Erectile Dysfunction After Prostate Cancer
by Admin
Posted on 21-03-2023 09:51 PM
Nearly all men will
experience
some erectile dysfunction for the first few months after prostate cancer treatment. However, within one year after treatment, nearly all men with intact nerves will see a substantial improvement.
Following surgery, many men experience erectile dysfunction (ed), but for many, the disruption is temporary. Nerves damaged during surgery may result in erectile dysfunction. A nerve-sparing prostatectomy may reduce the chances of nerve damage. “another factor is the surgeon’s skill level for performing the nerve-sparing technique, which if done correctly, may improve patients’ likelihood of retaining erectile function ,” says dr. Shelfo. Prostate cancer may also be treated with various types of radiation therapy—brachytherapy, external beam radiation or stereotactic body radiation therapy. Each type of therapy causes somewhat different side effects. About half of all prostate cancer patients who undergo any of these types of radiation therapy are likely to develop erectile dysfunction, according to a 2016 article published in advances in radiation oncology.
Prostate cancer is one of the most prevalent cancers and the second leading cause of cancer-related deaths in men in the united states. A large number of patients undergo radiation therapy (rt) as a standard care of treatment; however, rt causes erectile dysfunction (radiation-induced erectile dysfunction; ried) because of late side effects after rt that significantly affects quality of life of prostate cancer patients. Within 5 years of rt, approximately 50% of patients could develop ried. Based on the past and current research findings and number of publications from our group, the precise mechanism of ried is under exploration in detail.
Management of Erectile Dysfunction
Erectile dysfunction (ed) is one of the major but underreported concerns in cancer patients and survivors. It can lead to depression, lack of intimacy between the couple, and impaired quality of life.
The causes of erectile dysfunction are psychological distress and endocrinal dysfunction caused by cancer itself or side effect of anticancer treatment like surgery, radiotherapy, chemotherapy and hormonal therapy. The degree of ed depends on age, pre-cancer or pre-treatment potency level, comorbidities, type of cancer and its treatment. Treatment options available for ed are various pharmacotherapies, mechanical devices, penile implants, or reconstructive surgeries. A complete evaluation of sexual functioning should be done before starting anticancer therapy.
The main surgical option for erectile dysfunction management is an inflatable penile implant. Penile implants may be a last-line treatment option after other methods have failed since this option is the most invasive. A three-piece implant is inserted into the penis during implantation surgery. This implant has a button portion, placed into the testicle, a balloon-like piece that is attached to the abdominal wall and is filled with fluid, and a flexible plastic tube connected to the balloon structure that runs the length of the penis. The button can be pressed at any time when an erection is desired.
Erectile Dysfunction Following Radical Prostatectomy
The number of cancer survivors continues to increase due to the aging and growth of the population, and improvement in early detection and treatment ( 1 ). Among men, the most common cancer affects the prostate. About 60% of prostate cancer survivors are aged 70 years or older, and many remain interested in sex ( 2 ). Therefore it is important to understand the medical and psychosocial needs of prostate cancer survivors and proactively address sexual health. Primary treatments for prostate cancer are radical prostatectomy, radiotherapy (rt) (external-beam, brachytherapy or a combination), or observation. The choice of treatment depends on tumor staging, patient’s age and comorbidity, urologist’s and patient’s preferences ( 3 ).
Time is the most important factor in recovery. The healing process for men who have had nerve-sparing radical prostatectomy (removal of the prostate) is often 18 to 24 months or more, because nerve tissue requires a longer time to heal. How much erectile function returns depends on several things: the type of operation you had (one, both, or no nerves spared). Most men with intact nerves will see a substantial improvement within a year of treatment. Your age: men under 50 or 60 are more likely to recover their erections than older men. Your erectile function before the operation. Men who had good erections before surgery are more likely to recover their ability to get an erection than those who had previous erection problems.
Over the past two decades the number of cases of prostate cancer has soared. Approximately 50,000 new cases were diagnosed in 1981 and in 1997, more than 200,000 new cases were diagnosed. As the overall incidence of prostate cancer increases, the average age at the time of diagnosis has dropped dramatically from 72. 2 years in 1983 to 69 years in 1994. These two factors combined have made sexual dysfunction following radical prostatectomy a far more important issue. Most urologists are aware that erectile dysfunction is frequent following radical prostatectomy (rp). Most fail to appreciate and/or fail to inform their patients regarding the other sexual dysfunctions, which include the absence of ejaculation (although orgasm is generally preserved), and also possible penile curvature or length loss.
The authors also looked at other causes of erectile dysfunction, including partner status, body mass index (bmi), diabetes, cardiovascular disease, depression, baseline testosterone levels, and baseline use of erectile dysfunction (ed) medications. None of those, except bmi, had a statistically significant effect in this patient population at 2 years post-treatment. Some gained importance by 5 years, but because they are age dependent, and also affect baseline ed, none except bmi were independently important after baseline function and age were accounted for. A few known risk factors for ed were not included: medications (e. G. , beta-blockers, testosterone supplementation, etc. ), smoking, and substance abuse.
Before undergoing prostate cancer treatment, you will meet with one of our recovery specialists who are urologists specializing in erectile dysfunction treatment and male continence. Understanding how to prepare your body for your prostate cancer treatment will ultimately hasten your recovery. Your urologist will discuss: the importance of pelvic floor physical therapy to strengthen your pelvic floor muscles before and after treatment. A baseline assessment of erectile and bladder function.
The concept of penile rehabilitation after rp was first introduced in the late 1990s 15 and involves not only attempting to confer the ability to achieve erections sufficient for satisfactory sexual intercourse during the rehabilitation phase, but also to return erectile function to the pretreatment state (back-to-baseline). The clinical challenge is determining which treatment option is best for an individual patient, and each treatment has advantages and disadvantages. 4 , 6 the potential benefits and limitations of treatment options are presented in box 1. All treatment options should be presented to facilitate informed decision making. In this article, we propose a practical penile rehabilitation program for everyday clinical practice based on current understanding and treatment strategies ( box 2 ).