This document summarizes research on sexual function after prostate cancer treatment like prostatectomy. It finds that while some men regain erectile function after surgery or rehabilitation, many do not. Expectations often do not match reality, as sexual side effects can include loss of erections, ejaculation issues, penile shortening or Peyronie's disease. The optimal rehabilitation approach is still debated. Long-term hormone therapy may impact sexual function for over a year after stopping. Penile prostheses seem to better satisfy men with erectile dysfunction than other treatments. Overall, sexuality is altered after prostate cancer treatment and restoring only erectile function may not be enough.

1. ¿HAY SEXO DESPUÉS DE LA PRÓSTATA?
Eduard García Cruz
@drgarciacruz
Jefe de Servicio, Hospital Plató
Men´s Health, Hospital Clinic de Barcelona
@drgarciacruz
Eduard.garcia.cruz@gmail.com

2. ANTES

3. Defining and reporting erectile function outcomes after radical prostatectomy: challenges and misconceptions. Mulhall JP J Urol 2009;181:462-71.
14-90%

4. Pentafecta Outcomes of 230 Cases of Robotic-assisted Radical Prostatectomy with Bilateral Neurovascular Bundle Preservation. Ou YC Anticancer Res. 2015
Sep;35(9):5007-13
Erectile function after radical prostatectomy: Do patients return to baseline? Fode M Scand J Urol. 2016 Jun;50(3):160-3.
.
The complication-free rate was 93.9% (216/230), continence rate
98.3% (226/230), potency 86.1% (198/230), NSM 77.0%
(177/230) and BCR-free 92.6% (213/230). The trifecta rate
(continence, potency, BCR-free) was 81.7% (188/230). The
pentafecta rate was 60.4% (139/230).

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ANTES

7. Remembered International Index of Erectile Function domain scores are not accurate in assessing preoperative potency in candidates for bilateral nerve-
sparing radical retropubic prostatectomy. Salonia A J Sex Med. 2008 Mar;5(3):677-83.
Mean scores for the remembered IIEF were overall better than the real-time IIEF
scores, as supported by direct comparison of the mean IIEF domain scores.

8. Linguistic and psychometric validation of the Erection Hardness Score to Spanish. García-Cruz E J Sex Med. 2011 Feb;8(2):470-4.
Erection Hardness Score
¿Cómo puntuaría la dureza de su erección?
Por favor escoja la respuesta que mejor describa el estado más frecuente de su pene durante
la actividad sexual durante las últimas cuatro semanas.
0: El pene no aumenta de tamaño.
1: El pene aumenta de tamaño pero no llega a estar duro.
2: El pene está duro pero no lo suficiente como para poder penetrar.
3: El pene está suficientemente duro como para la penetración pero no
completamente duro.
4: El pene está completamente duro y plenamente rígido.

9. Erectile function after radical prostatectomy: Do patients return to baseline? Fode M Scand J Urol. 2016 Jun;50(3):160-3.
Edad
Nivel de PSA
Función eréctil previa
Tratamiento (PR/EBRT/Crio/Braqui)
Volumen cirujano
Preservación neurovascular
Rehab?

10. . Prediction of erectile function following treatment for prostate cancer.Alemozaffar M JAMA. 2011 Sep 21;306(11):1205-14

11. . Prediction of erectile function following treatment for prostate cancer. Alemozaffar M JAMA. 2011 Sep 21;306(11):1205-14

12. A survey of patient expectations regarding sexual function following radical prostatectomy. Deveci S BJU Int. 2016 Oct;118(4):641-5
Almost half of all patients were unaware that they were rendered anejaculatory by
their surgery. None of the RALP patients and only 10% of open RP patients recalled
being informed of the potential for penile length loss (P < 0.01) and none were aware
of the association between RP and Peyronie's disease.

13. Preparing Patients and Partners for Recovery From the Side Effects of Prostate Cancer Surgery: A Group Approach Paich K Urology. 2016 Feb;88:36-42.
Most patients and partners (84% and 90%, respectively) expected some urinary
incontinence and understood rehabilitation strategies to regain bladder control; 84% of
patients and 78% of partners expected postsurgery sexual activity to be different and
73% of patients and 65% of partners expected surgery to make erections worse.
Couples were incongruent regarding frequency of incontinence, likelihood of erectile
dysfunction, and sex being different after surgery: patients were more realistic.

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DURANTE

15. PR/EBRT/CRIO/BRAQUI

16. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study.
Yaxley JW1 Lancet. 2016 Sep 10;388(10049):1057-66
These two techniques yield similar functional outcomes at 12 weeks. Longer term
follow-up is needed. In the interim, we encourage patients to choose an experienced
surgeon they trust and with whom they have rapport, rather than a specific surgical
approach.
Robot/abierta?

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DESPUÉS

18. rehab

25. Penile rehabilitation after radical prostatectomy: does it work? Gandaglia G Transl Androl Urol. 2015 Apr;4(2):110-23.
Although preclinical evidences support the rationale for penile
rehabilitation after nerve-sparing RP, clinical studies reported
conflicting results regarding its efficacy on long-term EF recovery.
Nowadays, which is the optimal rehabilitation program still represents
a matter of debate.

26. Tadalafil 5/24
MUSE* 3/week
* Minimum dose to get functional erections
AFTER CATHETER
REMOVAL
STOP REHAB AND ASSESS3 MONTHS
Tadalafil 5/24
FUNCTIONAL ERECTIONS
Observation
BACK TO BASELINE
Tad 5/24 + MUSE 3/week
NON-FUNCTIONAL
ERECTIONS
STOP REHAB AND ASSESS12 MONTHS
Observation
BACK TO BASELINE
Patient preference
FUNCTIONAL ERECTIONS
PDEI-5* vs MUSE*
NON-FUNCTIONAL
ERECTIONS
PENILE PROSTHESIS
NON-FUNCTIONAL
ERECTIONS

27. Hormonal response recovery after long-term androgen deprivation therapy in patients with prostate cancer. Planas JScand J Urol. 2016 Sep 14:1-4
After 18 months of follow-up, all patients had recovered normal LH levels, while
38% of patients still presented castration levels of testosterone (< 50 ng/dl).

28. Is it worth continuing sexual rehabilitation after radical prostatectomy with intracavernous injection of alprostadil for more than 1 year? Yiou R1 Sex Med.
2015 Mar;3(1):42-8
The response to IAI remained stable after 2 years of treatment, and no significant
improvement of spontaneous erections during intercourse attempts was found between
M12 and M24. Patients should be informed of the limited effect of IAI on natural
erections after 1 year.

29. • Erectile dysfunction patients are more satisfied with penile prosthesis implantation compared with tadalafil and intracavernosal injection treatments.
Kucuk EV Andrology. 2016 Sep;4(5):952-6.
Partners' EDITS scores were 70.1 ± 10 in penile prosthesis implantation group, 50.2 ± 1.5
in intracavernosal injection group, 62.9 ± 7.8 in tadalafil 5 mg, and 61.3 ± 5.3 in tadalafil
20 mg group (p < 0.05). Erectile dysfunction patients who underwent penile prosthesis
implantation seem to be more satisfied compared with tadalafil treatment and
intracavernosal injection. Future clinical trials are warranted to confirm our results.

30. Sexuality Following Radical Prostatectomy: Is Restoration of Erectile Function Enough. Fode M Sex Med Rev. 2016 Aug 24.
Climacturia
Alteración del orgasmo
Acortamiento de pene
Peyronie

31. ANTES

32. EL SEXO DESPUÉS DE LA PRÓSTATA
Eduard García Cruz
@drgarciacruz
Jefe de Servicio, Hospital Plató
Men´s Health, Hospital Clinic de Barcelona
@drgarciacruz