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Prostate Cancer and Erectile Dysfunction


Surprising, prostate cancer rarely causes erectile dysfunction – but cancer treatments can cause ED, as well as other effects that can severely alter a man’s quality of life.

Cancer is a scary word, and most men are understandably frightened when they are diagnosed with prostate cancer.

The good news is that prostate cancer has a very low fatality rate. The 5-year survival rate is over 97%. However, if prostate cancer metastacizes (spreads beyond the prostate), it is much more serious. Therefore, the standard treatment is to destroy the cancer before it spreads, either through prostate removal surgery, or radiation.

The first priority of your oncologist is to remove the cancer and save your life. But oncologists rarely prepare men for the aftermath of successful treatment, and this is especially true of radical prostatectomies (the surgical removal of the prostate).

A study published in the journal Research and Reports in Urology found that the rate of prostatectomy-related regret increases over time, with up to 47 percent of men reporting regret five years after surgery.

The reason is simple: the after-effects of surgery and radiation treatments can be severe, life-changing, and often unexpected.

The After Effects

Following a prostate removal or radiation treatment, men may experience:

  • Erectile Dysfunction. In many cases the ED is so severe that ED pills (Viagra, Cialis, Levitra, Stendra, and their generic equivalents) no longer work.
  • Weak Orgasms. Orgasms may be weaker, and less satisfying.
  • Penile Shrinkage. Due to reduced blood flow to the penis, tissues may atrophy and the penis will shrink.
  • Incontinence. Men may lose bladder control, partially or completely.
  • Climacturia. Men may leak urine during orgasms.
  • Reduce Libido. May may experience a dimished desire for sex.
  • Inability to Ejaculate. If the seminal vesicles are removed along with the prostate (a common procedure), the man may still be able to have orgasms, but will not ejaculate.

Urologists often advise patients that they may experience some of these symptoms, but that most men will recover after a few months. The truth is that almost all men experience these symptoms, and many never fully recover.

The Alternatives

Given the risk of the cancer metastasizing, most men would accept the consequences, but there are alternatives.

  • Active Surveillance (aka Watchful Waiting). One option is to forgo treatment and simply monitor the cancer. If it is not aggressive, and isn’t spreading, no treatment may be needed. More men die with prostate cancer than of prostate cancer. In other words, many men live normal lives until they eventually die of other causes. Active surveillance may be the best option for older men, or men with slow-growing cancer.
  • Cyberknife. The Cyberknife procedure uses very targeted radiiation treatment to kill cancer cells with minimal damage to surrounding tissues or nerves.

Post Treatment Options

Reclaiming Sex & Intimacy

after prostate cancer

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If you do choose an aggressive treatment, be prepared to deal with the possible consequences.


You can minimize incontinence by regularly performing kegel exercises and physical therapy, which can strengthen the pelvic floor muscles. There are also surgical options that can improve bladder control.

Many men never fully recover, and may lose bladder control when exercise, coughing, or sneezing. For those men, it may be necessary to wear pads to avoid “accidents.”

Erectile Dysfunction

If ED pills no longer work, men may be able to achieve erections using intracavernous penile injections of alprostadil or Trimix.

Another option is an inflatable penile implant. Implants have the highest rate of patient satisfaction of any ED treatment.

Penile Shrinking

Clinical studies have shown that regular use of a vacuum pump can improve blood flow to the penis, and prevent or even reverse shrinkage.


This article is based on a post by Rick Redner, author of Everything You Never Wanted to Know about Erectile Dysfunction and Penile Implants and I Left My Prostate in San Francisco – Where’s Yours?

We highly recommend these excellent books for men considering prostate surgery, or for men dealing with the aftermath.

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