Prostate cancer is the most common cancer among men and the second leading cause of cancer death among white, black, American Indian and Hispanic men. Although early diagnosis and treatment can be life saving, must there be a trade-off with the loss of sexual function?
Erectile dysfunction (ED), or the inability to get or maintain an erection, is common among men who have undergone prostate cancer surgery to remove the prostate; cryosurgery, in which the prostate cancer cells are frozen and destroyed; or radiation therapy, in which X-rays are used to kill the prostate cancer cells or stop them from growing.
“With these treatments, penile nerve function is often lost,” said Urologist Richard Roach, M.D., Marshfield Clinic Minocqua Center. “A man may have had good erections prior to treatment, but a nerve-sparing treatment approach may not be the best option. It is important to successfully treat the cancer.”
ED, especially when it wasn’t present before prostate cancer treatment, can make successful treatment bittersweet. Talking about the problem may be more difficult than finding a solution.
“Sexual health is a private matter for most,” said Dr. Roach. “Fear that others will know inhibits some men from doing something about it.”
How important is my sexual relationship with my wife or significant other? Will treatment bring back my youthful sexual ability? “These are questions that men have, who have sought ED treatment following prostate cancer,” said Dr. Roach. “A common conclusion is that ultimately, you have to decide how important your sexual health is to you.”
ED treatment options include medications, mechanical devices, injection therapies or prosthesis implantation. Medication is usually tried first.
Medications work in response to sexual stimulation, said Dr. Roach. “You must take them one-half to one hour before anticipated sexual activity, and they can remain effective for up to 36 hours, depending on which medication is used.” These products cannot be taken with nitrates or certain medications for prostate enlargement, or if you have severe liver disease.
An external vacuum erection device or injection therapies can be safe and effective.
“Each type of ED treatment has advantages and disadvantages that need to be considered,” said Dr. Roach. “Patients need to be comfortable using the method they choose,” said Dr. Roach.
A surgically implanted inflatable penile prosthesis may be ideal when other treatments have been tried without success. “It works by pumping fluid into the cylinders of the penis, from a small reservoir placed in the abdomen,” said Dr. Roach. “This treatment is the most natural for patients and partners, and it is easy to use.”
Twenty to 40 million men suffer from ED. “Sexual health is important for bonding and your relationship with your spouse or significant other,” said Dr. Roach. “If having good sexual health is important to you and you no longer have it, I encourage you to not be shy about. Consider seeking help to get it restored.”
