Erectile Dysfunction after Prostate Cancer Treatment

Erectile dysfunction after prostate cancer treatment

Treatments for prostate cancer, including prostate surgery or hormone therapy, can cause significant sexual dysfunction in men, such as erectile dysfunction (ED) or the inability to ejaculate.  Surveys of cancer survivors indicate that sexual dysfunction is one of the most adverse side effects of cancer treatment.

• Psychological erectile dysfunction. Psychologically, the diagnosis and treatment of prostate cancer is often challenging for men.  Some men report feeling powerless, lack of confidence, and “less masculine”.  Poor emotional or psychological health can lead to sexual dysfunction.
• Hormone treatment for prostate cancer. Androgen deprivation therapy (ADT or prostate hormone therapy) is used to prevent recurring cancer for older, high risk patients or patients with advanced prostate cancer.   Loss of sexual desire and erectile dysfunction are extremely common side effects of ADT.  80% of ADT patients have ED.
• Prostate surgery often causes erectile dysfunction. Radical prostatectomy (surgical removal of the prostate gland) can cause damage to the blood vessels and nerves that stimulate the penis.  Some types of prostate cancer surgery can preserve more nerves. 60%-70% of men will have ED after a prostatectomy. Oral ED medication is successful in only some of those patients.  Leaking urine during orgasm is a common problem in men after radical prostatectomy.  Some improvements in erectile performance after prostate cancer surgery can be seen as time passes.
• Prostate cancer radiation therapy. Radiation therapy after 1 year of treatment causes ED and bladder problems in 50% of men.  ED tends to worsen after 2 years of radiation therapy.  ED medication is successful in half of treated men.
• Prostate brachytherapy. Brachytherapy causes the fewest complications of erectile dysfunction. 25% of men will have ED after brachytherapy.
• Age. Age at the time of prostate cancer treatment is a significant predictor of ED problems.  Men under 55 have a greater chance of preserving sexual function.
• Seeking early treatment. Treatment of ED that is started earlier tends to be more successful.

Treatment options for ED after cancer treatment include medication (viagra, levitra, cialis), penile injections (Tri-mix), vacuum pumps. 

Overall, medication is only successful in fewer than half of prostate cancer patients who were treated.  Men under 55 tend to have much more success with ED medications.  Trying more than one ED treatment is more likely to lead to more success in overcoming sexual problems.