Treating Erectile Dysfunction after Prostate Cancer
September marks the start of the Fall season and is also prostate cancer awareness month. Prostate cancer is quite common in men; In fact, it is the most common gender-specific cancer for men.1 Thankfully today, with over half of prostate cancers that are diagnosed, we can monitor them or watch them with what is called active surveillance.
However, a meaningful number of men continue to present with significant prostate cancer that requires definitive treatment. These treatments can include surgical removal of the prostate or radiation therapy in various forms to eradicate the prostate cancer.1 While these treatments are effective at treating or eliminating the prostate cancer, they do have side effects.
It is important to remember that for normal erectile function, there are nerves that connect stimulatory pathways in our brain to the penis. When these neural pathways are stimulated, blood flow can then be released into the penis to initiate the erection process.2 When surgery or radiation therapy is performed to treat prostate cancer, some men will have significant damage or irritation to these nerves.1 If normal stimulatory signals to enhance blood flow for the normal erectile process do not take place, then these men will develop erectile dysfunction. Obviously, it is important to treat the prostate cancer and ensure that it is under control. But for men who suffer from erectile dysfunction after treatment for their prostate cancer, there is hope. I often tell patients there are many options that can be tailored to their needs. For some of these men, they retain a partial ability to stimulate the natural erectile process. Simple solutions, such as oral therapies, with or without testosterone treatment if indicated, can be very effective.
However, for some of these patients with erectile dysfunction after prostate cancer therapy, their penile blood flow to have a natural erection is significantly limited.3 Just like any other patient experiencing erectile dysfunction, there are several treatment options available: vacuum erection devices, urethral suppositories, vasodilating medications directly injected into the penis, or penile implants.
Personally, I get excited about penile implants as a treatment option, and I have another blog post that goes more in-depth about the implants here. Patients report high satisfaction rates from a penile implant, as do their partners.4 In my opinion, penile implants provide a solution to treat erectile dysfunction after prostate cancer because many of these men do have significant nerve damage and blood flow limitations from the cancer treatment process.1 The penile implant restores the patient’s ability to have an erection, relationships, and emotional confidence.5,6 Some men are worried that they might not be a candidate for a penile implant procedure because they've had surgery for prostate cancer or radiation. This is NOT always the case for these men. These men can still expect a straightforward outpatient procedure, meaning come in, go home the same day, and return to normal routine daily activities within one to two weeks. Of course, there are always possible risks to procedures, but the risks for penile implants and men with prostate cancer therapy are the same as for men who have not had prostate cancer treatment.5 There is a possibility of mechanical malfunction of the implant, and over a prolonged period, usually 10 years, these implants can stop functioning.5 There is also a risk of infection, as there is with any device implanted in the human body.5 But for men I see in my clinic, the ability to achieve complete control over erectile function as an individual and as a partner in a relationship with spontaneity and satisfaction for both the patient and their partner, the penile implant is an option.
To learn more about the connection between erectile dysfunction and prostate cancer treatment visit EDCure.org/understanding-ed/prostate-cancer or visit my website TheMensMD.com, to make an appointment.
References
- American Cancer Society. Prostate Cancer. 2014. http://www.cancer.org/cancer/prostatecancer/index. Accessed November 3, 2015.
- Dean RC, Lue TF. Physiology of penile erection and pathophysiology of erectile dysfunction. Urol Clin North Am. 2005 Nov;32(4):379-95.
- Haglind E, Carlsson S, Stranne J, et al. Urinary incontinence and erectile dysfunction after robotic versus open radical prostatectomy: a prospective controlled nonrandomized trial. Eur Urol. 2015 Aug;68(2):216-25
- Bernal RM, Henry GD. Contemporary patient satisfaction rates for three-piece inflatable penile prostheses. Adv Urol. 2012;2012:707321.
- Data on file with Boston Scientific.
- Otero JR, Cruz CR, Gómez BG, et al. Comparison of the patient and partner satisfaction with 700CX and Titan penile prostheses. Asian J Androl. 2017 May-Jun;19(3):321-5.
EDCure.org is a website sponsored by Boston Scientific.
Caution: U.S. Federal law restricts this device to sale by or on the order of a physician.
Your doctor is your best source for information on the risks and benefits of the AMS 700™ Inflatable Penile Prosthesis. Talk to your doctor for a complete listing of risks, warnings and important safety information.
The AMS 700™ with Inflatable Penile Prosthesis is intended for use in the treatment of male erectile dysfunction (impotence). Implanting a penile prosthesis will damage or destroy any remaining ability to have a natural erection, as well as make other treatment options (oral medications, vacuum devices or injections) impossible.
Men with diabetes, spinal cord injuries or skin infections may have an increased risk of infection. Implantation may result in penile curvature or scarring. Some AMS 700 devices contain an antibiotic (InhibiZone™ Antibiotic Surface Treatment). The device is not suitable for patients who are allergic to the antibiotics contained within the device (rifampin, minocycline or other tetracyclines) or those who have systemic lupus, these patients should use one of the devices that do not contain InhibiZone antibiotic surface treatment.
Potential risks may include: device malfunction/failure leading to additional surgery, device migration potentially leading to exposure through the tissue, wearing away/loss of tissue (device/tissue erosion) infection, unintended-inflation of the device and pain/soreness. MH-545411-AB
J. Abram McBride, MD is a paid consultant of Boston Scientific.
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