The prostate gland
The prostate gland is a male sex organ and sits just below the bladder. The prostate's role is to secrete a clear fluid into the urethra during ejaculation. This forms up to a third of the semen that suspends the sperm and helps with their motility among other functions.
The prostate gland's role is to secrete a clear fluid into the urethra during ejaculation.
The prostate also contributes a muscle action to propel semen during ejaculation. A healthy prostate gland has a smooth, regular surface and is about the size of a walnut.
What is prostate cancer?
Prostate cancer is the most common non-skin cancer in men in the United States. There are an estimated quarter of a million new cases in the U.S. every year, according to information from the Cleveland Clinic and other sources. Tens of thousands of men die from the disease annually in the U.S.
According to the Centers for Disease Control and Prevention (CDC), most men who get prostate cancer are older than 65 years and do not die from it.
When a tumor of the prostate grows large enough, it can block the urethra, the outlet tube for urine.
Prostate cancer often produces no symptoms. When they do occur, they may include:
- Weak or intermittent urine stream
- Dribbling of urine
- A feeling of having not emptied the bladder fully or having to strain
- Blood in the urine
Cancerous cells from a prostate tumor can spread to other sites. This is rare, however, as most prostate cancers are slow-growing and do not spread.
The most common, slow tumors are known as acinar adenocarcinomas, and account for 9 in every 10 cases of prostate cancer, say Cancer Research UK.
Prostate cancer almost always occurs later in life. According to the Cleveland Clinic, up to 80 percent of men older than 80 years show signs of the disease after death. Many men have prostate cancer but die without a diagnosis.
Prostate cancer cannot be passed from one person to another, including via sex. It is not a contagious disease. It is not a sexually transmitted disease.
Prostate cancer and possible sex problems
Prostate cancer itself does not usually cause problems with sex for most men with the disease.
Most symptoms of prostate cancer relate to urine output. This is because the prostate gland begins to obstruct the urethra, the tube that carries urine out of the body. As well as changes to urine flow, there can be blood in the urine.
Many men with prostate cancer do not get any symptoms in the early stages of the disease. The first time many people know that they have prostate cancer is after other symptoms have been caused by the cancer spreading - to the bone, for example.
It is uncommon, but some men with prostate cancer do have erection difficulties related to the disease itself.
How does treatment for prostate cancer affect sex?
Prostate cancer itself does not usually cause problems with sex. However, it can be usual for men to feel depressed when going through cancer diagnosis and treatment.
Psychological problems surrounding cancer diagnosis and treatment can lead to sexual problems.
Worries about prostate cancer may mean less interest in sex or relationship stress. These problems should improve, and there can be support for psychological problems surrounding cancer.
There are many treatment options for prostate cancer, including just monitoring. Many men choose to monitor for any development that may need later active treatment. This approach for very slow-growing prostate cancer can be called "watchful waiting" or "active surveillance." It does not cause sex problems.
Active treatment of prostate cancer can lead to problems with sex. These therapies include:
- Radiation therapy
- Hormone therapy
Nerve supplies that help to control men's erections run close to the prostate gland. This raises the challenge of protecting the nerves from damage during treatment of the nearby prostate gland.
Surgery to completely remove the prostate gland is a risk for erectile dysfunction because of the potential nerve damage. This surgery is known as total prostatectomy or radical prostatectomy.
Radical prostatectomy is not appropriate for all men with prostate cancer. It is typically reserved for men who have more aggressive prostate cancer that is likely to grow or spread, and younger men.
The prostate gland can be surgically removed in a number of ways:
- Open surgery - the surgeon creates an opening in the belly or the area between the testicles and the anus
- Keyhole surgery - the prostate is removed via a small wound, and the surgeon is guided by a camera
Both options are similarly effective. Keyhole surgery may mean less bleeding and less time in the hospital than open surgery.
Keyhole surgery to remove the prostate gland can also be done with the help of a robot. Also known as da Vinci surgery, this is a more recent development in keyhole surgery for prostate cancer.
Nerve-sparing prostatectomy aims to preserve the nerves that control erections. This type of prostate cancer treatment reduces the risk of erectile dysfunction, but the risk of not fully treating the cancer also needs to be considered. There is a risk that some tumor may be left in place.
Nerve-sparing surgery is not possible in all cases. It depends on where and how severe the prostate cancer is.
Surgery is a risky treatment option for prostate cancer as it can lead to erectile dysfunction.
Biopsies are taken as part of any prostatectomy, and this enables the tissue to be examined in a lab. Biopsies may help to work out if cancer is only on one side of the prostate. If it is, the nerves on the other side may be spared.
Surgery is the riskiest treatment in terms of erectile dysfunction. Other options are also risky, including cryotherapy, in which probes are used to freeze prostate cancer cells.
Some decrease in erectile function can follow radiation therapy of the prostate. Erectile dysfunction may be less of a risk with the more focused radiation therapy called brachytherapy. This treatment involves implanting radioactive seeds into the prostate.
Hormonal therapy also carries the risk of erection problems, can cause loss of libido, and affect fertility. Treatments can also involve removing the testicles and antiandrogen drugs.
Fertility problems caused by prostate cancer treatment
Doctors may offer men the chance to store sperm before prostate treatment. Sperm banking is an option because different cancer treatments run the risk of making men infertile.
Not being able to father children may result from radiation therapy, surgery, or drug treatment.
If infertility does result from treatment and the man wishes to start a family, stored sperm can be used in artificial insemination or in vitro fertilization.
Sex life with prostate cancer
If erectile dysfunction does occur after prostate cancer treatment, a number of options are available to help with returning to normal sex function.
A loss of interest in sex may occur due to fatigue and other problems linked to prostate cancer and treatment. This can improve or disappear over time.
The number of men affected persistently by erectile dysfunction after prostate cancer surgery varies widely. Factors affecting likelihood include age and health before the operation.
Vacuum pumps, implants, and oral drugs are some of the treatments available to help men affected by erectile dysfunction.
A number of treatments are available to help achieve erections, including:
- Drugs taken by mouth, such as avanafil (Spedra), sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra)
- Cream applied to the penis - alprostadil (Vitaros) - and other locally active drugs such as injections and pellets
- Vacuum pumps specially designed to draw blood into the penis before sex
- Implants - options that are usually reserved for men who have had no success with drugs or treatments first
- Psychological support
A number of men talk on camera about their experiences of sexual dysfunction and prostate cancer at healthtalk.org.
Does sex raise the risk of prostate cancer?
A study published in European Urology sought to answer whether frequent ejaculating protects against prostate cancer.
The study was a follow-up of one that had found that more regular ejaculation seemed to cut prostate cancer risk. The new research involved almost 32,000 men and found that ejaculating more often lowered the chances of prostate cancer.
The researchers made changes to make sure that the results could not be explained by other factors. They add, though, that further work should be done because of the possibility that other factors aside from ejaculation could account for the results remained.
The researchers do not know how ejaculation might be working to protect against prostate cancer.
A number of possible biological mechanisms have been put forward. One theory known as prostate stagnation suggests that ejaculating less often allows potentially cancer-causing secretions to build up.