Erectile dysfunction in the setting of prostate cancer

Abstract

A diagnosis of prostate cancer (PCa) itself may negatively affect erectile function, as can the treatments. In addition, there are individual patient-related and psychological factors that may compromise erectile function in these men. Finally, PCa continues to be diagnosed in younger men, in whom potency preservation is an important consideration. Pretreatment erectile function, influenced by age, comorbidities, and psychological factors, is a predictor of posttreatment erectile function in men treated for PCa. Treatment-related factors may include intraoperative oncologic decisions and the postoperative course. Radiation, either in the form of brachytherapy or external beam, may have untoward effects on erectile function. The role of penile rehabilitation, as well as the optimal treatment protocol, remains undefined. It is clear that androgen deprivation therapy negatively impacts erections; conversely, the role of testosterone replacement in the setting of known PCa remains controversial. Sexual counseling is an important aspect of both therapy and prevention of ED in men with PCa. A more sophisticated understanding of the etiology of PCa-related ED will allow for more individualized therapy.