Although most men, when they are diagnosed with prostate cancer, are primarily concerned with staying alive, there is a surprisingly large constituency who, as my psychiatrist friend put it “vote with their dicks.” For these men, not being able to have an erection is literally a fate more awful than death. But for almost all of us, the degree to which sexual function returns—or fails to return—is a matter of serious concern.
The three basic questions doctors hear when discussing treatment options are:
Will it cure me?Will I have to wear diapers?
And the big one: Will I be able to get an erection?
No doctor can answer any of these questions with an unequivocal “Yes.” The reality is that there are no guarantees. It’s a tough call whether to go for a cure, or for quality of life—which for many of us means being able to get an erection.
“I gotta tell you, Betsy is so much younger than I am. She’s right at the peak of her sexuality,” my friend Calvin pointed out. “My ability to perform still matters a lot to her. And there are plenty of folks like us—the May and September couples. Far as I’m concerned, quality of life isn’t an option. It’s the name of the game."
Compared to other treatment options such as active surveillance or hormone therapy, surgery and radiation have one clear advantage: closure. But surgery is also the chief culprit when it comes to ruining your sex life. The nerve bundles that control erections are located perilously close to the prostate gland, so you’re cutting past a lot of delicate apparatus, and even with nerve-sparing surgery performed by an experienced and talented surgeon, it’s very easy for things to go wrong. Once those nerve bundles are cut, it’s goodbye to erections.
However, the two modern radiation options—permanently implanted radioactive seeds (Brachytherapy) and intensity modulated radiation therapy (IMRT)—are at least as effective as surgery at curing the disease. And more importantly, the precise targeting means less risk of “collateral damage.” In other words, Calvin has a better chance of keeping Betsy happy—especially with a little help from the wonders of modern pharmacology. Calvin and Viagra are now wedded at the hip!
According to the TV commercials, part of the cure for erectile dysfunction appears to be lounging with your sweetie in adjacent bathtubs while holding hands and watching the sunset. Providing, of course, you have taken the pill that does increase blood flow to your penis.
Bottom line: While the use of Viagra and Cialis to prevent ED after treatment is still not totally proven, and despite the fact that these pills can be very expensive, most of us guys, when we find out that using them will probably contribute to sustaining our long term sexual function and keeping the physical side of our relationships sweet and nourishing, we feel that using these pills regularly is a must. Like an insurance policy for intimacy.