Dr.
Tom F. Lue is internationally recognized as an expert in the field of managing
impotence. Prostate 8 investigators have complied his expertise on this topic…
What are the main causes of impotence/erectile dysfunction (ED)?
There are many potential causes of
impotence, which fall within the following categories: psychological,
neurogenic, hormonal, vascular, or drug-related.
Here
are some examples:
·
Psychological conditions: depression, stress,
and anxiety
·
Injuries or illnesses that affect the nervous
system: Parkinson’s, Alzheimer’s, stroke, head injury, diabetes, and spinal
cord injuries
·
Pelvic surgery (such as radical prostatectomy)
that may injure the cavernous nerves that control erection
·
Diseases and conditions that decrease
circulating testosterone in the body: castration or hormonal therapy used to
treat prostate cancer can decrease libido and impair erections
·
Diseases such as high blood pressure, high
triglyceride and cholesterol levels, and diabetes mellitus may damage blood
vessels and limit the ability to have an erection
·
Smoking, alcohol abuse, and some prescription
drugs
What
happens to sexual function after prostate cancer treatment?
The nerves involved in an erection lie
within millimeters behind and on the side of the prostatic capsule. Because of
their proximity to the prostate, these nerves may be injured during the radical
prostatectomy procedure. This may cause temporary or permanent impotence,
although sexual desire and the ability to achieve orgasm should remain.
Radiation to the prostate can also damage these nerves.
Can
men expect a return of sexual function after surgery or radiation treatment?
The
amount of “nerve-sparing” during a prostatectomy procedure influences the
likelihood of impotency after treatment. If both nerve bundles are spared,
50-90% of patients -- depending on age and health -- return to unassisted
erectile function over time. When only one nerve bundle is spared, the
percentage of patients that return to unassisted erectile function over time is
25-50%. If a non-nerve sparing technique is used, 16% or less of patients will
regain full erectile function. Even for men who do recover, return to unassisted
sexual function may take six months or more after surgery, and generally
continues to improve over two to three years.
For
men undergoing radiation the amount and extent of radiation as well as whether
or not
they
are treated with hormone therapy impacts the likelihood of impotence after
treatment.
In
patients who had external radiation therapy, ED may occur slowly over months or
years. On the other hand, ED after radical prostate surgery occurs
within weeks or months but may gradually recover if both nerve bundles are
saved.
For
men treated with external beam radiation for prostate cancer, 4 to 7 out of
every 10 men (40 to 70%) will no longer be able to get or keep an erection.
Hormone therapy before or after radiotherapy further increases the risk of
erection problems.
For
men treated with low dose brachytherapy, research studies show that in men who
could have erections before treatment, 15 to 40 out of 100 (15 to 40%) have
erection problems after treatment. As with radical prostatectomy, your age is a
factor - if you are under 65 when you are treated, impotence is less likely
than if you are over 70.
For
combined high dose rate brachytherapy and external beam radiotherapy, the
statistics on erection problems vary a great deal because the definitions of
impotence vary in these studies. Studies report that between 14 and 45 men in
every 100 treated (14 to 45%) have some degree of problem, while in older men,
up to 76 out of every 100 (76%) had erection problems 7 years after treatment.
These radiation statistics are taken
from Cancer Research UK:http://www.cancerresearchuk.org/about-cancer/type/prostate-cancer/treatment/radiotherapy/side-effects-of-prostate-cancer-radiotherapy
Can
men overcome impotence? What treatments are available?
Yes, in many cases, impotence can be
overcome. Common methods include the following:
Oral Medications: Sildenafil
(Viagra), Vardenafil (Levitra), and Tadalafil (Cialis).
Urethral Suppository – MUSE: Prostaglandin E1 (Alprostadil)
placed inside the penile urethra and medicated urethral system for erection (MUSE)
has been used when oral medications have been unsuccessful. The major advantage
of MUSE therapy is that it is applied locally and has few side effects. The
major drawbacks are that it may cause moderate penile pain and does not work
for everyone.
Penile Injection: When oral medication fails, penile
injections to induce erection are another alternative to treat impotence. Refer
to the document "Successful Self Penile Injection" found here: http://urology.ucsf.edu/patient-care/cancer/prostate-cancer
Vacuum Erection Device: These devices consist of a
plastic cylinder connected to a pump and a constriction ring. A vacuum pump
uses either manual or battery power to create suction around the penis and
bring blood into it; a constriction device is then released around the base of
the penis to keep blood in the penis and maintain the erection.
Penile prosthesis: For men with erectile dysfunction
who have failed or cannot tolerate other treatments, a penile prosthesis offers
an effective, but more invasive alternative. Prostheses come in either a
semi-rigid form or as an inflatable device. Most men prefer the placement of
the inflatable penile prosthesis.
Is
there any new ED-focused research happening at UCSF?
At
UCSF, researchers are studying the potential of using endogenous (one’s own)
stem cells to protect nerves and facilitate the recovery of erectile function
after radical prostatectomy. Clinic trials are expected in 1-2 years.
More info on the topic can be found at http://urology.ucsf.edu/patient-care/cancer/prostate-cancer
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