Management of postprostatectomy erectile dysfunction

Abstract

The concept of early penile rehabilitation following radical prostatectomy started in the 1990s with the evolution of several dynamic themes regarding prostate cancer diagnosis and management. First, with the maturation of serum prostate-specific antigen (PSA) testing, the detection of lower volume cancers changed the surgical margin rate and the rate of biochemical cures rose substantially, to the 80% to 90% range. The majority of our newly diagnosed tumors were histologic Gleason score 6/7 cancers and were pathologically organ confined. Recent cancer statistics for the year 2006 report that 91% of new prostate cancer cases are expected to be diagnosed at local or regional stages with five-year cancer-specific survivals approaching 100%.1 A second major theme of the 1990s was the substantial drop in patient age at diagnosis due to earlier screening with serum PSA testing and improved office-based ultrasound-guided biopsy techniques. In fact, the largest increase in prostate cancer incidence during the PSA era occurred in men under the age of 65. The Seattle-Puget Sound Surveillance, Epidemiology and End Results (SEER) cancer registry from 1995 to 1999 reported that 33% of all incident prostate cancer cases are now diagnosed in men under age 652-4 and this figure will invariably be higher in the subsequent five-year report. © 2007 Springer-Verlag London Limited.