This information has been reprinted courtesy of the Erectile Dysfunction Information Center (www.erectile-dysfunction-treatment.org) for personal use only.

Prostate cancer and surgery can cause impotence

To get an erection, you need the healthy blood vessels and nerves that control blood flow to your penis. Damage to these blood vessels and nerves can cause erectile dysfunction (ED), or impotence. When you have ED, you cannot get or maintain an erection that is firm enough for sexual intercourse.

Damage can be done by disease such as diabetes, injury, or surgery. Prostate cancer, surgery, and some other treatments for prostate cancer are high risks for ED.

What is the prostate?

The prostate is a gland located just below the bladder. It surrounds the urethra, which is the tube running from the bladder through the penis that enables you to urinate.

The gland is about the size of a walnut. It produces fluid that becomes part of semen.

Prostate Cancer

Prostate cancer occurs when cells in the prostate gland grow into a tumor. The tumor can grow across a blood vessel. The blood supply added by this vessel helps the tumor grow larger.

Who gets prostate cancer?

• Men over 65 have more than 75% of prostate cancer. The disease is most common over the age of 50 but can appear at any time.

• African Americans have a higher rate of prostate cancer. They are twice as likely to die from prostate cancer as white males. Clinical studies show that African Americans males do not see a physician as often as white males.

• The risk of prostate cancer is up to three times greater when a man has a first-generation relative with prostate cancer. The risk is six times greater when a first- and a second-degree relative both have prostate cancer.

How prostate cancer and treatment cause impotence

To the left is an MRI image of a prostate cancer tumor. A cancerous prostate gland may interfere with blood flow and nerve impulses to the penis. That can cause ED. In fact, impotence can be one of the signs of prostate cancer.

If aggressive treatment for prostate cancer is necessary, the choices often come down to two options. One choice is radical prostatectomy. This is an operation that completely removes the prostate. The other option is radiation therapy that effectively reduces or kills the cancer cells.

Advances in cryotherapy—the use of very low temperatures to destroy cancerous tissue—make it an attractive alternative. It is a much less invasive procedure than prostatectomy.

The choice of treatment depends on the individual, his disease, and his doctor. It is most important to remove the cancer. However, both prostate removal and radiation have a high risk of causing erectile dysfunction.

A radical prostatectomy (RP) can harm or destroy nerve bundles surrounding the prostate that help control an erection. During an RP, a surgeon sometimes can save some or all of these bundles. This can help prevent permanent ED. But there is no guarantee.

Whether surgery causes ED also depends on age. Younger men able to get firm erections before surgery are more likely to avoid ED after surgery. But 50-80% of men who have a radical prostatectomy become impotent. And even if the surgeon can spare all or part of the nerves, the trauma may cause some degree of impotence for the first year after surgery.

Many urologists feel that if satisfactory erectile function does not return within twelve months after surgery, the current level of ED is probably permanent.

Radiation therapy treats early prostate cancer by destroying cancer cells.

Older men often choose radiation treatment because it may cure or slow their cancer and increase life expectancy, or because they are not a good candidate for surgery. Radiation treatment also is an alternative for men with smaller tumors or a physical problem that prevents surgery, such as heart disease.

Radiation can cause impotence. It can damage arteries that carry blood to the penis. It can also cause scar tissue near the prostate that reduces blood flow to the penis.

Impotence as a result of radiation therapy may not be as immediate as with surgery. The problem may occur many months or even years after the treatment.

In addition to radical prostatectomy and radiation therapy, there are other kinds of treatment for prostate cancer. These often depend on the circumstances of the cancer. And like surgery and radiation, they can cause erectile problems.

You don't have to live with ED caused by prostate cancer

There are many treatments available for impotence. Today, doctors are successfully treating more men than ever. Viagra and other drugs, penile implants, vacuum erection devices, injection therapy, and urethral suppositories are options.

Viagra increases blood flow to the penis. Many men find it effective. However, Viagra fails for 30% - 40% of men who try it. Also, clinical data shows Viagra's effectiveness for a radical prostatectomy patient to be quite low.

Men who have not had success with Viagra should seek other treatments. Among available treatments, a penile implant often is the most effective long-term solution as well as the best choice for maximum sexual spontaneity.

Implants have been enhanced and perfected over a period of 25 years. Nearly 300,000 men have had a penile implant. Clinical studies show a very high degree of satisfaction with penile implants.

If you have ED related to prostate cancer or its treatment, see a doctor (usually a urologist specializing in the treatment of ED. Work with the doctor and your partner to determine the best treatment for you. There is a very good chance you will find a treatment that will help you achieve a firm erection.

Click here for more information about treatments for erectile dysfunction. For detailed information about prostate cancer, visit the Prostate Cancer Institute.

This page revised March 2005

Copyright 2005 Erectile Dysfunction Information Center. All rights reserved. This site contains information about erectile dysfunction (impotence) for men with ED and their partners. Nothing in this site may be reproduced without written authorization from the Erectile Dysfunction Information Center.