Prostate cancer and erectile dysfunction

For anatomical reasons, diseases of the prostate and their treatments can lead to erectile dysfunction. The main risk is the achievement of bands involved in the neurovascular mechanism of erection.
 
Located around the urethra, the gland interferes with the evacuation of urine when it begins to take pathologically volume. Sometimes it reveals its presence in a sometimes painful but in most cases the disease remains asymptomatic for a long time. It is usually discovered after routine screening performed on the proposal of the general practitioner when men approach middle age. The examination consists of a rectal examination and a blood assay of specific markers (PSA). The diagnosis must then be confirmed by an ultrasound and biopsy if necessary.

Prepare psychologically

As often, the more the disease is detected early, the chances of full recovery are important. The stage at which cancer of the prostate is found also determines the salary to be used. Given the impact on the sexual life of the patient, the physician must provide information "clear, fair and appropriate" as the expression goes by the code of medical ethics. Adverse events should be communicated to the patient so he can take his decision knowingly.

The issue of counseling and medication should be discussed even before the treatment has begun. There are three ways to treat prostate cancer: complete removal, radiotherapy and hormone therapy.

Prostatectomy radical

The total removal of the prostate and seminal vesicles resulted so far of erectile dysfunction in the vast majority of cases. Numerous studies have reported dysfunction in 33 to 98% of patients after radical prostatectomy1.

But in recent years the use of laparoscopy (or laparoscopy) preserves the essential bands neurovascular erectile mechanism. The team of Urologic Surgery Hospital Henri Mondor, Créteil2 reported in a scientific journal of his experience one year after completion of the preservation of erectile function for 56% of 134 patients. The results were more satisfactory than the preservation of the strips was bilateral.

Radiotherapy

Speaking to men whose tumors are small, treatment with less radiation reaches the mechanism of erection. However, sexual problems in moderate and severe erectile dysfunction full affect 21 to 61% of patients in various studies1. This depends, however, the patient's age, quality of tumescence sex before radiotherapy and duration of treatment.

Hormonal Treatments
Hormonal treatments are for men whose prostate cancer is not localized. They are generally unpopular because assimilated to a kind of "chemical castration" with all the implications and psychological self-esteem for the man. Professor Rousseau of the University of Laval in Quebec interviewed 44 patients treated with hormonal therapy for prostate cancer advanced3. Before treatment 80% reported having at least one report a week. With treatment, there were only 18% continue to have sexual activity while 70% reported a decline of interest in sex.

Brachytherapy, cryotherapy and ultrasound
For these three techniques, the number of study is less important because of their relative novelty. Thus, the consequences vary considerably. Brachytherapy proposed in some centers, is implanted in the prostate of the radioactive seeds are supposed to destroy cancer cells.

The U.S. studies published on the consequences of this technical report of erectile dysfunction in 13 to 39%1 men. Moreover, we note that persons who have undergone treatment are more frequently victims of erectile dysfunction4.

Cryotherapy and treatment by focused ultrasound treatments are being evaluated. However, early studies report high rates of erectile dysfunction for cryotherapy (80 to 98%).

The ultrasound treatment would bring rates lower (around 60%), according to Dr. Albert Gelet of Urology and Transplant Hospital Edouard Herriot in Lyon, we had questioned. But further studies are needed before this technique can be officially recommended.

 

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