Common prostate cancer treatments include robotic-assisted radical prostatectomy (RARP), radiotherapy (with or without hormonal therapy), and focal therapy using either high-intensity focussed ultrasound, cryotherapy, or irreversible electroporation (NanoKnife).
The side effects differ depending on the treatment but the most common two are erectile dysfunction and urinary incontinence. When these occur, they can have a significant impact on physical health and comfort, emotional wellbeing, intimate relationships, and overall quality of life.
In this blog, we’ll explore these side effects, the prostate cancer therapies available, and how modern techniques are helping to deliver better outcomes for patients.
Robotic-assisted radical prostatectomy (RARP)
RARP is a minimally invasive surgery used to remove the prostate gland. This procedure is carried out using a state-of-the-art robotic system called the da Vinci Xi or SP. This system is controlled by a surgeon and allows for very precise movements.
Before robotic surgery was available, most patients had an open prostatectomy, which required making a large cut in the abdomen. Today, robotic techniques offer a less invasive option. For patients, this means less pain, smaller scars, shorter hospital stays, and faster recovery.
Many men who undergo RARP experience improved bladder control and better preservation of sexual function. With techniques like nerve‑sparing surgery and NeuroSAFE, many patients maintain good quality of life after treatment.
Robotic-assisted radical prostatectomy (RARP)
Magnetic resonance imaging (MRI) guided radiotherapy is a minimally invasive treatment for prostate cancer. It uses targeted radiation beams inside an MRI scanner to treat tumours. This treatment is delivered using the MRIdian MR Linac system, through our partnership with GenesisCare.
The MR Linac provides a special form of radiotherapy called stereotactic ablative radiotherapy (SABR). SABR is more precise than standard radiotherapy because it allows doctors to see the tumour in real time. If the tumour moves even slightly, the system automatically pauses the radiation until it is back in the right position. This helps protect the healthy tissue around the tumour.
By reducing damage to healthy cells, MRI‑guided radiotherapy lowers the risk of side effects, including those that may affect sexual function. The treatment is targeted, safer, and often more effective.
Focal therapy
One of the latest treatments for prostate cancer – which has the lowest risk of urinary incontinence, erectile problems, and requires no hormonal therapy – is called focal therapy.
This is a term for three different treatments, all of which target the cancerous areas within the prostate while leaving the healthy tissue untouched. They are all delivered as a day case treatment, meaning no overnight stay is required.
Depending on the cancer’s location, your surgeon will either choose to use high-intensity focussed ultrasound (HIFU), cryotherapy, or NanoKnife (irreversible electroporation):
- HIFU is a minimally invasive treatment for localised prostate cancer. It uses high‑frequency sound waves to heat and destroy cancer cells.
- Cryotherapy (also called cryoablation) is a minimally invasive treatment that freezes and destroys prostate cancer cells. Instead of removing the prostate or using radiation, it uses extremely cold gases to destroy the tumour.
- NanoKnife (irreversible electroporation or IRE) is a minimally invasive, non‑thermal treatment for localised prostate cancer that uses short electrical pulses to destroy cancer cells while preserving surrounding healthy tissue.
Research shows that these treatments may cause fewer problems with erections and urination than other treatments, such as surgery to remove the prostate or radiotherapy.
Erectile dysfunction and loss of libido
Erectile dysfunction is when a man cannot get or maintain an erection for sexual activity. Research from Prostate Cancer UK shows that about 76% of men treated for prostate cancer experience some level of erectile dysfunction.
Erectile dysfunction can occur with any type of treatment but more often occurs as a side effect of RARP and radiotherapy. This is because the nerves that control erections, which sit at the sides of the prostate, are more likely to become damaged.
Modern robotic surgery and new techniques have improved the ability to save the nerves; however, it is often the cancer itself that dictates whether the nerves can or cannot be saved. Even with nerve-sparing techniques, nerves can still be harmed during the operation due to their delicate nature.
If damage does occur, men may have temporary or long‑term trouble with erections. Fortunately, erectile dysfunction often improves over time; medications, in addition to the use of a vacuum pump, can help. Most men notice progress within the first year, and many see major recovery within two years. The early treatment of erectile dysfunction can support both physical and emotional recovery.
Patients also develop erectile dysfunction due to not wanting sex and a loss of libido. This often occurs in those who are having hormonal therapy as part of their treatment. Hormonal therapy can both reduce testosterone in the body and suppress its effects, leading to hypogonadism (low testosterone). Men with low testosterone lose their interest in sexual activity, which can lead to erectile problems, feelings of loneliness, low self‑confidence, and stress.
Urinary incontinence
Urinary incontinence is when your bladder leaks urine, requiring the use of a continence pad. It is a common problem after prostate cancer surgery.
During surgery, a long, flexible tube called a catheter is placed to help urine drain during recovery. Once removed, usually a week following surgery, many men have temporary trouble controlling their bladder. This is because the pelvic floor muscles, which play an important role in stopping urine leakage, may be weakened post-surgery. Practising daily pelvic floor exercises before and after surgery can help reduce leakage.
Leakage also occurs more commonly in men who are overweight. Reducing body weight, doing more exercise, and improving diet before surgery may help reduce the occurrence of both urinary leakage and erections – this is called prehabilitation.
Most men will regain bladder control as they heal. Some may need extra help, such as bladder training exercises and medications. In rare cases, some men will need another procedure to strengthen the area. However, with proper support and treatment, most men see major improvement in their symptoms.
Support for side effects of prostate cancer treatment
At Cromwell Hospital, we support men throughout their prostate cancer treatment and recovery. This includes helping manage side effects that can impact on quality of life. Our team offers several treatments to help restore sexual function and confidence, including:
- Oral phosphodiesterase type 5 (PDE5) inhibitors – medications that improve blood flow to the penis during sexual arousal. They work by helping the blood vessels function better.
- Intra‑cavernosal injections (ICI) – injections into the penis that increase blood flow. This helps men maintain erections.
- Intraurethral suppositories or topical alprostadil – medicines placed inside the urethra or applied to the skin. They improve blood flow and support erections.
- Vacuum erection devices (VED) – external pumps that draw blood into the penis. This helps achieve and maintain an erection.
- Penile implants – devices, surgically placed inside the penis, that allow men to have an erection. They are used when other treatments do not work.
Each treatment plan is personalised to meet the needs of the individual. Our specialists work closely with patients to ensure they receive the most appropriate and effective support.
Cromwell Hospital is also partnered with Prostate Cancer UK, a leading men's health charity. Our shared mission is to empower every man with the knowledge and confidence to understand their risk, and to support those with a diagnosis to navigate their cancer journey.
