The latest research into the effects of prostate cancer treatment involves creating a model that will help doctors and patients together determine whether or not treatment may lead to impotence. Since survival statistics are rather high for patients with early-stage prostate cancer, the risk of impotence remains one of the most important post-treatment concerns for men, as it so directly impacts quality of life.
Findings published in the Journal of the American Medical Association show researchers trying to get at the heart of the issue—namely, a means of predicting, pre-treatment, which patients are the least and most likely to suffer from the likes of erectile dysfunction.
They went about this with a simple questionnaire given to 1,200 men recently diagnosed with early-stage prostate cancer who had not yet undergone treatment. It asked about their sexual function as well as any history of impotence or ED. The men were then followed for two years.
What they found was that the risk of impotence had a lot to do with the choice of treatment, with PSA levels, and with previous sexual function.
For men who had no history of impotence or ED, the researchers reported that:
- A prostatectomy (removal of the prostate) resulted in ED issues in 60 percent of those patients;
- External radiation resulted in ED issues in about 40 percent of those patients;
- Brachytherapy resulted in ED issues in less than 40 percent.
- High PSA levels tended to result in higher risk of impotence
Ultimately, researchers concluded that they can now predict impotence issues accurately as often as 90 percent of the time. Furthermore, the better a man's function prior to treatment, the higher likelihood he'll retain that after treatment.
What this does NOT mean is that the end of treatment-induced ED has arrived. Rather, it means that prostate cancer patients can be better informed about the potential consequences of their treatment decisions and be encouraged to seek second opinions. At the very least, the results suggest that men can and should be better informed about prostate cancer treatment and its effects, and this is extremely important since it speaks directly to the notion of informed consent.
Alemozaffar M et al. Helping Patients Make Better Personal Health Decisions: The Promise of Patient-Centered Outcomes Research. JAMA. 2011;306(11):1258-1259.
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The nerves that allow a man
The nerves that allow a man to achieve an erection are often only traumatized and not permanently damaged after prostate surgery and other prostate procedures. The problem is that when these nerves are traumatzied they do not transmit the signals they are supposed to and the man cannot achieve an erection. While the nerve function often returns in 12-24 months, if the man has not had regular and solid erections during this period of time, there is often permanent damage to the penis. The penis thrives on use. A program of penile rehabiliation which uses medications to allow the man to achieve good solid erections on a regular basis during this critically important 12-24 month time period after the surgery or procedure has been shown to dramatically increase the odds of a patient returning to his preoperative erectile function status.
I would welcome those interested to check out the Penile Rehabilitation section on my website:
WWW.MENSMEDICALNEWYORK.COM
Lawrence A. Smiley, M.D.