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Medical Forum / Diseases and Disorders / Prostate Cancer / November 2006Can PCa cause ED?
I know the treatments, both surgery and radiation, can impair erectile function. But I'm wondering if untreated PCa can also. The reason I ask this is that I was exploring the origination of nitric oxide in our bodies. I came across this website, http://www.life-enhancement.com/article_template.asp?ID=938. It stated: Now, another major mechanism of decreased production of nitric oxide has been reported: an increase in the arginase pathway for the use of arginine. Recent studies have reported increases in arginase in conditions including reperfusion injury,3 asthma,4,5 psoriasis,6 arthritis,7 and human breast cancer.8 (Since arginase II is highly expressed in the prostate, it would be interesting to see whether there is increased expression in prostate cancer.) The increased arginase decreases arginine availability to be converted to nitric oxide, as well as increasing ornithine that can be converted into polyamines, procellular proliferation factors.6 Does anyone have any ideas on this? Thanks, John > I know the treatments, both surgery and radiation, can impair erectile > function. But I'm wondering if untreated PCa can also. [quoted text clipped - 4 lines] > > John Dear John-- According to Dr. Scardino if not treated the cancer will eventually spread to the erectile nerves and produce the same result. According toThe Prostate Book, (page 269.) If left untreated, pca can cause ED and much worse, not only by growing directly into the nerves that lie close to the prostate but also by requiring further treatment --radiation or hormone therapy -- that can cause loss of erections and (in the case of hormones) decreasee libido as well. Good luck, Leah > According to Dr. Scardino if not treated the cancer will eventually > spread to the erectile nerves and produce the same result. Yes, Leah, that is Scardino's opinion. But in Strum's book in appendix 4.3 he says that Walsh found the nerve bundles are 4.9 mm away from the capsule. Most extra capsular penetration only goes out to 2 mm, then it heads up toward the seminal vesticles. In a study of more than 500 men, Walsh found positive margins near the nerve bundles in only 2% of the path reports. This leads me to believe that it is rare that the nerve bundles are involved in the cancer. Dr. Myers also said, "a paper from the Mayo clinic in the journal Cancer showed that in 99% of the cases, the cancer has spread less than 5 millimeters (about a quarter of an inch) from the prostate capsule." I guess I'm just wondering if, anecdotally, others on this list felt that they were losing potentcy from the PCa and not the treatment. Thanks, John > ... > Does anyone have any ideas on this? > ... This sounds to me like one of those speculations about which it is impossible to even make an educated guess. I would think someone has to do a bunch of studies to find out if nitric acid is reduced in prostate cancer patients, when and by how much, and to what extent, if any, that reduction contributes to ED. Sex is so much a psychological process that I think that just knowing that one has cancer is, all by itself, something that is likely to interfere with one's sex life. Growing older doesn't help either. So it's impossible to disentangle the various factors without a real empirical study. Alan > I know the treatments, both surgery and radiation, can impair erectile > function. But I'm wondering if untreated PCa can also. I agree with alan that this would be an extremely difficult question to study. Certainly, if the cancer progresses, it will eventually have to be treated with hormone therapy, in which case impotence will very ikely become moot. When the cancer becomes hormone independent, presumably few men are going to be concerned about impotence. Also, your trying to draw conclusions from what you find in various places about how far and in what direction the cancer spreads is not likely to lead you anywhere. You should keep in mind that without adequate training, which none of us here have, reasoning about such hypotheticals is bound to omit important facts and understandings and is not likely to yield reliable conclusions. Presumably Scardino knows all the facts you dredged up but still thinks that untreated prostate cancer can affect the nervess controlling erections. My inclination would be to accept what he says unless some other competent authority explicitly disagrees. > The reason I ask this is that I was exploring the origination of nitric > oxide in our bodies. I came across this website, [quoted text clipped - 18 lines] > > John >> I know the treatments, both surgery and radiation, can impair erectile >> function. But I'm wondering if untreated PCa can also. > > I agree with alan that this would be an extremely difficult question to > study. What am I missing? Won't PC -- a disease which erodes ever-expanding regions of our urinary and reproductive system including erectile hardware and software -- at some point impair if not altogether destroy those systems and functions? I.P. : >> I know the treatments, both surgery and radiation, can impair erectile : >> function. But I'm wondering if untreated PCa can also. [quoted text clipped - 8 lines] : : I.P. I don't think you've missed a thing, my friend, and your logic sounds perfectly reasonable to me. In my own case, and due to my own negligence, I waited until my PSA and a trusted urologist dictated surgery, pronto. Before that time I had almost totally lost interest in sexual relations with my beloved wife and could hardly function, anyway. I put it down to age (70+) and BPH. Now I no longer think that was entirely the case. (Follow up: Surgery, HRT, and external beam radiation has lowered the PSA to an undetectable level but I've lost everything else.) Ken Bland > : What am I missing? Won't PC -- a disease which erodes > : ever-expanding regions of our urinary and reproductive system including > : erectile hardware and software -- at some point impair if not altogether > : destroy those systems and functions? > I don't think you've missed a thing, my friend, and your logic sounds > perfectly reasonable to me. In my own case, and due to my own negligence, I [quoted text clipped - 5 lines] > (Follow up: Surgery, HRT, and external beam radiation has lowered the PSA to > an undetectable level but I've lost everything else.) Don't presume your delay destroyed your sex life. My uro onc said that although my PC probably began at least a decade ago (it was diagnosed in '04 with PSA around 1.2 in '00), it is an unlikely culprit in my ED which got noticeable (couldn't always finish the job) in the mid-90s, my early 50s, despite very minor, if any, BPH. But age? Tell that to the guys who still enjoy sex into their '80s . . . both of them. I.P. "I.P. Freely" <fuhgheddaboutit@noway.nohow> wrote [snip - no pun intended] > But age? Tell that to the guys who still enjoy sex into their '80s . . . > both of them. > > I.P. Not with each other, one hopes, lest we unleash another storm of God-will-smite-them e-mails. Alex > "I.P. Freely" <fuhgheddaboutit@noway.nohow> wrote > [snip - no pun intended] [quoted text clipped - 5 lines] > Not with each other, one hopes, lest we unleash another storm of > God-will-smite-them e-mails. LOL. Heck, at that age they've earned the right to consenting donkeys AFAIC. I.P. I think we are getting away from the original question. Maybe I didn't phrase it clearly. I was wondering what is the likelyhood that PC that is completely contained within the prostate (no nerve involvement) could cause a reduction in erectile function. As the article points out, arginase II is highly expressed in the prostate and that may increase with PC. The increased arginase decreases arginine availability to be converted to nitric oxide, which is necessary for erections. As Alan pointed out, "Sex is so much a psychological process that I think that just knowing that one has cancer is, all by itself, something that is likely to interfere with one's sex life." I agree. But what if you didn't know? In other words, do any of you remember your erectile function diminishing before you were diagnosed? Mine was. In fact, the only reason I went to get a physical was because my doctor required it before he would give me a prescription for Vitamin V. It was that PSA test that rocked my world. John > In other words, do any of you remember your erectile function > diminishing before you were diagnosed? I was slowing down but definitely not impaired prior to diagnosis at 57. The defining event was that 1st Lupron shot, or more precisely, 2 or 3 weeks afterward, after the testosterone flare had faded. Prior to the shot, I was usually good to go, perhaps not like when I was 30 but "pretty darn good". After the Lupron, the seeding, and the IMRT, life is an 8 on a scale of 10. Not terrific but serviceable. -kh > I think we are getting away from the original question. Maybe I didn't > phrase it clearly. [quoted text clipped - 13 lines] > In other words, do any of you remember your erectile function > diminishing before you were diagnosed? Erectile function diminishes with age in any case. Few of us, if any, had the kind of erections at 65 that we had when we were 16. But except for that, I had no problems whatsoever before my RP, and that includes the period between the biopsy and the operation. Personally, I doubt that prostate cancer when contained within the prostate gland can cause ED. Also, there are so many things that can cause ED that are more likely that attributing it to the cancer would seem a long shot. > Mine was. In fact, the only reason I went to get a physical was because > my doctor required it before he would give me a prescription for > Vitamin V. It was that PSA test that rocked my world. > > John > Erectile function diminishes with age in any case. Few of us, if any, > had the kind of erections at 65 that we had when we were 16. I didn't have the kind of erections at 45 that I had at 16! I had to find somewhere else to hang my wardrobe.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 PSA <0.04 Non Illegitimi Carborundum > I didn't have the kind of erections at 45 that I had at 16! I had to find > somewhere else to hang my wardrobe. LOL. But I've seen some real solid "hangers" courtesy of trimix. I'm sure you could hav3 hunt your clothes on there plus your wooden tie-rack. LFC |
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