Prostate Cancer and Erectile Dysfunction: What Patients Need to Know

By Mr Neil Haldar, Consultant Urological Surgeon

In brief

Erectile dysfunction is one of the most common concerns among men diagnosed with prostate cancer. For many, the possibility of losing erections can feel almost as troubling as the cancer diagnosis itself.

Prostate cancer does not usually cause erectile dysfunction in its early stages. The difficulty more often arises because the nerves and blood vessels responsible for erections lie extremely close to the prostate and can be affected by surgery, radiotherapy or hormone treatment.

The effect is different for each treatment:

• Surgery usually causes an immediate deterioration in erections, followed by a period of gradual and uncertain recovery.
• Radiotherapy may preserve erections initially, but erectile function can decline progressively over several years.
• Hormone therapy commonly affects sexual desire as well as the physical ability to achieve an erection.
• Active surveillance avoids or delays the immediate sexual side effects of radical treatment.
• Focal therapy may reduce sexual side effects in carefully selected patients, although its long-term evidence base is less mature than that for surgery and radiotherapy.

Natural erections cannot be guaranteed after prostate cancer treatment, even when nerve-sparing surgery is possible. However, erectile dysfunction is treatable. Tablets, vacuum devices, injections and penile implants can all help men regain useful and satisfying sexual function.

Early and honest discussion before treatment is important. It allows sexual priorities to be considered alongside cancer control and ensures that support can begin promptly after treatment.

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Why erectile function matters

Erectile dysfunction, often abbreviated to ED, means being unable to obtain or maintain an erection firm enough for satisfactory sexual activity.

Although it is sometimes discussed as a straightforward physical side effect, its effects can be much wider. Difficulties with erections may influence:

• confidence and self-esteem;
• feelings of masculinity or identity;
• intimacy with a partner;
• body image;
• emotional wellbeing;
• relationship dynamics;
• overall quality of life.

Not every man places the same importance on penetrative sex, and sexual priorities vary according to age, health, relationship status and personal circumstances. Nevertheless, every man should be given clear information about the likely sexual consequences of prostate cancer treatment.

Sexual function should not be treated as an embarrassing or secondary issue. It is a legitimate part of prostate cancer decision-making and follow-up care.

How erections work — and why the prostate matters

An erection depends on a complex interaction between the brain, nerves, blood vessels, hormones and penile tissue.

When a man becomes sexually aroused, nerve signals cause the smooth muscle inside the penis to relax. This allows blood to flow into two cylindrical structures called the corpora cavernosa. As these fill with blood, pressure rises, and the penis becomes firm.

The nerves responsible for triggering this process are known as the cavernous nerves. They travel within thin layers of tissue called the neurovascular bundles, which run immediately alongside the prostate.

This close anatomical relationship is central to understanding erectile dysfunction after prostate cancer treatment. Any treatment that removes the prostate, delivers radiation to it or affects testosterone levels can interfere with one or more parts of the erectile process.

The final outcome is therefore influenced not only by whether the nerves survive, but also by:

• the health of the penile blood vessels;
• the condition of the erectile tissue;
• testosterone levels;
• psychological wellbeing;
• the man’s erectile function before treatment.

Does prostate cancer itself cause erectile dysfunction?

In most men, early prostate cancer causes no symptoms. It is usually identified following a raised PSA blood test, an abnormal prostate examination, an MRI scan or a biopsy rather than because of any change in sexual function.

Erectile dysfunction that is already present at the time of diagnosis is frequently related to other factors, including:

• increasing age;
• diabetes;
• high blood pressure;
• cardiovascular disease;
• raised cholesterol;
• smoking;
• obesity;
• reduced physical activity;
• medication;
• anxiety or depression;
• relationship difficulties.

A prostate cancer diagnosis can itself affect sexual performance. Anxiety, fear about the future and concern about disappointing a partner can reduce desire or make erections less reliable, even before cancer treatment begins.

Locally advanced prostate cancer can occasionally affect nearby nerves or pelvic tissues directly. However, this is not the usual explanation for erectile dysfunction in men diagnosed with localised disease.

For most patients, the greater risk to erections comes from the treatment rather than the tumour itself.

How prostate cancer treatments affect erections

The principal treatment options for localised prostate cancer have different effects on sexual function and different patterns of recovery.

Direct comparisons can be difficult because men receiving surgery, radiotherapy or surveillance are not always alike. They may differ in age, general health, cancer aggressiveness and erectile function before treatment.

It is therefore more useful to understand the typical pattern associated with each treatment than to look for one universal percentage.

Radical prostatectomy and erectile function

A radical prostatectomy removes the prostate gland and usually the seminal vesicles. The bladder is then reconnected to the urethra.

Because the neurovascular bundles lie against the outer surface of the prostate, they must be carefully separated from it during surgery when this can be done safely.

What is nerve-sparing surgery?

Nerve-sparing surgery aims to preserve one or both neurovascular bundles.

The operation may be described as:

• bilateral nerve-sparing, when both bundles are preserved;
• unilateral nerve-sparing, when one bundle is preserved;
• non-nerve-sparing, when neither bundle can safely be retained.

Nerve-sparing is not simply a matter of patient preference. The surgeon must balance preservation of erectile function against the need to remove the cancer completely.

If MRI, biopsy findings or the appearance during surgery suggest that cancer extends close to or beyond the prostate capsule, wider removal may be necessary. Preserving nerves in an area at significant risk of cancer involvement could compromise the primary purpose of the operation.

Age and erectile function before surgery are major predictors of postoperative recovery, while preserving the neurovascular bundles improves the possibility of retaining erectile function.

Does robotic surgery prevent erectile dysfunction?

Robot-assisted surgery provides magnified vision, fine instrument control and a stable operating view. These features can assist precise dissection around the prostate and nerves.

However, the use of a robot does not guarantee preservation of erections. Evidence comparing robotic and open surgery has not consistently shown a major clinically meaningful difference in erectile outcomes based solely on the operating platform.

The factors that generally matter more are:

• whether the cancer permits nerve-sparing;
• how much of each nerve bundle can be preserved;
• the man’s age and baseline function;
• the quality of the dissection;
• the surgeon’s experience;
• other vascular or medical conditions.

The European Association of Urology notes that the influence of the surgical platform remains debated and that surgeon experience, baseline function and preservation of the nerves are important determinants of recovery.

Why do erections deteriorate immediately after surgery?

Even when both neurovascular bundles are preserved, erections usually deteriorate immediately after radical prostatectomy.

The nerves are extremely delicate. They can be stretched, handled, heated, or temporarily deprived of their blood supply during the operation. This can cause a period of temporary nerve dysfunction known as neuropraxia.

The nerves may remain anatomically intact but unable to transmit normal signals effectively.

Recovery is usually gradual. Some men begin to notice partial erections within several months, while others recover over 18 to 24 months or longer. The eventual outcome may not become clear for two or even three years.

Natural recovery is not guaranteed. Some men recover erections without assistance, some require tablets or other treatments, and others do not recover useful natural erections despite technically successful nerve-sparing surgery.

Radiotherapy and erectile function

Radiotherapy treats the prostate without removing it. Treatment may involve:

• external beam radiotherapy;
• stereotactic radiotherapy;
• low-dose-rate brachytherapy using permanent radioactive seeds;
• high-dose-rate brachytherapy using temporary treatment catheters.

Because the nerves are not surgically separated from the prostate, erectile function is often better preserved during the first year or two after radiotherapy than after radical prostatectomy.

However, radiation can gradually affect:

• the small blood vessels supplying the penis;
• the neurovascular bundles;
• the erectile tissue;
• surrounding pelvic structures.

Erectile dysfunction after radiotherapy therefore often develops more gradually than after surgery. A man may initially retain reasonable erections but notice progressive deterioration over several years.

The likelihood is also affected by whether radiotherapy is combined with androgen deprivation therapy. Hormone treatment can significantly reduce both libido and erectile function, particularly while testosterone remains suppressed.

Long-term patient-reported studies show that surgery and radiotherapy have different patterns of sexual side effects. Surgery generally causes the sharpest early deterioration, while radiotherapy may be followed by a more gradual decline. These outcomes do not necessarily become identical at a particular point in time.

Hormone therapy and sexual function

Androgen deprivation therapy, often called hormone therapy, lowers testosterone or blocks its action.

It may be used:

• alongside radiotherapy;
• before and after radiotherapy;
• for recurrent prostate cancer;
• for locally advanced or metastatic disease.

Testosterone has an important role in sexual desire as well as erectile function. Hormone therapy can therefore produce a different sexual experience from surgery alone.

Common effects include:

• reduced or absent libido;
• difficulty becoming sexually aroused;
• weaker or absent erections;
• reduced sexual thoughts;
• loss of spontaneous or morning erections;
• reduced energy;
• hot flushes;
• changes in mood;
• loss of muscle and increased body fat.

It is important to distinguish loss of desire from a purely mechanical erectile problem. A tablet that improves blood flow may be less helpful when the principal difficulty is profound loss of libido caused by very low testosterone.

Sexual desire and erections may improve after a temporary course of hormone treatment ends, but testosterone recovery can take many months or longer. Recovery varies according to age, the type of treatment and how long it was given. Some men do not return fully to their previous level of sexual function.

Active surveillance and erectile function

Active surveillance is an established option for many men with low-risk and some carefully selected intermediate-risk prostate cancers.

Rather than treating the cancer immediately, the medical team monitors it using a combination of:

• PSA tests;
• clinical review;
• MRI scans;
• repeat biopsy when appropriate.

Active surveillance avoids or delays the immediate erectile consequences of surgery or radiotherapy.

However, it does not mean that erectile function will necessarily remain unchanged. Erections may deteriorate over time because of ageing, vascular disease, medication, anxiety or changes in general health. Some men will eventually require radical treatment if there is evidence that the cancer is progressing.

Long-term ProtecT data found gradual age-related deterioration in sexual function among men initially managed with monitoring, while avoiding the immediate functional effects of radical treatment unless their management later changed.

Focal therapy and erectile function

Focal therapy treats the area of the prostate containing the clinically significant cancer rather than treating or removing the entire gland.

Techniques include:

• high-intensity focused ultrasound, or HIFU;
• cryotherapy;
• irreversible electroporation;
• other developing ablative treatments.

Because less of the prostate and surrounding tissue is treated, focal therapy may reduce the risk of erectile and urinary side effects in appropriately selected patients.

However, focal therapy is not suitable for every man. Prostate cancer is often multifocal, meaning that more than one area of cancer may be present. Careful MRI assessment and detailed biopsy are therefore important before treatment.

Patients should also understand that:

• cancer may remain elsewhere in the prostate;
• repeat focal treatment may be required;
• surgery or radiotherapy may later be necessary;
• long-term comparative cancer-control evidence is less mature than for established whole-gland treatments.

Current European guidance recognises the favourable functional outcomes of focal therapy but considers the quality of much of the evidence limited. It recommends that focal HIFU or cryotherapy should currently be delivered within a structured prospective registry.

What determines whether erections recover?

No single factor can predict recovery with certainty. The outcome usually reflects a combination of patient, cancer and treatment characteristics.

Erectile function before treatment

This is one of the strongest predictors.

A man who has regular, firm erections without medication before treatment has more potential function to preserve than someone who already has significant erectile dysfunction.

It is important to be honest when baseline function is assessed. Erectile recovery statistics based on younger men with excellent erections before surgery may not apply to an older man who already needs tablets or has inconsistent erections.

Age

Younger men generally recover better because their nerves, blood vessels and erectile tissue are usually healthier.

Age should not be viewed in isolation, however. A fit older man with good vascular health and strong baseline erections may have more recovery potential than a younger man with diabetes, smoking-related vascular disease or established erectile dysfunction.

Nerve-sparing

For surgery, preserving both neurovascular bundles generally offers the best probability of recovery.

Unilateral nerve-sparing can still allow erections to return, but the likelihood is usually lower. When neither bundle can safely be preserved, natural erectile recovery is much less likely, although erections can still be produced using injections, a vacuum device or a penile implant.

General health

Erections depend on healthy blood flow. Conditions that affect blood vessels and nerves can reduce both baseline function and recovery after treatment.

Important factors include:

• diabetes;
• high blood pressure;
• cardiovascular disease;
• raised cholesterol;
• obesity;
• smoking;
• physical inactivity;
• excessive alcohol consumption.

Optimising these factors is valuable for general health and may also improve the response to erectile dysfunction treatments.

The cancer itself

The position, size and extent of the tumour determine how closely the surgeon or radiation oncologist must treat areas near the neurovascular bundles.

Cancer control must remain the first priority. An apparently excellent functional result is not a successful outcome if cancer has knowingly been left behind.

Surgeon and centre experience

Radical prostatectomy is technically demanding, and functional outcomes vary between surgeons and centres.

Experience alone does not guarantee recovery, but a surgeon who performs the operation regularly is more likely to have developed consistent techniques for balancing cancer clearance with nerve preservation.

Patients should ask about the surgeon’s personal outcomes rather than relying only on general figures for robotic surgery.

Recovery statistics: what does “potency” mean?

Published erectile recovery rates vary widely.

One major reason is that studies define success differently. “Potency” may mean:

• any degree of erection;
• an erection firm enough for penetration;
• an erection achieved with tablets;
• an erection achieved without medication;
• successful intercourse;
• a particular score on a questionnaire;
• satisfaction for the man or couple.

A study reporting erections with the assistance of medication is measuring a different outcome from one reporting completely natural erections.

Follow-up time also matters. Results recorded six months after surgery cannot be compared directly with results at two or five years.

When patients are given percentages, they should ask:

• Were the men potent before treatment?
• What was their average age?
• Was nerve-sparing performed?
• Were tablets or injections included in the definition of success?
• How long after treatment was function measured?
• Was the figure produced by the treating surgeon or taken from a broader study?

Personalised estimates are more useful than a single headline percentage.

Erections, orgasm and ejaculation are different

Sexual recovery after prostate cancer treatment is not only about the firmness of an erection.

Erection, ejaculation, orgasm and fertility are separate processes. A change in one does not necessarily mean complete loss of the others.

What happens to ejaculation after prostatectomy?

After radical prostatectomy, the prostate and seminal vesicles are removed. These structures produce most of the fluid that makes up semen.

The vas deferens, which carry sperm from the testicles, are also divided as part of the operation. As a result, men no longer produce semen during orgasm.

This is known as anejaculation or a dry orgasm.

It is permanent. Even if erections recover fully, ejaculation will not return after radical prostatectomy.

Can a man still have an orgasm?

Many men can still experience orgasm after surgery because the nerves responsible for orgasm are not identical to those responsible for producing an erection.

However, orgasm may feel different. It may be:

• less intense;
• shorter;
• delayed;
• occasionally uncomfortable or painful;
• accompanied by leakage of urine.

Urine leakage during orgasm is known as climacturia. Some men may also leak urine during arousal or sexual activity. These problems can be embarrassing but should be discussed openly because management strategies are available.

Can the penis become shorter?

Some men perceive a reduction in penile length after radical prostatectomy. This may reflect anatomical changes after removal of the prostate, prolonged loss of erections, contraction of penile tissue or changes in body composition.

The degree varies, and not every man notices a meaningful change.

Can the shape of the penis change?

Scarring within the erectile tissue can occasionally contribute to curvature or a Peyronie’s-like change after treatment.

Any new curvature, painful erection or palpable penile lump should be assessed.

What happens to fertility?

Natural fertility is lost after radical prostatectomy because semen is no longer ejaculated.

Radiotherapy and hormone therapy can also impair sperm production and fertility.

Men who may wish to father children in the future should discuss sperm storage before treatment. This conversation must take place before surgery, radiotherapy or prolonged hormone therapy begins.

Current European guidance recommends discussing changes beyond erectile dysfunction, including reduced desire, altered orgasm, anejaculation, penile size changes and Peyronie’s-like problems.

What is penile rehabilitation?

Penile rehabilitation describes treatments introduced after prostate cancer therapy—most commonly after radical prostatectomy—to help a man resume sexual activity and support penile health while nerve function recovers.

A programme may include:

• PDE5-inhibitor tablets;
• a vacuum erection device;
• penile injections;
• counselling or psychosexual support;
• lifestyle and cardiovascular risk-factor management.

The biological rationale is that regular erections or increased blood flow may reduce prolonged low oxygen levels within the erectile tissue.

However, an important distinction must be made between:

1. helping a man obtain erections with treatment during recovery; and
2. increasing the eventual probability of spontaneous, medication-free erections.

Treatments can clearly help many men achieve usable erections. The evidence that any particular rehabilitation programme reliably restores natural erections is much less certain.

The European Association of Urology advises starting pro-erectile treatment early but states that evidence is insufficient to support one specific rehabilitation regimen. Its guideline also notes that PDE5-inhibitor rehabilitation has not been shown consistently to increase spontaneous erectile recovery.

A rehabilitation programme should therefore be personalised rather than presented as a guaranteed method of restoring natural potency.

Treatments for erectile dysfunction after prostate cancer

Erectile dysfunction after prostate cancer treatment is not a single-stage problem. Treatment can be adjusted according to the degree of nerve recovery, the man’s preferences and the response to previous therapies.

PDE5-inhibitor tablets

PDE5 inhibitors are usually the first treatment offered.

They include:

• sildenafil;
• tadalafil;
• vardenafil;
• avanafil.

These medicines enhance the normal erectile response by increasing blood flow into the penis. They do not automatically create an erection, and sexual stimulation is still required.

They generally work best when at least some nerve signalling remains. They are therefore more likely to be effective after bilateral nerve-sparing surgery than after complete removal of both neurovascular bundles.

A poor initial response does not always mean the medication will never work. After surgery, nerve recovery may be incomplete, and effectiveness can improve over time.

Common reasons for apparent treatment failure include:

• taking the medication incorrectly;
• inadequate sexual stimulation;
• taking sildenafil soon after a heavy meal;
• using an insufficient dose;
• trying the medicine only once or twice;
• expecting it to work before the nerves have begun recovering;
• profound testosterone suppression from hormone therapy.

PDE5 inhibitors must not be used with nitrate medication for angina because the combination can cause a dangerous fall in blood pressure. Suitability should be checked with the prescribing clinician.

NICE recommends offering PDE5 inhibitors to men who experience loss of erectile function after prostate cancer treatment and providing access to specialist erectile dysfunction services after radical treatment.

Vacuum erection devices

A vacuum erection device consists of a cylinder placed over the penis and a pump that creates negative pressure. This draws blood into the penis and produces an erection.

For sexual activity, a constriction ring can be placed around the base of the penis to help maintain the erection.

The erection may feel different from a natural erection. The penis may feel cooler, ejaculation may be restricted and some men experience bruising, discomfort or numbness.

The constriction ring should be removed within the period advised by the medical team or manufacturer; European guidance states that it should be removed within 30 minutes to avoid tissue injury.

A vacuum device may also be used without the ring as part of a rehabilitation programme.

Advantages include:

• no dependence on intact nerve signalling;
• avoidance of systemic medication;
• usefulness during the early postoperative period;
• the possibility of combining it with tablets.

Success often depends on appropriate instruction and practice rather than merely being given the device.

Intraurethral medication

Alprostadil can be administered into the urethra in selected patients.

It acts directly on the blood vessels rather than relying entirely on the cavernous nerves. It may therefore help when tablets are ineffective.

Possible side effects include penile discomfort, urethral pain, dizziness and a burning sensation.

Availability and individual suitability vary.

Penile injection therapy

Intracavernosal injection therapy involves injecting a small dose of medication directly into the side of the penis.

Although the idea of an injection can initially be daunting, the needle is very fine and many men find the process easier than anticipated once they have been properly taught.

The medication acts directly on the penile blood vessels and can create an erection even when nerve signalling is poor. This makes injections particularly useful after non-nerve-sparing surgery or when tablets have failed.

Potential complications include:

• penile pain;
• bruising;
• scarring;
• an erection lasting too long;
• priapism.

The first dose should usually be administered and taught under specialist supervision. The dose must be carefully adjusted, and men should know what action to take if an erection persists for an unsafe length of time.

Penile implants

A penile prosthesis may be considered when other treatments are ineffective, unsuitable or unacceptable to the patient.

The two principal types are:

• an inflatable implant;
• a malleable or semi-rigid implant.

An inflatable implant usually consists of cylinders placed inside the penis, a pump in the scrotum and a fluid reservoir. Activating the pump transfers fluid into the cylinders to create rigidity.

A penile implant does not restore natural nerve function, libido or ejaculation. It provides a mechanically reliable erection when required.

Implant surgery is generally reserved for men who have considered or tried less invasive treatments, although some men prefer it because it offers a definitive and predictable solution.

Penile prostheses have high reported satisfaction rates among appropriately counselled patients and partners. However, surgery carries risks including infection, mechanical failure and the possible need for revision.

Psychological and relationship support

Cancer treatment can alter a couple’s sexual relationship even when affection and commitment remain strong.

A man may avoid intimacy because he fears failure or embarrassment. A partner may avoid initiating sexual contact because they are worried about causing pressure, pain or distress. Each person may misinterpret the other’s behaviour as loss of attraction.

Open communication can help prevent this cycle.

Psychosexual counselling may assist with:

• anxiety about performance;
• adjustment to altered erections;
• loss of spontaneity;
• changes in orgasm or ejaculation;
• concerns about body image;
• partner communication;
• exploring sexual activity that does not depend on penetration.

Including a partner in consultations can be helpful when the patient is comfortable with this. Sexual recovery is often more successful when expectations, concerns and treatment preferences are shared.

Psychological support should complement medical treatment rather than be offered as an implication that the problem is “all in the mind”. Erectile dysfunction after prostate cancer treatment usually has genuine physical causes, but anxiety and relationship strain can amplify them.

What can men do before treatment?

The best time to begin discussing sexual recovery is before prostate cancer treatment starts.

Establish baseline function

Men should be asked about:

• the firmness and reliability of erections;
• whether medication is already required;
• the presence of morning erections;
• sexual desire;
• orgasm and ejaculation;
• relationship and sexual priorities.

This provides a realistic starting point against which recovery can later be assessed.

Optimise general health

Measures that support cardiovascular and erectile health include:

• stopping smoking;
• controlling diabetes;
• treating high blood pressure and raised cholesterol;
• maintaining a healthy weight;
• increasing regular physical activity;
• reducing excessive alcohol consumption;
• reviewing medications that may affect erections.

Erectile dysfunction can sometimes be an early marker of cardiovascular disease. New or unexplained ED should therefore not automatically be attributed to prostate cancer.

Discuss fertility

Men who may wish to have biological children should ask about sperm storage before treatment.

Ask whether nerve-sparing is appropriate

The useful question is not simply, “Will you spare my nerves?”

A more realistic discussion is:

• Is nerve-sparing oncologically safe in my case?
• Is bilateral or unilateral nerve-sparing expected?
• Could the surgical plan change during the operation?
• What are your own erectile outcomes for men similar to me?
• Do your published figures include medication-assisted erections?

Questions to ask your prostate cancer team

Patients may find it helpful to ask:

• What is my erectile function likely to be after each suitable treatment?
• How will my age and current erectile function affect recovery?
• Is my cancer suitable for nerve-sparing surgery?
• Are you expecting to preserve both nerve bundles or only one?
• What do your recovery statistics mean by a successful erection?
• Does your figure include the use of tablets?
• How might radiotherapy and hormone therapy affect my libido and erections?
• When will erectile dysfunction treatment begin?
• Who will supervise my penile rehabilitation or ED treatment?
• What happens if tablets do not work?
• Will I still be able to have an orgasm?
• Will I ejaculate after treatment?
• Should I consider sperm storage?
• Is psychosexual support available for me and my partner?

These questions are not a distraction from cancer care. They are part of choosing the treatment that offers the right balance between cancer control and quality of life.

When should you seek further help?

Men should ask for specialist help when:

• erectile function is causing distress;
• tablets have not worked despite being used correctly;
• there is penile pain or new curvature;
• orgasm is painful;
• urine leakage during sex is troublesome;
• libido remains very low after hormone treatment;
• treatment is affecting a relationship;
• there has been no review of erectile function after treatment;
• a man wishes to consider injections or an implant.

Men should not be expected simply to accept erectile dysfunction as an unavoidable consequence of cancer treatment. NICE recommends access to specialist erectile dysfunction services following radical prostate cancer treatment.

Key takeaways

Prostate cancer itself rarely causes erectile dysfunction when the disease is localised. Erectile difficulties more commonly result from treatment because the nerves and blood vessels involved in erections lie close to the prostate.

Surgery, radiotherapy and hormone treatment affect sexual function in different ways:

• Surgery usually causes an immediate decline, followed by gradual and uncertain recovery.
• Radiotherapy may preserve function initially but can cause progressive deterioration over time.
• Hormone treatment often reduces sexual desire as well as erectile capacity.
• Active surveillance avoids or delays the immediate effects of radical treatment.
• Focal therapy may reduce side effects in selected men, but long-term comparative evidence remains less established.

Recovery after surgery depends heavily on age, erectile function before treatment, general health and whether one or both neurovascular bundles can safely be preserved.

Even expert bilateral nerve-sparing surgery cannot guarantee natural erections.

Penile rehabilitation and early ED treatment can help men resume sexual activity, but no single programme has been shown to restore spontaneous erections reliably in every patient.

Erectile dysfunction is treatable. Tablets, vacuum devices, injections and penile implants allow many men to regain useful and satisfying sexual function, although this may not always be the same as their function before treatment.

Finally, sexual function is broader than erections. Men should also be counselled about changes in libido, ejaculation, orgasm, fertility, penile length or shape and urinary leakage during sexual activity.

Early, open discussion gives patients the best opportunity to choose treatment with realistic expectations and to receive appropriate support throughout recovery.

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Frequently asked questions

Further information and support

Prostate Cancer UK’s information about erectile dysfunction provides additional patient support and practical information about living with erection problems after treatment.

The British Association of Urological Surgeons also provides patient information about erectile dysfunction treatment options

Patients considering surgery may also wish to read the BAUS patient information about robotic-assisted radical prostatectomy

Speak to a prostate cancer specialist

Choosing between active surveillance, surgery, radiotherapy and other treatments can be difficult—particularly when you are trying to balance cancer control with urinary and sexual quality of life.

I offer private consultations and second opinions for men who would like a clear, personalised explanation of their diagnosis and treatment options.

Book a private consultation

Request a prostate cancer second opinion

Call: 07841 048975

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This article provides general information and does not replace personalised advice from a urologist, oncologist or erectile dysfunction specialist. Treatment suitability and recovery prospects depend on the individual patient, the characteristics of the cancer and the treatment required.