Current management of erectile dysfunction in prostate cancer survivors

Abstract

Although no standard management of erectile dysfunction in prostate cancer (CaP) survivors exists, many treatment options are available. This review summarizes the current understanding of the cause and management of erectile dysfunction in CaP survivors. Erectile dysfunction after radical therapy for CaP may be more common than previously thought. Genetics and vascular comorbidities may have a significant impact on erectile dysfunction after CaP treatment. Although penile rehabilitation with medical modalities show good efficacy in motivated patients, the return of erectile function is never guaranteed with nonsurgical management. Penile prosthesis placement results in early return to sexual function after CaP treatment with high patient satisfaction rates. Various techniques allow safe placement of a three-piece penile prosthesis in patients with a history of pelvic surgery. To optimize recovery of erectile function and prevent loss of penile length, penile rehabilitation should be initiated expeditiously after prostatectomy or radiation. In patients with refractory erectile dysfunction, dexterous and motivated patients remain excellent candidates for first and second-line medical therapies. However, early placement of a penile prosthesis following radical prostatectomy is now a proven and viable option.