A cancer diagnosis of any kind can be extremely distressing, but for men who are informed they must have surgery to remove a prostate-invading tumor, the risk of impotence can be almost as distressing.

To eradicate cancer, a radical prostatectomy entails removing the walnut-sized prostate gland, which is positioned between the bladder and rectum.

However, there is a considerable risk of injury to the sensitive nerves and arteries that maintain the penis’s health.

Modern procedures, known as nerve-sparing surgery, can lessen the hazards of prostatectomies, but the charity Prostate Cancer in the UK warns that up to 80% of these individuals afterward develop erectile dysfunction severe enough to endanger their sex lives and disrupt their relationships. Additionally, they may develop incontinence.

A growing body of information, however, suggests that the risk to men’s sexual lives may be drastically decreased if they were placed in a “pre-habilitation” program before surgery, which would involve treatments and exercises designed to prevent or greatly restrict any loss of virility.

Several weeks before surgery, frequent doses of the erectile dysfunction medication Cialis (generic name: tadalafil) are used to widen the microscopic blood arteries supplying the genitalia, to improve their condition.

Also recommended are daily workouts to strengthen a man’s pelvic floor muscles and regular usage of a vacuum pump to generate stronger erections by sucking blood into the penis, forcing it to erect.

The NHS already routinely authorizes the majority of these measures as part of a GP-supervised rehabilitation program designed to assist men in repairing any surgical harm after prostate removal. However, a rising number of studies indicate that the potential advantages are far greater if these actions are implemented well before patients enter the operation room.

Dr. Geoff Hackett, a former specialist in urology and sexual medicine at Good Hope Hospital in Birmingham and past president of the British Society of Sexual Medicine, states, “It’s a no-brainer.”

Why do all of this if the damage has already been done during surgery?” If the nerves, blood vessels, and muscles that control erectile and urine function are in better health before surgery, healing and recovery are significantly accelerated.

A study conducted by researchers at the Korea University College of Medicine in Seoul and published in the journal Oncology in April 2022 compared the outcomes of 20 men who received a daily 5mg dose of tadalafil two weeks before prostate removal with those of 21 men who received the drug four weeks after their surgery.

Twelve months after surgery, 80 percent of men who were given the medicine before surgery had restored the majority of their erectile function, compared to only 71,4 percent of men in the post-op therapy group.

The researchers concluded that pre-operative penile rehabilitation may result in improved erectile function than post-operative rehabilitation.

According to Dr. Hackett, preoperative administration of medications such as tadalafil increases the likelihood of restoring complete erectile function after surgery.

However, he claims that the medicine is more effective when a surgeon prepares nerve-sparing surgery, which minimizes damage to the tiny nerve bundles around the prostate that govern a man’s erections.

Conventional prostatectomy is more intrusive, harming delicate nerves and blood arteries and reducing the drug’s efficacy.

Nevertheless, the National Institute for Health and Care Excellence now only authorizes daily tadalafil for post-operative rehabilitation (NICE).

Dr. Hackett explains that the lack of large-scale clinical trials confirming its usefulness before surgery makes it extremely difficult to convince NICE to endorse it.

Therefore, men seeking advanced treatment must typically receive tadalafil with a private prescription. I frequently encounter such individuals, and I propose they begin ideally two to three months before surgery.’

Similarly, several studies have shown that beginning simple pelvic floor exercises before prostate surgery gives better benefits than after when the patient is frequently in too much pain to perform them correctly.

The Pelvic, Obstetric, and Gynecological Physiotherapy group, an organization of physiotherapists specializing in pelvic floor exercise instruction, states that the exercises strengthen two major muscles: the bulbocavernosus, which wraps around the base of the penis, and the ischiocavernosus, a group of muscles that ‘act like guy ropes’ in holding the penis up when it’s erect.

Clare Bourne, a private physiotherapist based in London who specializes in preparing men for prostate surgery, advises that the exercises can be performed at home or on the train to work, preferably at least six weeks before surgery.

She continues, “One practice is to imagine trying to hold in wind.” This contracts the pelvic muscles.

The testicles can also be softly raised by tightening the pelvic floor muscles. Perform these exercises five to ten times per day.

According to her, the exercises stimulate the release of vascular endothelial growth factor, a protein that promotes nerve regeneration in the penis and increases muscle strength. Regularly contracting pelvic muscles increases blood flow to the genitals.

Clare Bourne feels that pelvic “prehab” has psychological benefits for men in addition to physical ones.

For many, this is the first time they have ever been instructed to exercise their pelvic floor muscles, and they are typically comforted by the knowledge that they are doing everything possible to save their sex lives following surgery.