Is Erectile Dysfunction a Sign of Prostate Cancer?

Erectile dysfunction (also called ED or impotence) is the inability to maintain or develop an erection. Although ED is not directly caused by prostate cancer, it can develop after many of prostate cancer’s common treatment options, including radiation therapy, surgery (such as radical prostatectomy), and hormone therapy. Different treatment options carry varying probabilities of developing ED, as well as varying statistics on the possibility of the newly developed ED reversing itself overtime. There are three main categories of treatment to manage ED, including medications, mechanical devices, and surgery.

Medications for erectile dysfunction

The two main classes of ED medications include orally administered phosphodiesterase-5 (PDE5) inhibitors (including Viagra, Levitra, Stendra, and Cialis) and injectable or urethral suppository (pellet) versions of alprostadil. Although both of these medications are very different in administration, they both share similar underlying mechanisms of action: to act as vasodilators.

Vasodilators relax smooth muscle cells allowing blood vessels to expand. When blood vessels are allowed to expand, more blood can flow to the dilated area. During the normal sexual arousal process, compounds like nitric oxide are released in the body, setting off a chain reaction of muscle relaxing events that will lead to increased blood flow to the penis creating an erection. After prostate cancer treatment, this process can be disrupted and may need assistance from outside medications. Vasodilators support this process in different ways to ultimately relax the smooth muscle cells around the blood vessels leading to the penis and allow for increased blood flow to the area that will create an erection.

Mechanical devices for erectile dysfunction

Not everyone is able to take medication for ED, especially those with severe heart conditions or who are on other important nitrate-containing medications. If medication is not an option, mechanical devices may be used. These include penile rings and vacuum pumps. Penile rings are rubber medical devices that can be placed around the base of the penis. This device is for men who are able to get an erection, but not maintain their erection. Placing a penile ring can make the penis rigid enough to have sex.

Vacuum pumps can be operated by hand or by a battery. They are clear cylinders made of plastic to be placed over the penis. Air is removed from the pump creating suction that draws blood into the penis. This method is typically used for men who cannot maintain nor develop an erection at all. After the pump is removed, a penile ring is often used to maintain the erection. Regardless of which mechanical device is used, your doctor or healthcare team can instruct you on how to use these as well as where to purchase them.

Surgical options for erectile dysfunction

The main surgical option for erectile dysfunction management is an inflatable penile implant. Penile implants may be a last-line treatment option after other methods have failed since this option is the most invasive. A three-piece implant is inserted into the penis during implantation surgery. This implant has a button portion, placed into the testicle, a balloon-like piece that is attached to the abdominal wall and is filled with fluid, and a flexible plastic tube connected to the balloon structure that runs the length of the penis. The button can be pressed at any time when an erection is desired. Once the button is pushed and the device is activated, fluid rushes from the balloon structure into the plastic tube along the penis, creating an erection. When the device is not activated, the penis is flaccid. Penile implants are highly effective, as well as carry a high satisfaction rating.^1-3