Prostate cancer: surgery side effects
Surgery is one of a number of options available for the treatment of prostate cancer. The decision to undergo surgery is not one to be taken lightly. It should be made only after discussing the risks and benefits of the procedure with your doctor. Issues that need to be taken into account include the nature of the cancer, your age and your general health.
Impotence (erectile dysfunction)
One of the side effects associated with surgery for prostate cancer is impotence (the inability to achieve or sustain an erection). There is a high risk of impotence because the prostate lies next to the nerves and blood vessels that are important for erections, and these nerves and vessels can be damaged during the operation.
Similarly, incontinence (loss of bladder control) may be a problem after prostate cancer surgery, because the prostate is located at the base of the bladder and surrounds the urine outflow tube (urethra).
Risk of these side effects
The risk of being incontinent following surgery is quite low these days, with the majority of men not needing pads one year after surgery.
In the past, up to 70 per cent of men who had their whole prostate removed because of cancer had some difficulty achieving an erection afterwards. However, newer surgical techniques that aim to spare the nerves associated with erectile function have reduced the risk of this side effect. Erectile function can continue to improve over many years after surgery.
To minimise your risk of impotence following the operation, any factors that might predispose you to erection problems should be addressed. Such risk factors include smoking, high cholesterol, high blood pressure, obesity and diabetes. Your doctor will assess your risk and offer treatment or advice if necessary.
Sexual function after surgery
Spontaneous erections may return as early as 6 months after a successful nerve-sparing prostate removal operation. However, some men may not experience the return of spontaneous erections for up to 3 years.
Even if you can achieve an erection, after a radical prostatectomy you will not be able to ejaculate, thus affecting your ability to father a child naturally.
It is now believed that return to normal sexual functioning can be helped by so-called penile rehabilitation. It is thought that regular use of oral medicines such as sildenafil (Viagra) or injections into the penis such as alprostadil (Caverject) after the operation can speed up the return of spontaneous erections.
Although the thought of penile injecting therapy worries most men initially, the majority of men can successfully use this treatment with correct instruction and practice.
Side effects of penile injections include pain in the penis during injection.
Many men achieve success with oral erectile function medicines such as sildenafil (brand name Viagra), vardenafil (Levitra) and tadalafil (Cialis). For these to work the nerves must have been spared and be functioning. Sometimes the nerves can be spared but can take a while (up to 3 years) to become functional again.
Your doctor may suggest you start taking oral medicine 6 months after the operation. If the medicine does not appear to work at this time, you can try it again at a later date.
Side effects of these medicines include headache and flushing. Men with heart problems should not take these tablets.
For men who are impotent following surgery because they did not have a nerve-sparing procedure or because the nerve-sparing procedure was unsuccessful, a penile prosthesis is an option if they want to continue to have sex. Vacuum devices may also be helpful for some men.
Surgery for prostate cancer has been refined over the years, and is now associated with fewer complications and a good long-term success rate. Nonetheless, complications such as incontinence and erectile dysfunction do still occur and can be very distressing.
It is important to ask your surgeon for information about all the things that are important to you before the operation. However, they can only give you statistics and probabilities and will not be able to tell you exactly what will happen to you - every man has a different story to tell.
2. Urological Society of Australia and NZ. Prostate cancer fact sheet. (undated). http://www.usanz.org.au/uploads/29168/ufiles/Prostate%20Cancer.pdf (accessed Dec 2012).
3. Cancer Council NSW. Understanding Prostate Cancer. Updated June 2011. http://www.cancercouncil.com.au/1160/cc-publications/understanding-cancer-series/understanding-prostate-cancer/understanding-prostate-cancer/?pp=1160 (accessed Feb 2013).
4. eMIMS. Feb 2013 edition. Prescribing information for Viagra, Cialis, Caverject, Levitra.