Side effects of prostate cancer treatment

Before and after treatment, you can help keep your penis healthy in various ways, including: 

• foreplay and other sexual intimacy with a partner or masturbating
• trying to get erections, starting a month after surgery
• taking prescribed medicines to maintain blood flow in the penis
• stopping smoking and limiting the amount of alcohol you drink
• doing pelvic floor exercises
• injecting prescribed medicine into the penis.

Even without a full erection, you can still reach orgasm by stimulating the penis. 

After prostate surgery, issues with urinary incontinence are common for several weeks or months and usually improve slowly over time. Most people will need to use incontinence pads in the first few weeks after surgery.

Only a small number will need to use incontinence pads long term. You may find that you:

• lose a few drops of urine when you cough, sneeze, strain or lift something heavy
• leak some urine during sex
• have blood in your urine that may last a few weeks.

Urinary problems caused by radiation therapy are usually temporary and tend to improve within a few months of finishing treatment. In some cases, radiation therapy can:

• reduce how much urine the bladder can store
• irritate the bladder
• narrow the urethra
• weaken the pelvic floor muscles.

You may also find that you need to pass urine more often or in a hurry, or that you have difficulty passing urine. Sometimes, medicines or surgery can improve urine flow – ask your doctor if this is an option for you.

• Start pelvic floor exercises before surgery to help reduce the likelihood of ongoing urinary incontinence after surgery. The exercises are also important after surgery.
• Ask your doctor, urologist, continence physiotherapist or continence nurse about how to correctly do pelvic floor exercises.
• Drink plenty of water to dilute your urine – concentrated urine can irritate the bladder.
• Keep drinking plenty of fluids, even if you are afraid of leakage. Dehydration can cause constipation, which can also lead to leakage and difficulty passing urine.
• Limit tea and coffee as they contain caffeine, which can irritate the bladder. Alcohol and carbonated drinks may also irritate the bladder.
• Talk to a continence nurse or continence physiotherapist about continence aids if needed. These include absorbent pads to wear in your underpants, and bed and chair covers. They may also recommend medicines or a special plastic clamp for your penis.
• Ask your continence nurse or GP if you can apply for the Continence Aids Payment Scheme. This is a yearly payment to help cover the cost of continence products.
• If incontinence does not improve after 6–12 months, talk to your doctor or urologist about whether surgery is an option. For example, a surgically inserted sling or artificial sphincter works by pulling the urethra up to help the sphincter muscle close more effectively.
• Get resources from the Prostate Cancer Foundation of Australia and the Continence Foundation of Australia.

Reduced interest in sex (low libido) is common during cancer treatment.

While anxiety and fatigue can affect libido, it can also be affected by ADT, which lowers testosterone levels, and by the sexual side effects associated with radiation therapy or surgery.

Sex drive usually returns when treatment ends, but sometimes changes in libido are ongoing.

Depending on whether the prostate is removed, or radiation or hormone treatment damages the prostate, you may no longer feel pleasure from the prostate being stimulated.

Consider other ways to feel pleasure, such as stimulating the penis or the area around the anus.

After surgery, you will feel the muscular spasms and pleasure of an orgasm, but you won’t ejaculate semen. This is known as a dry orgasm.

It happens because the prostate and seminal vesicles that produce semen are removed during surgery, and the tubes from the testicles (vas deferens) are sealed.

Radiation therapy may also affect how much sperm you make, but this is often temporary.

A radical prostatectomy can weaken the sphincter muscle that controls the flow of urine. This may cause a small amount of urine to leak during intercourse and orgasm. You may find this embarrassing, but it won't harm your partner.

Before sex, empty your bladder. Try sex in the shower, or use a condom or a constriction ring (available from sex shops) at the base of the penis to prevent leakage. Talk to your doctor if you are concerned.

• Fatigue –  after surgery, it may take some time to get back your strength. With EBRT, you may get particularly tired near the end of treatment and for some weeks or months afterwards. Regular exercise can help.
• Bowel problems – although this is an uncommon side effect of radiation therapy, you may experience rectal bleeding after treatment. It is common to have a stronger sensation of needing to have a bowel movement. A gastroenterologist or colorectal surgeon may treat ongoing bowel problems with changes to your diet, steroid suppositories (a tablet that you insert into the rectum through the anus), laser therapy or other treatments applied to the bowel wall.
• Hot flushes – you may experience hot flushes if you are having ADT. Drinking less alcohol, avoiding hot drinks, wearing loose-fitting cotton clothing, getting regular exercise, learning relaxation techniques, and trying acupuncture may help. 
• Osteoporosis – loss of bone density can be a delayed side effect of ADT, so your specialist or GP may need to monitor your bone mineral density. Regular weight-bearing exercise, eating calcium-rich foods, getting enough vitamin D, limiting how much alcohol you drink, and not smoking will also help keep your bones strong.
• Heart problems – because ADT can increase the risk of heart problems and strokes, your doctor will monitor how well your heart is working.
• Loss of muscle mass and strength – you may find a decrease in muscle mass the longer you are on ADT. So staying as fit and active as you can may help. Clinical trials are looking at how strength and resistance training (used with supplements) may preserve muscle mass for people with prostate cancer.
• Hormone effects – weight gain, mood swings, breast swelling, body changes, and high cholesterol are more likely to happen the longer you use ADT. 

Regular exercise can help manage the side effects of ADT. A physiotherapist or exercise physiologist can develop an exercise program to meet your specific needs. Ask your doctor for a referral.

You should also aim to eat a balanced diet. See a dietitian for advice.

Your options will depend on the treatment you had. If you had surgery, you may be offered radiation therapy, and if you had radiation therapy, you may be offered further radiation therapy, surgery or other treatments.

If the cancer has spread beyond the prostate, ADT is usually suggested and sometimes radiation therapy. Surgery may be an option in some cases. You may be offered palliative treatment to manage symptoms.

It is possible for the cancer to come back in another part of your body. In this case, you may have treatment that focuses on the area where the cancer has returned. Talk to your doctors about your options or call 13 11 20 for support.