Prostate cancer remains the most common cancer in adult men. Its treatment usually results in compromised or absent erectile function. This article will review the treatment options available to resume sexual activity following prostate cancer therapy and will focus on non-surgical treatment options. In addition, intracavernosal injection therapy has been shown to enhance recovery of spontaneous, unassisted erections when started shortly after nerve-sparing radical prostatectomy. Most recently, oral treatment with sildenafil citrate begun shortly after surgery was shown in a placebo-controlled trial to encourage return of normal erections. Presumably this occurs by promoting nocturnal erections which appear to prevent the permanent neurovascular damage to the penis following radical prostate surgery.
Get full access to this article
View all access options for this article.
References
1.
LitwinM.S., HaysR.D., FinkA., et al.Quality of life outcomes in men treated for localized prostate cancer. JAMA, 1995; 273:129–135.
2.
WalshP.C., LeporH., EgglestonJ.C.Radical prostatectomy with preservation of sexual function: anatomical and pathological considerations. Prostate, 1983; 4:473–485.
3.
WalshP.C., MarschkeP., RickerD., et al.Patient-reported urinary continence and sexual function after anatomic radical prostatectomy. Urology, 2000; 55:58–61.
4.
ZelefskyM.J., Eid JF. Elucidating the etiology of erectile dysfunction after definitive therapy for prostate cancer. Int. J. Radiat Oncol Biol Phys., 1998; 40:129–133.
5.
GoldsteinI., FeldmanM.I., DeckersP.J., et al.Radiation associated impotence. A clinical study of its mechanisms. JAMA, 1984; 251:903–910.
6.
Sanchez-Ortiz. BroderickG.A., RovnerE.S., et al.Erectile function and quality of life after interstitial radiation therapy for prostate cancer. ISIR, 2000; 12(Suppl 3):S18–S24.
7.
KleinL.T., MillerM.I., ButtyanR.Apoptosis in the rat penis after penile denervation. J. Urol., 1997; 158:626–630.
8.
FraimanM.C., LeporH., McCulloughA.R.Changes in penile morphometrics in men with erectile dysfunction after nerve-sparing radical prostatectomy. Mol Urol., 1999; 3:109–115.
MulhallJ.P., HaysR.D., FinkA., et al.Erectile dysfunction after radical prostatectomy: hemodynamic profiles and their correlation with the recovery of erectile function. J. Urol., 2002; 167:1371–1375.
11.
DroupyS., HesselA., BenoitG., et al.Assessment of the functional role of accessory pudendal arteries in erection by transrectal color Doppler ultrasound. J. Urol., 1999; 162:1987–1991.
12.
McCulloughA.R.Management of erectile dysfunction following radical prostatectomy. Sexual Dysfunction in Medicine., 2000; 2(1):2–9.
13.
RabbaniF., StapletonA.M., KattanM.W., et al.Factors predicting recovery of erections after radical prostatectomy. J. Urol., 2000; 164(6):1929–1934.
14.
QuinlanD.M., EpsteinJ.I., CarterB.S., et al.Sexual function following radical prostatectomy: influence of preservation of neurovascular bundles. J. Urol., 1991; 145:998–1002.
15.
MantzC.A., SongP., FarhangiE., et al.Potency probability following conformal megavoltage radiotherapy using conventional doses for localized prostate cancer. Int. J. Radiat Oncol Bio Phys., 1997; 37:551–557.
16.
ChaikinD.C., BroderickG.A., MalloyT.R., et al.Erectile dysfunction following minimally invasive treatments for prostate cancer. Urology, 1996; 48(1):100–104.
17.
RainaR., LakinM.M., AgarwalA., et al.Long-term effect of sildenafil citrate on erectile dysfunction after radical prostatectomy: 3-year follow-up. Urology, 2003; 62(1):110–115.
18.
HongE.K., LeporH., McCulloughA.R.Time dependent patient satisfaction with sildenafil for erectile dysfunction (ED) after nerve-sparing radical retropubic prostatectomy. Int. J. Impotence Res., 1999; 11:15–22.
19.
ZippeC.D., KediaA.W., KediaK., et al.Treatment of erectile dysfunction after radical prostatectomy with sildenafil citrate (Viagra). Urology, 1998; 52:963–966.
20.
LowentrittB.H., ScardinoP.T., MilesB.J., et al.Sildenafil citrate after radical retropubic prostatectomy. J. Urol., 1999; 162:1614–1618.
21.
ZagajaG.P., MhoonD.A., AikensJ.E., et al.Sildenafil in the treatment of erectile dysfunction after radical prostatectomy. Urology, 2000; 56:631–634.
22.
BrockG., TaylorT., SegerM.Vardenafil PROSPECT Group Canada. Efficacy and tolerability of vardenafil in men with erectile dysfunction following radical prostatectomy. Eur Urol., 2002; 1:152.
23.
MontorsiF., McCulloughA., BrockG., et al.Tadalafil in the treatment of erectile dysfunction following bilateral nerve-sparing radical retropubic prostatectomy. Int. J. Impot Res., 2003; 15(Suppl 5):S170. Abstract 21.
24.
ZippeC.D., JhaveriF.M., KleinE.A., et al.Role of Viagra after radical prostatectomy. Urology, 2000; 55:241–245.
25.
CostabileR.A., SpevakM., FishmanI.J., et al.Efficacy and safety of transurethral alprostadil in patients with erectile dysfunction following radical prostatectomy. J. Urol., 1998; 160:1325–1328.
26.
Rodríguez VelaL., Gonzalvo IbarraA., Bono ArinoA., et al.Erectile dysfunction after radical prostatectomy. Etiopathology and Treatment. Actas Urol Esp., 1997; 21:909–921.
27.
AlthofS.E., TurnerL.A., LevineS.B., et al.Why do so many people drop out from auto injection therapy for impotence. J. Sex Marital Ther., 1999; 15:121–129.
28.
BanielJ., IsrailovS., SegenreichE., et al.Comparative evaluation of treatments for erectile dysfunction in patients with prostate cancer after radical retropubic prostatectomy. BJU Int., 2001; 88(1):58–62.
29.
NehraA., BluteM.L., BarrettD.M., et al.Rationale for combination therapy of intraurethral prostaglandin E(1) and sildenafil in the salvage of erectile dysfunction patients desiring noninvasive therapy. Int. J. Impot Res., 2002; 14(Suppl 1):S38–S42.
30.
KediaS., ZippeC.D., AgarwalA., et al.Treatment of erectile dysfunction with sildenafil citrate (Viagra) after radiation therapy for prostate cancer. Urology, 1999; 54:308–312.
31.
ZelefskyM.J., McKeeA.B., LeeH., et al.Efficacy of oral sildenafil in patients with erectile dysfunction after radiotherapy for carcinoma of the prostate. Urology, 1999; 53:775–778.
32.
MerrickG.S., et al.Efficacy of sildenafil citrate in prostate brachytherapy patients with erectile dysfunction. Urology, 1999; 53:1112–1116.
33.
MontorsiF., GuazzoniG., StrambiL., et al.Recovery of spontaneous erectile function after nerve-sparing radical retropubic prostatectomy with and without early intracavernous injections of alprostadil: results of a prospective, randomized trial. J. Urol., 1997; 158:1408–1410.
34.
FraimanM.C., LeporH., McCulloughA.R.Nocturnal penile tumescence activity in 81 patients presenting with erectile dysfunction after nerve sparing radical prostatectomy. J. Urol., 1999; 161:179.
35.
LevineL.A., McCulloughA.R., Padma-NathanH.Longitudinal randomized placebo- controlled study of the return of nocturnal erections after nerve-sparing radical prostatectomy in men treated with nightly sildenafil citrate. J. Urol., 2004; 171(Suppl 4):231. Abstract 875.
36.
MontorsiF., MagaT., SajoniaA., et al.Sildenafil taken at bedtime significantly increases nocturnal erectile activity: results of a prospective RIGISCAN study. J. Urol., 2000; 164:148.
37.
TerradasC., LevalleO., NagelbergA., et al.Sildenafil improves nocturnal penile erections in organic impotence. Int. J. Impot Res., 2001; 13:125–129.
38.
YamanO., TokatliZ., InalT., et al.Effect of sildenafil on nocturnal erections of potent men. Int. J. Impot Res., 2002; 14(Suppl 4):S10–S11. Poster 23.
39.
Padma-NathanH, McCulloughAR, GuilianoFet al. Postoperative nightly administration of sildenafil citrate significantly improves the return of normal spontaneous erectile function after bilateral nerve-sparing radical prostatectomy. J Urol, 2003; 169 (Supple) Abstract 1402.
