Prostate cancer: surgery side effects
Surgery is one of a number of options available for the treatment of prostate cancer. The decision to undergo surgery is not one to be taken lightly. It should be made only after discussing the risks and benefits of the procedure with your doctor. Issues that need to be taken into account include the nature of the cancer, your age and your general health.
Impotence (erectile dysfunction)
One of the side effects associated with surgery for prostate cancer is impotence (the inability to achieve or sustain an erection). There is a high risk of impotence because the prostate lies next to the nerves and blood vessels that are important for erections, and these nerves and vessels can be damaged during the operation.
Incontinence
Similarly, incontinence (loss of bladder control) may be a problem after this type of surgery, because the prostate is located at the base of the bladder and surrounds the urine outflow tube (urethra).
Risk
The risk of being incontinent following surgery is quite low these days, but about 30 to 70 per cent of men who have their whole prostate removed because of cancer will have some difficulty achieving an erection afterwards. Newer surgical techniques that aim to spare the nerves associated with erectile function have reduced the risk of this side effect in recent times.
To minimise your risk of impotence following the operation, any factors that might predispose you to erection problems should be addressed. Such risk factors include smoking, high cholesterol, high blood pressure, obesity and diabetes. Your doctor will assess your risk and offer treatment or advice if necessary.
Sexual function after surgery
Spontaneous erections may return as early as 6 months after a successful nerve-sparing prostate removal operation. However, some men may not experience the return of spontaneous erections for up to 3 years.
It is now believed that return to normal sexual functioning can be helped by using self-administered injections into the penis to create an erection. Starting these injections early after the operation is thought to speed up the return of spontaneous erections in men who have had the nerve-sparing operation. Although the thought of penile injecting therapy worries most men initially, the majority of men can successfully use this treatment with correct instruction and practice.
Oral medicine for erection problems can also be useful. Medicines such as sildenafil (brand name Viagra), vardenafil (Levitra) and tadalafil (Cialis) can be effective, but only if the nerves have been spared and are functional. Sometimes the nerves can be spared but can take a while (up to 3 years) to become functional again.
Your doctor may suggest you start taking oral medicine 6 months after the operation. If the medicine does not appear to work at this time, you can try it again at a later date.
For men who are impotent following surgery because they did not have a nerve-sparing procedure or because the nerve-sparing procedure was unsuccessful, a penile prosthesis is an option if they want to continue to have sex.
Surgery for prostate cancer has been refined over the years, and is now associated with fewer complications and a good long-term success rate.
Last Reviewed: 18 December 2007
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