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When prostate cancer is detected in its early stages, it has a notably high five-year survival rate. Specifically, the Prostate Cancer Foundation reports that early-stage prostate cancer diagnosis leads to a five-year survival rate greater than 99%.
Survival rates are an incredibly important factor when it comes to any disease. However, there are many quality-of-life issues to consider as well. That includes sexual side effects of prostate cancer and treatment for this disease.
Prostate cancer itself can lead to sexual side effects. Treatments for prostate cancer can also lead to issues such as erectile dysfunction.
However, prostate cancer treatments vary in the incidence of such side effects. For example, less-invasive treatments, such as laser focal therapy (LFT) and transurethral ultrasound ablation (TULSA-PRO), compare favorably to traditional treatments, such as radiation therapy and radical prostatectomy (full removal of the prostate gland), in terms of erectile dysfunction risk.
It’s vital to recognize the importance of an informed risk-benefit analysis in terms of treating prostate cancer. Many patients, especially those with early-stage prostate cancer, have options when it comes to treatment.
Understanding these risks, both through general research and in consultation with your physician, can help you make a more informed decision. Understanding the risks of treating or not treating prostate cancer on an individual level, both in terms of sexual function and overall survival, is crucial in this regard.
As you begin your research, consider the information in the following sections. We will review the sex-related complications caused by prostate cancer itself, as well as the side effects of common treatments for prostate cancer.
How Does Prostate Cancer Affect You Sexually?
There’s an important distinction to make in terms of prostate cancer itself and its potential effects on sexual performance and potency. Prostate cancer is not known to widely cause erectile dysfunction and other physical issues by itself.
However, the psychological impact of diagnosis can often lead to these issues. An article published in the peer-reviewed World Journal of Men’s Health explains “Prostate cancer frequently causes sexual dysfunction. A prostate cancer diagnosis by itself reduces sexual desire and the frequency of sexual intercourse.”
Complications caused by prostate cancer can lead to sex-related problems. For example, the Men’s Health article explains that a growing prostate tumor can lead to symptoms in the lower urinary tract. In some cases, those symptoms could interfere with sexual function.
Psychological issues related to a prostate cancer diagnosis are also important to consider. A physician-authored and reviewed article from GoodRX Health explains these psychological concerns in more detail.
A cancer diagnosis, even for early-stage cancers, is a major life event. Diagnosis can lead to anxiety and depression, both of which can have a negative effect on libido. This can be true both for the man diagnosed with prostate cancer and their spouse or partner.
These issues aren’t usually physical symptoms of living with prostate cancer in and of itself, but they can still have a noticeable effect on interest in sexual activity and overall sex life. The psychological impact of prostate cancer on marriage, and especially sexual intimacy, should be considered.
The same concept applies to treatments for prostate cancer and their direct potential for sexual side effects, which we will explore in the next section. Psychological stress and worry related to treatment as well as its side effects may have a negative impact on libido as well.
Prostate Cancer Treatment and Sexual Side Effects
There are many potential treatments for prostate cancer, depending on the stage of the disease and its spread in the prostate and surrounding areas.
The prostate gland surrounds the urethra and is close to nerve bundles that play a crucial role in sexual performance. Treatment can damage those nerves and interfere with normal erectile function. In general, complications caused by common treatments for prostate cancer include issues with achieving and maintaining an erection, as well as climax during sexual activity.
Remember that not all treatments are equal when it comes to their frequency or severity of sexual side effects. Let’s take a closer look at common prostate cancer treatments and their sexual side effects.
Surgery: Radical Prostatectomy
Radical prostatectomy refers to the complete removal of the prostate gland. As Mount Sinai explains, radical prostatectomy is used when prostate cancer is localized, i.e. it has not spread far beyond the prostate. There are several techniques used to perform a radical prostatectomy, but they all have the goal of removing the prostate.
This treatment option also involves the removal of the seminal vesicles. That’s especially important to consider in the context of sexual side effects.
Removing the prostate and seminal vesicles leads to dry orgasms. In other words, patients receiving a radical prostatectomy will not ejaculate when they reach climax.
Erectile dysfunction (ED) is another major risk to consider with radical prostatectomy. An article published in the medical journal Current Opinion in Supportive and Palliative Care explains that the specific risk level of ED varies based on the specific research referenced. However, “several recent studies have cited rates as high as 85%.”
Sex after prostate removal is possible for some patients. They can have sex without a prostate, in the absence of complications like ED. However, many patients experience those complications.
It’s also important to note that sex-related complications that don’t rise to the level of impotence are common with radical prostatectomy. It can become more difficult, but still possible, to achieve and maintain an erection, for example.
Radiation Therapy
Radiation therapy centers on the use of “high-energy rays or particles to kill cancer cells,” the American Cancer Society explains. Radiation therapy covers external and internal treatments, as well as the use of injected medications that include radiation. Radiation therapy is used for both low-grade and advanced cases of prostate cancer.
ED is a common complication following radiation therapy treatment for prostate cancer. A systematic review and meta-analysis of available research published in The Journal of Sexual Medicine found that 34% of patients experienced ED after one year. Additionally, 57% of men experienced ED 5.5 years after treatment. With a radical prostatectomy, erectile dysfunction usually immediately after the procedure with hopefully improvement over time. With radiation, symptoms of ED are usually delayed and get worse over time.
Radiation-induced prostatitis is another complication of radiation therapy that can affect the sex lives of some patients and is generally unpleasant and unwanted. Radiation can damage the rectum, leading to issues like rectal pain or burning, as well as diarrhea.
Laser Focal Therapy
Laser focal therapy (LFT) is a minimally invasive procedure. It uses the energy produced by laser light to precisely target and ablate (destroy) prostate cancer. The equipment used is also FDA-cleared for use in the brain, indicating its precise nature.
When millimeters matter, whether in the brain or in avoiding damage to nerve bundles next to the prostate, precision is key. The precision of LFT is further supported by the use of MRI guidance to specifically target prostate cancer and spare surrounding healthy tissue.
LFT is commonly used for localized prostate cancer of low to intermediate risk. It is especially effective when targeting well-defined lesions.
LFT treatment presents a risk of ED, but it is significantly lower than that of radiation therapy or radical prostatectomy. Research results shared by the medical journal Urology Today indicate that ED risk is less than 10%.
Transurethral Ultrasound Ablation (TULSA-PRO)
Transurethral ultrasound ablation (TULSA-PRO) is a minimally invasive procedure. It utilizes MRI guidance to deliver precise doses of therapeutic ultrasound, which destroys prostate cancer.
The targeted nature of TULSA-PRO can provide better results in terms of sparing healthy surrounding nerve tissue, as compared to radiation therapy and radical prostatectomy. Real-time MRI guidance also plays a key role in supporting precise ablation.
TULSA-PRO is used to treat larger cancers, and cancers that are more diffuse throughout the prostate, as compared to LFT.
TULSA-PRO carries a significantly lower risk of ED as compared to radiation therapy and radical prostatectomy. Data from the clinical trial conducted by device manufacturer Profound Medical indicates an ED risk of 25% for whole gland treatment.
Making an Informed Choice About Prostate Cancer Treatment
Sexual side effects are a major quality-of-life concern for many, although not every, patient with prostate cancer.
Learning about potential treatment options and their risk of sexual side effects can help to make a more informed decision about treatment. Remember that not all treatment options are effective for all cases of prostate cancer. The state of the cancer will play a major role in determining effective treatment options.
However, some patients, especially those with early-stage cancer, will have a choice in how their treatment progresses. Being informed is a crucial early step in having productive consultations with your physician and deciding on a course of action that balances effective treatment, risk factors, and every patient’s unique and individual situation.
Prostate Laser Center is dedicated to offering minimally invasive and effective treatment options. TULSA-PRO and FLA can offer a lower risk of sexual side effects, like ED, than traditional prostate cancer treatments.
Seeking treatment options for prostate cancer? Request a consultation today.
NOTE: The information provided on this website is general medical information and does not establish a physician-patient relationship. Please discuss your particular situation with a qualified medical professional.
