Prostatectomy side effects might not be a big deal for men who were already experiencing problems with urinary or sexual function because of their age, or those who quickly regained function after surgery. But for younger men or those left incontinent or impotent long-term, the effects can be devastating and life-altering.
Side Effects Catch Some Men Off Guard
Russ Maida underwent prostatectomy in May of 2018. His cancer was stage 1, he was 63 years old, and in otherwise good health at the time. His surgeon had performed thousands of these procedures.
Maida’s surgery went smoothly, but he was blindsided by its aftereffects. “I never expected that I would have zero ability to hold my urine,” he says. “I couldn’t hold it for weeks on end. It just ran out of me.” He wondered, “Am I going to be one of the ones [who deals with this for] the rest of my life?”
Realizing that other men were probably experiencing the same issues, Maida recorded a series of YouTube videos chronicling his recovery. The response was overwhelming. His videos have had close to 800,000 views and he still receives messages from men daily.
Though Maida recovered his sexual function relatively quickly and regained 99 percent of his continence by six months after surgery, many of the men he spoke with weren’t so lucky. Some told him, “It absolutely ruined my life. I can’t hold my urine. I can never have sex again,” he says.
While it’s standard procedure for surgeons to explain the possible side effects of prostatectomy during the pre-op consultation, men are often unprepared for what happens to them afterward. “It’s one thing to say, ‘You might have some erectile dysfunction, some urinary incontinence. It will resolve.’ But doctors can never say how this will feel to you,” says Vittorio Comelli, PsyD, a clinical psychologist and psycho-oncologist who works with cancer patients at UCSF Health in San Francisco. “There’s a lot of anxiety, a decrease in self-esteem, and depression” that follows prostatectomy, he says.
Losing the urinary control that you’ve had since early childhood can feel like an emotional regression, while erectile dysfunction suddenly brings your masculinity into question. “If someone had a history of being able to get reliable erections throughout their life and they are no longer able to, that can make them feel inadequate,” says Jennifer Litner, PhD, a certified sex therapist in Chicago, and founder of EmbraceSexualWellness.com.
Relationships After Prostatectomy
The cancer itself, as well as the sexual side effects that may follow prostate cancer treatment, can put a strain on even the most solid relationships. Some men find it hard to open up to their partner because they’ve been conditioned to hold their feelings inside. “There’s a lot of silence, there’s a lot of shame, and there’s a lot of suffering alone because it’s really difficult for men to talk about how this affects them,” says Dr. Comelli.
Losing erectile function can have an even more negative effect on gay men. It may stir up the trauma they experienced while coming out. “Some gay men have to completely shift their sexual identity in terms of their roles and sexual behavior, which has an added impact on their psychological life,” Comelli says.
But even if you do have sexual side effects, you and your partner don’t have to give up on that part of your relationship. An erection isn’t required to give and receive pleasure. You can achieve orgasm without getting hard or ejaculating.
“You’re still capable of having enjoyable and vibrant sex,” says Dr. Litner. “Maybe it’s going to look or feel different than it has in the past, but that doesn’t mean it’s going to be taken away.” If penetration isn’t possible, she suggests trying oral sex or exploring each other’s bodies with your hands. She stresses the importance of communicating with your partner as you explore new ways to be intimate.
Adapting to Life After Prostate Cancer Surgery
One of the hardest parts of life after prostate cancer surgery is the uncertainty. The erectile dysfunction and incontinence statistics your doctor gives you won’t necessarily reflect what will happen to you. Of course, having an experienced surgeon and being in the best possible health going into the procedure will give you better odds of having a positive outcome. But even with everything working in your favor, it’s going to take time for you to heal.
When you have realistic expectations going into the surgery, you won’t be shocked by the outcome. “Everybody’s going to have some side effects from this treatment. There’s no person who just breezes through this,” Comelli says.
Recovery from prostate cancer surgery is different for each person, and it doesn’t follow the same linear path as recovery from other types of surgery. You might stay dry for three days in a row, only to start leaking again. “It’s really important to understand that one has to tolerate uncertainty, be patient with the recovery, and get all the necessary supportive services that there are in the cancer world — including support groups and psychotherapy,” says Comelli.
Asking for Help
There are many types of resources and support available to help you cope after prostate cancer surgery.
Medications
If these treatments aren’t offered to you, ask your cancer surgeon or urologist about them.
Emotional Support
Emotional support is critical in the months following prostatectomy. That’s where your romantic partner can step in. “I’m not quite sure how I would have gotten through this without my wife,” says Eric Morrow, a retired military officer who underwent radical prostatectomy in 2021 at age 49. “In addition to the practical care she provided at home … she was there every step of the way to provide emotional support as well, and she still is.”
Whether you have a supportive partner or not, professional help is important, too. Most cancer centers have mental health providers on staff. Morrow sees a social worker for therapy once a month. “I talk to her about issues as they come up, and it’s been very helpful,” he says.
Therapy and Support Groups
Litner suggests that you also see a sex therapist if you have erectile dysfunction. The therapist can teach you how to relax, how to experience pleasure in different ways, and how to communicate more effectively with your partner. You can find a sex therapist through the Society for Sex Therapy and Research (SSTAR) or the American Association of Sexuality Educators, Counselors and Therapists (AASECT).
Another place to find support is at a prostate cancer support group. You can find them at some cancer hospitals and through organizations like the Prostate Cancer Foundation and ZERO Prostate Cancer.
Surrounding yourself with people who’ve been through the same treatment can break through the stigma and shame that may otherwise prevent you from opening up. “There’s a certain level of psychological healing that occurs when you’re participating in a group,” says Comelli.
Maida has been leading a prostate cancer support group every month for the last three years. “To me, support is the greatest thing in the world,” he says.
The Takeaway
Prostate cancer surgery can be a lifesaving — but also a life-changing — experience. Those changes will be easier to handle if you prepare ahead of time for what’s to come and get good support afterward.
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