Hi, I'm Dr. Scholz. Let's talk about prostate cancer.

 In this video we're going to talk about erectile dysfunction caused by treatment for prostate cancer. Talking about impotence like it's a black and white issue, either you have it or don't, is not always an accurate representation of some of the problems that need to be dealt with.

 When you're talking about treatment for prostate cancer, we're usually talking about radiation versus surgery. More recently, we're also dealing with types of treatment called focal treatments. If you look at the risk of erectile dysfunction occurring after treatment, it's going to be lowest with focal treatment. The next echelon of risk is going to be with radiation type treatments, and the most common problems with erectile dysfunction occur in men who have surgery.

 One thing that is sometimes overlooked is that men who have surgery all get erectile dysfunction immediately after treatment. And then a percentage slowly recover over time. Men who undergo radiation typically don't get erectile dysfunction immediately, but over a period of a year or two, the problem can develop. This difference in timing can have a major impact in some secondary issues related to sexual function. Long periods of time without getting erections, such as occur after surgery, can cause atrophy, loss of the size of the erections, and a problem with Peyronie's disease - which is a condition where men get scar tissue in the penis. Erectile atrophy and Peyronie's disease are both more common problems that occur after surgery compared to radiation or focal therapy.

 People that are in the mix of a scary decision about prostate cancer sometimes aren't completely counting the cost of what it's like for a man to lose his sexual potency. They're just worried about saving their lives and sex has been put on the back burner. But as people get educated about prostate cancer they're going to learn that many types of prostate cancer aren't that threatening, and their lack of attention to these issues is an unfortunate situation. People do need to consider the potential psychological implications that impact a man's identity if he loses the ability to get erections.

 Sexual function can continue in the presence of impotence. Sensation of the penis is usually maintained. When I first got started in taking care of men with prostate cancer, my assumption was that many men would adapt to the inability to get erections and develop other forms of sexual activity. I later discovered through my experience that that is usually not the case. Most men equate potency and manhood with the ability to get an erection, and the vast majority of men that I encounter withdraw from sexual activity when they can no longer get an erection. Whenever you're discussing sexual function after any type of treatment, sometimes men are not communicated the fact that they are going to have dry orgasms. The prostate gland makes the majority of the semen, so if you radiate it or remove it surgically, the majority of men will have dry orgasms. And this can change the quality and the character of the sexual experience. Often times men adapt to this very well. But if they're not informed in advance, it's quite a shock to people.

 In a previous video we mentioned that, in the prostate cancer world, people who can get an erection by taking Viagra or Cialis are, in statistical studies, not considered to have impotence. If men can get any sort of a serviceable erection after treatment with Viagra or Cialis, they're not considered impotent. This is very important to consider when doctors are quoting different risks for the development of impotence, that in the back of their minds  they're assuming that you will be taking Cialis or Viagra to try and restore normal sexual function, and that's included in the percentages that are being presented to you.

 The statistics that are quoted for a 50 year old man developing problems are much, much less than say a 65 or 70 year old. In people who are already taking Viagra or Cialis, those individuals are much more likely to develop problems with erectile dysfunction than those that don't need it. Not everyone is the same, and the risk of erectile dysfunction escalates dramatically as men get older.

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