Erectile dysfunction and treatment of carcinoma of the prostate |
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Authors: | Culley C Carson J Slade Hubbard Eric Wallen |
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Institution: | (1) Division of Urology, University of North Carolina, 2140 Bioinformatics Bldg CB 7235, 27599-7235 Chapel Hill, NC, USA |
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Abstract: | Prostate cancer is the leading malignancy in men in the United States and causes more than 60,000 deaths annually. Treatment
of prostate cancer, whether it be with surgery, radiation therapy, cryotherapy, or medical treatment, is associated with significant
life-altering morbidity. Incontinence and erectile dysfunction (ED) too often are sequelae of these treatment alternatives.
ED can be a significant complication and can alter the life of the patient with prostate cancer and his partner. Newer modifications
of the radical prostatectomy with nerve-sparing techniques are the cornerstone of erection preservation. Time following radical
prostatectomy has been shown to increase erectile function such that more patients have functional erections at 3 years than
1 year after surgery. With the advent of phosphodiesterase-5 (PDE-5) inhibitors, many men can have improved functional erections
and return to active coitus. Prevention of ED also is an important management technique. Evidence is gathering that prophylaxis
with regular vasoactive injection or daily PDE-5 agents may be an integral part of preservation of corpus cavernosum smooth
muscle function. Combination medical therapy and surgical penile prosthesis implantation also are options for patients who
do not respond to oral PDE-5 inhibitors. |
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