If you have been diagnosed with prostate cancer and are considering treatment options, please contact Dr Love to discuss the possible side effects and how these can be minimized.
Penile Rehabilitation helps to fix any sexual dysfunction, especially Erectile Dysfunction, that many men experience as a result of cancer treatments.
It is an important part of the care of men with prostate cancer and should be discussed even before cancer treatment occurs.
There is evidence that the earlier the erectile dysfunction is treated, the better the chance of a return of erections. This is because the lack of erections for a prolonged period of time causes permanent changes to occur in the structure of the penis, so that it may not be ever able to respond with a normal erection.
If natural erectile function returns after treatment, the quality of the erections may not be as good as in the past. Erections may take up to 3 years to recover to their maximum after surgery, but usually a good indication of the outcome is seen at 6 – 12 months, and if nothing in the way of “normal” erection is happening by then, usually nothing will.
The main treatments for prostate cancer are surgery – in the form of radical prostatectomy (open, laparoscopic, robotic), radiotherapy, or brachytherapy. Unfortunately, all these treatments can cause sexual dysfunction including Erectile Dysfunction, loss of ejaculation, shortened penis and the possibility of passing of urine during orgasm. Loss of libido can also occur when hormone therapy is used to treat prostate cancer.
How well the sexual function recovers after treatment for prostate cancer depends on the age of the patient, the level of sexual function present before treatment and, in the case of surgery, the sparing of the nerve bundles (better outcome if both sides are spared).
The other, and possibly the most important factor however, is to keep the penis “healthy” after cancer treatment to maximise the chance of return of erections, the so-called “use it or lose it” approach, or penile rehabilitation.
Surgery tends to result in immediate loss of erections that then hopefully will improve over time, whereas the other treatments such as radiotherapy may result in a delayed loss of erections, up to 6 months or more after treatment.
Unfortunately the chance of return of erections, even with these measures, is often less than the patient themselves, and their doctors, would like. Discussion towards moving on to erectile restoration with a penile implant should start during the first 6 -12 months if there is no sign of erectile activity.
The oral treatments for erection problems are known as PDE5 inhibitors, of which there are 4 available in Australia at present (Viagra, Levitra, Cialis and Spedra). The tablets are swallowed about 1 hour before planned sexual activity when being used on an ‘as required’ basis to improve a man’s erection.
However, during the first few months after surgery, these oral tablets may not have as successful an effect as penile injections, but some men may prefer tablets to injections at the early stage of recovery.
Men who may not be ready to engage in sexual intercourse in the first few months after surgery may use the tablets which could result in a softer erection not firm enough for penetration, but sexual play is encouraged as part of the “exercise” concept. An orgasm is entirely possible with a soft erection or indeed with no erection when adequate stimulation to the penis occurs.
However, there is some evidence that just by taking PDE5 inhibitors, even without an erection occurring, there may be benefit in prevention of deterioration of the erection tissues.
So, the concept has developed of use of the oral tablets as a regular dose to optimise the return of erections and to keep the erection tissues healthy during the period of absent erections.
It has been proposed that these tablets be taken at lower doses than normally used to help an erection prior to surgery, but on a daily or second daily basis. The common side effects include flushing of the face, headache and blocked nose.
PDE5 inhibitors cannot be taken by men who are on cardiac medication known as nitrates.
Erections can be induced within 2 to 3 weeks of surgery with penile injection therapy using prostaglandin E1 (PGE1) or Trimix. The penis is injected with a small dose of medication, once or twice a week, whether sexual activity occurs or not. The early and regular “exercising” of the penis to erection has been shown to help the return of erections (but only when the nerves have been saved).
Penile injection treatment has been safely used for many years but sometimes its use is painful due to a “chemical” pain. Care must be taken with the amount injected to avoid a prolonged erection and there is a risk of scarring occurring in the penile tissues.
This “exercising” regime allows fresh blood and oxygen to enter the erection tissues thus minimising the risk of deterioration of these tissues due to lack of use, and low oxygen (hypoxia) levels. If there appears to be an improvement in natural erections whilst on PGE1 therapy, then it can be continued in addition to oral therapies as part of penile rehabilitation.
Other treatment choices are use of a vacuum erection device which is a non-invasive method involving placement of a cylinder over the penis. Suction is applied by a pump that results in engorgement of the penis and the formation of an erection that is held in place by a rubber constriction ring. This may reduce the shortening that occurs after radical prostatectomy.
Dr Love is Australia’s foremost prosthetic urological surgeon and is the most experienced penile implant surgeon in Australia.
Men who want to continue having normal penetrative sex, with a guaranteed, firm, and long-lasting erection should consider erectile restoration surgery.
The surgical insertion of a penile prosthesis should be considered when it is apparent that there will be no return of natural erections. It may be possible to tell this as early as 6 months after the prostate surgery.
This device allows an erection suitable for penetrative intercourse to occur with the simple activation of a pump discreetly placed in the scrotum and is an excellent way for men to return to normal sexual function after prostate cancer surgery without waiting for years to see if natural improvement occurs.
The best results for this penile implant surgery are within the first 12 or so months from radical prostate surgery. This is to ensure action is taken before there is irreversible penile shortening and to minimize any psychological effects such as depression and loss of self-esteem as a result of the erectile dysfunction.
Dr Love and his team understand that you may be feeling nervous, anxious or embarrassed about your symptoms or condition. We want you to know that you deserve to get the treatment you need and that you can go on to live a fulfilling and satisfying life. It’s never too late.
You can call our expert team confidentially and ask any questions you may have about your symptoms, condition, treatment options and the best way forward. No obligation.
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