The M. D. Anderson literature states “Proton Therapy is cancer killing machine that targets cancer with precision to a millimeter while sparing nearby healthy tissues and causing very few, if any, side effects”.
Many of us have found that statement to be true and accurate, but we must remember that, although Loma Linda has used proton radiation successfully since 1990, the M. D. Anderson facility treated its first proton patient May 2006 and we have all agreed to be part of the hospital’s “Quality of Life Study” which is on going. This is an important point to remember. The jury is still out, but we are all optimistic and have great confidence in M. D. Anderson. Although this page is about erectile dysfunction it is important to remember the bigger goal is to kill cancer.
Other than cancer itself, erectile dysfunction is a primary concern of many patients choosing treatment for prostate cancer. Many of us choose proton radiation for this reason alone after hearing horror stories caused by all other treatments.
Since being a patient, since talking to other patients, since reading other patient replies on this web-site and since questioning our doctors, I must acknowledge that erectile dysfunction is not as black and white as I desired it to be.
Most of the proton patients are in their 60’s or 70’s with different degrees of healthiness. Health and age in itself are huge variables in the ED puzzle. On one end of the scale, for some ED was not a concern as sex is no longer important. At the other end of the scale, I’ve heard men strongly consider watchful waiting as they would just as soon die as to give up sex. So it’s clear another huge variable is the degree of interest in sex. Theoretically there is a natural decline in erectile function with age, and we are all getting up there, but that decline is not always the case. There are also other contributing factors such as: Diabetes, smoking (past or present), peripheral vascular disease, high blood pressure, other medications, etc. Most importantly, everyone may be a little different in their response to proton radiation.
The doctor I questioned made two key statements that concerned me on this subject. “I DO think that proton treatments have the potential to contribute to E.D” and “No therapy is going to be without some potential side effects”. “Potential” is the key word. Many of us will not have any problem, but still there is the potential for various problems and as stated above there are many variables and we all will have a different response to treatment.
Each patient has their own brass plates and Lucite compensators (see Photo Slide Show) carefully designed for their prostate. The hole in the plate is slightly larger than the prostate. Although kept to a minimum, one can easily visualize that the protons can affect areas other than the prostate even with this precise design. It is obvious that the urethra where it passes through the prostate gets a full dose or radiation. This has not caused a problem with many patients, but it has the “potential”.
The sex related neurovascular bundles typically run along the sides of the prostate @ 5:00 and 7:00 and the nerves ultimately form a plexus (kind of like a web) that may go into the prostatic capsule. In other words, the nerves are intimate with the prostate and in some cases the tumor may be abutting or involving these sex related nerves. Again a “potential” problem.
Even a “nerve-sparing” radical prostatectomy is somewhat of a misnomer, since the nerves themselves are usually not visible. The surgeon has an “idea” of where the nerves run and try to dissect off as much tissue in that area while still getting the prostate out in toto.
Even the mechanism by which radiation (x-rays or protons or brachytherapy) may lead to late E.D. may be variable. It may be due to the nerves, it may be due to the vessels, and/or it may be due to the microvessels feeding the nerves. There is some data that it may be related to incompetence of the venous valves that keeps blood in the penis to keep an erection. It probably is multifactorial for different individuals.
Generally speaking, we have been told by the doctors that if you had no problem with erectile dysfunction before treatment that you should have no problem after. In general, patients with good erectile function before treatment have a higher chance of preserving after treatment compared to men who may be having some level of ED pre-treatment. Another key point seems to be use it or loose it!
Again, any radical therapy for prostate cancer can possibly impact erectile function (proton therapy included), however, the incidence of this can varying significantly between types of therapies as well as individuals. Suggest you obtain Sexuality and Cancer published by the American Cancer Society and available in the Proton Therapy Center lower lobby or refer to the ACS web section Sexuality for the Man with Cancer. Medications like Viagra, Cialis, and Levitra can help (just not for everybody). There are also many erectile aids (separate from pills) that can be considered and MDACC has an erectile function clinic devoted to helping these men. Also MDACC is recommending a pump for certain patients. The pump can help some men obtain an erection sufficient for intercourse and/or the use of the pump can be used for erectile rehabilitation. The process of having blood flowing into the erectile tissue and having it expand can help preserve erectile function and in some cases may help improve it. Call MDACC for specific recommendations.
Please also read Erectile Dysfunction with and without Hormonal Therapy and read patient’s replies.
We will continue to develop these pages as we know more.
Note: ProtonPals is simply an information sharing network of patients. ProtonPals hopes to inform, encourage and help patients through shared knowledge. Members are not doctors so more serious concerns should be directed directly to your doctor. ProtonPals also desires to promote the M. D. Anderson Proton Therapy Center as for virtually everyone it has been a very positive if not life saving experience.