Hi, I'm Dr. Scholz. Let's talk about prostate cancer.
In this video, we're going to talk about erectile dysfunction caused by treatment for prostate
cancer. Talking about impotence like it's a black and white issue—either you have
it or you don't—is not always an accurate representation of some of the problems that
need to be dealt with.
When you're talking about treatment for prostate cancer, we're usually talking about radiation
versus surgery. More recently, we're also dealing with types of treatments called focal
treatments. If you look at the risk of erectile dysfunction occurring after treatment, it's
going to be lowest with focal treatments. The next echelon of risk is going to be with
radiation type treatments. And the most common problems with erectile dysfunction occur in
men who have surgery.
One thing that is sometimes overlooked is that men who have surgery all get erectile
dysfunction immediately after treatment, and then a percentage slowly recover over time.
Men who undergo radiation typically don't get erectile dysfunction immediately, but
over a period of a year or two, the problem can develop. This difference in timing can
have a major impact in some secondary issues related to sexual function. Long periods of
time without getting erections, such as [though that] occur after surgery, can cause atrophy—loss
of the size of the erection—and a problem with Peyronie's disease, which is a condition
where men get scar tissue in the penis. Erectile atrophy and Peyronie's disease are both more
common problems that occur after surgery compared to radiation or focal therapy.
People that are in the mix of a scary decision about prostate cancer sometimes aren't completely
counting the cost of what it's like for a man to lose his sexual potency. They're just
worried about saving their lives and sex has been put on the back burner. But as people
get educated about prostate cancer, they're going to learn that many types of prostate
cancer aren't that threatening and their lack of attention to these issues is an unfortunate
situation. People do need to consider the potential psychological implications that
impact a man's identity if he loses the ability to get erections. Sexual function can continue
in the presence of impotence. Sensation of the penis is usually maintained.
When I first got started in taking care of men with prostate cancer my assumption was
that many men would adapt to the inability to get an erection and develop other forms
of sexual activity. I later discovered through experience that that is usually not the case.
Most men equate potency and manhood with the ability to get an erection and the vast majority
of men that I encounter withdraw from sexual activity when they can no longer get an erection.
Whenever you're discussing sexual function after any type of treatment, sometimes men
are not communicated the fact that they're going to have dry orgasms. The prostate gland
makes the majority of the semen, so if you radiate it or remove it surgically, the majority
of men will have dry orgasms. And this can change the quality or the character of the
sexual experience. Often times, men adapt to this very well, but if they're not informed
in advance it's quite a shock to people.
In a previous video, we mentioned that in the prostate cancer world people who can get
an erection by taking Viagra or Cialis are in statistical studies not considered to have
impotence. If men can get any sort of a serviceable erection after treatment with Viagra or Cialis,
they're not considered impotent. So this is very important to consider when doctors are
quoting different risks for the development of impotence, that in the back of their minds
they're assuming that you will be taking Cialis or Viagra to try and restore normal sexual
function, and that's included in the percentages that are being presented to you.
The statistics that are quoted for a 50-year-old man developing problems are much much less
than say a 65 or 70 year old. In people who are already taking Viagra or Cialis, those
individuals are much more likely to develop with erectile dysfunction than those that
don't need it. Not everyone is the same, and the risk of erectile dysfunction escalates
dramatically as men get older.
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