Treatment options for patients who have undergone radical
prostatectomy include oral drug therapy, drugs that are injected into the penis,
drugs in the forms of suppositories or pellets that are deposited in the urethra
of the penis, a vacuum pump device, and surgery to insert penile implants or
prostheses. The success rates of any of these treatments are dependent on such
factors as the type of surgery (nerve-sparing or non-nerve-sparing), the age of
the patient, and whether the patient received hormone therapy prior to surgery
or additional therapies such as radiation therapy, either prior to or after the
Three oral drugs have been used in patients who have had radical
prostatectomy for prostate cancer. These three drugs are Viagra, Levitra, and
Cialis. While success rates with these drugs have varied, patients who have
achieved the most benefit are those who have had bilateral nerve-sparing radical
prostatectomy. Up to 70 percent of these patients may respond to one or more of
these three drugs (response to each individual drug may from person to person).
Success is less likely in patients who have had only a single nerve spared, and
is very unlikely in patients who have had no nerves spared during surgery.
Success rates with oral therapy are also higher in younger patients and are
probably better in patients who do not have other risk factors for erectile
dysfunction, such as cigarette smoking, hypertension, high cholesterol, and
coronary artery disease.
When oral medications are unsuccessful, the following devices and alternative medication delivery routes are other options.
Vacuum constriction devices
Vacuum constriction devices consist of an acrylic cylinder that is placed
over the penis. A lubricant is used to create a good seal between the body and
the cylinder and a pump mechanism is used to create a vacuum inside the
cylinder, which allows a patient to achieve an adequate erection. If an adequate
erection is achieved, a band or ring is then placed over the base of the penis
(the part of the penis closest to the body), which is used to help maintain the
erection. Although some men find these devices helpful for achieving
intercourse, many men find the band at the base to be uncomfortable or find the
device to be somewhat cumbersome. These detractions tend to limit the number of
men who choose this therapy following radical prostatectomy.
Intracavernous or penile injections
Penile injections are probably the most widely used non-surgical method when
oral therapy fails to produce an adequate response and, in particular, are the
most widely used medical treatment option amongst patients who have had a
radical prostatectomy. This method will work in patients regardless of their
nerve-sparing status. Penile injections are successful in approximately 80
percent of patients who try it. The patients do need to inject each time they
want to have sex and the drug is injected directly into the erection tissue.
With proper technique, the injections themselves are not painful. However, after
radical prostatectomy, the most commonly used medication for injection,
alprostadil, results in an erection that is painful in a significant number of
men. Complications of injection therapy include a prolonged erection (which
would require injecting additional medication into the penis to make it flaccid
or soft again) and the possibility of scar tissue (which could result in
curvature of the penis). Drug-induced prolonged erections are rare, fortunately.
Scar tissue development seems to be related to both the frequency of injections
and duration of use of this therapy. Although this is a successful therapy,
there is a significant dropout rate over time.