Preventing ED While Curing Prostate Cancer

"67% of men who included Penile Rehabilitation in their prostate cancer treatment had a return of normal erections at 6 months – compared to only 20% of men who didn't."

The Delaware Center For Restorative Urology

The Secret to Keeping Your Erections While Curing Prostate Cancer: Penile Rehabilitation

      Prostate cancer is the second most common cancer in men. With the age at the time of diagnosis steadily decreasing, the impact of any cancer treatment on a man's lifestyle becomes increasingly important. All of the three main therapies (external beam, brachytherapy -also known as "seeds", and surgical removal) have excellent cure rates - but they also all have a 40% chance of causing erectile dysfunction.

There is, however, GOOD NEWS! 

      Treating your cancer doesn't have to cause ED. You can do something to prevent it. Chances are the very same quality of life, intimacy and erections you enjoyed earlier, before discovering your malignancy, can remain unchanged after it's treated  – if you map out a pro-active strategy of "penile rehabilitation therapy" with an ED specialist like Dr, Muench before your cancer treatment.

What Causes ED after Prostate Cancer Cures?

      The nerves controlling erections run right by the prostate. With modern cancer therapies increasingly able to both cure cancer and preserve those nerves, the persistent 40% ED rate seemed high -suggesting there was some unknown “additional cause”. Studies showed that even undamaged erection nerves go to sleep - a term called "neuropraxia" - for up to 18 months after being stretched. The erection nerves get unavoidably stretched during any prostate cancer treatment -stretched either by being pushed away from the prostate during its surgical removal or stretched by the swelling of the prostate that normally follows any type of radiation.

      Previously, it was felt that neuropraxia was simply a time of healing & rest during which nothing bad was happening in the penis. All post-treatment ED was previously felt to be solely due to the cancer-curing treatments themselves. We’ve now identified the periods of prolonged flaccidity (lack of erections during neuropraxia) as the “additional cause”.

      During those periods, two undesirable microscopic changes occur rather quickly in the penis: 1) increased fibrosis 2) decreased smooth muscle. Those changes are not due to the surgery or radiation, but due to the prolonged lack of erections alone. Either change can ruin erections. Getting both obviously is worse: a one-two punch that can knock out any patient's hopes of returning to the quality of life he enjoyed before his cancer was diagnosed. To preserve erectile function, they must be avoided.

What is Penile Rehabilitation?

      We used to encourage men to patiently wait out those “neuropraxia periods” of no-erections until they passed. Now we know that waiting them out harms erection tissue further. The concept of penile rehabilitation is that by regularly self-inducing erections soon after any prostate-cancer-curing treatment, a man protects his erection tissue, reduces his loss of length and function, and speeds up the return of his own natural erections. Beginning intensified erectile restoration sessions at home soon after any of the prostate cancer therapies helps greatly lessen that 40% chance of ED seen after each. Those unwanted microscopic changes are actually prevented and reversed in patients who commit to active participation in structured rehabilitation programs.  

      The benefits of a rehab program are similar to those of using physical therapy after a stroke. When a stoke leaves a man unable to move his arm, he begins regular therapy as soon as possible to keep the arm in good shape, so it doesn't wither while waiting for his nerve function to return. Under the guidance of Dr. Muench, penile rehabilitation prevents the penis from withering while waiting for the nerves to awaken from their sleep.

      One study in men who had their prostates removed showed that 67% of those who began penile rehabilitation therapy within the first two months of surgery had a return of spontaneous erections (requiring no medications) sufficient for intercourse at 6 months, compared to only 20% with return of normal function among those who didn't.  Rehab isn't just for surgery. We're finding similar benefits when restoration therapy is begun with all forms of prostate cancer radiation too.

Who Should Consider Penile Rehab?

      Any patient wishing to preserve erectile function should anticipate the need for penile rehab. Such programs work best when devised in advance and begun before being needed - ie before loss is recognized or extended.

      Most prostate cancers are discovered in men who are of an age where they may have already noticed some decline in their sexual function. Men with pre-existing mild ED who participate in rehab have a greater chance of keeping their ED from progressing. There is a benefit to keeping mild ED from becoming more severe: it's easier to treat, responding better to a wider array of treatment options. Therapy for any level of erectile function helps preserve and improve it.

      Loss of erections isn’t always immediate after cancer treatment. Some loss is delayed – appearing months later. This has been documented following both surgical and radiation treatment of prostate cancer. Men seeing immediate return of their erections after cancer treatment might assume they don’t need rehab. Nothing could be further from the truth. For them, early penile rehab helps prevent the delayed form of loss.

      So, all men benefit from early participation in erection-preserving therapy programs -even when there is no immediately apparent problem. 

The idea, throughout the possible 18 months of therapy, is not to simply "do enough for now", but to "do more than you need at the moment", to maximize successful long term preservation. Patients who fully accept the realities of this and truly commit to rehab are the most rewarded in the long run.

THE PROSTATE CANCER PENILE REHABILITATION PROGRAM at the DELAWARE CENTER for RESTORATIVE UROLOGY

     The amount of medical information available is increasing so rapidly that no one doctor can keep up with all the discoveries affecting your health. Only your radiation oncologist or oncologic urologist has the expertise, time and interest needed to stay abreast of all of the advances that will maximize your chances of cancer cure. The body of information concerning the causes and cures of erectile dysfunction has equally grown over the past 15 years. The best outcomes in both cancer cure and erectile preservation are obtained when patients enlist specialists dedicated to each respective goal to work cooperatively on your behalf. This requires a team approach. Dr. Peter Muench, at the Delaware Center for Restorative Urology, is a specialist in the latest approaches to prevent and treat erectile dysfunction. Before he treats your cancer, your urologist (or radiation oncologist) may suggest you and your partner (if you have one) consult with Dr. Muench about adding a program to protect erectile function to his cancer care plan.

Before Your Prostate Cancer Treatment

     At the Delaware Center for Restorative Urology, the program for Penile Rehabilitation begins BEFORE cancer treatment, with a thorough assessment of your pre-treatment level of sexual function. Dr. Muench will familiarize you with the many different preservation methods (and the research supporting each). From them, a comprehensive program (perhaps combining several methods) to prevent post-treatment loss will be created that is tailored specifically to your individual needs and pre-existing conditions.

      The ideal penile rehab program has two parts: a) therapy to maximize penile health before entering cancer treatment, and b) more intensive therapy as soon as possible after cancer treatment to reverse or prevent loss. Before entering prostate cancer treatment, even men with "normal" function should begin medications which optimize erectile tissue health. There are several strategies -discussed at your first visit -that can be used to do this. Adding the more intensified rehab exercises later, after cancer treatment, helps all patients -even those who seem unaffected -reverse any unwanted microscopic changes and prevent delayed ED.

      The idea, throughout the possible 18 months of therapy, is not to simply "do enough for now", but to "do more than you need at the moment", to maximize successful long term preservation. Patients who fully accept the realities of this and truly commit to rehab are the most rewarded in the long run.

During Your Prostate Cancer Treatment

      During treatment, your urologist or radiation oncologist combines his meticulous skill with the latest technology to cure your cancer while minimizing the impact on your erectile nerves. They keep us informed of your treatment course and any final pathology reports - to make sure the penile preservation program we selected earlier continues to accurately target your anticipated needs.

After Your Prostate Cancer Treatment

      Before beginning the post-treatment portion of your program, you should again see Dr. Muench at the Center for Restorative Urology to assess any changes to your pre-treatment level of sexual function. The comprehensive penile rehabilitation program anticipated at your first visit will then be reviewed, adjusted if indicated, and started. Once begun, men use those preservation methods outlined in their program to regularly induce 2-3 erections per week AT HOME - with or without sexual relations. Most men are able (and eager) to begin preservation therapy at one to two months. With this program, you are not only improving the health of your penis but you are also making sure that you have a satisfying sex life while doing so.

      The program includes periodic follow up with Dr. Muench - to assess and document function and length preservation, adjust the intensity or frequency of  the erection-inducing methods being used, and  provide encouragement -helping  patients stay motivated and on schedule. This last element, providing encouragement, is essential -since men may need to continue therapy for up to 18 months after cancer treatment before it's possible to draw conclusions regarding the return of their own erections.

      Just as stroke patients are discharged from physical therapy once their function has returned, penile rehabilitation at The Center is a short term program. Your relationship with your referring urologist and/or radiation oncologist is a special one that remains respected and preserved throughout. Dr. Muench oversees only your penile preservation and keeps them informed of your progress. During that time, you’ll continue to follow up with your referring urologist for ALL other urologic care. Once erectile function has been restored, you'll be discharged from therapy to continue solely with your original referring urologist - who will receive a final summary of your rehab care.
ALL ED IS CURABLE and Dr. Muench has over 20 years experience helping men restore intimacy to their relationships. The Center's goal, however, remains preventing loss and maximizing every patient's chances of retaining the same quality of life he enjoyed before prostate cancer was diagnosed.
 
Peter J. Muench M.D. is a board certified Urologist. A native of Pennsylvania, he attended Temple University School of Medicine, completed his General Surgical Residency at Temple University Hospital, and his Urology training at Thomas Jefferson University Hospital. He has 20 years experience with a focus on Restorative Urology - specializing in the prevention and treatment of erectile dysfunction.

Delaware Center for Restorative Urology
Peter J. Muench M.D.
H-50 Omega Dr.
Newark, DE 19713
(302) 266-7577