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Managing the side effects of treatment for prostate cancer

The various treatments for prostate cancer may cause a range of side effects, which will vary depending on the treatment and from person to person. You may not experience any of the side effects listed below. In most cases, side effects last for only a few weeks or months, although sometimes they will be permanent. Fortunately, there are many ways to reduce or manage side effects.

You may have trouble getting or keeping an erection firm enough for intercourse or other sexual activity after treatment. This is called erectile dysfunction (ED) or impotence. While erection problems become more common with age, they can also be affected by health conditions such as diabetes and heart disease; certain medicines for blood pressure or depression; previous surgery to the bowel or abdomen; smoking or heavy drinking; or emotional concerns.

The prostate lies close to nerves and blood vessels that help control erections. These can be damaged during treatment. After surgery, problems with erections occur immediately. After radiation therapy, erection problems develop slowly over time. Erectile function can continue to improve for up to three years after treatment has finished. Sometimes, erection problems may be permanent.

Before and after treatment, various methods can help keep your penis healthy (penile rehabilitation). These may include:

  • engaging in foreplay and other sexual intimacy with your partner
  • trying to get erections, starting a month after surgery
  • taking prescribed medicines to maintain blood flow in the penis
  • using a vacuum erection device to stop the penis shortening or losing flexibility
  • injecting prescribed medicine into the penis.

Ways to improve erections

There are several medical options for trying to improve the quality of your erections, regardless of the type of prostate cancer treatment you have had. Ask your treatment team for more details about the following methods.

Tablets – Your doctor can prescribe tablets to increase blood flow to the penis. These only help if the nerves controlling erections are working, which is unlikely soon after surgery. 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.

These tablets should not be taken with some heart medicines. Check with your doctor.

Vacuum erection device – A vacuum erection device (VED) or vacuum pump device uses suction to make blood flow into the penis. This device can also help to strengthen or maintain a natural erection.

You place a clear, rigid tube over the penis. A manual or battery-operated pump then creates a vacuum that forces 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.

Injections – Penile injection therapy (PIT) has to be prescribed by a doctor. You will be taught to inject the penis with medicine that makes blood vessels in the penis expand and fill with blood, creating an erection. The erection usually occurs within 5–10 minutes and lasts for 30–60 minutes.

The syringes can come pre-loaded with the medicine and are single use, or as vials from a compounding pharmacy that you measure out. Injecting your penis may sound unpleasant, but many people say it causes only a moment of discomfort.

PIT works well for most people, but a few may have pain and scarring. A rare side effect is a prolonged and painful erection (known as priapism). This requires 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.

Penile implants can be expensive, though part or all of the cost may be covered by private health insurance or Medicare if the implant is medically necessary.

If the implant is removed, it won’t be possible to have an erection.

You may see or hear ads for ways to treat erection problems. This may include herbal preparations, natural therapies, nasal sprays and lozenges. If you are thinking about using these, talk to your doctor first, as there could be risks without any benefits. Products that contain testosterone or act like testosterone in the body may encourage the prostate cancer to grow.

You may notice other changes to your sexual functioning, which can affect your sexuality and how you express 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.

Dry orgasm – After surgery, you will feel the muscular spasms and pleasure of an orgasm, but you won’t ejaculate semen when you orgasm. This is known as a dry orgasm. It happens because the prostate and seminal vesicles that produce semen are removed during surgery and the vas deferens is sealed. You may also produce less semen after radiation therapy. While you may worry that a dry orgasm will be less pleasurable for your partner, most partners say they don’t feel the release of semen during intercourse.

Leaking urine during sex – A prostatectomy can damage 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 leaking urine during sex embarrassing, but there are ways to manage urine leakage. Before sex, empty your bladder (urinate). Consider having 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. Speak with your doctor if you are still concerned.

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 should talk to your doctor about the 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.

Download our booklet ‘Fertility and Cancer’

Whether you are single, in a relationship, heterosexual, gay, bisexual or transgender, cancer can affect your sexuality in both physical and emotional ways. The impact of these changes depends on many factors, such as the cancer treatment and its side effects, how you and your partner communicate, and your level of self-confidence. It may take some time to adjust to any changes to sex drive, which may also affect self-esteem and feelings of masculinity.

Communicating with a new partner

Deciding when to tell a potential sexual partner about your cancer experience isn’t easy, and you may avoid dating for fear of rejection. While the timing will be different for each person, it can be helpful to wait until you and your new partner have developed a mutual level of trust and caring. It is best 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 accepting and supportive.

Managing changes in your sex life

  • Talk about the changes and your feelings about sex. If you have a partner, these changes will probably affect you both. Reassure them that intimacy is still important to you.
  • Focus on giving and receiving pleasure in different ways without expectations of sexual penetration. Other ways of expressing love include touching, holding, caressing and massage.
  • Take time to get used to any changes. Look at yourself naked in the mirror and touch your genitals to feel any differences or soreness. Show your partner the changes so they can adjust to them.
  • Start slowly – touch each other’s skin, then include genital touching.
  • Attempt intercourse even with a partial erection. This stimulation may encourage more and better erections.
  • Explore your ability to enjoy sex and understand any changes by masturbating.
  • Ask your partner to help you reach orgasm through gentle hand-stroking. Use silicone-based lubricants for prolonged stimulation.
  • Try different positions to find out what feels comfortable for both of you. Having sex while kneeling or standing may also help with erections.
  • Use mindfulness techniques to help you stay in the moment with your partner. Listen to our meditation and relaxation recordings or call 13 11 20 for your free copies.
  • Talk to your doctor, a sexual health physician or counsellor if the changes are causing depression or problems in your relationship.
  • Download the Prostate Cancer Foundation of Australia’s booklet on sexual issues after cancer treatment from prostate.org.au.

Download our booklet ‘Sexuality, Intimacy and Cancer’

Listen to our podcast ‘Sex and Cancer’

Trouble controlling the flow of urine (urinary incontinence) is a common side effect of some treatments. After prostate surgery, issues with  incontinence are common for several weeks or months and usually improve slowly over time. You may find that you lose a few drops of urine when you cough, sneeze, strain or lift something heavy. Some people also leak some urine during sex. For others, symptoms may be more severe and require the use of incontinence pads.

In some cases, radiation therapy can reduce how much urine the bladder can store, irritate the bladder, narrow the urethra and weaken the pelvic floor muscles. This can lead to feeling like you just can’t wait (urinary urgency) and difficulty passing urine. Sometimes, medicines can improve urine flow – ask your doctor if this is a option for you.

Coping with urinary incontinence

  • Find out how to do pelvic floor exercises. Starting pelvic floor exercises before surgery can 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 for more information.
  • Drink plenty of water to dilute your urine – concentrated urine can irritate the bladder.
  • Avoid drinking less fluids because you are afraid of leakage. Dehydration can cause constipation, which can also lead to leakage.
  • 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 about continence aids if needed. These aids can include absorbent pads to wear in your underpants, and bed and chair covers. The nurse may also recommend medicines or special clamps.
  • 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 hasn’t improved after 12 months, talk to your doctor or urologist about whether surgical treatment is an option. For example, a surgically inserted sling or artificial sphincter work by pulling the urethra up to help the sphincter muscle close more effectively.
  • Get resources from the Prostate Cancer Foundation of Australia or call 1800 22 00 99 and the Continence Foundation of Australia or call 1800 33 00 66.

For information on pelvic floor exercise:

Download our booklet ‘Exercise for People Living with Cancer’

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

Bowel problems – Although this is an uncommon side effect of radiation therapy, you may experience rectal bleeding after treatment. Even less commonly, you may feel the need to have a bowel movement urgently. A gastroenterologist or colorectal surgeon may treat these bowel problems with changes to your diet, steroid suppositories (a tablet that you insert into the rectum through the anus) or other treatments applied to the bowel wall. For more information, talk to your radiation oncologist or a continence nurse.

Fatigue – Cancer treatment often makes people very tired. After surgery, it may take some time to get back your strength. With external beam radiation therapy, you may get particularly tired near the end of treatment and for some weeks or months afterwards. Regular exercise can help reduce tiredness.

Download our fact sheet ‘Fatigue and Cancer’

Download our booklet ‘Exercise for People Living with Cancer’

Hot flushes – You may experience hot flushes if you are having ADT. Drinking less alcohol, avoiding hot drinks, getting regular exercise and learning relaxation techniques 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.

Heart problems – Because ADT can increase the risk of heart problems and strokes, your GP or specialist will monitor your heart function and may refer you to a dietitian or exercise physiologist for advice.

Other ADT side effects – The risk of weight gain, mood swings, enlarged breasts, decreased muscle mass, change in body shape, and high cholesterol increases the longer you use ADT.

This information is reviewed by

This information was last reviewed in March 2020 by the following expert content reviewers: Dr Amy Hayden, Radiation Oncologist, Westmead and Blacktown Hospitals, and Chair, Faculty of Radiation Genito-Urinary Group (FROGG), The Royal Australian and New Zealand College of Radiologists, NSW; Prof Shomik Sengupta, Professor of Surgery and Deputy Head, Eastern Health Clinical School, Monash University, and Visiting Urologist and Uro-Oncology Lead, Urology Department, Eastern Health, VIC; A/Prof Arun Azad, Medical Oncologist, Urological and Prostate Cancers, Peter MacCallum Cancer Centre, VIC; Ken Bezant, Consumer; Dr Marcus Dreosti, Radiation Oncologist, GenesisCare, and Clinical Strategy Lead, Oncology Australia, SA; A/Prof Nat Lenzo, Nuclear Physician, Specialist in Internal Medicine, Group Clinical Director, GenesisCare Theranostics and The University of Western Australia, WA; Jessica Medd, Senior Clinical Psychologist, Department of Urology, Concord Repatriation General Hospital, and HeadwayHealth Clinical and Consulting Psychology Services, NSW; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council Western Australia; Graham Rees, Consumer; Kerry Santoro, Prostate Cancer Specialist Nurse, Southern Adelaide Local Health Network, SA; A/Prof David Smith, Senior Research Fellow, Cancer Research Division, Cancer Council NSW; Matthew Starr, Consumer.