After Treatment for Prostate Cancer

People on hormone therapy, also called androgen deprivation therapy (ADT), might experience anemia or low red blood cell counts. People on these treatments might have their blood counts checked once a year.

Anemia may need to be treated if symptoms develop. Symptoms of anemia can include low energy, weakness, shortness of breath, dizziness, pale skin, or palpitations.

Hormone therapy, also called androgen deprivation therapy (ADT), radiation treatments, and prostate cancer that has spread to the bones can cause bones to weaken, increasing the risk of fractures.

Your cancer care team might recommend a DEXA scan to check the health of your bones after treatment. If the test shows you have a high risk of a fracture or you have already had a fracture, treatment with medications that strengthen the bones may be recommended.

For all survivors, experts recommend a diet that includes vitamin D and calcium to support good bone health. Weight-bearing exercises, such as walking, dancing, climbing stairs, and tai chi, can put good stress on the body, which helps the muscles and bones to strengthen.

For more information on bone health after treatment, see Osteoporosis.

Surgery or radiation treatments in the pelvic area can damage the nerves of the bowel. When this happens, you may develop changes in bowel habits, bowel leakage, or bleeding.

Establishing a regular bowel routine may help if you have trouble emptying your bowels, leakage, or hemorrhoids. This can include setting a bathroom schedule, making changes to your diet, or medication. Talk to your healthcare team to find out what might help you.

If you experience rectal bleeding, it is important to speak to your healthcare team to find a cause. Bleeding can be a sign of cancer or another health problem. People who have been treated with radiation to the rectum are at a higher risk of colorectal cancer.

See Bowel Incontinence for more information.

Hormone therapy, also called androgen deprivation therapy (ADT), can impact the health of your heart and blood vessels.

After prostate cancer treatment, your healthcare team should monitor you closely for other health problems such as high cholesterol, diabetes, and high blood pressure, because these can also affect the health of your heart.

Surgery to remove the prostate increases the risk of developing an inguinal (groin) hernia in the future. This is because surgery in this area can weaken the abdominal wall.

This is a rare complication of removing lymph nodes near the prostate. When nodes are removed, fluid may build up in the legs or genital region, causing swelling and pain.

It can be treated with physical therapy but may not go away completely.

See Lymphedema for more information.

People who’ve had prostate cancer can still get other cancers (known as second cancers). Certain factors, such as radiation treatment, age, and family cancer syndromes, can impact your individual risk for a second cancer.

Second cancers in survivors of prostate cancer can include:

• Small intestine cancer
• Soft tissue cancer
• Bladder cancer
• Thyroid cancer
• Melanoma of the skin
• Rectal cancer
• Acute myeloid leukemia (AML)

In most cases, no additional testing is recommended to look for second cancers in people who’ve had prostate cancer. Still, it’s important to let your doctor know about any new symptoms or problems you have, because they could be caused by the prostate cancer coming back, or by a new disease or second cancer.

Surgery to remove the prostate, radiation therapy, and hormone therapy can affect sexual health.

Erectile dysfunction

If the nerves that cause erections are damaged or removed, you can experience erectile dysfunction. If you were able to have erections prior to treatment but are no longer able, talk to your healthcare team about your symptoms. Medications or aids such as penile pumps or implants might be an option.

See How Cancer Can Affect Erections for more information.

Changes in orgasm and sexual desire

People treated with surgery, radiation, hormone therapy, or a combination might experience changes in orgasms and sexual desire after treatment.

The prostate gland is responsible for producing most of the liquid in semen. If the prostate gland has been removed, an orgasm may be “dry.” This means no liquid may come out of the penis at the time of the orgasm, but the sensation may still be felt. Some people report less intense orgasms after removal of the prostate gland. Less commonly, some people experience pain with orgasm.

People treated with hormone therapy (androgen deprivation therapy, ADT) might experience low sexual desire, low mood, or difficulty achieving an erection or orgasm.

See How Cancer Can Affect Sexual Desire in Men for more information.

See How Cancer Can Affect Ejaculation and Orgasm for more information.

Impacts on fertility

When the prostate is removed surgically, the surgeon also cuts the vas deferens, which is the pathway between the testicles (where sperm are made) and the urethra (through which sperm leave the body). Your testicles will still make sperm, but the sperm can’t leave the body when you ejaculate. This means you can no longer have a biological child through sex.

If this is a concern for you, talk with your cancer care team about fertility preservation prior to surgery.

Change in penis length

A possible effect of surgery is a small decrease in penis length. This can result from an inability to get an erection or a shortening of the urethra when a portion of it is removed along with the prostate.

After surgery or radiation treatments, you may not be able to control your urine, or you might have leakage or dribbling. There are several types of incontinence.

• Stress incontinence: Urine might leak when coughing, laughing, sneezing, or exercising. This type of incontinence is most common after surgery. Surgery for prostate cancer can injure the nerves of the valve that closes to keep urine in the bladder.
• Overflow incontinence: This happens when the bladder is too full and leaks urine because the bladder cannot empty completely. People with this condition often take a long time to urinate and may have a weak or dribbling urine stream. After surgery or radiation, a blockage or narrowing of the lower bladder or urethra (the tube that carries urine from the bladder to outside the body) might cause this.
• Urge incontinence: A person may have a sudden need to urinate. This happens when the bladder becomes too sensitive to being stretched as it fills. This is more common after radiation treatment.

Bladder control often improves with time, but some people may continue to have bladder control problems. Having a bathroom schedule can help avoid accidents. Sometimes medication or pelvic floor therapy might also be an option. Depending on the exact cause of urinary problems, there may be other treatments that can help.

See Bladder Incontinence for more information and talk to your healthcare team about your specific situation.

People treated with radiation for prostate cancer have a higher risk of developing bladder cancer. If you experience blood in the urine, it is important to talk with your healthcare team about your symptoms.