Surgery involves the removal of the entire prostate gland for men whose cancer has not spread (localised prostate cancer). The side effects from surgery relate to physical changes to that area of your body after the prostate gland has been removed. Learning about the possible side effects from surgery is particularly important because some of them are permanent. The main side effects from surgery include:
Temporary or ongoing incontinence
The removal of the prostate gland may affect your ability to control the bladder. This is because the prostate gland surrounds the urethra, the tube through which urine passes from the bladder. Urine is controlled at the bladder neck and by the urinary sphincter, both of which are located very close to the prostate and can be compromised during the surgery. When the urinary sphincter is affected, people can experience ‘stress urinary incontinence’ – losing control of bladder during physical activities (e.g. exercising) or reactions (e.g. coughing, sneezing). Improvement should occur over a few months, but if you are still troubled by 6 months, then further treatment can help. Talk to members of your healthcare team if you are concerned.
- Soon after surgery, when the catheter is removed, it is common to need to wear a pad, but any incontinence should improve over time, particularly if you perform pelvic floor exercises (PFEs) regularly. It is also important to perform these prior to surgery. Talk with a continence nurse or physiotherapist for information on pelvic floor exercises.
- Use of pads could help with concerns you might have when in public. A continence nurse can offer suggestions about the best products for your needs. Information is also available through the Continence Foundation of Australia.
You may have some erectile difficulties after the surgery. How long this will last depends on your age and your erectile function before surgery. The nerves that enable you to have an erection are on either side of the prostate. If cancer has not grown near the nerves, a ‘nerve-sparing operation’ can be performed when removing the prostate. This improves the chance of you regaining your ability to have an erection naturally. However, if these nerves are removed, erectile difficulties may be ongoing or permanent. Treatments are available that can help, and if you are troubled, you should talk to your healthcare team.
- Medications: Some medications in tablet and injectable forms can manage erectile difficulties. Because these medications can have side effects, you will be told if they are suitable for you.
- Devices/implants: If you don’t want to use medications, vacuum devices that draw blood into the penis (e.g. vacuum erection device) or the use of penile implants (e.g. flexible rods or inflatable tubes, as pictured) could be ways of getting an erection.
- Think about other ways that you could enjoy sex without penetration (e.g. oral sex, kissing, masturbating your partner).
- Talk with your partner about what feels good for you and to ask what feels good for them.
- Ask for a referral to a professional or service that specialises in sexuality matters.
Change in penis size
A possible side effect from surgery is a reduced length and width of the penis, while erect and/or flaccid/soft.
- Talking with a health professional such as a psychologist, social worker or qualified counsellor can help you manage your feelings about changes to the appearance of your penis. You will be given strategies to help reduce the impact these changes have for you.
Surgery for treating prostate cancer causes infertility. If this is an issue for you now or may be in the future, ask your doctor or a member of your healthcare team for information about what can be done before the surgery, particularly in regards to sperm banking.
- If fertility is important for you, consider procedures such as sperm banking before the surgery. This will store sperm so that fathering a child is possible in the future.