New options for treating erectile dysfunction

Penile rehabilitation after treatment for prostate cancer

Studies indicate that anywhere from 30% to 70% of men who undergo radical prostatectomy or external beam radiation therapy, and 30% to 50% of men who opt for brachytherapy, will develop impotence after treatment. Recent insights into why this happens have led to a whole new approach in treating men who are interested in preserving their sexual function. The new therapies are often referred to collectively as penile rehabilitation, a concept first introduced by European physicians in 1997. Since then, penile rehabilitation has gradually evolved and is now being offered at a number of major teaching hospitals; it is less likely to be offered in the community setting. Although exact regimens vary, penile rehabilitation typically consists of oral or injected medications, alone or in combination with other interventions, to restore and preserve erectile function before any long-term damage occurs.

But this therapy remains controversial. Although preliminary results look promising, only a handful of reliable studies evaluating various types of penile rehabilitation have been published — and these have used different types of interventions, for different periods, so it is difficult to compare one method with another. Moreover, no consensus yet exists about which approach is best for a particular patient. Even so, penile rehabilitation may be something worth asking your doctor about if you have just been diagnosed with prostate cancer or are currently undergoing treatment. This article briefly reviews options in penile rehabilitation and the limited scientific evidence.

New insights into erectile dysfunction

When erectile function becomes impaired following radical prostatectomy, the problem has traditionally been attributed to nerve damage. The nerves that trigger erections may become damaged during surgery (even during so-called nerve-sparing surgery), leading to a problem known as neuropraxia — a temporary loss of function that theoretically should recover in time. The problem is that it can take as long as two years for the nerves to recover sufficiently to enable a man to have a spontaneous erection, and by then other damage may have occurred.

Recent research suggests that when the penis is flaccid for long periods of time, and therefore deprived of a lot of oxygen-rich blood, the low oxygen level causes some muscle cells in the columns of erectile tissue (corpora cavernosa) to lose their flexibility and gradually change into something akin to scar tissue. This scar tissue, moreover, seems to interfere with the penis’s ability to expand when it’s filled with blood. In fact, imaging studies indicate that blood may drain away from the penis rather than fill it.

Less research has been done about impotence after radiation therapy, but it appears that the underlying cascade of damaging events is similar to what occurs after radical prostatectomy. Radiation damages the lining of the small blood vessels, but this damage may take months or even years to manifest itself.

What all this means is that the traditional advice given to men — essentially to wait for erectile function to return on its own — may not be adequate. Simply put, erections seem to work on a use-it-or-lose-it basis. To prevent the secondary damage that may occur if the penis remains flaccid for a prolonged period, researchers now think that a better approach is to intervene soon after treatment to restore erectile function. (For more information about the studies highlighted here, see “For more information: Penile rehabilitation,” below.)

For more information: Penile rehabilitation

Gontero P, Fontana F, Bagnasacco A, et al. Is There an Optimal Time for Intracavernous Prostaglandin E1 Rehabilitation Following Nonnerve Sparing Radical Prostatectomy? Journal of Urology 2003;169:2166–9. PMID: 12771740.

Montorsi F, Guazzoni G, Strambi LF, et al. Recovery of Spontaneous Erectile Function after Nerve-Sparing Radical Retropubic Prostatectomy with and without Early Intracavernous Injections of Alprostadil. Journal of Urology 1997;158:1408–10. PMID: 9302132.

Mulhall J, Land S, Parker M, et al. The Use of an Erectogenic Pharmacotherapy Regimen Following Radical Prostatectomy Improves Recovery of Spontaneous Erectile Function. Journal of Sexual Medicine 2005;2:532–40. PMID: 16422848.

Ohebshalom M, Parker M, Guhring P, Mulhall JP. The Efficacy of Sildenafil Citrate Following Radiation Therapy for Prostate Cancer: Temporal Considerations. Journal of Urology 2005;174:258–62. PMID: 15947650.

Raina R, Agarwal A, Allamaneni SS, et al. Sildenafil Citrate and Vacuum Constriction Device Combination Enhances Sexual Satisfaction in Erectile Dysfunction after Radical Prostatectomy. Urology 2005;65:360–4. PMID: 15708053.

Options after radical prostatectomy

Preliminary studies indicate that penile rehabilitation for men who undergo radical prostatectomy is most effective when it begins soon after surgery and involves a combination of therapies.

A study published in 2005 in the Journal of Sexual Medicine, for example, reported the results of 132 men who were followed for 18 months after radical prostatectomy. A total of 58 men enrolled in a penile rehabilitation program within six months of surgery and took sildenafil (Viagra) or penile injections (see Figure 1) to achieve erections three times a week. When investigators followed up 18 months later, 52% of the men in the penile rehabilitation group said they could have spontaneous erections firm enough for intercourse, compared with 19% of the men who did not seek intervention. A larger proportion of men who underwent penile rehabilitation also said they responded to sildenafil when they needed to take it: 64% of the rehabilitation group responded versus 24% of the untreated group.

Figure 1: Injection therapy

Injection therapy

Using a small needle (about half an inch long, the same size as those used to inject insulin), a man can inject one or more prescription drugs into the side of the penis. The injected drugs all work by relaxing the smooth muscle tissue of the penis and allowing blood to flow into the erectile tissue.

Although the study was not randomized — and thus its results could be influenced by patient self-selection or investigator bias — it confirmed the results of an earlier small study conducted by the European team that first pioneered the concept of penile rehabilitation. In 1997, researchers from Italy reported in the Journal of Urology that they had followed 30 men who underwent nerve-sparing radical prostatectomy, who were then randomized either to an observation group or to one that received penile injections three times a week, starting within a month after surgery. When investigators assessed the men at a six-month follow-up exam, they found that 67% of those who completed the entire schedule of injections reported spontaneous erections firm enough for intercourse, compared with 20% of men who did not receive injections. Imaging studies with ultrasound also indicated that the men who did not receive penile therapy had developed nerve, tissue, and vascular damage that may have contributed to their higher rates of erectile dysfunction.

Although both studies were small, they provide evidence that early intervention to restore erectile function may be important. Exactly when treatment should begin, though, is still an open question. One small study has looked at various intervention points. As reported in the Journal of Urology in 2003, investigators enrolled 73 men who underwent radical prostatectomy and randomly assigned them to receive injections at various times (within a month, 2–3 months, 4–6 months, or 7–12 months) after surgery. A total of 36 men received injections within the first three months, while 37 received injections between months 4 and 12. When the men were examined 5, 10, and 20 minutes after receiving the injection, the investigators found that 70% of the men who received an injection within the first three months after surgery could achieve erections firm enough for intercourse, compared with 40% of men receiving an injection after three months.

The results of this study are sometimes used to support the opinion that penile rehabilitation is most effective for men following radical prostatectomy if it begins within three months of surgery. However, it’s important to point out that the study involved only a single injection given within particular time frames after surgery; it’s not clear that the men would continue to respond so dramatically later on.

In addition to looking at the timing of treatment, investigators are conducting studies to determine the best mode of treatment. So far, the results indicate that a combination of therapies is probably best. For example, in 2005, investigators reported in Urology that men who had undergone radical prostatectomy and were not able to obtain erectile function after trying a vacuum constriction device (see Figure 2) might benefit by taking sildenafil before using the device. The study involved 31 men who began taking 100 mg of sildenafil an hour or two before using the vacuum device. At an 18-month follow-up, researchers found that seven men did not benefit from treatment, but 24 said that by using this combination therapy, they were able to have erections again.

Figure 2: Vacuum device

Vacuum device

This technique creates an erection by way of a vacuum pump. A man lubricates his penis and puts it into an airtight plastic cylinder attached to a hand-held pump. Air is pumped out of the cylinder to create a vacuum, which increases blood flow to the penis and causes an erection. An elastic band placed at the base of the penis maintains the erection.

Options after radiation therapy

The use of penile rehabilitation after radiation therapy has been less frequently studied, but one report in the Journal of Urology bears mention. In this study, 110 men who had developed erectile dysfunction after undergoing some form of radiation therapy were followed after they began taking sildenafil, at an average of eight months following cancer treatment. Investigators then checked in with them at three different times.

The investigators found that men who underwent brachytherapy had better results than those who underwent external beam radiation therapy. In the first year of penile rehabilitation treatment, 76% of men who underwent brachytherapy responded to sildenafil, and 60% reported erections firm enough for intercourse, compared with a 68% response rate among men who underwent external beam radiation therapy, with 50% reporting erections firm enough for intercourse. By the third year of treatment, however, response rates had fallen in both groups: Only 44% of the men who received brachytherapy were still responding to sildenafil, compared with 38% of men who received external beam radiation therapy. Likewise, only 26% of the men who received brachytherapy reported erections firm enough for intercourse, compared with 19% of those who received external beam radiation therapy.

What you can do now

Research continues in an effort to find new modalities for restoring erectile function following prostate cancer treatment. Some investigators are experimenting with ways to encourage nerves to regenerate faster, for example.

In the meantime, although the evidence isn’t perfect, you may want to ask your doctor about options for penile rehabilitation while you are discussing treatments. Although the field is still in its infancy, penile rehabilitation may help increase the odds that you will regain erectile function.

Originally published April 1, 2007; last reviewed April 22, 2011.

Comments
50
Jim,PhD

When de-sensitization is an issue, try using a superior penis health crème (health professionals recommend Man1 Man Oil) containing acetyl L carnitine, which helps with peripheral nerve damage issues.

john

2 years post nerve sparing RP with little or no erectile function. Currently using a tri mix injection that works, but don’t have length or girth of before. Reaching a point of wanting to give up and go the implant route. Hoping something new coming down the pipeline even if it is a clinical trial. Anyone know much about stem cell therapy?

fred pickett

is there certain type of food to eat for a better blood flow to penis after prostate surgery 2 and a half years ago

JAmes

After years of superior sexual performance with a large penis surgery has rendered me almost useless. Help

Craig mlagen

There is hope for you. I also had similar issues and i got a medicine that cured me from Dr. Hillary on hillaconn @ gmail. Com he can help you too.. I hope this information helps.

Art

Good summary. I have read some of the supporting research articles, too. 6 weeks now since robotic RP with nerves spared and totally dead down under now. This is normal but started rehabilitation with daily PDE5 (no erection from it, but again normal), L-Arganine, gym workouts, and daily vacuum device. Do NOT just wait around with flacidity or will result in permanent damage. Penis needs daily blood flow! Thinking about adding injections as some studies suggest a health affect. Don’T give up JAmes!

mark

Been a year since surgery. Been using pump about once a week for good erections. Using trimix for six months and I love it. Found that .40 ml is just right for very firm erections for sex and good climax. Lots of luck to you all.

MikeH

Guys.. vitamins and nutrients are key to sustained sexual health. The best way to get several of these directly into your penis skin is by using a penis health creme. I use one called Man1 Man Oil and my penis looks and feels better than it has in a very long time. Definitely check it out.

DonaldAO

3 months post op DiVinci RRP with nerve sparing. Doing sildenafil and vacuum pump. My sex partner also gives regular deep penile massage followed by lubricated hand jobs to orgasm. However, there is no show of ANY sort of rigidity, certainly nothing spontaneous. She really has nothing to hold on to. We had a great sex-life (every other day) before surgery. Penile length with the pump is down about 1.2 inches (as I started pumping before surgery.) Orgasms are VERY different from before even ignoring the lack of stimulation provided by the ejaculate. I liken them to female orgasms now: longer to achieve and more body-centric than penis-centric, still good. I think that multiple orgasms might be possible if we tried long enough. Alcohol inhibits orgasm and several attempts have been frustratingly unrewarding. I am thinking that for penetration the old fashioned way, the injections might be the next try. I don’t want to wait too long. I think I can endure the actual injection, but the cost might bring me down. On the bright side, my continence is about 99.9%.

Rap

I am 44 yeras old and just had the DaVinci RP 11 days ago. The surgeon was confident that my nerves were spared. My catheter removed 3 days ago. To my surprise, no incontinence. I have gone the last two days without any pads and have had no leakage. I haven’t tried anything yet to gain an erection. I’m going to start low dose, 25mg daily, viagra along with pump in order to rehabilitate. I will try injections soon after. DonaldAO, the injections are not bad at all. I started them a couple of months prior to surgery and they were amazing. I was having problems getting/maintaining erections prior to surgery. The Trimix injections instantly fixed it. The shots were painless. The best erection I have had in almost 20 years. I was able to get perfect results with .10. I started with .20 and erection lasted for almost 4 hours….not fun. I’m sure I will have to use more post op. I hope I get the same results post surgery. If you haven’t tried the Trimix, I encourage you to do so. It is way worth it.

Bradley Hyde

I had DaVinci rp 11 months ago, right full nerve sparing, left partial. No erections so far. VED works well but isn’t very romantic; I use it almost every day for rehab. Have taken several months of daily Cialis but no joy. Doc says it will come back — age 68. Tried samples of 4 other ED meds, no joy. Tried 500 mg MUSE, some stiffening but not useful and when I used the VED, some aching pain. I may try the 1000 mg MUSE but am nervous. Orgasms often even without an erection, not like before but fun just the same. Occasional doubles with the VED and bands within the allotted 30 minutes with intercourse. Use of penile sleeves with VED greatly improves comfort, function, and angle for intercourse. Don’t like needles, especially there — but might be willing to try, especially if it offers better rehab prospects.

Craig mlagen

Reach out to Dr Hillary on hillaconn @ gmail. Com he helped me with his medicine and im sure it will work for you too.

MR JOHN HEATH

I had my prostate done when i WAS 48 YEARS OLD it was enlarged ,after I have not been able to hold or keep my erection for a satisfying intercourse , I am now 67years old and would like to have a good sex life with my wife.
Please can you give me some good advice on this matter,
Thank you John Heath

Andrew Makesh

In the past 7 years of my life i have never been so embarrassed in my emotional life, i get ridiculed by my partners and i have had 6 breakups due to this problem, during my early youth days i was into high masturbation and this really affected me and i began to have premature ejaculation and weak erection problems. I have tried a lot of therapies and medication but none of them worked. I was opportuned to read a post of appreciation to Dr Hillary by someone (amanda) how Dr Hillary helped her husband with a permanent cure and i contacted the doctor via his email and that was all. He sent me a very powerful medication which i used as he said. My erection is back real strong and with no side effects and i can perform crazily in bed now (lol). Do not hide in silence, weak erection (ED) has a permanent cure and i am a living witness of it. You too can contact him on (hillaconn @ gmail.com).

Carlos Bellamy

I just had prostate surgery(July 2016). Can you please provide me with more insight regarding this doctor and his medication? Thanks.

Newton Murray

For more than 12 years i have suffered from the problem of weak erection, and for that 12 years you have no idea what i went through in the hands of my various partners. It got to a point that i was running away from my duty as a man.I started searching for solution every were and i became addicted to some certain drugs all because i want to make a difference and show my strength sexually. One day i decided to open up to a friend of mine and that was how i was told about Dr Hillary. I was given his contact i contacted him and i was told what to do and how to get his products which i did and within the space of days i was cured permanently without any side effects. Today i am super active sexually (lol) and i can perform extensively in bed today as a real man. For his product on erectile dysfunction,premature ejaculation and weak erection problems contact him on (hillaconn @ gmail.com).

georgebenjamin

Unbelievable, i remembered i was once here in need of help on how to go about the problem of poor penis erection i was

having, i must say those years was so frustrating, the experience was something outside the world of being normal, i could

have sworn that i was witnessing my marraige crumbling to nothing, my wife had to join me in search of various kind of

help, and the search lasted for 1year 4months and like a dove sent from heaven , a cousin to my wife referred me to “Dr

christopher onome”, a specialist with a distance full of knowledge, with his vaccines/medications and his advice on what to

stay clear off and how to approach the problem , in less than 3 weeks i was doing fine sexually, am indeed proud to say am

now a father of a bouncing baby boy and up to this moment am still thinking this all some very big dream that everything is

actually back to normal, i believe i will forever be greatful for his guidance, so am recommending all those who are

currently in the condition i was in back then, or know someone who is in any related problems like unnecessary bleeding,

Virginia odour, poor penis erection, inability to release sperm (low sperm count), kidney problems, blood in the urine or

whatever is there that’s not normal should try and contact him through his email:christopheronome12@gmail.com

Steve

Skip the pills, get some good cardio, remove nearly all meat and dairy from your diet, eat more plant based whole foods, use a VAC daily. Read a book called the China Study and watch the documentary called Forks Over Knives. This is not the quick easy road but everything about you will improve including erectile function.

Alan Pickney

What type of meds are this DR. selling ? what do they cost? Is it a daily med or use before sex.

I tried what seemed like every treatment under the sun to get a firm erection, but it wasn’t until my doctor got me on bimix injections that I finally was able to have great sex again. It takes out some of the spontaneity, but having a great erection that easily lasts long enough makes up for it. Injections don’t sound pleasant but they have worked wonders for me.

Harold St Germain

I have tried everything to get and maintain an erection after prostate surgery removal. Not has worded, injections, vaccumm,
Pills like viagarnow I’m going to try 1000mg of MUSE. Can you suggest anything for me. I had the surgery 6 years ago, I am 65yrs.old

Craig mlagen

Try contacting hillaconn @ gmail. com you can see some comments below. He has a cure and can help. I have used this medicine.

capel nicolas

As a sign of gratitude i want to also reach out to others out there not lose all hope. 3 years ago I had a prostate cancer surgery. Since then I have not been able to have any erection to enable me have sex. Despite having taken various medications and supplements, I have not at all been successful. In my state of compliant i was opportune to speak to a cousin of mine because at first i was shy about the problem but this was almost tearing my marriage apart and my wife saw me as a half man who could not perform his duty as a man to satisfy her. He gave me the contact information on how to contact the doctor who sent this very powerful herbal medicine to his friend that had similar problem, i contacted him and he sent me the medication which i used too and that was all. In my life i never thought i would ever be able to have any erection not to talk about having sex again but i was proven all wrong and now i am so active like i am in my early 20’s. Do not suffer in silence or be shy you can contact him too on (info @ edlifepanacea. com or www .edifepanacea. com) He will sure be able to help you too.

Jeffrey

I am 63 post radical 3 and a half years. Pills worked at 13 months but gave me horrible headaches. Began using Trimix two months ago. Incredible results. Best erections since my thirties. Injections are nearly painless. Just a little freaky at first. I’m getting better night time erections. Wonder if starting injections sooner might have led to unassisted hard ons.

enzo lucas

4 years ago my prostate were removed because of cancer and 3 months later i could not achieve any erection, this was bad for me because i enjoyed sex alot. I tried to seek medical help from my family doctor and others who were introduced to me by friends but all failed. A colleague of my wife actually told her about ED life and she decided to give a try. They told her about a medication that can cure me and make me normal again, When my wife brought me the medication i was so reluctant to use it because i have suffered from chronic side effects from a lot of Viagra and stimulants. She talked me into taking it and when i was done with it, i must say it’s awesome. My erection comes hard naturally now no side effects and it’s been 2 years now and i am still very much okay. I decided to take this time out to reach out to people out there with this little story of mine to in return serve as a word of encouragement too. If you have a similar problem or any ED related problem do not hesitate to contact (info @ edlifepanacea. com) i am very 100% sure they can help you too.

alvin justin

I got married to the love of my life and the man i love so much when i was 24 and i have always fantasized about how amazing our marriage is going to be together. Little did i know that this joy will soon be stolen away by his inability to father a child. He had watery sperm and his motility was low and because of that he could not get me pregnant for over 6 years and many friends and family had already tagged me as barren which was not true. We have searched far and wide for a cure/solution to his problem but to no avail, we visited several doctors, urologists bought different drugs but none seem to put the problem to an end. Still in our misery we went to see a cousin of ours on vacation when we brought the topic and he told us about someone who has a cure and he is very reliable. We contacted him and he sent us a medicine which my husband took and in a matter of weeks his sperm was thick and the count was more than average. Today we have two kids and we are living happily ever after. I decided to write my story to motivate those who have lost hope on ever getting a child, there is hope for you just contact him on (info@ edlifepanacea. com) i am 100% sure he can help you solve it permanently.

alvin justin

I got married to the love of my life and the man i love so much when i was 24 and i have always fantasized about how amazing our marriage is going to be together. Little did i know that this joy will soon be stolen away by his inability to father a child. He had watery sperm and his motility was low and because of that he could not get me pregnant for over 6 years and many friends and family had already tagged me as barren which was not true. We have searched far and wide for a cure/solution to his problem but to no avail, we visited several doctors, urologists bought different drugs but none seem to put the problem to an end. Still in our misery we went to see a cousin of ours on vacation when we brought the topic and he told us about someone who has a cure and he is very reliable. We contacted him and he sent us a medicine which my husband took and in a matter of weeks his sperm was thick and the count was more than average. Today we have two kids and we are living happily ever after. I decided to write my story to motivate those who have lost hope on ever getting a child, there is hope for you just contact him on info@ edlifepanacea. com i am 100% sure he can help you solve it permanently.

Brandon Ryan

Weak erection and low sperm is one of the most embarrassing problem in this world. This problem almost ruined my marriage and almost made me childless for life. All thanks to doctor Hillary who was able to come to my rescue using his herbal medication and saved my life and marriage. Today i have my third child. If you are still held bound by weak erection, low or watery sperm (azoospermia) feel free to contact him on (hillaconn @ gmail. com) he will be able to render professional advise.

Richard Hemsley

Richard Hemsley
I had radical surgery eight years ago and haven’t really had a proper erection since. After surgery the emphasis seemed to be more about bladder control than erections and it seemed like an age before treatment started. Strangely one week after surgery I had one perfectly normal erection, much to my and my wife’s delight. Sadly after that it was all downhill. I was given a pump, but even using the tightest restrictor band could not keep hard (and no I’m not unusually small) I tried Viagra and Cialis but both gave me splitting headaches and no erection. I was then prescribed Viradal, and experimented with different amounts. There was some success here, though even with increased dosage it doesn’t always work, and its effectiveness seems to be slipping away. Also the pain associated with a two to three hour erection is horrendous, and the weird disfigurement of the penis is scary. So is there anything new out there, I am 65 and would probably have just given up by now. However my lovely wife is a very young 53 and has stuck by me throughout, I owe her, so will keep trying.

Mirjana

Hello I am trying to help my friend , I am little suspicious on that medicine , I can not find anything anywhere about , did really helped you ? It is little pricy to risk
Thanks

Craig mlagen

I had a robotic prostectomy 12/6/16, with excellent results in regard to both continents and nerve sensation. However ED is still not working that well as yet. Reading all the reviews on this page I came ac cross a Dr Hillary Connor Odiha from ED Life Panacea which had glowing reports and promises to cure erectile dysfunction.
Be very wary of this scammer and his web site. After he extorted $650 usd of me I never heard from him again, the last email I received from him was telling me his email address has been linked to a scam and to not contact it again.
Don’t fall into his false promise of a cure, it will just cost you money with no product sent to you.

Craig mlagen

I complained about being scammed by Dr Hillary Connor. Well i want to use this medium to apologize to everyone here because i have received the medicine now and i am okay. The money i paid was not in vain. Please accept my apology. Thanks

Craig mlagen

He is a honest man and you can contact him too for your erectile dysfunction issues. He sure has an effective cure which has no side effects. Contact him on hillaconn @ gmail. Com

John Baptist

Someone out there tell me whether this Hillary Connor fellow is fake and out to fleece desperate people of their hard earned money or a genuine operator. If he is genuine why does he not patent his drugs and get big money?

Zev Guber

I am post radiation for prostate cancer ad would appreciate a call from someone that has utilized the services of Dr. Hillary Connor.I would like to discuss the effectiveness of his product and services.

Please call Zev . 973-985-3725
.

Anonymous

Men beware!

Read the hard facts about prostate cancer testing and treatment what no one will tell you about, even after it’s too late. This is information all men over 40 should have. Also anyone concerned about cancer in general should read this warning.

Prostate cancer patients are often elderly, over treated and exploited for profits, AKA elderly abuse.

The overtreatment of prostate cancer for profit must stop!

The treatment and well documented overtreatment of prostate cancer often results in devastating and unnecessary side effects and sometimes death.

Per some studies:
1 man in 6 will be diagnosed with prostate cancer in his life.
About 233,000 new cases per year of prostate cancer.
About 1 Million blind biopsy’s performed per year.
6.9% hospitalization within 30 days from a biopsy complication.
About 1.3 to 3.5 deaths per 1,000 from prostate blind biopsies.
.2% deaths as a result of prostate cancer surgery.
60% had a prescription filled for an infection after a Biopsy.
Medical mistakes are the third cause of deaths in the USA.
Prostate cancer patients are at an increased risk for fatigue, depression, suicide, heart attacks and accidental death.

Prostate cancer patients are often elderly and exploited for profit, the treatments offered almost always have horrible side effects, and newer treatment options are ether unavailable or not offered to patients or available outside the USA. Also men are often over treated for profit. Prostate cancer is often slow growing and of low risk and can just be monitored. Often no treatment is the best treatment.

If a surgeon is financially responsible for a building lease or a large staff or an oncologist is also responsible for a lease on 5 million dollars of radiation treatment equipment, do you think they would be more or less upfront about the benefits and hazards of treatment? Do you think the profit margin would compromise some doctor’s ethics?

The risks percentages for side effects from a blind biopsy and Prostate cancer treatments are usually understated to patients and some side effects are not disclosed at all.

Men with a high PSA tests result are usually sent to an urologist for a blind biopsy. Men should be told about other options: Percent free PSA test, PCA3 urine test or a MRI test before receiving a blind biopsy. These tests can often eliminate the need for a more risky and invasive blind biopsy. Insertion of 12 to 18 large holes through the rectum into a gland the size of a walnut, a blind Biopsy can result in prostate infections, a risk of permanent or temporary Erectile Dysfunction, urinary problems and sometimes even death from sepsis (About 1.3 to 3.5 deaths per 1,000 from Blind biopsies). A blind biopsy can also increase your PSA reading for weeks or months.

Prostate cancer patients are often sent for a bone scan. A bone scan has about a 13% chance of having a false positive and only 3 men in 1,000 have bone cancer who have a bone scan. Bone scans are usually unnecessary in lower risk prostate cancer patients.

Low risk Cancer patients or patients with advanced age are often sent for aggressive treatment by some doctors when monitoring is usually a better option. An extreme example of overtreatment is one SBRT (a 5 day radiation treatment) clinical trial. Prostate cancer patients where intentionally treaded with a huge dose (50 Gy) of radiation resulting in disastrous long term side effect for some of these men. A large percentage of prostate cancer patients in this study had low risk cancer.

Clinical trials may or may not be hazardous to patients. The goal of a clinical trial is to gather information; the intent is not necessarily to help or cure patients. In a clinical trial, if someone is given a treatment that will harm them (as in the above example) or given a placebo in place of treatment or needed treatment is withheld, the patient may be deceived or harmed. Investigate before you participate in a clinical trial.

Prostate cancer patients are asked to fill out a series of EPIC questioners and other questioners. The EPIC questioners ask intimate details about patient’s sex life, urinary and bowl function. By a prostate cancer patient completing a EPIC questioner, he may be able to have his doctor, nurse or other office workers track his progress or decline. By refusing to fill out these questioners he can help insure his privacy and insure he do not unknowingly become part of a study or clinical trial or other collective survey. He may be told these questioners and records are confidential; this may not be completely true. Most of the time a patient has no idea who has access to the records or why the records are being looked at. Who has access to medical records? Records are vulnerable. Probably everyone that works in a medical office or building. This may include/however not limited to non-medical employees, office workers, bookkeepers, janitors, insurance companies, temporary high school or collage interns, etc.. Often records are placed on a health information exchange (HIE), dozens or sometimes even hundreds of people may possibly have access to the records. This may include other medical facilities, programmers, hackers, researchers, drug companies, etc. Records may be packaged with other patient records and offered for sale on the internet, this sometimes does happen. If a doctor or a patient or insurance company is involved in a criminal or civil case, medical records may become public court or law enforcement records. All patients should get a copy and read any confidentiality disclosures statements (HIPAA statements). Patients can also become the victims of medical Identity theft. All patients should avoid supplying unnecessary information whenever possible, supply relevant information only.

The most common treatment options for men with prostate cancer are radiation, Brachytherapy, surgery, cryotherapy and hormones (ADT). Sometimes chemotherapy, immunotherapy and castration (Orchiectomy) are used. A combination of treatments is often used. All of these treatments have long term or short term side effects. Often men are not told about all of the true risks and side effects or they are downplayed for both a blind biopsy and treatments.

Brachytherapy is radiation seed implant. This treatment procedure implants 50 to 100 radioactive seeds in the prostate, commonly resulting in urinary problems. The patient will literally become radioactive for about a year. The patient can set off radiation alarm and metal detectors at airport. His semen will become radioactive. The patient will become like a walking Chernobyl, having radioactive scrap metal in his crotch. He will also be required to carry a card in his wallet stating he is radioactive. The videos of this procedure seem disturbing and bizarre. However Brachytherapy seems to have less sexual side effects than some of the other treatments available.

Men are sometimes prescribed hormone therapy (ADT therapy), AKA chemical castration as an additional or only treatment. Hormone therapy is often very expensive (profitable for doctors) and has horrible, strange and devastating side effects. Hormone (ADT) therapy is sometimes over prescribed for profit. This treatment has so many temporary and permanent mind and body altering side effects that doctors will not inform patients about all of them, one of them being feminization. Men are sometimes actually castrated (Orchiectomy) as a cancer treatment to reduce testosterone.

Nerve sparing Robotic-assisted daVinci Surgery is touted as being a better treatment and having fewer side effects, this is usually an exaggeration. The nerves can not always be spared. Robotic surgery can result in a faster initial recovery. However the long term risk of Sexual dysfunction, incontinence, fatigue, etc. is about the same as conventional surgery. Surgery almost always results in Sexual dysfunction and commonly results in incontinence and other side effects. Patients undergoing surgery are at a small risk of developing post traumatic stress disorder (PTSD). 25% chance of long term or permanent fatigue. Also .2% risk of deaths as a result of prostate cancer surgery or medical mistakes.

Patients should not be naïve. Medical mistakes are the third cause of deaths in the USA. Medical mistakes cause more deaths then suicide, firearms and motor vehicle accidents combined. Countless other patients have been harmed by medical mistakes If you are having surgery, Brachytherapy, a biopsy or a procedure take precautions if possible. Have someone qualified or knowledgeable monitor you and your medications, etc.. Doctors, nurses and technicians can be profit motivated, use obsolete procedures, be lazy, be incompetent, make mistakes, be apathetic and in some cases harm can be done or not prevented with intent.

A blind biopsy or treatments are often worse then the disease: Resulting in Chronic/permanent fatigue, incontinence, depression and sexual dysfunction. Hormone therapy has an extensive list of side effects that can be devastating for men. Biopsies and treatment are degrading, stressful and often unnecessary.

The risk of long term chronic and permanent fatigue is almost always understated if mentioned at all to patients. Depending on your treatment; your risk of long term or permanent fatigue is about 25% to 60%. Radiation with Hormone therapy has a high risk of fatigue. Long term fatigue also increases the risk of clinical depression and suicide.

In my opinion: Castration, hormone therapy (chemical castration), Brachytherapy (radiation seed implant), surgery and blind biopsies are often psychically and emotionally brutal, traumatic and disturbing. These types of treatments (Frankenstein stile medicine) are primitive and almost beyond belief in today’s world of advanced technology. Newer treatments like hyperthermia, Boron Neutron capture therapy, Focal Ablation and orphan drugs should be approved and used when appropriate. Biopsies should be limited to selective image guided samples only, no blind biopsies should be performed.

Advances in prostate cancer treatment mostly consisting of newer more accurate radiation treatments, robotic surgery and new drugs. These advances sound like greater strides have been made. However most of these approved advances are of limited benefit to prostate cancer patients and still have about the same amount of side effects. Compared to other technologies, computers, communications, electronics, aviation, etc., Cancer treatment approved advances have been dismal. QOL (quality of life) issues have not been adequately addressed. Profit often outweighs QOL issues.

Some oncologists are using Radiotherapy (EBRT-external beam radiation treatment) for cancer treatment. New technology consists of: IMRT, SBRT, IGRT VMAT, TrueBeam, RapidArc, Cyberknife, etc. This newer, faster, more accurate and easer to setup radiation equipment is of much benefit for doctors, staff and a good selling point to patients. However as far as reducing long term side effects, only very small gains have been made with the newer Radiotherapy equipment. A patient should be extrenly skeptical if exaggerated claims are made about reduced long term side effects.

Radiotherapy can result in a 5% to 30% temporary or permanent drop in testosterone levels. This drop is determined by the testicular radiation dose (treatment equipment and planning). A significant drop in testosterone can result in increased fatigue, depression and sexual dysfunction.

Radiation can also occasionally result in secondary cancers and damage to “organs at risk” (organs close to the prostate). Radiation has high probability of sexual dysfunction. Sometimes radiation can also cause bowel and urinary problems. A 5 day SBRT radiation treatment is now commonly available with about the same results and side effects as a 9 week treatment.

It seems all of the best treatments for prostate cancer have not been approved and most are only available outside the USA. Treatment options outside the country or under development are HIFU, Laser, Hyperthermia, Boron Neutron capture therapy and orphan drugs, Just to name a few. Focal Laser Ablation is a good option with fewer side effects however it is not widely available in the USA and sometimes not practical.

Any cancer patient (Man or woman) who are being offered chemotherapy should be particularly cautious. Most Chemotherapy is extremely toxic and sometimes deadly. Without genomic testing or proof of the effectiveness of the specific drug being used on the exact cancer type being treated, Chemotherapy is often more toxic to the patient then to the cancer. Chemotherapy is also extremely expensive, profitable for doctors and often misused or sometimes overused.

Do you think the AMA, FDA or any other regulatory agency will stop the exploitation of elderly men with a high PSA or prostate cancer or approve new treatments at the risk of financially bankrupting thousands of treatment facilities and jeopardizing thousands more jobs? Do you think any regulatory agency will set guidelines for treatment and monitoring at the risk of upsetting the doctors who are over treating? Most elderly men are not willing to openly discus there sex life, incontinence or other personal problem making them a more vulnerable victim.

Most of the time few good choices exist for treatment. A prostate cancer patient treatment choice often ends up being the least worst choice or the choice with the side effects a patient thinks he can tolerate. Patients are often misled about the expected side effects and results of the treatment being offered. The risk of chronic fatigue is almost never disclosed.

Long term care consists of regular PSA testing for years. Long term care for side effects is often lacking or exploitive or ineffective. Often complaints of side effects are disregarded by nurses, urologists and oncologists and sometimes referred out to other doctors. The patient is sometimes left to figure out what to do about his side effects with the resources available to him. Long term side effects often consist of fatigue, bowel or urinary problems, sexual dysfunction, depression and other symptoms. Patients with complaints of chronic fatigue are almost always told to exercise, get plenty of sleep, pace yours self and eat a healthy diet; this advice is of limited help for chronic fatigue. Often treatments for long term side effects are embarrassing, degrading, unavailable, nonexistent, costly, not effective, not offered or bothersome. Prostate cancer treatment often results in fatigue, depression, isolation and sometimes suicide. Billions of dollars are profited from ED. drug and other ED products, catheters, pads and diapers, drugs for depression or pain or insomnia or incontinence, additional treatments and surgeries for side effects. Also treatments for the multiple and bizarre side effects from hormone ADT therapy (chemical castration).

Depression in prostate cancer patients is common, about 27% at 5 years (per some studies) and for advanced prostate cancer patient’s depression is even higher. Prostate cancer patients are at an increased risk of Suicide.

Almost all prostate cancer treatments usually result in erectile dysfunction. Loss of libido occurs at about 45%. Often claims of prompt effective treatment for ED if it occurs after treatment are misleading. Statistics for ED percentages from treatment are quoted after treatment with Viagra, Muse or other ED treatments, therefore the statistics are very misleading. ED rated at 5 years may be as high as 50% to 80% or higher for most treatments. The cost for ED drugs like Levitra, Cialis, Viagra and Muse are kept very expensive by drug companies, $10 to $30 per 1 pill. Most insurance companies will not pay for ED drugs or treatment. Less expensive generic drugs are usually unavailable. Viagra should have already become available in a generic form for about $1 to $2 a pill. This is further exploitation by the drug companies of men in general. These drugs are not always effective and may have side effects. ED treatments can also be embarrassing, not offered, not practical, painful, expensive/not covered by insurance.

In conclusion: Prostate cancer patients are often elderly and exploited for profit. A blind biopsy is unsafe and newer test methods should be used. The treatments offered have horrible side effects. Some doctors are treating patients with low risk cancer or advanced age when monitoring is often a better option. Patience with low risk cancer or advanced age should often be offered “watchful waiting” or “active surveillance” instead of treatment. Aftercare for long term side effects is frequently ineffective, expensive, not offered or nonexistent. Prostate cancer patients are seldom told about chronic fatigue and the true risk of side effects are usually understated. Modern medicine often fails and victimizes prostate cancer patients.

If a patient has intermediate or high risk prostate cancer and dose not have advanced age he may need treatment. He should look into other advanced treatments if available. Also he should try and avoid Hormone therapy if possible because of the multiple side effects. If advanced treatments are not available a 5 day SBRT radiation treatment may be considered (In my opinion, it could be the best of the bad choices). SBRT seems to be fast, least invasive and traumatic. ED and fatigue is still a long term risk. Radiation with Hormone therapy has a high risk of long term fatigue.

Protect yourself: Do not let the sterile, friendly and professional environment of a doctor’s office denture you from protecting yourself from overtreatment or any unnecessary life changing tests and treatments. If you are concerned about misuse or privacy issues, refuse to fill out EPIC questioners and limit the information given to relevant information only. If you have a high PSA or prostate cancer, educate yourself. A patient should be extremely skeptical if exaggerated claims are made about minimal long term side effects from conventional treatments or blind biopsies. Bring someone educated or astute with you to your consultations and appointments. Avoid doctors that are mostly profit motivated. Do not submit to a blind biopsy if other options are available. Get a second or third opinion if you are being offered treatment with low risk cancer or advanced age. Learn about all your treatment options, testing and side effects. Verify everything you are told. Under the HIPAA law you are entitle to a copy of all your medical records and bills. Be very cautious if you are ever refused a copy of your records; demand a copy of your records and a reason for any denial and seek other advice. Get a copy and keep a file of your test results, biopsy report-Gleason score, PSA, MRI report, treatment plan, bills, insurance payouts, etc.. Carefully monitor your PSA. Expect a temporary increase (for weeks or months) in PSA after most procedures. If treatment is necessary talk to your doctor about side effect management, chronic fatigue, ED, Etc.. Contact a good prostate cancer support group like PAACT “Patient Advocates for Advanced Cancer Treatments” at 616 453-1477 or a local support group without a conflict of interest.

Disclaimer: I have no confect of interest. I have no affiliation with any support group or other organization. I am not a doctor. I do not prevent, treat, diagnose, cure or advise on medical matters. The information above is for educational purposes only. If you need treatment or medical advice, consult a competent and trustworthy medical doctor.

Anonymous

I am 37 years old. A couple of months ago I was misguided into an unnecessary penile implant although I was a good responder to pills, I still can’t understand why I was so stupid. Dr. William Conners from Men’s Health Boston ruined my life with this invasive thing and he never explained the disastrous consequences.
I have decided to have it removed ASAP and I am in talks with other doctors for the removal surgery and recovery of my penis.
Any advice on how to restore my erectile tissue after removal and be able to have natural erections again with my beloved pills?
Thanks

Richard Wylie

I was grateful for finding on google and successfully
using a new penis support device called Stays-Hard.
No More Anguish !

Richard WAlker

Is anyone investigating the transplantation of a pig prostate into a human to restore erectile function/

Richard Walker

My last comment was NOT a joke or ridicule. There have been many observations regarding the similarity between the human and pig bi chemistry and other physical features. I am desperate to find a cure for my ED. My wife is beautiful and we love each other dearly…but sex is now impossible after my radiation therapy for prostate cancer.

I am wondering if such research is being carried on in Europe.

Craig mlagen

Ignore all other glowing reports of ed life panacea and a so called dr Hillary Connor Odiha. The reports of help to inocent prostate patients that have been helped are false to say the least. He stole $800 of me and no product. Don’t be scared like I was with this leech to humanity, ave your dollars and sanity as you will only get lies and no help, just more stress at a time it is not needed. Hopefully the law has caught up with this scumbag and he’s spending time behind bars by now.

Nemese

For penile rehabilitation is there a difference between a penile injection erection and a vacuum device erection?

Anonymous

I took some time to read through the comment made by a Anonymous Participant to this blog on 25 December 2016 12:25 pm and this is in my humble opinion is the best and most objective comment I came across after reading and searching information on this subject for many days.

I want to thank you for your input.

Question ….. what is the long term effect of the injection on your health ?

After the injection, what is the real experience and the results apart from an erection , pain side affects etc. ?

Thank you

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