Dealing with side effects of treatment for prostate cancer
Unfortunately, treatment for cancer of the prostate can cause unpleasant and distressing side effects, both short and long-term.
Sexual problems/erection difficulties
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Any prostate cancer treatment can make you less interested in sex. This is known as loss of libido and is common to many illnesses, not just cancer. Erection difficulties (impotence) are also a fairly common side effect of prostate cancer treatment. However, the problems may not be permanent and can sometimes be caused by anxiety rather than the treatment itself.
Many men find it difficult to talk about such personal subjects as erection problems, particularly with their doctor or other medical staff. Some men also find it difficult to talk to their partner, if they have one, 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.
You may find it helpful to read our information about relationships and communication.
If you find the effect on your sex life difficult to deal with 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 them. Most hospitals also have specialist nurses who can discuss the issues with you.
If you have problems getting or maintaining an erection there are many options to help. They may give you an erection, but won’t necessarily increase your feelings of arousal.
The tablets sildenafil, vardenafil and tadalafil have similar benefits and risks. They all require sexual stimulation in order to achieve an erection and can all cause erections that last a long time. If the erection lasts for more than two hours it can damage the tissues of the penis If this happens you should get medical help as soon as possible. The tablets shouldn’t be taken if you are taking some types of heart medicines (nitrates).
Sildenafil (Viagra®) tablets can help 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 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 taken up to 24 hours before sex. They work by increasing the blood supply to the penis and have similar side effects to sildenafil and vardenafil.
Your doctor can prescribe sildenafil, vardenafil or tadalafil for you on the NHS.
Some men may be able to use injections of drugs called alprostadil (Caverject®, Viridal®) or papaverine. A small needle is used to inject directly into the penis, which can cause an instant erection. The drugs restrict blood flow and trap blood in the penis. 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. If the erection lasts longer than two hours, you should get medical help as soon as possible.
The injections are prescribed by your GP. This method is not recommended to be used more than once a week.
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 uncomfortable at first.
Alprostadil and papaverine are usually prescribed by specialist doctors at first. If you would like to know more about these treatments, talk to your specialist doctor or nurse.
These can also be used to produce an erection. They are 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 having sex, 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 or taking any drugs, but it can take a few tries to get used to using it. It’s particularly helpful for people who are not able to take other medicines.
Your partner may find your penis is slightly colder than usual. The ring should only be worn for half an hour at a time, but it can be used as many times as you want, as long as you allow half an hour between each use.
Most men who have erection problems after a prostatectomy or radiotherapy will benefit from the treatments described above, but everyone is different. Specialist advice and counselling can also be useful. You can ask your doctor to refer you for this help, or contact one of the organisations in our database. Medical help for sexual problems caused by prostate cancer is usually available on the NHS.
Our information on sexuality and cancer discusses all of the above methods in detail. It also discusses the effect that sexual problems may have on your relationship.
Losing control of your bladder may be caused by the cancer itself, by surgery or, rarely, by radiotherapy. 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 concerns with your doctor or nurse. Some hospitals have medical staff who are specially trained to give advice about incontinence. The Bladder and Bowel Foundation can also offer useful information.
It’s important to recognise that these problems don’t affect all men. You can ask your doctor, specialist nurse or our cancer support specialists about your treatment and its possible side effects. Then you can be better prepared to cope if problems arise.
If you need 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 or pubs, etc. The Just Can’t Wait toilet card allows you to use their toilets without them asking awkward questions. You can get the cards from The Bladder and Bowel Foundation or RADAR or the National Association of Crohn’s and Colitis (NACC).
Most treatments for prostate cancer 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 cancer specialist can talk to you about this before you start treatment, and you may wish to discuss the issue with your partner, if you have one. It’s 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.
If your doctors recommend hormone treatment that 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 in men taking the hormonal therapy drug bicalutamide.