Treatment for prostate cancer may damage nerves and muscles near the prostate, bladder and bowel. This may cause side effects including urinary incontinence, changes in bowel habits, erectile dysfunction and infertility. Lower testosterone levels as a result of ADT can also cause loss of interest in sex (libido).
Side effects will vary from person to person. Some men will not have any, while others may experience a few. Side effects may last for a few weeks or be permanent. Fortunately, there are many ways to reduce or manage side effects. Many go away in time and most men are able to continue to lead active lives after their treatment.
Urinary incontinence, accidental or involuntary leakage of urine, is a common side effect of treatment that is usually temporary.
After prostate surgery, most men have some degree of incontinence for 3–6 months. Some men may lose a few drops when they cough, sneeze, strain or lift something heavy. For others, symptoms may be more severe and require the use of incontinence pads. Incontinence is usually worse shortly after surgery, but generally improves within a year.
Although rare, radiotherapy can reduce the capacity of the bladder to store urine, irritate the bladder, narrow the urethra and weaken the pelvic floor muscles. This can lead to urinary urgency and difficulty passing urine. Talk to your doctor or a continence nurse or physiotherapist if these problems occur.
Surgery for incontinence may be considered if incontinence hasn’t improved significantly after 12 months. There are two surgical options: a sling or an artificial sphincter. These devices work by putting pressure on the urethra to close it off and control urinary flow. Talk to your doctor or urologist to see if surgical treatment may be an option for you.
When a man has trouble getting or keeping an erection firm enough for intercourse or other sexual activity, it is called erectile dysfunction or impotence. The quality of erections usually declines naturally as men get older.
Erection problems are common in men following treatment for prostate cancer, particularly radiotherapy and prostate surgery. The prostate lies close to nerves and blood vessels that are important for erectile function. These can be damaged during surgery or radiotherapy.
The body needs time to heal after surgery. There may be a gradual recovery, with some men noticing their erectile function continues to improve for up to three years after treatment has finished.
There is increasing evidence that sexual rehabilitation before and after surgery and radiotherapy helps recovery. Your chance of a strong recovery of erectile functioning may be improved by:
For many men, an orgasm can still be achieved without a full erection. See tips on managing changes to your sex life after prostate cancer treatment.
Sometimes cancer treatment adds to existing erection problems, which may be caused by:
There are several options for trying to improve the quality of your erections, regardless of the type of cancer treatment you have had.
There are prescription medications that can help the body’s natural response to sexual stimulation by increasing blood flow to the penis. These are only effective if the nerves necessary for erections are working. Possible side effects include headaches, nausea, facial flushing and backache, but these only last a few hours, until the drug is out of your system.
Men with existing heart problems should check with their doctor before using these medications. These medications can cause changes in blood pressure, and some heart medications are not recommended (contraindicated) with these tablets.
Penile injection therapy is a commonly used and effective treatment prescribed by a doctor. Men are taught to inject their penis with medication that causes blood vessels in the penis to expand and fill with blood, causing an erection. An erection usually occurs within 15 minutes and lasts 30–60 minutes.
This treatment works well for most men, but a few may experience pain and scarring. A rare side effect is a prolonged and painful erection (priapism); this requires emergency medical attention.
A vacuum erection device (VED) or vacuum pump device uses suction to draw blood into the penis.This device can also help to strengthen or maintain a natural erection.
A rigid tube is placed over the penis. A manual or battery- operated pump then creates a partial vacuum that forces blood to flow into the penis so it becomes hard. A band placed onto the base of the penis keeps the erection firm. The band can be worn comfortably for up to 30 minutes.
Using a VED is painless and relatively easy; however, it may take some practice to feel confident. VEDs are available on prescription or from sex aid shops.
You may see and hear advertisements for products offering treatment for erectile dysfunction. Products include herbal preparations, natural therapies, nasal sprays and lozenges.
Be cautious about using testosterone or natural products that act like testosterone in the body, as they may involve risks without any benefits.
Talk to your doctor or sexual health physician before taking any over-the-counter or prescription medications to improve erections.
A penile prosthesis is an implant that is surgically placed in the penis. This implant allows men to mechanically create an erection.
Flexible rods or thin, inflatable cylinders are placed in the penis and connected to a pump, which is put into the scrotum during surgery under general anaesthetic. The pump is turned on or squeezed when an erection is desired.
Implants are usually performed no sooner than 12 months after prostate cancer treatment. They are generally considered only after other less invasive penile rehabilitation options have been trialled, such as medications or injections. Implantation is effective, however the surgery permanently changes the structure of the penis, as part of the tissue within the penis is removed to implant the device. If the device is removed, a man will be unable to achieve an erection.
Sexuality means different things to different people. Whether you are single, in a relationship, heterosexual, gay, bisexual or transgender, you may notice other changes to your sexual functioning, which can affect the way you experience sexuality and intimacy.
After surgery, radiotherapy or hormone therapy for prostate cancer, most men become infertile. This means they can no longer have children naturally. If you want to have children, you and your partner should talk to your doctor about your options before treatment starts. You may be able to have your sperm stored at a fertility clinic for use at a later time when you are ready to start a family.
Reduced interest in sex (low libido) is common during cancer treatment. Quite often it occurs due to anxiety and fatigue rather than the treatment itself. However, hormone treatment and sexual side effects associated with radiotherapy or surgery can also reduce libido. Most men notice that their sex drive returns when treatment finishes, but for some men, the problem is ongoing.
Adjusting to changes in sex drive can be emotionally and physically challenging for men and their partners. See the restoring your sex life section for tips to help with this issue.
After a prostatectomy, you will no longer produce semen, as the prostate, vas deferens and seminal vesicles have been removed. You will still feel the rhythmic muscular spasms and pleasure that accompany an orgasm, but you will no longer ejaculate. This is called a dry orgasm.
Some men notice a reduction in the sensation of the orgasm. You may worry that a dry orgasm will be less pleasurable for your partner. However, most partners say this is not the case, especially as many do not feel the release of semen during intercourse. Semen production is also affected (reduced) following radiotherapy.
Some men notice a small leakage of urine during intercourse and orgasm. This is due to damage to the sphincter muscle that controls urine flow. This can be embarrassing, but is not harmful to your partner. If this is a problem for you, empty your bladder (urinate) before sex. Speak with your doctor if you are still concerned.
"I don’t feel less of a man because I have prostate cancer and the treatment has affected my sex drive. My partner almost always initiates the foreplay and that gets me interested." – John
Deciding when to tell a new potential sexual partner about your cancer experience isn’t easy. Some single men may avoid dating for fear of rejection.
While the timing will be different for each person, it can be helpful to wait until you and your new partner have developed a mutual level of trust and caring. It is best to talk with a new partner about your concerns before becoming sexually intimate.
By communicating openly, you may find that your partner is more accepting and understanding.
Cancer can affect your sexuality in both physical and emotional ways. The impact of these changes depends on many factors, such as your treatment and its side effects, the way you and your partner communicate, and your self-confidence.
The importance of sexual activity for a man before prostate cancer will influence how changes to his sex life affect him (and his partner, if he has one) after treatment. Some men link their sense of masculinity with their sex drive, making adjusting to changes difficult. Others might feel they have lost a part of themselves or may question their self-worth.
For many people, a relationship based on trust and understanding is an important part of a satisfying, intimate sexual experience.
Although less common now, radiotherapy may damage the rectum, leading to bleeding and/or diarrhoea. A bowel specialist (a gastroenterologist or a colorectal surgeon) may treat these side effects with steroid suppositories or treatments applied to the bowel. For more information, talk to your radiation oncologist or continence nurse.
Hot flushes may occur as a result of ADT. Reducing alcohol intake, avoiding hot drinks, getting regular exercise and relaxation may help.
Osteoporosis can be a delayed side effect of hormone therapy and monitoring of your bone mineral density by your GP may be required.
These may occur as a result of hormone therapy and may be monitored by your doctor. You may be referred to a dietitian or exercise physiologist for advice.