Dr.Vikas Roshan
Prostate cancer occurs when there is uncontrolled growth of abnormal prostate cells in the prostate gland—a gland about the size of a walnut located below the bladder, near the base of the penis, and close to the urethra.
The disease, which cropped 30,000 men in India in 2020, is more common in older men, with 60% of cases picked in men aged 65 or older. Nearly all prostate cancers are adenocarcinoma , which are cancers that begin in the glands lining the inside of organs.
Prostate cancer can affect men’s sexual function—including lowered libido (i.e. sex drive), erectile dysfunction, difficulty achieving orgasms, and problems ejaculating.This is usually a result of prostate cancer treatment and treatment side effects.
How treatment affects sexual function
Localized prostate cancer is generally treated with surgery and Radiotherapy. However, surgery and Radiotherapy comes with a risk of damaging tiny bundles of nerves that control erections, running on either side of the prostate.
This can affect erectile function for many men following treatment. The chance of preserving erectile function after treatment is influenced by age at presentation, pre-treatment erectile function, and whether a nerve-sparing approach for management is feasible.
Usually, young patients are more likely to preserve sexual functions after surgery. Still, it often takes a few months to twenty-four months after surgery for spontaneous erections to return.
In prostate cancer management, hormones play a vital role in curative management.
Unfortunately, two to three years of use of ADT will result in decreased testosterone levels, leading to suppressed sexual desire, erectile dysfunction, and shrinkage of the testicles and penis.
Prostate cancer treatment invariably leads to infertility. This is because surgery removes the prostate and seminal vesicles that produce semen (carrier fluid) for sperm transportation and it also cuts off the vas deferens—or sperm duct—which is a pathway between the testicles (where sperm production occurs) and the urethra ( a muscular tube through which sperm leave the body).
On the other hand, Radiotherapy of the prostate and seminal vesicles impair semen production and may also partially damage sperm production in the testicles.
As prostate cancer generally affects older men aged 60 and above, many patients at this age do not put much importance on fertility after treatment. However, in the uncommon scenario where patients desire to father children after receiving a prostate cancer diagnosis, sperm banking can be explored to preserve fertility before undergoing treatment.
It is vital to understand that while patients may become infertile after undergoing treatment, a good proportion of patients may still achieve erections and retain sexual function.
Managing sexual dysfunction
Lowered testosterone levels and loss of libido resulting from ADT may be a significant cause for concern for the patient and the partner. In such cases, couples counselling should be done that alleviate stress. Generally, testosterone levels touch normal levels, and libido will improve for most men once ADT is stopped.
For men experiencing erectile dysfunction, phosphodiesterase-5 (PDE5) inhibitors such as sildenafil are pills that can help with erections, incredibly if the nerves that control erections can be preserved. Other alternatives include vacuum-assisted devices to create an erection and penile implants.
After surgery or Radiotherapy to the prostate, there will be minimal or no ejaculation. However, penile sensation remains intact, potentially achieving orgasms even if the erectile nerves are damaged during treatment.
A prostate cancer diagnosis, treatment and its side effects that lead to changes in body shape, body language and sex life can significantly influence your sense of self-image and impact your relationships.
A multidisciplinary approach to managing prostate cancer, which includes medicine, counselling and other support services, can provide holistic care that can help you continue living as normally as possible following treatment.
