Harvard Perspectives on Prostate Disease

New options for treating erectile dysfunction

Penile rehabilitation after treatment for prostate cancer

Studies indicate that anywhere from 30% to 70% of men who undergo radical prostatectomy or external beam radiation therapy, and 30% to 50% of men who opt for brachytherapy, will develop impotence after treatment. Recent insights into why this happens have led to a whole new approach in treating men who are interested in preserving their sexual function. The new therapies are often referred to collectively as penile rehabilitation, a concept first introduced by European physicians in 1997. Since then, penile rehabilitation has gradually evolved and is now being offered at a number of major teaching hospitals; it is less likely to be offered in the community setting. Although exact regimens vary, penile rehabilitation typically consists of oral or injected medications, alone or in combination with other interventions, to restore and preserve erectile function before any long-term damage occurs.

But this therapy remains controversial. Although preliminary results look promising, only a handful of reliable studies evaluating various types of penile rehabilitation have been published "" and these have used different types of interventions, for different periods, so it is difficult to compare one method with another. Moreover, no consensus yet exists about which approach is best for a particular patient. Even so, penile rehabilitation may be something worth asking your doctor about if you have just been diagnosed with prostate cancer or are currently undergoing treatment. This article briefly reviews options in penile rehabilitation and the limited scientific evidence.

New insights into erectile dysfunction

When erectile function becomes impaired following radical prostatectomy, the problem has traditionally been attributed to nerve damage. The nerves that trigger erections may become damaged during surgery (even during so-called nerve-sparing surgery), leading to a problem known as neuropraxia "" a temporary loss of function that theoretically should recover in time. The problem is that it can take as long as two years for the nerves to recover sufficiently to enable a man to have a spontaneous erection, and by then other damage may have occurred.

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