Erectile Rehab After Prostate Cancer Treatment

A prostate cancer diagnosis triggers a flood of questions, fear and worry. Right after concerns about emerging cancer free, most men want to know if they will retain sexual function following treatment—specifically if they will be able to achieve and retain an erection for intercourse. “The answer is different for every man, and depends on a number of factors,” says Rich Bevan-Thomas, M.D., medical director of USMD Prostate Cancer Center. “Age, strength of erections before cancer treatment, the extent of the cancer, and type of treatment prescribed all play a role. The good news is, there is a lot we can do to maximize the return of penile health. With erectile rehabilitation, we can prevent the development of scar tissue and promote better blood flow into the penis—making it easier to get erections in the long term.”

Whether you undergo nerve-sparing surgery, radiation therapy or cryosurgery, your body will need time to recover. And so, too, will your ability to have an erection—due in large, part to the delicate anatomy of the penis.

The penis is a complex collection of muscle, blood vessels and nerves. When aroused, nerves send messages to relax the smooth muscle tissue in the penis, allowing the arteries to pump more blood into the chambers inside the muscle. As the penis lengthens, the veins stretch and shut themselves off—trapping blood inside the penis. If these arteries or nerves are damaged during treatment, it can have an impact on sexual function.

Erectile dysfunction (ED) can occur in any man following treatment for prostate cancer—even those who undergo nerve-sparing robot-assisted radical prostatectomy. While the bundle of nerves that signal the penis during an erection are left in tact, the cavernosal nerves largely responsible for erections may sustain neuropraxia, a temporary paralysis caused when the nerves are deprived of oxygen.

There can be vascular issues, too. An overabundance of an enzyme known as phosphodiesterase-5 (PDE-5) has an adverse effect on cyclic guanosine monophosphate (cGMP)—a messenger nucleotide that signals smooth muscle cells that line blood vessels in the penis to relax. Without enough cGMP, the muscle cells can’t relax and blood flow to the penis is restricted.

“During erectile rehabilitation, we use a variety of medications and treatments to address these issues—therapies designed to stretch the penis, dilate the blood vessels, increase blood flow and improve oxygenation to the penis so patients regain their ability to have an erection over time,” Dr. Bevan-Thomas says. “Our goal is to minimize the extent and duration of ED.”

There are five well-established treatments for erectile dysfunction. Many are often used in tandem to produce erections that are rigid enough for intimacy. Your physician may even start your rehab before surgery or other cancer treatments. Detailed information about each will be featured in our next blog post. They include:

  • Oral phosphodiesterase-5 (PDE-5) 5 inhibitors such as Viagra, Cialis and Levitra
  • Vacuum erection device (VED)
  • Urethral suppository alprostadil such as MUSE
  • Penile injection therapy
  • Penile implant

“These treatments give us a powerful arsenal to combat ED. I like to compare erectile rehab to training for a marathon,” Dr. Bevan-Thomas says. “Erectile function continues to improve for up to four-and-a-half years after prostate cancer treatment, so the more men work at improving oxygenation and blood flow to the penis, the better the outcome.”

Learn more about common treatments for erectile rehab in part 2 of this topic.

Learn more about erectile rehabilitation treatments in our next blog post. Until then, please feel free to call us at 1-888-PROSTATE for more information, or to schedule an appointment with one of our board-certified urologists.

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