Erectile dysfunction also referred to as impotence is the most common side effect of prostate cancer treatments. Impotence is the inability to develop or maintain an erection satisfactory for sexual intercourse. Although, prostate cancer does not cause impotence the treatments do. All types of prostate cancer treatments whether hormone therapy, prostatectomy surgery, brachytherapy, external beam radiation, high intensity focused ultrasound (HIFU) or surgery are capable of causing impotence. The risk is present regardless of the method used. Most men will experience erectile dysfunction of some degree for at least the first few months after treatment. This is due to the fact that any trauma to this area of the body negatively affects the delicate nerves and blood vessels that control the physical aspect of an erection.
Hormone therapy also called androgen deprivation therapy or androgen suppression therapy is used to control the growth of prostate cancer. It works by either reducing levels of male hormones, or androgens in the body or preventing them from reaching prostate cancer cells. Prostate cancer needs male hormones in order to grow and survive. Testosterone regulates the prostate gland and is the major male hormone in the body. It is responsible for secondary sex characteristics in males. Hormonal therapy also decreases arousal, desire and the ability of a man to achieve a full erection. Continued hormonal therapy also causes the penis and testicles to shrink. Additional side effects include urinary incontinence and possible urine leakage during sexual activity. Hormone therapy is the primary treatment for prostate cancer that has spread beyond the prostate gland such as organs and bones. Although it is not a cure for prostate cancer it can shrink tumors and possibly stop or limit the spread of prostate cancer for several years.
Radiation therapy involves the use of high-powered energy to kill cancer cells. Radiation therapy can cause erectile dysfunction due to damage to the penile arteries which leads to a blockage of blood flow into the penis. There are two methods used to deliver this radiation therapy. They are external beam radiation and internal beam radiation.
External beam radiation refers to radiation that comes from outside of the patient’s body. With this method the patient will lie on a table while a machine moves around their body, directing high-powered energy beams to the prostate cancer. This type of radiation therapy typically is done five days a week over a period of several weeks.
Internal beam radiation refers to brachytherapy. This method involves placing numerous radioactive seeds approximately the size of rice in the patient’s prostate gland. The physician uses a needle and ultrasound images as a guide to implant the radioactive seeds in the prostate gland. This method allows the radiation to be delivered at a low dose over an extended period of time. These implanted seeds don’t need to be removed as they eventually stop giving off radiation.
Side effects of radiation therapy often include painful urination, frequent urination and urgent urination. There can also be rectal side effects such as pain when defecating or loose stools. Erectile dysfunction commonly occurs after radiation therapy. A more serious side effect of radiation therapy is the possibility that it can cause another form of cancer in the future. (This can include bladder cancer or rectal cancer.) This may be rare, but it can occur.
Many men incorrectly believe they may be permanently impotent after prostate cancer treatments. However, there is hope for a large majority of men to enable them to be able to resume sexual activity after prostate cancer treatments.
Medications are often used to treat impotence. There are a few popular medications on the market to help enable men to obtain erections. However, not all men can take these medications due to the risks involved. Major side effects include:
1. sudden blindness or vision changes
2. ringing in ears or sudden hearing loss
3. chest pain, shortness of breath,
4. swelling in hands, ankles or feet
5. feeling light-headed or fainting
6. penis erection that is painful or last 4 hours or longer
7.heart attack, irregular heartbeat or heavy feeling
Medical devices are available for men who are unable or unwilling to take medications to help improve erectile function. Vacuum pumps and penile implants are two options.
The vacuum constriction device referred to as a vacuum pump is one such device. This is a safe way for many men to deal with E.D. without the use of drugs or surgery. A vacuum pump consists of a plastic tube that fits over the penis, a pump attached to the tube and a soft elastic support ring. It works by creating a vacuum around the penis which naturally forces blood into the penis thereby creating an erection mechanically. The support ring which is placed around the base of the penis helps to hold the blood in the area allowing the man to sustain an erection. The ring must be removed immediately after intercourse to prevent damage to the tissue due to the lack of flowing oxygen.
The surgically inserted penile implant is the final option for treating erectile dysfunction. This is a very durable device made of synthetic materials that is placed surgically in the body. It is inserted either through one incision in the scrotum or through an incision in the lower abdomen, right above the penis. Although there are different types of implants, the inflatable prosthesis appears to be most popular type. It is a small balloon-like device filled with fluid attached to the abdominal wall with a release button inserted into the testicle. The penis remains flaccid until an erection is desired. When an erection is desired the man only needs to press the button and fluid from the balloon rushes into the plastic tube. The tube straightens from being filled with fluid, pulls the penis up with it thereby creates an erection. These devices have approximately a 10% risk of breakage and the plastic materials can degrade over time.