In September, Prostatepedia is talking about erectile dysfunction after treatment with Drs. Mohit Khera, John Mulhall, Arthur Burnett, and Jean-Francois Eid. We also talk with Kathie Houchens, the wife of a prostate cancer patient, and Paul Nelson, the man behind online support group franktalk.org.
This month, we’re talking about erectile dysfunction (ED) in men with prostate cancer. The three major prostate cancer treatment tools—surgery, radiation, and hormonal therapy—all result in serious sexual dysfunction in a majority of men. And ED treatment options each pose serious issues with side effects, effectiveness, and cost.
Viagra and related drugs can be helpful for many men. There is extensive medical literature that supports using these drugs after surgery or radiation. Most medical oncologists do not focus on sexual function. I think this may, in part, explain why we do not have well-established programs to counter sexual dysfunction in men on hormonal therapy. With that in mind, I thought it might be worthwhile to mention what has worked in my clinic.
Hormonal therapy can cause severe ED. As a result, the Viagra drug family often does not pose sufficient activity to facilitate vaginal penetration. Fortunately, two drugs have been shown in randomized trials to significantly improve the effectiveness of Viagra. The first drug is losartan, a blood pressure drug that blocks angiotensin, a hormone that causes blood vessels to contract. By blocking the action of angiotensin, losartan causes blood vessels to relax. As erections require relaxation of the arteries to the penis, the benefit of losartan is obvious.
Cabergoline is the second drug that has been shown to improve the effectiveness of Viagra. Cabergoline is a long-acting, very potent dopamine agonist that has been shown to act as an aphrodisiac in both men and women. A randomized trial comparing Viagra alone to Viagra in addition to cabergoline showed improved sexual performance in the cabergoline arm.
While there are a range of other treatment options for men who have been on hormonal therapy and for whom Viagra is not sufficient, I have seen the most success with penile injections and penile implants. Both approaches have a high success rate in our patients, but many men are reluctant to inject their penises and even fewer have elected to get a penile implant. However, those patients who have elected to get penile implants have been very satisfied with the result.
As one patient said, “I push a bulb in my scrotum and I get an erection. It stays up until I push a second time. I wasn’t that good at 17!”
The bottom line? Talk to your doctor about erectile dysfunction after treatment.
Patient Conference: Sept 9-11 in LA
Dr. Snuffy Myers talks further about CT scans and cancer risk.