ED and prostate cancer treatment

Erectile dysfunction, also called impotence, is the inability to develop or sustain an erection satisfactory for sexual intercourse.

Although prostate cancer is not a cause of erectile dysfunction, treatments for the disease can cause the problem. These include:

• Surgery to remove the entire prostate gland
• Radiotherapy, whether by external beam or radioactive seed implants
• High Intensity Focussed Ultrasound (HIFU)
• Cryosurgery (freezing cancerous tissue)
• Hormone therapy

All current treatments for prostate cancer can cause erectile dysfunction, although some treatments may lead to it sooner than others.

When can erectile dysfunction occur after treatment?

Surgery. Some degree of erectile dysfunction occurs straight after surgery to remove the prostate, regardless of whether this surgery includes trying to spare the nerve that controls erections.

The severity of the erectile dysfunction depends on the type of surgery used, the stage of the cancer and the skill of the surgeon.

If the nerve-sparing technique is used, the patient may recover from erectile dysfunction within a year of surgery. Recovery of erectile function after non-nerve-sparing surgery is unlikely but possible.

If an erection can be achieved after surgery, the ability to reach orgasm is maintained but these are “dry” orgasms in which little (if any) ejaculate comes out. With most men this results in infertility. Although that is often not a concern, since most men are over 50 years old at the time of diagnosis, you can talk to your doctor about “banking” sperm before the procedure.

Radiotherapy. The onset of erectile dysfunction following radiotherapy is gradual and usually begins about six months after the treatment.

Loss of erectile function is the most common long-term complication of radiotherapy. But it occurs less frequently when more sophisticated treatments such as radioactive seed implants (brachytherapy), intensity-modulated radiotherapy (IMRT) and 3-D conformal radiotherapy are used.

Hormone therapy. When hormone therapy is used, erectile dysfunction may occur approximately two to four weeks after the start of therapy. This is accompanied by a reduced desire for sex.

How is erectile dysfunction treated?

The current options for erectile dysfunction in men who have received treatment for prostate cancer include:

• Oral medications such as sildenafil, tadalafil or vardenafil
• Injections of medicine into the penis before intercourse (called intracavernous or intracavernosal injection therapy)
• Use of a vacuum constriction device to draw blood into the penis, causing an erection
• Medicine that is inserted into the penis (intraurethral pellet) prior to intercourse
• Penile implants

How effective are oral erectile dysfunction drugs?

• Following surgery. Experience suggests many men who have had nerves spared on both sides of their prostate will regain erections. The results are less favourable with men who have had a single nerve spared or no nerves spared.
• Following radiotherapy. Some men regain erections with drugs following radiotherapy for prostate cancer. However current data on effectiveness remains rather limited.
• Hormone therapy. Specialists find that men treated with hormone therapy do not respond well to any erectile dysfunction treatments including medications although data are limited.