Success After Prostate Cancer
J. Stephen Jones, MD
Vice Chairman, Glickman Urological Institute, Cleveland Clinic
Dr. Jones presented a comprehensive review of Erectile Dysfunction and also included Stress Urinary Incontinence for good measure. In discussing the ED issue he showed a slide describing the epidemiology of ED world wide.
It is projected by 2025 that some 322 million men will suffer one degree or another of ED. This is an increase from 152 million in 1995. These data were taken from an article by McKinley, Int. J. of Impot. Res., 20000: 12 (suppl 4). It’s not clear how these data were developed.
The US was shown at 9.1 million, Europe at 11.9, Asia at 113 million and Australia and New Zealand at 0.9 million.
[Ed Note: These data also included Africa at 19.3 million. One has to wonder how these data were obtained given the notorious dishonesty of men who are polled with questions concerning ED]
He described other health conditions that have ED to one degree or another as a consequence. For example, men (smokers) with heart disease had ED ranging between 56% (complete) to 78% (moderate to complete). Men experiencing depression ranged from 41% (complete ED) to 90% (moderate to complete). He made the point that prostate cancer treatments are not the only cause of Ed.
He described how cases were handled in 16th century France if the wife requested an annulment because her husband could not perform his marital duties. Either the husband would have to confess his ED to a court or the couple might be brought before a public gathering of doctors, surgeons, matrons and judges where he would be expected to demonstrate his potency. If he failed to produce an erection for all to witness, the marriage would be declared null and void. Imagine the poor man’s “performance anxiety” under these circumstances.
In the case of prostate cancer, every treatment can produce ED ranging from mild to total. For example, he cited some data for erectile function after radiotherapy (external beam): 1 year after RT, some 68 – 85% reported potency.
But after five years, the % potent rate dropped to 38 – 60%. He also reported on potency rates after EBRT followed by sildenafil (Viagra®): over different time intervals between the EBRT and the use of Sildenafil, he reported multiple studies that showed from 71% to 91% potency restoration.
Similar studies of brachytherapy with I – 125 seeds, showed a potency retention range from 18% to 92%.
Jones then went into a more detailed presentation of the effectiveness of drugs such as Sildenafil (Viagra®) and its cousins. He also discussed the vacuum devices, injection therapy, Muse®, and penile implants.
For men who have undergone treatment for PCa this was familiar territory. He described the results of external beam radiation on ED because of irradiation of the penile bulb itself. In the case of brachytherapy, seed placement near the neurovascular bundle contributes to subsequent ED issues.
Dr. Jones made the point that early intervention following primary treatment is the best course of action regardless of the approach taken. “Use it or lose it” is the guiding principal here. In 1997, he reported, work at the University of Milan School of Medicine, showed the value of immediate post-operative injection therapy 3X/week following RP in returning natural erectile function in 6 months.
Dr. Jones emphasized the fact that most early intervention programs produced the best overall results regardless of what the primary treatment for the PCa actually was. He concluded his ED lecture with a slide that showed % satisfaction for all the ED treatments covered: it ranged from a low of 28% (oral meds) to a high of 94% for surgical implant. He concluded that:
ED is as old as man (and woman)
Men with PCa are at risk based on both the disease and the treatment
Management is always possible
Prevention is harder, but progress is being made
He has written two books:
"The Complete Prostate Book"
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