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Restore and Maintain Erectile Performance: Key 4, Seven Keys to Treating Prostate Cancer

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Johns Hopkins Health Alerts | Prostate Disorders | Restore and Maintain Erectile Performance: Key 4

Key Four: Restore and Maintain Erectile Performance

If erectile dysfunction (ED) is something you worry about or have already experienced, whether it is occasional or more frequent, help is now available. Remember: ED has a profound affect on the lives of the people it touches.

Countless marriages and long-term relationships have been broken by it; people who otherwise cared deeply for each other felt separation was a better solution; and innumerable others continued to live together sexually unfulfilled.

Sex is, of course, not the only component of a strong and lasting relationship, but it is an important one. Moreover, if ED is a problem, the variety of therapies now available will not only treat it, they will help you renew your bond with the person you care most about.

Sexual Side Effects of Prostate Cancer Surgery
Advances in early detection of prostate cancer and improved surgical procedures have greatly improved survival rates. However, removal of the prostate can also affect the ability to have an erection suitable for intercourse even when a talented surgeon performs the procedure.

Prior to the introduction in the 1980s of the nerve-sparing radical prostatectomy procedure by Dr. Patrick C. Walsh, the former Director of the Brady Urological Institute at Johns Hopkins, total ED was a given; Men were never able to have a hard erection following this surgery.

Now with Dr. Walsh's refinements of the surgery, the potency rates at Johns Hopkins are among the best in the world. Dr. Walsh has reported that in the hands of a skilled surgeon performing the nerve-sparing procedure, potency should return in at least 80% of men in their 40s and 50s if both nerve bundles are preserved; at least 60% of men in their 60s should have a return of potency. The numbers drop to about 25% in men in their 70s, most likely because of the aging process, which may affect the function of the nerves they were born with.

Nationwide, the figures for return of erectile performance following a radical prostatectomy are not as impressive as the results at Johns Hopkins, ranging from 14% to 60%, with full erections returning only in those men with both nerve bundles preserved.

Erection Restoration Following a Radical Prostatectomy
Men are concerned about the restoration of erections following their surgery. The time varies, due in part to a man's overall health, age, and erectile hardness prior to surgery. If a man has had one or both nerve bundles preserved, the potential for an erection is certainly there. Men need to be patient, however. Erections return gradually, starting in the first few weeks following surgery. For some men, it can take up to four years to experience full recovery of potency. That's because the body has been through a surgical trauma and simply needs time to recover. In the meantime, don't be discouraged and give up on the idea of sexual intercourse. Week by week, as the nerves recover and blood flow increases to the penis, you will slowly make gains in penile axial rigidity (the scientific name for penile hardness), eventually achieving an erection suitable for intercourse.

ED Following Radiation Therapy for Prostate Cancer
While surgery has an immediate impact on the ability to have a hard erection, the devastating effects of radiation therapy (external radiation and brachytherapy) on erections are generally more gradual. Immediately after radiation therapy, erections may be normal. However, with the passage of months, penile hardness may slowly start to diminish, so much so that by two years post-procedure, achieving an erection suitable for intercourse is sometimes very difficult, if not impossible.

No one is quite certain what is specifically causing the ED following radiotherapy. Some believe that the high doses of radiation eventually damage the arteries that provide blood to the penis. Other researchers point to the damage radiation causes to the neurovascular bundles responsible for erections.

The problem with radiation-induced ED is that once the erectile nerves are destroyed by the radiation, oral erection medications will not work as well. In that case, the patient will have to resort to second-line therapy (injection therapy) or third-line therapy (penile prosthesis) in order to achieve an erection.

The Role of Medications
Some common misconceptions about the three "erection" drugs (Cialis, Levitra, Viagra) must be cleared up first. These ED drugs can play an important role in the restoration of erections, doing so by amplifying the action of important chemicals that trigger erections. However, these medicines are not libido enhancers nor do they cause instant erections after taking them. Nor will they kill you— unless you happen to take a nitrate-based medication (such as heart medications containing nitroglycerin) with them.

In rare instances, men taking these oral erectile dysfunction medicines reported a sudden decrease or loss of vision. It is not possible to determine whether these events are related directly to these medicines or to other factors.

If you experience sudden decrease or loss of vision, stop taking the erection drug, and call a doctor right away.

That said, these drugs can play a very important role in the restoration of erections. If a man has had his neurovascular bundles spared during a radical prostatectomy and was performing well sexually prior to the surgery, he should be able to achieve an erection suitable for intercourse at some time after the surgery.

The stress triggered by a diagnosis of prostate cancer is often enough to cause serious anxiety and depression.

As you'll learn in Key #5, recently diagnosed prostate cancer patients often need treatments not just for their bodies but for their minds as well.

KEY 5 is titled: Seek Extra Help If Needed This Special Report is not intended to provide advice on personal medical matters or to substitute for consultation with a physician Copyright © 2006 Medletter Associates, LLC All rights reserved

Johns Hopkins Health Alerts | Prostate Disorders | Restore and Maintain Erectile Performance: Key 4

Posted in Prostate Disorders on July 22, 2007


Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Johns Hopkins Health Alerts Disclaimer


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Health Alerts registered users may post comments and share experiences here at their own discretion. We regret that questions on individual health concerns to the Johns Hopkins editors cannot be answered in this space.

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This is an interesting and pointed article, certainly worthy of reading by PCa patients. My comment is directed to a particular portion of the article: 'That said, these drugs can play a very important role in the restoration of erections. If a man has had his neurovascular bundles spared during a radical prostatectomy and was performing well sexually prior to the surgery, he should be able to achieve an erection suitable for intercourse at some time after the surgery.'

What's not addressed here and should be, I believe, is what is considered by some urologists, the role of 'penile rehabilitation'. In my particular case in 2005, it was expected to let the body 'heal' from the trauma done by the operation. I used no medications for five months post surgery.I now have read that early intervention using medications, or the use of a VED (Vacuum Erectile Divice) or pump without the use of the rings, might be the best way to help the body recover erections before the onset of too much scar tissue.

I would like the John Hopkins Health Alert address their thoughts about penile rehabilitation for post-rp patients in a future issue.

Posted by: RussD | February 10, 2008 7:42 AM

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