Prostate cancer and erectile dysfunction
The prostate is a gland that is about the size of a walnut and is located by the urethra. It is responsible for the level of pleasure you feel before and during sex as it is like an epicentre of nerves. When aroused, the prostate helps attract blood to this localised location, facilitating you to gain an erection.
When you have prostate cancer, this gland is nearly always removed in its entirety, thus removing the sensitivity and intensity of sexual intercourse. This often results in a lowered libido and/or a form of sexual dysfunction. This can often be temporary, but it can be treated until you have fully recovered.
It's important to remember that prostate cancer is never the CAUSE of erectile dysfunction, but the treatments you necessarily partake in to cure the disease. This include the following:
- Prostate surgery to partially or completely remove the prostate gland.
- Hormone therapy and radiation therapy - The latter uses either an external beam or radioactive seed implants.
The types of cancer surgery include the following:
- Total pelvic exenteration – This is not only the removal of prostate, but the removal of the bladder, seminal vesicles and rectum. This is usually connected tumours that are large and have affected the urine and solid waste tubes.
- Total mesorectal excision (TME) - This is associated with rectal cancer and is the removal of the rectum that may in turn affect the prostate.
- Abdominoperineal (AP) resection - Surgery associated with colon cancer, it is the removal of the lower colon and rectum.
- Radical prostatectomy - This surgery is the removal of the prostate and seminal vesicles as a result of prostate cancer.
- Radical cystectomy - This is the removal of the prostate as well as the following; bladder, upper urethra and seminal vesicles. This is usually associated with bladder cancer.
How do I know I have impotence due to prostate surgery?
It is not unusual to develop erectile dysfunction after prostate surgery, however, the severity and duration can differ from person-to-person. Some men find the condition disappears by itself once the area has healed after a couple of months.
For many men, having sex after prostate surgery isn't exactly the first thing on their mind. In addition, the doctor will list a number of precautions post-surgery – such as a rest period from sexual activity - so the symptoms will likely not be apparent straight away. This being said, it's best to let your body and mind fully recuperate before considering having sex.
Another circumstance is the ability to gain an erection but not to climax, or no semen is produced. This requires a different selection of treatments and support options that your doctor can run you through.
Whatever the circumstance, if you're ready to have sex again, there are treatments and self-help techniques to help you along the way.
How long is the healing process?
The surgeon and your following check-ups will determine how long the healing process after prostate surgery will be.
Surgery can include a "nerve-sparing technique" and if this has been used, the typical healing process tends to be around 2 years. An overall timeframe is difficult to determine as the cancer, surgery and individual varies massively.
For radiation therapy, the typical timeframe of healing is around 6 months. For hormone therapy, the typical healing time for most men is around 2-4 weeks from the beginning of therapy treatment. Again, this may vary and you can receive further details regarding this from your surgeon and medical support.
Do I need prostate surgery?
For men who are told they have prostate cancer, their immediate reaction may well be to ask about surgical options. We are accustomed to most forms of cancer - breast, testicular or lung for example - being treated in part through physical removal of the tumour where possible. It's true that in the case of prostate cancer, surgery is often possible as even the entire prostate can be removed without a serious risk to life.
Ultimately the decision is yours after an in-depth discussion with doctors and medical professional specialised in that particular area.
Potentially serious side effects
Prostate surgery (prostatectomy) can have side effects that may adversely affect quality of life. These include https://www.healthexpress.co.uk/incontinence urinary incontinence , infertility and erectile dysfunction.
It is for this reason that doctors often advise other treatments instead of surgery for prostate cancer. These can include hormone treatments, chemotherapy, radiotherapy and steroids, all of which can prevent the cancer spreading or even kill the cancerous cells.
If the cancer is not yet causing any symptoms, a doctor may even advise a period of 'watchful waiting' to see how quickly it develops before taking any action. In fact, many who opt for watchful waiting never need any treatment for prostate cancer.
This type of cancer is most common among older men, and can be very slow to develop. This means that the likelihood of dying from other natural causes before the cancer has developed to a late stage is moderate-high.
Looking at the numbers of men who survive for many years after diagnosis, the outlook is fairly positive. More than 80 out of every 100 men will survive for 10 years or more after being diagnosed with prostate cancer.
What you need to know about prostate cancer
A new study carried out in the US looked at the understanding prostate cancer patients have regarding the side effects of surgery. The men involved in the study had come into a clinic because they were experiencing sexual dysfunction following a prostatectomy due to cancer.
Researchers asked the men about the information they had received before the surgery regarding the effect of the procedure on their sexual function and found that they had 'largely unrealistic expectations' about how the surgery would affect their ability to achieve erections and other physical ramifications.
The men, whose average age was 64, had nearly all been able to have sex before the procedure. Just 38% knew whether they'd had the type of surgery that attempts to preserve sexual function, and only 10% of them realised that their penis length might decrease following the procedure. Very few recalled being told that they might experience changes or pain during orgasms.
The researchers didn't record what patients were advised on before the procedure, however, so it is possible that some of the men had been told and forgotten this information.
Can sexual function be restored?
Multiple sources have stated that sexual function should be restored in the months following prostate surgery and that erectile dysfunction shouldn't be a permanent side effect. The NYU Langone Medical Center has claimed that it can take most men up to a year after prostate surgery before they can experience an erection. The timetable for this normally states that sexual function will be restored between 3-12 months after prostate surgery. In rare cases some men may see no improvement up to 2 years after surgery. However, this doesn't mean restoration isn't possible.
"Most men will continue to see erectile-potency improvements up to two years after surgery, so we would expect to see even better outcomes by then" Dr. Jim Hu, director of minimally invasive surgery in the department of urology at the David Geffen School of Medicine at UCLA.
Certain studies have found that sexual function will continue to improve over time post-surgery. A study in the Journal of Urology has found 60% of men were able to successfully perform sex up to 2 years after prostate surgery. This was the case without any of the men needing to take ED medications during this time.
Treatment options for ED caused by prostate surgery
The results concerning the effects of prostate surgery on sexual function doesn't mean to say all men with prostate cancer should avoid surgery, as this can be a good option. But it does suggest that patients should not rush into any decision regarding treatment.
In some cases, depending on how much damage occurs to the nerves during the procedure, erectile dysfunction as a result of prostate surgery can be treated with oral prescription medications such as Viagra or Cialis.
On top of being able to effectively treat erectile dysfunction caused by prostate surgery, there is strong evidence to suggest that Viagra can be used as a part of the treatment process when treating the cancer itself.
The drug Doxorubicin has been used for years as an anti-cancer drug for prostate cancer among other forms of the disease. Although Doxorubicin is effective, it has been associated with irreversible heart damage, which generally occurs several years after treatment stops. Researchers have worked hard to find a medication that protects the heart without limiting the effect of the chemotherapy. Now it seems that the erectile dysfunction treatment Viagra may be the answer.
Experts at Virginia Commonwealth University School of Medicine gave Viagra to rats while simultaneously treating them with Doxorubicin. Not only did the combination of the two drugs reduce tumour size, but it also alleviated damage to the heart.
Lead investigator Dr Rakesh C. Kukreja said: "We believe sildenafil could be an excellent candidate for incorporation into cancer treatment protocols with the potential of enhancing the anti-tumour efficacy, while protecting the heart against both short-term and long-term damage."
The research team are now hoping to proceed to the next stage of the trial - testing the combination of drugs on cancer patients. Their findings so far are published in the latest edition of the journal Proceedings of the National Academy of Sciences.
To find out more about how these treatments work, and whether they are right for you, visit our ED compare treatment information page.
Intracavernous injection therapy
This particular type of therapy is a medicine that is injected into the penis before sexual intercourse. Around 80% of men who use injection will experience erections.
The chemical is injected into the corpora cavernosa and works as a muscle relaxant to help the blood flow increase and move more quickly in the penis to cause an erection.
The thought of injecting such an area is bound to cause anxiety, however the injection is said to have miminal discomfort, especially as you begin to get use to the treatment.
Similar to suppositories for infections such a thrush, a penis suppository comes with a plastic applicator. This is inserted gently into the urinary tube (urethra) with a small tablet containing alprostadil. That helps to loosen vessels and increase blood flow.
Vacuum constriction device
The vacuum constriction device comes in the form of a cylinder that is placed on the penis. Air is then pumped into the device causing blood to circulate the penis more efficiently, causing an erection.
To keep your erection, a band originally attached to the cylinder can be taken off and placed on the base of the penis. This can stay in place for approximately 30 minutes.
This is the last port of call if you have exhausted all of your other options and haven't had erectile dysfunction for a prolonged space of time (typically over a year). A penile implant is a prosthesis that is applied during a surgery procedure.
What else can I do to help?
Medication treatment is a popular option for men with erectile dysfunction. There are many varieties and most are highly tolerable. In addition, you can use self-help techniques to support treatment options, or choose to try these on their own.
- A healthy lifestyle by improving your diet and exercise regularly.
- Limiting and/or cutting out alcohol and drug use. Quit smoking if you do so.
- Mindful techniques to remove your levels of stress and anxiety.
- Getting a good night's sleep.
Will I always have erectile dysfunction?
Nearly all men that have prostate surgery will have temporary erectile dysfunction and this will improve over time. Over half of these men will have improved sexual intercourse within 2 years. During this time, you can try any of the options above.
Advice for your partner
Impotence after prostate surgery can put an understandable strain on your relationship. It is not only the physical act but also the emotional repercussions. The dent in self-confidence can transfer from yourself to your partner.
The leading prostate cancer charity in the UK offers relationship support, including how to move forward from here and improving intimacy.