- The results of this treatment in young patients, with localized, well-defined, low-risk tumors are very satisfactory
- Da Vinci robotic assisted surgery, indicated in patients with more advanced tumors, also offers better results in terms of sexual function than laparoscopy or open surgery, where erectile dysfunction rates can reach 80-90%
- Although preservation of reproductive function is not possible, MD Anderson Cancer Center Madrid offers its patients the option of freezing sperm for future artificial insemination
Madrid, December 2, 2020 - The loss of sexual function is one of the most common concerns among prostate cancer patients once they overcome the disease, something understandable if we take into account that, with traditional open surgery, the rate of erectile dysfunction exceeds 80-90%, a percentage that is reduced to 40-60% using of laparoscopy. "The figures are so high because the nerves that produce an erection are very close to the prostate, and as a result, these nerves are often injured when the prostate is removed", explains Dr. Carlos Nuñez, head of the Urology Service at MD Anderson Cancer Center Madrid.
In his opinion, these figures are too high, especially in young patients (on average around 60 years of age) who are diagnosed with a localized, well-defined tumor (affecting only one or, sometimes, two adjacent quadrants) which is not very aggressive. In these cases, Dr. Nuñez recommends focal therapy, a very novel technique where only the affected part of the prostate is destroyed using different sources of energy.
So far, this technique has meant that more than 90-95% of patients can maintain an erection after tumor removal. With these figures, Dr. Núñez talks about the possibility of even removing tumors that could, in principle, be managed through active surveillance. “These patients sometimes believe the specialist isn’t listening to them, they are afraid and develop anxiety; now, thanks to focal therapy, we can remove the tumor without any side effects and, from there, begin active surveillance of the patient”, points out Dr. Nuñez.
MD Anderson Madrid is currently running a clinical trial with a sample of 50 patients who have already been monitored for between two and three years after undergoing focal therapy. "In ideal cases, the results are frankly good - we have less than 10% relapses at five years with preservation of sexual function at more than 90% and urinary continence at practically 100%".
In fact, good results in urinary continence are usually related to good results in preservation of sexual function, since, as the specialist explains, “there are studies that have detected, with magnetic resonance, that neurovascular bundles not only contain the erectile nerves, but also nerves that end in the sphincter”. These findings confirm that treatments like focal therapy may be useful, not only in maintaining erectile function, but also in protecting urinary continence.
In patients with more advanced stages of cancer (involving both sides of the prostate, for example), Da Vinci robot assisted surgery is also producing results up to 10-20% better than those obtained with laparoscopy. "In cases where it is an option because the cancer is not so widespread, robot assisted surgery allows us to perform a less aggressive dissection of the erectile nerves, so we achieve improved recovery of sexual function", emphasizes the doctor.
What is not possible to preserve today with any approach to prostate cancer is the ability to reproduce. "We can maintain an erection and even orgasm, the sensation of pleasure, but we cannot maintain ejaculation because we remove the prostate and seminal vesicles and cannot, therefore, maintain reproductive capacity," acknowledges Dr. Nuñez. For this reason, in young patients, Dr. Nuñez's team offers the possibility of freezing the patient’s semen, a process very similar to that of freezing eggs and that will allow the patient to fulfill their desire to be a father by means of artificial fertilization in the future.
Restoring erectile function after tumor removal
About 60% of patients do not need further recovery after surgery, especially if they are young (around 60 years of age) and have undergone bilateral preservation of the prostate. On the other hand, about 10-15% of patients will need follow-up treatment with Sildenafil (Viagra) or Taladafil to achieve a full erection, since, as Dr. Nuñez points out, “it has been shown that the early administration of these "drugs achieves lower deposits of collagen in the penis, keeping it more elastic, favoring erection". It is important treatment starts in the first weeks after surgery to achieve the desired effect.
If the patient does not achieve an erection in approximately three months, there are other options, such as vacuum erectile devices (VED), which also seek greater elasticity and activity of the penis, or, later, prostaglandin injections, which produce an artificial erection. Ultimately, it is possible to resort to a penile prosthesis, but this is less common, since it is an irreversible technique and is usually used only in those patients in whom both neurovascular bundles have had to be removed.
A whole series of options Dr. Nuñez offers his patients as time goes by and, above all, as the patients themselves demand. “Each patient has his own sexual life - it is a very personal issue where, often, the patient’s partner also contributes to the decision-making process”, says Dr. Nuñez, who points out that preservation of sexual function is a more important issue, the younger the patient is.