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Prostate Cancer Treatments & Sexuality

FAQs on risks and side effects

We’ll review in this article the most frequent asked questions pertaining to prostate cancer & sexuality

The most common treatments of prostate cancer are prostatectomy (surgical removal of the prostate) and radiotherapy (external irradiation of cancerous prostate).

The patient should be fully informed about risks and side effects of these treatments and how they might impact his sexual life. These include: libido issues, erectile dysfunction and ejaculation concerns. It is also essential to reassure the patient by exposing him the wide array of solutions that can limit these effects (we’ll cover these solutions through a future article).

Here are questions frequently asked by patients in relation with prostate cancer treatments:

 

What are treatments possible impacts on my libido?

Libido (or sexual desire) may be affected by physical and psychological consequences of the disease. Libido can be altered by possible side effects of prostate cancer treatments, but also by patient’s anxieties in this area that might have exist prior treatments implementation. Indeed, the announcement of diagnosis might awaken fears connected to cancer evolution and/or loss of erectile function, which altogether can reduce sexual desire.

The situation will have to be defused explaining the patient and his partner the importance of dialogue and necessity to leverage understanding & complicity in order to regain a blooming sexual life.

Consulting a sex therapist can be necessary in some situations.

 

Will I recover normal erectile function?

The possibilities to find a normal erection after surgery depend on the extension of cancerous tumor.

  1. In case of limited extension of cancerous tumor, the surgeon may preserve the nerves involved in the physiological mechanism responsible for erectile function: those nerves are covered by two neurovascular bundles (bundles localized on either side of the prostate). In such scenario chances of success are relatively good, as in 40 to 85% of cases, erectile function will be fully or partially recovered.

Post- prostatectomy, recovery of erections is usually progressive and occur within the two years following the intervention, spontaneously or after implementation of treatment.

 

  1. In case of locally advanced tumor, both neurovascular bundles must be sacrificed to clean cancerous lesions, as primary objective is to fully cure patient’s cancer. The recovery of a normal sex life will require patient to follow treatments as long as his sexual desire persists.

 

After Radiation therapy, the patient should expect the erectile function to gradually decrease throughout 2 years post-treatment (in 30 to 60% of cases, erection issues are reported 1 year after irradiation). But patient should be comforted by the fact +50% of patients will recover full or partial erectile capacity several years after the operation while solutions exist for other patients.

In all cases, the patient should be reassured since multiple treatments exist to overcome erectile problems by maintaining a sufficient rigidity of the penis to allow satisfactory sexual activity. These treatments will be detailed through a different article.

 

Will I regain normal ejaculations?

The operation definitively and irreversibly prevents the external ejaculation of semen, while erectile function can be recovered to maintain normal sexual life for the patient and his partner, ability to experience orgasm will be preserved.

Direct reproductive capabilities are definitely affected and other procreation methods should be preferred if patient plan to procreate, which rarely occurs at ages prostate cancer is diagnosed.

 

What are the treatment options to recover a normal sexual life?

Patient should be comforted since modern medicine progresses brought an array of solutions aiming to help the patient to recover a normal sexual life after cancer treatments. The success of these solutions is conditioned by couple’s readiness to carry out prescription received on the long term, understanding that psychological and physical efforts will be involved. These solutions will be discussed in another article.

 

How soon should I expect to recover a satisfactory sexual activity?

The recovery of sexual function may occur within a few weeks to 2 years after prostatectomy.

Recovery can take place spontaneously, although it usually happens after prescription of treatments that are not necessarily definitive, but adjusted throughout the medical monitoring on patient’s progress with erections rehabilitation.

These treatments should be instituted early after surgery, to prevent erectile tissues fibrosis that may compromise the quality of sexual rehabilitation final result.

For patients treated with radiation therapy, in the years following the irradiation, a gradual deterioration of sexual function might occur, with installation of erectile dysfunction accessible to treatments.

 

Some bibliographic elements:

Effects of cancer on sexuality (French)

http://www.ligue-cancer.net/sites/default/files/brochures/sexualite-cancer-homme.pdf

Erection and ejaculation issues (French)

http://www.ff3s.fr/v2/data/sante_sexuelle_au_masculin/masculin04.asp

Statistics on sexual life quality (French)

http://urofrance.org/science-et-recherche/base-bibliographique/article/html/etude-de-la-qualite-de-vie-des-patients-ayant-un-cancer-de-prostate-localise-traite-par-hifu.html

Prostate cancer treatment & impact on sexual activity (French)

https://books.google.co.il/books?id=hjqbyj2mfQEC&pg=PA104&lpg=PA104&dq=prostate+questions+sexualit%C3%A9&source=bl&ots=UUbzxQcKL_&sig=yUZKjig9Uun331LuY8TqURdRhaY&hl=fr&sa=X&ei=dG0ZVeqnPIP0asrmgfAO&ved=0CDsQ6AEwBTgK#v=onepage&q=prostate%20questions%20sexualit%C3%A9&f=false

Prostate cancer & sex life (English booklet)

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