Dealing with side effects of treatment for prostate cancer

 

Sexual problems/erection difficulties Back To Top

Any type of treatment may make you less interested in sex. This is known as loss of libido and is common to many illnesses, not just cancer.

Many men find it very difficult to talk about such personal subjects as erection problems, particularly with their doctor or other medical staff. The problems may not be permanent and can sometimes be caused by anxiety rather than the treatment. Men may also find it difficult to talk to their partners, for fear of rejection, but these fears are often unfounded. Sexual relationships are built on many things, such as love, trust and common experiences. It can help to talk to your partner about your fears and worries.

If you find the effect on your sex life disturbing you could discuss this with your doctor. Although you may worry that this will be embarrassing, doctors who deal with prostate cancer are very used to talking about these issues and will be able to give you advice. There are practical ways to help overcome impotence and your doctor will be able to give you further information about these. Most hospitals also have specialist nurses who can discuss the issues with you.

Medicines, injections and pumps

If you have problems getting or maintaining an erection there are many options to help you with this. These may give you a hard penis but will not necessarily increase your feelings of arousal. Sildenafil, vardenafil and tadalafil are tablets that have similar benefits and risks. All of them can give an erection when sexual stimulation takes place. They should not be taken if you are taking some types of heart medicines (nitrates) and they can cause erections that last a long time. If the erection goes on for more than two hours it can damage the penis.

Sildenafil (Viagra®) tablets can help to produce an erection by increasing the blood supply in the penis. They are usually taken an hour before lovemaking, and an erection then occurs following direct sexual stimulation. These tablets should be prescribed by your GP. They can cause side effects for some men, which include heartburn, headaches, dizziness and visual changes.

Vardenafil (Levitra®) tablets are similar to sildenafil. They normally work within 25-60 minutes. The most common side effects are headaches and flushing of the face.

Tadalafil (Cialis®) tablets can be used. They can be taken up to 24 hours before lovemaking. Your doctor may be able to prescribe them on the NHS. Tadalafil works by increasing the blood supply to the penis.

Injection of a drug such as alprostadil (Caverject®, Viridal®) or papaverine directly into the penis, using a small needle, causes an erection. The drug restricts blood flow and traps blood in the penis, causing an instant erection. Some experimentation is often needed at first to get the dose right. One of the possible side effects is that if too much of the drug is given, the erection stays for too long and there is a danger of damaging the tissues. Some men who use these injections say that the head of the penis is not as hard as the shaft. The injections are prescribed by your GP. Usually this method is recommended to be used not more than once a week, which may not be enough for some men.

Pellets of alprostadil (MUSE®) can be inserted into the penis. The pellet melts into the urethra, and, after some rubbing to distribute it into the nearby tissues, produces an erection. Some men find that the pellet is initially uncomfortable.

Vacuum pumps can also be used to produce an erection. They are also sometimes called vacuum constriction devices. The pump is a simple device with a hollow tube that you put your penis into. The pump makes the penis fill with blood by creating a vacuum. A rubber ring is then put around the base of the penis to give an erection. The erection can be maintained for about 30 minutes. Once you have finished making love the ring is taken off and the blood flows normally again. The advantage of this device is that it doesn't involve inserting anything into the penis, but it can take a few tries to get used to using it. It is particularly helpful for people who are not able to take other medicines. Your partner may experience your penis as feeling slightly colder than usual. The ring should only be worn for half an hour at a time.

Pumps can be used as often as you want, as long as you allow half an hour between each use. They are available on the NHS.

Most men who have erection problems after prostatectomy| or radiotherapy| will probably have some benefit from the treatments described above, but everyone is different. Specialist advice and counselling can be useful for many men. You can ask your doctor to refer you, or contact a support organisation.

Any medical treatment for sexual problems caused by prostate cancer is available on the NHS.

Our section on sexuality| discusses all of the above methods in detail. It also discusses the effect that sexual problems may have on your relationship.

Urinary incontinence Back To Top

Losing control of your bladder may be caused by the cancer itself, by surgery or, rarely, radiotherapy. Recently a lot of progress has been made in dealing with incontinence and there are several different ways of coping with the problem. You can discuss any worries with your doctor or nurse. Some hospitals have medical staff who are specially trained to give advice about incontinence and the Continence Foundation| can also offer useful information.

It is important to recognise that these problems do not affect all men. You can ask your doctor or our cancer support specialists| as many questions as you like about your treatment and the possible side effects. Then you can be better prepared to cope if problems arise.

Just Can't Wait card Back To Top

If you want to go to the toilet more often, or feel that you can't wait when you do want to go, you can get a card to show to staff in shops, pubs and other public places. The card allows you to use their loos without them asking awkward questions. You can get the cards from Incontact|, RADAR| or the National Association of Crohn's and Colitis (NACC)|.

Infertility Back To Top

Most treatments for cancer of the prostate are likely to cause infertility, which means that you will no longer be able to father a child. This may be very distressing if you want to have children. Your doctor or radiotherapist can talk to you about this before you start treatment and you may wish to discuss the issue with your partner. It is sometimes possible to store sperm before treatment starts. The sperm may then be used later as part of fertility treatment.

We have information on ways of preserving fertility|.

Breast swelling Back To Top

If your doctors recommend hormone treatment| which they feel may cause breast swelling, they may advise a short course of low-dose radiotherapy to your breasts, before you start the drugs. This will very often prevent any breast swelling, and causes very few, if any, side effects. Alternatively taking a low dose of another hormonal drug, called tamoxifen|, may prevent breast swelling developing.