Understanding decision regret after penile prosthesis surgery in pelvic cancer survivors

Background: Erectile dysfunction is a highly prevalent consequence of pelvic cancer treatment in males. For erectile dysfunction that is refractory to pharmacological intervention, surgical implantation of a penile prosthesis offers a more definitive treatment option. In this paper, we aim to assess patient decision satisfaction and regret levels amongst pelvic cancer patients who subsequently underwent penile prosthesis implantation, as there is a lack of data available amongst this patient cohort. Methods: A cross-sectional telephone survey was administered to men who underwent implantation of a penile prosthesis at a single tertiary andrology centre between December 2023 and May 2025. The survey purported to assess specific aspects of the post-prosthesis implantation experience, including cosmesis and ejaculatory function, as well as overall decision satisfaction and regret. Demographics were collected from medical records, and responses were analysed using simple data analysis and Fisher’s Exact Tests. Results: Eighteen men were identified who had developed erectile dysfunction secondary to pelvic cancer treatment and had subsequently undergone implantation of a penile prosthesis (mean age 62, mean Body Mass Index 28.9). Overall, 72% of patients were either “Happy” or “Very Happy” with their procedure, with only one patient stating that they would “Probably Not” undergo the procedure again. A significant association was identified between increased patient age and reduced decision satisfaction levels (p = 0.0294). Conclusions: Implantable penile prosthesis is generally a well-tolerated procedure amongst the male pelvic cancer patient cohort, with high overall decision satisfaction rates. This permits more informative pre-operative counselling allowing prospective patients to make more informed treatment decisions, and may provide greater confidence for patients worried about how treatment could affect their sexual function.

Penile implant; Pelvic cancer; Satisfaction; Regret

[1] Pizzol D, Xiao T, Smith L, Sánchez GFL, Garolla A, Parris C, et al. Prevalence of erectile dysfunction in male survivors of cancer: a systematic review and meta-analysis of cross-sectional studies. British Journal of General Practice. 2021; 71: e372–e380.

[2] Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2021; 71: 209–249.

[3] Romeo M, Spaggiari G, Furini C, Granata ARM, Toss A, Simoni M, et al. Talking about sex: erectile dysfunction in the oncology patient. Endocrine-Related Cancer. 2023; 30: e220401.

[4] Araujo AB, Durante R, Feldman HA, Goldstein I, McKinlay JB. The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging Study. Psychosomatic Medicine. 1998; 60: 458–465.

[5] Nelson CJ, Mulhall JP, Roth AJ. The association between erectile dysfunction and depressive symptoms in men treated for prostate cancer. The Journal of Sexual Medicine. 2011; 8: 560–566.

[6] Fisher WA, Rosen RC, Eardley I, Sand M, Goldstein I. Sexual experience of female partners of men with erectile dysfunction: the female experience of men’s attitudes to life events and sexuality (FEMALES) study. The Journal of Sexual Medicine. 2005; 2: 675–684.

[7] Yafi FA, Jenkins L, Albersen M, Corona G, Isidori AM, Goldfarb S, et al. Erectile dysfunction. Nature Reviews Disease Primers. 2016; 2: 16003.

[8] Corona G, Santi D, Cocci A, Vena W, Pizzocaro A, Vignozzi L, et al. Long-term penile prosthesis couple’s satisfaction: a systematic review and meta-analysis. Andrology. 2025; 13: 610–623.

[9] Likert R. A technique for the measurement of attitudes [doctoral dissertation]. The Science Press. 1932.

[10] Brehaut JC, O’Connor AM, Wood TJ, Hack TF, Siminoff L, Gordon E, et al. Validation of a decision regret scale. Medical Decision Making. 2003; 23: 281–292.

[11] Salter CA, Bach PV, Jenkins L, Bennett N, Yafi FA, El Khatib F, et al. Development and validation of the Satisfaction Survey for Inflatable Penile Implant (SSIPI). The Journal of Sexual Medicine. 2021; 18: 1641–1651.

[12] Ghaffar U, Abbasi B, Li KD, Venishetty N, Hakam N, Fernandez A, et al. Ejaculatory function after radiotherapy for prostate cancer: a systematic review and meta-analysis. Prostate Cancer and Prostatic Diseases. 2025; 28: 572–577.

[13] Singh A, Cooper CA, Hou SW, Raheem OA. A systematic review of partner satisfaction after penile prosthesis with special emphasis on LGBTQ + populations. Current Urology Reports. 2023; 24: 105–115.

[14] Manocchio N, Vita G, Giordani L, Ljoka C, Monello C, Foti C. Rehabilitation for women and men experiencing sexual dysfunction after abdominal or pelvic surgery. Surgeries. 2025; 6: 40.