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Several Therapies May Help Post-Prostate Impotence

NEW YORK (Reuters Health, Dec 30, 2002) - Only a small minority of men who have surgery or radiation therapy to treat prostate cancer (news - web sites) recover normal sexual function after treatment, according to a new survey.

For most men, treatment for erectile dysfunction is disappointing, although men who tried more than one approach were most likely to find one that worked, Dr. Leslie R. Schover, of the University of Texas M.D. Anderson Cancer Center in Houston, and colleagues found in a survey of more than 1,000 men treated for prostate cancer.

"If you are a man with erection problems after prostate cancer, it is worth trying a medical treatment for erectile dysfunction," Schover told Reuters Health. "But if at first you don't succeed, be prepared to try, try again," she said.

According to Schover, most studies that have examined the rate of erectile dysfunction after treatment for prostate cancer "have given men an overly positive idea of what is likely to happen after their cancer treatment." Most studies consider a man to be "potent" if he is able to have sex even just one time with a "not necessarily very firm" erection, Schover said.

In the new survey, which included men who underwent a variety of prostate cancer therapies, Schover and her colleagues used a stricter standard. The researchers defined "success" as usually having a firm erection during the previous four weeks when a man tried to have intercourse.

By that standard, only 13% had a successful sex life without any treatment for erectile dysfunction. Another 8% had reliable, firm erections with the aid of some sort of treatment. Younger men, as well as men who had "nerve-sparing" surgery or had radioactive seeds implanted in the prostate, were more likely to recover sexual function after treatment. Also, even after other factors were taken into account, men who placed more importance on sex and who had the support of a partner who still enjoyed sex tended to have a better sex life after cancer treatment.

The results of the survey are reported in the October 15th and December 1st issues of the journal Cancer.

Most men experience some sort of erectile dysfunction after prostate cancer, but less than two-thirds, 59%, seek treatment for the problem. Of men who sought treatment for their performance problems, only 38% found a medical treatment that provided at least some help. At the time of the survey, three out of 10 men were using some sort of treatment for erectile dysfunction.

Schover said that most men preferred treatments like the anti-impotence pill Viagra (sildenafil), but she pointed out that these pills only helped 16% of men. The most effective treatments, she said, were ones that involve the most "hassle," including injecting medication into the penis to trigger an erection or surgery to implant an inflatable penile prosthesis.

She noted that "men who succeeded in finding a treatment that worked for them often made several tries with different types of medical therapies before settling on one that helped."

A major issue after treatment for prostate cancer, according to Schover, is the need for counseling that includes a man and his partner and helps them "change their lovemaking routine to maximize the chance that a medical treatment for erectile dysfunction will work and gives them more realistic expectations about the hassles involved with each type of treatment." For single men, counseling may help them communicate about sexual needs with new partners, Schover said.

Schover advised men with erectile dysfunction to "include your partner in the help-seeking process and make sure that your lovemaking focuses on her needs and pleasure, too, not just on getting a hard erection."

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