1. Will prostate cancer affect my sex life?

Prostate cancer itself typically doesn’t have an impact on sexual function. However, treatment for prostate cancer often impairs sexual function.

This is one reason why prostate cancer treatment should be reserved for men with aggressive prostate cancers that have the potential to spread outside the prostate. Most low grade (non-aggressive) prostate cancers are best managed with active surveillance, an approach where cancers are monitored over time without treatment.

If you require treatment, talk to your doctor about the expected impact of each treatment on your sex life.

2. Which treatments will impact my sex life?

Prostate cancer treatments can have significant adverse effects on sexual function. Treatments for prostate cancer include surgery (radical prostatectomy), radiation, and hormone treatment. These are sometimes given in combination.

Surgery for prostate cancer leads to at least temporary erectile dysfunction (inability to get an erection) in most men. Erections may improve over time depending on a man’s age, pre-surgical sexual function, feasibility of sparing the nerves near the prostate during surgery, and the skill of the surgeon.

Radiation for prostate cancer can also cause erectile dysfunction, although less frequently than after surgery.

Hormone treatment given for advanced prostate cancer or in combination with radiation will also impact sexual function. Hormone treatment lowers testosterone levels and reduces interest in sex.

3. Will prostate cancer treatment leave me sterile?

Since the average age at diagnosis is 66, most men with prostate cancer are no longer interested in the ability to father a child. But, if you’re still interested in having children, know that treatments can lead to infertility.

For example, after prostatectomy, the testicles will still make sperm, but there is no path for the sperm to pass through the penis with orgasm. As a result, fertility would only be possible with in vitro fertilization. After radiation, the amount of semen produced with orgasms decreases significantly. As a result, most men will not be able to father a child after radiation. Hormone treatment for prostate cancer also impairs fertility.

4. I don’t have the same desire for sex that I had before treatment. What can I do?

Desire for sex is called libido. This can be impacted by psychological, physical, and hormonal factors. Men on hormone treatment for prostate cancer have very low levels of testosterone. As a result, desire for sex is typically low. For men with low testosterone who aren’t receiving hormone treatment, testosterone supplementation can improve desire for sex.

Some men with normal testosterone levels can also have low desire for sex. Causes include erectile dysfunction, depression, sleep problems, aging, other medical conditions, and stress. Counseling, regular exercise, a healthy diet, getting enough sleep, managing stress, and treatment of erectile dysfunction can help with this.

5. I can no longer get erections after treatment. What can I do?

Erectile dysfunction is common after treatment for prostate cancer. If you recently had a prostatectomy, sexual function may improve over time. If you had surgery years ago or underwent radiation, function usually doesn’t improve over time.

Typically, the initial step is to try medications such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra). These medications increase blood flow to the penis, leading to erection. If this doesn’t work, other options include medicine placed into the urethra, injections of medication into the penis, vacuum pump devices, or surgical implants.

These treatments are more effective than medications taken by mouth. Since they’re more invasive, though, they’re usually reserved for men who cannot take oral medications or if the medication didn’t work. If you’re having difficulty with erections, discuss these options with your doctor.

6. What can I do about my extreme fatigue?

Fatigue can occur when you’re recovering from surgery, after undergoing radiation, or from being on hormone treatment. It can be worsened by physical pain, stress, lack of sleep, poor diet, and lack of exercise.

The best thing to do to combat fatigue is to lead a healthy lifestyle by staying active, getting plenty of sleep, regularly exercising, and eating a healthy diet. Keep your doctor updated about your fatigue and inquire about ways to improve it.

7. What are the side effects of hormone therapy for prostate cancer?

You may experience various side effects from hormone therapy for prostate cancer, including:

  • hot flashes
  • fatigue
  • loss of bone density
  • broken bones
  • loss of muscle mass and strength
  • weight gain (as fat increases and replaces muscle mass)
  • loss of interest in sex
  • erectile dysfunction
  • headache
  • mood swings and depression
  • memory loss
  • increased chance of diabetes and heart attacks
  • changes in blood lipids
  • growth of breast tissue

In some situations, side effects can be reduced by replacing continued hormone treatment with intermittent hormone treatment. During breaks from hormone treatment, the level of testosterone may recover, leading to fewer side effects. Talk to your doctor to see if this is an option for you.

Dr. Geoffrey Sonn is a urologic oncologist specializing in the treatment of prostate cancer at Stanford University Medical Center. His clinical and research interest is in the use of advanced imaging to improve the diagnosis and treatment of prostate cancer.