Post-Prostate Cancer Care Begins at Diagnosis

While overcoming any cancer diagnosis is a cause for celebration, getting the all-clear for prostate cancer means the work may be just beginning.

Prostate cancer treatments, which are generally very effective, can include side effects that impact both physical and mental health. The best defense is a good offense, so managing the side effects should begin at diagnosis.

Anyone who's been diagnosed with prostate cancer should know about the potential aftereffects of care and what to discuss with their doctor before treatment begins.

Let's talk about sex

Prostate cancer is the second most common type of cancer in men, but it also has one of the highest survival rates, with a nearly 100 percent five-year relative survival rate when the cancer is diagnosed before it has spread to distant parts of the body.

However, prostate cancer can lead to complications from treatment, including erectile dysfunction (ED). A 2021 meta-analysis in the British Journal of General Practice indicated ED is a common experience for men following the removal of the prostate gland. The analysis cited a 12-year follow-up study that found 84 percent of men who had a radical prostatectomy reported suffering from ED.

If the entire prostate and nearby nerves have to be removed, as is the case with high-grade cases of prostate cancer—in which the cancer cells grow and spread aggressively—there is a chance erections can be affected, said Austin DeRosa, M.D., a urologist who practices at the UCHealth Cancer Center in Highlands Ranch, Colorado. This is because the nerves that supply erectile function are very close to the prostate gland, which is located below the bladder and in front of the rectum. In less severe cases of prostate cancer, these nerves can usually be spared, a measure that can preserve function.

Although the prostate gland is a sexual organ, cancer won't necessarily ruin sexual function, according to Timothy Wilson, M.D., a urologic oncologist and the director of the Urology and Urologic Oncology Research Program at Saint John's Cancer Institute at Providence Saint John's Health Center in Santa Monica, California. The prostate's primary function is not to impact arousal or pleasure, but to produce seminal fluid that nourishes and transports sperm.

"That's all the prostate does," he said. "It's important for men to know that a prostate is not necessary for libido or sex drive."

Outside of semen production, the prostate has no bearing on the main components of sex, including sex drive, erections or producing the hormones that facilitate sex. Additionally, removing the prostate—often a treatment for prostate cancer—will not change any of the physical sensations of sex or affect the nerves in the penis responsible for how sex feels.

"Taking a prostate out does not change the way men think about sex—it doesn't affect their testosterone or their brain," Wilson added.

However, since the prostate's main job is to make seminal fluid, removing it comes with a risk of decreasing fertility. Banking their sperm is usually recommended before treatment for men who want to preserve the option of having children.

The mechanics of an orgasm will not be different without a prostate, but with little or no semen, the climax can be dry—and that sensation can feel different for everyone.

"Some say it feels even better, some say it's not as good and some say it's completely the same," Wilson noted.

It takes three to tango

While it might be reassuring to hear prostate cancer treatment can leave many of the tangible aspects of sex intact, sexual intimacy encompasses more than just the physical. It's important for cancer survivors and their partners to enter post-cancer life with open communication and an awareness of sexual issues that could occur.

For instance, Wilson noted that a man might be fine physically, but the entire process of going through cancer and the fear of the unknown can have an emotional and mental impact.

"Sex is complicated," he said. "It's not just one thing—it's hormones, it's blood supply, it's nerves and, typically, it's the right partner."

Prostate cancer most commonly strikes men in their early to mid-60s, and many of these men are in long-term relationships, which come with their own complications, such as menopause in a female partner.

"Any kind of cancer treatment can exacerbate issues," Wilson added.

Although sexual concerns following cancer treatment can be common, a 2020 survey of cancer survivors by the American Society for Radiation Oncology (ASTRO) found that 87 percent of participants, both male and female, experienced sexual side effects, but most were not asked about sexual health as part of their cancer treatment and follow-up care. The lack of routine assessment for sexual health means newly diagnosed individuals, their partners and their doctors need to be willing early on in the cancer journey to discuss how sex can be affected.

"Too often, I see surgeons glossing over the effects prostate cancer treatment can have on sexual health," DeRosa noted. "Those patients are almost routinely frustrated after they have been cured of cancer because their surgeon did not properly counsel them. Ask questions. Ask for timelines. Ask about penile rehabilitation."

In cases where sexual intimacy has been impacted negatively, treatment options are available. For instance, DeRosa sends all of his patients to his medical practice partner, David Sobel, M.D., who specializes in sexual medicine, so they can engage in penile rehabilitation.

"We have a fairly aggressive protocol, which gets men back to normal sexual performance within months after treatment," DeRosa explained.

Wilson added that he has seen positive benefits from couples and sexual health counseling with a clinical psychologist, so even if the conversation is started after problems have already manifested, there's hope. The status of sexual health following prostate cancer is completely individualized. If you and your partner are comfortable with the changes to your sex life, that's fine, too. Sexual health treatment is an option, not a necessity.

Relationships can be strained by ED, but it's a challenge that can definitely be conquered for an even stronger relationship afterward. Giddy psychologist Dr. Susan Ansorge talks about creating normalcy in a relationship despite the occurrence of erectile dysfunction. Watch the video here to learn more.

Talk it out

While sexual function can be preserved despite prostate cancer, treatment can cause other physical problems. For instance, the primary effect can be on urination, because the urethra runs directly through the prostate. As a result, any surgery or treatment, such as radiation or chemotherapy, can affect bladder control.

The goal of prostate cancer treatment is always to prevent and minimize negative side effects, such as bladder dysfunction or incontinence, but if they do happen, a good urologist can recommend specialists who can help.

No matter what issues are in store for you post-cancer, Wilson recommends the first step you should take in your prostate cancer fight is finding a urologist you feel comfortable speaking with. The right urologist—one who will talk you through all of your options and what's in store for you throughout your treatment—is key. So is patient awareness. You should be cognizant that you have the right to address your health holistically with your urologist. Beating cancer doesn't mean you have to settle in other areas of your life—you deserve wellness physically, mentally and emotionally.

"At your follow-up appointment, take a big sigh of relief and then talk about sexual health and bladder health," Wilson said. "And understand that this is a disease that can be managed successfully, and we can deal with it in a way that helps you live a normal and full life."