Prostatectomy, the surgical removal of the prostate gland, often results in impotence due to damage to the cavernous nerves in the penis. However, nerve-sparing surgery can minimize this side effect. Brachytherapy, a new treatment that involves placing radiation sources in or next to the prostate, eliminates the problem of impotence. Patients should discuss their specific situation with their doctors to determine the correct course of action.
Radical prostatectomy is an invasive surgery that removes all or part of the prostate gland and, often, surrounding tissue. The connection between prostatectomy and impotence exists because the cavernous nerves in the penis, which control an erection, run close to the prostate and are often damaged or destroyed during surgery. This damage to the cavernous nerves results in the inability to get or maintain an erection.
Prostate cancer is the second most frequently diagnosed cancer among men. It is also the second leading cause of cancer death among men worldwide. With early detection, however, prostate cancer can be effectively treated and cured. Among the most commonly used treatments is surgery, or radical prostatectomy. Men who undergo a prostatectomy have a very high chance of surviving at least 15 years, but the procedure is often accompanied by unpleasant side effects, such as incontinence and impotence.
The most common surgical procedure for prostate cancer is radical retropubic prostatectomy, in which an incision is made in the abdomen and the prostate is removed from behind the pubic bone. Another surgical technique is radical perineal prostatectomy. This involves making an incision between the anus and the base of the scrotum. In this technique, the incision is smaller and there is less blood, but the surgeon’s ability to save surrounding nerves is limited. Success rates for radical prostatectomy depend on how early the cancer is detected and can be around 98 percent if the cancer is confined to the prostate or 30 to 80 percent if the cancer has spread to surrounding tissue.
The connection between prostatectomy and impotence can be minimized with nerve-sparing surgery. Patients who have prostate cancer that is clinically unlikely to have spread beyond the prostate gland are often offered nerve-sparing surgery, which can reduce or eliminate postoperative incontinence and impotence problems. The success of nerve-sparing prostatectomy is highly dependent on the skill and experience of the surgeon, as well as the age and pre-existing sexual function of the patient.
Erectile dysfunction associated with prostate surgery may be temporary, but recovery of normal sexual function is slow. Most surgeons will not claim that patients will ever achieve the erectile function they had before surgery. It may take 18-24 months after surgery before the patient gets an erection. A significant percentage of men experience permanent impotence.
Impotence refers only to the inability to get an erection firm enough to have sex. The connection between prostatectomy and impotence does not affect sensation in the penis or the ability to have an orgasm and experience sexual pleasure. Orgasms after prostatectomy are likely to be dry or without ejaculation. This is because the prostate and seminal vesicles that produce ejaculatory fluid are removed during the prostatectomy.
Therapies and remedies for postoperative erectile dysfunction include medications, penile injections, vacuum devices, and penile implants. These therapies are limited and can be uncomfortable. It is recommended that couples attend post-operative counseling to adjust to their new situation.
Brachytherapy is a new prostate cancer treatment that completely avoids the problem of prostatectomy and impotence. It is also known as internal radiation therapy. In brachytherapy, sources of radiation, or seeds, are placed in or next to the prostate. This delivers a very high dose of radiation localized to the targeted area while sparing the surrounding tissue. Brachytherapy is an increasingly popular prostate cancer treatment among men who have cancers that have not spread beyond the prostate.
The problem of impotence is eliminated by brachytherapy because the prostate and surrounding tissues are not removed and the cavernous nerves of the penis are not damaged. Men concerned about prostatectomy and impotence should ask their doctor about brachytherapy. No single treatment or combination of prostate cancer treatments is right for everyone. Patients should discuss their specific situation with their doctors to determine the correct course of action.
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