Erectile Rehabilitation Treatments for Prostate Cancer Surgery Patients

Erectile Rehabilitation Treatments for Prostate Cancer Surgery Patients


So, erectile rehabilitation is a name which
we have affectionately given to men who we are trying to preserve and actually reinvigorate
their erections and routinely we use it after some type of definitive therapy for their
prostate cancer and in particular, we use it for men after their robotic prostatectomy,
so let’s talk about what I routinely recommend for my patients. Number 1 is that there are
a fair number of patients who within a very short period of time after surgery, they regain
their erections actually pretty quickly which is great but unfortunately not all men actually
just, you know, start doing fantastic right after surgery, how much we love to believe
that as surgeons, it just does not work that way. So what we look at is we try to make
sure that we are preserving that erectile function and actually reinvigorating that
erectile function, so how do we do that. So, part 1 is that we want to make sure that we
are hoping those nerves actually get stimulated and the way we do that is number 1 is routinely
I recommend phosphodiesterase inhibitors. Now, whether it is going to be a daily Cialis
or phosphodiesterase inhibitor is a Viagra, a Cialis, you know Levitra and there is a
new one out called Stendra and what these medications do, you have to understand how
they work is that the nerves that actually run right alongside the prostate, what they
do is they actually will release a chemical and that chemical is released inside the penis
and that actually causes the vasodilation which is the blood flow actually in the penis.
So, you know, people have this misinterpretation that they take a Viagra, they can be sitting
on a couch and all of a sudden, they get an erection and it is not the way it works and
I will callously tell patients, you know, when you take a Viagra, you got to do something
to make the erections work a little bit. You cannot just sort of hang out, need a bowl
of soup and kind of whole things will happen, so the way that you do that is you have to
get somehow stimulated, whether it is going to be a visual stimulation or whether it is
going to be a tactile, in other words a touch stimulation. So, the end of the day, a phosphodiesterase
inhibitor actually helps preserve so when those nerves actually release that chemical,
that chemical causes that blood flow and that blood flow will increase and then it causes
the erection. So we want to do is we want to increase the amount of that chemical that
actually stays around longer, so when a man gets stimulated again that erection gets better.
So Viagra, Cialis, Levitra, Stendra what have you, they don’t cause the erections, they
make your erections better than you have, so we want to make that erection better and
the way we do that is we start that in and I usually start for patients, a fair number
of patients I actually started on actually prior to surgery and I do that because we
know that the better erection they have going into surgery, the better erection they are
going to have coming out of surgery, so then and then shortly thereafter we put him back
on that and again a lot of that depends on whether a patient has had side effects from
one of those medications, a lot of times I use daily Cialis, I like it, there is some
interesting data that actually says that it can actually help. So, that is from a phosphodiesterase
inhibitorwise. We want to get those nerves releasing that chemical to actually get those
nerves actually start functioning and get blood flow in them. A second thing routinely
we do is what is called a vacuum erection device and a vacuum erection device is a pump
that goes on the penis, you know a lot of people make jokes about these, you know, from
Austin Powers, you know, and it is not my penis pump and at the end of day, its pretty
funny, you know, topic of discussion, there is no doubt about it but what it does is it
pulls blood flow in the penis and what we know about that is that it is particularly
important to actually get blood flow in there and what we think is that it minimizes the
effect of scarring in the penis, so if we are not getting full erections right after
surgery, we know that the sooner that we actually start activating that and sooner we actually
get blood flow in the penis, the less chances we have of actually scarring in the penis.
My analogy to that is very similar to a rubber band, so if you have a rubber band and you
stretch out that rubber band and it is working fine, well great, if I leave that rubber band
sort of like, you know, out in the yard for two or three months and then I try to stretch
that rubber band, what happens that rubber band just does not stretch out as much. Well
as an analogywise, we want to make sure that that penis is actually stretching out, so
we are minimizing any scarring tissue and that is what the vacuum erection device does.
A lot of times too depending on, you know, how we are doing with the erectile function,
we actually recommend injection therapy which if, you know, you think you are talking about,
you know, using a pump and things then you start talking about needles in the penis,
that really gets, you know, men’s attention they go, you know, come again, like did you
really just tell me I am going to put a needle in my penis and the answer is yes and here
is the reason why because depending on those erections, we want to actually make sure that
we are actually getting oxygenated blood flow in the penis and the way that we do that is
we actually have a small little needle that goes into the side of the penis and it actually
causes that direct vasodilation, so it is sort of like Viagra going directly into the
penis but it actually causes a direct vasodilation, we bypass the nerves for that and again we
don’t do it on all men but we do it on specific men who we want to get those good erections
back, you know, sooner when it has taken them a little bit longer but it is particularly
important to do that again because we want to minimize that scarring in the penis, we
want to get oxygenated blood flow in there and again we want those nerves and we want
that penis to actually start, you know, functioning the way it should do again and then on top
of all those things, you know, I tell men it is important that actually we do some kind
of cardiovascular activity and then we really look at their diet. You know, I think it is
really important that we just get men back to, you know, really trying to eat as healthy
as possible because what happens is that for men what happens is, you start having, slightly
right after surgery, you get a little bit of shortening of the penis, we want to actually
preserve that and one of the challenges we have, if the guy is not in the greatest shape,
you get a little fat pad and then what ends up happening is that penis actually will look
smaller and they say what I am going to do with that and the end of the day, we are going
to do all those things that we talked about but we are also trying to get in the best
shape possible so that penis actually looks like it has more length, all of those things
will help and I do all these things with my patients and the more aggressive they are
earlier on then we know that the better off they are going to be. We know that there are
great studies that erections will continue to improve for four and a half years after
surgery and we don’t wait that long and the reason why we don’t wait that long, number
1 is the fact that the sooner we start becoming proactive with the erectile function, the
better off they are going to be long term, so if we actually start working on this in
the first, you know, six weeks or three months, they are going to be that much better as opposed
to waiting a year or two years down the road because again think of that rubber hand, if
that rubber band has potentially got a little bit of scar tissue on it, it becomes much
more challenging for that to work. Some prostate cancers are high risk, aggressive,
and more likely to spread. Others are low risk, least likely to have bad outcomes. The
biopsy says cancer, but current diagnostic tools provide limited information about how
aggressive a man’s individual disease is, so most men decide to treat prostate cancer
immediately. Once treated, many men experience serious long-term side effects like incontinence
and sexual impotence. Immediate treatment is not always needed, but right now a man
can’t be sure if his cancer is the kind that is likely to require treatment or if he is
okay to wait for now. What if there was a test that could determine how aggressive prostate
cancer is. Genomic health is developing a new test to do just that. By reviewing the
underlying biology of the tumor and using genes from multiple biologic pathways, the
test can predict the aggressiveness of prostate cancer when diagnosed, allowing a man to make
a more informed treatment decision with confidence, taking care of himself with more information
and greater peace of mind.