Two recent articles by Salonia et al. (from the Fourth International Consultation for Sexual Medicine or ICSM 2015) have provided us with a series of nine recommendations to clinicians regarding sexual rehabilitation after radical prostatectomy for localized prostate cancer.
The nine recommendations are listed below, in order:
- Clinicians should discuss the occurrence of post-surgical erectile dysfunction (temporary or permanent) with every candidate for radical prostatectomy.
- Validated instruments for assessing erectile function recovery such as the International Index of Erectile Function and Expanded Prostate Cancer Index Composite questionnaires are available to monitor recovery of erectile function after radical prostatectomy
- There is insufficient evidence that a specific surgical technique (open vs laparoscopic vs robot-assisted radical prostatectomy) promotes better results in postoperative recovery of erectile function.
- Recognized predictors of recovery of erectile function include but are not limited to younger age, preoperative erectile function, and bilateral nerve-sparing surgery.
- Patients should be informed about key elements of the pathophysiology of postoperative erectile dysfunction, such as nerve injury and cavernous venous leakage (i.e, leakage of blood from the erect penis and the resulting loss of erection).
- The recovery of postoperative erectile function can take several years.
- There are conflicting data as to whether penile rehabilitation with phosphodiesterase type 5 inhibitors (PDE-5 inhibitors; i.e., drugs like sildenafil/Viagra or tadalafil/Cialis) improves recovery of spontaneous erections.
- The available data are inadequate to support any specific regimen as optimal for penile rehabilitation.
- Men undergoing radical prostatectomy (carried out by any technique) are at risk of sexual changes other than erectile dysfunction, including decreased libido, changes in orgasm, anejaculation, Peyronie-like disease, and changes in penile size.
For those who wish to try to obtain complete copies of the two articles, they can be found at these two links:
- Salonia A, et al. Sexual rehabilitation after treatment for prostate Cancer — Part 1: Recommendations from the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sexual Med. 2017;14:285–296.
- Salonia A, et al. Sexual rehabilitation after treatment for prostate Cancer — Part 2: Recommendations from the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sexual Med. 2017;14:297–315.
Unfortunately the full texts of these two papers are not available on line (unless one is willing to pay for them).
However, the good news is that we finally have a very clear set of statements from the sexual medicine community about the problems associated with the recovery of good quality erectile and sexual function after radical prostatectomy.
Support group leaders and other prostate cancer educators are welcome to print out this set of recommendations and use them to distribute to any patients with whom they are discussing the benefits and risks of surgical treatment for localized prostate cancer.
As we have noted on numerous prior occasions, the recovery and the quality of erectile function after a radical prostatectomy may also be affected by the skill and experience of the individual surgeon and by the anatomy of the individual patient as well. However, The “New” Prostate Cancer InfoLink would hope that the urology community would take note of these recommendations from ICSM 2015 and build this information into future treatment guidelines and patient education about the risks associated with the surgical treatment of localized prostate cancer.