Prostate Cancer: Erectile Dysfunction (ED) after Treatment

Erectile dysfunction (ED) is when a man is not able to have or keep an erection to have sex. It's often a side effect of the treatments for prostate cancer, such as surgery or radiation therapy. Some men have trouble getting or keeping an erection after prostate cancer treatment. Or they may notice that erections are not as firm as they used to be. Other men are no longer able to have an erection after treatment.

How common is ED after prostate cancer treatment?

The risk of having ED after treatment depends on a number of factors. Younger men are less likely to have ED after treatment than older men. A man's ability to have an erection before surgery or radiation affects whether he will have ED after treatment. Men who were able to have and keep strong erections before treatment are more likely to have them after treatment. 

• ED after surgery. In men who have surgery to remove the prostate, called radical prostatectomy, ED rates depend on a man's age and other factors. For example, the rates of ED are lower when a surgeon can spare the nerves near the prostate that control erections. This is known as nerve-sparing surgery. ED after surgery tends to happen right away, but some men regain their ability to have erections over the next year or two.

• ED after radiation therapy. Most men can expect to lose at least some ability to have erections after radiation treatment. Unlike with surgery, erection problems after radiation therapy tend to develop slowly and get worse over time. Most men will not notice any changes at first. But erectile function can decline over the next few years.

• The patterns of ED are different after surgery and radiation therapy. But it is not clear if one treatment or the other offers a man a better chance to maintain erections after treatment. There is no strong evidence clearly showing one is better than the other.

• ED with hormone therapy. Hormone therapy affects testosterone and other hormones in the body. It is often part of the treatment for more advanced prostate cancers. Most types of hormone therapy typically cause ED. This often happens along with the loss of sexual desire. This happens less often if a medicine called an anti-androgen is used by itself. But this is not a common treatment.  

Treatments for ED

Treatment options include:

• Oral medicine. This includes medicines such as sildenafil, vardenafil, and tadalafil. These are taken in pill form. The medicines work by increasing blood flow to the penis, which can lead to a fuller erection. The most common side effects of these pills are headache, facial flushing, and upset stomach. Less common side effects are bluish or blurred vision and sensitivity to light. An eye exam may be advised before using these medicines. They can also have serious interactions with some other medicines, such as nitrates taken for chest pains. Men with heart problems should check with their healthcare provider before using these medicines.

• Vacuum device. This is a tool that helps create an erection for intercourse. The device works by causing blood to go into the penis and stay there. The penis is inserted into a hollow, plastic tube. The tube is then pressed against the body. This creates an airtight seal. A small hand pump creates a vacuum inside the tube. This cause blood to go into the penis and make the penis firm. Pumping is done for a few minutes. Then a small rubber ring is put around the base of the penis. This keeps blood in the penis so the erection stays. Side effects of a vacuum device include coldness or numbness in the penis after the rubber ring has been removed. Also, the vacuum device may interfere with foreplay.

• Penis injections or pellets. These treatments are done at home. For the injection, the man or his partner uses a tiny needle to inject medicine into the side of the penis. The injections begin to work within 5 to 10 minutes and create an erection. A similar treatment is a small medicine pellet. The pellet is inserted into the opening at the tip of the penis. The pellet dissolves and the medicine goes into the penis. Side effects of the medicine used either way include dizziness or feeling flushed. The medicine may also cause an erection that lasts too long. A man should get medical attention if he has an erection that lasts longer than 4 hours.

• Penile implants. A penile implant is a solid or fluid-filled tube. It’s put into the penis during a surgery. It can then be used to create an erection. The implant can be inflatable or noninflatable. The risks of an implant include infection, numbness at the head of the penis, or discomfort during sex. If the implant is removed, there is an increased risk for ED. This is because the implant changes the inside tissues of the penis.

Talking with your healthcare team

Talk with your healthcare team before treatment. They can help you understand your risk for ED. They can help you learn what to expect, and what treatments may be options for you. After treatment, tell your healthcare provider what kinds of problems you’re having that you want to address. He or she can help you decide about treatments.

Getting support

ED can be upsetting and stressful. Be open with your partner about your fears and concerns. Talk about ways to work around the ED. Talk with your partner about the treatment options.

You may also find it helpful to discuss ED with other men who are also experiencing it. A support group can connect you with other men coping with similar issues. For example, Us Too is a prostate cancer education and support group that has local chapters where men can talk with each other. Go to www.ustoo.org to find a support group near you.