I will now discuss why in some patients with prostate cancer, the nerves can readily be spared during the removal of the prostate and in others they need to be removed. When the patient is first diagnosed with cancer of the prostate, obviously, all options of treatment are presented to the patient. I then need to get an accurate assessment of the patient's baseline erectile dysfunction. I will often tell them that no treatment for prostate cancer will "improve" their erectile function. Hopefully, it won't make it any worse, but knowing where the patient stands before any intervention is vital to prepare the patient for what to expect after surgery or radiation.
This assessment is done usually be a questionnaire administered in the office. There are several questionnaires that exist that have been validated on an international level. This will be the patient's baseline. For example, a man may be currently using a low dose of an oral medication for their erections prior to the procedure with a very good result or they may be using nothing at all.
Next the patient's stage of disease must be analyzed. This is done with laboratory studies (prostate specific antigen, or PSA), physical examination (how the prostate feels on the digital rectal examination), the pathology result (how aggressive the cancer looked under the microscope), and X-ray studies (computerized tomography, magnetic resonance imaging or bone scan). These tests will determine the "stage" of disease or whether it is still located within the prostate or whether it has spread beyond the prostate.
Published On: September 24, 2007