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Sexual Impotence and Prostate Cancer: Understand the Relationship

Sexual Impotence and Prostate Cancer: Understand the Relationship

Prostate cancer is the most common malignancy in men worldwide when we exclude cancers from the skin. It is estimated that approximately 1,300,000 new cases are diagnosed each year in the world.

In industrialized countries, most cases are diagnosed in the early stages. Already in developing countries the disease is usually discovered in more advanced stages.

Sexual impotence is a major concern of men with prostate cancer, as well as physicians responsible for treatment. Studies in the medical literature show a wide variation of the occurrence of this side effect, ranging from 7 to 90% of the cases treated with surgery or radiotherapy.

This wide range of results occurs due to several factors that make it difficult to compare groups of patients. The amount of information collected in each study differs greatly from one to the other, as well as the characteristics of each man, the disease, and the degree of experience of the medical staff with a particular type of treatment.

It is clear that the occurrence of impotence is a multifactorial event and that the risk of its occurrence should be discussed in an individualized manner in each case. In rare situations sexual impotence may be the initial symptom of prostate cancer. This occurs when the disease breaks the boundaries of the prostate capsule and infiltrates the nerves that pass around the prostate and drives the erection to the penis.

Decreased sexual performance can occur naturally with the male aging process and most of the times is not related to the presence of prostate cancer.

Since the nerves that drive the erection are compromised by the infiltration of the disease or destroyed during the treatment of cancer, conduction of the stimulus naturally to the penis is not more possible. In this situation the use of oral medications does not produce the desired effects. Treatments such as injectable vasodilators in the penile tissue, or even the use of artificial prostheses, appear as treatment alternatives.

Erection performance can also be influenced by decreased libido or sexual desire. This is a relatively common effect and can occur at any point in treatment or even before it. Libido can be influenced by psychological issues related to the diagnosis of prostate cancer itself, as well as being a direct consequence of the use of medications that levels of testosterone with the goal of slowing the growth of prostate cancer cells.

These medications are often used only in cases of advanced prostate cancer or with metastases. Soon after prostate cancer treatment with surgery, radiotherapy or other methods the medical team will initiate a protocol for rehabilitation of sexual function. This involves a psychological accompaniment of the couple, as well as the use of oral medications that facilitate the arrival of blood flow directly into the penis.

When the first-line measures are ineffective, treatments considered second-line, such as the injection of vasodilator medications into the penis and even the use of devices can be useful tools in the rehabilitation of erectile function. Finally, when the two initial measures do not show satisfactory results, there is the possibility of implanting an artificial device known as a penile prosthesis.

There is a wide variety of penile prosthesis models as well as the possibility of implantation of malleable or inflatable devices. The procedure is considered definitive and requires surgical intervention. To better understand the risk of occurrence of sexual impotence following prostate cancer treatment, it is important to always keep in mind 5 key factors in the assessment:

  • Age
  • Other health problems associated with
  • Stage in which cancer of the prostate has been diagnosed
  • Treatment mode used
  • Level of experience of medical staff

There is a group of men who fall into a category of high risk for the occurrence of definitive sexual impotence after the treatment of cancer of prostate. This group includes men over 65 years of age, diabetics, obese, smokers, heart patients, who use antidepressants and in whom the disease has been found to have an advanced stage of nerve involvement that drives erection stimuli. Men who do not have any of the features mentioned above are those at the lowest risk of experiencing definitive sexual impotence. Another variable that must be taken into account is the experience of the medical assisting staff.

In the case of prostate removal surgery , there are studies in the medical literature indicating an equivalence in the probability of cancer cure, regardless of the method of surgery used (open laparoscopic or robotic). However, the results of a recently published meta-analysis indicate that the robotic surgery technique presented better results in terms of faster recovery of urinary continence and erection, lower blood loss during surgery, less postoperative pain and fewer days of hospital stay.

But it is important to keep in mind that most comparative studies between surgical techniques run counter to methodological problems that impede effective comparison. This is because there is a great variability of the degree of experience of the surgeons involved, as well as their stage in the learning curve of the procedure. What seems clear is that regardless of the method, the more experienced and familiar the surgeon better functional outcomes. Treatment modalities like radiotherapy and other methods of focal therapy, also have their outcomes influenced by the level of experience of the medical staff. It is clear that maintaining the quality of sexual function involves psychological aspects, health conditions prior to cancer treatment, type of treatment employed, the stage at which the disease was discovered, the treatment modality used and the degree of experience of the medical staff

In order for you and your doctor to have an open and enlightening conversation about your risks of presenting this or other sequelae after treatment, it is important to keep in mind all aspects of prostate cancer treatment and its rehabilitation.

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