Once it is documented that the patient has "organ confined disease," or cancer that is only within the prostate and has not spread to other organs or bone, treatment options are discussed. The options include watchful waiting, active surveillance, cryotherapy, radiation therapy (whether brachytherapy, external beam therapy or something called intensity modulated radiation therapy or IMRT) or surgery (retropubic, perineal, laparoscopic or robotic). Each will have a varying effect on a patient's erectile function. Once again, this all depends on the patient's degree of problems before the intervention.
Let's start with something called "watchful waiting." Prostate cancer can be a slow growing cancer. It is often quoted that some men diagnosed with prostate cancer will die "with" the disease rather than "of" their disease. This statement refers to patients who are perhaps older and diagnosed late in life. Statistics from autopsy studies show that nearly 75% of men in their nineties will have prostate cancer in the gland although that was probably not what caused their death. In some patients a "do nothing" approach is taken. This means that they are periodically examined and seen in the office for blood work to follow their prostate cancer, and no intervention or treatment is given. Once again, this is not an option for every patient, and only your urologist can determine whether it is an appropriate course for you. This option will obviously not affect your erectile function as nothing is being done.
Active surveillance is another option that involves following a patients prostate cancer with serial blood tests (PSA), physical exam and often repeat prostate biopsies, but no treatment is given. This option is entertained only in men with very low stage disease (low Gleason score, low density and volume of disease and low PSA). If a cancer becomes more aggressive or grows as we follow it, it is then treated with definitive therapy (surgery, cryotherapy or radiation). As someone is undergoing active surveillance, their erections are not affected because there is no treatment given. If the cancer progresses and treatment is given, their erections may suffer based on the prospective treatment (this will be discussed shortly).
Cryotherapy is sometimes referred to as the "freezing of the prostate." The patient is given general anesthesia for the procedure. The freezer probes are inserted into the prostate through the perineum (the area under the scrotum). An ice ball then forms on the tip of the probes. After two freezing and thawing cycles, the probes are removed. It is the combination of the freezing AND thawing that cause the cancer cells to die. Ultrasound is used to place the probes into the prostate. Care is taken to avoid the areas where the nerves responsible for erection are located. This is done by ultrasound guidance. The nerves cannot be seen on the ultrasound, but the area where they are anatomically located can be approximated and avoided. Long-term data for this treatment are not yet available. Early publications do show a moderate amount of erectile dysfunction after the procedure.