Dr. Nelson Bennett, an Associate Professor in the Department of Urology at the Feinberg School of Medicine at Northwestern University, specializes in erectile dysfunction.
Prostatepedia spoke with him about erectile dysfunction after prostate cancer treatment.
Is ED more common after certain types of prostate cancer treatments?
Dr. Bennett: After prostate cancer surgery, 100% of people have ED. It gets better with time, but initially, 100% experience softening of the erection. And it can take up to two years to recover.
When radiation therapy starts, men don’t experience any erectile issues. As the years go by, up to about five years, they settle down to the level of those who’ve had prostate cancer surgery. There’s a slow decline in erectile dysfunction after radiation.
What about hormonal therapy? If you block testosterone, you’re going to block out erections too, right?
Dr. Bennett: Yes, you’re going to have immediate decreases in erectile rigidity, libido, sexual thoughts, and so on. Usually, hormonal therapy is used in conjunction with radiation, so they end up getting lumped together. The penile muscle has testosterone receptors, and if they’re not filled, the muscle doesn’t function as efficiently as it could or should..
You said 100% of men have erectile dysfunction after surgery, and they slowly recover over the course of two years. Why is that?
Dr. Bennett: The prostatectomist has to get the whole prostate out with the cancer inside of it. The nerves that go down to the penis run right along the side of the prostate. Simply exposing or touching those nerves damages them. It causes a concussion, or stunning, of those nerves, and they just don’t function as efficiently immediately after surgery.
It takes a good two years for those nerves to become as functional as they’re going to be. All else being equal, 60% of men will get back to where they were prior to surgery if they have had good nerve sparing and if they had excellent erections prior to their surgery.
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