How Can a Man Prevent Impotence After Having Prostate Surgery?

QUESTION: What can be done to prevent impotence after men have surgery for
cancer of the prostate?
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ANSWER: After age 50, prostate cancer is among the most common in men, with
about 36 out of every 100,000 men developing it every year. It occurs much
more frequently as we age. Half of those with prostate cancer are 70 or
older; yet very few are under 50 years old.
Many males in that group are much less concerned about erections than
they were when younger. However, each patient is different. When possible,
every effort is made not to interfere with the parts of the body vital to
erections during treatments involving the prostate.
Nevertheless, difficulty with erections occur in about 40 percent of men
with prostate cancer even before they receive any treatment. In many of
those, it is due to other chronic illnesses, not the cancer.
Advances in treating prostate cancer are encouraging. Basically, we use
radiation and surgery.
Surgery usually removes the prostate gland, seminal vesicles and part of
the urinary bladder and often, but not always, causes impotence.
There have been important advances in radiation therapy and it is used
with certain forms of prostate cancer and may not cause impotence.
However, I must point out that one scientific study revealed that smokers
were far more likely to develop impotence following radiation for prostate
cancer than were those who do not smoke.
In one particular form of radiation treatment called brachytherapy, a
radioactive source is placed in close proximity to the cancer. It delivers
only a low dose to the surrounding normal tissues but extremely high ones to
the cancer. Results have suggested that brachytherapy prevents impotence in a
great majority of those treated with it, yet some experts question its
long-term effectiveness against certain types of cancer.