Prostate Cancer and Erectile Dysfunction

In men, prostate cancer affects the prostate gland that produces seminal fluid, which nourishes sperm. The blood vessels and nerves surrounding the prostate are very sensitive and therefore respond very easily to trauma, including cancer treatments.

Because of this, erectile dysfunction (ED) is the most common side effect of prostate cancer treatment. However, as treatments, especially radiation, become increasingly advanced, these side effects are becoming less common. There are also many promising treatments for erectile dysfunction. For a complete guide on Prostate Cancer, download our eBook.

Erectile dysfunction, also known as ED or impotence, describes the inability to maintain a firm erection through sexual intercourse. ED can stem from difficulty getting an erection, maintaining an erection, or an inactive libido (sex drive). It can also affect your ability to climax or ejaculate.

Erectile dysfunction can be an independent issue, or it can be the symptom of another health problem. If you experience erectile dysfunction prior to your cancer treatment, especially as a result of a disease like diabetes or vascular problems, you will be more likely to experience erectile dysfunction after cancer treatment. Your erectile function after treatment will only be as consistent after treatment as it was before your cancer.

Radiation is one of the preferred methods of treating prostate cancer. Because it is non-invasive and highly precise, radiation spares surrounding tissues better than many other treatments.

However, erectile dysfunction is still the most common side effect of prostate cancer radiation. A patient’s erectile dysfunction following radiation depends on a number of factors, including the amount of time following the treatment and the specific radiation treatment implemented.

• Immediately Following Radiation Treatment: It is rare that patients experience erectile dysfunction immediately following radiation treatment for prostate cancer.
• Long-term Erectile Dysfunction: On average, 70% of patients without ED prior to their treatment will retain that level of erectile function for 5–10 years following treatment. ED does become increasingly common in patients after 15 years.

Compared to other prostate cancer treatments, the chances of erectile dysfunction are typically better with radiation therapy. In the short term, erectile dysfunction typically begins within six months of therapy.

Most patients (70%) who were able to maintain baseline erectile function prior to radiation treatment will return to that baseline function within two to three years. By 15 years after treatment, however, the rates of ED among radiation patients are similar to those who underwent surgery.

In addition to the timeline, another important factor in determining the likelihood of erectile dysfunction is the type of radiation treatment the patient undergoes. As more advanced treatments are developed—such as brachytherapy (radioactive seed implants), intensity-modulated radiotherapy (IMRT), and 3-D conformal radiotherapy—rates of ED decrease.

For example, only 25 to 50% of men who undergo brachytherapy experience long-term erectile dysfunction. Those who undergo traditional external beam radiation, on the other hand, experience ED at a rate of some 50%.

The experience of the radiation oncologist can also influence the likelihood of long-term erectile dysfunction in patients. More experienced radiation oncologists are able to deliver more precise radiation and spare surrounding tissues, protecting delicate blood vessels and nerves and preserving erectile function.

Erectile dysfunction is the most common side effect of any prostate cancer treatment. Whether or not you develop erectile dysfunction following treatment is largely the product of the treatment you choose, the doctor who performs your treatment, and their experience. That’s why it’s important to carefully research and decide treatments and oncologists before proceeding with any treatment option.

• Immediately Following Treatment: Most patients experience some degree of ED immediately following a surgery to remove the prostate.
• Long-term Erectile Dysfunction: Studies show that 50% of men who experience no erectile dysfunction prior to their prostate cancer treatment return to normal erectile function within one to two years of treatment.

For several decades, oncologists have preferred “nerve-sparing” prostatectomies for prostate cancer surgeries. As the name suggests, these procedures spare the nerves surrounding the prostate during surgery.

While the trauma of the surgery itself may cause temporary ED, many patients recover their erectile function as healing occurs. Studies show that 40 to 50% of men recover within one year, and 30 to 60% recover within two years.

The more the cancer has spread, the fewer nerves can be spared, and the more likely erectile dysfunction is long-term. Other factors, including pre-existing conditions like diabetes and obesity, may also increase the likelihood of long-term ED.

• Immediately Following Treatment: Most patients do not experience erectile dysfunction immediately following the beginning of hormone therapy.
• Long-term Erectile Dysfunction: ED, particularly a reduction in libido, often occurs within two to four weeks of therapy.

Doctors are still studying the effects of hormone therapy on erectile dysfunction, and there is not yet enough data to come to firm conclusions. However, most patients do experience a reduction in sex drive following hormone therapy.

Hormone therapy affects the hormones of the patient, which may affect their erectile function and especially their sex drive. These drugs are designed to reduce testosterone, which has a positive effect in treating cancer, but a negative effect on ED. Without treatment, ED from hormone therapy can be permanent.

Even the most skilled practitioner or advanced treatment does not guarantee a patient will return to their pre-treatment erectile function. In this case, there are increasingly effective treatments available for treating ED.

Medications like Viagra, Cialis, and Levitra are effective at treating erectile dysfunction in prostate cancer patients. These drugs relax the muscles of the penis, allowing blood in and achieving an erection within one hour.

Some 75% of patients who underwent nerve-sparing surgery or precise radiation therapies experienced successful erections following the use of oral medication.

Injectable medications are an alternative for those who do not experience success with oral medications. These medications are injected into the penis prior to intercourse.

80% of men reported successful erections using injectable medications.

Using a vacuum constriction device, blood is pulled into the penis. A band is then used to hold the blood in the penis and maintain an erection for 30 minutes.

Some 80% of users found this successful, but those who underwent surgery often found the band uncomfortable.

For those who continue to experience ED for over a year following prostate cancer treatment, a surgical implant may be an option. During surgery, a tube is inserted into the penis, which can be filled with fluid from a balloon attached to the abdominal wall when desired.

When successfully inserted, a penile implant is 100% effective.

The potential of erectile dysfunction is only one of many factors you’ll likely consider when deciding on a prostate cancer treatment. The cancer care teams at SERO are here to help.

Our 30+ board-certified radiation oncologists have combined decades of experience in treating prostate and other cancers. Our expertise allows us to identify the best treatment for your cancer and apply it with precision, our compassionate care teams will help you navigate any side effects and symptoms that may arise.