Prostate cancer is the most prevalent cancer among men. The most common treatment for localized prostate cancer is surgery: complete removal of the prostate, a procedure called “radical prostatectomy” (RP). With advances in prostate cancer detection, patients are diagnosed and treated earlier, at a younger age, when sexual function is an important constituent of their quality of life and well-being. Erectile dysfunction (ED) is a well-reported adverse outcome of RP; however, there are additional sexual function related sequelae that are not as often discussed with the patient, before or after surgery. Erectile dysfunction preservation has become feasible with the introduction of nerve-sparing radical prostatectomy in 1982, a surgical technique that allows removal of the prostate without transaction of the neighboring erection nerves, preventing complete loss of erections. However, “nerve-sparing" is not synonymous with “erection quality sparing" and even with excellent nerve-sparing by a highly experienced surgeon men do experience some degree of temporary or permanent decline of their erection hardness. In addition to its effect on erection quality, RP renders all patients unable to ejaculate, and consequently men are infertile after surgery. Advanced reproductive procedures are required if pregnancy is desired. Additional consequences of RP may also include changes in the nature of orgasm, penile length shortening, and penile curvature. With advances in sexual medicine research, today we have a wider knowledge of prevalence of various forms of sexual dysfunction after RP and a better understanding of the underlying mechanisms involved in their evolution. Hence, experts are able to better address sexual function issues, provide men and their partners with counseling, and tailor treatment individually according to patient’s needs. Sexual dysfunction issues should be discussed early, preferably before surgery, despite thoughts of inappropriateness in the light of a recent cancer diagnosis, to avoid any delay in patient and partner education and treatment. Prompt rehabilitative treatment after surgery maximizes the chances of returning to full sexual function. Unaddressed sexual health concerns may have deleterious psychogenic consequences on men and their partners as individuals as well as their well-being as a couple and may include loss of self-esteem and body image, feelings of guilt and shame, and loss of self-confidence and intimacy.
The aim of this chapter, titled “Sexual Dysfunction After Radical Prostatectomy," is to provide the reader with the latest information on sexual health after RP, present emerging concepts of our understanding of its etiology and their implications for treatment.