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Prostate cancer


Managing side effects

Page last updated: June 2024

The information on this webpage was adapted from Understanding Prostate Cancer - A guide for people with cancer, their families and friends (2024 edition). This webpage was last updated in June 2024.

Expert content reviewers:

This information was developed based on Australian and international clinical practice guidelines, and with the help of a range of health professionals and people affected by prostate cancer:

  • Prof Declan Murphy, Consultant Urologist, Director – Genitourinary Oncology, Peter MacCallum Cancer Centre and The University of Melbourne, VIC
  • Alan Barlee, Consumer
  • Dr Patrick Bowden, Radiation Oncologist, Epworth Hospital, Richmond, VIC
  • Bob Carnaby, Consumer
  • Dr Megan Crumbaker, Medical Oncologist, St Vincent’s Hospital Sydney, NSW
  • Henry McGregor, Health Physiotherapist, Adelaide Men’s Health Physio, SA
  • Jessica Medd, Senior Clinical Psychologist, Department of Urology, Concord Repatriation General Hospital and Headway Health, NSW
  • Dr Gary Morrison, Shine a Light (LGBTQIA+ Cancer Support Group)
  • Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA;
  • Graham Rees, Consumer
  • Kerry Santoro, Prostate Cancer Specialist Nurse Consultant, Southern Adelaide Local Health Network, SA
  • Prof Phillip Stricker, Chairman, Department of Urology, St Vincent’s Private Hospital, NSW
  • Dr Sylvia van Dyk, Brachytherapy Lead, Peter MacCallum Cancer Centre, VIC.

 
It will take some time to recover from the physical and emotional changes caused by prostate cancer treatment.

Side effects can vary – some people experience many, while others have few. Side effects may last from a few weeks to a few months or, in some cases, years or permanently. Fortunately, there are many ways to reduce or manage side effects.

If you have ongoing side effects after cancer treatment, talk to your GP about developing a GP Management Plan and Team Care Arrangement to help you manage them.

This means you may be eligible for a Medicare rebate for up to five visits each calendar year to allied health professionals.

 

Treatments and their possible side effects

Prostatectomy

erection problems, urinary problems, loss of libido, dry orgasm, urine leakage during sex, infertility and fatigue.

EBRT

erection problems, urinary problems, loss of libido, dry orgasm, infertility, fatigue and bowel problems.
Brachytherapy erection problems, urinary problems, loss of libido, dry orgasm, infertility and bowel problems.
ADT erection problems, loss of libido, infertility, fatigue, hot flushes, osteoporosis, heart problems, breast growth and mood swings
Targeted therapy fatigue and bowel problems.

 

Your guide to best cancer care

A lot can happen in a hurry when you’re diagnosed with cancer. The  guide to best cancer care for prostate cancer can help you make sense of what should happen.

It will help you with what questions to ask your health professionals to make sure you receive the best care at every step.

Read the guide

Erection problems

You may have trouble getting or keeping an erection firm enough for intercourse (vaginal or anal) or other sexual activity after any treatment for prostate cancer. This is called erectile dysfunction or impotence.

The prostate is close to nerves, muscles and blood vessels that help control erections, and these can be damaged during treatment.

If the nerves are removed during surgery, erection problems happen immediately. After radiation therapy and ADT, problems may begin slowly.

The quality of your erections usually improves over time and can continue to improve for up to three years after treatment has finished. Sometimes, erection problems may be permanent.

Aside from cancer treatment, erection problems become more common with age. Erections can also be affected by:

  • diabetes and heart disease
  • some medicines for blood pressure or depression
  • surgery to the bowel or abdomen
  • smoking or heavy drinking
  • emotional concerns.

Penile rehabilitation

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. 

Ways to improve erections

There are several medical options to try to improve the quality of your erections, no matter what type of prostate cancer treatment you've had.

Ask your treatment team for more details about these methods and other things you can do to improve erections.

You may see or hear ads for ways to treat erection problems (e.g. herbal preparations, natural therapies, nasal sprays and lozenges).

If you're thinking about using these products, talk to your doctor first, as there could be risks. Products that contain testosterone or act like testosterone in the body may encourage some cancers to grow.

Tablets

Your doctor can prescribe tablets to increase blood flow to the penis. These only help if the nerves controlling erections are working. These tablets should not be taken with certain blood pressure medicines.

Check with your doctor about the medicines you take. Your doctor may recommend using the tablets before and soon after surgery, as the increased blood flow can help preserve penis health until the nerves recover.

Tablets are also an option after radiation therapy and ADT.

Vacuum erection device (VED)

A vacuum erection device (VED) or “penis pump” uses suction to make blood flow into the penis. This device can also help to strengthen or maintain a natural erection. Talk to your doctor about suitable devices for you and where to buy them.

You place a clear, rigid tube over the penis. A manual or battery-operated pump then creates a vacuum that causes blood to flow into the penis so it gets hard.

You place a rubber ring at the base of the penis to keep the erection firm for intercourse after the pump is removed. The ring can be worn comfortably for 30 minutes.

Penile injection therapy (PIT)

Penile injection therapy (PIT) involves injecting the penis with medicine that makes blood vessels in the penis expand and fill with blood, creating an erection. This usually occurs within 15 minutes and lasts for 30–60 minutes.

The medicine has to be prescribed by a doctor. It often comes in pre-loaded syringes, which are single use. You can also buy it in vials from a compounding pharmacy and measure it out into a syringe yourself.

You will be taught how to inject the penis. Injecting your penis may sound unpleasant, but many people say it causes only a moment of discomfort. PIT works well for many people, but a few may have pain and scarring.

A rare side effect is a prolonged and painful erection (priapism). This needs emergency medical attention.

Implants

A penile prosthesis is a permanent implant that allows you to create an erection. Flexible rods or thin, inflatable cylinders are placed in the penis during surgery and connected to a pump in the scrotum.

You turn on or squeeze the pump when you want an erection. An implant is not usually recommended for at least a year after prostate cancer treatment, and non-surgical options such as oral medicines or injections will usually be tried first.

Occasionally, penile implants need to be removed. If this happens, you will no longer be able to have an erection.

Urinary problems

Trouble controlling the flow of urine (urinary incontinence) is a common side effect of some prostate cancer treatments.

Urinary problems caused by surgery

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

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.

Coping with urinary incontinence

  • 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.

 

Restoring your sex life

Prostate cancer can affect your sex life physically and emotionally. How much will depend on factors such as:

  • the cancer treatment and its side effects
  • your general health
  • how you and your partner/s communicate, and
  • your self-confidence.

It takes time to adjust to changes in your sex drive, your self-esteem and relationships.

Telling a new partner

Deciding when to tell a potential sexual partner about your cancer experience isn’t easy, and you may even avoid dating or sex.

It can be helpful to wait until you and your new partner have developed a mutual level of trust and caring.

You might prefer to talk with a new partner about your concerns before becoming sexually intimate. By communicating openly, you avoid misunderstandings and may find that your partner is more supportive.

Other sexual function changes

Changes may affect your feelings of pleasure, sexuality and intimacy.

Loss of libido

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.

Loss of pleasure from prostate stimulation

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.

Dry orgasm

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.

Leaking urine during sex

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.

Fertility problems

Infertility is common after surgery, radiation therapy or ADT for prostate cancer. This means you can no longer have children naturally.

If you may want to have children in the future, you (and your partner if you have one) should talk to your doctor about your options before treatment starts.

You may be able to store some sperm at a fertility clinic to use when you are ready to start a family.

Radiation therapy may affect sperm quality for 6–12 months after treatment and cause birth defects. You will need to use contraception or not have penetrative sex to avoid conceiving during this time. 

Learn more

Other side effects

Treatment for prostate cancer may lead to a range of other concerns, but most of these can be managed.

Managing other side effects

  • 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.

 

Life after treatment

For most people, the cancer experience doesn’t end on the last day of treatment. Life after cancer treatment has its own challenges.

You may have mixed feelings when treatment ends, and worry that every ache and pain means the cancer is coming back. Some people say that they feel pressure to return to “normal life”.

It is important to allow yourself time to adjust to the physical and emotional changes, and establish a new daily routine at your own pace. Your family and friends may also need time to adjust. 

Contact cancer support

Check-ups after treatment

After treatment ends, you will have regular appointments to monitor your health, manage any long-term side effects, check that the cancer hasn’t come back and discuss any concerns you have.

During check-ups, you may have a physical examination, x-rays or scans and a PSA test.

Over time, if there are no further problems, your check-ups will become less frequent. If you notice any new symptoms between check-ups, you should let your GP or specialist know.

Understanding the results of a PSA test

Depending on the type of treatment you had, PSA results will vary:

  • After surgery, if it has been possible to remove all the cancer, there should be no prostate cells left to make PSA antigen and your PSA level should drop quickly.
  • After radiation therapy, your PSA level will drop gradually, and it may take 2–3 years for your PSA to reach its lowest level.
  • If you have ADT as well as radiation therapy, your PSA level will generally be very low while undergoing treatment.

The usefulness of the PSA test will vary. If you had localised prostate cancer, it can help find any cancer cells that come back.

With advanced prostate cancer, particularly when the Gleason score or Grade Group is very high, the PSA test may be less useful.

Your doctor will also consider your symptoms and other test results along with the PSA test results.

These all help to build a picture of what is happening to the cancer that is more accurate and informative than just the PSA test alone.

Recurrence

Sometimes prostate cancer does come back after treatment, which is known as a recurrence.

If your PSA level starts to rise and the cancer has not spread beyond the prostate, this may mean you still have cancer cells in the prostate area.

If this happens, you may be monitored with regular blood tests or you may be offered further treatment, which is known as salvage treatment.

Salvage treatment options

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.

 

Understanding Prostate Cancer

Download our Understanding Prostate Cancer booklet to learn more.

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