October 05, 2011
Louis Kavoussi, MD
An article published in this month’s Journal of the American Medical Association (JAMA) looks at factors that put men at risk for loss of erections. The authors studied the sexual function in 1,027 men who had treatment for prostate cancer and were followed for 2 years. The authors found that only 48 percent of all patients who had sexual function before treatment had erections sufficient for intercourse after treatment.
Several factors were found to result in problems. Patients with any degree of difficulty with erections prior to treatment had more difficulty afterwards. Also, older patients or those patients who had a higher PSA level (blood test that detects prostate cancer), were overweight or were Caucasian had a lower rate of recovery. In best case scenarios where men had positive risk factors (young, thin, normal function, minimal disease), sexual function was preserved 70 percent of the time. Those with poor factors only had a 10 percent rate of recovery of sexual function.
This study is important in helping physicians set expectations for patients considering any treatment for prostate cancer. Any treatment of prostate cancer, be it surgery, external beam radiation or radioactive seeds, has the potential to affect sexual function. Although the ability to be aroused and climax are not affected, loss of erections sufficient for penetration can occur. This is because nerves responsible for erections lie directly upon the prostate. So any trauma--whether manipulation during surgery or scatter of energy from irradiation--can injure the nerves and cause difficulty with erections. Even modern therapies such as nerve-sparing prostatectomy and conformal irradiation do not guarantee preservation of normal erections.