Erectile dysfunction is not uncommon in patients with cancer. Although it is an age dependent disorder, men with diabetes, heart disease and hypertension have significantly higher probabilities for ED. Cancer patients who have coexisting ED, which may or may not be related to the cancer itself or the underlying treatment, often presented to their specialist with such complaint after recovering from the initial management of cancer and they are ready to go back to their usual lifestyle. Some form of brief counseling that includes education on the impact of cancer treatment on ED; suggestions on resuming sex comfortably and improving sexual communication before treatment is mandatory in cancer patients who are at particular risk of ED from the treatment such as radical prostatectomy for localized prostate cancer.

In treating ED in cancer patients, I have adopted a “goal oriented approach”. H aving reviewed the general medical information, a clear delineation of risk factors for ED such as age (over 40), cardiovascular disease, diabetes, hypertension, surgery to the pelvis, medication such as hormonal therapy and depression is important . The physical exam and laboratory exams that are done in this category are done to assess whether risk factors are under maximal control i.e.. blood pressure, serum glycosylated hemoglobin, lipid profile, testosterone etc.

The introduction of phosphodiesterase type 5 (PDE5) inhibitor such as sildenafil, and recently tadalafil (Cialis) heralded the new era of oral treatment for ED. Most of the patients will be offered this as the initial treatment. While oral agents have provided promising results as the first line therapy for the treatment of male sexual dysfunction, limitations secondary to lack of efficacy, contraindications or the presence of side effects allow patients to choose among intracorporeal injection of prostaglandin E1 or triple therapy and vacuum device as second line therapies. Unless the patients are particularly interested in investigating the underlying etiology, there is no need to proceed with advanced diagnostic testing.

The cause and severity of the condition are important factors in determining the best treatment or combination of treatments for the patients and the overall success rate of the therapy. In National Cancer Center, the urologists who are dedicated to serve the special needs of cancer patients could provide such evaluation and treatment.

 

Weber Lau
Senior Consultant
Dept of Urology
Singapore General Hospital