‘Princess Bride’ Star Mandy Patinkin, 70, Was Worried Prostate Cancer Surgery Would Affect Sex Life Understanding the Potential Side Effects

The Emmy and Tony Award-winning actor and singer, perhaps best known for his portrayal of Inigo Montoya in “The Princess Bride,” was diagnosed with prostate cancer in 2004 at age 51 around the same age his father passed away from pancreatic cancer about 30 years prior.

Thankfully his cancer was discovered early on, and Patinkin underwent a successful radical prostatectomy surgery to remove his prostate gland entirely, including some of the tissue around it and the seminal vesicles (the glands that make most of the fluid for semen).

Prior to the surgery, the actor admitted he was worried about how it would affect his sex life. However, he told Coping Magazine that his doctor said to him, “The most important thing to attend to is that we get rid of the cancer.

“That is our number one job.  You'll be able to have a sexual life. You'll be able to function. You might have to adjust to some changes, but you'll be fine.”

Following his doctor’s confidence in the surgery and attempt to offer Patinkin comfort, the father of two understood.

Patinkin, who recovered well from his surgery and beat cancer, said, “What's more important, having a sex life or getting rid of cancer?”

“Ever since I got cancer and went through the surgery and recovered. I've realized that aside from my wife and children, cancer was the greatest gift I was ever given,” he explained.

“I always appreciated my life, my wife, my kids, my music, the fact that I get to do what I love. But I took my life for granted. I would say I didn't, but I did. I was kidding myself,” Patinkin continued.

RELATED: Mandy Patinkin Gives Solid Relationship Advice With Beloved Wife of More Than 40 Years: How Couples Can Stay Strong Through Cancer

“And after cancer, every day, including this second while I am talking to you, is precious to me every sunrise and sunset, every walk in the park, every visit with my children, every time I hold my wife, every time I get to perform.”

Following his cancer battle, Patinkinwho often shares uplifting videos of him and his wife on Instagramchanged his mantra to just “be happy,” and admitted he was “so very aware” that he could have a long life.

SN & You: Discussing Sex and Sexuality After Cancer

Referring to the thought of turning 100 years old one day, he said, “I hope I do. I probably will never die from prostate cancer; I don't have a prostate anymore. But I know that life could be over in 5 seconds, or 50 minutes, or 50 years. I just hope I get 50 years rather than 50 minutes.”

Sex Life After Prostate Cancer

Many men battling prostate cancer, like Mandy Patinkin, wonder about how the disease will affect their sex lives. Our experts want you to know that yes, you can have a good sex life after prostate cancer treatment.

RELATED: Sex Is Possible After Prostate Cancerand 5 Other Facts You Should Know

It’s important to know that a large percentage of men suffer from problems in the bedroom, or sexual side effects, as a result of treatment (radiation or surgery). Some men may also have trouble maintaining an erection, while others can no longer have an erection at all.

Erections are controlled by nerves on either side of the prostate. If the cancer is anywhere near that area, the surgeon will need to take them out. In this case, a man would not be able to have what are called spontaneous erections.

“There are neurovascular bundles on the back of the prostate, and they are responsible for erection,” Dr. Ethan Halpern, co-director of the Prostate Diagnostic Center at Jefferson University Hospitals and researcher at the Sidney Kimmel Cancer Center in Philadelphia, told SurvivorNet in an earlier interview.

If those bundles are destroyed in the ablation (surgery) process, impotence will occur.

A Healthy Sex Life Is Possible Following Prostate Surgery

However, there are ways men can return to being sexually active, Dr. James Brooks, Chief of Urologic Oncology at Stanford Medicine, told SurvivorNet in a previous interview.

If You Have a Family History of Prostate Cancer, Get Screened Early

“Prostate cancer can require couples to think more broadly about their intimacy,” explains Dr. Brooks, who suggests men talk about their situation with their urologist and perhaps seek counseling with a sex therapist.

Younger men tend to bounce back more quickly after surgery in the erection department. Sometimes it can take up to two years to be able to have a natural erection.

If your ability to have erections does return after surgery, it often returns slowly. In fact, it can take from a few months up to 2 years. During the first few months, you will probably not be able to have a spontaneous erection, so you may need to use medicines or other treatments.

There are several options for treating erectile dysfunction:

Phosphodiesterase-5 (PDE5) inhibitors such as sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis), and avanafil (Stendra) are pills that can help with erections. However, these drugs won't work if both nerves that control erections have been damaged or removed.

Mechanical pumps are also used to help a man's impotence. The air is sucked out of the pump, which directs blood flow into the penis. A strong rubber band is placed temporarily at the base of the penis when the pump is removed, then the band is removed after sex.

Some men have had success with penile implants. An operation is needed to put these silicone rods or other inflatable devices inside the penis.

Treating Prostate Cancer

Two of the most common treatments for prostate cancer include surgery and radiation. Dr. Stephen Freedland, a urologist at Cedars-Sinai Medical Center, told SurvivorNet that, ten years after prostate cancer treatment, most patients have similar results with surgery as they do with radiation.

Dr. Stephen Freedland On Deciding Between Surgery & Radiation For Prostate Cancer

What this means, in part, is that deciding on surgery versus radiation is a choice that often falls to the patient.

Dr. Freedland shared that doctors will often have their own biases regarding which treatment method they prefer, so a lot of men will benefit from seeking second or third decisions before choosing radiation versus surgery.

The surgery to treat prostate cancer usually involves removing part or all of the prostate gland, like Patinkin underwent.

“It's a big operation," Dr. Freedland said, explaining that it's usually done either through a minimally invasive robotic technique called “laparoscopic” surgery, or through a longer incision that's made from the belly button down to the pubic bone.

“Nowadays, the minimally invasive approaches are really standard procedure for most surgeries,” Dr. James Brooks, a urologic oncologist at Stanford Medicine, previously told SurvivorNet.

With the minimally invasive method, he said, patients usually have less blood loss and better recovery rates.

The procedure tends to require at least a one night's stay in the hospital, and then once home, Dr.Brooks said, “it's really just recovering, gaining your strength back.” During the recovery period, a catheter usually remains inserted, which can come out about 10 days after the surgery.

“Whether you have [the surgery] open or robotic, I tell patients it's probably a good month or so until you're really back to yourself,” Dr. Brooks said.

Types of Treatment

• Radical prostatectomy: The most common type of surgery for prostate cancer is a radical prostatectomy, where the surgeon removes the entire prostate gland, including some of the tissue around it, and the seminal vesicles, which are glands found in the male pelvis.
• An open prostatectomy is a traditional approach to surgery, where the surgeon operates through a single long skin incision (cut) to remove the prostate and nearby tissues.
• In a laparoscopic prostatectomy, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate directly, or controls robotic arms to hold the tool. The surgeon either holds the tools directly, or uses a control panel to precisely move robotic arms that hold the tools.
• During a radical retropubic prostatectomy, which is an open operation, the surgeon cuts from the belly button to the pubic bone.
• And of the less common surgeries is a radical perineal prostatectomy, where the surgeon cuts between the anus and the scrotum. This type of surgery is more likely to lead to erection problems However, it is a shorter operation usually with quicker recovery time.
• Radiation is also used to treat prostate cancer and help shrink tumors. Urinary issues and erection problems can also occur due to radiation therapy, along with bowel issues and fatigue.

It’s important to note the risks of a radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:

• Reactions to anesthesia
• Bleeding from the surgery
• Blood clots in the legs or lungs
• Damage to nearby organs
• Infections at the surgery site.
• Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.

If lymph nodes are removed during surgery, lymph fluid may form and need to be drained. In highly rare cases, a man can die due to complications with this surgery.

Sometimes with aggressive prostate cancer, you may have to make the decision between effectively treating the cancer or retaining sexual function. With "nerve-sparing surgery," you can attempt to reduce damage to the nerves outside the prostate gland, so the chance of retaining sexual function after surgery is a lot better.

"One of the terms that have become popularized with the treatment of prostate cancer is achieving the trifecta, which is being cancer-free, regaining your continence, as well as regaining one's ability to have an erection,” Dr. Jim Hu from Weill Cornell Medicine previously SurvivorNet, who elaborates on the trade-off.

MORE: Preserving Sexual Function Ask Your Surgeon About Nerve-Sparing Surgery

"In men with higher volume or more aggressive cancers, because these cancers may be right at the border of the prostate, or may sometimes spread beyond the capsule of the prostate, or outside … right outside the prostate capsule, of course, are these nerve fibers," he says.

“And so the real trade then becomes losing the ability to have erections versus curing the cancer. And if the patient tells me, look, if I lose my erections that's a deal breaker for me, because there's extenuating circumstances. They may be single. They're very sexually active. They may have a younger partner. In those instances, that patient may be best served by doing either active surveillance or even something called focal therapy.”

Active surveillance is an option to help men with low-risk disease avoid aggressive treatment. It includes the close monitoring of a patient's condition by looking for changes in test results. With this option, patients undergo certain exams and tests on a regular schedule.

Focal therapy refers to high-intensity focused ultrasound (HIFU), a relatively new treatment for localized prostate cancer that uses high-frequency ultrasound energy to heat and kill cancer cells.

Other Side Effects: Bladder Control Issues

Aside from erectile dysfunction, prostate cancer surgery may also lead to urinary incontinence, which can affect men as much emotionally as they do physically.

Having bladder control issues can hinder social activities, affect your confidence in a relationship, and obviously affect your sex life.

Unfortunately, doctors can't predict who will be affected in what way after surgery. Older men tend to have more bladder issues than younger men. Finding a highly skilled surgeon in your network is crucial in trying to diminish these side effects.

The good news is that bladder issues can often be treated, so it’s important for men to talk to your doctor about available methods.

Another big side effect of prostate cancer surgery is a change in orgasm where there may be no ejaculation of semen, referred to as a "dry" orgasm.” The orgasms can become less intense or go away completely.

Loss of fertility can occur, which is why it's important to freeze your sperm beforehand should you want childrenor more children.

There also can be a slight decrease in penis length, which can be due to a shortening of the urethra when some of it is removed during surgery.

These all can be devastating side effects to a man, and in addition to getting help from a doctor to help guide you through these issues and help find solutions for them, it is also imperative to talk to a mental health expert that can help you with the emotions that are associated with dealing with these issues.

Some of these treatments may not be covered by insurance and can be very pricey, so it is crucial to do your research and ask for resources from your medical team if you need financial help.

Since side effects of prostate cancer surgery can be daunting, SurvivorNet experts say that treatment will likely differ depending on which doctor or hospital you choose. The challenge for your oncology team is whether to treat and if so, how.

Contributing: SurvivorNet Staff

Learn more about SurvivorNet's rigorous medical review process.

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