Erectile Dysfunction

Many men may experience difficulty getting an erection (erectile dysfunction or “E.D.” for short) as a side effect of treatment for prostate cancer.

The nerves responsible for erection (the “cavernous nerves”) travel very close to the prostate gland and may be injured during surgery or by radiation therapy. Hormone treatments may also affect the ability to get or maintain an erection. This fact may get lost in the process of dealing with the initial diagnosis and treatment of the cancer, and men often become more acutely aware of their erectile dysfunction after they have successfully cleared these initial hurdles in treatment.

Psychological Support

Roswell Park offers the opportunity for couples to meet with members of our Psychology Department who may be of assistance in helping couples to cope with this issue and its potential impact on their relationship. The relative importance of sexual function between couples is highly variable and dependent on many factors.

Our psychology staff can also help with the greater issue of cancer treatment and the potential unforeseen strains that it might place on a relationship that may be more manageable if the couple is prepared

Recovering Sexual Function

The degree of recovery of erectile function depends on multiple factors including the type of treatment you have, your age, and your erectile function before treatment.

It is important to understand that time is perhaps the most important factor in the recovery process. Nerves may take time to heal. It is also very common for a man to require medications to assist with erectile function, even though he did not need them prior to treatment.

Through the use of standardized questionnaires, your questions and your doctor’s inquiries, information is gathered at each visit designed to help evaluate your overall progress and make any changes in your treatment plan as necessary.

Rehabilitation

See the table and diagrams below for descriptions and diagrams of how some of these therapies are administered and pros and cons of each. Instruction and assistance with these treatments would be supervised by the physicians and the dedicated staff in the Urology Clinic/Prostate Cancer Center.

Support organizations such as Us TOO International are available to provide a forum for men experiencing many common issues surrounding prostate cancer treatment including erectile dysfunction. We have included a list of web sites, books, and organizations that can offer assistance.

Oral Medication (Viagra®, Levitra®, Cialis®)

Pros:

• Pills taken by mouth
• Effective in many men

Cons:

• Not effective unless nerve-sparing approach used
• Side effects including headache. Viagra and Levitra may cause blurry vision. Cialis may cause joint or back pain
• Should not be used in some patients
• 30-60 minute wait for response
• Cannot be taken with some medications

Intraurethral Prostaglandin Suppository (MUSE™)

Pros:

• Small pellet placed in the urethra without needles
• Few systemic side effects
• Effective in 43-62% of men

Cons:

• Can cause penile or urethral pain
• Requires simple training
• Refrigeration required
• May require tension ring placed at base of penis for best effects
• Side effects include (rarely) painful & prolonged erection (more than six hours) fainting, dizziness

Penile Injection

Pros:

• Highly effective
• Few systemic side effects
• Works in three to five minutes

Cons:

• Some medications require refrigeration
• Requires injection
• Requires office training
• Can cause penile pain
• Can cause prolonged erection and penile fibrosis or scaring

Vacuum Erection Device

Pros:

• Least expensive
• No systemic side effects
• Effective in 66-71 percent of patients

Cons:

• May cause numbness or bruising
• Less “natural” erection
• Some find awkward to use

Penile Prosthesis

Pros:

• Highly effective
• For men who have failed or are not satisfied with medical treatment of impotence

Cons:

• Small risk of infection
• Requires anesthesia and surgery
• May require replacement after many years of use

Psychological Support at Roswell Park

Roswell Park offers the opportunity for men and their families to meet with members of our Psychology Department who may be of assistance in helping navigate these emotional challenges.

Psychologists can meet individually with you, or with couples or family members. If you would like to meet with a psychologist, let your medical provider know, or contact the Psychology Department at (716) 845-3052.

Social Work Department

Our licensed Clinical Social Workers and licensed Masters Social Workers are available to assist you and your family members in adapting to the stresses related to your diagnosis including counseling services, support groups, health care proxy, finances, housing, transportation and community resources as well as helping you locate rehabilitation facilities. For more information on any of these services, please call (716) 845-8022.

Multimedia Reference Sources for Men with Prostate Cancer

Books

• The Lovin’ Ain’t Over: The Couple’s Guide to Better Sex after Prostate Disease by Ralph and Barbara Alterowitz. Health Education Literary Publisher, Westbury, NY, 1999. ISBN: 1883257034
• Our Journey Through Prostate Cancer by Jim and Julia Miller. JJM Publishing, San Francisco, CA, 2003. ISBN: 0974317209
• Couples Confronting Cancer: Keeping your Relationship Strong by Joy L. Fincannon and Katherine V. Bruss. American Cancer Society, Atlanta, GA, 2003. ISBN: 0944235255

Websites

• Us TOO International
• Phoenix 5: Phoenix 5’s mission statement is to help men and their companions overcome the effects of prostate cancer.
• Prostate Cancer Intimacy (PCAI): PCAI offers an open and frank discussion about the problems associated with intimacy and prostate cancer

Other Sources

• American Association for Marriage and Family Therapy 112 South Alfred Street, Alexandria, VA 22314-3061 Phone: (703) 838-9808 Fax: (703) 838-9805
• American Association of Sex Educators, Counselors, and Therapists P.O. Box 5488 Richmond, VA 23220-0488
• Sexual Function Health Council American Foundation for Urologic Disease, Inc.1000 Corporate Blvd, Suite 410 Linthicum, MD 21090 Phone: (410) 689-3990 or (800) 828-7866Fax: (410) 689-3998
• The Sexuality Information and Education Council of the United States (SIECUS)130 West 42nd Street, Suite 350 New York, NY 10036Phone: (212) 819-9770
• Sexual Medicine Society of North America, Inc.1111 N. Plaza Drive, Suite 550Schaumburg, IL 60173Phone: (847) 517-7225Fax: (847) 517-7229
• Us TOO International 1-800-80-US TOO