The Most Common Side Effects of Prostate Removal (Prostatectomy) and Radiation

Prostate cancer treatment is lifesaving, but it may come with several side effects. Some types of treatment, like surgery or radiation therapy, can affect organs that are near the prostate — like the bladder or bowel. 

Knowing the side effects of different treatments can help you come up with a plan for how to manage your symptoms. Let’s take a look at the most common side effects and what you can expect from your treatment plan. 

What are common side effects of prostate removal (prostatectomy)?

Prostate removal (prostatectomy) is a surgical procedure that helps treat prostate cancer. This surgery may lead to bladder problems and sexual dysfunction. 

Removing the prostate also removes the cancer cells inside the prostate. But the prostate is located deep inside the pelvis. It’s next to important structures that control bladder and bowel functions as well as the ability to achieve and maintain an erection. Sometimes these structures can get injured during a prostate removal. This can happen even if your surgeon is very skilled because the structures are so close to the prostate. 

Damage to these structures can lead to side effects. Let’s take a closer look.

Urinary dysfunction

Urinary dysfunction means problems with urination (peeing). This is a common side effect of prostate removal surgery (prostatectomy) and radiation therapy. 

Symptoms of urinary dysfunction include:

• Pain or burning when urinating

• Waking up during the night to go to the bathroom 

• Feeling like you need to go to bathroom more often 

• Bladder leakage, or dribbling urine when you don’t mean to

• Urinary incontinence, or not being able to hold in your urine

When the prostate is removed, the bladder changes position in the body. The muscle band around the urethra can also get damaged during surgery. Because of these changes, your bladder can have trouble holding urine. 

Almost everyone who has prostate removal surgery has urinary dysfunction at first. But symptoms get better over time. After a year, only 1 in 10 people need to use pads for urine leaking and incontinence. 

Not being able to pass urine is not a “normal” side effect. If you have trouble urinating, you should call your healthcare team right away. Trouble urinating can lead to infections and kidney damage. 

Sexual dysfunction

Sexual dysfunction is one of the most common side effects of prostate cancer treatment. Sexual dysfunction can mean:

• A lower sex drive

• Trouble getting or maintaining an erection

• Trouble achieving orgasm

These symptoms happen because treatment can damage the nerves, hormones, and blood vessels that control the ability to have and maintain an erection. This can happen with prostate removal surgery, radiation treatment, and hormone therapy. 

The good news is there are a lot of treatment options available for sexual dysfunction. This includes medications and medical devices that can help you achieve an erection. 

Fertility

The prostate plays an important role in male fertility. Without a prostate, it’s very unlikely that you will be able to conceive through sex. But there are treatments that can help you keep your fertility. 

You can choose to freeze and store your sperm before removing your prostate. If you want to have a child, your sperm can be thawed and used later with intrauterine insemination (IUI) or in vitro fertilization (IVF). 

If you didn’t store your sperm before surgery, you still have options. You can have a medical procedure that removes sperm directly from your testicles. The sperm is then injected into an egg as part of IVF. 

What are the side effects of prostate radiation?

Radiation is an important tool for prostate cancer treatment. But, like prostate cancer removal, it can cause trouble with bladder and bowel function. It can also affect sexual function and fertility. 

Radiation therapy kills cancer cells, but it can damage regular cells too. Healthcare teams do their best to make sure radiation treatment remains as close to the prostate as possible. But since these structures are also close to the prostate, they can’t completely avoid the radiation that’s directed at the prostate. 

Most side effects from radiation go away over time. Only 5% of people develop long-term side effects from radiation therapy for prostate cancer. Let’s review common side effects from prostate radiation.

Urinary changes

The most common symptoms from radiation treatment are having to go to the bathroom more often and waking up to go to the bathroom. People also experience urgency. This means that they may feel the sudden need to pee and feel like they can’t hold it in. 

Some people also notice that their urine stream is weaker. Others feel like they can’t completely empty their bladder when they go to the bathroom. 

These symptoms will fade after you finish treatment. Only 1% of people develop urinary leakage or incontinence from radiation treatment. 

Bowel dysfunction

Bowel dysfunction describes problems with passing stool. During radiation, you may experience some or all of the following:

• Diarrhea

• Loose stools

• A feeling that you can’t hold in your stool

• Bleeding in the stool

• Rectal irritation or inflammation

But these symptoms won’t last long. The bowels recover from radiation, and severe symptoms aren't common. 

Erectile dysfunction

Like prostate removal, prostate radiation can cause erectile dysfunction (ED). But radiation is less likely than surgery to affect your ability to achieve or maintain an erection right away. 

Studies show that people who got radiation were less likely to have ED within the first 5 to 10 years after treatment when compared to people who had prostate removal. After 15 years, the rates of ED were similar in people who had radiation or prostate removal. 

But ED doesn’t always after radiation therapy. Newer radiation techniques are less likely to damage blood vessels around the prostate, so people are able to achieve and maintain erections. 

Tips for recovery after prostate cancer treatment

The side effects of prostate cancer treatment can be overwhelming. But remember, many symptoms will get better over time as your body heals from cancer and treatment. In the meantime, there are a lot of great treatment options that can help you manage symptoms. 

Treatments for urinary dysfunction

To help with urinary symptoms, your healthcare team may recommend:

• Pelvic floor muscle exercises: These exercises can help lessen bladder leakage after surgery. A physical therapist can teach you the right way to do these exercises.

• Alpha blockers: These medications work by relaxing the muscles around your bladder so it’s easier for you to pass urine. 

• Anticholinergic medications: These medications relax your bladder so you don’t feel like you have to go to the bathroom all the time.

If these options aren’t enough to help your symptoms, your healthcare team might recommend:

• Collagen injections: These tighten the urethra, making it more difficult for urine to leak through. 

• Sling surgery: A surgeon places a silicone band under the urethra, which relieves pressure on the bladder. This can help lessen bladder leakage. Because surgery is invasive, it’s important to talk with your healthcare team about risk and benefits. 

Treatments for bowel dysfunction

To help with symptoms of bowel dysfunction, your healthcare team may recommend:

• Avoiding foods that can irritate your bowels

• Taking antidiarrheal medications

• Getting more fiber from fruits and vegetables

If you have persistent rectal bleeding, your team may recommend laser therapy. Laser therapy will scar the blood vessels in your rectum so they stop bleeding. 

Treatments for sexual dysfunction

There are many options to help with sexual dysfunction:

• Medications: Sildenafil (Viagra) and tadalafil (Cialis) relax the muscles in the penis. This lets more blood flow to the penis so you can maintain an erection. 

• Pumps: Mechanical devices like pumps work by pushing blood into the penis and then letting it out after sex. 

• Implants: A penile implant is a medical device that helps you have an erection. It works by filling a tube with fluid, which pulls the penis up and creates an erection. An implant requires surgery. So it’s important to talk with your healthcare team about the risks and benefits of surgery. 

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Written by:

Shiv Sudhakar, MD

Shiv Sudhakar, MD, is a fellow of the Infectious Disease Society of America and works as a physician in California. He has co-authored over 10 peer-reviewed research articles, published several short stories, had a script recently optioned, and presented 20 scientific presentations, two of which placed in the top 3 at the American College of Physicians.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Brandon R. Mancini, MD, MBA, FACRO

Brandon R. Mancini, MD, MBA, FACRO, serves as medical director at BAMF Health in Grand Rapids, Michigan in the emerging field of theranostics. His primary clinical focus is on the treatment of people with metastatic prostate and neuroendocrine cancers.

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