Erectile Dysfunction options

Erectile dysfunction or ED is the consistent inability to sustain an erection sufficient for sexual intercourse. It can be a total inability to achieve an erection, an inconsistent ability to do so or a tendency to sustain only brief erections. Roughly 50% of men between the ages of 40 and 70 have erectile dysfunction. The causes of erectile dysfunction for the most part are physical. So what is an erection? An erection is an involuntary reaction in response to sexual stimulation and excitement. There are nerves, veins and arteries in the penis and it's the relationship between these structures that allow the erection to occur. When the chemicals are produced in the body due to sexual arousal they influence the muscles and blood flow in the penis. When it's not working properly there are ways that we can deal with this. Treatment options can include oral medications such as Viagra, Levitra, and Cialis or vacuum erection devices, injection therapy, urethral suppositories or penile implants. The oral medications can alter the chemical reactions normally produced in the body. Injection therapy is similar but allows for more concentrated higher dosing than the oral medications. When other treatment options don't work or there are other factors such as a radical prostatectomy, diabetes, trauma to the penis, severe venous leak or Peyronie’s disease then we have the option of a penile implant. A penile implant involves cylinders that fit into the erectile body, a reservoir that goes behind the abdominal wall and a pump that goes in the scrotum. The penile prosthesis is totally implanted. When an erection is desired the pump is manipulated to transfer fluid from the reservoir into the cylinders creating an erection. At the conclusion that pump is again manipulated allowing the fluid to transfer from the cylinders back to the reservoir. So there are options you just have to match the appropriate treatment to the patient.

AUA 2014

The 2014 Annual Meeting of the American Urological Association will be held in Orlando, Florida from May 16-21, 2014. http://www.aua2014.org

A few stats about prostate cancer.

More than 230,000 men will be diagnosed with prostate cancer in 2014. Prostate cancer costs society more than $2.2 billion annually in Medicare costs not including drug costs. About 10,000 men are told they have advanced prostate cancer each year. The good news is that 2.5 million men in the United States are prostate cancer survivors.

High Intensity Focused Ultrasound or HIFU is the newest treatment for prostate cancer.

The newest ablative therapy is High Intensity Focused Ultrasound (HIFU). HIFU is a sophisticated, technical system that precisely directs energy only to the prostate cells. This technology can be compared to a magnifying glass that focuses the sun’s rays to ignite a piece of paper.  A hand placed between the magnifying glass and the paper does not get hot.

So too with HIFU, the normal tissues are cool, while the “significant” cancer is treated with the heat of focused ultrasound. By combining the image from a 3T MRI and HIFU system, we are able to spare the nerves and vessels that maintain erection, continence, ejaculatory function and a large portion of the prostate gland.  This produces a very rapid recovery in days, rather than weeks or months.

Focal Therapy, it's like taking care of the bad spot in the apple instead of throwing the whole thing away.

When we can distinguish “significant” prostate cancer from non-aggressive prostate cancer, ablative treatment options can be considered. When minimally invasive ablative therapy is used, it can treat the entire prostate gland or just the area with the known disease. Treating only the “significant” prostate cancer is known as focal therapy. Focal therapy eliminates the aggressive cells without destroying the rest of the prostate. This minimizes the potential for urinary incontinence or sexual dysfunction.

Focal prostate treatment is similar to the advancing technology for breast cancer. Today, lumpectomy has largely replaced the radical mastectomy.  Another way of thinking about focal treatment is to consider an apple with a bad spot. Rather than tossing the whole apple, only the bad spot is removed.

What does it mean when we put a patient on Active Surveillance?

In some cases, when a non-aggressive prostate cancer is diagnosed active surveillance is the appropriate treatment option. It is considered a treatment since it requires careful monitoring and follow-up. PSAs, digital rectal exams, imaging studies and prostate biopsies are routinely scheduled. If progression of the disease is identified other treatment options should be considered.

This type of surveillance is recommended only in cases of prostate confined, low grade, low volume cancers.  Only men who are committed to this type of treatment plan should be considered for active surveillance. Some men who initially decided on active surveillance change course and opt for another treatment because of the rigors of follow up or because they are uncomfortable with the  knowledge that they have a cancer and want to do something more.

What is "significant" prostate cancer?

What is “significant” prostate cancer? Genetic research has concluded that cancers, found in the prostate, are not all life-threatening. The life-threatening cancers are referred to as “significant” cancer and do require treatment.

The ability to differentiate the aggressive, significant cancer from non-aggressive cancer opens up more treatment options including focal ablative therapy. Ablative therapy can treat the entire prostate or just the area(s) with the aggressive cancer cells. If treatment is directed only to the aggressive cells it is referred to as focal therapy. Focal therapy eliminates the aggressive cells without destroying the rest of the prostate. This minimizes the potential for sexual dysfunction and urinary incontinence.

 Focal prostate treatment is similar to the advancing technology for breast cancer. Today lumpectomy has largely replaced the radical mastectomy. Another way of thinking about focal treatment is to consider an apple with a bad spot. Rather than tossing the whole apple, only the bad spot is removed.

3T MRI, what's that?

Magnetic resonance imaging, MRI, is an excellent study that does not use radiation. It produces images of organs. A newer MRI known as the 3-Tesla, or 3T, uses a more powerful magnet and can be used to provide us with a better image of the prostate. The 3T MRI actually looks inside the prostate and allows us to visualize down to the cellular level. This allows us to see the development of cancer at its very early stage. We then have an opportunity to do targeted biopsies so that we can determine if it is a cancer that needs to be treated. If the 3T MRI is negative, a prostate biopsy may not be necessary.