Help managing the sexual and reproductive side effects of prostate cancer treatment

October 13, 2020 in Disease Management  •  By Miles Varn, MD
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Prostate cancer is the second most common type of cancer diagnosed in men in the U.S. An estimated 191,930 new cases of prostate cancer will be diagnosed in the U.S. in 2020, with one in nine men at risk of being diagnosed with this cancer during his lifetime. And while advanced or aggressive prostate cancer can lead to death, most men diagnosed with the disease do not die from it. In fact, many physicians describe prostate cancer as a disease that older men die with, not from, meaning that the cause of death is frequently another health condition, such as heart disease, stroke, or dementia.

Currently, more than 3 million American men are living with prostate cancer.  Many of them are also living with side effects caused by their treatment. These side effects can vary depending on the type of treatment your doctor recommends, which can include hormone therapy, radiation, surgery, immunotherapy, cryotherapy, and chemotherapy. In addition to incontinence, two of the other most common side effects of prostate cancer treatment are erectile dysfunction and infertility. The good news is that there are approaches that can help you manage and mitigate these side effects in most cases.

Treatments for erectile dysfunction

The first step in building a plan to manage treatment side effects is to talk with your urologist, who can outline the potential treatments and help you decide which one is most appropriate for you. A health advisor can also be a valuable resource, providing evidence-based information on treatments as well as expedited access to specialists who can help you build your plan.

If cancer treatment affects erectile function, there are a number treatment options that may help. Oral medications, such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra), that relax the muscles in the penis and allow blood to flow to the organ more freely and quickly are one option.

For some men these medications are not effective or they have other health conditions that make taking these medications risky or take other medications, including medications for angina or other heart problems and alpha-blockers to treat high blood pressure, that may interact with these medications. For those men, there are other options to consider, including:

  • Alprostadil (MUSE), tiny a medicated pellet inserted into the urethra to stimulate blood flow to the penis and Alprostadil (CaverJect), an injectable form of this medication
  • Vacuum pumps that mechanically create an erection
  • Surgical penile implants made up of a narrow plastic tube, a small fluid filled balloon that is attached to the abdominal wall, and a release button placed in the testicle

Strategies to preserve fertility

In most cases, treatment of prostate cancer causes infertility. Men who undergo surgical removal of the prostate are no longer able to produce semen, which makes ejaculation of sperm impossible. Radiation can affect the prostate cells and seminal vesicles, which in turn results in semen that does not transport sperm effectively. In some cases, radiation can also damage a man’s sperm.

If you plan to have children after prostate cancer treatment, you should talk with your doctor about sperm banking and artificial insemination before you begin treatment. One other option is directly extracting sperm from the testicles and injecting it into an egg. If the egg is fertilized, it can then be implanted in the uterine wall to create a pregnancy, though this approach has a relatively low successful conception rate of less than 50%.

A health advisor can connect you with specialists in male fertility, including endocrinologists, andrologists (a urologist who focuses on conditions that affect male fertility and sexual function), and urologists so you can explore all your options.


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