Prostate Cancer

Impotence

Impotence (problems with erections) is a common long-term unwanted side effect of radical prostatectomy and hormone treatment, and sometimes it follows other treatments such as radiotherapy and brachytherapy. Occasionally it occurs when symptoms are improved using transurethral resection. All of the men interviewed who had undergone radical prostatectomy reported some degree of impotence, but their experiences varied. They tried practical ways to help them overcome their problem, some with more success than others.

National Institute for Health and Care Excellence (NICE) guidelines 2014 (CG175) recommends that men should be advised that long term hormone therapy can cause reduction in libido and possible loss of sexual function. Men and their partners should be told about possible loss of fertility and be offered sperm storage, and those starting hormone therapy should have access to specialist erectile dysfunction services and be considered for psychosexual counselling. 

Men who received hormones or a combination of hormone treatment and radiotherapy also described how treatment had affected their sex lives. A man who had had brachytherapy said that his operation had led to impotence and another man described how treatment of his symptoms by transurethral resection had led to some change in his sex life.

Newer surgical procedures and treatments such as robot-assisted laparoscopic radical prostatectomy, and HIFU are reported to cause fewer erectile problems and incontinence problems than radical surgery.

NICE also recommends that men with erectile problems following prostate cancer treatment should be offered PDE5 inhibitors (such as Sildenafil (Viagra®), Vardenafil (Levitra®), Tadalafil (Cialis®) and avanafil (Spedra)) and if PDE5 inhibitors fail to restore erectile function or are contraindicated, they should be offered vacuum devices, intraurethral inserts or penile injections, or penile prostheses as an alternative.
 
 
Last reviewed July 2017.
Last updated March 2015.

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