No matter the cancer, treatments often cause side effects that affect patients’ quality of life. But with prostate cancer, the potential side effects can be particularly concerning to men who are trying to decide which approach is right for them. Surgery, radiation therapy and other treatments may impact a patient’s sex life, causing challenges like low sex drive, loss of penis length, dry orgasm or low sperm counts. Despite the angst these issues may cause, experts say most of these side effects can be managed and many men have a good chance of returning to a full sex life after prostate cancer treatment.
“Unfortunately, sexual dysfunction is a possibility for nearly all treatment options for prostate cancer, including surgery,” says Scott Shelfo, MD, FACS, Medical Director of Urology at our hospital near Atlanta. “The degree of dysfunction depends on many factors, including the patients’ overall health, co-existing medical problems, as well as the patient’s level of sexual function and ability before treatment.”
Following surgery, many men experience erectile dysfunction (ED), but for many, the disruption is temporary. Nerves damaged during surgery may result in erectile dysfunction. A nerve-sparing prostatectomy may reduce the chances of nerve damage. “Another factor is the surgeon’s skill level for performing the nerve-sparing technique, which if done correctly, may improve patients’ likelihood of retaining erectile function,” says Dr. Shelfo.
Prostate cancer may also be treated with various types of radiation therapy—brachytherapy, external beam radiation or stereotactic body radiation therapy. Each type of therapy causes somewhat different side effects. About half of all prostate cancer patients who undergo any of these types of radiation therapy are likely to develop erectile dysfunction, according to a 2016 article published in Advances in Radiation Oncology.
“When you compare surgery with radiation, both may affect erections,” says Dr. Shelfo. “Surgery is usually more immediate, and sexual dysfunction has the potential with time to improve. With radiation, erections are usually less affected in the beginning, but over time—months or, sometimes, years—sexual dysfunction may develop. Both treatments may affect sexual function, resulting in no ejaculate or the ability to attain erections.”
The goal of hormone therapy is to reduce the level of male hormones in the body, or to stop them from fueling prostate cancer cells. Hormone therapy may cause a loss of libido (sex drive) for some but not all patients. Some men find that they maintain their desire for sex but are unable to get an erection or are unable to reach orgasm. Hormone therapy may also reduce the amount of semen released at ejaculation.
Chemotherapy drugs are used to kill cancer cells or limit their growth. Some patients may lose their sex drive and have difficulty achieving an erection after chemotherapy. With all prostate cancer treatments, the patient’s age and overall health will influence his ability to return to an active sex life after treatment. The younger he is, the more likely he is to regain sexual function.
“Most of the men we see are in their 40s, 50s and 60s and still enjoy a healthy sex life,” says Dr. Shelfo. “So not only are we talking about the appropriate way to treat their cancer, but we're trying to limit the side effects of treatment so that they keep their quality of life.”
Patients should not be shy about discussing intimacy issues with their doctor. He or she may be able to prescribe medications to help. Certain medications—such as sildenafil (Viagra®), tadalafil (Cialis®) or vardenafil (Levitra®)—are typically tried first. But these drugs may not help men achieve an erection if the nerves responsible are not healthy. In fact, the medications only work for a small percentage of men in the first few months after surgery, according to a 2017 study published in the International Journal of Sexual Health.
“Besides oral medications for erectile dysfunction, there are other options available to men with ED after prostate cancer treatment,” says Dr. Shelfo. “These include penile injection therapy, which involves injecting a small amount of medication directly into the base of the penis. That has helped many men achieve erections.” Another option is an intraurethral suppository of medication, an external vacuum erection device, or surgery may be performed to implant a penile prosthesis.
While regaining erectile function is not possible for all men treated for prostate cancer, it is important to remember that an erection is just one aspect of a satisfying sex life. Intimacy is another major component, one that may become more important as sexual relationships become more difficult after cancer treatment.
Learn four steps to resuming a healthy sex life after cancer.