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Can Prostate Surgery Cause Erectile Dysfunction

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How Is Erectile Dysfunction Treated

Is erectile dysfunction common after radical prostatectomy?

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

  • Oral medications, such as tadalafil , vardenafil , avanfil , orà sildenafil
  • Injections of medicine into the before intercourse
  • Use of a vacuum constriction device to draw blood into the to cause an erection
  • Penile implants

What Are The Current Expectations With Regard To Outcomes After Radical Prostatectomy

Following a series of anatomical discoveries of the prostate and its surrounding structures about 2 decades ago, changes in the surgical approach permitted the procedure to be performed with significantly improved outcomes. Now after the surgery, expectations are that physical capacity is fully recovered in most patients within several weeks, return of urinary continence is achieved by more than 95% of patients within a few months, and erection recovery with ability to engage in sexual intercourse is regained by most patients with or without oral phosphodiesterase 5 inhibitors within 2 years.

Ask Your Doctor About Solutions

Patients should not be shy about discussing intimacy issues with their doctor. He or she may be able to prescribe medications to help. Certain medicationssuch as sildenafil , tadalafil or vardenafil are typically tried first. But these drugs may not help men achieve an erection if the nerves responsible are not healthy. In fact, the medications only work for a small percentage of men in the first few months after surgery, according to a 2017 study published in the International Journal of Sexual Health.

While regaining erectile function is not possible for all men treated for prostate cancer, it is important to remember that an erection is just one aspect of a satisfying sex life. Intimacy is another major component, one that may become more important as sexual relationships become more difficult after cancer treatment.

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Ali Atan1* Ersin Koseoglu2 And Altug Tuncel2

1Department of Urology, Gazi University, Ankara, Turkey2Department of Urology, Ankara Numune Training and Research Hospital, Ankara, Turkey

*Corresponding author: Ali Atan, MD, Professor, Department of Urology, Gazi University, Emniyet, 06560 Yenimahalle/Ankara, Turkey, Tel: +90 312 202 4444, Fax: +90312 2213202, E-mail: Int Arch Urol Complic, IAUC-2-018, , Review Article ISSN: 2469-5742Received: July 31, 2016 | Accepted: September 24, 2016 | September 26, 2016Citation: Atan A, Koseoglu E, Tuncel A The Effect of Prostate Biopsy on Erectile Functions. Int Arch Urol Complic 2:018. 10.23937/2469-5742/1510018Copyright:© 2016 Atan A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Erectile dysfunction, Prostate cancer, Prostate needle biopsy, Repeat prostate biopsy, Saturation prostate biopsy

PCa is the most common malignancy among men in the United States of America . Digital rectal examination and PSA are the first investigations for the diagnosis of PCa . PCa could only be diagnosed exactly by tissue examination. In recent years, the serum PSA measurement and number of prostate biopsies performed have become more frequent. Tissue samples should be taken from different parts of prostate by transrectal prostate biopsy and these samples should be examined histopathologically.

Prevalence Of Erectile Dysfunction

When does a Patient Require a Rezum Procedure?

On the contrary, the prevalence of ED in this study is higher than the finding obtained in a population-based multinational study in regions of the UK , Netherland , France , Korea linking ED and LUTS due to BPE in 4800 men aged 40 to70 years. The study observed a prevalence of 21.1%. The difference in this observation may be due to the fact that larger group of patients with LUTS due to BPE were enrolled compared to the 117 patients with symptomatic BPE enrolled in this study . However, the consistent observation is that ED and symptomatic BPE were significantly associated with increasing age .

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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.

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.

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Early Penile Rehabilitation After Surgery

Penile rehabilitation has 2 parts:

  • Using a low-dose pill to help the blood flow around the nerves and help the nerves heal.

Medicines to help produce erections pills such as sildenafil , tadalafil , or vardenafil are typically used in combination with other therapies or devices. Since the drugs might not produce an erection because they need the nerves responsible for erections to be healthy, penile injections or vacuum devices might be offered. See Managing Male Sexual Problems Related to Cancer to learn more.

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How Long Does Erectile Dysfunction Last After Surgery

According to Cancer Research UK, after prostate surgery you may experience erectile dysfunction from anything between three months to three years. This is because prostate surgery may injure the nerves, muscles or blood vessels required for an erection. Some men may also experience erectile dysfunction for the rest of their lives and require treatment to achieve an erection.

Having a radical prostatectomy will also leave you with a higher chance of getting erectile dysfunction than having a nerve sparing prostatectomy. According to the NHS, before treatment, 67% of men who had prostate cancer said that they could get erections firm enough for intercourse. After getting a radical prostatectomy, they were asked again after 6 months, and this decreased to 12%. In contrast, according to the Prostate Cancer Foundation, approximately 50% of men who receive a nerve sparing prostatectomy who could have erections before surgery will maintain this ability long term.

Urinary Symptoms Linked To Sexual Dysfunction

How Surgery & Certain Cancer Treatments Can Cause Erectile Dysfunction | Memorial Sloan Kettering

In this study, published in the current issue of Mayo Clinic Proceedings, researchers studied 2,115 men between the ages of 40 and 79. The men completed questionnaires about their sexual function and urinary tract symptoms every two years.

Researchers found that each of the indicators of sexual function was inversely related to the severity of urinary tract symptoms reported by the men. As the mens urinary symptoms increased, their level of sexual function decreased.

After adjusting for age, urinary tract symptoms resulting from an enlarged prostate that were most strongly associated with sexual dysfunction were:

  • A feeling of urgency
  • Needing to get up multiple times at night to urinate
  • A weak urine stream

These symptoms were associated with:

  • Difficulty getting or maintaining an erection
  • Sexual satisfaction problems

However, the association with mens urinary tract symptoms and sexual dysfunction diminished with advancing age. No association between these symptoms and most sexual problems were found in men over age 70.

Researchers say that because both of these conditions are common in aging man, it may be very difficult to see if a true association exists outside of an age-related one.

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Causes Of An Enlarged Prostate

We dont actually know what causes prostate enlargement. Potential factors include:

We do know that men who have their testicles removed â for example, due to testicular cancer â do not experience prostate enlargement.

If the testicles are removed after prostate enlargement occurs, the prostate begins to shrink

What we do know is that:

  • Your chances of developing an enlarged prostate increase with age
  • Enlarged prostates are so common that its believed all males will eventually experience an enlarged prostate if they live long enough. In fact, over 90% of males over 80 have BPH.
  • There are no specific risk factors for prostate enlargement, other than having testicles.

What Causes Benign Prostatic Hyperplasia

Its a little hard to say for sure what causes BPH.

What we do know for a fact is that men go through two main stages of prostate growth in their lives first at puberty, where the prostate doubles in size, and then growth begins around the age of 25 and continues during most of a mans life.

BPH is known to surface in this second stage, and mostly affects men above the age of forty. Autopsy data has found evidence of the condition in about 90 percent of men above the age of eighty.

The growth of the prostate in this second stage may be linked to androgens in the body. Men produce testosterone throughout their lives. They also produce estrogen the female hormone but only in small amounts.

When testosterone levels drop as they inevitably do with age a higher proportion of estrogen may remain.

This increase in the ratio of Estrogen or its receptors to testosterone may directly and indirectly affect the growth of prostate cells.

Another possible cause is DHT or dihydrotestosterone. This male hormone is a bit of a villain. It is a major cause of alopecia in men, but is however useful for the development and maintenance of the prostate.

Unfortunately, this role can be dangerous for the adult prostate, as DHT can cause excessive growth.

BPH may also result when there is an imbalance between the production and death of prostate cells. When the imbalance is in favor of cell proliferation, it can lead to BPH.

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The Impact Of An Enlarged Prostate On Erectile Dysfunction

It is easy to see a symptom while misunderstanding the underlying cause.

Erectile dysfunction is a common medical condition that impacts more than a third of men at some point in their lives. As men get older, they tend to struggle more commonly with erectile dysfunction . There are many other health issues for men as they get older. Some of these health risks may have an impact on their ED as well.

One common area with troubling conditions for aging men is their prostate. Their prostates can be a source of cancer, but even when they are cancer-free, they may have an enlarged prostate called Benign Prostatic Hyperplasia . In this article, we will focus on how BPH impacts mens health and how that may contribute to erectile dysfunction.

The Connection Between Prostate Cancer And Erectile Dysfunction

Prostate Surgery and Erectile and Ejaculatory Function

Prostate cancer is a condition that begins in the prostate, often resulting from genetic mutations. There are many options for diagnosing prostate cancer, and its progress or stage determines treatment options. Symptoms or complications of prostate cancer include progressive problems with urination, blood in urine, body pain and erectile dysfunction .

When a patient experiences ED as a complication of prostate cancer, there are new aspects to their treatment that must be considered. Because this topic is often private for patients, physicians are trained to discuss this condition with the greatest level of sensitivity and work alongside patients to achieve positive outcomes.

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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.

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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Can Other Treatments For Prostate Cancer Cause Erectile Dysfunction

Other treatments for prostate cancer, including radiotherapy and brachytherapy can also cause erectile dysfunction. Brachytherapy involves delivering doses of radiation therapy directly to the inside of the prostate rather than on the outside of the body as with normal radiotherapy.

Hormonal treatments, given as injections, tablets or a combination of the two, help to manage the progression of advanced prostate cancer by blocking the effects of the male hormone, testosterone. Testosterone helps prostate tumours grow, so blocking its action helps to prevent further growth of the tumour. It isnt a cure, but is often used in conjunction with other treatments. This kind of treatment can also cause erectile dysfunction due to the loss of testosterone.

Cryotherapy, where cancer cells are killed by freezing them using tiny probes inserted into the prostate can also cause erectile dysfunction. This is because cryotherapy also may damage the nerves controlling erection.

What type of treatment you have for your prostate cancer will be determined by the stage and speed of growth of your cancer.

If you suffer with erectile dysfunction after treatment, how long this may last and how much it affects your life will also depend on your type of treatment and the severity of your prostate cancer.

Who Might Be An Ideal Patient For Penile Prosthesis

Erectile Dysfunction Solutions after Prostate Cancer Treatment

But once those were exhausted, then we would move on to penile implants. Historically, the implant had actually been around before those drugs were developed. So we were doing, although a limited number just because the public wasn’t familiar with it, we were doing more surgery for erectile dysfunction, then you have the injectable agents and the pills became available. And so those were able to treat men with minor erectile dysfunction. However, as we age, it’s the sort of the same risk factors for having a heart attacksmoking, high blood pressure, diabetesthese are all risks that people have for erectile dysfunction. Because of clogging of the arteries. If you think of anything that causes a heart attack, or a stroke, those risk factors also cause erectile dysfunction. So we get men that are older and that blockage is such that it can’t be overcome by those injectable agents or pills, and so those are great candidates for the penile implant.

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Prostate Cancer And Ed

What is erectile dysfunction?

Erectile dysfunction or ED is the consistent inability to achieve an erection sufficient for satisfactory intercourse. Although not all people with ED identify as men, as many as 30 million Americans have ED. Most men with ED are sexually active, but they are usually having problems with how they may expect their body to respond or function during intercourse.

How does prostate cancer lead to erectile dysfunction?

Prostate cancer does not directly cause ED, but treatments for prostate cancer can cause a patient to experience this condition. In fact, ED is one of the most common side effects after any kind of prostate cancer treatment.

Treatments for prostate cancer can decrease your bodys ability to create testosterone. Low testosterone can impact your libido and ability to achieve and maintain an erection.

Other treatments, such as prostatectomy, can affect the blood vessels and nerves responsible for causing erections. If these structures in your body experience trauma, it can make it more difficult for them to work properly, causing ED.

Erectile Dysfunction And The Prostate: What’s The Relationship


Written by the UPGUYS Editorial Team Published on March 21, 2022

Did you know that 49.4% of Canadian men between ages 40 and 88 experience ED? In the United States, 52% of men experience some form of erectile dysfunction as well. Complete ED usually increases from 5% to 15% in men between the ages of 40 and 70.

Erectile dysfunction and prostate problems are common for men, especially as they get older. While the cause of ED can be physical or psychological, one factor that is often overlooked is the role of the prostate.

We’re going to explore the relationship between ED and the prostate. We’ll also take a look at what men can do to improve their sexual health. Keep reading to find out more.

In this article, we’re going to cover the following:

  • Does and How Are Erectile Dysfunction and Prostate Problems Connected?
  • The Kinds of Prostate Problems That Can Cause Erectile Dysfunction
  • Symptoms of Erectile Dysfunction Caused by Prostate Problems
  • Can You Take Erectile Dysfunction Medications if You Are Taking Prostate Problems Medications?
  • Does Prostate Disease Medication Cause Erectile Dysfunction?
  • How to Treat Erectile Dysfunction Caused by Prostate Diseases?
  • Improving Symptoms and Prevention
  • FAQs About Erectile Dysfunction and Prostate Diseases

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Are There Any Surgical Techniques That Have Been Developed To Improve Erectile Function Outcomes

At this time, there are several different surgical approaches to carry out the surgery, including retropubic or perineal approaches as well as laparoscopic procedures with freehand or robotic instrumentation. Much debate but no consensus exists about the advantages and disadvantages of the different approaches. Further study is needed before obtaining meaningful determinations of the success with different new approaches.

Correlation Between Erectile Dysfunction And Symptomatic Benign Prostatic Enlargement

Erectile Dysfunction Symptoms, Risk Factors, and Diagnosis

The severity of ED was directly related to prostate size and men with larger prostate had ED compared to those with smaller prostate. Braun et al. noted that the prevalence of ED in men with BPE was 72% in their Cologne Male Survey involving approximately 5000 German men and this was similar to the high prevalence of 76.9% in men with BPE observed in this study. This shows that ED is common in men with BPE and further supports the need to consider ED in managing patients with symptomatic BPE. Raymond et al. in another clinic-based population study in Western countries observed that the prevalence of ED in patients with LUTS ranged from 41 to 71% with statistical significance . This finding was similar to that noted in this study with a P value of 0.001 which was statistically significant.

Ngai et al. noted a statistically significant correlation between ED and symptomatic BPE. This was similar to the observation made in this study which shows positive correlation between ED and symptomatic BPE with statistical significance . BPE may be an indicator of ED, and patients should be evaluated holistically due to the high prevalence of ED in men with symptomatic BPE and positive correlation between both pathologies .

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