Prostate Cancer Won't Stop Good Sex

Erectile dysfunction in men with prostate cancer can be treated

It should come as no surprise that a good and healthy sex life is closely tied to happiness and overall quality of life. Moreover, erectile dysfunction (ED) is tied to reduced quality of life and depressive symptoms.

A common misconception among some is that prostate cancer necessarily takes a toll on your sex life.  This misconception is untrue, and although ED is a common adverse effect of prostate cancer treatment, and this adverse effect may persist, there are a slew of treatments including drugs (think Viagra), injections, psychotherapy and implants that help people with prostate cancer have good sex.

  If desired, people with prostate cancer can (and should) have great sex.

A couple common reasons why people with prostate cancer think they shouldn't have sex is because the sex will somehow make their prostate cancer worse or diminish the efficacy of treatments including prostatectomy (surgery) or radiotherapy.  Rest assured that these concerns are baseless.  Sex doesn't make prostate cancer worse or attenuate treatment.  

A group of Swedish researchers publishing in the Journal of Sexual Medicine set out to better understand use of ED drugs among men with stages 1 to III (localized) prostate cancer.  They examined a whopping 23,390 men and 126,944 controls (men without cancer) from 2006 to 2009 for patterns of prescription ED medication use. 

The ED medications in this study included PDE5 inhibitors (drugs like Viagra, Levitra and Cialis) and penile injection with intracavernosal or intraurethral alprostadil.

  (I know that injecting your penis with drugs may sound terribly painful, but the needles used are smaller and of lower gauge.  Apparently, the shots don't hurt too much.)   

Of note, the men in the experimental group were at various stages of treatment including watchful waiting, active surveillance, radiotherapy and post radical prostatectomy Radical prostatectomy is a surgery where the entire prostate along with some surrounding tissue is removed.

  Of note, radical prostatectomy can be nerve sparing, which augurs well for sexual function.

Here are some of the researcher's findings:

  • Men who were younger and had higher income levels and completed more schooling were most likely to fill prescriptions for ED medications.
  • Men who had prostate cancer of low or intermediate risk were more likely to fill prescriptions for ED medications.
  • In the 2 years following diagnosis, men who received radical prostatectomy were most likely to fill at least one prescription for an ED drug (74 percent) as compared with men who were treated with radiotherapy (33 percent), men being actively surveilled (21 percent), men in watchful waiting (10 percent) and men who were without cancer (8 percent).
  • Although the highest proportion of men who filled ED prescriptions were those who had received radical prostatectomy, these increases were transient with only 40 percent of these men filling 3 or more prescriptions.
  • Although a lower proportion of men who received radiotherapy filled ED scripts initially, over time, these men were more likely to fill ED scripts.  This discrepancy may reflect the fact that sexual desire and function improved over time.
  • Men who discontinued use of ED medications mostly claimed that the drugs were either too expensive or failed to meet expectations.

It should be noted that although powerful (large sample size), this study did have its limitations.  First, because researchers were tracking cases and prescriptions in national registries, it was impossible to determine whether participants were ordering scripts online.  Second, just because somebody filled a script doesn't mean they took it.  Third, differing baseline characteristics between men who received radical prostatectomy and men who received radiotherapy likely confound results.  For example, men receiving androgen-ablating radiotherapy--which messes with sex hormones--may feel less inclined to have sex. Fourth, some participants may have received ED drugs as part of a penile rehabilitation program and thus been compelled to receive the drugs,

So what do the results of this study mean?  For one, the fact that many men with prostate cancer stop filling scripts for ED drugs may imply that there's some breakdown in the system.  Maybe these men need better counseling in order to better understand how long-term use of ED medications may be useful in helping them have sex.  Alternatively, counseling could help adjust expectations about sex and limit feelings of inadequacy or discouragement among these men.

Another inference that can be drawn from this study is that in Sweden ED meds cost way too much--a problem that we have in the United States, too.  Currently, few insurance plans cover drugs like Viagra and Cialis which is a darn shame.  It saddens me to think that somebody with prostate cancer may want sex but can't afford medication.

Selected Sources

Harris ME, Gutknecht DR. Chapter 43. Erectile Dysfunction. In: Henderson MC, Tierney LM, Jr., Smetana GW. eds. The Patient History: An Evidence-Based Approach to Differential Diagnosis. New York, NY: McGraw-Hill; 2012. Accessed July 09, 2015.

Article titled "Drug Prescription for Erectile Dysfunction Before and After Diagnosis of Localized Prostate Cancer" by A Plym and co-authors published in the Journal of Sexual Medicine in 2014.  Accessed July 08, 2015.



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