Here's to a realistic post-radical prostatectomy potency talk

January 1, 2012

Surveys of patients and their partners have found previous numbers regarding post-op potency to be highly unrealistic, and results of recent studies, such as one from Memorial Sloan-Kettering Cancer Center, are closer to reality.

Radical prostatectomy (RP) is the most commonly selected option for treating localized prostate cancer. The annual numbers of this procedure have grown tremendously in the last 2 decades, and the surgical technique to achieve optimal results has evolved.

Another recent study, this one from Mayo Clinic, shows that the erectile dysfunction present after RP is due mostly to arterial insufficiency or venous leakage, not neural impairment (see article, "Most post-RP ED cases have non-neurogenic etiology"). This operation, by its nature, is detrimental to erections even when performed by the most skilled surgeons using optimal nerve-sparing technique. Those with good erectile reserves (ie, younger patients and those with no prior ED and few vascular risk factors) will likely have the best chance of potency preservation or adequate erections with the assistance of medications. Those with pre-existing, pre-op erectile difficulties or older patients will very likely experience poor erections after surgery.

The urologist performing RP should give realistic expectations in his pre-op discussion. The patient will likely choose the treatment he thinks will be best for cancer control, not the best for preserving his erections, as that problem can be very adequately dealt with later if the problem arises. Post-op, patients should be encouraged with penile rehabilitation protocols to be proactive in restoring the blood flow to the penis, and the positive aspects of a penile implant should be presented.

Dr. Mulcahy, a member of the Urology Times Editorial Council, is in private practice in Madison, AL.