Potency

BY RALPH BLUM

One of the most worrying questions men diagnosed with prostate cancer face is: What are my chances of losing sexual function after treatment? The truth is all forms of prostate cancer treatment carry significant risk of impotence—defined as the inability to maintain an erection hard enough to penetrate. However, your chances vary greatly depending on a number of factors including your age, general health, potency prior to treatment, PSA levels, and last but not least, your treatment choice. Not surprisingly, regardless of which treatment they choose, older men whose sexual function is already low have the worst chance of good results.

While some men are willing to choose a therapy that offers a shorter life expectancy but better potency following treatment, for others the most important factor is curing the cancer. As one man said, “If you’re not alive, you don’t have to worry about sex.” Clearly it is a very individual choice as each man experiences sexual dysfunction in a profoundly personal way.

Since most men treated for early-stage prostate cancer typically live for decades, the choice of treatment is of paramount importance when it comes to quality of life issues. Surgery is still the preferred treatment for many men. But being operated on by less than the very finest surgeon dramatically increases the chances of impotence. The popularity of robotic surgery would lead one to believe that extensive studies have shown superior results compared to the traditional prostatectomy. However, according to Dr. Michael Barry of Massachusetts General Hospital in Boston and President of the Foundation for Informed Decision Making, it is not yet clear whether a robot-assisted laparoscopic prostatectomy is better or worse for maintaining sexual function than the older surgical techniques.

If retaining potency is your primary goal, IMRT or brachytherapy appear to give you the best results.  However, Dr. Durado Brooks, prostate cancer director for the American Cancer Society, cautions that sexual problems can show up later for men who also have either type of radiation therapy.

If you are like the gentleman in his early eighties who told me, “I’d rather be dead than unable to have another erection,” there are no easy answers. As far as I am concerned, the monastery beckons.