Penile Rehabilitation

Dear Dr G,

I am a 58-year-old man who recently went for a health screening and discovered that my cancer marker PSA had elevated. The doctor advised me to go for a biopsy and sure enough, they detected cancer.

After further tests, I am glad I discovered that the prostate cancer was at its early stage and the chance of a cure is still high.

I have been to the urologist, who advised me to undergo a radical operation to eliminate the cancer. The surgeon told me the chances of cure is high, but there may be complications of incontinence and impotency.

I am terrified. Although I am approaching 60, I have a very senior position in a company, and live an active life, and have a terrific sex life.

My wife is in her mid 40s and we engage in intimacy at least once a week. This is a very important part of our relationship and I worry it may be taken away from me immediately after the operation!

I hope to put Dr G on the spot to help me to decide what to do.

Can you please tell me why do men get sexual dysfunction after radical prostatectomy? What are the chances of incontinence and ED?

I was asked to undergo robotic radical prostatectomy – can this really reduce my complication rate?

Can you also tell me what is the role of penile rehabilitation programme?

Can I have the best of both worlds in getting cured from the cancer and yet preserving my manhood?

Warmest regards

Desperate man

Prostate cancer is fast becoming the most frequently diagnosed cancer, which constitutes at least 15% of all male cancers. Although the cancer is less common in South-East Asia, the prevalence is rising, as the malignancy is associated with advancing age and sedentary lifestyle.

The treatment modalities for prostate cancer can be quite variable according to the type of tumours in different individuals.

This can range from careful monitoring to robotic radical prostate removal. Clearly, the adversity of the intervention is dependent on the pre-operative status of the individuals, the extent of the cancer and the type of operation performed.

Although surgery carries the highest chance of complete eradication of tumour, men affected by prostate cancer have to consider the potential long-term compromises, with respect to their sexual health.

The affected men after surgery often describe the ability to climax without ejaculation (dry orgasm).

The complete removal of the prostate gland, together with the seminal vesicles and the vas deferens, also immediately induce a cessation of any form of ejaculation.

This clearly may pose as an obstacle for men still eager to father a child naturally.

The two most feared complications of men undergoing radical prostatectomy are urinary incontinence and erectile dysfunction.

Not surprisingly, scientific literature revealed a wide range of complication rates, ranging from 0% to 100%, with huge variability of patients’ pre-morbid potencies.

Various surgical modalities, such as nerve-sparing techniques, have been proposed to preserve the nerve that is required to achieve erectile function.

Multiple operative approaches, such as keyhole laparoscopic and robotic assisted radical prostatectomy, have been proposed as the gold standard.

Such minimally invasive interventions are believed to diminish the traumatic manipulation of the gland, without compromising on the cancer elimination.

Multiple studies have also been published on the effectiveness of the penile rehabilitation programme following radical prostatectomy.

The strategy is to assist men to recover post-operative erectile function, by introducing medications or “exercises” to the penis.

This process is proven in many studies, as the oral medications, injections or vacuum devices promote the healing process following the operation.

Men are also advised to have regular intercourse or masturbate frequently as soon as they see fit after the operation.

Peter Hobson, the Professor of Developmental Psychopathology at University College London, once said: “One of the things that’s often forgotten about rehabilitation, it’s not a destiny. It’s a journey.”

Dr G’s advice is: “It’s going to be a hard journey, but with a bit of modern operative technology and post operative penile rehabilitation, the destiny hopefully will be harder!”