Prostate Cancer and Impotence
It could be one of those random quiz items – what do Robert de Niro, Rudy Guiliani, Nelson Mandela, Arnold Palmer, Harry Belafonte and Colin Powell have in common?
The answer is that all of them have had prostate cancer, been treated in a variety of ways, (from surgery to radiation to hormone therapy), survived to tell the tale and with a couple of exceptions (mainly de Niro) have been willing to talk publicly to encourage other men to get tested.
In Rudy Guiliani’s case that openness included acknowledging the issue that is still only reluctantly discussed by many men when facing up to prostate cancer – impotence as a possible side effect of treatment.
During divorce proceedings in 2001 Mr Guiliani said he had been impotent for a year as a result of his prostate cancer treatments (hormone therapy followed with radiation in implanted pellet form and 25 external radiation treatments).
Outcome Can’t Be Predicted
Temporary or permanent impotence can affect up to 70 per cent of men with prostate cancer, and doctors says as of now there is no way to determine who will be affected or for how long after treatment. Even in the best conditions, 10 per cent of patients may be impotent afterwards.
Andrew Penman, chief executive of the Cancer Council of NSW, (Australia) says doctors who suggest testing younger men PSA levels to identify possible cancers must also tell them at the first interview about ”flow-on issues.”
It very much depends on a range of factors including the size and aggressiveness of the tumor, the patient’s age, lifestyle, and overall health, and the treatment option chosen.
Treatment Options & Risks
- Hormonal therapy – Testosterone is either reduced or its uptake blocked. Erectile dysfunction and a loss of desire usually occur after two to four weeks of treatment.
- Surgery – The prostate and surrounding cancerous tissue are removed. If nerve-sparing surgery is used, erectile function can return within the first year. Recovery of erectile function after a non-nerve-sparing surgery is unlikely, but possible.
- Radiation – The tumour area may be blasted with external beam radiation, more tightly targeted for proton radiation, or implanted with radioactive pellets for continuing therapy. ED is the most common complication and usually occurs six months after treatment.
- Observation – Often called “watchful waiting,” this strategy may be appropriate in some cases where disease progression is slow.
How Effective Are Oral Erectile Dysfunction Drugs?
- Following surgery Web MD reports that as many as 60 to 70 per cent of men who have had nerves spared on both sides of the prostate will regain erections. Results are less favourable for men who have had a single nerve spared or no nerves spared.
- Following radiation therapy Overall, 50 to 60 per cent of men regain erections with Viagra following radiation for prostate cancer. However, current data are rather limited, especially for patients treated with radioactive seed implants.
- Hormone therapy Specialists at the Cleveland Clinic find that men treated with hormone therapy do not respond well to any erectile dysfunction treatments, including Viagra, but data are limited.
Can I Use Herbal Supplements?
There is continuing research into natural ingredients that may be of benefit for prostate health, including saw palmetto and the tomato-based active substance lycopene. Tribulus terrestris in herbal supplements like Herbal Ignite is NOT recommended without doctor’s approval because it stimulates testosterone levels which may be counter-productive to treatment.
Prostate cancer survivor Jim Tucker’s Prostablog contains a comprehensive section on natural ingredients and therapies which is regularly updated.