How To Manage Erectile Dysfunction During And After Prostate Cancer Treatment
The ultimate goal of both surgery and radiation therapy for prostate cancer is to remove as much of the cancer as possible while maintaining a patients desired quality of life.
Remember: your ideal treatment plan should be unique to your situation. Thats why its so important to get a second opinion and consult with an expert team of medical professionals including urology, radiation oncology, and other specialists.
If you want to learn more about potential treatment options for erectile dysfunction, or just have a lot of questions youd like answered, click here for resources from EDCure.org.
If youre looking for a doctor and want to discuss your options for treatment as well as possible side effects you can expect, feel free to use our free doctor finder tool below:
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.
Can I Prevent Ed After Prostate Surgery
These days, many prostatectomies use nerve-sparing techniques to reduce injury to the tissue and prevent ED, though it still can happen. There are also several interventions for men after prostate surgery to help regain erectile function and prevent ED. Research shows that after surgery, 20% 25% of men regain their erectile function, but it may take several years.
To increase the chances of penile recovery and to prevent ED, several interventions after surgery may be offered. One option is called penile rehabilitation which uses medications to help improve blood flow into the penis. This may include the use of drugs like Viagra or Muse taken at night before bedtime. However, current research on the benefits of this intervention is limited. Still, its recommended that men be encouraged to proceed with normal sexual habits after healing, as it may help prevent long-term issues, and to use medications to increase blood flow and improve erections.
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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.
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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Surgical Treatments For Bph
While many doctors claim to treat prostate enlargement with surgery, such claims are almost always related to improving urinary function. Since the prostate surrounds the urethra, symptoms of BPH almost always involve urinary function. If a man has severe urinary issues or blockage, surgery may help.
Some doctors recommend removing the prostate to resolve the urinary issues in severe cases. The prostatectomy will likely resolve the urinary issues, but the surgerys side effects will surely deteriorate the mans quality of life.
Surgery should never be the first choice to relieve problems associated with BPH. Any urologist recommending surgery as a first-line treatment for BPH is not providing patients with the best advice. Every surgery has side effects. Some can be minor and others life-altering. Many solutions can make BPH more tolerable without destroying a mans quality of life.
What Have I Learned By Reading This
You learned about:
- Why prostate cancer treatment can cause erectile dysfunction
- What can be done about erectile dysfunction
- How erectile dysfunction may affect your sex life
- What your partner can expect
If you have any questions, please talk to your doctor or health care team. It is important that you understand what is going on with your prostate cancer treatment. This knowledge will help you take better care of yourself and feel more in control. It will also help you manage any side effects you may have from your treatment.
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Nerve Damage From Surgery
The most common way surgery affects erections is by removing or causing injury to the nerves that help cause an erection. All of the operations listed above can damage these nerves. The nerves surround the back and sides of the prostate gland between the prostate and the rectum, and fan out like a cobweb around the prostate, which makes it easy to damage them during an operation.
When possible, nerve-sparing methods are used in radical prostatectomy, radical cystectomy, AP resection, or TME. In nerve-sparing surgery, doctors carefully try to avoid these nerves. When the size and location of a tumor allow for nerve-sparing surgery, more men recover erections than with other techniques. But even if the surgeon is able to spare these nerves, they might still be injured during the operation and need time to heal.
Even when the nerves are spared, research has shown that the healing process takes up to 2 years for most men. We dont know all the reasons some men regain full erections and others do not. We do know that men are more likely to recover erections when nerves on both the left and right sides of the prostate are spared.
What Does The Prostate Have To Do With Erectile Function
The prostate gland is wrapped around the male urethra, and when problems occur such as an enlargement, the development of a tumor, or inflammation of the prostate, it may damage or put pressure on the vessels and nerves which innervate and supply the penis. The proximity of the prostate to the penis can link these two together when issues occur and tissues are damaged. Damage to the nerves and vessels near the penile area may lead to temporary or lasting erectile dysfunction.
Additionally, some of the medications used to treat prostate concerns may have the side effect of potential erectile dysfunction, or prostate surgeries and radiation treatments can damage the surrounding tissues and lead to malfunction. The bottom line is, the prostate and the penis share a lot of the same territory, so problems with the prostate can directly or indirectly cause issues with erectile function.
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How Effective Is Injection Therapy With Each Type Of Treatment
If oral erectile dysfunction drugs fail, injections into the penis can be an effective form of treatment for men who have undergone surgery or who have received radiation therapy for prostate cancer.
Overall, up to 80% of men will regain erections with the use of injection treatments. Side effects include occasional pain due to one of the drugs used for injection therapy, and the development of scar tissue.
Can A Man Develop Erectile Dysfunction After A Prostate Biopsy
Erectile dysfunction can occur after prostate biopsy, but the reasons for this are unclear. Some men do recover their function in a few months, however.
When a man has a prostate biopsy, small samples of prostate tissue are removed and checked for cancer cells. To collect the samples, a urologist uses a small needle.
Generally, there are three ways to approach the prostate for a biopsy: through the rectum , through the urethra , and through the perineum . The transrectal approach is the most common one.
Several studies have found that men develop ED after prostate biopsy.
In 2015, BJUI International published a study involving 220 men who underwent transrectal prostate biopsy. The mens erectile function was assessed before the biopsy and again at 1-, 4-, and 12-week time points afterward.
Erections were poorer at all three intervals, especially for men who were age 60 and older and those who had a positive diagnosis of prostate cancer. The scientists were not sure why erectile function declined, but some experts think that the stress associated with the biopsy could be a factor.
Men who are concerned about their erections after biopsy should talk to their urologist, who can let them know what to expect.
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What Determines Erection Recovery After Surgery
The most obvious determinant of postoperative erectile dysfunction is preoperative potency status. Some men may experience a decline in erectile function over time, as an age-dependent process. Furthermore, postoperative erectile dysfunction is compounded in some patients by preexisting risk factors that include older age, comorbid disease states , lifestyle factors , and the use of medications such as antihypertensive agents that have antierectile effects.
Does Enlarged Prostate Cause Ed
Of the many symptoms caused by BPH, one of the most common complaints men have when visiting a urologist is Erectile Dysfunction or ED. This is defined as the inability of a man to attain or maintain an erection sufficient for vaginal penetration and satisfactory sexual performance.
BPH does not directly cause ED, but many men with BPH seek medical attention to relieve ED.
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Hormone Therapy Effects On Erections
Hormone treatment is commonly given for prostate cancer. Men given androgen deprivation therapy are at a high risk for sexual problems, including loss of sexual desire and erectile dysfunction. Erections may or may not recover when ADT is stopped. Erectile dysfunction drugs do not usually work in these cases because they don’t help with the loss of sexual desire.
Does Chronic Prostatitis Affect Sexual Function
Symptoms of prostatitis include difficulty to urinate, pain in the genital area and pelvic floor, painful ejaculation, premature ejaculation, erectile dysfunction and low sexual desire. Once the inflammation is treated, sexual problems are resolved. However, in the meantime until remission of inflammation, there are erectile drugs called Phosphodiesterase type 5 inhibitors that can be used to restore quality of erection and increase perfusion of the prostate gland which is essential to treat the inflammation. In very rare cases only, erectile dysfunction may remain even though symptoms have subsided. If so,, the problem is purely psychogenic and it is highly recommended to visit a Sexologist.
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Common Scenarios Of Misdiagnosis
There are three common scenarios that make doctors misdiagnose the root cause of ED as something other than CP:
Other Things That Affect Erections After Surgery
A wide range of ED rates have been reported, even in men who havent had surgery. But for the most part, the younger a man is, the more likely he is to regain full erections after surgery. Men under 60, and especially those under 50, are more likely to recover their erections than older men.
- Strength of erections before surgery: Men who had good erections before cancer surgery are far more likely to recover their erections than are men who had erection problems.
- Other conditions, such as Peyronies disease: In some men, the penis can develop a painful curve or knot when they have an erection. This condition is called Peyronies disease. Its most often due to scar tissue forming inside the penis, and has been linked to some cancer surgeries, such as surgery to remove the prostate . Still, Peyronies disease is rarely linked to cancer treatment, and it can be treated with injections of certain drugs or with surgery. If you have painful erections, ask your doctor for help finding a urologist with experience treating this disease.
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Is Another Treatment Option Better For Preservation Of Erectile Function
The growing interest in pelvic radiation, including brachytherapy, as an alternative to surgery can be attributed in part to the supposition that surgery carries a higher risk of erectile dysfunction. Clearly, surgery is associated with an immediate, precipitous loss of erectile function that does not occur when radiation therapy is performed, although with surgery recovery is possible in many with appropriately extended follow-up. Radiation therapy, by contrast, often results in a steady decline in erectile function to a hardly trivial degree over time.
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.
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What Are Some Causes Of Erectile Dysfunction
It can be caused by several factors:
Psychological nature. Depression and anxiety can result in impotence. If a man experiences loss of erection, he may worry that it will happen again. This can produce anxiety associated with performance and may lead to chronic problems during sex.Childhood trauma, abuse, confusing regarding sexual preferences and many of issues of this kind also can lead to impotence and erectile dysfunctions. The only way to work out these issues is through therapy.
Disease. In case with heart disease and high blood pressure erectile disorders happen due to poor blood circulation. If the blood system is not functioning properly throughout the body, sexual function may suffer also. Other cases include diabetes, obesity, Parkinsons and sometimes metabolic syndrome.
Drugs, such as alcohol, nicotine, narcotics, stimulants, antihypertensives and antihestamines.
Some anti depressants, such as Prozac, Paxil and Zoloft and known to reduce libido
Low testosterone , condition you are sometimes born with
Age. As we age, testosterone levels decline
Enlarged prostate and/or BPH.
Treatment Of Prostate Cancer And Sexual Function
Prostate cancer treatments include surgery, hormone therapy, radiotherapy, and chemotherapy. Each treatment method is selected primarily according to the disease stage of the patient. In prostate cancer treatment, as testosterone is involved in the prostate and its mechanism of action, erectile dysfunction often occurs as a critical complication regardless of the selection of a surgical treatment or hormonal therapy.
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What Current Options Exist To Treat Erectile Dysfunction After Radical Prostatectomy
Options include pharmacologic and nonpharmacologic interventions. Pharmacotherapies include the oral PDE-5 inhibitors , intraurethral suppositories , and intracavernous injections . Non-pharmacologic therapies, which do not rely on the biochemical reactivity of the erectile tissue, include vacuum constriction devices and penile implants .
Men who have undergone nerve-sparing technique should be offered therapies that are not expected to interfere with the potential recovery of spontaneous, natural erectile function. In this light, penile prosthesis surgery would not be considered an option in this select group, at least in the initial 2 year post-operative period, until it becomes evident in some individuals that such recovery is unlikely.
Bph Medications And Sexual Side Effects
Some drugs used to treat BPH can cause difficulty in maintaining an erection. Men who take alpha-blockers such as doxazosin and terazosin may experience decreased ejaculation. This is because alpha-blockers relax the bladder and prostate muscle cells.
Alpha reductase inhibitors can also cause ED. Additionally, reduced sex drive is a possible side effect of the alpha reductase inhibitors dutasteride and finasteride.
Approximately 3 percent of men taking dutasteride reported experiencing a decreased libido in the first six months. About 6.4 percent of those taking finasteride experienced this within the first year. Roughly 4.5 percent of men taking dutasteride-tamsulosin reported decreased libido in the first six months.
Men who take these medications may also experience lower sperm count, decreased sperm volume, and lower sperm movement. Adverse events typically decrease with continued use.
Medications that treat erectile dysfunction may help improve BPH. The ED drugs below have all been shown to reduce BPH symptoms:
- sildenafil
- tadalafil
However, they arent currently approved to treat BPH.
These medications inhibit a protein that breaks down a chemical called cyclic guanosine monophosphate , which increases blood flow to the penis. By inhibiting the protein that breaks down cGMP, blood flow to the penis can be increased.
One comparing tadalafil and a placebo showed that men who took 5 milligrams of tadalafil daily had significant improvement in both BPH and ED symptoms.
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