Radical prostatectomy is an invasive surgery that removes all or part of the prostate gland and often, surrounding tissues. The connection between prostatectomy and impotence exists because the cavernous nerves of the penis, which control erections run next to the prostate and are often damaged or destroyed during the surgery. This damage to the cavernous nerves results in inability to achieve or maintain an erection.
Prostate cancer is the second most frequently diagnosed cancer among men. It also is the second-leading cause of cancer related death among men around the world. With early detection, however, prostate cancer can be effectively treated and cured. Among the most commonly used treatment is surgery, or radical prostatectomy. Men who undergo a prostatectomy have a very high chance of surviving at least 15 years, but the procedure is often accompanied by unpleasant side effects, such as incontinence and impotence.
The most common surgical procedure for prostate cancer is the radical retropubic prostatectomy, in which an incision is made in the abdomen and the prostate is removed from behind the pubic bone. Another surgical technique is radical perineal prostatectomy. This involves an incision between the anus and the base of the scrotum. In this technique, the incision is smaller and there is less blood, but the surgeon’s ability to save the surrounding nerves is limited. Success rates for radical prostatectomy depend on how early the cancer is detected and can be about 98 percent if the cancer is confined to the prostate or 30-80 percent if the cancer has spread to surrounding tissues.
The connection between prostatectomy and impotence can be minimized by nerve-sparing surgery. Patients who have prostate cancer that is clinically unlikely to have spread beyond the prostate gland are often offered nerve-sparing surgery, which can reduce or eliminate post-operative incontinence and impotency issues. The success of nerve-sparing prostatectomy is highly dependent upon the skill and experience of the surgeon, as well as the age and previously existing sexual function of the patient.
Erectile dysfunction associated with prostate surgery can be temporary, but recovery to normal sexual function is slow. Most surgeons will not claim that patients will ever achieve the erectile function they had before surgery. It might take 18-24 months after surgery before the patient experiences an erection. A significant percentage of men experience permanent impotence.
Impotence refers only to the inability to achieve an erection that is rigid enough to have sexual intercourse. The connection between prostatectomy and impotence does not affect sensation in the penis or the ability to have an orgasm and experience sexual pleasure. Orgasms following prostatectomy are likely to be dry, or without ejaculation. This is because the prostate and seminal vesicles that produce ejaculatory fluid are removed during the prostatectomy.
Therapies and remedies to the problem of post-operative erectile dysfunction include medications, penile injections, vacuum devices and penile implants. These therapies are limited and can be inconvenient. It is recommended that couples participate in post-operative counseling to adjust to their new situation.
Brachytherapy is a newer prostate cancer treatment that completely avoids the prostatectomy and impotence issue. It is also known as internal radiation therapy. In brachytherapy, radiation sources, or seeds, are placed inside or next to the prostate. This provides a very high dose of localized radiation to the targeted area while sparing surrounding tissue. Brachytherapy is an increasingly popular prostate cancer treatment among men who have cancers that have not spread beyond the prostate.
The problem of impotence is eliminated by brachytherapy because the prostate and surrounding tissues are not removed, and there is no damage to the cavernous nerves of the penis. Men who are concerned about prostatectomy and impotence should ask their doctor about brachytherapy. No single treatment or combination of prostate cancer treatments is right for everyone. Patients should discuss their specific situation with their physicians to determine the proper course of action.