For men just diagnosed with prostate cancer, the threat treatment poses for sexual function looms large and can play a major role in which treatment they choose. It can even lead some men to choose to avoid  or delay treatment. It can even lead some men to avoid tests that can lead to the diagnosis  of prostate cancer so that they are not confronted with the possible loss of sexual function. In this review, we will try to put these issues into perspective to help patients think more clearly about decisions they face.

First, I should point out that prostate cancer and its treatment do not represent the most common threat to male sexual function.  The most common medical cause  of male sexual dysfunction  is cardiovascular disease that damages the blood flow to the penis. In fact, loss of erectile function can  often be an indication of developing cardiovascular disease and is associated with a greater risk  of heart attack or stroke. As you might expect, this scenario is more likely if you have hypertension, diabetes, or elevated cholesterol or triglycerides. Management of these risk factors for cardiovascular disease can often improve erectile function. These issues are quite common in men with prostate cancer and can make impotence from prostate cancer treatment more likely. If you want to preserve sexual function, you should work with your physician to optimize cardiovascular health.

Second, I should point out that as prostate cancer progresses it can impair sexual function. The arteries and nerves to the penis sit on either side of the prostate gland. As the cancer grows, it will engulph these arteries and nerves, resulting in the loss of sexual function. As a result, if you have clinically significant cancer and need treatment,  the no treatment option will not prevent loss of sexual function.  This path might only serve to delay for a while that loss.

Charles E. Myers, Jr., MD       

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