Sex after Prostate Cancer or BPH

There is no way to sugar coat it. If you are diagnosed with any form of prostate disease you will experience some type of erectile dysfunction, even if it is a surgical procedure using the nerve sparing technique.

There is no need to repeat thetreatments mentioned elewhere, but let’s take a moment to review some of the possibilities that are available to men AFTER being diagnosed with prostate disease who experience erectile dysfunction:

    There are now numerous erectile dysfunction drugs (EDDs) available. These drugs promote erections by increasing blood flow to the penis.

    There is a substance called Prostaglandin E1 that can produce erections. It is produced naturally and can be injected almost painlessly into the base of the penis before sex.

    A penile implant or prostheses can restore an ability to achieve an erection.

    There are vacuum devices that are designed especially to create an erection by placing around the entire penis before sex.

While erectile dysfunction will most likely begin immediately following surgery for prostate removal, if the technique of nerve sparing is used there is a possibility of recovery within a year of the procedure. If non-nerve sparing is used the recovery of erectile function is highly unlikely.

Chemotherapy for Prostate Cancer

While chemotherapy is an aggressive approach, according to the medical community it is not necessarily effective as a choice to fight the slow growing prostate cancer cells.

This does not mean that it should be ruled out entirely. New anti-cancer drugs are always being studied and released. There are a few currently under study that are being included surgical or radiation therapy in men at Stage III prostate cancer.

Another study includes them in the regimen along with hormonal therapy. This is specifically being used for men with advanced cancer that is not responsive to hormonal therapy by itself.

Early Hormonal Therapy

Just as the name signifies, this is the practice of starting hormonal therapy immediately upon the diagnosis of prostate cancer. The goal is to slow the growth of cancer cells that have grown beyond the prostate and into surrounding tissue and even the lymph nodes. Sometimes early hormonal therapy helps in shrinking the tumor.

Cryosurgery for Prostate Cancer

This process is used to kill prostate cancer cells by freezing them. Similar to the tiny radioactive seeds delivered through thin needles that we discussed previously, rather than seeds liquid nitrogen is passed through thin probes that are passed through needles that have been passed through the perineum directly into the prostate.

The liquid nitrogen will form a ball of ice from the cancer cells and as the frozen cells thaw out they break up. This procedure will take a couple of hours under anesthesia which can be either local or a spinal and a 1 or 2 day hospital stay.

There is a downside to this treatment. Even though a “warming catheter” is inserted into the penis to protect the urethra, the overlying nerve bundles usually freeze as well rendering the man impotent.

Hormonal therapy for Prostate Cancer

For cancer spread beyond the prostate, in this situation the localized therapies just won’t be enough to stop the growth. This is Stage III and radiation therapy will most likely help by keeping the tumor in check. Radiation combined with hormonal therapy will help to slow the growth.

With hormonal therapy, the goal is to cut off all production of male hormones, such as testosterone, resulting in castration. Castration can be surgical or medical but the end result is the same and for good reason. Prostate cancer cells can actually “feed” on male hormones causing them to grow. Blocking the hormones with an antiandrogen (drugs that block male hormones from circulating in the blood) will slow the growth of the cancer cells. This process is the equivalent of a medical castration.

There are numerous approaches to the use of hormonal therapy. Different drugs have been combined to test the results. An example of one such combination is known as maximum androgen blockade. This is a total hormonal therapy usually combined with either surgical or medical castration. An antiandrogen pill is ingested each day for months or years.

Internal Radiation Therapy for Prostate Cancer

Internal Radiation Therapy is a procedure that delivers a very high dose of radiation to tissue in the immediately affected area and minimizes the damage to healthy tissue like the rectum and the bladder.
This is accomplished by inserting dozens of tiny seeds that are radioactive directly into the prostate gland. The therapy depends on ultrasound or CT that guides placement of very thin needles through the skin of the perineum.

The needles deliver the tiny seeds (made up of radioactive palladium or iodine) directly into the prostate using a pre-determined, customized pattern created by extremely sophisticated computer programming. This high tech process allows the needles and seeds to directly conform to the size and shape of each prostate.
This procedure is normally completed in just an hour or two. It is done under a local anesthesia and the patient goes home the same day.

Radiation is emitted from the seeds for up to several weeks. Once insertion is complete, the seeds remain in place causing no harm whatsoever.

Some physicians use a different approach. They will use a more powerful radioactive seed and implement over several days. These are temporary implants. This procedure requires hospitalization and may be combined with low doses of external beam radiation.

Prostate Cancer – External Beam Radiation Therapy

Radiation therapy consists of using very high energy x-rays. They are delivered by an external beam from a machine or actually implanted in the prostate to kill cancer cells. This treatment can also be used to treat men whose cancer tumors have advanced into the pelvis and can’t be removed with surgery if they have no indication of lymph node invasion. Radiation therapy can also reduce tumors and relieve pain for men who have advanced disease.

External beam radiation therapy treatments are usually conducted 5 days a week for up to 6 or 7 weeks. The treatments are painless with each session lasting just a few minutes. Sometimes, if the tumor is extremely large, hormonal therapy may begin during the radiation therapy and can continue for several years.

Hormonal therapy prevents cancer cells from receiving the hormones that feed their growth. In prostate cancer, male hormones are blocked with hormonal drugs or by surgically removing the testicles.

The prime target of the external beam radiation is the prostate gland itself as well as irradiating the seminal vesicles as they are a common area of cancer spread. It was once believed that irradiating the lymph nodes in the pelvis was necessary, but the long term benefits have proven that this only applies to certain situations.

Surgery for Prostate Cancer

Surgery is an invasive procedure. There is evidence that surgery for prostate cancer is rampant in the United States with an increase of 60% between 1984 and 1990. Contrast this with the Watchful Waiting approach used in Europe for the same stage prostate cancer. Recent studies, however, do show a decrease in the number of men having radical prostatectomy procedures.

While the medical community would like to see more incidence of the Watchful Waiting approach, patients find the approach too stressful.

Let’s discuss the actual surgical procedure. It is called a radical prostatectomy and is the complete removal of the prostate as well as tissue nearby. The procedure can be further described by the incision used to accomplish the procedure. These incisions are:

    Retropubic prostatectomy. The prostate is reached via an incision in the lower abdomen;
    Perineal prostatectomy. The prostate is reached via an incision in the perineum which is the space between the scrotum and the anus.

Radical prostatectomy consists of removing the entire prostate gland, the seminal vesicles, both of the ampullae (the enlarged lower sections of the two vas deferens which are the tubes that carry sperm from the testicles to the actual prostate gland) and the other surrounding tissue. The portion of the urethra that travels through the prostate is cut away as well as the bladder neck and some of the sphincter muscle that controls urine flow.

Treatment Options for Localized Prostate Cancer

In this situation you are looking at Stage I or II based on the Gleason Score. In this particular scenario, you are looking at three different choices of treatment for treatment that can result in long term survival.

One is called Watchful Waiting; one is Surgery; and finally Radiation. Let’s explore each of these options further.

Watchful Waiting

Watchful Waiting is the term coined by the medical community to describe an approach for managing cancer that has not yet moved beyond the prostate gland. This approach is also known as “observation” or “surveillance.”

Because cancer in this stage advances very slowly there is the possibility that it will not cause any lifetime problems. This is especially true of older men. Men who opt for this approach do not participate in any active treatment without cause. They visit their physicians for monitoring but unless a problem arises they have no other treatment.

If there are no indications of infection, kidney or bladder damage this can be a reasonable approach. Other obvious advantages to this approach are sparing the man pain and potential side effects related to surgery or radiation.