Senior Couple in bed

Consequences of prostate cancer treatment on patient’s sexual life

Prostate cancer treatments can impact sexual life of patient, affecting to varying degrees of severity their libido, erectile function & ejaculation capacity. These medical issues can be accessible for treatments and will be addressed through another article.

 

Main treatments and their effects

Prostate cancer is the most common men (+50 aged) cancer in France with 70.000 cases and 9.000 deaths annually. Healing chances remain high when cancer is treated early.

There are two main curative treatments indicated for localized cancers:

Prostatectomy, most frequently proposed treatment; it consists in removing prostate and seminal vesicles (glands leading into the prostate, responsible for liquefying semen).

Radiation therapy uses x-rays to kill cancer cells in the prostate. It may be external beam radiation or interstitial brachytherapy which consists of ionizing radiation using radioactive material placed inside the prostate.

Sexual function is usually evaluated before offering these treatments. Thus, it appears that more than a third of patients are already facing difficulties in their sexual life.

These difficulties can be related to aging, vascular risk factors, psychological problems or can be consequences of other treatments (relating to other medical issues)

Prostate cancer treatments may alter the patient’s sex life, including their libido, the strength of their erections or their ejaculation capacity, but an appropriate care can limit such effects.

 

Libido issues

Sexual desire, or “libido”, is usually refers to as attraction felt for the partner and interest for sexual relations. The libido is likely to be affected by physical and psychological consequences of the illness as well as treatments involved.

The psychological consequences thereof together with difficulties & interruptions of sex life require the couple to engage in dialogue efforts, understanding, complicity and, where appropriate, consultation with a sexologist.

 

Erection issues

prostate modern anatomy

Prostate anatomy with neurovascular bundles

P: Prostate

Rec: rectum

LPF: prostatic fascia

LA: levator ani muscle

PF: pelvic fascia

BVN: neuro vascular bundle

 

 

 

 

 

 

 

After Prostatectomy

Sexual disorders depend on the extent of the cancer.

1st case: the cancer isn’t too extensive, the surgery may save the nerves involved in the physiological mechanism of the erection, preserving the two neurovascular bundles covering them (bundles localized on either side of the prostate), or at least one of the two bundles. In this case, the erectile function is recoverable in all or part:

  • Fully recovered for 75-85% of patients when preservation of 2 bundles was successful
  • & for 40-70% of patients in case of unilateral preservation.

However, the recovery of erections is not only conditioned by nerve preservation. The vascular modifications – arterial and venous – induced by prostate & seminal vesicles dissection may also participate in erectile difficulties since the erection is a complex physiological process: erection remains a vascular mechanism, neurologically commanded that must occur in a specific hormonal climate.

The “rehabilitation” of sexual function takes place usually within two years following the prostatectomy. First reappearance of weak erections is seen within first weeks/months post ablation.

Thereafter the patient will gradually recover erectile function and sexuality enjoyment spontaneously or with the help of treatments.

 

2nd case: the cancer has spread: both neurovascular bundles must be sacrificed to clean cancerous lesions while negative surgical margins are set in hope to fully cure patient’s cancer.

This need for wide excision does not necessarily mean the abandonment of any sexual life. If the couple shows an high motivation, urologist will be able to advise proper treatments overcoming these problems.

In overall, despite erection issues spot in 30 to 80% of post-operative patients, at least 80% of them can recover erectile capacity (with or without treatment) compatible with a satisfactory sexuality.

 

After external radiotherapy, or brachytherapy

The X-rays administered to the prostate and penis bulb (at its base) may alter erectile nerves contained in the neurovascular bundles, and also the blood vessels.

Erectile dysfunction depend on radiation doses administered as well as on patient’s sexuality before surgery and his age.

Unlike surgery, where erectile dysfunction is faced in the aftermath of the intervention (but where possibilities of sexual function recovery occur within two years after prostatectomy),irradiated patients don’t necessarily face sexual issues at the end of treatment. However, disorders can be faced months after and subsequently increase during next years after treatment ended.

From 30 to 60% of patients (upon X-ray doses administered) face erectile dysfunction 1 year after irradiation.

Overall nearly half of patients will keep all or part of their erectile capacity few years after irradiation.

For others, the urologist can advise treatments that should overcome these problems successfully.

 

Ejaculation problems

Post Prostatectomy

The surgery removes definitively and irrevocably external semen ejaculation but

erections capacities are in most cases recovered to help the patient and his partner coming back to normal sexual life while capacity to experience orgasm isn’t altered.

Direct reproductive capabilities are definitely affected and patient who wish to extend their family should choose other methods; this remains rare at ages prostate cancer usually occur.

Semen is composed of secretions produced by testicles (sperm), by seminal vesicles and by prostate.

 

Further to radical prostatectomy surgical intervention, the prostate as well as seminal vesicles are entirely removed. Since canals responsible for carrying sperm are cut, it is easy to understand why sperm ejaculation is not possible after prostatectomy.

Disappearance of sperm is different from retrograde ejaculation observed after benign prostatic hypertrophy surgery (a different surgery not to be confused with radical prostatectomy for cancer)

Benign prostatic hypertrophy surgery expands the bladder neck and it can therefore no longer be closed during ejaculation: this led to semen expulsion into the bladder instead of outside the penis.

 

After radiotherapy

Since external beam radiation or brachytherapy deliver high doses of radiation right into the prostate, ejaculation disorders may occur with varying degrees of severity: reduced amount of ejaculation fluid, disappearance of ejaculation, painful ejaculation, deterioration of orgasm quality.

Information to patients with localized prostate cancer should consider the andrology dimension as a whole (including ejaculation and orgasm) and shouldn’t limit itself to the only erectile function.

 

Some bibliographic elements:

 

http://www.e-cancer.fr/cancerinfo/les-cancers/cancers-de-la-prostate/la-sexualite

http://sante.lefigaro.fr/mieux-etre/sexualite/prostate-sexualite/quest-ce-que-cest

Cancer and sexual life (French):

http://www3.ligue-cancer.net/files/national/article/documents/bro/sexualite_homme.pdf

Prostatectomy effects (French):

http://www.cancer-de-la-prostate.fr/comprendre-cancer-prostate/sexualite-risque-operatoire-cancer-prostate.html

http://urofrance.org/lurologie-grandpublic/urologie-expliquee-aux-patients/interventions-urologiques/prostatectomie-totale-flash.html

Radiotherapy effects (French):

http://urofrance.org/lurologie-grandpublic/urologie-expliquee-aux-patients/interventions-urologiques/curietherapie-prostatique-flash.html

http://www.e-cancer.fr/cancerinfo/les-cancers/cancers-de-la-prostate/la-radiotherapie-externe/les-effets-secondaires

Impact on sexuality:

http://prostatecanceruk.org/media/1689186/prostate-cancer-and-your-sex-life-booklet.pdf