What Will I Learn By Reading This
When you have treatment for your prostate cancer, you may have erectile dysfunction also known as impotence. Erectile dysfunction is a very common side effect . Side effects from prostate cancer treatment are different from one man to the next. They may also be different from one treatment to the next. Some men have no erectile dysfunction. The good news is that there are ways to deal with erectile dysfunction. In this booklet you will learn:
- What erectile dysfunction is
- 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
It is important for you to learn how to deal with erectile dysfunction so that you can continue to have a satisfying intimate relationship.
What Do We Know About Potency After A Robitic Prostatectomy
The return of potency is dependent on several factors:
- Previous sexual function before surgery. Unfortunately, robotic prostatectomy will at best return you to your level of sexual function pre-surgery. It will not improve upon what you already had before surgery.
- Age. Theyounger you are, the better your chances. Men under 65 have abetter chance of regaining potency, or erectile function than those over 65.
- How many nerves are spared. As discussed previously, ideally both nerves can be spared and thiswill give you the highest chance of regain erections. However,even men with no nerve sparing can regain erectile function.
What Are The Risks Of Radiation Treatment
Radiation treatment for prostate cancer may increase a manâs risk for having another cancer later in life, such as bladder or rectal cancer.
Some radiation side effects, like urinary problems, are usually short-term problems that go away with time. But a radiation side effect can become a long-term problem. Common side effects from radiation treatment include:
- Bowel problems, such as rectal pain, diarrhea, blood in your stool, and rectal leakage.
- In one study, 67 out of 100 men had erections firm enough for intercourse before they had radiation. Six years later, 27 out of 100 men who had radiation had erections firm enough for intercourse.footnote 4
For men with intermediate-risk or high-risk prostate cancer, radiation treatment may be given along with hormone therapy. Hormone therapy has side effects, such as the loss of bone density and muscle mass. It can also increase the risk for bone fractures, diabetes, and heart disease.
Your doctor might advise you to have surgery if:
- You are healthy enough to have major surgery.
- Radiation therapy isnât a good option for you because you have had previous radiation therapy to your pelvic area or you have a serious bowel disease such as ulcerative colitis.
Your doctor might advise you to have radiation if:
- You want to avoid the side effects of surgery, such as leaking urine and erection problems.
- You have other health problems that make surgery too risky.
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Dealing With Erectile Dysfunction: For You And Your Partner
The following information is based on the general experiences of many prostate cancer patients. Your experience may be different. If you have any questions about what prostate cancer treatment services are covered by your health insurance, please contact your health care provider or health insurance provider. This education material was made possible by a Grant from the California Department of Justice, Antitrust Law Section, from litigation settlement funds to benefit Californians diagnosed with cancer or their families.
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Sexual Dysfunction After Prostate Surgery Is More Common Than Previously Reported Says Hutchinson Center Study
Media briefing: A media briefing will be held at 1 p.m. PST Tuesday, Jan. 18 at the Center’s Metropolitan Park East Campus, 1730 Minor Ave., between Olive and Howell streets. A Media Relations representative will greet you in the lobby and escort you to the briefing room. Free parking is available in an underground garage entrance off Minor Ave. A map of the site is available upon request.
B-roll available: A related video news release, including sound bites and b-roll of Dr. Janet Stanford and a Seattle-area prostate-cancer survivor, will be available via satellite feed twice on Tuesday, Jan. 18: first between 6 and 6:30 a.m. PST and again between 11 and 11:30 a.m. PST .
SEATTLE — Sexual dysfunction among men who undergo prostatectomy appears more prevalent than previously reported, according to a multi-center study led by an investigator from the Fred Hutchinson Cancer Research Center in Seattle.
The results will appear in the Jan. 19 issue of the Journal of the American Medical Association.
Funded by the National Cancer Institute, the Prostate Cancer Outcomes Study is the first comprehensive, population-based assessment of sexual function and urinary continence among men treated with radical prostatectomy for early stage, localized prostate cancer. It is also the first study to examine the sexual and urinary side effects of such surgery in minority populations.
Age and education also had an impact on the frequency of impotence.
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LOCALIZED PROSTATE CANCER
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Q: Does Prostate Removal Surgery Cause Erectile Dysfunction
A:Yes. Erectile dysfunction can and often does occur after a radical prostatectomy the complete removal of the prostate gland. Thats because the operation can sometimes injure tiny nerves, muscles and blood vessels involved in getting an erection.
If you develop ED after undergoing surgery, the problem isnt necessarily permanent. Many men regain full sexual function over time, usually within a year, though for some it can take a few years.
If problems continue, medicines and devices can help. Your doctor may also prescribe medicines and devices during recovery to help bring back erection.
You are more likely to develop ED following surgery for prostate cancer if:
- You are 60 or older
- You had some evidence of erectile dysfunction before surgery
- You are in poor health
Its important to also point out that there are different types of treatments for prostate cancer and many men who are diagnosed dont need to be treated right away. If you have slow-growing cancer, your doctor may recommend observation as the first phase of treatment. Watchful waiting involves monitoring changes in your symptoms and tumors.
Each treatment option for prostate cancer has different benefits and risks. Talk to your doctor about what option is best for you.
For more information about Mount Sinai South Nassaus Center for Prostate Health, .
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Avoidance And Difficulty Sustaining Ed Treatments
Although there are effective treatments for ED, many men avoid seeking medical help for this condition. In a study of men who were found that have ED, 69% of men did not accept that they had ED and the median time to pursue treatment for ED was 2 years . In men with prostate cancer , a study found that only 50% of men who were interested in seeking treatment for ED actually took steps to find treatment . Of men who seek help to treat their ED, compliance is poor. It is estimated that 50 to 80% of men discontinue their use of ED treatments within a year of starting them . This applies to men with and without PC. Considering the importance of penile rehabilitation following PC surgery, the difficulty starting and sustaining treatment could have a negative impact on mens ability to recovery erections following RP.
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Who Has Nerve Preservation
Patient who are potent are understandably keen to retain this and so are we. As well as allowing erections following surgery, nerve preservation also allows an earlier return to continence so we always practice nerve preservation whenever the cancer control allows it, which is in about 80% of men. When the cancer is close to one of the nerves we might partially nerve preserve on that side if it is safe to do so and will discuss this with you beforehand if this seems likely.
The decision to nerve preserve is taken after considering the patients existing erections, PSA level, biopsy report, MRI scan, rectal examination under anaesthetic immediately before the operation starts and the way the NVB looks and feels during the operation. It is always discussed with patients before surgery.
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Tips For Talking With Your Partner
Feeling less of a desire to have sex or having trouble getting an erection may affect your relationship. Try to be as open with your partner as you can. Here are some tips:
- Bring your partner with you to doctors visits. Being part of the conversation may help them understand what youre experiencing.
- Listen to your partners concerns, too. Remember that this issue affects both of you.
- See a therapist or a sex therapist to help you work out any issues that are affecting your sex life.
- If sex is a problem right now, its possible to fulfill each other sexually in other ways. Cuddling, kissing, and caressing can also be pleasurable.
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Sex After Prostate Cancer Radiation Treatment
A radiation oncologist is likely to administer radiation treatments. External beam radiation is a treatment delivered through a machine used to aim high-energy rays from outside the tumor into the tumor. Brachytherapy or seed implant treatment places small radioactive seeds within the prostate itself, giving the prostate gland localized radiation therapy. Forty percent of men report ED after radiation treatment.
A clinical study was conducted to determine if tadafil preserved erectile function in men treated with radiotherapy for prostate cancer. Among 221 participants it was observed that daily use of tadafil did not improve sexual activity. The findings did not support the use of Cialis to prevent ED. While men may not have positive results with Cialis, penile injections and erectile dysfunction pumps are usually successful treatments.
Surgically Induced Erectile Dysfunction
Unfortunately, many men have unrealistic expectations for sexual recovery after surgery. In many cases, treatment for prostate cancer, especially with radical prostatectomy, has permanent side effects.
Long-term and potentially permanent sexual dysfunction is a common consequence of radical prostatectomy. This can be a massive issue for both a man and his partner.
Even when a mans doctor is quite candid concerning reduced or non-existent sexual function, many men still expect improvements in sexual functioning one or more years after surgery. 4
It is a given that a man might be capable of recovering usable erections after surgery. However, it is also a given that sexual sensations after a prostatectomy will never be the same as they were before surgery.
In most cases, sensation after surgery is significantly altered. Therefore, if a patients expectation for success means recovery to the physical action and sensations prior to surgery, he is destined to be, at the very least, disappointed.
Loss of erectile function often causes a devastating blow to a man used to having sexual performance. Due to a lack of communication with his doctor, he may also be rather surprised about how total the loss is. This loss may also be perceived quite strongly by his partner.
Since complete surgical erectile dysfunction is a very real possibility, any man considering a radical prostatectomy, must, if he values his sex life, also consider other options very seriously.
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Treatments For Erection Problems And Penile Rehabilitation
Different treatments work for different people and they can have side effects. Talk through your options with a doctor or nurse with expertise in this area. Ask them to refer you to your local Erectile Dysfunction Clinic if they are not able to give you this specialist advice.
The aim of penile rehabilitation is to:
- provide a stimulus for erections
This can hopefully help you to adapt to changes in your sexual function and relationships.
A penile rehabilitation programme includes:
- counselling and sex therapy
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Effect Of Tadalafil On Cavernosal Tissue After Cavernosal Nerve Injury
Tadalafil, a potent PDE-5 inhibitor, is effective from 30 min after administration and efficacy can be maintained for up to 36 h. The T1/2 of tadalafil is 17.5 h, longer than several other PDE-5 inhibitors, and it is not affected by food . Several animal studies investigated the effect of PDE-5 inhibitors on cavernosal tissue after cavernosal nerve injuries. Kovanecz and colleagues investigated the effect of chronic tadalafil on cavernosal tissue in rats undergoing a unilateral or bilateral cavernosal nerve resection. The authors showed that using 45 days of daily tadalafil restored intracorporeal pressure, preserved smooth muscle content, increased smooth muscle to collagen ratio, and reduced the penile apoptotic index . Lysiak and colleagues examined penile tissue at 2, 4 and 6 weeks after bilateral cavernosal nerve resection in an animal study. They found that using tadalafil decreased the number of apoptotic cells and increased the phosphorylation of the two survival-associated kinases Akt and extracellular signal-regulated kinase 1/2 via an apoptotic-related mechanism. In addition, they showed the amount of apoptotic cells further increased 4 and 6 weeks after nerve resection .
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Making An Informed Decision
There are many things to consider when agreeing to proctectomy. Thus, one should ask healthcare providers various questions, from the cost of prostate cancer surgery to prostate cancer surgery after side effects.
During appointments or doctor visits, take more interest in prostate cancer treatment medications, supplements, how the process is done, whether the doctor would consider hormone therapy, other treatment options, sex life after prostatectomy, diet after surgery, rehabilitation, and more.
When agreeing to proctectomy, one should consider the risk and benefits and explore all non-surgical options. Once the prostate gland is removed, one will have to live with specific issues for a long.
Life After Prostate Removal: What To Expect
The prostate gland is prone to inflammation and developing cancer.
Almost half of the men above the age of 60 have benign prostate hyperplasia or prostate enlargement.
However, BPH does not cause removing the prostate, but the presence of cancer or its early sign is the reason for prostate removal.
Prostate cancer has become a significant concern in recent years. Its incidence is increasing, and now its diagnosis is becoming more common even among middle-aged men.
Prostate cancer is now among the most common cancers in older men.
Aging indeed has lots to do with the increased prostate cancer rate, but it is not the only cause. It seems that this disproportionate increase in the annual incidence of prostate cancer also has to do with other lifestyle issues like a high-fat diet, greater prevalence of metabolic disorders, environmental toxins, hormonal changes, and more.
The prostate plays an important role in male fertility and sex life. Although men can survive without a prostate, unfortunately, for many men, prostate removal results in poor quality of life, issues like erectile dysfunction, and more.
Some men can expect to recover well from proctectomy. However, for others the journey to recovery is prolonged and distressing. Keep reading to find out more about life after prostate removal and what you can expect.
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What Might Affect My Sex Drive
The following things may affect your sex drive.
Hormone therapy for prostate cancer is likely to lower your sex drive. This is because some types of hormone therapy lower your testosterone levels, which is what gives you your sex drive.
If youre on long-term hormone therapy, ask your doctor or nurse about intermittent hormone therapy. This is where you stop hormone therapy when your PSA level is low and steady, and start it again if it starts to rise. Your sex drive may improve while youre not having hormone therapy. But this can take several months and some men dont notice any improvement. Intermittent hormone therapy isnt suitable for everyone.
If having sex is important to you, you can still try treatments if your sex drive is low. Some of the treatments for erection problems may still work for you.
Your thoughts and feelings
Some men with prostate cancer feel that they have lost their self-esteem, self-confidence or sense of masculinity. Feeling down or stressed can mean you have less interest in sex. If you feel like this then consider getting some support. As well as helping you to feel better about yourself it may help improve your sex life.
All treatments for prostate cancer can cause tiredness or fatigue during or after treatment. If you feel very tired, you may lose interest in sex or not have enough energy for it.
Other side effects
Side Effects Of Prostate Surgery
The major possible side effects of radical prostatectomy are urinary incontinence and erectile dysfunction . These side effects can also occur with other forms of prostate cancer treatment.
Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence:
- Men with stress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. It’s usually caused by problems with the valve that keeps urine in the bladder . Prostate cancer treatments can damage this valve or the nerves that keep the valve working.
- Men with overflow incontinence have trouble emptying their bladder. They take a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue.
- Men with urge incontinencehave a sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine.
- Rarely after surgery, men lose all ability to control their urine. This is called continuous incontinence.
After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time.
There are several options for treating erectile dysfunction:
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