The prostate is a sex gland. Diseases affecting it and its treatment inevitably impact on a man’s sex life. Prior to any treatment, your consultant should advise you of the impact of the disease and of each treatment type, so that you can make an informed choice. All radical treatments affect sexual function. Any treatment that damages the prostate will result in loss or severe impairment of ejaculatory function and hence fertility. If fertility is important to you, you should discuss creating a sperm bank with your consultant.
As the nerves that control erections cover the surface of the prostate, most treatments will affect erectile function to a greater or lesser degree. Surgery often has a significant initial impact, but, where the surgery is nerve-sparing, this normally improves over time. Radiotherapy treatments may affect erections less but, unlike surgery, there is generally no gradual post-treatment improvement. Brachytherapy is similar to or slightly better than external beam radiotherapy in this respect. Results from HIFU are fairly encouraging. Few patients achieve erections after cryotherapy. It should be noted that, with some treatments, orgasm is normally achievable in spite of these problems. After treatment, it is important to get the system back into working order as quickly as possible. ‘Use it or lose it’ is the motto.
There are a variety of treatments for erectile dysfunction. These include pills (e.g. Viagra, Cialis, Levitra, Spedra), all of which are available on normal prescription through your GP. Asking for a repeat prescription can avoid any possible embarrassment. In addition there is Alprostadil, available as a pellet inserted into the end of the penis (called MUSE), as a cream or by injection. Other methods include vacuum pumps, a penile implant and a treatment using a small pump in the scrotum, now also available on the NHS. You should be aware that all treatments can be at some cost to spontaneity.
You and your partner
Discussion with your partner is essential. Hormonal treatments in particular cause lack of interest in sex, and this can become a barrier to discussion. In such circumstances your partner may be in for a particularly distressing time, as the cause of the problem, if not discussed, may not be apparent.
Psychological and sexual counselling
Problems can be mental as well as physical. Many hospitals now have staff with expertise in this area, and you should not be frightened to ask. If you wish it, you and your partner are entitled to sexual counselling. Remember that treatments for sexual problems caused by prostate cancer are available free under the NHS.