Erectile dysfunction and prostate surgery

This study investigated erectile function after prostate surgery in men with high-risk localized prostate cancer. Researchers reported high rates of erectile dysfunction following prostate surgery. 

Surgical removal of the prostate gland is a common treatment for localized prostate cancer (cancer confined to the prostate). Surgery is often recommended when there is a high risk of cancer recurrence. A common side effect associated with prostate surgery is erectile dysfunction. Neurovascular bundle preservation (NBP) is a type of prostate surgery that spares nerve bundles. This is believed to help preserve erectile function. However, not all men are eligible for NBP. Men with high-risk prostate cancer are often not offered NBP. This is usually due to cancer control being the primary concern. The rate of erectile dysfunction after surgery for high-risk prostate cancer is still under exam.

This study included 531 men with high-risk localized prostate cancer. All men underwent treatment with prostate surgery. 35% of men were eligible for NBP. Erectile function after surgery was compared to before surgery. All men were counseled after surgery regarding their erectile function. Men were also offered phosphodiesterase-5 (PDE5) inhibitors, such as sildenafil (Viagra) or tadalafil (Cialis).

Overall, erectile function returned to baseline in 23.5% of men. The probability of achieving this was greater following NBP. Erectile function returned to baseline in 69.4% of men who underwent complete NBP. This is significantly higher compared to men who did not undergo NBP (4%) or who underwent partial NBP (43%). Whether or not men used PDE5 inhibitors did not affect this outcome.

Men undergoing complete NBP showed a return of erectile function within 6 to 18 months after the procedure. Men undergoing partial NBP recovered their baseline erectile function within 24 months.

Younger men (aged 60 years or less) and those with good erectile function before surgery had a greater chance at recovering erectile function following NBP. The absence of high blood pressure was overall a good predictor of erectile function. It increased the chances of recovering erectile function regardless of the type of surgery received. 

Researchers concluded that erectile dysfunction is very common among men undergoing prostate surgery for high-risk localized prostate cancer. NBP was associated with a higher chance of the return of erectile function.