Frank J. Costa: We know that there have been several studies that have been done, that have showed a very distinct relation between prostate problems in sexual or erectile dysfunction. As a matter of fact as the increase in prostate problems occur, so too do the decrease in sexual function or erectile function. So that there is an association. As far as whether or not this is causing an effect is still not been determined. As it relates to prostate surgery, it depends if the surgery is performed for benign, the sort of the prostate or whether it's performed for cancer. Now some of the more minimally invasive procedures for prostate surgery are associated with a less risk of erectile dysfunction, assuming of course that there are not any other causes that maybe contribute to any sexual dysfunction. So that I would say that the risk of sexual dysfunction or erectile dysfunction following standard prostate operations for benign diseases are probably much less than five to ten percent.However in patients that undergo surgery for prostate cancer, we have an operation called a prostatectomy where the entire prostate with the adjacent organs is removed. And historically this was associated with a very high rate of erectile dysfunction, almost 100%. Anthony Douglas: The treatments almost always cause a erectile dysfunction, whether it's surgery or oral medications, the chemotherapies, but heart disease, diabetes, cholesterol disorders that kind of thing, again it's all about blood vessels. It's all about blood vessel functions and if your blood vessels aren't functioning, you are not going to have a normal erection. Randall B. Meacham: The ability of a patient to achieve an erection after a radical prostatectomy which is the procedure that's usually done for the surgical treatments of prostate cancer depends on number of things. The better the patient's sexual function before having the operation, the more likely he is to retain good sexual function. The older the patient when he has his surgical procedure, the less likely that he has to be able to maintain sexual function. A lot of it also depends on the operative technique used and it also may depend on the extent of the disease. Patients that have large or bulkier tumors in their prostate may require a more widespread or more radical surgical procedure which may to a greater extent affect the nerves, that allow sexual function to take place. Having said that published values have shown that anywhere between 20 and 70, possibly even 80% of men undergoing surgery for prostate cancer will have either a diminution of or in some cases a complete lack of sexual function following that operative procedure.Frank J. Costa: However, we are now performing a new operation called the nerve sparing prostatectomy and this is where the nerves that allow patients to function sexually are preserved, and done in the hands of a proper surgeon and I have done many of these nerve sparing prostatectomy, we can in many cases preserve sexual function in anywhere from 50-90% of patients, particularly if the sexual function is present prior to the surgery. So that again it depends on the individual patient and it depends on the expertise of the surgeon and we can restore, maintain sexual function in many of these patients after prostate surgery.