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Erectile Dysfunction and Prostate Cancer (Portuguese)

Erectile Dysfunction and Prostate Cancer (Portuguese)

The main purpose of this lecture is to go over prostate cancer and possible impact on male sexual function. Prostate carcinoma is the most frequently noncutaneous diagnosed cancer and the second leading cause of death in men, accounting for one quarter of all such cancers. The estimated lifetime risk of disease and risk of death is respectively around 17 %, and 3 %, considering Caucasian population. It seems likely that prostate cancer (PCa) mortality declines significantly.

Radiation and radical prostatectomy are efficient therapeutic options for PCa. Each form of therapy has its own set of complications including erectile dysfunction (ED), that is, the inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse. ED rates in some surgical series are as high as 60% to 90% one or more years following treatment. Among the series that include men treated only with radiotherapy, specifically Intensity-Modulated Radiation Therapy (IMRT) technique appear to result in greater preservation of erections. Rate of ED is below 50% one year and later post treatment. Younger men (<60 years) were more likely to maintain erections than older ones. ED and urinary incontinence are higher followed by radical prostatectomy and IMRT.

However, patient and, when possible, his partner should be informed of the relevant treatment options for those who underwent to radical surgery, IMRT or combination of both. The ideal alternative should be made jointly by the physician, patient, and partner, taking into consideration patient preferences, expectations and age. The management of ED begins with the identification of organic comorbidities, psychosexual dysfunctions possible depression and anxiety due to PCa. All should be appropriately treated or their care triaged. Currently employed medical interventions for the management of ED include oral therapies that target the penis through phosphodiesterase type 5 (PDE5) inhibitors such as sildenafil, tadalafil, udenafil, vardenafil and others. Antianginal agents like organic nitrates (isosorbide) and calcium antagonists are relatively restricted because of lowered blood pressure. Intrapenile therapies consist of intra-urethral suppositories of alprostadil (synthetic vasodilator identical to PGE1) or intracavernous injections (ICI). ICI is the most effective nonsurgical treatment for ED and can be carried out with prostasglandin E1, papaverine, phentolamine.

The patient should be able to adjust within specific bounds the total dose of medication injected to match the specific situation for which it is used. The vacuum constriction device is a noninvasive mechanical device and may be helpful for some individuals. Surgical therapy includes penile prostheses which can be divided into two general types: malleable or noninflatable and inflatable.  Noninflatable devices are also commonly referred to as semirigid rod prostheses. Inflatable penile prostheses provide the recipient with closer to normal flaccidity and erection. Both can be done as out patient procedures. Psychosexual therapy or counseling may be necessary because sexual bother increases post radical surgery or IMRT even in men with “good” erection followed by PCa treatment. These include shame, embarrassment and reduction in general life happiness. The co-administration of oral PDE5 inhibitors, ICI and psycho-sexual counseling has been applied in specific situations. These appropriate treatment options should be applied in a stepwise fashion with increasing invasiveness and risk balanced against the likelihood of efficacy.

Areas of Interest / Categories: Erectile Dysfunction, WAS 2013

WAS 2013

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