Erectile dysfunction, commonly known as impotence, is the inability to produce or maintain an erection to satisfy sexual intercourse. Although prostate cancer is not a cause of erectile dysfunction, treatment of this disease can cause erectile dysfunction, such as prostatectomy, radiation therapy, and endocrine therapy.
Surgery
Surgical removal of the prostate (radical prostatectomy for prostate cancer) usually results in some degree of erectile dysfunction immediately after surgery, even with a nerve-preserving prostatectomy. The severity of erectile dysfunction depends on the type of surgery, the stage of the cancer, and the skill level of the surgeon.
If nerve-preserving surgery is taken, then the patient is likely to regain erectile function within the first two years after surgery. However, it is also possible for patients who have had a nerve-preserving prostatectomy to achieve a normal erection.
Vacuum erection devices or medications for erectile dysfunction can improve the quality of erections and can accelerate the return of normal sexual function.
If an erection can be accomplished after surgery, it also means that orgasm can be achieved. However, the orgasm may be a “dry” orgasm, meaning that there is only a minimal amount of ejaculation. Most patients will be infertile, and since most prostate cancer patients are older men, this may not be a concern.
Radiotherapy
Radiotherapy can also cause erectile dysfunction, and it usually starts 6 months after treatment.
Erectile dysfunction is the most common long-term complication of radiotherapy. However, its incidence is reduced when more complex treatments such as radioactive particle implants (brachytherapy), intensity-modulated radiotherapy (IMRT), or 3-D conformal radiotherapy are used.
Endocrine therapy
Erectile dysfunction and decreased libido may occur 2 to 4 weeks after endocrine therapy, due to medications that lower testosterone levels.