin E1, iNOS: inductible nitric oxide synthase.
Treatment Options For Symptomatic Bph
Symptoms related to BPH, particularly LUTS, can be managed by waiting for spontaneous improvement of symptoms, by medical therapies, or by various surgical procedures. The choice of treatment depends on the severity and annoyance of the patients symptoms, his expectations of treatment, and his acceptance of the risks of treatment.
One of the factors most frequently considered by patients contemplating a particular therapy for BPH is the effect of that therapy on sexuality. An inability to ejaculate or a significant decrease in ejaculate volume is significantly associated with deterioration in QOL. The selective 1-blockers cause few sexual side effects as a result, they are associated with a higher QOL. Physicians should inquire about sexual function as part of each patients pretreatment evaluation and, where appropriate, manage BPH and ED simultaneously.
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How Can Prostate Surgery And Radiation Therapy Cause Ed
Both prostate surgery and radiation therapy can damage tissue around the prostate and cause ED. In fact, it is estimated that 25% 75% of men will have ED after the removal of the prostate, called a prostatectomy. Similarly, radiation therapy can also cause damage to the tissue around the prostate. If nerves get damaged, signals from the brain may not be able to reach the penis to initiate an erection. And even when sexual stimulation is present, if blood vessels are damaged, that might mean that blood cant flow properly to the penis to maintain an erection.
Can Prostate Biopsy Cause Erectile Dysfunction
If are recommended by your doctor to undergo prostate biopsy procedure for the detection of cancer, you must have a lot of questions and reservations. One of the most common question that people usually have is, can prostate biopsy cause erectile dysfunction or alter the quality of sex life at all?
The answer is yes erectile dysfunction may occur after prostate biopsy in some susceptible individuals but it is usually transient and self-limiting.
Accorded to a study published in the Journal of Urology, men who undergo prostate biopsy are at risk of temporary erectile dysfunction due to anxiety or pain however, in most men, symptoms improve within a couple of weeks.
Can A Swollen Prostate Cause Erectile Dysfunction
Erectile dysfunction can affect your ability to get and maintain an erection.
It is a very common condition around 322 million men globally by 2025 are projected to experience persistent difficulty achieving and sustaining erections.
This condition may be caused by psychological factors like performance anxiety or stress.
Likewise, your medication for managing high blood pressure or ulcers or other conditions could also affect erectile functioning.
Well be examining how a swollen prostate can lead to ED.
Well do this by looking through the links between benign prostatic hyperplasia, prostatitis and erectile dysfunction, their causes, as well as treatment options which may affect erectile abilities.
Are There New Strategies In The Near Future That May Be Helpful In Improving Erection Recovery After Surgery
Recent strategies have included cavernous nerve interposition grafting and neuromodulatory therapy. The former, as a surgical innovation meant to reestablish continuity of the nerve tissue to the penis may be particularly applicable when nerve tissue has been excised during prostate removal. In the modern era of commonly early diagnosed prostate cancer, nerve-sparing technique remains indicated for the majority of surgically treated patients.
Neuromodulatory therapy, represents an exciting, rapidly developing approach to revitalize intact nerves and promote nerve growth. Therapeutic prospects include neurotrophins, neuroimmunophilin ligands, neuronal cell death inhibitors, nerve guides, tissue engineering/stem cell therapy, electrical stimulation, and even gene therapy.
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Can A Reversal Of The Vasectomy Be Performed
Although a vasectomy should be considered a permanent surgical procedure, there is a surgical procedure that can reverse a vasectomy. It is called a Vasovasostomy. A vasovasostomy involves surgical reconnection of the vas deferens to re-establish the flow of sperm. Patients are cautioned that fertility is not guaranteed.
Why Is There Increasing Concern At This Time Regarding Erectile Dysfunction Issues Following Radical Prostatectomy
The reality of the recovery process after radical prostatectomy today is that erectile function recovery lags behind functional recovery in other areas. Patients are understandably concerned about this issue and, following months of erectile dysfunction, become skeptical of reassurances that their potency will return.
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Prostate Cancer And Erectile Dysfunction
Prostate cancer may lead to erectile dysfunction in two ways, the tumor itself may invade and damage the surrounding tissues leading to erectile dysfunction, or the treatments to remove, treat, or shrink the tumor may lead to temporary or lasting erectile dysfunction.
A quickly developing case of ED may even be a sign of a developing prostate cancer, so abrupt changes in erectile function should always be brought to the attention of your doctor.
If required, surgical removal of the prostate gland due to prostate cancer may lead to the severing of arteries and nerves needed to develop an erection and may lead to ED in some patients. It is estimated that between 25% and 80% of men will regain their sexual function after a radical prostatectomy, but this will depend on the tumor location, nerve-sparing techniques used, the skill of the surgeon, and the patientâs age. It is important to note, that during the period of time that the vessels, nerves, and tissues are healing from surgery you may experience ED, but once everything has had time to recover, erectile function may improve.
Radiation therapy for prostate cancer may also lead to damage of the surrounding tissues and cause erectile dysfunction. Certain hormonal medications are sometimes utilized for the treatment of prostate cancer, such as Leuprolide, Goserelin, Flutamide, or Bicalutamide can also lead to hormonal effects that cause ED in some users.
Eating Diet And Nutrition
Researchers have not found that eating, diet, and nutrition play a role in causing or preventing prostatitis. During treatment of bacterial prostatitis, urologists may recommend increasing intake of liquids and avoiding or reducing intake of substances that irritate the bladder. Men should talk with a health care provider or dietitian about what diet is right for them.
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Why Is Rehabilitation Important
Whether you are single, or in a relationship, you should have the opportunity to discuss penile rehabilitation with your doctor or specialist nurse. Self pleasuring is important for many people and this can play a part in rehabilitation. This might help to give you confidence and to become aware of the changes that your treatment might have caused.
It might still be worth talking to your doctor even if you are not sexually active, or dont plan to be. This is because penile rehabilitation has benefits in terms of keeping the penis healthy.
Ideally, rehabilitation should start soon after your prostate cancer treatment, or in some situations before treatment. For example, you should start rehabilitation within 3 to 6 months of starting hormone therapy or radiotherapy. Or within the first 3 months of surgery to remove the prostate gland.