Current management of erectile dysfunction after cancer treatment

Erectile dysfunction has a major impact on quality of life. Treating sexual dysfunction after cancer treatment requires special concern because of specific medical, psychological and social factors. This article presents the relevant experimental and clinical recent literature on rehabilitation of erectile function after surgery, external beam radiotherapy, brachytherapy or hormonal deprivation therapy for prostate cancer as it is the most studied model for erectile dysfunction management.

Counseling and reeducation with a multidisciplinary approach seems to be both mandatory and effective in achieving erectile function recovery. Administration of proerectile drugs nightly or on-demand early after cancer treatment is probably the key factor of erectile rehabilitation. Several studies have highlighted the presumption of a potential role for phosphodiesterase type 5 inhibitors (PDE5-Is) in the prevention of endothelial damage related to ischemia-reperfusion and denervation following surgery or pelvic radiation. Larger multicancer, randomized, controlled trials are needed to assess the role of PDE5-Is in erectile dysfunction pharmacological prophylaxis and rehabilitation strategy.

Erectile dysfunction postcancer treatment requires multimodal management with early administration of PDE5-Is, combined therapy to maintain erectile tissue oxygenation if necessary with PDE5-Is, intracavernosal injection and transurethral alprostadil or even vacuum erect device, psychological counseling considering erectile dysfunction as a couple's issue. The best modality to optimize postcancer erectile dysfunction management has not yet been standardized and is still challenging.