Erectile Dysfunction And The Prostate: What Are The Connections?

Main Category: Erectile Dysfunction / Premature Ejaculation
Also Included In: Prostate / Prostate Cancer;  Urology / Nephrology;  Cancer / Oncology
Article Date: 07 Aug 2008 - 3:00 PDT

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UroToday.com - Prostate cancer is the leading malignancy in American men and causes more than 60,000 deaths annually. Treatment of prostate cancer with either surgery, radiation therapy, cryotherapy or medical treatment is associated with significant life altering morbidity. Both incontinence and erectile dysfunction (ED) are too often sequelae of these treatment alternatives. ED can be a significant complication and can alter the life of both the prostate cancer patient and his partner. Newer modifications of the radical prostatectomy with nerve sparing techniques are the cornerstone of erection preservation.

Time following radical prostatectomy has been shown to increase erectile function such that more patients have functional erections at 3 years than 1 year after surgery. With the advent of PDE 5 inhibitors, many men can have improved functional erections and return to active coitus. Prevention of ED is also an important management technique. Evidence is gathering that prophylaxis with regular vasoactive injection or daily PDE 5 agents may be an integral part of preservation of corpus cavernosum smooth muscle function. Combination medical therapy and surgical penile prosthesis implantation are also options for patients failing oral PDE 5 inhibitors.

Lower urinary tract symptoms (LUTS) are an age independent risk factor for ED as demonstrated by large epidemiologic studies such as the MSAM-7 study. Etiology may be mediated via alpha adrenergic over activity. The large concentrations of PDE5 receptors in prostate, bladder and urethra suggest that PDE5 inhibitors may be a treatment alternative for the ED LUTS combination.

Presented by: Culley C. Carson, MD, at the Masters in Urology Meeting - July 31, 2008 - August 2, 2008, Elbow Beach, Bermuda

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