Expert Point of View: Michael Krychman, MD


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Like female cancer survivors, men experience high rates of sexual dysfunction following a cancer diagnosis and treatment, especially for prostate cancer, with as many as 90% of men reporting erectile dysfunction after radical prostatectomy and nearly as many suffering with the problem following external-beam radiation therapy, studies show.1-4 In addition to erectile dysfunction, men may also experience low libido and problems with arousal or the ability to reach orgasm. These sexual side effects are also common after treatment for bladder, colon, and rectal cancers and are also seen in men who have undergone a stem cell or bone marrow transplant.

Differing Rates of Therapeutic Improvements

Although the rates of sexual dysfunction may be similar for men and women, advances to combat the problem in men are happening more rapidly than they are for women. Newer measures include a second generation of erectile dysfunction medications since the availability of sildenafil citrate (Viagra), other PDE5 (phosphodiesterase type 5) inhibitors (tadalafil, vardenafil) used before surgery to keep penile tissue healthy and preserve smooth muscles, and penile rehabilitation strategies (such as penile self-injection therapy) used after prostate cancer therapy.

“Men and women may be similar in terms of their biological and psychological determinants of sexual function. Yet how they express their sexuality may be different,” said Michael Krychman, MD, Executive Director of the Southern California Center for Sexual Health and Survivorship Medicine in Newport Beach. “We have a better understanding of the veins, arteries, and nerves that provide sexual function in men than we do in women. We understand the pathophysiology of erection and how we can impact it with medication.”

Long-term Effects of Prostate Cancer Treatment

A recent study in the Journal of Clinical Oncology5 found that men treated for prostate cancer may suffer from sexual dysfunction and have more bladder control problems for up to 10 years after treatment. The use of prediction models for early-stage prostate cancer—which include such variables as the patients’ sexual function and serum prostate-specific antigen levels prior to prostate cancer treatment, age, and treatment plan—may help physicians determine how quickly patients will recover from erectile dysfunction following prostatectomy, external radiotherapy, or brachytherapy. Such models also provide patients with information to help them decide which treatment options have the best chance of preserving potency and sexual function.

In a study of prediction models, published last year in The Journal of the American Medical Association,6 researchers were able to accurately estimate erectile function probabilities 2 years after prostate cancer treatment “from as low as 10% to as high as 70% or greater, depending on the individual’s pretreatment patient characteristics and treatment details.”

How sexually active men were before their cancer treatment may also impact their sexual function afterward. “If a patient is in a bad marriage [or relationship] and he was not connecting sexually before his cancer diagnosis, having cancer is not going to improve his overall intimate connection with his partner and his sexual function. But for patients who were doing well sexually before their diagnosis, it is likely they will do well after their recovery, although they may have some changes in overall penile and sexual functioning,” said Dr. Krychman.

Disclosure: Dr. Krychman reported no potential conflicts of interest.

References

1. Walsh PC, Epstein JI, Lowe FC: Potency following radical prostatectomy with wide unilateral excision of the neurovascular bundle. J Urol 138:823-827, 1987.

2. Talcott JA, Rieker P, Clark JA, et al: Patient-reported symptoms after primary therapy for early prostate cancer: Results of a prospective cohort study. J Clin Oncol 16:275-283, 1998.

3. Smith DS, Carvalhal GF, Schneider K, et al: Quality-of-life outcomes for men with prostate carcinoma detected by screening. Cancer 88:1454-1463, 2000.

4. Stanford JL, Feng Z, Hamilton AS, et al.: Urinary and sexual function after radical prostatectomy for clinically localized prostate cancer: The Prostate Cancer Outcomes Study. JAMA 283:354-360, 2000.

5. Taylor KL, Luta G, Miller AB, et al: Long-term disease-specific functioning among prostate cancer survivors and noncancer controls in the prostate, lung, colorectal and ovarian cancer screening trial. J Clin Oncol 30:2768-2775, 2012.

6. Alemozaffar M, Regan MM, Cooperberg MR, et al: Prediction of erectile function following treatment for prostate cancer. JAMA 306:1205-1214, 2011.


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