Cancer and Erectile Dysfunction

Ten years have passed since the introduction of phosphodiesterase (PDE-5) inhibitors (Viagra followed by Levitra and Cialis) for the treatment of erectile dysfunction. Recently, while watching a televised soccer game with my children, I saw one of the “anniversary commercials.” I, like most parents, exhaled when I did not get any questions about “what exactly is erectile dysfunction?”

However, I began to wonder if Madison Avenue has trivialized a serious medical discussion.

A number of cancer treatments create ED, whether through surgery, radiation therapy or even chemotherapy. One need look no further than management of prostate cancer, bladder and rectal carcinoma, and the management of certain testicular carcinomas to see the scope of the problem. It is estimated that men who undergo prostate treatment, even with newer techniques, have at least a 50 percent risk of impotence. A recent study from Canada, which reviewed a large number of patients treated for rectal cancer, found an astonishing 32 percent of males reported impotence with another 52 percent reporting partial impotence.

Erectile dysfunction is a serious complication from the treatment of these cancers. Once past the initial threat of their diagnosis, patients frequently report ED as one of the most frustrating side effects. Part of this appears to stem from inadequate discussion between patients and their doctors concerning the risks for ED and the likelihood of recovery. This frustration is also seen in the partners of these men, and this spans all age groups; contrary to advertising, intimacy is not confined to the young. Studies have indicated up to half of men aged 70 or older are sexually active.

PDE-5 inhibitors represent the first major step in drug therapy for erectile dysfunction. Nevertheless, these drugs have a number of side effects and may not work at all in a substantial number of patients. Research continues in an effort to define other pathways for drug therapy. And the advent of less invasive surgery and more precise radiotherapy may diminish the risk of ED resulting from these treatments.

So what have we learned in the last decade about erectile dysfunction despite all the marketing sensationalism? Clearly, it is a far more common problem than we knew and it has a significant impact upon men and their partners’ quality of life. Where I hope we are going is that patients and partners share with their treating physicians a free and open discussion about ED as a potential side effect. These discussions are normal, healthy and reasonable. Understanding the risks for ED and the treatments available are the keys to realistic expectations.

Jan Dombrowski, M.D., is medical director and radiation oncologist at Pluta Cancer Center.

• What happened? Sexual consequences of prostate cancer and its treatment.
• Quality of life in patients with prostate cancer.
• The efficacy of sildenafil citrate following radiation therapy for prostate cancer: temporal considerations.
• Sequelae of definitive radiation therapy for prostate cancer localized to the pelvis.
• Finding help for sexual problems after prostate cancer treatment: a phone survey of men’s and women’s perspectives.