Prostate Cancer – the Most Risky Treatments
It’s a topic that has made it into the story lines of 30 Rock and Boston Legal, but it’s still a “touchy” subject men are reluctant to talk about, and that’s the risk of temporary or permanent impotence from a radical prostatectomy operation.
Temporary or permanent impotence can affect up to 70 per cent of men with prostate cancer, and few high profile men – Rudy Guiliani in the US, and broadcaster Paul Holmes in New Zealand – are willing to publicly acknowledge the issue, even when they talk about prostate cancer.
Whether a man retains good sexual function very much depends on a range of factors, including the size and aggressiveness of the tumour, the patient’s age, lifestyle, and overall health, and the treatment option chosen.
It’s impossible for a doctor to predict ahead of treatment what the outcome for an individual is likely to be.
But here is a rundown on the prostate cancer treatment options and the risk factors involved:
Surgery (Radical Prostatectomy)
The first US nationally representative study to evaluate long-term outcomes after radical prostatectomy concluded that impotence occurs far more frequently than previously reported.
Those who have so-called nerve-sparing surgeries have better results than those whose surgeries affect the nerves around the prostate. Some evidence also suggests that sexual function rates might improve if the nerve-sparing prostate surgeries also spare the ducts that carry semen.
It is important to remember that regaining erectile function takes time after radical robotic prostatectomy. Most studies in the literature use endpoints of 18-36 months after prostate cancer surgery.
Nerve tissue can be easily damaged during radical prostatectomy, regardless of the skill of the surgeon, and takes a long time to regenerate. It is believed that early postoperative medical therapy can aid an earlier return to potency.
Prostate Surgery – How Long Before Sexual Function Returns?
Some degree of impotence occurs right after surgery to remove the prostate, regardless of whether the technique that tries to spare the nerve that controls erections is performed or not.
- If the nerve-sparing technique is used, recovery from impotence may occur within the first year following the procedure. Recovery of erectile function after a non-nerve-sparing surgery is unlikely, but possible.
- One study taken one year after surgery shows impotence rates of:
- 66% for nerve-sparing prostatectomy
- versus 75% for non-nerve sparing surgery
- The use of vacuum devices or drugs such as Viagra after surgery once the body has healed may improve the quality of erections and speed the return of normal sexual function.
- Some studies suggest that impotence after prostate surgery may in part be due to injury to the smooth muscles in the blood vessels.
- Early treatments to maintain penile bloodflow, particularly alprostadil injections, may helpful in restoring erectile function.
- In one study, men administered injections every other night for six months. They then started taking sildenafil (Viagra) three months after surgery. At six months, 82% of these men achieved penetration compared to only 52% of men who took Viagra only. The vacuum pump may serve a similar purpose as the injections.
Radiation Treatment for Prostate Cancer
Loss of erectile function is the most common long-term complication of radiation therapy.
- The onset of impotence following radiation therapy is gradual and usually begins about six months following the treatment.
- Although it is generally believed that radiation poses a lower risk for impotence than does surgery, studies have reported similar rates after three years. Experts suggest radiation injures the blood vessels and so leads to impotence over time.
- Some studies report a lower risk for impotence from brachytherapy, a radiation technique that involves the implantation of radioactive seeds compared to external-beam radiation.
- Still, there have been very few studies that have lasted more than two years. One five-year study reported a high long-term rate of impotence (53%) with brachytherapy, which is close to that of standard externally administered radiation.
- Early use of alprostadil injections and Viagra may help these men as well as those who had surgery.
Drug Treatments for Prostate Cancer
Prostate cancer medical treatments commonly employ androgen-suppressive treatments, (lowering testosterone) which cause impotence.
- When hormone therapy is used, impotence may occur approximately two to four weeks after the start of therapy. A decreased desire for sex also occurs.
Prostate Cancer Follow Up – Use it Or Lose It
Increasingly doctors are recommending therapy to increase bloodflow to the penis after treatment, because it is now considered cells benefit from a regular oxygen supply. In the US doctors are now recommending maintaining a regular bloodflow to the penis in the weeks following surgery.
Known as erectile rehabilitation, it is based on the premise of preventing tissue damage and encouraging normal sexual function sooner.
Whether your doctor has recommended radical prostatectomy or an alternative prostate cancer treatment, impotence need not be a permanent side effect.