When men undergo treatment for prostate cancer, they can often suffer a decline in their sexual function. This can include difficulty getting or maintaining an erection, loss of libido and loss of ejaculate.
Our goal is to help patients make an informed decision when choosing the appropriate treatment option. Cancer control is always the priority, but preservation of sexual function, when possible, should certainly be attempted.
Normal erectile function is provided by the neurovascular bundles (“NVB”). These are discrete collections of nerves and blood vessels that lie behind the prostate on both the left and right and are intimately adherent to the prostate capsule. A good analogy would be the prostate is the train and the neurovascular bundles are the tracks. Healthy NVB are critical for normal erectile function.
During radiation therapy for prostate cancer, the scatter of radiation energy can injure the NVB, creating a “slow burn” effect. This presents as a gradual decline in erectile function over years after treatment. During a radical prostatectomy, the NVB can be cut, cauterized, or stretched during the dissection leading to erectile dysfunction.
A “nerve-sparing” technique performed during a radical prostatectomy involves preserving the NVB on one or both sides of the prostate by carefully dissecting them off the prostate capsule. This is a delicate procedure, attempting to stay in the perfect plane to remove the entire prostate and not leave any cancer behind while simultaneously preserving these important surrounding structures. There are microscopic nerves outside the actual neurovascular bundles that are also critical for normal erectile function. Even when a bilateral nerve-sparing technique is performed, these can get damaged during the dissection leading to some degree of erectile dysfunction.
Both surgery and radiation therapy result in a loss of ejaculate as well. During prostatectomy, the ejaculatory duct and seminal vesicles are actually removed. Radiation causes inflammation and scarring of the ejaculatory ducts.
Psychological factors including depression, fear and anxiety can also have a profound effect on male sexual function and libido after prostate cancer treatment.
HIFU is an appealing option for prostate cancer treatment in younger sexually active men because it can provide excellent oncologic outcomes while preserving sexual function. Especially with focal therapy, HIFU energy can be precisely directed toward the cancer while avoiding the NVB, sphincter, and other critical nearby structures. Several large studies have demonstrated exceptional preservation of sexual function with HIFU.
It’s important to understand all of the available treatment options for prostate cancer and how they can affect sexual function and overall quality of life. Innovative technologies such as HIFU can provide excellent outcomes for patients while minimizing side effects. This technology has limited availability in the U.S. but is available in Florida at Sarasota Prostate Care.