Although prostate cancer doesn’t directly cause erectile dysfunction, the treatments for this disease can often result in its development. Prostate cancer treatments that can cause impotence range from surgery to remove either part or all of the prostate gland (prostatectomy), radiation therapy (both external beam and brachytherapy [radioactive seed implants]), and hormone therapy. Depending on the treatment, some can cause erectile dysfunction (ED) more quickly than others. Let’s take a closer look at the link between prostate cancer and erectile dysfunction.
Erectile dysfunction from prostate surgery
Erectile dysfunction may occur immediately after prostatectomy, even if the surgeon uses specialized techniques to try and spare the nerves responsible for erections. However, the severity of ED can vary depending on the type of surgery undertaken, the cancer stage at the time of surgery, and the skill of the surgeon.
For example, use of nerve-sparing techniques during surgery generally results in the complete recovery of erectile function within two years. When non-nerve-sparing techniques are used, however, full recovery of erectile function is very unlikely, although possible.
Men may want to consider using either a vacuum device or an ED drug once the body has completely healed from surgery. These tools may assist erectile performance and how rapidly the body recovers and returns to normal sexual function.
Men who are capable of achieving an erection following surgery will also be able to experience an orgasm. However, the orgasm may be accompanied by little to no ejaculate, which is referred to as a dry orgasm. A dry orgasm can often cause infertility for the majority of men. Most men are older when they have prostate cancer, so this is often not a big concern. For those who want to be able to reproduce after a prostate cancer diagnosis, banking sperm is a good idea.
Erectile dysfunction from radiation therapy
Erectile dysfunction is often the most common side effect from radiation treatment. If ED occurs after radiation therapy, it is often gradual and generally begins around six months posttreatment. There is a decreased risk of erectile dysfunction when patients undergo more sophisticated radiation treatments, which include intensity-modulated or 3D radiotherapy and brachytherapy.
Erectile dysfunction from hormone therapy
For prostate cancer sufferers who undergo hormone therapy, erectile dysfunction can start within two to four weeks of the therapy starting. Decreased sexual desire is another side effect that may occur. The reason ED may result is the reduction in testosterone caused by the drugs. Decreased sexual desire is another side effect that may occur.
What types of erectile dysfunction treatments are available?
A wide range of treatments are available for men who are experiencing erectile dysfunction after prostate cancer. The most common are oral ED medications, such as Cialis, Levitra, Stendra, Staxyn, and Viagra. Another treatment option is medications that are injected directly into the penis, known as intracavernous injection therapy. Vacuum constriction devices, designed to draw blood to the penis, also can assist erections. Yet other options include penile implants and suppository drugs, which are placed directly in the penis.
Are oral drugs for erectile dysfunction every effective?
For men who have undergone prostatectomy, the current figure of those who regain erections with nerve sparing surgery and the use of oral ED drugs is 70 percent. Fifty to 60 percent of patients who have had radiation therapy will recover full erectile function when using oral medications. Erectile dysfunction treatments often don’t work for men who undergo hormone therapy.
Does injection therapy work well for erectile dysfunction?
If oral drugs haven’t been effective, injections into the penis can have great results in recovering erectile function. Close to 80 percent of men regain their erections using this type of treatment following nerve-sparing surgery or radiation therapy.
Penile implants, penile suppositories, and vacuum constriction devices have had varying levels of success treating those with erectile dysfunction from radiation therapy or nerve-sparing surgery. With vacuum constriction devices, some users have experienced discomfort, as a band is placed around the base of the penis after the desired erection occurs to maintain it during sexual intercourse. For those who have had surgery, many patients don’t like using vacuum constriction devices to aid erections.
If you are experiencing erectile dysfunction after prostate cancer treatment, it is worth seeing your doctor to discuss the most effective options available to you. Depending on the severity of the cancer treatment, some erectile dysfunction medications, devices, and therapies may be ineffective for your personal situation.
Read more in our Prostate Cancer Health Center.
Dr. Phillip Katelaris, a urologist in Sydney, Australia, has more than 25 years of experience in urological practice and surgery. Dr. Katelaris is a well-respected professional in the field who has been interviewed on Channel 7, 2GB and 2UE on his expertise and experience in urological practice and men’s health issues.