Imaging Prostate Cancer
Posted: Nov 01, 2018
POSTED: February 19, 2020
Philip G. Pearson, M.D., is an urologist with City of Hope in Pasadena, California.
Prostatepedia spoke with him about erectile dysfunction after surgery.
Why did you become a doctor? What attracted you to medicine in the first place?
Dr. Philip G. Pearson: I fell into it. I found that I had a talent for math and sciences. I applied to medical school and got in. It seemed to be a good match for me. I wanted to get into a good profession where I could make a difference. This seemed to open up for me.
Have you had any patients over the years whose cases changed how you view your own role or the art of medicine?
Dr. Pearson: I would say there isn’t any one particular patient or case that stands out. Rather, just the collective of years of practice, and of dealing with patients and families has changed my view. Helping people when they’re in real need and don’t know which way is up and what to do. They get different opinions and misleading information. To give them guidance and help them along their path is
rewarding. Ultimately, we develop a relationship. Especially those patients I’ve seen over a long period of time, it’s certainly nice to have them come back and update us as to their progress on how they’re doing.
How common is erectile dysfunction (ED) after a radical prostatectomy?
Dr. Pearson: It varies. It depends on a lot of different factors. Some of them are related to the patient. Some of them are related to the cancer. Some are related to the surgery.
For example, for patients coming into surgery who already have problems with erectile dysfunction, having a radical prostatectomy is not going to help things. It’s going to be tougher for them on the other side.
Whereas for patients who come through and say they have no problems before surgery, the percentage of maintaining that potency after surgery is greater.
The other factors have to do with the cancer. If it’s a more aggressive or advanced cancer, then that’s going to be more difficult to bounce back from as opposed to very early stage low grade cancer.
Then in terms of the surgery, whether the surgeon can perform a bilateral nerve sparing procedure or whether the surgeon has to go wide if it’s a very aggressive or advanced cancer, then that’s going to affect the rate of potency after surgery as well.
Does it make sense for a man to discuss
the potential risk of ED with his surgeon before a radical prostatectomy? What kinds of questions do you suggest he ask his urologist?
Dr. Pearson: I think it’s essential to talk to your surgeon prior to surgery about erectile dysfunction. It has to be done. It’s one of those factors that is going to be affected by the surgery. Even in the best-case scenario, it’s going to have some effect on erectile dysfunction. Hopefully, the patient regains their function, but it has to be something that you have to focus on and coordinate with.
Sometimes it’s a bit of an awkward conversation to have between the surgeon and the patient. I think that if you address that upfront prior to surgery, then you break down those barriers so that when you’re in your post-op visits, the surgeon can say, “Remember when we discussed sexual function? How are you doing in that department?” It’s a much easier way. If you get it out of the way up front, then you can circle back to that much more easily.
In terms of what questions you should ask, you should ask what type of surgery you’re getting. Are you getting a unilateral nerve sparing procedure or a bilateral nerve sparing procedure? What does the surgeon think your rate of maintaining potency after surgery might be?
Is there anything a man can do before surgery to prepare himself for the potentiality of dealing with ED after surgery? Is there any kind of prehabilitation?
Dr. Pearson: I think you’ve hit on a hot topic these days in terms of preparing for surgery. Traditionally, we always just go in and have surgery. Then you rehab from surgery. Now, more and more surgeons are focusing on prehabilitation . In other words, optimizing the patient prior to surgery. This can be a whole range of things. There are some obvious things like smoking cessation, diet, and weight loss. Exercise as much as you can.
Generally speaking, I tell my patients to get in the best shape that you can
prior to coming into surgery. Think of it like an athletic event or something
that you have to train for. Don’t start bad habits. Keep up with your good habits. There has been more and more research on prehablitation in terms of optimizing your immune system. There are different drinks and supplements that can be used prior to surgery that at least theoretically optimize and strengthen your immune system prior to going into surgery. Hopefully, that will optimize your outcomes on the other side.
What kinds of treatments are most effective for men dealing with ED after surgery, as opposed to those who are dealing with ED after radiation treatments?
Dr. Pearson: Rehabilitation of sexual function after surgery has to start relatively soon after the procedure. We like to get these discussions going pretty quickly after surgery. There is a use it or lose it phenomenon with erectile dysfunction. If you just avoid the topic and don’t talk about it and don’t do anything about it for six months after surgery, then you’re going to have a harder time getting back your sexual function.
Start early after surgery. The treatments run the gamut from medication, such as the phosphodiesterase inhibitors like Viagra or Cialis, to vacuum pump devices, which are really effective. There are injection therapies to penile implants that can really work very well for almost anyone with even the most severe erectile dysfunction.
Do you have any advice for men who are either anxious about the possibility of ED after surgery, or who are already struggling with ED?
Dr. Pearson: Know that there are treatments out there. You can correct
this problem. I think it’s also important to keep your focus on the fact that this
is a cancer operation. We’re doing this first and foremost to save your life and to treat the cancer. Some of those treatments will have side effects in terms of sexual function.
Get rid of the mystique of ED and talk to your physician about it. Get on some sort of treatment, whatever you think would be a good starting place. Keep in mind, if that’s not working, we have lots of other options that we can move up to get you into a more suitable pattern of sexual activity.