14 April 2022

By Christopher McNamara
PCFA Clinical Nurse Specialist — Sexual Function Programs Leader

Did you know that more than half of Australian men over the age of 45 have some form of erectile dysfunction (ED)? The risk of ED increases with age, and for men with prostate cancer, it’s a major concern.

The good news is, there are a range of options for managing ED, and PCFA has just increased the support available for men who want individualised and evidence-based information on treatment options, relationship support, and self-management strategies.

What causes erectile dysfunction?

Erectile function is stimulated by nerves which increase the blood flow to the penis. If something interferes with either your blood vessels or your nerves, you may experience ED. The incidence and treatment of prostate cancer can do both, preventing men from getting and maintaining normal erections.

Surgery, radiation therapy, and hormone therapy can all increase your risk of ED, resulting in changes in your penis length, your erectile function, and your ability to ejaculate.

Radical prostatectomy: Radical prostatectomy can result in nerve damage and increase a man’s risk of ED. Depending on the size and location of the tumour, and any concerns about its spread, surgeons can avoid cutting the nerves near the prostate – a procedure called nerve-sparing radical prostatectomy. After radical prostatectomy, no semen is produced because the prostate gland and seminal vesicles have been removed. While men are therefore not able to ejaculate, orgasm is still achievable.

Trans Urethral Resection Prostatectomy (TURP): Men undergoing treatment for with TURP, sometimes used prior to radiation therapy, may experience ejaculatory problems, though sensation of orgasm is usually preserved. In the case of TURP, semen is still produced, but passes retrogradely into the bladder.

Radiation Therapy: Prostate cancer may also be treated with various types of radiation therapy including brachytherapy, external beam radiation or stereotactic body radiation therapy. Each type of therapy causes different side effects.

Hormone Therapy: The goal of hormone therapy is to reduce the level of testosterone in the body, or to stop hormones from supplying prostate cancer cells. Hormone therapy may cause a loss of libido for some but not all men. Some men find that they maintain their desire for sex but are unable to get an erection or are unable to reach orgasm. Hormone therapy may also reduce the amount of semen released at ejaculation.

Chemotherapy: Chemotherapy drugs are used to kill cancer cells or limit their growth. Some patients may lose their libido and have difficulty achieving an erection after chemotherapy.

Management and treatment options after prostate cancer treatment:

While every man’s experience of ED will be different, most men feel deeply bothered by it, and rightly so. Whether it impacts on sexual intimacy, including loss of libido, interactions with a partner, and it alters a man’s perception of their masculinity, and even identity, it can be hard to know where to turn.

But the good news is, there are a range of treatment options such as oral medications, vacuum erection devices, intracavernosal injections and penile implants. You can speak with a trusted health professional, or a Prostate Cancer Specialist Nurse about the pros and cons of each treatment and what might be right for you.

While everyone’s recovery looks different, generally recovery of erectile function can take between six to 36 months after surgery. If you don’t regain erectile function, which can happen, it’s important to find a health professional to support you through this.

If you have a partner, it can also help to have open and honest conversations with each other and investigate together what options will work best for you both. A sexual therapist, psychologist or relationships counsellor can also offer professional assistance.

Common treatment options include:

Manual stimulation: Masturbation may help a man gain and maintain an erection. Orgasms after prostate cancer treatment are possible and enjoyable. Some men who experience ED after treatment may find orgasms are possible even without an erection. Masturbation is a great way to learn about how your body responds to stimulation and build confidence. Masturbation also encourages blood flow to the penis.

Oral Medications: Oral medications allow greater blood flow to the penis, allowing an erection to be achieved with sexual stimulation. Medications known as Phosphodiesterase Type 5 Inhibitors (PDEi5) are tablets used to treat erection problems. They relax the smooth muscle cells lining the blood vessels and allow blood flow to the penis. They don’t work for every man, and it depends on the nature of the damage that is preventing erections. Common PDEi5 medications are Viagra (sildenafil), Cialis (tadalafil), Levitra (vardenafil) and Spedra (Avanafil).

Intracavenosal injections: If oral medication does not work or remaining penile nerves are not functioning effectively, penile injections may be more effective. Alprostadil is one of a range of drugs that may be injected into the penis to induce erections. Clinical trials have shown this treatment helps men achieve erections after prostate surgery. Like any medication, Alprostadil has potential side effects so it’s important to speak with your GP about these.

Vacuum erection devices: A vacuum erection device (VED) helps draw blood into the penis to stimulate an erection by creating a negative pressure. Your treating doctor may be able to tell you where to purchase the devices and advise you on correct technique. Penile rings can be used by men who can achieve an erection but can’t maintain it long enough. These are made of rubber and are placed onto the base of the penis while using a VED.

Penile implants: When treating ED following prostate cancer it is common practice to start with least invasive options and therefore penile implants are a consideration if less invasive options have not been successful. A penile implant creates a mechanical erection, and a penile implant is generally used when all else has failed. Surgery is required to insert the implants.

What else can I do to support my recovery?

Lifestyle changes can be a valuable addition to any ED treatment. Make sure you are physically healthy, getting enough exercise, eating healthy and reducing your risks of health conditions like high cholesterol and type 2 diabetes.

Where can I find support? Call PCFA

If you’re experiencing erectile dysfunction following treatment for prostate cancer, reach out for support. Call our Telenursing Team on 1800 22 00 99 during business hours or talk to your local Prostate Cancer Specialist Nurse, General Practitioner or Urologist.

You can also download PCFA’s Understanding Sexual Issues information booklet.


Additional resources

Facing the Tiger: A survivorship guide for men with prostate cancer and their partners, Prof Suzanne Chambers AO.

Your Guide to Prostate Cancer: The disease, treatment options and outcomes – A/Prof Prem Rashid. Order your copy here.

A Touchy Subject, an online resource developed by a psychologist to help with managing sexuality and intimacy after treatment for prostate cancer: www.atouchysubject.com

Society of Australian Sexologists, find a practitioner directory: https://societyaustraliansexologists.org.au/directory

Healthy Male: Information and factsheets on men’s health related issues: www.healthymale.org.au