Prostate cancer is increasingly common. As of 2021, it was the fifth-most common cancer among adult men in Korea, and its incidence is on the rise in many other countries as well. Experts believe this is partly due to changes in dietary habits (namely, the adoption of Westernized diets) and more advanced tools for detecting the disease.
Erectile dysfunction (ED) is the inability to achieve and maintain an erection firm enough for satisfying sexual intercourse at least 25% of the time. In other words, it’s more than just an occasional problem. ED can cause a lot of distress and strain relationships.
If you’re facing prostate cancer, you should know that treatments for the disease can significantly impact your sexual function. One of the potential side effects of prostate cancer treatment is erectile dysfunction. Other potential side effects are changes in ejaculation and sensation.
If you’re wondering whether prostate cancer can cause erectile dysfunction, the answer is yes, but more often, the treatments for prostate cancer are responsible. In this article, we’ll look at how different prostate cancer treatments can affect erectile function and what you can do to manage ED after prostate cancer treatment.
Understanding the Prostate and Erectile Function
To understand how prostate cancer can cause erectile dysfunction (ED), it helps to understand the prostate gland itself and how erections work.
Anatomy and Function of the Prostate
The prostate is a small gland located just below the bladder and in front of the rectum. It surrounds the urethra, the tube that carries urine from the bladder out of the body. In a healthy adult male, the prostate weighs about 20 grams – roughly the size of a walnut.
The prostate’s main job is to produce fluid that makes up part of semen. This prostatic fluid accounts for about 20-30% of the total volume of semen. It contains enzymes and other substances that help protect and nourish sperm.
The Physiology of Erection
An erection is basically a plumbing function. It involves blood flow into the penis. When a man is sexually stimulated, nerves in the penis release nitric oxide.
Nitric oxide triggers a chain reaction that leads to the production of something called cyclic guanosine monophosphate, or cGMP. cGMP causes the smooth muscles in the penis to relax, which allows the arteries to widen. This vasodilation increases blood flow into the penis, filling the spongy tissues called the corpora cavernosa and corpus spongiosum. As these tissues fill with blood, the penis becomes firm and erect.
Prostate Cancer Treatments and Their Impact on Erectile Function
Prostate cancer treatments can have a significant impact on erectile function. It’s important to understand these potential side effects when discussing treatment options with your doctor. Here’s a breakdown of common treatments and how they can affect your ability to achieve and maintain an erection:
Radical Prostatectomy
A radical prostatectomy is a surgical procedure that involves the complete removal of the prostate gland. It’s often recommended for men with localized prostate cancer. The goal is to eliminate the cancerous tissue, but unfortunately, this procedure can sometimes lead to erectile dysfunction.
One of the major reasons for ED after a radical prostatectomy is nerve damage. The nerves responsible for erections run very close to the prostate gland. While surgeons take great care to preserve these nerves, injury can still occur during the procedure. This injury can disrupt the signals that allow blood to flow into the penis, resulting in difficulty achieving an erection. Luckily, surgical techniques have improved over the years, and “nerve-sparing” surgery is now a common approach to minimize this risk.
It’s important to remember that the incidence of ED after a radical prostatectomy varies. Study results show that anywhere from 10% to 100% of men experience some degree of erectile dysfunction following the surgery. This wide range is due to factors like the extent of the cancer, the surgeon’s skill, the patient’s age, and overall health.
Radiation Therapy
Radiation therapy is another common treatment option for prostate cancer. There are different types of radiation therapy, including external beam radiation and brachytherapy (internal radiation).
Radiation therapy can cause ED, although the exact mechanism isn’t fully understood. Radiation can damage the blood vessels and tissues in the penis, which can impair blood flow and lead to erectile dysfunction. It can also damage the nerves responsible for erections.
Studies show that about 50% of men maintain their erectile function after radiation therapy. However, this number can vary depending on the type of radiation used. For example, studies indicate that 25-50% of men undergoing brachytherapy experience ED, compared to nearly 50% who receive standard external beam radiation. Brachytherapy may have a slightly lower risk of ED because the radiation is delivered directly to the prostate, potentially sparing surrounding tissues.
Hormonal Therapy (Androgen Deprivation Therapy)
Hormonal therapy, also known as androgen-deprivation therapy (ADT), is often used to treat prostate cancer that has spread beyond the prostate gland or has a high risk of recurrence. The purpose of hormonal therapy is to lower the levels of male hormones (androgens), such as testosterone, in the body. Prostate cancer cells need these hormones to grow, so reducing their levels can slow the growth of the cancer.
Unfortunately, hormonal therapy frequently causes sexual dysfunction, including erectile dysfunction and decreased libido (sexual desire). Lowering testosterone levels can directly affect the ability to achieve and maintain an erection. It can also reduce sexual interest and overall sexual satisfaction.
Other Treatments (Cryosurgery, HIFU)
Besides surgery and radiation, other treatments for prostate cancer include cryosurgery and HIFU (High-Intensity Focused Ultrasound).
Cryosurgery involves freezing the prostate gland to destroy the cancer cells. HIFU uses focused ultrasound waves to generate heat and destroy prostate tissue. Limited data suggests that cryosurgery may have a lower rate of sexual dysfunction compared to other treatments, but more research is needed to confirm these findings. HIFU may also have fewer immediate issues regarding sexual function, but long-term studies are still ongoing.
Diagnosing Erectile Dysfunction After Prostate Cancer Treatment
If you’re experiencing erectile dysfunction after prostate cancer treatment, the first step is a thorough medical history and physical exam. Don’t be shy; your doctor needs to understand what’s happening to help you.
You should be prepared to answer specific questions about your symptoms, including how often you experience ED and when it occurs. For example, does it happen every time you attempt intercourse, or only sometimes? Is it worse at certain times of the day?
In some cases, your doctor may recommend nocturnal penile tumescence (NPT) testing. This involves monitoring erections during sleep. It’s a way to determine if the ED is physical or psychological in nature. Don’t worry, it’s not as invasive as it sounds! The results of these tests, combined with your medical history, will help your doctor determine the best course of treatment.
Treatment Options for Erectile Dysfunction Post-Prostate Cancer Treatment
So, you’ve gone through prostate cancer treatment, and now you’re dealing with erectile dysfunction (ED). It’s a common side effect, and thankfully, there are several treatment options available. Let’s break them down:
PDE5 Inhibitors (Viagra, Cialis, Levitra)
These are often the first line of defense. PDE5 inhibitors work by blocking an enzyme called phosphodiesterase 5, which normally breaks down a substance called cGMP. cGMP helps relax the muscles in the penis, allowing blood to flow in and create an erection. So, by blocking the enzyme that breaks it down, you get more cGMP and better blood flow.
If you’ve had nerve-sparing prostatectomy or more precise radiation therapy, there’s a good chance these drugs will work for you. Studies show that around 75% of men in these situations can achieve erections with PDE5 inhibitors.
Of course, there are potential side effects. The most common is a headache, affecting about 16% of users. Other side effects can include flushing, nasal congestion, and visual disturbances. Also, keep in mind that sexual stimulation is still needed for these medications to work their magic.
Intracavernosal Injections (Alprostadil)
This option involves injecting medication directly into the penis. Yes, it sounds a bit intimidating, but it can be effective. The medication, usually alprostadil, relaxes the blood vessels in the penis, allowing blood to flow in and create an erection. You’ll usually get an erection within about 15 minutes, and it can last for 30 to 40 minutes.
Side effects can occur, affecting about 10% of men. These can include pain, bruising, or difficulty ejaculating. It’s definitely something to discuss with your doctor.
MUSE (Medicated Urethral System for Erection)
MUSE is a less invasive alternative to injections. It involves inserting a small pellet containing alprostadil into the urethra. The medication is absorbed into the surrounding tissues, causing the blood vessels to relax and allowing for an erection. You’ll typically see results in about 10 minutes, with erections lasting up to 60 minutes.
Like injections, MUSE can have side effects. Around 10% of users report mild pain during application, and about 3% experience dizziness and low blood pressure.
Vacuum Constriction Devices (VCDs)
VCDs are non-invasive and involve placing a plastic cylinder over the penis and using a pump to create a vacuum. This vacuum draws blood into the penis, creating an erection. A constriction ring is then placed at the base of the penis to maintain the erection.
VCDs can be quite effective, with about 80% of men finding them successful. However, potential side effects include bruising, pain, and numbness.
Penile Implants (Prostheses)
For men who haven’t had success with other treatments, penile implants are a surgical option. There are two main types: inflatable and malleable. Inflatable implants consist of inflatable cylinders that are surgically placed in the penis, along with a pump and reservoir implanted in the scrotum. Malleable implants are bendable rods that are surgically placed in the penis, allowing the man to manually position the penis for intercourse.
Penile implants have a high success rate, often approaching 100%. However, they are a surgical procedure, so there are potential complications, such as infection, mechanical failure, and erosion. Studies show that about 70% of men are still satisfied with their penile implants after 10 years, assuming they’re still working correctly. About 5% of men may need a second operation to replace the implant.
Other Therapies
Besides the above, and more common treatments, there are a few other options worth mentioning, including exploring whether to use red light therapy for ED. Combination therapy, which involves using multiple treatments together, can sometimes be effective. Testosterone replacement therapy is also gaining attention, especially for men with low testosterone levels. Vascular surgery, which aims to improve blood flow to the penis, is another possibility, although it’s less commonly performed.
The Importance of Penile Rehabilitation
Penile rehabilitation is a strategy that combines different treatments to improve sexual function after prostate cancer treatment. The goal is to restore or maintain erectile function as much as possible.
Ideally, sexual rehabilitation should start before, or soon after, you begin prostate cancer treatment. Early intervention gives you the best chance of maintaining function and minimizing the impact of treatment on your sex life.
It’s worth noting that penile rehabilitation isn’t just for those who are currently sexually active. Maintaining healthy blood flow and tissue health in the penis is important regardless of your current sexual activity. Think of it as physical therapy for a vital part of your body. It can help preserve function and potentially make future sexual activity more satisfying.
Psychological and Relationship Aspects of ED After Prostate Cancer
Erectile dysfunction after prostate cancer treatment isn’t just a physical problem; it can take a real emotional toll on men and their partners. Dealing with erection issues and a lower sex drive can strain relationships and impact mental well-being. Sex becomes difficult, and that intimacy that couples once enjoyed might feel like a distant memory.
That’s why open communication with your partner is so crucial. Talking honestly about your feelings, fears, and needs can help you both navigate this challenging time. It’s important to acknowledge that this is a shared experience, and working together is key.
Don’t hesitate to consider counseling or sex therapy. These resources can provide valuable emotional support, help you address relationship issues, and offer strategies for coping with ED. Remember, you’re not alone, and seeking help is a sign of strength.
Lifestyle Factors and ED
Regardless of the cause, healthy lifestyle changes can improve both ED and overall health. It’s almost always worth examining your habits to see if you can improve your sexual health.
Some key lifestyle changes to consider:
- Exercise: Regular physical activity improves blood flow and cardiovascular health, which are essential for erections.
- Weight Management: Obesity can contribute to ED, so maintaining a healthy weight is important.
- Smoking Cessation: Smoking damages blood vessels and can worsen ED. Quitting smoking can significantly improve sexual function.
- Alcohol Reduction: Excessive alcohol consumption can impair sexual performance. Moderation is key.
Also, some studies show that pelvic floor exercises can help improve erection problems.
Frequently Asked Questions
Can I have cancer and feel fine?
Yes, it’s possible to have cancer, including prostate cancer, and feel perfectly fine, especially in the early stages. Many cancers are asymptomatic initially, meaning they don’t cause noticeable symptoms. This is why regular screenings are crucial for early detection.
How long can you live with untreatable prostate cancer?
The prognosis for untreatable prostate cancer varies greatly depending on the stage, aggressiveness, and individual health factors. Some men may live for several years, while others may have a shorter life expectancy. Palliative care can help manage symptoms and improve quality of life.
What kills prostate cancer cells naturally?
While no natural substance definitively “kills” prostate cancer cells, some research suggests that certain compounds, like lycopene found in tomatoes and selenium, may have anti-cancer properties. However, these should be considered complementary approaches and not replacements for conventional medical treatment.
Can you have stage 4 prostate cancer and not know it?
It is less common to have stage 4 prostate cancer and not know it, but it’s possible. Stage 4 often involves metastasis (spread to other parts of the body), which can eventually cause symptoms like bone pain, fatigue, or weight loss. However, some men may experience subtle or easily dismissed symptoms initially.
What is the best thing to drink for your prostate?
Staying hydrated is generally good for prostate health. Water is always a great choice. Some studies suggest that green tea, due to its antioxidant properties, may also be beneficial. However, it’s essential to maintain a balanced diet and consult with a healthcare professional for personalized recommendations.
In Conclusion
Erectile dysfunction is a common side effect of prostate cancer treatment. In fact, many people who undergo treatment for prostate cancer experience ED to some degree.
But there are ways to address ED and get your sex life back on track. Treatments range from medications like PDE5 inhibitors to injections, vacuum devices, combination therapies, and even penile implants.
The important thing is to talk with your doctor about the options that are right for you. Your doctor can help you create a treatment plan that addresses your specific needs and concerns.
Remember that managing sexual side effects involves more than just medical treatments; finding the right doctors for men’s problems is also essential. It’s also important to get emotional support and make healthy lifestyle choices. A holistic approach can make a big difference in your overall well-being.
Recovery is possible for many people, and with the right support and treatment, you can improve your quality of life and enjoy a fulfilling sex life again.