March 2014Walnut Club Meeting

A well attended meeting where we met a new member, Mike, who has been recently diagnosed.

Club members introduced themselves to him and each gave a brief summary of their history.

We were then treated to a very informative presentation by Mr Giulio Garaffa, who had come straight from operating, on the subject of erectile dysfunction. He explained that all forms of prostate cancer treatment were likely to lead to ED to a greater or lesser extent although this would become apparent at different times depending on the form of treatment, immediate in the case of a radical prostectomy but developing over a period of months in the case of external radiotherapy or brachytherapy.

He stressed the importance of maintaining as much erection as possible, not only for intercourse but also to exchange the blood within the penile erectile tissue with fresh blood to maintain the health of the organ. He then outlined the methods of obtaining and enhancing erections including oral medication such as viagra; a tablet inserted into the penis; self-injecting into penis; the use of a vacuum pump; and inflatable implants.

After Mr Garaffa had answered questions from members he left and the group continued with general discussion.


Further notes of the talk:

Surgery: concern about shortening of the penis is not the result of a shortening of the urethra but of scarring – which can also result in distortion of the penis.  This may be aggravated by lack of erections in the period after surgery, particularly if nerve sparing surgery has not been possible.

Continued incontinence can be dealt with by the fitting of an artificial sphincter.

Erectile Dysfunction (ED) is a common side-effect of all treatments for prostate cancer – surgery, EBRT, brachytherapy and hormone treatment.  Where some nerves are left after surgery the PDE5 inhibitor drugs (Viagra family) often help and this is good because voluntary or involuntary erections exercise the penis tissues, and reduce scarring effects.  These drugs are also helpful after either of the radiation treatments where nerves and/or their blood supplies are only partly damaged.

Hormone therapy, which can severely affect libido and also suppresses involuntary erections – those associated with REM sleep periods – can cause damage to the penis because the cavernosa tissues never get exercised.  Penis pumps can help at least for that part outside the body cavity as well as for penetrative sex. However, a pump does not exercise the erectile tissues inside the body wall.

Drugs injected directly into the penis or administered by tablet placed in the urethra, which act directly on the blood supply to the cavernosa tissues, may be useful where the Viagra type drugs are ineffective  – but have their own side effects, including tissue damage, in the longer term.

Implants within the penis consisting of small bladders on either side of the shaft of the penis and inflated from a fluid reservoir in the scrotum are effective when drugs don’t work.