How to Have a Terrific Sex Life after Prostate Cancer

Dudley S. Danoff, MD, FACSWhen patients learn they have prostate cancer, they often fear that impotence is inevitable. In almost all cases, fear of impotence is totally unwarranted. It is true that the old surgical cure for prostate cancer left 60 to 80 percent of patients impotent since surgery damaged the vital nerve bundles that make erection possible. Today, however, the majority of men who undergo treatment for prostate cancer will still be able to enjoy an active sex life after treatment. Here’s how you can have a terrific sex life after prostate cancer.

Get Diagnosed Early

The most essential aspect of ensuring the preservation of normal life expectancy and a high quality sex life is the early diagnosis and prompt treatment of the prostate cancer. Early diagnosis of prostate cancer has an extremely high success rate of restoring prostate health and sexual function. If a prostate cancer has not extended beyond the prostate, prompt, early treatment offers a high percentage of disease-free survival. If you experience any of the following symptoms, you should seek an immediate urologic consultation:

  • A weak or interrupted urinary stream
  • Difficulty starting the urinary stream
  • The need to urinate frequently, especially throughout the night
  • Blood in the urine
  • Dribbling after you think you have completely emptied your bladder
  • Painful or burning urination (dysuria)
  • Persistent pain in the lower back, pelvis, or lower abdomen


Men over forty should have a yearly digital rectal examination by a qualified examiner, a PSA (prostatic specific antigen) blood test, and an ultrasonic-guided prostate biopsy, if needed, all key to getting an early diagnosis. Once a diagnosis of prostate cancer is made, a qualified urologist will be able to determine the stage of the cancer and help you decide what treatment is right for you.

Consider a Nerve-Sparing Prostatectomy

Many people don’t realize that the prostate is a secondary sexual organ and that you can perform perfectly well without it. Approximately 80 percent of patients who undergo today’s much advanced nerve-sparing prostatectomy emerge from their recuperation with their full sexual power intact.

This surgical procedure entails surgically removing the entire prostate gland as opposed to removing only the portion that obstructs urine flow. This is done by creating only a coin-sized incision. A laparoscope with the da Vinci robot avoids severing any muscle tissue, which is the key reason this surgical procedure has had especially good results with regard to maintaining erectile function. Based on the improved understanding of the anatomy of the neurovascular bundle (the packet of nerves and blood vessels that run like railroad tracks on both sides of the prostate and are essential for erectile function), the newest surgical techniques have made prostate surgery safe and effective.

Seek Help if You Need It

Despite the new and improved techniques, surgery is suitable only for those patients whose cancer is completely confined to the prostate gland without any evidence of extension beyond the capsule (outer shell) of the prostate or into the adjacent lymph nodes. And while the majority of those who undergo surgery will experience no side effects to their sexual functioning, a small percentage may experience difficulties post surgery. A good urologic surgeon will do everything possible to avoid damaging the nerves that are essential for sexual functioning (and with current techniques are often able to do so).

When it is absolutely necessary, the surgeon may make the choice to sacrifice sexual function to save your life. Even in this situation, further steps can be taken later to help restore any loss of function.
With the aid of oral erectile dysfunction drugs, injection therapy (prostaglandin-E1), or occasionally a penile prosthesis, you can still enjoy sex after prostate cancer and treatment. Modern technology has enabled medical professionals to help men who want to maintain their sex life do so. A discussion with your urologist will help determine the best fit for you to restore any loss of function.

As with any setback, attitude is vital. A man with a positive mind-set will find ways to continue enjoying his sexuality to the maximum extent possible. A man with a superpotent attitude can retain his sexual power regardless of his physical condition, even if he has to stretch his imagination and alter his sex habits.

Dudley Seth Danoff, MD, FACS, is a president and founder of the Cedars-Sinai Tower Urology Group in Los Angeles, a Diplomate of the American Board of Urology, a Fellow of the American College of Surgeons, and the author of two books on men’s health, including The Ultimate Guide to Male Sexual Health.