Dealing with the side effects of treatment

It’s important to understand the possible side effects of treatments for prostate cancer.

After treatment you may be less interested in sex. Erection difficulties (erectile dysfunction – ED) can occur with prostate cancer treatment. This may get better in time but is sometimes permanent.

There are different treatments to help you get or maintain an erection. These include drugs which you can take as tablets, injections or pellets. Vacuum pumps can also be used, and in a few cases your doctor may suggest a penile implant. Your doctor or specialist nurse can discuss with you what would be best for you.

The cancer or its treatment sometimes causes urinary incontinence. There are several different ways of coping with this.

Most treatments for prostate cancer are likely to cause infertility. You can talk to your doctor about freezing your sperm before treatment if you may want to father a child in the future.

Some hormonal therapies may cause breast swelling. If this is likely to happen, your doctor can suggest treatments to prevent it.

Side effects of treatments for prostate cancer

Unfortunately, treatment for prostate cancer can cause unpleasant and distressing side effects, both short- and long-term.


Sexual problems and erection difficulties

Any type of 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 (erectile dysfunction - ED) are 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 personal subjects such as erection problems, particularly with their doctor or other healthcare staff. Some men with a partner also find it difficult to talk to them because of 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.

We have more information on cancer and how it affects you and your partner.

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

Coping with sexual difficulties

Brian talks about the impact of prostate cancer and impotence on his sex life. He explains how his relationship with Elizabeth remained strong.

About our cancer information videos

Coping with sexual difficulties

Brian talks about the impact of prostate cancer and impotence on his sex life. He explains how his relationship with Elizabeth remained strong.

About our cancer information videos


Tablets

This is the most widely used treatment for ED. It may not be recommended for you if you have heart problems. It should not be taken with certain prescription drugs, such as nitrates or recreational drugs such as amyl nitrate (poppers).

Sildenafil (Viagra®) increases and maintains the blood supply in the penis. It is usually taken about 60 minutes before sex, on an empty stomach. Then, after direct sexual stimulation, an erection can occur.

Sildenafil should be prescribed by your GP. It can cause side effects for some people, including heartburn, headaches, dizziness and changes in eyesight.

Vardenafil (Levitra®) tablets are similar to sildenafil. They work within 30 to 60 minutes. The most common side effects are headaches and facial flushing.

Avanfil (Spedra®) is similar to sildenafil and vardenafil. It is taken 15 to 30 minutes before sex.

Tadalafil (Cialis®) helps increase blood-flow to the penis during sexual arousal. Your doctor can prescribe it to you in two different ways:

  • You can take it once a day. In this case, it takes about 5 to 7 days to build up in the body. Once you have started, you need to take it every day for it to work.
  • You can take it just when needed. In this case, you take it between 30 minutes and two hours before sexual activity. The medicine stays active for about 36 hours.


Injections

This treatment may be more effective than tablets for men who have ED due to nerve damage.

A drug called alprostadil (Caverject®, Viridal®) is injected directly into the shaft of the penis, using a small needle. This causes an erection in 5 to 20 minutes. The drugs restrict blood-flow out of the penis, making it hard. The head of the penis may not become as hard as the shaft.

A healthcare professional will give you the first dose and teach you how to do this yourself. It is recommended that the injections are only used once in 24 hours and no more than three times a week. You should also change the site of the injections regularly.

A possible side effect of this treatment is having an erection that lasts for several hours. Doctors call this priapism. It is a serious side effect, as it can damage the tissues of the penis. If your erection lasts longer than two hours, you should always get medical help as soon as possible.

To reduce the risk of priapism, you will be prescribed a low dose of the injection to begin with. This is gradually increased to find the right dose for you. The person who prescribes your injections or tablets will explain the risk of priapism and how it can be treated.


Pellets or cream

Alprostadil can also come as pellets (MUSE®) or a cream (Vitaros®). You insert it into the opening of the penis using a specially designed applicator. The cream or pellet is absorbed into the penis and produces an erection. You need to pass urine before inserting the pellets. This wets the urethra and helps the pellet dissolve. Inserting the pellet or cream does not cause any discomfort. But the drug may cause a burning feeling in the urethra or pain in the penis.

Your first dose will be given to you in hospital. You will be prescribed a set dose of the drug to begin with. This can then be adjusted until you find the right dose for you. Priapism may occur with this treatment, but this is rare.


Pumps

Vacuum pumps can also be used to produce an erection. They are also called vacuum erection devices (VEDs).

The pump is a hollow tube that you put your penis into. The pump makes the penis fill with blood by creating a vacuum. You then put a stretchy constriction ring around the base of the penis to hold the erection. The erection can be maintained for up to 30 minutes. Once you have had sex, you take the ring off and the blood flows normally again. The pump can be used as many times as you want, as long as you leave half an hour between each use.

The advantage of the pump is that it doesn’t involve any medication, so it doesn’t interact with other medicines you are taking. You may need to try it a few times before you get used to using it. The pump may make your penis slightly bigger, but colder than usual. The pumps are available on the NHS.

Your doctor or nurse may encourage you to use a pump routinely to help the penis recover, and not just for sex. This is so that when you are ready to start sexual activity, you will have a better chance of getting an erection.

The nerves between the spine and the penis were cut and I am no longer able to have an erection. I use either an injection or a machine to get an erection.

Neil


Penile implants

These are sometimes used after all other methods have been tried. A penile implant is inserted during an operation. There are two main types. The first type uses semi-rigid rods that keep the penis fairly rigid all the time, but allow it to be bent down when an erection isn’t needed. The second type is an inflatable device that, when activated, causes an erection. Your doctor can discuss penile implants with you.

If you think any of these options might be useful to you, your doctor or nurse can give more information or you can contact the organisations on our database.

Most men who have erection problems after a prostatectomy or radiotherapy will probably benefit from these treatments, but everyone is different. Specialist advice and counselling can also be useful. You can ask your doctor to refer you for this help.

Our information on sexuality and cancer discusses all of the above methods in detail. It also talks about the effect that sexual problems may have on your relationship.


Urinary incontinence

Losing control of your bladder may be caused by the cancer itself, by surgery or, rarely, radiotherapy. A lot of progress has been made in dealing with incontinence, and there are several different ways of coping with the problem. Discuss any concerns you have with your doctor or nurse. Some hospitals have staff who are specially trained to give advice about incontinence. The Bladder and Bowel Foundation also has useful information.

Just can’t wait toilet card

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, restaurants and pubs. 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 for a small fee.

Macmillan also has a toilet card that can help you access toilets when you're away from home.


Infertility

Most treatments for prostate cancer are likely to cause infertility, which means 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 usually possible to store sperm before treatment starts. The sperm may then be used later as part of fertility treatment.

We have information about ways of preserving fertility.


Breast swelling

Some hormonal therapies may cause breast swelling. Ask your doctor if this is likely to happen to you. They may advise a short course of low-dose radiotherapy to your breast tissue before you start treatment. This may prevent any breast swelling and causes very few, if any, side effects.

If you are taking bicalutamide another option is to also take a hormonal drug called tamoxifen to prevent breast swelling.