Diagram: Location of Prostate Gland and Associated Structures
What is a Prostatectomy?
The surgery for prostate cancer is called radical prostatectomy, which involves removing the prostate gland. The entire prostate is removed because on average, a man will have five or more tumors in his prostate, and their exact locations cannot be identified before surgery. Therefore, to make sure they get all the cancer within the prostate, surgeons remove the entire gland.
A radical prostatectomy can be performed using any one of four different techniques: retropubic, perineal, laparoscopic, and robot-assisted laparoscopic prostatectomy. Men need to discuss the risks and benefits of each type of surgery with their oncologist and surgeon so they can decide which procedure is best for them. The number and severity of side effects following prostatectomy depend on the type of surgery performed and can range from urinary incontinence to bowel problems and hernias. One of the most common and distressing side effects is erectile dysfunction. More on prostate surgery
Prostate Surgery and ED
Despite advances in nerve-sparing techniques during prostatectomy, erectile dysfunction is still a major consequence of this surgical procedure. Most men suffer erectile dysfunction to some degree after prostate surgery because of the trauma to the soft erectile tissue and the nerves, increased muscle atrophy of the cavernosal smooth muscle, and fibrosis (excessive tissue formation). (Shaiji)
After prostatectomy the penile muscles go to sleep and atrophy. This leads to a lack of nighttime erections, which are necessary to maintain erectile tissue. For some men erectile dysfunction is temporary, but for others it can be permanent. The severity of erectile dysfunction depends on the type of surgery, the stage of cancer, and skill of the surgeon.
In addition to the penile muscles, the erection nerves also are at risk during a prostatectomy. Even if a surgeon is highly skilled at nerve-sparing prostatectomy, erection nerves go to sleep when they are handled, and they can remain dormant for one to two years. The good news is that dormant nerves can revive, and so erectile dysfunction can resolve over time. Read more on Questions to Ask About ED and Incontinence [PDF]
Long Term Effects of Prostatectomy on Sexual Function
According to a study published in the Journal of the American Medical Association, for example, 18 months after their radical prostatectomy, nearly 60 percent of men reported an inability to get an erection. That percentage dropped to 41.9 percent after 24 months. (Stanford 2000)
For men who undergo a nerve-sparing technique, recovery from erectile dysfunction may occur within 12 months of surgery. Recovery of erectile function after a non-nerve-sparing procedure is less likely. One study, for example, found that one year after prostatectomy, 66 percent of men experienced erectile dysfunction after having a nerve-sparing procedure versus 75 percent who did not have nerve-sparing surgery.
The good news is that more men may regain erectile function if they participated in a penile rehabilitation program within a few months of prostatectomy. Men who are considering prostatectomy should discuss this program with their physicians even before undergoing surgery.
See also
Questions to Ask About Prostate Surgery [PDF]
Sexual Function and ED Expectations after Prostate Surgery
Can a Prostate Biopsy Cause Erectile Dysfunction?
