If radical prostatectomy is the treatment option, you will have taken some time to explore whether a nerve-sparing procedure is an option for you. The nerves responsible for achieving an erection run on either side of your penis and along the urethra (the structure that urine runs through when flowing out the penis). There are also nerves related to having an erection in the pelvis itself. When your surgeon removes your prostate, he may be able to leave all or some of these nerves intact. This will enhance your ability to have an erection after your surgery.
There are also surgical technologies which allow grafting of new nerves in the pelvis at the time of the prostatertomy. (If your surgeon cannot avoid removing your own nerves, discuss with him/her whether this is an option for you.)
The extent of your surgery will determine the degree to which you can achieve an erection. If all the nerves are removed during surgery, an erection will not be possible afterward. Because the prostate is responsible for producing semen, once it’s removed, you will no longer have an ejaculation.
The ability to have an erection will be immediately impacted after surgery. If you’ve had a nerve-sparing procedure, your surgeon will start you in a therapy program right away to enhance your erections over time. Various therapies for erectile enhancement are discussed later in this section
Hormone therapy may be used in older men who don’t want or are unable to have surgery and would like to slow the growth of the prostate cancer. The hormones can be taken orally or by injection and block the effects of testosterone on the cancer, shrinking it and slowing its growth. Side effects of the hormone therapy include decreased libido (lack of interest in sex), hot flashes, anxiety and depression, fatigue, breast pain and enlargement, bone pain and fragility, loss of muscle mass, penis and scrotal shrinkage, weight gain, and erectile dysfunction (ED). ED generally occurs shortly after the start of hormone therapy.
Chemotherapy may be used when the cancer has spread to the lymph nodes, bone, or other pelvic organs. Chemotherapy may cause nausea, vomiting, fatigue, hair loss, nerve pain in the arms and legs, and secondary illnesses related to a compromised immune system. It is not surprising that most men are unlikely to be interested in sexual relations while trying to manage these side effects.
Brachytherapy is the placement of radioactive seeds in the prostate to eliminate the cancer. Side effects include erectile dysfunction (ED), pain with ejaculation, urinary frequency and urgency, rectal pain and burning, and frequency and urgency with bowel movements. There may also be a small amount of blood in your urine and semen for a few days following seed placement.
Radiation therapy is provided through an external beam aimed directly at the prostate to kill the cancer. The bladder, rectum, and urethra (the structure that urine runs through when flowing out the penis) can be affected by the radiation. Side effects include erectile dysfunction (ED), fatigue, skin irritation in the treated areas, urinary frequency and pain, rectal irritation, and frequent stools. Unlike radical prostatectomy, erectile dysfunction caused by radiation is more gradual and can peek up to 2 years after treatment.
If you are experiencing any of the described effects from chemotherapy, brachytherapy, or radiation therapy, it is important that you discuss them with your medical team so your symptoms can be managed.