Dr. David Fenig understands the impact that loss of erection following prostate cancer treatment has on patients and their partners. That is why he developed and manages a comprehensive program to help preserve erectile function in men undergoing prostate cancer surgery or radiation. The goal of the program is to provide men with improved and earlier return of erections following prostate cancer treatment.
Dr. Fenig believes in combining compassionate care with the latest advances in ED treatment, working with a highly trained staff to ensure that you receive the best experience and results following treatment for prostate cancer.
Erectile dysfunction (ED) is defined as the inability of a man to obtain or maintain a firm erection long enough to have or complete sexual intercourse, and remains a frequent problem for men following treatment for prostate cancer. While a great deal of research has focused on men who are treated with prostatectomy (surgical removal of the prostate), ED occurs regardless of prostate cancer treatment. The reason men experience ED following treatment involves many factors. For example, many treatments such as external beam radiation, brachytherapy (seed implantation) and radical prostatectomy (open or robotic) cause nerve damage in the area surrounding the prostate, which causes reduced oxygen in the penis and leads to scarring and ultimately, decreased erections.
Fortunately, early treatment can prevent these side effects. Under Dr. Fenig’s leadership, this comprehensive ED treatment program enables increased nerve stimulation, greater oxygenation and less scarring, thereby leading to the best possible outcome for you.
Penile Rehabilitation Following Prostate Cancer Treatment - How it Works
Multiple nonsurgical treatments for erectile dysfunction exist, including:
- Oral medications known as PDE-5 inhibitors such as Viagra™, Levitra™, Staxyn™, and Cialis™
- Intraurethral pellet (Medicated Urethral System for Erection or MUSE™)
- The vacuum erection device (VED)
- Penile injections
Based on current research, by combining these treatment options, men may get their erections back quicker and better than would normally occur following treatment for their prostate cancer. The idea is that no one treatment by itself is enough. By combining treatments, and treating the patient before and during his prostate cancer treatment, better outcomes will be achieved.
Erectile Dysfunction Treatments Following Prostate Cancer Treatment
Oral PDE-5 inhibitors: Medications like Viagra, Levitra, Staxyn and Cialis rely on input from penile nerves to stimulate erections. Animal studies in which prostatic and penile nerves were intentionally cut have demonstrated a reduction in penile scarring and vascular problems after treatment with this class of medications.
Similarly, human studies have demonstrated improved nighttime erections and erections not requiring medication with nightly Viagra administration. Nightly administration of low-dose Viagra (25mg) with 100mg on demand at the time of sexual activity may therefore provide adequate penile rehabilitation and enhance erectile function.
Alprostadil pellets: Another promising technique is called MUSE, which stands for "medicated urethral system for erections." A small pellet containing the drug alprostadil is inserted inside the urethra, the opening at the end of the penis.
A tube-like applicator containing the pellet is inserted into the urethra, and by pressing a button on the applicator the pellet is released. The medicine is absorbed through the membrane that lines the inside of the urethra and an erection develops in about 10 minutes. Erections last approximately 30 minutes.
MUSE increases blood flow and penile oxygenation, and, unlike oral medications, this process is not dependent on integrity of the nerves. Nightly dosing of MUSE results in increases in penile oxygenation even one day after application. One clinical research study demonstrated an increase in penile oxygenation after MUSE insertion. Administering 125mcg or 250mcg three times a week after radical prostatectomy resulted in a three-fold increase in spontaneous erections in treated vs. untreated patients. More recent data indicated a 16% improvement in spontaneous erections at six months in patients taking MUSE compared to those taking Viagra.
Importantly, another recent study found that patients on combined MUSE and Viagra therapy were 4.9 times more likely to achieve an erection sufficient for penetration at three months after surgery than patients using Viagra alone. Although nightly MUSE could be potentially more efficacious, based on the available data and due to cost concerns, a three times weekly dosing regimen of 250mcg MUSE beginning immediately after catheter removal is recommended by Dr. Fenig. The use of MUSE prior to surgery will help familiarize you with the application of the medication.
Vacuum erection device: Loss of penile length may occur immediately after prostatectomy. The VED functions by mechanically increasing penile blood flow. Nightly use of the VED postoperatively results in earlier sexual intercourse and sexual satisfaction, increased maintenance of penile length, and potentially an earlier return of natural erections sufficient for vaginal penetration. Therefore, nightly use of a VED cycled over a 10-minute period may prevent loss of penile length and assist in early recovery of sexual function.
Penile injection therapy: Penile injection therapy or intracavernosal injection (ICI) is a time-tested method of treatment for ED. Recent studies have supported ICI use in patients who do not respond to oral medications. Due to the invasiveness of treatment and the availability of alternatives, ICI should not be recommended for initial rehabilitation, however early use of ICI after three months of unsuccessful oral combination treatment will be considered.
Testosterone replacement therapy (TRT): Low testosterone, or hypogonadism, is an under-diagnosed problem in the aging male. Testosterone replacement therapy (TRT) has been an underutilized therapy in men treated for prostate cancer due to largely historical concerns about increasing the risk of prostate cancer spread and recurrence. Recent data has cast doubt on this notion, however. TRT has been used in select patients after radical prostatectomy, brachytherapy and external beam radiation therapy. Both animal and clinical studies indicate that testosterone therapy improves both erectile function and the response to PDE-5 inhibitors in patients with ED and hypogonadism. This treatment is not for all prostate cancer patients with low testosterone, however. In treated men with low grade, organ-confined prostate cancer and serial negative follow-up PSAs, treatment of hypogonadism may be indicated by Dr. Fenig after discussing potential risks and benefits.