Prostate cancer occurs when cells in the prostate grow out of control. The prostate is a gland in men that helps produce fluid that goes into semen. The prostate is located in front of the rectum and just below the bladder.
Sex after prostate cancer is possible for many men, however, erectile dysfunction (ED) and loss of sex drive (libido) are common following prostate cancer treatment and not all men will regain erectile function.
Different treatments for prostate cancer can cause different problems with sexual function.
- Surgery to treat prostate cancer can cause erectile dysfunction
- Radiation therapy can also cause ED in about half of all patients
- With radiation, ED doesn’t always occur immediately, but may develop over months to years
- Hormone therapy to reduce levels of male hormones in the body to stop them from fueling prostate cancer cells can cause a loss of sex drive for some patients
- Chemotherapy may cause a loss of sex drive and difficulty getting an erection
- The younger a man is when he receives treatment, the more likely he is to regain sexual function
Treatments for sexual dysfunction following prostate cancer treatment include:
- Erectile dysfunction medications such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra)
- These can only help men achieve an erection if the nerves responsible are healthy
- Penile injection therapy, in which a small amount of medication is injected directly into the base of the penis
- Intraurethral suppository of medication
- External vacuum erection device
- Surgery to implant a penile prosthesis
Talk to your doctor if you are concerned with any sexual side effects from prostate cancer treatment. The important thing to remember is that there are many options, and a man can have a satisfying and intimate sex life even without erections.
What Are Symptoms of Prostate Cancer?
Prostate cancer often causes no symptoms in the early stages. As the cancer progresses, symptoms may include:
- Problems with urination
- Slow or weak urinary stream
- Urinary urgency, especially at night
- Blood in urine or semen
- Difficulty getting an erection (erectile dysfunction, or ED)
- Weakness or numbness in the legs or feet
- Loss of bladder or bowel control if the cancer presses on the spinal cord
- Pain in the hips, back (spine), chest (ribs), or other areas from cancer that spreads to bones
What Causes Prostate Cancer?
The cause of prostate cancer is unknown but it may be due to inherited or acquired genetic changes.
Risk factors for developing prostate cancer include:
- Age: increased risk in men after age 50
- Family history
- Genetic changes
- Geography: most common in North America, the Caribbean islands, northwestern Europe, and Australia
- Race/ethnicity: more common in African-American men and Caribbean men of African ancestry than in men of other races
- Other factors that might increase the risk of developing prostate cancer — though these links are less clear and have not been conclusively proven — include:
- Obesity
- Smoking
- High consumption of dairy products
- Prostatitis (inflammation of the prostate gland)
- Sexually transmitted diseases, such as chlamydia or gonorrhea
- Vasectomy
- Certain chemical exposures, such as Agent Orange
How Is Prostate Cancer Diagnosed?
Prostate cancer is diagnosed with a patient history and physical examination, which includes a digital rectal examination in which a doctor inserts a gloved finger into the rectum to examine the prostate.
Other tests to diagnose prostate cancer include:
- Blood test to check prostate-specific antigen (PSA) levels
- Prostate health index (PHI) blood test
- Prostate cancer urine test
- Imaging test of the prostate gland
- Magnetic resonance imaging (MRI) (such as multiparametric MRI)
- Transrectal ultrasound (TRUS)
- Biopsy of the prostate
What Is the Treatment for Prostate Cancer?
Treatment for prostate cancer depends on whether cancer is in part or all of the prostate, if the cancer has spread (metastasized) to other parts of the body, and the age and overall health of the patient. Treatment may include one or more of the following:
- Watchful waiting (active surveillance)
- Surgery: removal of the entire prostate and some nearby tissue
- Radiation therapy
- Brachytherapy (internal radiation)
- External beam radiation
- Cryotherapy (also called cryosurgery or cryoablation), which uses very cold temperatures to freeze and kill prostate cancer cells and most of the prostate
- Hormone therapy
- Androgen deprivation therapy (ADT) uses surgery or medicines to lower the levels of androgens made in the testicles
- Orchiectomy (surgical castration)
- Luteinizing hormone-releasing hormone (LHRH) agonists (also called LHRH analogs or GnRH agonists) are drugs that lower the amount of testosterone made by the testicles (also called medical castration)
- LHRH antagonists
- Chemotherapy
- Immunotherapy
- Cancer vaccine (doesn’t stop prostate cancer from growing, but may help men live several months longer)
- Immune checkpoint inhibitors
- PD-1 inhibitor
- Targeted therapy
- PARP (poly(ADP)-ribose polymerase) inhibitors
- Treatments for prostate cancer spread to bones
- Surgery
- Pain medicines
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https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostate-cancer/prostate-cancer-advancements-in-screenings
https://www.cancercenter.com/community/blog/2017/09/how-to-return-to-an-active-sex-life-after-prostate-cancer-treatment