Unfortunately, all treatments for prostate cancer have side effects, including some that may have a negative impact on urinary and sexual health. Infertility, urinary incontinence (inability to control urine flow), reduced sexual desire, impotence or erectile dysfunction, and changes in orgasm are all potential side effects of prostate cancer treatment.
Your Seattle Cancer Care Alliance (SCCA) team will talk with you about the side effects you can expect. This page provides some general information. The side effects you might experience will depend on a number of factors, including the details of your cancer (location, stage, and grade), your age, your general health, your treatment, and the skill of your doctor. Your team will help you weigh the benefits and risks of your treatment options and will do everything possible to reduce the risk of side effects and to help you manage any side effects that occur.
SCCA offers extensive support for patients being treated here. If you have psychological concerns or concerns related to sexuality and cancer, learn about SCCA’s psychosocial and sexuality resources that are available to you.
If you have surgery to remove your prostate (prostatectomy), you will lose your fertility and no longer be able to father a child. If you have radiation therapy to your pelvic region, you probably will be infertile as well. If infertility is a concern for you, talk to your doctor about options such as freezing your sperm before your treatment so that it will be available if you want to father a child in the future.
Urinary incontinence is the loss of bladder control or involuntary leakage of urine. Before and after treatment for prostate cancer, doing Kegel exercises to strengthen your pelvic-floor muscles may help minimize incontinence.
You may need to wear a small pad to catch leaking urine. Ask your doctor about medications that may help. Severe incontinence can often be corrected later with surgery.
Short-term incontinence, lasting a few weeks or months, is a common side effect after a radical prostatectomy. With an expert surgeon, the life-long risk of severe incontinence is less than 5 percent.
With radiation therapy, urinary incontinence is also a possible side effect; however, severe incontinence is uncommon. The likelihood of needing to wear a pad for mild leakage several years after treatment is less than 5 percent in younger men and around 10 percent in men who are older. The typical incontinence experienced is usually a mild urge to urinate with a small amount of leakage.
Reduced Sexual Desire
Lack of sexual desire, or low libido, is a continued lack of desire to have sex. In men it can be caused by aging and physical factors that reduce testosterone as well as emotional distress that may come with having cancer. Reduced sexual desire occurs in most men being treated with hormone therapy.
Impotence, or erectile dysfunction, is the inability to have or maintain an erection. Treatment may completely or partially injure the two nerve bundles near the prostate that are responsible for allowing a normal erection.
During surgery, unless both nerve bundles are sacrificed due to the extent of the cancer, there is a chance of recovering erectile function, but it may be very slow, taking up to two years after surgery for full recovery.
Both external-beam radiation therapy and internal radiation therapy frequently cause impotence as well. Usually it does not occur right after radiation therapy but develops slowly over a year or more. The majority of men who undergo radiation therapy notice some decrease in their erectile function, with more than 50 percent having a permanent change.
Recovery of erectile function is related to your age, erectile function prior to treatment, and whether the nerve bundles were damaged by treatment. In general, the younger you are and the better your sexual function before surgery, the more likely you will be to regain function after treatment. Some men notice that their erections are less rigid and durable, even after they get return of some function. Ask your doctor about medications or devices that can help.
Changes in Orgasm
You will still be able to experience orgasm after a radical prostatectomy or radiation therapy, even if you have erectile dysfunction, but you may note a change in the nature of the sensation of orgasm and there will be very little, if any, ejaculate. Some men may experience the release of urine with orgasm (climacturia) after surgery.
Quality-of-Life Outcome Studies
Outcome studies measure changes in quality of life, including bowel, urinary, and erectile function, after prostate cancer treatment. The results vary between centers and between doctors based on their technical skill; however, at present there are fewer than 20 urologic surgeons or radiation oncologists in the United States who track and know their own results. Bruce L. Dalkin, MD, is one of the few who does. In order to honestly and accurately counsel newly diagnosed men about prostate cancer surgery, he has been participating in a high-quality, well-designed outcomes study, and his results have been consistently better than those typically seen. Visit Dr. Dalkin’s profile for more information about his quality-of-life study results.