Erectile Dysfunction (ED) After Prostate Cancer Surgery: What Are My Treatment Options

Key takeaways:

• Prostate cancer treatment can block testosterone, which can cause erectile dysfunction (ED).

• There are medication and non-medication options to treat ED after prostate cancer treatment.

• Talk to a healthcare professional if you're having ED symptoms. They can recommend treatments that work best for you.

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Other than skin cancer, prostate cancer is the most common cancer affecting men in the U.S. About 1 out of every 8 men will be diagnosed with prostate cancer during their lifetime.

A prostate cancer diagnosis by itself affects sexual desire. Not only that, treatments can cause erectile dysfunction (ED) as well. Some treatments - like cryosurgery - affect almost 90% of men after treatment.

Fortunately, there are several helpful options for managing ED after prostate cancer surgery.

Let's take a closer look at medications and other alternatives for treating erectile dysfunction after prostate surgery and prostate cancer treatment.

Does prostate cancer cause ED?

Prostate cancer alone can cause ED. You may have impotence after prostate surgery. In addition, radiation and hormone therapy can also worsen ED symptoms after treatment.

This is because there are many nerves, muscles, and blood vessels near your prostate, and they can become weakened or damaged with treatment. This can affect your ability to get an erection.

Hormone therapy - also called androgen suppression therapy - is also commonly given to treat prostate cancer. These treatments work by lowering androgens (like testosterone) to help slow prostate cancer cell growth. But testosterone is also important for libido and sexual function. So, androgen suppression therapy can result in ED as a side effect.

Prostate cancer erectile dysfunction symptoms

Prostate cancer erectile dysfunction symptoms are like ED symptoms in people without prostate cancer. In some cases, symptoms start right away. In others, symptoms take some time to develop.

Some initial ED symptoms might include the following, especially if they're persistent:

• Less sexual desire (low libido)

• Difficulty getting an erection

• Difficulty keeping an erection

• Minimal or no ejaculate

ED symptoms after prostate cancer treatment - and their onset - can depend on the treatment you've received or the procedure you've had done. This can also vary from person to person.

ED after prostate cancer hormone therapy treatment

ED symptoms from hormone therapy might include:

• Low libido

• Difficulty getting an erection

• Problems with climaxing

Since this treatment type doesn't cause nerve damage like surgery or radiation, you may see symptom improvement over time.

ED after prostate cancer surgery

If you had prostate surgery, your ED symptoms would typically start right after surgery - and they may improve over time. It's important to know that your prostate is responsible for making semen. So, you shouldn't expect to have any once it has been removed.

ED after prostate cancer radiation therapy

If you had radiation therapy, you may not develop ED symptoms right away. This can take some time to develop. And it may take 6 months or longer. ED symptoms after prostate cancer radiation are often permanent. In these cases, ED typically doesn't improve over time.

Treatment for ED after prostate cancer surgery

After treatment, your healthcare professional will work with you to find the best options for your ED. Treatment for ED after prostate cancer surgery is similar to the treatments used for people who don't have prostate cancer. In some cases, your options may depend on your health conditions and other medications you're taking.

PDE5 inhibitors

The most common ED medication prescribed after prostate cancer treatment is a phosphodiesterase type 5 (PDE5) inhibitor. PDE5 inhibitors are oral medications that include:

• Sildenafil (Viagra)

• Tadalafil (Cialis)

• Vardenafil (Levitra)

• Avanafil (Stendra)

These medications work by helping the chemicals released after sexual arousal stay around longer in your body. This helps certain muscles and blood vessels relax, causing more blood flow to the penis for an erection.

PDE5 inhibitors are typically taken 30 minutes to 1 hour before sex, and you shouldn't take more than 1 pill a day. Keep in mind they'll only work if you're aroused. This means that they may not work as well for you if you're experiencing low sexual desire or arousal issues.

If you're taking nitroglycerin or nitrates for chest pain, you shouldn't take PDE5 inhibitors. This can result in dangerously low blood pressure. And if you're taking other blood pressure medications, PDE5 inhibitors should be used with caution due to low blood pressure as well.

Alprostadil

If oral PDE5 inhibitors don't work, you may have to try injections for erectile dysfunction after prostate surgery. Alprostadil (Caverject, Caverject Impulse, Edex) works by widening blood vessels and relaxing smooth muscle to help blood flow to the penis for an erection. This medication is injected into the penis before sex, causing an erection within 5 to 20 minutes.

Alprostadil is also available as a suppository (Muse). It's inserted into the urethral opening at the tip of the penis, causing an erection within 5 to 10 minutes.

Alprostadil injections and suppositories are only available as brand-name medications, so they'll be more expensive than oral PDE5 inhibitors. GoodRx discounts can help make them more affordable.

Each alprostadil product is different, so it's important to follow your prescriber's instructions on how to use it properly.

What to know about Viagra and prostate cancer treatment

Viagra and other PDE5 inhibitors are among the most commonly prescribed drugs in the world. A few years ago, a study from Germany raised concerns that use of PDE5 inhibitors might increase the risk of prostate cancer recurrence.

But other reports from Italy, Sweden, and the U.S. all show no increased risk of recurrence after prostate cancer surgery. One study even suggests that sildenafil can actually help chemotherapy kill prostate cancer cells more effectively.

While the data is conflicting, many experts agree that Viagra after prostate cancer surgery and radiation seems to be safe. Unfortunately, Viagra and other PDE5 inhibitors aren't effective for ED if you're taking hormone treatment for prostate cancer. That's because Viagra doesn't improve the loss of libido caused by hormone therapy drugs.

Talk to your healthcare team about your options and whether Viagra is a safe and effective treatment for you.

In addition to medication, how can ED be treated?

ED treatment starts by taking care of your overall health. In addition to medication, there are general lifestyle modifications that are helpful. These include:

• Eating a nutritious diet

• Quitting smoking

• Limiting alcohol and recreational drug use

• Exercising more

• Working on stress management

• Treating sleep apnea

In addition to lifestyle changes, there are also other tools to help with ED after prostate cancer. Here are a few non-medication options to discuss with your care team.

Sex therapy

Sex therapy involves you and your partner working with a therapist to address concerns together. This therapy type involves discussing the link between certain emotions and physical ED factors. The therapist will help you gradually make changes to your sexual behavior and offer suggestions to make sex more enjoyable.

Vacuum erection device

A vacuum erection device is a plastic tube with a vacuum pump that's placed on the penis. It works by creating a low-pressure vacuum to stimulate blood flow to the penis, resulting in an erection.

It's used before sex and can result in an erection within 30 seconds to 7 minutes. However, it can cause some pain due to constriction.

Surgical implants

Another option is an implant. There are two different types - semi-rigid and inflatable. They're typically used when other options have failed:

• Semi-rigid implants: These are silicone rods that help the penis achieve the firmness needed for sexual penetration. The implant is bendable, so you can bend it upward for sex (or downward for urination).

• Inflatable implants: These are ​​fluid-filled cylinders that are placed lengthwise in the penis. It allows you to control firmness and it results in a natural feeling for your partner. Sometimes, the implant allows you to control the erection size.

The bottom line

Prostate cancer is one of the most common types of cancer in men. While the most important thing is getting rid of the cancer, you should talk with your care team about having sex after treatment.

There are many types of ED treatment after prostate cancer. These include lifestyle changes, medications, sex therapy, a vacuum erection device, and surgery. If you're having ED after prostate cancer treatment, your care team can help you find a treatment option that's right for you.

References

American Cancer Society. (2023). Hormone therapy for prostate cancer.

American Cancer Society. (2024). Key statistics for prostate cancer.

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Hoyland, K., et al. (2013). The use of vacuum erection devices in erectile dysfunction after radical prostatectomy. Reviews in Urology.

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Madan, R., et al. (2020). Erectile dysfunction and cancer: Current perspective. Radiation Oncology Journal.

Maiorino, M. I., et al. (2015). Lifestyle modifications and erectile dysfunction: What can be expected?Asian Journal of Andrology.

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Michl, U., et al. (2015). Use of phosphodiesterase type 5 inhibitors may adversely impact biochemical recurrence after radical prostatectomy. Journal of Urology.

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UCLA Health. (n.d.). Dealing with erectile dysfunction.

Urology Care Foundation. (2018). Erectile dysfunction (ED).

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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