ASK DR.K: Prostate Cancer and ED

Updated: Mar 11, 2021

Dear Dr. K, I've had prostate cancer. What are my options for treating ED?

Prostate cancer is the second most prevalent cancer in men behind lung cancer.

1 out of 6 men will develop prostate cancer in their lifetime. In and of itself, prostate cancer is not a cause of Erectile Dysfunction (ED). However, ED often results from the different treatment methods for prostate cancer.

The current alternatives for treating prostate cancer include:

· Surgery either “open” or conventional surgery, or robot-assisted surgery

· Radiation therapy - external beam radiation or radium “seed” implants in the prostate itself

· Hormone suppression

After surgery some degree of ED can occur. Regardless of whether a nerve-sparing technique is used or not, ED is a common occurrence after surgery and can be either temporary, lasting up to two years, or permanent. The severity of the ED depends on the type of surgery and the stage of the cancer. If a nerve-sparing technique is used recovery from ED may occur in the first two years after surgery. Recovery from ED after non-nerve-sparing surgery is unlikely, but possible.

The use of vacuum pump devices or ED drugs may improve the quality of erections. These treatments are also used in “penis rehab” post-operatively to help maintain penis size and elasticity. However, there may be “dry” or retrograde ejaculations in which the semen is passed into the bladder, resulting in infertility. If this is a concern for you, then you may want to consider banking your sperm prior to surgery.

Radiation therapy (XRT) whether with external beam radiation or with implanted radium “seeds” can cause ED. The radiation can cause injury to both the arteries and nerves to the penis, which may not become apparent until 6 to 12 months after therapy. ED is the most common long-term complication of XRT. However, newer, more sophisticated methods of delivering XRT may lessen the occurrence of ED.

Hormone therapy used to decrease testosterone may lead to ED and decreased libido within 2 to 4 weeks after the start of therapy.

Treatment Options

Oral therapy with ED drugs (Viagra, Cialis) have varying degrees of success. Up to 70% of men who have had nerve-sparing surgery will regain erections with the use of one or more oral drugs. Results are not as favorable in surgery where one or both nerves are not spared. After XRT, 50 to 60% of men regain erections with the use of these medications. Men who have do not respond well to ED medications.

Injections into the penis may be successful if ED drugs fail. Up to 80% of men regain erections using injection therapy.

If these therapies fail, or the idea of sticking a needle into your penis is less than appealing, the use of a mechanical vacuum device may help achieve erections. Even though they can be effective, vacuum devices are generally less desirable for men who have had surgery. Penile suppositories placed in the urethra contain medication similar to that in the injections. This relaxes the vessels in the penis allowing increased blood flow to the penis.

Finally, penile implants may be considered to treat ED in men for whom other modalities have failed. The current device is a three-piece implant. Two inflatable cylinders are implanted in the shaft of the penis. A fluid reservoir is buried in the fatty tissue of the lower abdomen and a pump is placed in the scrotum behind the testicles. Squeezing the pump causes the fluid in the reservoir to flow into the cylinders, making them enlarge and stiffen. A “button” on the side of the pump causes the fluid to flow in the reverse direction, allowing the chambers to empty and the erection to subside. In the non-inflated state, the penis has a more natural appearance compared to the rigid implant.

Low-Intensity Shockwave Therapy (Li-SWT)

Li-SWT offers another alternative treatment for ED following treatment for prostate cancer. Li-SWT stimulates neovascularization or new blood vessel growth in the treated tissue and may help correct damage to the nerves and blood vessels supplying the penis. Li-SWT is a non-invasive treatment, performed in a physician's office and requires no down time. More information about Li-SWT is available from the staff and physician at Renewal Medical Centers of North Texas.

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