Erectile dysfunction and prostate cancer

Reviewed by our clinical team

Prostate cancer is one of the four most common forms of cancers in the UK. The number of men having treatment for prostate cancer has jumped by more than a quarter in England in one year. New NHS figures show in November 2022, almost 4,000 men received prostate cancer treatment in August compared to just over 3,000 in the same month the previous year year.

Receiving a diagnosis of prostate cancer can be hugely overwhelming for men, not only because of the treatment, prognosis and impact on their friends and family, but also the impact it might have on things like their sex life.

In this article, we’ll take a look at the way prostate cancer can affect sexual health, as well as how it can be treated.

What is prostate cancer? 

Prostate cancer is a cancer that occurs in the prostate, a small walnut-shaped gland just below the bladder that produces seminal fluid - the liquid that carries sperm. Prostate cancer the most common cancer in males in the UK, accounting for 27% of all new cancer cases in males shown in statistics 2016-2018.

Signs of prostate cancer

The most common symptoms of prostate cancer are:

Needing to pee frequently 

You might find that you need to urinate several times a day or through the night.

Feeling that bladder has not emptied fully 

Feeling as though you still need to pee even after going to the toilet can be a sign of prostate cancer.

Blood in urine or semen

If you are noticing blood in your urine or semen, you should seek out a medical professional, as this can be a sign of prostate cancer.

Is erectile dysfunction a sign of prostate cancer? 

Erectile dysfunction (ED) is not a common symptom of prostate cancer. However more advanced prostate cancers can sometimes cause symptoms of ED.

Treatments for cancer can trigger ED by lowering the amount of testosterone in the body or damaging nerve endings. Research by Prostate Cancer UK showed that up to 76% of men experience erectile dysfunction following prostate cancer treatment.

Other common early signs of prostate cancer include:

• Difficulty in starting to urinate
• Straining while peeing
• Weak urine flow

It’s important to keep in mind that these symptoms do not necessarily mean you have prostate cancer. As men age, the prostate grows larger naturally, causing symptoms similar to the above. As always, if you’re concerned, you should speak to your doctor as soon as possible.

What causes prostate cancer?

All cancers are due to an uncontrolled growth of cancerous cells in the body. A person’s risk of cancer can depend on a range of factors, including age, ethnicity, family history of certain cancers, and hormone levels. 

Lifestyle factors such as smoking, weight and diet can also lead to a greater risk of cancer, however, no preventable risk factors have been clearly linked to prostate cancer.

Does prostate cancer cause erectile dysfunction?

As mentioned above, prostate cancer doesn’t commonly cause erectile dysfunction. However, many men with prostate cancer experience ED when undergoing treatment such as radiotherapy or chemotherapy, as these treatments can be very hard on the body and reduce the amount of testosterone produced.

Prostate surgery can also damage nerve endings, reducing sensation and making it more difficult to achieve erections.

How to check for prostate cancer

It’s not possible to check whether you have prostate cancer by yourself at home, so if you are concerned you should speak to a doctor to carry out a proper medical examination. 

There are a number of tests available for checking the prostate, and your doctor should discuss your options with you beforehand. Methods of checking for prostate cancer include blood tests, urine sample testing, or a physical test known as digital rectal examination, where a doctor inserts a gloved finger into your anus to check for abnormalities.

If your doctor has concerns about the results of any of these tests, you will likely be referred for further testing, either via an MRI or biopsy.

PSA testing

There is an informed choice programme, called prostate cancer risk management, for healthy men aged 50 or over who ask their GP about prostate-specific antigen (PSA) level testing. PSA tests are controversial because they're not very accurate, but in some cases an find aggressive prostate cancer that needs treatment. 

The prostate cancer risk management programme aims to give men good information on the pros and cons of a PSA test. 

If you're aged 50 or over and decide to have your PSA levels tested after talking to a GP, they can arrange for it to be carried free on the NHS. 

Treatment for prostate cancer

The prognosis for men diagnosed with prostate cancer can be very good if treatment is started early on. It’s thought that around 87% of men diagnosed with prostate cancer in England survive for five years or more. 

Depending on the progression of the disease, there are a few treatments available designed to either shrink the growth or remove it completely. The most common method of treatment for prostate cancer is radiotherapy, where radiation is used to kill the cancer cells.

Your doctor might also recommend surgery to physically remove the growth.

Chemotherapy is another potential treatment for prostate cancer, but this is usually a last resort following the treatments above, as chemotherapy can be very hard on the body and lead to a longer period of recovery. Chemotherapy may be the only option if the cancer has spread beyond the prostate.

Side effects of prostate cancer treatment 

Depending on the treatment you receive, you might experience some side effects. 

Radiotherapy

If you receive radiotherapy, you will notice side effects starting within two weeks of treatment, and you’ll usually find that they get worse as treatment goes on. They will generally start to improve around two weeks after treatment finishes. Side effects include:

• Diarrhoea
• Tiredness and weakness
• Excessive urination, or trouble urinating
• Sore skin in the treatment area
• Loss of pubic hair
• Erectile dysfunction due to reduced testosterone

Chemotherapy

Chemotherapy isn’t generally used to treat prostate cancer unless it has already begun to spread, or metastasize. Chemotherapy involves using very strong anti-cancer drugs (usually delivered through an IV) to destroy cancer cells across the body. Chemotherapy is very powerful but can also make you very ill, so doctors will usually exhaust other options first. Side effects of chemotherapy for prostate cancer include:

• Hair loss
• Sores in the mouth
• Nausea and vomiting
• Loss of appetite
• Diarrhoea or loose stool
• Increase in infections
• Bruising or bleeding easily
• Being very tired (fatigue)
• Erectile dysfunction due to reduced testosterone

Prostatectomy (prostate surgery)

Prostatectomy involves partial (simple) or total (radical) removal of the prostate gland to remove any growths and prevent the spread of cancer. A prostatectomy is usually the preferred method of treatment for localised cancer, as well as other severe prostate problems.

Although it’s a very safe, minimally invasive procedure, you might experience some side effects:

• Excessive urination or difficulty urinating
• Difficulty emptying your bladder
• Blood in urine or semen
• UTIs
• Dry orgasm (orgasming without ejaculation)
• Narrowing of the urethra
• Erectile dysfunction due to damaged nerve endings

If you undergo a radical (full) prostatectomy, you might also experience additional symptoms such as urethral cysts.

If you have any of these symptoms, you should tell your nurse or doctor, as they might be able to provide creams and other treatments to minimise discomfort.

Keep in mind that while prostate cancer itself rarely leads to erectile dysfunction, ED can be triggered by the type of treatment you receive. This is because radiotherapy and chemotherapy can reduce the level of testosterone in your body, while surgery can cause damage to nerve endings, both of which make it harder to achieve and sustain an erection.

Certain medications prescribed to treat those with prostate cancer or ease other symptoms can also trigger ED. If you begin to experience ED, speak to your doctor or nurse, as this can sometimes be improved by switching to another medication or treatment.

How long does ED last after prostate surgery? 

Although prostate surgery is a crucial part of prostate cancer treatment, and a very effective way of improving chances of survival, many men are concerned about the possibility of ED as a side effect and the impact it might have on sex after prostate cancer is treated.

Some men find that their ability to get an erection returns following treatment, but this can be anywhere between three months and three years after. Others might find they experience ED for the rest of their lives. 

It’s important to remember that prostate treatments are very safe and the best way to improve your prognosis following a diagnosis of prostate cancer. Although ED is a potential side effect, your health should always be prioritised. If you’re worried about developing ED, you should speak to your doctor for more advice.

Treatments for ED after prostate cancer 

Developing ED, whether due to prostate cancer treatments or other conditions, can be very stressful for men and lead to feelings of shame, anxiety, and more. It’s very important to keep in mind that ED is very treatable, however, and there’s no need to suffer in silence. Your doctor will usually be able to provide a treatment that works for you.

Does Viagra work after prostate surgery? 

Viagra and other erectile dysfunction medications can be safely taken by men who have had prostate surgery, although their effectiveness will depend on the damage done to your nerve endings. If Viagra does not work for you, you can ask your doctor to try another treatment.

Vacuum pumps

Vacuum pumps are a great alternative to Viagra. They consist of a plastic tube that fits over the penis, a battery or hand-powered pump that is connected to the tube, and a constriction band or ring that fits around the base of the penis. The pump works by creating a vacuum around the penis, encouraging blood flow and triggering an erection.

Penile implant 

Another alternative to Viagra, penis implants usually consist of a cylinder which is implanted into the penis, connected to an air or saline reservoir in the scrotum. By using the reservoir to ‘pump’ air or saline into the cylinder, implants can be used to simulate an erection and allow for intercourse. 

Penile implants are generally a last resort and are not offered to many men in the UK. 

Sexual therapy 

Often, erectile dysfunction can be triggered by stress or anxiety, which are very common in men diagnosed with prostate cancer. In these cases, your doctor will often prescribe sexual or talking therapy to help you overcome these issues. If you have undergone prostate cancer treatment, your ED is most likely due to a physical condition rather than a psychological issue, however you might still consider therapy to help you come to terms with things.

Vitaros cream 

Vitaros is a topical (cream) alternative to Viagra. A type of ‘vasodilator’, it works by widening blood vessels to the penis, enabling greater blood flow. Vitaros usually starts to work within 5-30 minutes after application, and last for 1-2 hours. However, much like Viagra, the effectiveness will depend on the amount of damage done to your nerve endings during treatment. Vitaros is available over the counter and is perfectly safe for those who have undergone prostate cancer treatment or surgery to use.

Summary

The period following prostate cancer diagnosis and treatment is often very difficult, particularly when erectile dysfunction is also a factor. As well as the physical toll, these two conditions together can seriously impact mental wellbeing and lead to anxiety and depression if not tackled. 

It’s very important to remember that treatments are available for both conditions, and the sooner you seek these treatments out, the greater your chances of surviving and maintaining a satisfying sex life.

References

https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer
https://prostatecanceruk.org/about-us/projects-and-policies/erectile-dysfunction
https://www.cancerresearchuk.org/about-cancer/prostate-cancer/practical-emotional-support/sex-relationships/difficulty-getting-erection
https://www.england.nhs.uk/2022/11/nhs-prostate-cancer-treatments-surge-in-england/
https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/signs-symptoms
https://prostatecanceruk.org/prostate-information/about-prostate-cancer/prostate-cancer-symptoms
https://www.nhs.uk/conditions/prostate-cancer/psa-testing/