I posted recently ("Paradise Lost - Vale Sir Lust") about my impotency issues, 2 years post radiotherapy for prostate cancer. In hind-sight, it was a rather depressing post, written in resignation. But I'm not the sort of person to give up without a fight.
I knew that impotence was a possibility with radical prostatectomy, but had had no warning of the likely-hood of similar effects from radiotherapy. Further, I was a bit disappointed with my urologists' response to my current condition, of only suggesting a penile implant. I wasn't ready to give up on sex completely. I wanted to know more about what medical experts had to say about ED after prostate cancer treatment. So I turned to Dr Google - a number of on-line papers on the subject are listed in the foot-notes, and sections quoted here-in.
Statistics
In summary, between 50% and 85% of patients will suffer ED after treatment within 3-5 years. "The major predictors of recovery are:-
- age at the time of radiation: the younger the man is, the better erectile function at the time of treatment and the better the long-term function is going to be;
- erectile function at or before the time of radiation;
- type of radiotherapy causing less nerve damage of the prostate and the less amount of surrounding tissues exposed to radiation, the better the outcome;
- the health of erectile tissues."
"Normal erections generally depend upon 3 processes:
- increased arterial blood flow into the penis by neurological initiation,
- cavernosal smooth muscle relaxation,
- restriction of venous blood outflow from the penis.
Impairment of any of these processes can lead to ED". (Viagra works via the first two of these processes).
"If your sexual function's not what it used to be a year or two after prostate surgery, hang in there. Men who are having trouble achieving erections after prostatectomy for prostate cancer can achieve improvement in function that's sufficient for sexual intercourse more than two years later, researchers say.
"The message to patients who have erectile dysfunction -- even those who have failed to have erections after surgery -- is that improvement does occur in a substantial number of men," says researcher Jeffrey Schiff, MD, a resident in urology at the State University of New York Downstate Medical Center in Brooklyn, New York.
Overall, one-third of men with marginal erectile function and one-fourth of men with serious erectile dysfunction 24 months after surgery continue to have improvement in erectile function on follow-up visits, he tells WebMD.
The findings were reported here at the 105th annual meeting of the American Urological Association (AUA)".
Radiation Injury
Radiation affects the erectile processes via damage/injury of the nerves and erectile tissues. The ability to recover depends on the type and degree of damage. A key factor in the healing process is increased blood flow.
Recovery Factors
Major recovery factors include:-
- condition of ED prior to treatment;
- age of patient - the younger, the better recovery chance;
- non-smoker;
- non-drinker;
- no diabetes or obesity;
- controlled blood pressure and cholesterol;
Well, 5 out of 6 gives me hope.
Finally, the age of one's partner is a major factor. +1 for me - all my "buddies" are 20-30 years my junior and all with high sex-drive.
Proactive recovery recommends daily low-dose use of Sildenafil ('Viagra', a PDE5-inhibitor), use of a "cock-ring" to limit venous blood out-flow and regular ejaculations. Improvement will take from 6-24 months.
On to Rehab.
So here I am, starting rehab. I will report and track my progress on this blog conversation, monthly in 6 months. Is recovery more psychological or is physical healing the principal improvement? Let's find out. Please follow and comment if you have a similar situation or concerns.
