EXPERTS suggest that men are eternally preoccupied with sex and treasure greatly their ability to perform sexually. Therefore, it is not surprising that across the globe they have shied away from prostate cancer screening because of fears associated with permanent erectile dysfunction and reduced sexual prowess should they be diagnosed with the disease.

Several men hold firm to the belief that once they have been diagnosed with the much-feared cancer and undergo an operation they will be sentenced to a life which no longer includes sex. However, this belief, according to consultant urologist, Dr Richard Mayhew, is false.

“It is far from the truth that erectile dysfunction or problems with sexual function go hand-in-hand with treatment of prostate cancer. It is a reality that some difficulties may be faced but there are effective solutions for the majority of problems,” he said.

Dr Mayhew, who was addressing a recent forum on prostate cancer at Guardian Life Centre in New Kingston, said while it is true that the majority of treatments can result in some dysfunction, the degree of the sexual problem is determined by the treatment option selected and the level at which an individual was performing before.

“The moment you start testing, you have to prepare your mind, if nothing more, for what is inevitable, and the mistake we all make is that we are going to perform at the same level throughout life. Rubbish!” said Dr Mayhew.

“Everybody knows how they were doing before the surgery, but a lot of us are not completely honest with ourselves and we overrate ourselves and our abilities,” Dr Mayhew said.

Treatment options, he said, are grouped into three categories: surgery, radiotherapy and hormonal therapy.

“As far as surgery is concerned, it was pretty much accepted some 30 years ago that once you had your prostate removed you are going to have permanent erectile dysfunction,” he said, before explaining that this was as a result of the doctor’s inability to spare the penile nerves.

However, Dr Mayhew said that while it is not an absolute guarantee, it is now possible to spare the nerves and provide men with a better chance of having the return of successful sexual function.

“If you are relatively young and you had good sexual function before the surgery and the surgeon is able to preserve both nerves, then you can realistically expect over the next three years following your surgery to get about 76 per cent of erections; in fact, if you are young and had good function before, you can have erections from as early as the time that you remove the catheter (tube placed inside the penis to control flow of urine after surgery),” he said.

On the other hand, he said if the patient is an older man and the surgeon was unsuccessful in preserving the nerves then the chance of regaining an erection will be slim.

“If you had a unilateral nerve injury, at the end of three years there is still possibly 40 per cent of patients who will recover satisfactory function, so you need to remember all is not lost if you decide to have surgery,” he said.

At the same time, Dr Mayhew advised that even preservation of the penile nerves is not a guarantee that a man’s sexual function won’t be affected.

“During surgery the nerves may be pulled, stretched, inadvertently cauterised or blood supplies to nerves may be disrupted, which can all affect the penis’s chance of getting an erection, in addition to other health problems such as diabetes, cardiovascular problems and stress associated with prostate cancer diagnosis,” he said.

“Lack of erection immediately after surgery does not mean that sexual functions will never return. What it means is that you have to prepare to wait months rather than hours, and you may have to use aids initially to help with getting an erection,” Dr Mayhew said, adding that sensation will not be affected and so the quality of an orgasm at end of intercourse will remain the same.

“So after surgery, sexual function remains the same but gradually changes three years after having radiation,” Dr Mayhew pointed out .”External beam (treatment) preserves function better but it can only be applied to early-stage cancer,” he explained.

In hormonal therapy, he indicated that the testosterone level is reduced in order to control growth of cancer, but this poses a problem as the hormone not only controls men’s ability to perform sexually, but also how they feel; their sexual attraction and desires.

However, he added that as much as about 20 per cent of men find that they have no significant problems with the treatment, which is generally recommended for men over 70.

Following surgery, oral medication such as Viagra and Cialis or penile injections are recommended to help men who are having problems getting an erection.

Dr Mayhew said that it is very important for patients to keep their penis healthy following the treatment to prevent shrinkage.

But, he said if there are further problems, a penile implant is recommended, where a cylinder is placed in the penis along with a small reservoir and a pump. “It works very well and the satisfaction that you get with an erection sometimes exceeds that which existed before surgery with a natural erection”, said Dr Mayhew.

Dr Audley Betton, a family physician and prostate cancer survivor, who was diagnosed in 2007, shared the view that men are refusing to do prostate examination because they think they will not be able to perform sexually after diagnosis.

“The fear, I think, of decreased sexual prowess is one of the biggest reasons why men don’t want to get their prostate checked,” he said.

“This rectal examination is not a big thing, look at the size of my finger,” Dr Mayhew interjected, jokingly.

Dr Betton added “God gave it (prostate cancer) to me for a reason and it is the challenge that I must adapt to change, be rational and do whatever it takes to make my life worthwhile.”

“Don’t let what is said here fall on deaf hears, don’t let your tomorrows be indifferent to what can happen, make the necessary effort, do your PSA and go and see a doctor,” he warned.