Physical and Emotional Aftermath from Prostate Cancer Surgery
- Prostate cancer is often known as the slow-growing cancer that can can be treated easily if caught early. But even with an early diagnosis, the side effects from surgery can be difficult, and embarrassing for a man to deal with.
- Issues such as erectile dysfunction, incontinence (a lack of control of bladder function), or a change in a man’s penis length can arise. Shockingly, surgeons have told us they don’t always “counsel” their patients on this jarring side effect.
- Top urologists explain that a man’s penis size can indeed decrease after surgery, and they explain that nerve-sparing surgery can help reduce some of the other sexual side effects.
- Insurance may not always cover medication for erectile dysfunction or penile prosthesis to help with ED.
“It’s a question we get frequently. On average, it probably does get a little bit smaller,” Dr. Freedland says. “It’s always hard to predict in the individual person. We think it may relate to some scarring that occurs when the wound is healing … but it is a common complaint we get from people that the penis is shorter after surgery.”
Dr. Freedland says surgeons believe shrinkage is likely the result of surrounding skin being tightened during surgery. Researchers in Japan found that the reduction in size is likely to be greatest at 10 days after surgery, but that in many men the penis returned to its normal size by 12 months after surgery.
“For men that do lose some length after surgery, it’s not a lot of length,” he says. “But we don’t have good treatments to restore that length. So that’s something they need to be aware of.”
Types of Surgery
Thankfully, men have a number of treatment options for prostate cancer that has not spread to other parts of the body. The SurvivorNet resources on these options come from doctors with a variety of different approaches. It’s important to note that these doctors don’t always agree.
Surgery is one treatment option following a prostate cancer diagnosis, as long as the cancer has not spread outside the prostate gland. It is important to be aware of the different types of surgery and the risks that come with it. Active surveillance—where a patient’s condition is closely watched and they are not given any treatment—is an option for early-stage patients, but many men report that they just want the surgery to get the cancer out of them. That is why it’s imperative to know what you could be dealing with before making that decision.
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 toold. 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.
One 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.
Once the prostate is removed, a catheter (thin, flexible tube) will be inserted into your penis to help drain your bladder and will stay in for 1-2 weeks until you are healed. This procedure is performed while the patient is still under anesthesia. You may need to recover in the hospital for a few days, then take it easy with daily activities for the first several weeks.
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.
Risks of Prostate Surgery
The risks with any type of 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’s 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 tells SurvivorNet, who elaborates on the trade-off.
“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.”
As mentioned above, the major possible side effects of some of the more intense surgeries are urinary incontinence and erectile dysfunction, 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. Not being able to get a full or partial erection is even more detrimental on a man’s emotional and physical health.
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.
Treating Side Effects
The good news is that bladder issues can often be treated. Erectile dysfunction is more difficult to treat. Since 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.
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.
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 children—or 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 are all 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 frequent depression that is 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.