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Nov. 30, 1999 (Washington) — Men with prostate cancer who have their
prostate removed are usually free of cancer, but the procedure often comes with
a cost — impotence. A new study, however, shows that Viagra (sildenafil), the
popular medication for erectile dysfunction, can restore impotency lost in
surgery. Whether men respond, however, depends on how much nerve damage
occurred during surgery.
Each year some 200,000 men are diagnosed with prostate cancer and, of those,
50,000 will have to undergo surgical removal of the prostate.
” and impotence are the two most common prostatectomy side
effects. A large number of patients, even with nerve-sparing techniques, end up
with erectile dysfunction,” Milton Lakin, MD, who leads the medical urology
section at Cleveland Clinic Foundation, tells WebMD. “The first thing
doctors want to do is a very good cancer operation. Cancers are being
discovered early enough that in many cases it is possible to spare both nerves,
or at least one.”
The new study, which appears in the November Journal of Urology, was
completed by physicians at Baylor College of Medicine in Houston. It involved
about 80 men who ranged in age from 47 to 76 years old. All were prescribed
Viagra following prostate removal surgery. Based on their responses to a series
of questionnaires, 53% had improved erections and 40% had improved ability to
have intercourse.
Among those with nerves spared on both sides of the prostate, almost 60% had
improved erections and about 45% reported improvement in their ability to have
intercourse. Of men who had nerves spared on one side of the prostate, close to
40% had improvement of their ability to have intercourse. For men with no
nerves spared, the reported increase in erections dropped to 20%, with only 10%
noting an improvement in the ability to have intercourse.
At least one side effect each was experienced by 63% of the men, most
commonly flushing, headache, nasal congestion, and heartburn.
Brian Miles, MD, one of the study authors, called the results
“gratifying” and noted that the findings indicate patients should start
on the medication about six months after surgery. He tells WebMD that he has
had success with nerve transfers that involve a leg nerve in the
pelvis, which can help maintain normal erectile function.
These findings confirm previous study results and put a greater spotlight on
the prostate surgery itself, says Lakin, who was not involved in this study but
has been part of nearly identical studies that produced similar results. “I
am not a surgeon. I deal primarily with sexual dysfunction. But where I think
this study will have the most impact is in causing physicians to pay more
attention to nerve sparing,” he says.
Lakin says that he commonly prescribes Viagra following surgery for prostate
cancer because other options are more invasive. “, it’s very
hard not to offer a patient a pill even if their nerves have been cut, but I am
very honest with them. And if they call and say it didn’t work, we go on from
there.”
If Viagra fails, physicians can recommend other options, including
injections and vacuum devices, both of which have good success rates, even
among men whose nerves were damaged, according to Lakin.
Vital Information:
- Viagra is an effective treatment for impotency in men who have their
prostate removed.
- For men whose nerves have been spared, the drug improves the ability to
have an erection by nearly 60%, but the effectiveness drops to 20% in those
with no nerves spared.
- There are other options for men who don’t respond to Viagra, including
injections and vacuum devices.
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