Erectile dysfunction management in prostate cancer survivors

Background: Prostate cancer (PCa) is the most commonly diagnosed malignancy among men worldwide. Despite advancements in treatment, erectile dysfunction (ED) remains a frequent and distressing complication, significantly affecting survivors' quality of life (QoL). Material and methods: A narrative review was conducted to assess ED management following radical prostatectomy (RP), radiation therapy (RT), and androgen deprivation therapy (ADT). Studies from the past decade were analyzed, focusing on pharmacological and rehabilitative strategies, their efficacy, adherence, and long-term outcomes. Results: ED remains a major challenge after RP, RT, and ADT, with variable recovery rates. Phosphodiesterase type-5 inhibitors (PDE5i) are the first-line therapy, with early post-RP administration improving spontaneous erectile function recovery. Alprostadil, administered via intracavernous injection or urethral suppositories (MUSE), offers an alternative but has limited long-term adherence. Vacuum erection devices (VED) help improve penile blood flow and tissue integrity, supporting rehabilitation. Penile prostheses are a definitive treatment for ED in patients who have not responded to or cannot use less invasive options. The procedure involves the insertion of either inflatable or semi-rigid implants to restore erectile function. It provides high satisfaction rates, especially in cases resistant to other treatments. Additionally, post-procedure rehabilitation can improve outcomes and support long-term sexual health. Early initiation of pelvic floor rehabilitation has been shown to enhance erectile function and quality of life, optimizing recovery and maintaining sexual function over time. Psychosocial support, including patient education, partner involvement, and counseling, improves coping, QoL, and overall treatment satisfaction. Conclusions: Optimal ED management in PCa survivors requires a personalized, multimodal approach. A comprehensive plan should integrate pharmacological treatment, rehabilitation, patient education, and psychosocial support to restore sexual function and improve QoL.