According to the American Cancer Society, prostate cancer is least common among Asian men and most common among black men, with figures for white men in-between. Prostate cancer occurs in 1 out of 6 men. Treatment options include: Surgery- Da Vinci Robotic or Laproscopic prostatectomy, radiation therapy, hormonal therapy, occasionally chemotherapy, proton therapy, or some combination of these.

As previously mentioned, in the process of removing tissue surrounding the cancer, surgery may damage nerve function or interrupt blood flow. Radiation therapy for prostate or bladder cancer also can permanently damage arteries.

Rates of ED post treatment of prostate cancer vary widely across the world. Although there are many new nerve-sparing techniques aimed at lowering the incidence of impotence I still see upwards of 60% of treated patients having a significant degree of ED. Temporary impotence is also associated with these procedures and recovery can be expected up to the first 18 months following the surgery.

A significant number (40%) of patients following radiation therapy will also develop erectile dysfunction, especially if pre treatment with hormone therapy has been prescribed. ED following radiation therapy usually occurs 6 to 12 months after the treatment and is due to blockage of penile arteries and decreased circulation of blood to the penis. More recently, erectile dysfunction after prostate radiotherapy may not be related to dose exposure, research indicates.

“Erectile dysfunction after external beam radiotherapy (EBRT) for prostate cancer is not related to the radiation dose administered to the crura (base) or penile bulb,” according to a study published in the International Journal of Radiation Oncology Biology Physics. Researchers “conducted a randomized dose-escalation trial of EBRT, comparing 68 Gy and 78 Gy doses in 96 patients.” Two years later, “researchers found that 36 percent of the patients…suffer[ed] from erectile dysfunction.” 

Treatment of ED after prostate cancer
In most cases, the degree of your ED will be determined by your age and if you had experienced partial ED prior to cancer treatment. Patients with decreased erectile function requiring treatment with a medication prior to the surgery are unlikely to recover function.  Patients with medical conditions affecting blood flow such as diabetes, high blood pressure, High cholesterol and heart disease are also less likely to recover the erections. The quality of the nerve sparing prostatectomy also plays a major role in determining potency. The more experienced the surgeon, the better. Older patients, over 65 years old, are more likely to have advanced ED.