The realities of erectile dysfunction after radical prostatectomy

We have commented previously on the increasing number of papers that appear to be looking with greater clarity at issues related to the adverse consequences of prostate cancer therapy. A new paper on the impact of “sexual bother” (for which you can read “physical or psychological distress related to sexual intercourse”) appears to be another paper in this “series.”

In this paper, Nelson et al. describe their attempts to determine whether or not “sexual bother” really increases following radical prostatectomy (RP); whether men “adjust” to a diminished ability to have high quality erections; and whether they could identify specific pre-surgical “predictors” of post-surgical sexual bother. Their database was 183 men treated with RP at Memorial Sloan-Kettering Cancer Center who completed specific study questionnaires about erectile function and “sexual bother” preoperatively and at 12 and 24 months postoperatively.

Their results showed the following:

  • The average (mean) age of the patients was 58 ± 7 years.
  • The mean erectile function scores decreased significantly over time — from 24.8 at baseline to 16.7 at the the 24-month time point (measured against a maximum score of 30.0).
  • The mean “sexual bother” scores increased from 4.3 at baseline to 6.7 at the 12-month time point and remained stable between the 12-month to the 24-month time points (6.7 vs. 6.3) — for men with and without ED.
  • Only 7 percent of men with erectile dysfunction (ED) moved from being “bothered” at 12 months to reporting “no bother” at 24 months.
  • The authors were not able to identify any significant pre-surgical predictors of post-surgical “sexual bother.”
  • The change in erectile function scores was the only significant predictor of “sexual bother” scores.

Now this is not the first paper on erectile function and “sexual bother” after surgery or other forms of prostate cancer therapy. Historically, the published literature on “sexual bother” after treatment in men with prostate cancer has been conflicting. Some papers have suggested that there is a high level of “bother” whereas others have focused more on the “life-saving” nature of the treatment and suggest that this may override concerns related to erectile dysfunction.

The current paper appears to clarify this issue — at least for American men who undergo RP. The authors clearly conclude that, “Sexual bother increases post-RP, even in men with ‘good’ erections postoperatively, and includes shame, embarrassment, and a reduction in general life happiness.” They go on to state that, “Because men do not seem to ‘adjust’ to ED, referral or evaluation should occur early in this population.”

The “New” Prostate Cancer InfoLink believes that this paper again implies the need for a structured form of postoperative care for men who undergo radical prostatectomy — and perhaps other forms of treatment too. Such care should be designed to address issues related to continence, sexual function, and issues around the patient’s self-image. It should also be designed to address the needs of both the patient and his partner — where relevant. It is high time that prostate cancer treatment merited this type of recuperative care. Surgery and other forms of prostate cancer treatment profoundly affect the “whole man,” not just his cancer. As a consequence we need to offer postoperative care that will help recovery of the “whole man.” It is not enough to be able to say that we think we “got all the cancer” when he is left partially (or completely) impotent and emotionally damaged by his treatment.

Of course 93 percent of prostate cancer patients with sexual dysfunction (and “bother” about it) post-RP might have been able to give researchers some very clear insights into this issue without a good deal of the research! They just needed to be asked.

2 Responses

  1. I wonder how much the failed expectation of a return to something like normality impacts over time?

    The promise of “cure” implied in we “got all the cancer,” despite an expected biochemical failure rate of over 20% even when there are no positive margins, can perhaps be equated to promise of recovery of erectile function implied by the nerve-sparing technique. It seems too that many men are told that there will be a continuous recovery during the 12 months after surgery and maybe longer — or at least they report that is what they heard. When they hit the 12-month mark with no improvement it must be disheartening.

    Other aspects of bother must surely relate to the leakage of urine at climax for those fortunate enough to have a stuffable erection. Some men take this in their stride, others find it less palatable, but very few seem to be told of the probability of this occurring.

    Peyronie’s syndrome is another aspect that seems to be more common than expected and rarely discussed prior to the procedure.

    All in all these must increase the bother rate once the relief of ‘cure’ is over, especially with the publicity given to unneccessary treatment.

  2. This is what I know from the other side of prostate cancer: earlier treatment, better recovery.

    1. The more you know, the better the recovery.
    2. Seeing a specialist before surgery can improve chances of a return to presurgery sexual activity.
    3. There is a finite period following surgery in which to prevent long lasting ED.

    The MD listed above is in NY metro area and has had success with this type of protocol with my other half. Get in touch with him to see if you are a candidate for his treatments.

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