The prostate is a sex gland. Diseases affecting it and their treatment inevitably impact on a man’s sex life. Prior to any treatment, your consultant should advise you of the impact of the disease and of each treatment type, so that you can make an informed choice.
All radical treatments have an impact on sexual function. Any treatment that damages the prostate will result in loss or severe impairment of ejaculatory function and hence fertility. If fertility is important to you, you should discuss creating a sperm bank with your consultant.
Most treatments affect erectile function to a greater or lesser degree. Surgery often has a significant initial impact, but, where the surgery nerve-sparing, this normally improves over time. Radiotherapy treatments may affect erections less but, unlike surgery, there is generally no gradual post-treatment improvement. Brachytherapy is reported to be similar to external beam radiotherapy in this respect. Results from HIFU are fairly encouraging. Few patients, however, achieve erections after cryotherapy. It should be noted that, with some treatments, orgasm is normally achievable in spite of these problems and may even be enhanced. After treatment, it is important to get the system back into working order as quickly as possible. ‘Use it or lose it’ is the motto.
There are a variety of treatments for erectile dysfunction. These include pills (e.g. Viagra, Cialis and Levitra), pellets inserted into the end of the penis (e.g. MUSE), vacuum pumps, and penile injections. Penile implants, and a treatment using a small pump in the scrotum, are not yet available on the NHS. All treatments can be at some cost to spontaneity.
Discussion with your partner is essential. Some treatments (e.g. hormone therapy) cause lack of interest in sex, and this can become a barrier to discussion. In such circumstances your partner may be in for a particularly distressing time, as the cause of the problem, if not discussed, may not be apparent.
Problems can be mental as well as physical. Many hospitals now have staff who have expertise in this area, and you should not be frightened to ask. If you wish it, you and your partner are entitled to sexual counselling. Remember that treatments for sexual problems caused by prostate cancer are available free under the NHS, and tablets, available in different strengths, are available on normal prescription through your GP. Asking for a repeat prescription can avoid any possible embarrassment.