prostate cancer is the most common cancers in humans. For anatomical reasons, diseases of the prostate and their treatments can lead to erectile dysfunction. The main risk is the achievement of neurovascular strips involved in the mechanism of erection.
Around the urethra, the gland hampers evacuation of urine when it first began to take pathologically volume. Sometimes it reveals its presence in a sometimes painful but in most cases the disease remains asymptomatic long. It is usually discovered after a routine screening performed on the proposal of the general practitioner when men approach middle age. The examination consists of a digital rectal examination and a blood assay of specific markers (PSA). The diagnosis must be confirmed by an ultrasound and possibly a biopsy.
Prepare psychologically
As often, the disease is detected early, the greater the chance of complete recovery are important. The stage at which prostate cancer is discovered also determines the salary to be used. Given the impact on the sexual life of the patient, the doctor must provide information “clear, fair and appropriate” in the words enshrined in the Code of Medical Ethics. Adverse events should be communicated to patients so that they can make its decision in full knowledge of the facts.
The issue of counseling and medication should be discussed before the treatment has begun. There are three ways to treat prostate cancer: complete removal, radiotherapy and hormone therapy.
Radical prostatectomy
The total ablation of the prostate and seminal vesicles resulted so far from erectile dysfunction in the vast majority of cases. Numerous studies report malfunctions in 33 to 98% of patients after prostatectomy radicale1.
But in recent years the use of laparoscopy (or laparoscopy) helps to preserve vital neurovascular strips erectile mechanism. The team of urologic surgery at the hospital of Henri Mondor Créteil2 reported in a scientific journal of his experience one year after the operation for the preservation of erectile function for 56% of 134 patients. The results were more satisfactory than the preservation of the strips was bilateral.
Radiotherapy
Speaking to men whose tumor is small, treatment with less radiation reaches the mechanism of erection. However, sexual dysfunction and moderate to severe erectile dysfunction affects 21 to complete 61% of patients in various études1. This depends on the age of the patient, the quality of tumescence of sex before radiotherapy and duration of treatment.
Hormone
Hormone treatments are for men whose prostate cancer is not localized. They are generally not treated as valued as a kind of “chemical castration” with all the impact on the psychological and self-esteem for the man. Professor Rousseau of the University of Laval in Quebec has interviewed 44 patients treated with hormonal therapy for prostate cancer avancé3. Before treatment 80% reported having at least one report a week. Treatment, only 18% to continue sexual activity while 70% reported a decline of interest in sexuality.
Brachytherapy, cryotherapy and ultrasound
For these three techniques, the number of study is much lower, because of their relative novelty. Thus, the consequences vary considerably. Brachytherapy proposed in some centers, is to be implanted in the prostate of the radioactive seeds supposed to destroy cancer cells.
The U.S. studies published on the effects of this technique have reported erectile dysfunction in 13 to 39% of men 1. Moreover, we find that persons who have undergone this treatment are then more frequent victims of unrest érectiles
And cryotherapy treatment with focused ultrasound treatments are being evaluated. However, early studies report high rates of erectile dysfunction for cryotherapy (80 to 98%).
The ultrasonic treatment bring lower rates (around 60%), according to Dr. Albert Gelet Service of Urology and Transplantation of the Hospital Edouard Herriot in Lyon, we had interviewed. But more research is needed before this technique can be officially recommended.