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#GatekeepersofMen Series

Episode 5

Penile Rehabilitation: Life After Prostate Cancer

The American Cancer Society estimates that 1 out of 7 men will be diagnosed with prostate cancer during his lifetime.  Nevertheless, 5-year survival rates after treatment of localized prostate cancer approximate 98%.   Yes, you read it correctly.  When diagnosed early and the cancer is still localized within the prostate, there is almost 100% chance you will be cured. 

How can prostate cancer be cured?

The most common treatment options are surgery and radiation, both of which are able to successfully treat the cancer.  Nowadays, most urologic surgeons use the assistance of a robot to remove the prostate through very small holes (laparoscopy).    This avoids a big incision and provides a smooth and quicker recovery.

So….  you are cured. Now what? 

Despite its efficacy in treating prostate cancer, surgery and radiation have been shown to affect erectile function and urinary continence, and hence, the patient’s quality of life.  Unfortunately, many men with history of prostate cancer find themselves trading their erections for a cure.  Overall, studies have shown that the incidence of ED after radical prostatectomy (surgery for prostate cancer) ranges between 14% and 90%. (1)  A study in 2015 looked at patient-reported outcomes of more than 2500 men and found that more than 70% of men had erectile dysfunction 1 year after surgery.

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What can I do if I developed ED after prostate cancer?

Rehabilitation is one of the foundations in medicine today for the successful recovery in multiple diseases.  And just as your leg goes through rehabilitation after a knee surgery, your penis should go through rehabilitation after prostate cancer surgery.  Yes, there is such a thing.  Now the key to a successful rehabilitation is to start as early as possible among other factors.

What to know about Penile Rehabilitation?

In order to know who has a better chance of regaining their sexual function back, there are several factors to consider:

  1. Preoperative erectile function:   research has shown that men who had normal erections prior to their surgery have a higher likelihood of recovering their erectile function after surgery.   Basically, if things were not working before surgery, it is unlikely they will work after surgery.
  2. Surgical technique:  Did the surgeon attempt to preserve your nerves, also called ‘nerve-sparing’ technique?  Was your surgery done with the assistance of a robot?  Research has shown that those who underwent nerve-sparing robotic-assisted surgery had a better recovery when compared to those undergoing open surgery.
  3. Timing since surgery:   As stated above, the key to a successful rehabilitation is to start as early as possible.   Those who start rehab weeks after the surgery have a higher likelihood of recovery than those starting 1 year or 2 years out.

In Conclusion…

There is no standard algorithm for penile rehabilitation. However, we believe any rehabilitation is undeniably better than no action at all.  If you or anyone you know has undergone treatment for prostate cancer, there is a high likelihood you (or him) struggle with erectile dysfunction.  We encourage you to visit our office and hear out how we can help you.

Remember, there is LIFE after prostate cancer treatments. Our goal is to help you recover that quality of life back.

1.     Clavell-Hernandez J, Ermeç B, Kadıoğlu A, Wang R. The perplexity of penile rehabilitation following radical prostatectomy. Turk J Urol 2019;45(2):77-82. 

This article was authored by Dr. Jonathan Clavell. Dr. Clavell is a urologist who specializes in men’s health including erectile dysfunction, low testosterone, Peyronie’s Disease and BPH

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