Prostate cancer is cancer that begins in the prostate, a walnut-sized gland that exists in individuals who have a penis. It is responsible for creating seminal fluid, which helps transport and protect sperm.

One treatment for prostate cancer involves surgically removing the entire prostate gland, including the spermatic vesicles, to stop the cancer from spreading to other parts of the body. This type of surgery is known as a radical prostatectomy.

Radical prostatectomy can have unfavorable side effects, including erectile dysfunction (ED). Fortunately, there are ways to mitigate the negative side effects and optimize the sexual functioning of a man post-prostate cancer surgery such as penile rehabilitation.

As the name suggests, penile rehabilitation is a treatment strategy designed for helping an individual regain their erectile function after radical prostatectomy.

While any treatment approach aimed at this goal could be considered penile rehabilitation, the most common penile rehabilitation treatment options used after surgery for prostate cancer are oral ED medications, intracavernosal injections, vacuum erection devices, and/or a combination of these therapies.

Oral ED medications: Phosphodiesterase type-5 inhibitors (PDE5 inhibitors) are a type of drug that is used to treat ED. Some examples of PDE5 inhibitors are Viagra (sildenafil), Cialis (tadalafil), Levitra and Staxyn (vardenafil), and Stendra (avanafil). These drugs help relax the smooth muscle cells in the blood vessels of the penis, allowing for increased blood flow, which is essential for achieving and maintaining an erection. Since they are taken orally and are generally safe for many individuals with ED, these medications are often included in penile rehabilitation post-radical prostatectomy.

Intracavernosal injections: Penile injections, also called intracavernosal injections, may be part of a penile rehabilitation plan. This treatment method involves the injection of a medication directly into the erectile tissue of the penis to relax the smooth muscles and induce an erection. It is typically reserved for individuals who do not respond well to oral ED medications or cannot take them due to contraindications or side effects.

Vacuum erection devices: A vacuum erection device (VED) is an external cylindrical pump that an individual can use to get an erection. By placing the device on the penis and activating it, air is pulled out of the cylinder and blood is simultaneously drawn into the penis. This is an effective way to achieve an erection. Nevertheless, erections created with the help of a VED can differ from natural erections. They may be purplish in color and cool to the touch, but these are generally not harmful side effects.

Surviving prostate cancer need not mean the end of satisfying sexual activity. A qualified health care professional can help you determine which penile rehabilitation plan is best for you, and if one option does not fit your goals or lifestyle, you may choose to experiment with other options.

References:

• Gandaglia, G., Suardi, N., Cucchiara, V., Bianchi, M., Shariat, S. F., Roupret, M., Salonia, A., Montorsi, F., & Briganti, A. (2015). Penile rehabilitation after radical prostatectomy: does it work?. Translational andrology and urology, 4(2), 110–123. https://doi.org/10.3978/j.issn.2223-4683.2015.02.01
  
  
• Key, A.P. Medically Reviewed by Nazia Q Bandukwala, DO. (2022, May 9). Penile Rehabilitation After Prostatectomy: What to Know. https://www.webmd.com/prostate-cancer/penile-rehabilitation-after-prostatectomy