According to Dr. Schover, most of the problems men experience after prostate cancer are related to their specific treatments. Surgery to remove the entire prostate, a prostatectomy, damages nerves that control blood flow to the penis, creating erection problems in 50-80 percent of patients having the procedure. Despite efforts to spare these nerves during surgery, only those men who are under 60 and have very good erections before surgery have a good chance of recovering fully functional erections. Most other men need to use some type of medical treatment, ranging from Viagra to a surgical implant. Erection problems are less common but still frequent following radiation therapy.
Problems develop more slowly, often showing up within six months to two years after treatment.
These erection problems are probably caused by scarring of tissue near the prostate, reducing the blood flow available to the penis, says Dr. Schover. Men who use hormonal therapy to control more advanced prostate cancer have a different kind of sexual problem. The loss of testosterone reduces a man's desire for sex. Eighty to 90 percent of men receiving this type of treatment have sexual difficulties. There are successful treatments for erectile dysfunction, and counseling is very important in encouraging couples to stay sexually active.