Penile rehabilitation after prostate cancer

Dear Dr. G,

I am emailing out of desperation, and I really hope you can help me; I am a fifty-nine-year-old man who unfortunately was diagnosed with prostate cancer at the beginning of the year.

In view of my age, the specialist I visited persuaded me to undergo robotic surgery to eliminate the cancer.

Before the operation, the surgeon advised that urinary incontinence and erection problems are possible complications from the surgery.

Since the cancer was stage one, the doctor was confident of a cure. He was also optimistic that he could protect my sexual function.

I am grateful the operation went really well. I made a good recovery after six weeks, and I am fully back to work.

Although I am optimistic about the prospect of a long-term cure, I am rather disappointed that I am completely impotent and I am now very depressed as my wife is twelve years younger than me and our active sex life used to be an important part of our intimacy.

The doctor told me it is still early and the erection should return. He also recommended something called penile rehabilitation.

I am so sorry to put Dr. G on the spot, but can you tell me what exactly is penile rehabilitation and how is it done?

Why did a “nerve sparing operation” not work for me?

Lastly, can you clarify whether this is the end of the road for my sex life?

Yours truly,

Depressed.

Public awareness about prostate cancer and the use of Prostate Specific Antigen (PSA) as a marker in tests has become more prevalent in the last two decades, and as such men are now presenting with the disease in their early stages – making it more suitable for radical intervention.

Additionally, recent advancements in robotic surgery also allow surgeons to maximize cancer eradication with minimal complications.

Improvements in medical technology and surgical techniques mean that clinicians have an advantage in identifying and protecting the neurovascular bundle that is responsible for the erectile and sexual functions of men.

Having said that, the rate of erectile dysfunction can still be at best 14% and in some series as high as 100% in men after the operation despite the introduction of “nerve sparing” radical prostatectomy.

The negative impact of the sexual dysfunction after the prostate operation cannot be underestimated, as the complication has an effect on the relationship, quality of life, self-confidence and overall well-being of affected men.

Of course, post-operative erectile function recovery is quite variable. The factors that may play a role influencing the return of sexual function include the age, baseline sexual ability before the operation and preoperative state of health. Clearly, men who have other illnesses such as diabetes, smoking, hypertension and dyslipidemia would expect a poorer outcome in terms of sexual performance after the operation.

On rehabilitation, the term is somewhat misleading as the notion of penile rehabilitation is essentially to prevent irreversible structural and functional damage.

This is achieved by forcefully enhancing the circulation and hence oxygenation of the tissues to facilitate the recovery from the surgery. It is generally agreed that the first four weeks following the operation is non-beneficial to rehabilitate the penis. It is also well recognized that the window of responsiveness ranges from one to twenty-four months; on the procedure, apart from the recovery of erectile rigidity, some studies have even demonstrated benefits of sensory recovery and penile length that had been compromised after cancer surgery.

The regime that is utilized to rehabilitate the penis can vary. This can range from daily doses medications such as the blue pill to daily uses of penile vacuum pumps and injections of medications. Also, data is also emerging on the uses of shock waves aimed at generating new vasculature in the penis to restore function.

Although many trials have demonstrated success, the exact dosage, interval of rehabilitation and the long-term benefit of penile rehabilitation is generally unknown.

The detection of prostate cancer in its early stages often ensures higher chances of oncological outcome with radical surgery, especially in younger men with aggressive disease. Undoubtedly, the trauma of surgery itself often leaves men with adversity such as erectile dysfunction and incontinence. Although the concept of penile rehabilitation may be at its early stages of research, this at least is a potential hope for men to regain their manhood after a hard time dealing with the surgery.

When Dr. G is put on the spot to advise for rehab or not after the op, his advice is simply to kick start the little brother and start using it as soon as possible. After all, like everything else, if you don’t use it you lose it

On that note, I wish Depressed a “hard” road to rehabilitation!